School-Based Intervention Strategies for Children with ADHD

Image: Pebel Baby

Sol Koemhong
International Christian UniversityTokyo, Japan
December 01, 2020

Introduction

ADHD stands for Attention-Deficit/Hyperactivity Disorder. It is known as one of the most common neurobehavioral disorders in children. Fox (2001) points out that ADHD is a term used to present people with behavioral impulsivity and low self-control and attention levels. There can be many reasons why a child becomes inattentive and disruptive in class; however, those presented with these behavioral problems can be regarded as possessing a form of ADHD (Meyer & Lasky, 2017). ADHD can significantly affect children’s physical and emotional well-being, academic achievements, and interactions with others. Children with ADHD appear to experience significant difficulties in a range of functions. Even though impulsivity, inattention, and overactivity are common, they can serve as an attraction of other difficulties (DuPaul & Stoner, 2003). DuPaul and Stoner emphasize that children with ADHD frequently experience low academic achievement, a high level of non-compliance and aggression, and poor relationships. This social and emotional impairment dramatically affects the quality of their life (Wehmeier et al., 2010).

Therefore, understanding children with ADHD and taking appropriate interventions to support them are crucial to their future success. This article offers some suggested school-based intervention strategies to support children with ADHD.

There is no single exact cause of ADHD that can be fully understood. According to the National Health Service (NHS) of the United Kingdom, a combination of causes/factors is believed to contribute to ADHD, including genetics, brain function and structure, and other possible causes (NHS, 2018). The genes inherited from parents are an undeniable factor that explains the condition. Research indicates that both parents and siblings of children with ADHD are four to five times more likely to have ADHD themselves (NHS, 2018). However, it is difficult to understand how ADHD is inherited. Some differences in brain function and structure are also found in children with ADHD compared to those without ADHD (NHS, 2018). Other possible causes of ADHD include premature birth, low birth weight, brain damage, smoking and misuse of drugs during pregnancy, and exposure to high toxic levels (NHS, 2018).

Even though we can identify some characteristics of ADHD, it is not easy to be diagnosed because it is a highly hereditary neurobiological problem characterized by behavioral difficulties that may vary in intensity.  Environment, attitude, and internal motivation can influence behaviors (Meyer & Lasky, 2017). Therefore, a child must be rigorously assessed. The American Psychiatric Association (2013) provides a comprehensive list of criteria that can be used to diagnose ADHD (see Appendix).

Suggested School-Based Intervention Strategies

Many studies reported that children diagnosed with ADHD experience considerable challenges with their academic life. They are at significant risk for poor academic achievement, behavior, and social interaction; therefore, a systematic and ongoing school-based approach is necessary to help them succeed in school (DuPaul & Stoner, 2003). From here onwards, some suggested school-based intervention strategies to support children with ADHD will be discussed. The discussion will be based mainly on the work of DuPaul and Stoner, who are leading researchers in the field of special education.

Self-management strategies

Self-management is one of the effective school-based intervention strategies used to help ADHD children develop appropriate self-control levels. It is expected that this strategy will be able to equip ADHD children with age-appropriate behaviors, both socially and academically. DuPaul and Stoner (2003) discuss two approaches associated with self-management strategies. They are self-monitoring and self-reinforcement.  Many children diagnosed with ADHD are capable of performing desired behaviors; however, they cannot perform stably for a certain period of time because of personal issues with self-control (Brock et al., 2010). DuPaul and Stoner (2003, p. 166) claim that ADHD children “can be taught to observe and record the occurrence of their own behaviors” during academic work. For example, teachers can use auditory or visual stimuli periodically throughout a certain period of time to remind the children to observe their current behavior. Then children can be asked to record their instances of on-task behavior using a grid or chart. With regard to self-reinforcement, it requires that children set their goals, self-assess, and evaluate their own performance. This approach may be appropriate for ADHD children at the secondary level (DuPaul & Stoner, 2003). For example, token reinforcement programs and teachers’ feedback are often used for the self-reinforcement. However, designers of the self-management strategies must be aware that ADHD children may lack the skill to judge and evaluate their own behavior; hence, they need to know how to use the system and be aware of the behaviors expected of them (DuPaul & Stoner, 2003).

The teaching of classroom rules and expectations

Children with ADHD will learn best when clear classroom expectations are fully communicated (Henderson, 2008). For better management of behaviors, the teaching of classroom rules and expectations is imperative. Because ADHD children can quickly become disruptive, teachers must keep reminding them about the rules and expectations so that they can stay on the right track and get engaged in the classroom. For example, teachers can (1) prompt students of expected behaviors before commencing classroom activities, (2) assure that every academic and nonacademic activity and classroom routine are clearly communicated with and understood by students, (3) use nonverbal signals to redirect a student while working with other students, and (4) regularly communicate their expectations about the use of time blocks (DuPaul & Stoner, 2003).

Study and organizational skills

Several studies reported that ADHD children usually experience difficulties in fulfilling tasks, organizing learning materials, following instructions, and studying for exams (DuPaul & Stoner, 2003). Therefore, teaching them study and organizational skills will benefit them. Henderson (2008) recommends some necessary study skills for ADHD children to be taught. They include using Venn diagrams to demonstrate and arrange main concepts or information, taking notes of key concepts, creating an academic checklist for frequently made mistakes and homework supplies, and so on. For organizational skills, Henderson (2008) suggests that teachers teach the children to use assignment notebooks to organize schoolwork and homework and use color-coded folders for different academic subjects and other purposes. Even though many strategies have been suggested and proved to be effective, teachers should select appropriate strategies that are workable in their own classroom contexts.

Peer tutoring

Peer tutoring is one of the most effective school-based intervention strategies to assist ADHD children and even children without this disorder with their academic progress. Peer tutoring is a flexible, peer-mediated strategy that involves students serving as academic tutors and tutees (Hott et al., 2012). Peer tutoring allows ADHD children to receive necessary one-to-one assistance, gain more opportunities to respond in small groups, obtain more time to engage in tasks, and develop personal self-esteem. Peer tutoring will be most effective when participating children are guided appropriately (Greenwood & Delquadri, 1995Piffner, 2011).

Computer-assisted instruction

Computer-assisted instruction (CAI) is an intervention strategy that is believed to be useful for teaching ADHD children. CAI involves the use of computer programs or software to support classroom instruction. CAI has been used to develop students’ knowledge and skills and enhance their academic performance (Miller, 2002). Alontaga et al. (2012) advocate that CAI provides ADHD children with a highly stimulating instructional environment where children gain immediate feedback on their performance, reinforcement, and ongoing opportunities to respond to academic stimuli. A study that investigated the effects of using math software called “Math Blaster” with three primary male students identified with ADHD indicated some significant decreases in off-task behaviors because the three students appeared to engage more with the software (DuPaul & Stoner, 2003).

Task modification

Task modification (TM) is used to enhance the academic performance of children identified with ADHD. TM involves reviewing aspects of learning (curriculum) to lessen inappropriate behaviors and increase proper classroom behaviors. However, Meyer and Evans (1989) argue that TM responds more positively only to the personal needs of individual students. Choice-making is one form of TM. It requires students to select activities from two or more choices. Studies investigating the effects of choice-making on students with developmental disabilities have shown rises in social behaviors and reductions in excessively active behaviors (Dyer et al., 1990; Koegel et al., 1987 as cited in DuPaul & Stoner, 2003). Another study conducted by Dunlap et al. (1994) examined the effects of choice-making on three students; one of them was a 12-year-old male ADHD student. The outcomes indicated that choice-making led to increased trustworthy task engagement and decreased overactive behaviors.

Instructional modification

Instructional modification (IM) is a necessary intervention strategy for teaching ADHD children. Modifications in instruction can be carried out to improve the academic environment, especially for children with ADHD. A study conducted by Skinner and his colleagues (1995), as cited in DuPaul & Stoner (2003), examined the effects of two taped-words, fast-taped words (FTW) and slow-taped words (STW) intervention on word-reading performance based on accuracy rates. The study results indicated that there were relatively greater accuracy rates in STW intervention, suggesting that this intervention strategy be effective in promoting reading accuracy rate for ADHD students.

Strategy training

Strategy training involves teaching students to use a particular set of strategies to complete academic work in demanding academic situations (DuPaul & Stoner 2003). This strategy seems suitable for adolescents with ADHD, as they are likely to present poor organizational and study skills. For example, students with ADHD may face difficulties in note-taking for future review. Spires & Stone (1989) developed a note-taking strategy widely known as Directed Note-taking Activity. Students can learn this note-taking skill through teacher-directed presentation/speech and prompts. It is believed that this note-taking strategy can level up on-task behaviors and academic performance of ADHD adolescents.

Contingency contracting

Contingency contracting, sometimes known as classroom behavior agreement, is another school-based strategy for behavior management. It involves negotiating a contractual behavior agreement between a student and a teacher. Agreed behaviors are typically set along with positive and negative consequences when the desired behaviors are met and not met, respectively. However, this strategy is relatively straightforward and might not be suitable for ADHD children aged under six due to some factors such as inadequate rule-following skills and an inability to delay reinforcement for a longer time (DuPaul & Stoner, 2003).

Conclusion

Children diagnosed with ADHD face plenty of difficulties in their classroom behavior and academic performance, resulting in low academic achievement, complicated social interactions, and other behavior-related consequences. Regardless of any disorder labeling, each child has different needs and learning styles; they respond differently to different strategies and learning environments. Therefore, well-established school-based intervention strategies, including behavioral and instructional strategies, are required to ensure that every ADHD child’s chances for academic success are maximized. It is crucial that all stakeholders, including schools, parents, and the community, work together to support ADHD children in their pursuit of academic and social success. Moreover, other interventions, such as medical interventions, behavior-related therapy, good parenting program, etc., should be used along with school-based interventions.

The Author

SOL Koemhong is currently a Japanese Government (MEXT) scholar pursuing a Doctor of Philosophy in Education at the Graduate School of Arts and Sciences of the International Christian University in Tokyo, Japan. He is also an Associate Editor for the Cambodian Education Forum. In 2016, he was awarded a Chevening scholarship to undertake his Master of Arts in Education Management and Leadership at the University of South Wales in the United Kingdom. Prior to leaving for Japan, he was a lecturer at the Faculty of Education of the Paññāsāstra University of Cambodia. His research interests center on teacher education and policy, continuous professional development (CPD) for EFL teachers, school leadership, special education, and learning and teaching assessment.

References

Alontaga, J. V. Q., Lim, E., Balaji, S., Murugaiyan, M.S., Holly Deviarti, S. E., Heny Kurniawati, S.E., Yen Sun, S.E., & Heri Sukendar, W.D. (2012). A computer-assisted instruction module on enhancing numeracy skills of preschoolers with attention-deficit hyperactivity disorder, International Journal of Information Technology and Business Management2(1), 1-15.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5). Virginia: American Psychiatric Publishing.

Brock, S.E., Glove, B., & Searls, M. (2010). ADHD: Classroom interventions. Maryland: National Association of School Psychologists.

Dunlap, G., DePerczel, M., Clarke, S., Wilson, D., Wright, S., White, R., & Gomez, A. (1994). Choice making to promote adaptive behavior for students with emotional and behavioral challenges, Journal of Applied Behavior Analysis27(3), 505-518.

DuPaul, G.J., & Stoner, G. (2003). ADHD in the schools: Assessment and    intervention strategies (2nd ed.). New York: Guilford Publications.

Fox, G. (2001). Supporting children with behaviour difficulties: A guide for assistants in schools. London: David Fulton Publishers.

Greenwood, C. R., & Delquardri, J. (1995). Classwide peer tutoring and the prevention of school failure, Preventing School Failure39(4), 21-25.

Henderson, K. (2008). Teaching children with attention deficit hyperactivity disorder: Instructional strategies and practices. Washington, D.C: U.S. Department of Education, Office of Special Education and Rehabilitative Services, Office of Special Education.

Hott, B., Walker, J., & Sahni, J. (2012). Peer tutoring. Retrieved from http://council-for-learning-disabilities.org/peer-tutoring-flexible-peer-mediated-strategy-that-involves-students-serving-as-academic-tutors

Meyer, L. H., & Evans, I. M. (1989). Nonaversive intervention for behavior problems: A manual for home and community. Baltimore: Paul H. Brookes.

Meyer, H., & Lasky, S. (2017) School-based management of children with attention-deficit/hyperactivity disorder: 105 tips for teachers. Retrieved from http://www.addrc.org/disorder-105-tips-for-teachers/

Miller, S. P. (2002). Validated practices for teaching students with diverse needs and abilities. Boston: Allyn & Bacon.

National Health Service. (2018). Attention Deficit Hyperactivity Disorder. Retrieved from https://www.nhs.uk/conditions/attention-deficit-hyperactivity-disorder-adhd/ 

Piffner, L. J. (2011). All about ADHD: The complete practical guide for classroom teachers (2nd ed.). New York: Scholastic.

Spires, H. A., & Stone, P. D. (1989). The directed note-taking activity: A self-questioning approach, Journal of Reading33(1), 36-39.

Wehmeier, P. M., Schacht, A., & Barkley, R. A. (2010). Social and emotional impairment in children and adolescents with ADHD and the impact on quality of life, Journal of Adolescent Health46(3), 209-217.

Appendix: Diagnostic Criteria for ADHD (American Psychiatric Association, 2013, pp. 59-60)

People with ADHD show a persistent pattern of inattention and/ or hyperactivity-impulsivity that interferes with functioning or development:

A. Inattention: Six or more symptoms of inattention for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of inattention have been present for at least 6 months, and they are inappropriate for developmental level:

  1. Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities
  2. Often has trouble holding attention on tasks or play activities
  3. Often does not seem to listen when spoken to directly
  4. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked)
  5. Often has trouble organizing tasks and activities
  6. Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework)
  7. Often loses things necessary for tasks and activities (e.g., school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones)
  8. Is often easily distracted
  9. Is often forgetful in daily activities

B. Hyperactivity and Impulsivity: Six or more symptoms of hyperactivity-impulsivity for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for the person’s developmental level:

  1. Often fidgets with or taps hands or feet, or squirms in seat
  2. Often leaves seat in situations when remaining seated is expected
  3. Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless)
  4. Often unable to play or take part in leisure activities quietly
  5. Is often “on the go” acting as if “driven by a motor”
  6. Often talks excessively
  7. Often blurts out an answer before a question has been completed
  8. Often has trouble waiting his/her turn
  9. Often interrupts or intrudes on others (e.g., butts into conversations or games)

In addition, the following conditions must be met:

  1. Several inattentive or hyperactive-impulsive symptoms were present before age 12 years
  2. Several symptoms are present in two or more setting, (such as at home, school or work; with friends or relatives; in other activities)
  3. There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning
  4. The symptoms are not better explained by another mental disorder (such as a mood disorder, anxiety disorder, dissociative disorder, or a personality disorder). The symptoms do not happen only during the course of schizophrenia or another psychotic disorder.
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