ADHD & The High School Classroom

Agenda

1 Understanding adolescent development

2 ADHD student in the context of High School

3 Academic Skills –> literacy skills

4 Academic Enablers

The Adolescent Brain

The Paradox

• Measures of most abilities indicate that adolescence is the healthiest and most resilient period of the lifespan.

• Strength, speed, reaction time, mental reasoning abilities, immune system all improve

• Yet overall mortality increases 200-300 times from childhood to late adolescence. (Dr R. DAHL)

• Primary causes of death and disability related to

Problems with control of behaviour and emotions

USA Data for Teen Deaths

• 2006(Eaton, et al)- 13,000 teen deaths

- 70% were accidental (car accidents, accidents, homicides & suicides )

- education prevention programs = $1 billion

- 95% of teens understand risks associated with smoking, drinking & driving, unprotected sex etc.

Research on Adolescent Reasoning Risk & Rationality in adolescent Decision Making, Reyna & Farley (2006)

• Have same level of reasoning as adults

• Do not see themselves as invulnerable

• Over-estimate risk, compared to adults

• Capable of rational decision making,

except when……………

Except when…….

• Decisions involve long-term goals vs short term goals

• Decisions are made within the context of peers

• Decisions are made in a heightened emotional context

• Decisions must be made in the spur of the moment

• Decisions are made in unfamiliar situations

Adolescences & Brain Development

1. Fluctuation in Grey matter

2. Increase in White matter

3. Frontal Cortex just beginning development

1,2,& 3 are all shaped by experience

“use it or lose it”

1 Fluctuation in Grey Matter

• Grey matter made up of neurons & synapses

• Peaks in production at about 5 years of age, declines and then peaks again at 11/12 years

• Decline is known as synaptic pruning

• Up to 5 years of age & again in early teens – time of “plasticity”

2 & 3. Increase in White Matter & Maturation of Frontal Lobes

• White matter – myelin covering of axons

• Facilitates conduction of signals from one neuron to another

• Increases consistently from childhood to adulthood

• As the brain re-organizes, white matter moves from front of brain to back of brain

Limbic System from Birth to 21

Age

Years

Dr Jim Stieben MEHRI

The Problem Frontal Lobe Development

Autonomy Average age of first

sexual encounter in

Canada

drivers license

Dr Jim Stieben MEHRI

Disjoint between emotions and reason

Romantic motivations

Sexual interest

Peer approval

Emotional intensity

Changes in sleep/arousal

Increase in risk taking, novelty seeking,

sensation seeking behaviors

Biology of Adolescence

Possible negative consequences

Emotional Difficulties

• Aggression

• Mood swings

• Suicidal Ideation

Compulsive Behaviors

• Alcohol/substance abuse

• Self-mutilation

• Preoccupation with looks

Risk Taking

• Substance abuse

• Unprotected sex

Attention Problems

• Distractibility

• Poor academic planning

Possible Positive Consequences

• Time for social development

• Highly passionate about life

• Time for idealism

• Highly creative time

• Strong motivational drives for what is of interest

ADHD in adolescence & adulthood

childhood adolescence adulthood

60%-80% cases 50-60% cases

Normal levels

Subthreshold but impairing levels

Diagnostic level

HSC/TeachADHD 2005 Biederman et al., 2002; Lee et al., 2008; Owens et al., 2009;

Shaw et al. 2006: “Children with ADHD had global thinning of the cortex (mean reduction, -0.09 mm; p=.02)”

Characteristics of Youth with ADHD

• Wolraich et al. (2009) noted the following behavioral characteristics:

– Often “emotionally immature”

– Often are easily frustrated

– Have a tendency to procrastinate, struggle with project or time management

Adolescents with ADHD and Academic Skills

• Adolescents with ADHD are more likely than their peers to exhibit: – weaknesses in basic reading skills (Lee et al., 2008; Owens et al., 2009) – poor math skills (Antshel et al., 2007; Owens et al., 2009)

• Adults with ADHD (reported a prior diagnosis) also report having more problems with school relative to adults without ADHD – More problems with organization, paying attention, following instructions, and

monitoring their work for errors (Biederman et al., 2006)

• Recent data suggests that approximately – 25% to 40% of students with ADHD will exhibit a co-existing reading disorder – 65% of students with ADHD found to exhibit written expression disorder (2 large

samples of clinic-referred children) – 31% have an LD in mathematics

Mayes & Calhoun, 2007; Willcutt et al., 2007; Zentall, 2007

Cognitive Strengths and Weaknesses in ADHD

• Typical range of intellectual ability

• Weaknesses in executive functions evident in some students with ADHD – Inhibition

– Set shifting

– Planning

– Sustained attention

– Working memory

Biederman et al., 2004; Pennington & Ozonoff, 1996; Toplak et

al., 2009

ADHD and Self-Regulation

• Students with ADHD – May lack knowledge of effective strategies and/or may not

consistently apply the strategy

– Found to exhibit problems with error monitoring, goal setting

– BUT recent research has shown that they also respond positively to interventions teaching specific strategies for • Note-taking

• Comprehension strategies

• Written composition

– Have been found to respond positively to self-monitoring interventions (e.g., goal setting, evaluating performance)

See review by Barkley & Murphy, 2005; review by DuPaul et

al., 2003; Reid & Ortiz-Lieinemann, 2006; Rogevich & Perin, 2008;

Summary

• Many of the academic tasks in secondary classrooms involve

self-regulation and executive functions

• Students with ADHD may struggle with academic tasks for many reasons… – Weaknesses in basic academic skills – Difficulty accessing the curriculum content due to reading or listening

comprehension difficulties – Lack of knowledge of and/or ability to apply learning strategies across

multiple contexts/courses – Difficulties with executive functions/self-regulation (e.g., organization,

time management, planning)

Part 2

Support in High School

Supporting the adolescent with ADHD in high school

• Must not simply focus on the behavioral symptoms of ADHD

• Must consider the youth’s strengths and weaknesses

• Recent research has focused on “intervention packages” for youth with ADHD that target multiple domains – E.g., Academic enablers and skills such as note-taking and test taking,

reading, and written expression

– Homework completion

– Findings are generally positive, but limited by the small samples

Academic Competence

• Reading

• Writing

• Math

Academic Skills

(taught skills)

• Study Skills

• Engagement

• Interpersonal Skills

• Motivation

Academic Enablers

(attitudes & behaviors)

The Nature of Transition

From the Research Perspective: Transition is associated with a temporary dip in academic achievement, in

self-esteem, & an increase in social anxiety (Galton, 2003)

From the student Perspective: Academic concerns: homework & pressure to do well

Social Concerns: getting lost, making new friends, bullying (Akos 2004)

Organizational concerns: size of school, timetable, multiple teachers, remembering where to go (Graham & Hill,2001)

Protective Factors

From the student perspective: More freedom

friends (especially friends interested in academic success)

Extra-curricular activities

From the research perspective, what parents can do:

A place of study at home Maintaining rules, limiting t.v. time & defining study time

Frequent checking of homework

Discussion of school

Monitoring both academic progress & social life

Ability to intercede on child’s behalf when necessary

Parent Involvement & The IEP

• Parents can help in the preparation of the IEP

• Parents should monitor if the teachers’ compliance of IEP

• Parents should consult with teachers regarding benchmarks & outcomes of goals

Parent Consultation & The IEP

Transition plan:

For students 14 or older, the IEP must have a transition plan to post-secondary activities. (school or work)

It must include specific goals, actions to achieve goals, partners for transition & responsibilities

IEP & Accommodations

Accommodation types:

Instructional – changes in teaching strategies

Environmental – changes in classroom & school contexts

Assessment – changes in how students demonstrate learning

IEP & Assistive Technologies

University students with LD & ADHD identified any software that supports writing as their 1 choice for assistive technology

Caveat for High School & Assistive technology:

• High school students are self-conscious of being singled-out for using AT

• Poor reliability & implementation of High School AT

Instructional Accommodations

• Recognizing cognitive load

• Using ‘direct instruction’

• Informal assessment & monitoring with immediate feedback

Types of curriculum content & learning tasks that may may present high cognitive load for students with ADHD

DuPaul & Stoner, 2003

New content

(weak schemata)

Multi stimulation

Requires fast processing

(spoken language)

Requires self-regulation &

self-monitoring

(projects)

Direct (Explicit) Instruction (4 or more of activities)

• Breaking down a task into small steps

• Administrating probes

• Administrating feedback repeatedly

• Providing visual support

• Allowing individual practice

• Breaking instruction down

• Instructing in small group

• Modeling a skill

• Using a rapid pace

• Teacher directed questions

• Individualized instruction

Academic Competence

• Reading

• Writing • Math

Academic Skills

(taught skills)

• Study Skills

• Engagement

• Interpersonal Skills

• Motivation

Academic Enablers

(attitudes & behaviors)

Two major components of writing

• Handwriting

• Spelling

• Punctuation

• Capitalization

• Grammar

Transcription

• Planning

• Production

• Editing/revision

Composition

or Text Generation

Common Behaviors of Learners with Writing Difficulties

Transcription Level – poor hand writing, spelling

Composition level – minimal production

- limited editing and revision

Two major components of writing

• Handwriting

• Spelling

• Punctuation

• Capitalization

• Grammar

Transcription

• Planning

• Production

• Editing/revision

Composition

or Text Generation

Why problems with production & editing/revision

• Executive functions: moving ideas to text

• Working memory: integrate new and old information as text is generated & make operational organization strategies for text formation

• Attention: sustained ability to stay focused & on task

Assessing Writing Problems

Poor writers in general:

• Lack awareness of what good writing is

• They do not know how to produce text

• They lack knowledge of text structure (genre)

• They do not monitor their own performance

• They show poor attention to detail and have limited concentration

Executive Function Difficulties

• Procrastinate, can’t get started

• Low productivity

• Difficulty estimating outcomes, maintaining a sense of whole

• Difficulty narrowing topic

• Difficulty distinguishing salient information

• Disorganization of time, space & materials

• Knows material, but can’t put on paper

Teaching writing

• Naturalistic approach (natural learning) – discover writing by writing

• Explicit Instruction approach

1 Mechanics – spelling, grammar, genre

2 Process – planning, writing, editing

Teaching the writing process Pre-writing (generating & organizing idea)

Reading, research, brainstorming, developing a thesis, doing an outline, narrowing the topic, identifying the audience

Writing/drafting Writing thesis statement, topic sentence, intro/conclusion, writing the body the body

Revising (clarifying ideas)

Sharing, conferencing, self-evaluation, getting feed back,

Editing (spelling, punctuation, grammar)

Re-checking low-level transcription skills

Publishing (completed text)

Complete final revised text

Strategy Instruction

• Self-regulated strategy development (SRSD) developed by Karen Harris & Steve Graham

• Promotes quality of writing, knowledge of writing, approaches to writing & self-efficacy

• Mastery based

• Involves teaching strategies for writing through explicit instruction & interactive learning

Three effective elements for Improving writing Expression (Gersten & Baker, 1999)

Use a framework for planning, writing, revising Teach each step explicitly, using examples

Use a think sheet, prompt cards or mnemonic for support

Planning: use semantic map, verbalize steps –who am I writing for? Why? What do I know?

Writing: create a first draft using plan created.

Revising: use peer editing, teacher-student conference

Explicitly teach critical steps in writing process Teach text structure (genre)

Use explicit models, prompts & mnemonics

Provide Relevant & Immediate feedback on what is taught Help student develop metacognitive skills

What are the 5 critical domains for reading assessment & instruction?

1. Phonemic/phonological awareness

2. Alphabet principle

3. Fluency

4. Vocabulary

5. Text comprehension

National Reading Panel (2000): Teaching Children to Read. Washington, DC: NICHHD Clearing House

What are the 5 critical domains for reading assessment & instruction?

1. Phonemic/phonological awareness

2. Alphabet principle

3. Fluency

4. Vocabulary

5. Text comprehension

National Reading Panel (2000): Teaching Children to Read. Washington, DC: NICHHD Clearing House

Developmental Impact of ADHD on Achievement (e.g., Reading)

Phonological processing: OK Rapid Automatized Naming: Slow • Reading fluency: Slow • Reading Comprehension: Weak

– Factual – OK – Inferential - Weak

– Comprehension Strategies - Weak

Fluency

Text Comprehension

DEEP UNDERSTANDING

ADHD & reading • I’m a very slow reader. In high school & middle

school I really hated to read because it took me a long time & I would have to read things over and over again.

• I would find myself at the end of the chapter & not remember anything I had just read…I realized would have to go back and read it all over again.

• It got to the point in middle school where I was sick of school already & I hated going.” Knowles (2006): Grant, a 21-yr-old college student

Reading Fluency

Fluency:

• “the ability to read connected text rapidly, smoothly, effortlessly, & automatically with little conscious attention to the mechanics of reading (e.g., decoding)”

• Fluency requires an appropriate rate, high accuracy, and appropriate expression

Signs of poor reading fluency

Reads word-by-word with limited expression or prosody, ignores punctuation, does not divide sentences into meaningful phrases

Vocabulary Building

Opportunity to promote subject specific activity

Build a etymology component into introduction of new topics

Encourage practice of new vocabulary

Look at morpho/grammatical shifts

Introduce concept of nominalization

Text Comprehension

• A process by which readers construct meaning by interacting with the text through the combination of:

• Prior knowledge & previous experience

• Information in the text

• The stance readers take in relationship to the ideas presented in the text

Text comprehension

Characteristics of

Good Readers Poor Comprehenders • Reads actively

• Reads for a purpose

• Previews text

• Uses a variety of strategies when reading

– Predicting

– Questioning

– Summarizing

– Visualizing

• Uses prior knowledge

• Monitors understanding

• Adjusts reading rate

• Limited vocabulary

• Poor attention

• Poor working memory

• Lack persistence

• Poor or fluent decoding

• Do not use strategies when reading

• Do not use prior knowledge

• Do not monitor their understanding

Effective instruction in text comprehension

A. Vocabulary instruction

B. Seven effective comprehension strategies:

1. Comprehension monitoring

2. Question answering

3. Question generating

4. Summarization

5. Cooperative learning

6. Graphic & semantic organizers

7. Story structures

Reading Accommodations

• Quiet space, more time

• Modified language

• Assistive technologies (text to speech)

Academic Competence

• Reading

• Writing

• Math

Academic Skills

(taught skills)

• Study Skills

• Engagement

• Interpersonal Skills

• Motivation

Academic Enablers

(attitudes & behaviors)

Promoting study skills

• Teaching & modeling organization of materials & time – ADVANCE ORGANIZER

• Teaching & modeling planning

• Teaching goal setting and self-monitoring

• Teaching study strategies

• Teach note-taking

Time Management

• Use assignment sheets, calendars, agendas

• Create a routine time & location for homework

• Avoid Procrastination – 5 minute wedge strategy

• Recognize that “timed tests” are a challenge for WM deficit students ******

Cornell Note-taking Method

< --------- 21/2” -------- > Cue/question Column

< --------------------------- 6”---------------------------------- > Note-taking Column 1. Record: during lecture write key points 2. Question: in cue column write questions for recorded

notes 3. Recite: cover note-taking column & answer questions 4. Reflect: ask yourself how this fits into the bigger picture

of the course 5. Review: at the end of the week take 10 minutes to

review your notes _________________________________________________ Summary Notes

McMaster University promoting study skills

http://maclife.mcmaster.ca/academicskills/online_resources.cfm

Motivation

Adolescent self-concept & academic expectations

• Self-esteem: perception of one-self as a person of worth; defined by interactions (positive or negative) with peers, parents and school

• Locus of control: perception of one self as an effective person; defined by power in context of situation

Self-motivation

• Assess for required skill level

• Promote positive learning classroom

• Teach self-monitoring & goal setting

• Link learning to student’s area of interest

• Allow students to participate in setting assignments

• Give marks for maintaining daily planner

Types of Motivation

• Extrinsic – based on external force or reward such as money, grades, punishment & rewards

• Intrinsic – based on interest or enjoyment of task & therefore internal drive to do task

Students with intrinsic motivation believe they are agents of their learning & have a desire to improve skills

The Many Faces of Engagement

• Engagement – making the class interesting & motivating

• Engagement – student involvement – student “attending”, “listening”, “reading”, “thinking “reflecting”

Distinguishing Active and Passive Engagement

Passive

•Silent reading

•Listening to lecture

•Listening to another student responding

•Listening to instructions

Active

•Oral reading

•Peer tutoring

•Note taking stratgies

•In class assignment

• Discussion opportunity

•Study groups

PROMOTING SOCIAL SKILLS

• Establish a positive learning classroom

• Use partnering and grouping for class projects

• Establish a homework club

• Look for any opportunity for collaborative learning

Time for me to stop! Time for you to ask

questions!