Workshop on effective strategies for elementary school ... › cms › CADDAC_pdf › Events ›...

Workshop on effective strategies for

elementary school children with ADHD

Reflection

“When you plant lettuce, if it does not grow well,

you don’t blame the lettuce. You look into the

reasons it is not doing well. It may need fertilizer,

or more water, or less sun. You never blame the

lettuce. Yet if we have problems with our friends or

family, we blame the other person. But if we know

how to take care of them, they will grow well, like

lettuce.”

– Thich Nhat Hanh 1991, p. 78

Plan for the workshop

Review of learning problems in ADHD

Two useful frameworks for thinking about

intervention for ADHD

Developing a student’s profile

Tier-1: Prevention/intervention for ALL students

Tier-2/3: Extra steps for students with ADHD

Case study

Why is ADHD associated with poor

academic/occupational outcome?

Behavioral symptoms of

ADHD: inattention,

Hyperactivity/impulsivity

Cognitive Deficits Executive Function,

Processing speed

Altered

reinforcement/motivation

Academic

underachievement Reading, Mathematics,

Written expression,

Spoken language

Comorbid LD

A

c

a

d

e

m

ic

Aca

de

mic

en

ab

lers

Recap: key points so far

ADHD – Beyond Behaviour

Behavioural difficulties

Inattentive /Disruptive

Cognitive difficulties

Working Memory & EF

Cognitive Processing Speed

Poor Academic Competency

Academic skills & enablers

Challenged

child

Challenged

parents

Challenged

teachers

Challenged

school

system

States of

Unreadiness

Achievement gap between ADHD and

their peers increases over time

0

20

40

60

80

100

120

140

160

K-Fall K-Spring Gr-1 Gr-3 Gr-5

Full sample

ADHD

Mathematics scores

Scheffler et al (2009) Pediatrics 123(5): 1273-79

Full sample: n=8370

ADHD: n=594 (9%)

Reading scores

Part 2

Overall goal: Accelerate the rate of growth

ADHD calls for a co-ordinated,

sustainable, multi-system approach

System-level

Classroom-level

School-level

• Transition plans (sector-

to-sector, school-to-school,

grade-to-grade, class-to-

class, home-school)

• Instructional pathways

(credit-recovery, credit-

rescue, co-op etc)

• Capacity-building

(professional development) Student

Systems:

Education

Post-sec education

Medical

Mental Health

School /classroom

Teacher-child

Family (parent-child)

Parent-teacher

Family

(Goldhaber & Hannaway, 2009,pp . 3−4) ,

Creat ing a new teaching profession

. Wash ing ton , DC: Urban Ins t i tu te Press .

“teaching quality is the most

important schooling factor

affecting student achievement”

How you teach is the critical factor

– not what you teach (i.e, curriculum)

Frameworks for School-based

Intervention for ADHD/symptoms

“Resource-Demand Imbalance” Model

Tiered Intervention

Response to Instruction/Intervention (RTI)

developmental changes in

educational needs in ADHD

Turguay et al (2012) J Clin Psychiatry 73:2

Demand-resource imbalance in ADHD

Environmental demands

Academic, occupational, financial, social activities &

functions

Demands tend to increase in number, scope,&

complexity with increasing age & level of

independence

Resources used/needed to meet demands

Internal

Working memory, ability to await one’s turn, sustain focus, plan

& prioritize tasks to reach goals etc

External

People (parents, siblings, teachers, peers, physicians)

Tangible Supports (alarm clocks, calendars, reminders,

medication)

What are the major changes in demands?

Educational

phase

Environmental /Learning

demands

Resources

Internal External

Kindergarten

Grades 1-3

Grades 4-6

Grades 7-9

When the student’s internal

resources cannot meet the

demands, then there will be a need

for increase role of external

resources (teaching, tangible

supports)

Multi-tier Model

Response to Intervention (RTI): Definition

• RTI integrates assessment & intervention within a multi-level prevention system to maximize student achievement & reduce behavioral problems.

• With RTI, schools use data to:

• Identify students at risk for poor learning outcomes

• Monitor student progress

• Provide evidence-based interventions & adjust the intensity & nature of those interventions, depending on student’s responsiveness,

• (Identify students with learning disabilities or other disabilities)

RTI: Three Levels of Prevention

•Primary Prevention: high quality core instruction that meets the needs of most students

•Secondary Prevention: evidence-based intervention(s) of moderate intensity that address the learning or behavioral challenges of most of the at-risk students

•Tertiary Prevention: Individualized intervention(s) of increased intensity for students who show minimal response to secondary prevention

•At all levels: attend to fidelity of implementation, with consideration for cultural & linguistic responsiveness, & recognition of student strengths

Linking Academic and Behavior

Supports

Effective school-wide and classroom wide behavior support is linked to increased academic engagement.

Improved academic engagement with effective instruction is linked to improved academic outcomes.

The systems needed to implement effective academic supports and effective behavior supports are very similar.

Key Points

Tier-1 prevention approaches are relevant for ALL

students, but essential for students with ADHD /

symptoms

The need for additional Tier-2 or Tier-3

interventions will depend on the learning needs of

the individual student with ADHD/symptoms –

which in turn will depend on the balance between

resources/demands in the learning context

Need to develop a full understanding of each

student’s profile

Case Study; who is this boy?

“The pool is a safe haven. Two walls at either end, lane lines on both sides, and a black stripe on the bottom for direction”

‘Longest putt ever captured on camera’

Greatest Olympian!

20

Develop a

student profile Analysis of the

curriculum &

lesson plan

Setting goals Developing

action plan

Monitoring

progress

INSTRUCTIONAL PLANNING PROCESS

Develop a

student profile

Behavioral symptoms

Academic Enablers

Academic Skills

• Inattention

• Hyperactivity

• Impulsivity

• Study Skills

• Interpersonal skills

• Motivation

• Engagement

• Oral language

• Reading

• Mathematics

• Written Expression Stu

de

nt

Fa

mily/H

om

e

Te

ac

he

r/

Cla

ss

roo

m/S

ch

oo

l

STUDENT PROFILE: Factors to consider

Academic Strengths & Weaknesses Subject area Strengths (comments) Weaknesses (comments)

Reading

Decoding skills

Fluency

comprehension

Written

expression

Fluency

Planning

Production

Vocabulary

Basic

Multiple meanings

Mathematics

Computation

Fact fluency

Application problems

Academic Enablers

Learning

skills/strategy

Strengths Weaknesses

Study Skills

•Organization

•Note-taking

Interpersonal

Skills

Motivation

Engagement

Behaviour Profile

What are the

student’s main

behaviours of

concern?

When does the

behaviour

occur? (activity,

transition,

setting)

How often

does the

behaviour

occur?

Academic

profile/learning

skills affecting

behaviour

The Classroom Context

context strengths weaknesses

Routines:

Morning/afternoon

Large Group

instruction

Small group

instruction

Independent seat-

work

Transitions (recess,

lessons)

Peer relationships

Case Study 1: Grade 6

http://adhdruthie.weebly.com/index.html



Yousif’s Academic Profile

Yousif’s Behavioral Profile

Your handouts include more information

on Yousif’s behavioral profile

Anecdotal Observations (2)

Incident monitoring chart

School Report: Learning Skills & Work Habits

Draft 1

Take a moment ….

Think about Yousif’s profile…

Note down what you think are his major needs

Note down in order of priority, three

intervention goals

We will revisit these questions after I discuss

Tier-1 approaches to optimize school

performance for all students

Tier-1

Modifying school/class contexts &

instructional practices

Goals:

to reduce the triggers that elicit ADHD

symptoms & impede learning

to increase triggers for active engagement &

learning

Basic principles for supporting students

with inattention, impulsivity, hyperactivity

ORGANIZATION:

Classroom, Materials, Time, Thoughts

PREDICTABILTY

Schedule, Routines, Learning expectations,

Behavioural expectations & contingencies

FLEXIBILITY

Choices, flex-time

Creating ADHD-friendly classrooms! (adapted from Chapter 2 in Linda Pfiffner’s, ALL ABOUT ADHD,2011)

Physical Environment

Seating, seating boundaries

Organization of classroom, desks

Class rules

Instructional Environment

Lesson delivery to maximize engagement

Accommodations for assignments

Promoting academic enabling skills

Social environment

Peer tutoring/study-buddy

Co-operative learning

Promoting peer acceptance & support

Tier-1 interventions

See your handout

Classwide Antecedent strategies

1. Clear rules & expectations

2. Clear directions

Teach Behavioral Expectations

Transform broad school-wide Expectations into

specific, observable behaviors.

Teach in the actual settings where behaviors are

to occur

Teach (a) the words, and (b) the actions.

Post in prominent locations for ALL to see,

monitor, & support

Build a social culture that is predictable, and

focused on student success.

For all students but

essential for those with

ADHD/symptoms

10 Basic Instructional & Classroom

Management Approaches

In your Handout

Rowe KJ: 2003 Australian Council for Educational Research

Rowe K, Pollard J, Rowe K (2005) [www.acer.edu.au/news/latestnews.html]

Teachers were taught how to: assess a student’s ability to process & remember

verbal information

adapt their instructional language “Speak short & sweet & repeat”

Children showed improvements in: literacy outcomes

behavior

Improvements persisted over several years

Use Effective Instructions & Commands

Rowe & Rowe’s Rules of Thumb for inattention & literacy risk (2006)

Children not at risk Median/mean number of words accurately

recalled = age in years + 4 (up to age 10)

Children in high-risk category for literacy Cannot recall sentences of word length

more than age in years + 3

Likely to be rated as inattentive & poor academics

Use Effective Instructions & Commands

ATTRACT the student’s attention

Maintain eye contact

SPEAK clearly, paced

Use short sentences (‘chunked’)

Use visual cues & wait for compliance

PAUSE between sentences

MONITOR the student

If child has ‘blank look’

stop & begin instruction again

TO REPEAT INSTRUCTION

Restate slowly and simply

Do not expand

Intervention Goals for Yousif

Academic

skills

Academic Enablers

Behavior




Pairs/Small Group Activity

1. Required materials

Use the 2 frameworks to guide your thinking

(Resource/Demand Imbalance; RTI)

Handout materials (ADHD-friendly classrooms; 10

Basic Instructional & Classroom Management

Practices; Yousif’s profile)

2. ACTIVITY

Review Yousif’s profile

Select & prioritize intervention goals

Select Tier-1 prevention approaches that

would be essential for Yousif

1. Which

classroom

layout would

you select for

Yousif for

small group

work?

2. Where would

seat him for

small-group

work?

Pair/small group activity: see handout

Teacher’s intervention goals for

Yousif – do you agree?

Home-School Daily Report Card

rationale & goals

Provides

Daily communication between parent and teacher

Frequent reinforcement for child

Tool for monitoring progress

Purpose

To help change child’s behaviour and academic

efficiency at school

To reduce need for calls and discipline at school

To emphasize positive attainments as well as

areas for improvement

Possible targets for Daily Report Card

Behaviour

Following classroom rules

Peer relationships

Teacher relationships

Time out behaviour

Responsibility for belongings

Academic functions

Readiness to learn

Academic productivity

Homework

Daily/Weekly Report Name:___________ Date:_______

Class (period)________________

M T W T F

Homework turned in: ____________

Class work completed: ____________

Test scores: ____________

Comments:________________________________________________ ______________________________________________________________________________________________________________

Incomplete work:__________________________________

Teacher signature: ______________

Ontario Ministry of Education Report Card:

Student Learning Skills & Work Habits

Responsibility

Organization

Independent Work

Collaboration

Initiative

Self-Regulation

These skills are

impaired in ADHD

(academic enablers)

What effective

instructional practices

will promote these

student skills?

Examples of effective instructional practices for

promoting students’ learning skills

1. RESPONSIBILITY

1. Uses routines at start & end of day for handing in &

recording assignments

2. Reviews & discusses assigned work (homework,

classwork etc)

3. Creates linguistic and non-linguistic representations

pictographic representations, mental imagery, physical

models, graphic organizers

4. Posts, teaches, reviews, prompts classroom rules

RESPONSIBILITY: Sample student behaviours:

•Completes & submits classwork, homework, etc for agreed-upon

deadline

•Takes responsibility for & manages own behaviour

Examples of effective instructional practices for

promoting students’ learning skills

2. ORGANIZATION

Keeps the classroom organized & uncluttered

Provides advance organizers of work required

and exemplars of expectations

Demonstrates and models organization & time

management strategies (think-aloud)

Teaches students the tools & skills for

organization (calendar, clock, agenda,

sequencing, ordering, grouping)

ORGANIZATION: Sample student behaviours:

•Devises follows a plan & process for completing work & tasks

•Establishes priorities & manages time to complete tasks & achieve

goals

Examples of effective instructional practices for promoting

students’ learning skills

3. INDEPENDENT WORK

States directions/instructions specifically, clearly and

succinctly using brief & direct statements & repeats as

needed

Checks students understanding of the

directions/instructions by asking them to repeat

Uses strategies to support student’s independent work

tells them who & how to ask for help, teacher responds to

students’ signals or requests for help;

Scans & moves around class to give support & positive

feedback to individual students)

INDEPENDENT WORK: Sample student behaviours:

•Follows instruction with minimal supervision

•Uses class time appropriately to complete tasks



4. COLLABORATION

Sets up opportunity for small group & partner

work

Sets up protocol, roles, goals etc for small group

or partner work; prompts & remind

Scan & moves around class to give support &

positive feedback to groups/partners

Models & teaches desirable social behaviors,

explicitly/directly

COLLABORATION: Sample student behaviours:

•Accepts various roles & share of work in a group

•Responds positively to others’ ideas, values, traditions

•Works with others to resolve conflicts & build concensus to obtain group

goals



5. INITIATIVE

Provides and posts “bell work’ for start of day or

lesson; posts “what to do when you’re done” list

of suggested/permitted activities

Provides opportunity for students to choose

activity or apply activity to preferred interest

Uses open questions to solicit student opinions

& promote discussion & dialog

INITIATIVE: Sample student behaviours:

•Demonstrates curiosity & interest in learning

•Looks for & acts on new ideas & opportunities for learning

•Demonstrates capacity for innovation & willingness to take risks



6. SELF-REGULATION

Gives frequent positive feedback (using 3:1 ratio

of positive to negative comments)

Models & uses signals for self-regulation of

attention & behavior

red light/orange light; lights on& off; raises hand to

signal children to do likewise

SELF-REGULATION: Sample student behaviours:

•Seeks clarification or assistance when needed

•Perseveres & makes an effort in response to challenges

•Sets own individual goals &self-monitors progress

•Assesses & reflects critically on own strengths, needs, interests

Teacher’s intervention goals for

Yousif – focus on writing

Using assistive technology to

help with written expression

His opinions & thinking are now very clear!

WRITTEN EXPRESSION

Self Regulated Strategy Development (SRSD)

Tier 2

Collaborative teams of 2 students

Explicit/systematic strategies for accomplishing

specific writing task

Goal setting, self-monitoring and graphic

organization

Self-Regulated Strategy Development (SRSD) RTL Tier 2

SRSD OVERVIEW

David’s peer student group will be explicitly

taught self-regulation procedures including:

goal setting

self-monitoring

self-instructions

self-reinforcement

Self-regulation then applied to writing strategies and will be

monitored for one term.

General planning strategy represented by POW-mnemonic

(Planning, Organizing, Writing) as follows…

Evidence-based SRSD writing strategy which has been shown to improve the

completeness and quality of struggling writers stories and persuasive essays

(Graham, et al, 2005).

SRSD Organization Strategies

Struggling writers mastered two genres in

approximately 11 hours and, on average,

showed some generalization to other

writing genres (Peer support condition in

Graham, et al, 2005).

To support organization of notes, are

taught genre-specific strategies that

prompt generation of ideas for basic

parts of a story and persuasive essays.

WWW, What = 2, How = 2 and TREE

Students are taught to use this

intervention strategy for one school term

and the impact of the strategy on writing

goals monitored.

Peer support component

Once a week students meet, discuss and

record with a peer strategies application

each other’s writing and other classroom

situations (Graham, et al, 2004).

Level-2 Prevention/Intervention for ADHD:

Organization & Homework Management.

Langberg et al(2008)

8-week intervention program:

2 days/week after school , 1.25 hrs per session

20 min individual; 55 group intervention

Taught/supervised by trained adults (non-school staff),

3:1 student: counselor ratio

Instructors’ Manual; Organization checklist; Homework Manaement Checklist

3 components: (plus ‘reward’ system)

Physical organization of materials (binder, book-bag,

locker)

Accurate recording of homework & tests in a planner

Long-term planning for tests/projects

Parent involvement: 2 x 1hr evening sessions

Summary Effective educational environments meet both

the academic & social needs of students – including those with ADHD /symptoms.

Effective behavior support enhances academic outcomes – including in those students with ADHD / symptoms.

Effective instruction enhances social behavior – including in those students with ADHD /symptoms.

ADHD calls for a co-ordinated,

sustainable, multi-system approach

System-level

Classroom-level

School-level

• Transition plans (sector-

to-sector, school-to-school,

grade-to-grade, class-to-

class, home-school)

• Instructional pathways

(credit-recovery, credit-

rescue, co-op etc)

• Capacity-building

(professional development) Student

Systems:

Education

Post-sec education

Medical

Mental Health

School /classroom

Teacher-child

Family (parent-child)

Parent-teacher

Family

Collaborative Strategic reading (CSR)

Incorporates 4 key elements

Prior knowledge

Vocabulary development

Questioning techniques

Opportunities to practice

CSR: 4 reading strategies

Click & Clunk Strategy Distinguishing between ‘clicks’ & ‘clunks’

4 fix-it-up strategies for ‘clunks’

Re-read sentence, leaving gap for clunk, try to guess

missing word (might be synonym)

Re-read sentence with the clunk; re-read sentences

before and after clunk-sentence to look for clues

Look for prefix or suffix in the clunk

If possible, break clunk into smaller words that might

give clue to its meaning

Effective reading comprehension

strategies S

tep

1:

Before:

Ste

p

2:

During:

Ste

p

3:

After:

Activate prior knowledge.

Preview the layout.

Ex. read down a column, not across

columns. Captions go with pictures.

Quotations mean conversation.

Make predictions.

Visualize

Think aloud , make connections,

inferences. Ex. Give sticky notes to attach "I agree", "This reminds

me of..."

Stop to summarize at end of paragraphs.

Vocabulary: predict, confirm and pronounce

Revise predictions.

A final reading.

Questions:

Direct (answers are in the

story/book)

Indirect (provoke thought "why")

Personal questions (expand answer based on

experience).

Use graphic organizers.

Think-aloud reading comprehension

strategies

Visualize

“I can see it

clearly…”

Prediction

“I think I

know what

will

happen…”

Vocab

“What does

____

mean?”

Inference

“I figured it

out!”

Purpose

“I want to

find out…”

Connect

“That reminds

me of when…”

• Explicitly teach “think-aloud”

reading comprehension strategies,

• Create posters as classroom prompts.

• Promote ongoing use of these

strategies across the curriculum,

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