add/adhd strategies in school. middle school: what works? advance organization advance organization...

ADD/ADHDADD/ADHD

Strategies in SchoolStrategies in School

Middle School: What Middle School: What Works?Works? Advance OrganizationAdvance Organization Daily OrganizationDaily Organization Study SkillsStudy Skills AttentionAttention Planning SkillsPlanning Skills 80% still need medication 80% still need medication

(NIMH)(NIMH) Sleep, Sleep, SleepSleep, Sleep, Sleep

Advance OrganizationAdvance Organization

Background information Background information before new tasksbefore new tasks

Complete a “walk through” Complete a “walk through” to each classroomto each classroom

Practice opening lockers Practice opening lockers and padlocksand padlocks

Daily OrganizationDaily Organization

Order and Routine in the Order and Routine in the ClassroomClassroom

Post SchedulePost Schedule Color-coded materialsColor-coded materials Designated places for Designated places for

materialsmaterials

Study SkillsStudy Skills

Teach study skills (SQ3R) Teach study skills (SQ3R) and note taking strategiesand note taking strategies

Match tutors/mentors to Match tutors/mentors to help students organize and help students organize and keep up with daily workkeep up with daily work

AttentionAttention

Mnemonic strategiesMnemonic strategies Strong visual depictionsStrong visual depictions Present in short, brief Present in short, brief

segmentssegments Use overheadsUse overheads Audiotapes of lessons Audiotapes of lessons

available to studentsavailable to students Opportunities for controlled Opportunities for controlled

movement in the classroommovement in the classroom

Planning SkillsPlanning Skills

Variety and novelty in Variety and novelty in lessonslessons

Opportunities for small-Opportunities for small-group learninggroup learning

Peer/Mentor TutoringPeer/Mentor Tutoring

High School: What Works?High School: What Works?

Experience based curriculumExperience based curriculum Use of demonstrations and role playingUse of demonstrations and role playing Hands-on experiences and activitiesHands-on experiences and activities Project-oriented curriculumProject-oriented curriculum Multimedia technologyMultimedia technology Mentorship, Tutoring, CoachingMentorship, Tutoring, Coaching Learning GamesLearning Games Compensatory Strategies: hand Compensatory Strategies: hand

speller, calculator, study outlines, tape speller, calculator, study outlines, tape recordersrecorders

Teacher Selection: matching teacher’s Teacher Selection: matching teacher’s style to students’ strengthsstyle to students’ strengths

Challenges: Poor Note Challenges: Poor Note Taking SkillsTaking Skills Hand out a written format for note Hand out a written format for note

taking before classtaking before class Audiotape the classAudiotape the class Designate a class “note-taker” each Designate a class “note-taker” each

day and photocopy the notesday and photocopy the notes Number or Alphabetize information Number or Alphabetize information

used in the lectureused in the lecture Review notes with class one time per Review notes with class one time per

week and highlight important areasweek and highlight important areas Periodically collect notes to determine Periodically collect notes to determine

what helps students the mostwhat helps students the most

Poor Organizational SkillsPoor Organizational Skills

Allow students to keep one book in Allow students to keep one book in class and one at homeclass and one at home

Use e-mail for homework Use e-mail for homework assignments. Students can look from assignments. Students can look from home to determine assignmentshome to determine assignments

Assign study buddies for the last 5 Assign study buddies for the last 5 minutes of class to review notes and minutes of class to review notes and assignmentsassignments

Have row captains to ensure all Have row captains to ensure all homework is turned inhomework is turned in

Assign a phone study buddy to each Assign a phone study buddy to each student. They can call one another to student. They can call one another to discuss homework, tests, or questionsdiscuss homework, tests, or questions

Difficulty concentrating when Difficulty concentrating when reading silentlyreading silently

Allow the student to use a colored Allow the student to use a colored note card to mark the line being note card to mark the line being readread

Allow students to read anywhere in Allow students to read anywhere in the classroomthe classroom

Have two students take turns Have two students take turns reading to one anotherreading to one another

Allow students to listen to a book Allow students to listen to a book on audiotape before reading it to on audiotape before reading it to enhance visualization of the enhance visualization of the materialmaterial

Calendars and Daily Calendars and Daily PlannersPlanners Post a large planning Post a large planning

calendar in the room to calendar in the room to model how to record model how to record assignments, test dates, etc.assignments, test dates, etc.

Teach the student to Teach the student to highlight important dateshighlight important dates

Encourage the student to Encourage the student to carry a daily calendar bookcarry a daily calendar book

Test Taking StrategiesTest Taking Strategies Allow the student to write the # or Allow the student to write the # or

letter of the correct answer onlyletter of the correct answer only Allow the student to write directly Allow the student to write directly

on the main copy of the teston the main copy of the test Demonstrate how to check Demonstrate how to check

carefully that the # on answer carefully that the # on answer sheet matches the # of the ?sheet matches the # of the ?

Teach your students to check the Teach your students to check the page # every time they turn a page # every time they turn a pagepage

General AccommodationsGeneral Accommodations

Maintain a positive atmosphereMaintain a positive atmosphere Give students a blank piece of Give students a blank piece of

paper to jot down anything they paper to jot down anything they can remember and let them use can remember and let them use this page during the testthis page during the test

Suggest students learn to read Suggest students learn to read the answers first, then read the answers first, then read the ? to ensure they read all the the ? to ensure they read all the details of the answersdetails of the answers

Encourage visual recall to the Encourage visual recall to the lecture in class if they cannot lecture in class if they cannot remember an answerremember an answer

General AccommodationsGeneral Accommodations Seat placement (front is not Seat placement (front is not

always best)always best) Small group activitiesSmall group activities Encourage students to pause Encourage students to pause

before answering questionsbefore answering questions Keep assignments short or Keep assignments short or

break them into sectionsbreak them into sections Close supervision with frequent, Close supervision with frequent,

positive, (subtle) cues to stay positive, (subtle) cues to stay on taskon task

Test Taking OptionsTest Taking Options Taped response test rather than writing Taped response test rather than writing

the answersthe answers Individual conferencingIndividual conferencing Small group testsSmall group tests Teacher-read testsTeacher-read tests Essay testEssay test Audiotaped tests—allow use of Audiotaped tests—allow use of

earphones to reduce distractionsearphones to reduce distractions Take home testsTake home tests Alternative projectAlternative project Study questionsStudy questions Student designed testsStudent designed tests Chunking—Use highlighters to divide Chunking—Use highlighters to divide

sections of the test. Use color, tricks, & sections of the test. Use color, tricks, & visual impact to trigger memory & recallvisual impact to trigger memory & recall

Study ToolsStudy Tools ClipboardClipboard Electronic handspeller w/ dictionaryElectronic handspeller w/ dictionary Post it NotesPost it Notes Three hole punchThree hole punch Large 3 ring notebook with colored Large 3 ring notebook with colored

inserts inserts Mechanical pencils/Fine tipped pensMechanical pencils/Fine tipped pens Hand held tape recorderHand held tape recorder HighlightersHighlighters Colored index cards/paper clipsColored index cards/paper clips Personal organizational plannersPersonal organizational planners

Classroom InterventionsClassroom Interventions

What worksWhat works And what does And what does notnot work work

Not recommended!Not recommended!

What What we knowwe know works: works:

Drug TherapyDrug Therapy Behavior TherapyBehavior Therapy Combined Combined

Behavioral/Drug Behavioral/Drug TreatmentsTreatments

APA Task Force on Evidence-Based APA Task Force on Evidence-Based Treatments, JCCAP, Pelham, Wheeler, & Treatments, JCCAP, Pelham, Wheeler, & Chronis, 1998Chronis, 1998

American Academic of PediatricsAmerican Academic of Pediatrics

AAP GuidelinesAAP Guidelines

1. Establish a management 1. Establish a management program that recognizes program that recognizes ADHD as a ADHD as a chronic chronic conditioncondition (strength of evidence: (strength of evidence: good; strength of recommendation: strong).good; strength of recommendation: strong).


2. Clinician, parents, and 2. Clinician, parents, and child, in collaboration with child, in collaboration with school should school should specify specify appropriate target appropriate target outcomesoutcomes to guide to guide management management (strength of (strength of evidence: good; strength of evidence: good; strength of recommendation: strong).recommendation: strong).


3. Recommend stimulant 3. Recommend stimulant medication and/or medication and/or behavior therapybehavior therapy as as appropriate appropriate (strength of evidence: (strength of evidence: strong).strong).


4. When management has 4. When management has not met target, clinicians not met target, clinicians should evaluate the should evaluate the original diagnosis, original diagnosis, treatments, adherence and treatments, adherence and coexisting conditions coexisting conditions (evidence: weak; recommendation: strong).(evidence: weak; recommendation: strong).


5. Periodically provide 5. Periodically provide systematic follow-upsystematic follow-up to to monitor targets and monitor targets and adverse effects by gaining adverse effects by gaining information from child, information from child, parents, and teachers parents, and teachers (evidence: fair; recommendation: strong).(evidence: fair; recommendation: strong).

What What we knowwe know DOESN’T DOESN’T work:work: Play therapyPlay therapy Individual or family counseling Individual or family counseling

(without altering the (without altering the environment)environment)

Dietary managementDietary management Megavitamin therapyMegavitamin therapy Sensory integration Sensory integration

therapy/chiropracticstherapy/chiropractics EEG BiofeedbackEEG Biofeedback

Doesn’t work. . .Doesn’t work. . .

Optometric vision trainingOptometric vision training Anti-motion-sickness Anti-motion-sickness

medicationmedication Treatment for candida yeast Treatment for candida yeast

infectioninfection Applied kinesiology Applied kinesiology

(realigning bones in the (realigning bones in the skull)skull)

What What we knowwe know works: works:

CNS Stimulant MedicationsCNS Stimulant Medicationso 250 studies (N > 5000)250 studies (N > 5000)

Behavior TherapyBehavior Therapyo 48 classroom studies (N > 900)48 classroom studies (N > 900)o 80 parent/home studies (N > 80 parent/home studies (N >

5,000)5,000) Combined Behavioral/Drug Combined Behavioral/Drug

TreatmentsTreatmentso 25 studies (N > 800)25 studies (N > 800)

Behavior Therapy for Behavior Therapy for ADHDADHD

ComponentsComponents Highly structuredHighly structured Immediate feedbackImmediate feedback

reinforcer or reward for appropriate reinforcer or reward for appropriate behaviorbehavior

consequence for inappropriate consequence for inappropriate behaviorbehavior

Salient/meaningful feedbackSalient/meaningful feedback Programming at home and Programming at home and

schoolschool

School Behavior School Behavior InterventionIntervention

Examples:Examples:

1. The Attention Training 1. The Attention Training

System (ATS)System (ATS)

2. Home School Note2. Home School Note

3. Self-monitoring3. Self-monitoring

School Behavior School Behavior Intervention:Intervention:The Attention Training System (ATS)The Attention Training System (ATS)

1. Technology1. Technology

Teacher ModuleTeacher Module

Student ModuleStudent Module

2. Immediate feedback2. Immediate feedback

3. Meaningful consequences3. Meaningful consequences

4. Structured “time”4. Structured “time”

School Behavior School Behavior InterventionInterventionThe ATS: LisaThe ATS: Lisa

0102030405060708090

100

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

Days

%TimeOff

Task

No ATS ATS No ATS ATS

School Behavior School Behavior InterventionInterventionThe ATS: TroyThe ATS: Troy

0102030405060708090

100

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23

Days

%TimeOff

Task

No ATS No ATS No ATS

ATS ATS Meds Only

School Behavior School Behavior InterventionInterventionHome School NotesHome School Notes

Address Problems WithAddress Problems With Academic effortAcademic effort In-class behaviorsIn-class behaviors Assignment completionAssignment completion


ProceduresProcedures Identify target behaviorsIdentify target behaviors

School Behavior InterventionSchool Behavior InterventionHome School NotesHome School Notes

Academic BehaviorsAcademic Behaviors Working on Working on

assignmentsassignments Completing Completing

homeworkhomework Handing in Handing in

assignmentsassignments All work up to All work up to

datedate On time for classOn time for class

Social BehaviorsSocial Behaviors Out of seatOut of seat Talking without Talking without

permissionpermission Disrespectful Disrespectful

behaviorbehavior Bothering peersBothering peers Following Following

instructionsinstructions Hands to selfHands to self


ProceduresProcedures Identify target behaviorsIdentify target behaviors Design school note formDesign school note form


GOAL:GOAL:

8 of 12 YES8 of 12 YES

Desk neat and Desk neat and organizedorganized

Homework written Homework written neatly, neatly, accurately in accurately in book by class book by class bellbell

Class assignment Class assignment neat and 80% neat and 80% accurate or accurate or betterbetter

MathMath L. ArtsL. Arts HistoryHistory ScienceScience

Yes NoYes No Yes NoYes No Yes NoYes No Yes NoYes No




ProceduresProcedures Identify target behaviorsIdentify target behaviors Design school note formDesign school note form Identify reinforcers and Identify reinforcers and

consequencesconsequences


Reinforcer ExamplesReinforcer Examples Wear an outfit of your choice to Wear an outfit of your choice to

schoolschool Get out of a choreGet out of a chore TV/video TV/video

games/telephone/computer timegames/telephone/computer time AllowanceAllowance Token toward weekend activityToken toward weekend activity


ProceduresProcedures Identify target behaviorsIdentify target behaviors Design school note formDesign school note form Identify reinforcers and Identify reinforcers and

consequencesconsequences Establish criterion for reinforcementEstablish criterion for reinforcement Increase criterion as progress is Increase criterion as progress is

mademade Plan for generalization and Plan for generalization and

maintenancemaintenance


What makes it effective:What makes it effective: Frequent, immediate Frequent, immediate

feedback (school).feedback (school). Highly structured (short Highly structured (short

time).time). Salient consequences Salient consequences

(home).(home).

Date:Date:

Cross off each picture each time Cross off each picture each time you talk without raising your you talk without raising your hand or having permission. hand or having permission. Teacher will cross off two Teacher will cross off two pictures if you don’t.pictures if you don’t.

RESOURCESRESOURCES Attention Deficit Disorder: Attention Deficit Disorder:

Strategies for School-Age Strategies for School-Age Children by Clare B. Jones, Ph.D.Children by Clare B. Jones, Ph.D.

Treatments that Work with Treatments that Work with Children: Empirically Supported Children: Empirically Supported Strategies for Managing Strategies for Managing Childhood Problems by Edward Childhood Problems by Edward R. Christophersen, Susan L. R. Christophersen, Susan L. Mortweet Mortweet

Taking Charge of ADHD, Revised Taking Charge of ADHD, Revised Edition: The Complete, Edition: The Complete, Authoritative Guide for ParentsAuthoritative Guide for Parents by Russell A. Barkley by Russell A. Barkley

ADHD and the Nature of Self ADHD and the Nature of Self Control by Russell A. Control by Russell A. Barkley Barkley

Attention-Deficit Attention-Deficit Hyperactivity Disorder: A Hyperactivity Disorder: A Clinical Workbook, Second Clinical Workbook, Second Edition by Russell A. Edition by Russell A. Barkley, Kevin R. MurphyBarkley, Kevin R. Murphy

Effective School Effective School Interventions by Natalie Interventions by Natalie RathvonRathvon

add/adhd strategies in school. middle school: what works? advance organization advance organization...

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sleep slide

classroom slide

skills hand

students strengths slide

students opportunities

school slide

study skills sq3r

sleep sleep