SPED 310: Teaching Students with Learning Disabilities

SPED 310: Teaching Students with Learning Disabilities Kathy Kelker, Ed.D. Topic 9: Behavior Management Week 6

Advance Organizer #9 • When and why do children with learning disabilities have behavior problems? • What do students with AD/HD need to be successful in school? • What are effective treatments for ADD? • How can positive behavioral interventions be used to modify the behavior of LD students?

Terms to Know • stimulant medications • Hewitt’s Triangle • Premack Principle • planned ignoring • proximity control • hurdle lessons • mutual contracts • multi-modal treatment

Do LD Students Have Behavior Problems? Generally speaking, having an academic learning disability does not necessarily cause a child to have behavior problems. Of children who have learning disabilities, the ones who are most likely to display inappropriate behavior in school are the children who have attention deficit disorder. Children with learning disabilities who do not have AD/HD may display some social problems related to their disability. These issues will be covered in Topic #14 which deals with social competence.

Why Do Students with AD/HD Have Behavior Problems? The behavior problems that children with AD/HD display are definitely related to the disability itself. Because of the differences in the ways their brains function, these children are… • Less aware of social norms (e.g., boundaries) • Less able to follow expected routines • Less able to inhibit impulses • Less able to respond appropriately to authority figures

Needs at School of AD/HD Students In many ways school is an unfortunate environment for children with AD/HD. At school, what these children are good at--paying attention to lots of things at once, being creative, having high energy--is often not as valued as what they are not good at--sitting still, paying attention to one message, being persistent, doing one thing at a time.

Can AD/HD Children Ever Be Successful in School? Often unintentionally, children with AD/HD get into constant trouble at school. They experience school as a place where they can never be successful, even when they try their hardest to “be good.”However,school can be successful for children with AD/HD if their needs are met.

What Works with AD/HD Students? Because they act impulsively and often do not attend well to directions, these children benefit greatly from a school environment where there are 1)more clues to guide them in how to behave, and 2) richer, more immediate rewards for compliance with behavioral expectations.

Needs of Children with AD/HD • Escape valve outlets • Predictability of schedules and routines • Extra time to process information and • perform tasks • Extra space • Creative, engaging curriculum • Help with coping skills and feelings of • frustration • Adaptations and modifications of the • curriculum and environment • Modeling and teacher-guided instruction • Meaningful learning experiences • Choices (e.g., Hewitt’s Triangle) • Teaching strategies that build on strengths • and help bypass their weaknesses • Teachers in their lives who are positive and • flexible • Clarity of expectations • Structuring of work environment, tasks, and materials • Assistance through transitions • External assistance in helping to get and maintain attention • Cueing, prompting, and reminders • Active learning • High-response opportunities • Help with organization and study skills • Multi-sensory instruction • Learning-style accommodations • Written output modifications

Research Supports Behavior Modification Techniques Research conducted by Dr. Russell Barkley at the University of Massachusettshas shown conclusively that certain behavior modification techniques are highly effective in helping students with AD/HD do well behaviorally in regular classroom settings.

Principles for Behavioral Intervention with AD/HD Students 1. Immediacy of consequences 2. Frequency of consequences 3. Saliency of consequences 4. Act, don’t yak 5. Positives before negatives 6. Anticipate potential problems 7. Maintain a sense of priorities 8. Keep a disability perspective 9. Don’t personalize the problems 10. Practice forgiveness

Incompetent vs. Noncompliant Students with AD/HD can be very annoying children to have in a classroom. The recommendation to “keep a disability perspective” is important because there is a tendency to become frustrated with AD/HD students and see their behavior as intentional noncompliance when in reality their misbehavior is a result, at least in part, of their disability.

AD/HD List of “Don’ts” DON’T assume the student is being lazy. There are reasons why the student is underachieving. DON’T be fooled by inconsistency or assume the student is deliberately not performing because you have observed that at times he or she is able to do the task. DON’T give up on any student. These challenging students often try the patience of both parents and teachers. DON’T be afraid to modify, make exceptions, and alter assignments for students, as needed. Your goal is the student’s success. You want the student to keep responding so be flexible and make special arrangements with some students.

Address Learning Disabilities Too It is important to keep in mind that many children with AD/HD also have academic learning disabilities (commonly in reading, written language, or math).Their academic difficulties must also be addressed as well as their behavioral problems. Often relieving the difficulties in academic areas first has the unexpected and pleasant side effect of improving behavior as well.

“Pure” AD/HD Students who have only AD/HD and have no academic learning disabilities cannot be identified for special education under the category of “learning disabilities.” They may, however, qualify for special education under the category of “other health impaired” (OHI). The OHI category fits if the child’s inattentiveness is so extreme that it has an adverse effect on learning.

Balky Behavior Children with AD/HD can be very balky about following “direct orders” from teachers, particularly when they are being told to “get to work” or “finish an assignment.” When the child refuses to get to work, the teacher’s natural reaction is to be more insistent. This response usually backfires, leading to an escalation in the student’s inappropriate behaviorand a power struggle between student and teacher.

To avoid power struggles and resolve situations when an AD/HD student becomes balky, try using Hewitt’s Triangle. This technique is described for you in Activity 9.1. Read about Hewitt’s Triangle and then answer these questions: • What behavioral principles make Hewitt’s Triangle a successful technique? • Why do you suppose some teachers might feel uncomfortable using this technique? • What does Hewitt’s Triangle tell us about “winning” and “losing” between teacher and student?

Tricks of the Trade We have already learned about the basic behavior management techniques that work well with students who have AD/HD. There are also some quick management techniques that can be added to a basic behavior management program. These “tricks of the trade” can help a teacher solve specific problems that occur sporadically with an AD/HD student. (See Activity 9.2) (See Tricks of the Trade in Document Sharing. This ideas provided by your instructor).

Multi-Modal Treatment AD/HD is a complex disorder that usually requires a multi-faceted approach to treatment. As we have been learning, behavior management and educational interventions can be helpful. Sometimes children also benefit from counseling that helps them to understand their disability and how it affects their relationships with other people.

Besides educational intervention, behavior modification, and psychological counseling, some children with AD/HD require medical intervention in the form of medication. Behavior Modification Educational Planning Treatment for AD/HD Psychological Counseling Medical Management

Use of Medication Is Controversial Medication for the treatment of AD/HD symptoms has been used in the United States for over 30 years and has been found to be effective in many cases. But the use of medication to modify behavior remains controversial. Parents typically are reluctant to use drugs. School officials are sometimes over zealous in recommending medication. See Up Close: The Medication Debate at … http://www.pbs.org/wgbh/misunderstoodminds/attention.html

The most commonly prescribed medications for treatment of AD/HD are stimulants, particularly Ritalin. • Methylphenidate (Ritalin) • Extremely safe • Highly effective • Dose = .3-.10 mg/kg/dose • Higher doses modulate activity • Actions: Nonspecific increase in attention • and cognitive functions: memory, recall, writing, • calculations • Side effects: decreased appetite, insomnia, growth disturbance, tics, emotional lability, headaches, stomach- aches

Dextroamphetamines (Dexedrine, Adderal) are also used, but less commonly because amphetamines are “street drugs” and may be more prone to abuse.

Newer Medications In 2001 some newer medications with state-of-the art delivery systems came on the market. These medications are designed to deal with some of the problems encountered with the older drugs. Ritalin, for example, has a very short effectiveness period (2 to 4 hours), so school-age children must take Ritalin at school in order to have the positive effects throughout the school day. The new drugs are more long acting and eliminate the need to take medications at school.

Concerta and Extended Release Adderall

In addition to stimulant medications, sometimes tricyclic antidepressants and other psychotropic medications are used to treat AD/HD. Pros and Cons of Nonstimulant Drugs Drug Advantages Disadvantages Bupropion May decrease Few studies in ADHD hyperactivity and May decrease aggression seizure threshold May improve May exacerbate tics cognitive performance Tricyclic May have better Efficacy less than response in cases stimulants of comorbid anxiety Serious potential or depression cardiac effects May be useful in in children patients with Need for cardiac and tic disorders blood monitoring Longer duration of action Clonidine May be useful to Maximum clinical effects treat very hyper- may take several active or aggressive weeks patient Does not affect Improves ability inattention to fall asleep symptoms May be useful in Sedation patients with tic Risk of adverse disorders cardiovascular effects, depression, and decreased glucose tolerance

Are Medications Effective? Research has shown that stimulant medications are effective in helping children pay better attention and in curbing hyperactive behavior. The medications have some positive cognitive effects on memory and organizational skills as well. Use of medication seems to help some children be more amenable to instruction, but the medications alone do not “teach” academic or social skills.

Effectiveness of stimulant medications has actually been reported in the medical literature since the 1930s. Over the long period in which stimulant medications have been used, they do not appear to have dangerous or long lasting side effects. “Possibly the most striking change in behavior during the week of Benzedrine therapy occurred in the school activities of many of these patients….There appeared a definite drive to accomplish as much as possible during the school period, and often to spend extra time completing additional work. Speed of comprehension and accuracy of performance were increased in most cases. The improvement was noted in all school subjects.” Bradley, 1937

Below are examples of similar art projects done by a child with AD/HD without medication and then with medication. There is a notable difference in organization and completeness.

Probably the most interesting study of the effectiveness of stimulant medications versus other treatments for AD/HD was published by the National Institute of Mental Health in 1999. In this study, medication alone was compared with the effectiveness of behavior modification, counseling, or the combination of medication and behavioral andcounseling interventions. The results are in the table below. • Results of the MTA Study • Medication and combined treatment groups did equally well with respect • to ADHD core symptoms • Both groups did better than the behavioral treatment-alone group • Behavioral treatment-alone group did better than the community control • group • Children with ADHD and anxiety disorder responded as well to medication • as the children with ADHD without anxiety disorder • Children with ADHD with anxiety in the combined treatment group did • better than those in the medication-only group • Adapted from Arnold LD, Abikoff HB, Cantwell DP, et al.

Teachers’ Role in AD/HD TreatmentWith respect to working with students who have AD/HD, a teacher’s role is to be a teacher. • Teachers should not suggest to parents that their children should take medication. • If children with AD/HD also have learning disabilities, teachers should make sure that the learning disabilities are addressed and that educational interventions occur. • Teachers should use research-based behavior modification techniques to manage the behavior of students with AD/HD in the classroom. • Teachers should collect objective data about a child’s behavior in the classroom and share that data with parents. • When a child is being treated for AD/HD by a physician, teachers should work closely with the physician and provide objective information about how the child is performing in the classroom. On the next slide, there is a case study for a student named Brent. Read the case study and do the activities that follow on slides #18 and #19.

Case Study: Brent Directions: Read the following case study and then do the activities that follow. Brent is a seventh grader who is constantly in trouble at school. He is often tardy to class and annoys teachers and fellow students with disruptive clowning. Brent always acts as though he were “wired.” He is fidgety when sitting down and constantly on the move between classes. In the hallways, he bumps into other people and doesn’t seem to notice the disruption. As far as academics go, Brent’s performance is erratic. He has great difficulty completing assignments, tuning in to salient information, and performing consistently on examinations and written reports. However, he participates well in class discussions and brings up interesting and creative ideas. Brent’s teachers think he is quite bright and should be performing better. Brent’s counselor has noted that Brent was once in the gifted and talented program in elementary school and his tested IQ was 138. Despite impressively high intelligence scores, Brent continues to exhibit a discrepancy between his verbal fluency, level of thinking, and creativity and his ability to get ideas down on paper. Brent himself says that he prefers concepts and theories to details. He finds school “boring” and teachers “dull and unimaginative.” Brent thinks he is brighter than his teachers and that he has better insights than his classmates. The reality is that Brent dabbles in a lot of interests (e.g., reading science fiction, motor repair) but he doesn’t care about school and he can’t wait to drop out and join the Navy. (See Activity 9.3)

Using the information in the case study, list the characteristics of AD/HD that Brent exhibits. Hyperactivity _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ Impulsivity _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ Inattentiveness _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________

Imagine that you are a member of team that is developing a plan to help Brent do better in school. Think about the strategies and recommendations that work for students with AD/HD. Using the form on the next page, develop a written plan for Brent that includes research-based strategies designed to manage the annoying or dysfunctional symptoms of AD/HD. Be sure that your plan focuses on objective data (behaviors that have been observed). The form below has been used in many school districts. If the plan is well devised and implemented properly, improvement in behavior is usually noted within two weeks. AD/HD Management Plan Student's Strengths (list 4-5) _______________________________________________________________________________________________ _______________________________________________________________________________________________ Areas of Concern (list 4-5 of the most important) _______________________________________________________________________________________________ _______________________________________________________________________________________________ Academic Strategies (choose 3-5) _______________________________________________________________________________________________ _______________________________________________________________________________________________ Behavioral Strategies (choose 3-5) _______________________________________________________________________________________________ _______________________________________________________________________________________________

Reflections “The energy which makes a child hard to manage is the energy which afterward makes him a manager of life.” Henry Ward Beecher

SPED 310: Teaching Students with Learning Disabilities