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ADD/ADHD

ADD/ADHD. Strategies in School. Middle School: What Works?. Advance Organization Daily Organization Study Skills Attention Planning Skills 80% still need medication (NIMH) Sleep, Sleep, Sleep. Advance Organization . Background information before new tasks

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ADD/ADHD

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  1. ADD/ADHD Strategies in School

  2. Middle School: What Works? • Advance Organization • Daily Organization • Study Skills • Attention • Planning Skills • 80% still need medication (NIMH) • Sleep, Sleep, Sleep

  3. Advance Organization • Background information before new tasks • Complete a “walk through” to each classroom • Practice opening lockers and padlocks

  4. Daily Organization • Order and Routine in the Classroom • Post Schedule • Color-coded materials • Designated places for materials

  5. Study Skills • Teach study skills (SQ3R) and note taking strategies • Match tutors/mentors to help students organize and keep up with daily work

  6. Attention • Mnemonic strategies • Strong visual depictions • Present in short, brief segments • Use overheads • Audiotapes of lessons available to students • Opportunities for controlled movement in the classroom

  7. Planning Skills • Variety and novelty in lessons • Opportunities for small-group learning • Peer/Mentor Tutoring

  8. High School: What Works? • Experience based curriculum • Use of demonstrations and role playing • Hands-on experiences and activities • Project-oriented curriculum • Multimedia technology • Mentorship, Tutoring, Coaching • Learning Games • Compensatory Strategies: hand speller, calculator, study outlines, tape recorders • Teacher Selection: matching teacher’s style to students’ strengths

  9. Challenges: Poor Note Taking Skills • Hand out a written format for note taking before class • Audiotape the class • Designate a class “note-taker” each day and photocopy the notes • Number or Alphabetize information used in the lecture • Review notes with class one time per week and highlight important areas • Periodically collect notes to determine what helps students the most

  10. Poor Organizational Skills • Allow students to keep one book in class and one at home • Use e-mail for homework assignments. Students can look from home to determine assignments • Assign study buddies for the last 5 minutes of class to review notes and assignments • Have row captains to ensure all homework is turned in • Assign a phone study buddy to each student. They can call one another to discuss homework, tests, or questions

  11. Difficulty concentrating when reading silently • Allow the student to use a colored note card to mark the line being read • Allow students to read anywhere in the classroom • Have two students take turns reading to one another • Allow students to listen to a book on audiotape before reading it to enhance visualization of the material

  12. Calendars and Daily Planners • Post a large planning calendar in the room to model how to record assignments, test dates, etc. • Teach the student to highlight important dates • Encourage the student to carry a daily calendar book

  13. Test Taking Strategies • Allow the student to write the # or letter of the correct answer only • Allow the student to write directly on the main copy of the test • Demonstrate how to check carefully that the # on answer sheet matches the # of the ? • Teach your students to check the page # every time they turn a page

  14. General Accommodations • Maintain a positive atmosphere • Give students a blank piece of paper to jot down anything they can remember and let them use this page during the test • Suggest students learn to read the answers first, then read the ? to ensure they read all the details of the answers • Encourage visual recall to the lecture in class if they cannot remember an answer

  15. General Accommodations • Seat placement (front is not always best) • Small group activities • Encourage students to pause before answering questions • Keep assignments short or break them into sections • Close supervision with frequent, positive, (subtle) cues to stay on task

  16. Test Taking Options • Taped response test rather than writing the answers • Individual conferencing • Small group tests • Teacher-read tests • Essay test • Audiotaped tests—allow use of earphones to reduce distractions • Take home tests • Alternative project • Study questions • Student designed tests • Chunking—Use highlighters to divide sections of the test. Use color, tricks, & visual impact to trigger memory & recall

  17. Study Tools • Clipboard • Electronic handspeller w/ dictionary • Post it Notes • Three hole punch • Large 3 ring notebook with colored inserts • Mechanical pencils/Fine tipped pens • Hand held tape recorder • Highlighters • Colored index cards/paper clips • Personal organizational planners

  18. Classroom Interventions • What works • And what does not work

  19. Not recommended!

  20. What we know works: • Drug Therapy • Behavior Therapy • Combined Behavioral/Drug Treatments APA Task Force on Evidence-Based Treatments, JCCAP, Pelham, Wheeler, & Chronis, 1998 American Academic of Pediatrics

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

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

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

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

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

  26. What we know DOESN’T work: • Play therapy • Individual or family counseling (without altering the environment) • Dietary management • Megavitamin therapy • Sensory integration therapy/chiropractics • EEG Biofeedback

  27. Doesn’t work. . . • Optometric vision training • Anti-motion-sickness medication • Treatment for candida yeast infection • Applied kinesiology (realigning bones in the skull)

  28. What we know works: • CNS Stimulant Medications • 250 studies (N > 5000) • Behavior Therapy • 48 classroom studies (N > 900) • 80 parent/home studies (N > 5,000) • Combined Behavioral/Drug Treatments • 25 studies (N > 800)

  29. Behavior Therapy for ADHD Components • Highly structured • Immediate feedback • reinforcer or reward for appropriate behavior • consequence for inappropriate behavior • Salient/meaningful feedback • Programming at home and school

  30. School Behavior Intervention Examples: 1. The Attention Training System (ATS) 2. Home School Note 3. Self-monitoring

  31. School Behavior Intervention:The Attention Training System (ATS) 1. Technology Teacher Module Student Module 2. Immediate feedback 3. Meaningful consequences 4. Structured “time”

  32. School Behavior InterventionThe ATS: Lisa No ATS ATS No ATS ATS % Time Off Task Days

  33. School Behavior InterventionThe ATS: Troy No ATS No ATS ATS No ATS ATS Meds Only % Time Off Task Days

  34. School Behavior InterventionHome School Notes Address Problems With • Academic effort • In-class behaviors • Assignment completion

  35. School Behavior InterventionHome School Notes Procedures • Identify target behaviors

  36. Academic Behaviors Working on assignments Completing homework Handing in assignments All work up to date On time for class Social Behaviors Out of seat Talking without permission Disrespectful behavior Bothering peers Following instructions Hands to self School Behavior InterventionHome School Notes

  37. School Behavior InterventionHome School Notes Procedures • Identify target behaviors • Design school note form

  38. School Behavior InterventionHome School Notes

  39. School Behavior InterventionHome School Notes Procedures • Identify target behaviors • Design school note form • Identify reinforcers and consequences

  40. School Behavior InterventionHome School Notes Reinforcer Examples • Wear an outfit of your choice to school • Get out of a chore • TV/video games/telephone/computer time • Allowance • Token toward weekend activity

  41. School Behavior InterventionHome School Notes Procedures • Identify target behaviors • Design school note form • Identify reinforcers and consequences • Establish criterion for reinforcement • Increase criterion as progress is made • Plan for generalization and maintenance

  42. School Behavior InterventionHome School Notes What makes it effective: • Frequent, immediate feedback (school). • Highly structured (short time). • Salient consequences (home).

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

  44. RESOURCES • Attention Deficit Disorder: Strategies for School-Age Children by Clare B. Jones, Ph.D. • Treatments that Work with Children: Empirically Supported Strategies for Managing Childhood Problems by Edward R. Christophersen, Susan L. Mortweet • Taking Charge of ADHD, Revised Edition: The Complete, Authoritative Guide for Parentsby Russell A. Barkley

  45. ADHD and the Nature of Self Control by Russell A. Barkley • Attention-Deficit Hyperactivity Disorder: A Clinical Workbook, Second Edition by Russell A. Barkley, Kevin R. Murphy • Effective School Interventions by Natalie Rathvon

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