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Running head: ADHD INTERVENTIONS FOR ELEMENTARY SCHOOL 1

ADHD Interventions for Elementary School Children

An Experiential Project

Presented to

The Faculty of the Adler Graduate School

__________________________

In Partial Fulfillment of the Requirements for

the Degree of Master of Arts in

Marriage and Family Therapy

__________________________

By:

Judith A. Richardson-Mahre

October, 2014

ADHD INTERVENTIONS FOR ELEMENTARY SCHOOL 2

Abstract

Approximately 5-7 percent of children between the ages of 3-17 have been diagnosed with

Attention Deficit Hyperactivity Disorder (ADHD). ADHD is the most common mental illness in

children. (Centers for Disease Control and Prevention, 2014, p. 1; Brown, 2007) According to

top researchers, ADHD is a neurobiological disorder involving the developmental delay of

executive functions. (Loo & Barkley, 2005; Barkley 1997; Brown, 2006, p. 36) It is generally

accepted that early intervention is the key to effective treatment. Many children are not

diagnosed until adolescents after many of their early academic struggles have begun and they are

already discouraged. The most recent brain development research shows concrete evidence of

the brain’s neuroplasticity (Doidge, 2007) as well as how the student’s attitude and mindset

impact their ability to learn. (Yeager & Dweck, 2012) In addition to the science of the brain

and ADHD, the Adlerian model of encouragement and social interest is very applicable when

working with children, especially those with special needs. (Adler, 1988) Early intervention

with psychological and academic tools and techniques designed to assist elementary students will

help them develop strong foundational skills for learning and set them on a path for greater

school success. (Abikoff et al., 2012) The goal of the interventions outlined in the presentation

is to equip parents and teachers to help students develop a greater understanding of their own

disability, provide tools and encouragement to support self-advocacy, set up interventions that

develop neural pathways and habits for learning and ultimately create a greater chance for

success for individuals with ADHD.


ADHD Interventions for Elementary School Children

Approximately 5-7 percent of children between the ages of 3-17 have been diagnosed

with ADHD (Centers for Disease Control and Prevention, 2014, p. 1). ADHD is the most

common mental disorder in children (Wolraich et al., 2005, p. 1734). Children and adolescents

with ADHD experience difficulties with inattentive and impulsive behaviors that negatively

impact their peer relationships, academics and create family conflict. The long-term outcomes of

individuals with ADHD include “significant work-related impairments, driving problems,

difficulties with romantic and interpersonal relationships, higher rates of criminal behavior, and

risk for substance-use disorders” (Sibley et al., 2011, p. 140).

According to Russell Barkley, children with ADHD are punished more than any other

group of children (Barkley, 2012). This is largely due to the fact that parents, teachers, and

children do not have a clear understanding of what ADHD is, so they often mistake children’s

behavior as lazy or unmotivated (Zeigler Dendy, 2014). Furthermore, the information most

people receive from the media is that ADHD is not a real disorder; it is caused by poor parenting,

food sensitivities or defiant children (Wallace, 2005).

Many parents suspect that there is something more going on with their child but are

unable to find good information, positive support and encouragement or tools and techniques to

help their children (Wallace, 2005). There are additional barriers that impact individuals and

families from getting effective treatment including “fears due to inadequate understanding of

ADHD, lack of resources for assessment and treatment, prejudice against considering genes as a

major cause of ADHD and prejudice against using medications to treat an apparent ‘lack of

willpower’” (Brown, 2005, p. 306-307). Even when they do find practitioners who claim to be


experts in the field of ADHD, parents often find that their practitioner does not completely

understand ADHD or its treatment (Wallace, 2005).

Studies have shown that the most effective treatment for this disorder is medication and

there is quite a bit of controversy over medication as a treatment (Sibley et al., 2011). Effective

medication for ADHD is considered controlled substances and often parents of children and

adolescents are hesitant to use these medications or only consider them as a last resort. In

addition, there is much controversy around over-diagnosis of the disorder and over-medication of

our children. Research shows that “ADHD is one of the best-researched disorders in medicine,

and the overall data on its validity are far more compelling than for most mental disorders and

even for many medical conditions” (Brown, 2005, p. 296).

The research on the long-term outcomes for individuals with ADHD is very

discouraging. Higher rates of unwanted pregnancies, substance abuse, vehicular accidents,

interpersonal relationships difficulties and the inability to keep a job are just a few of the

outcomes seen in individuals who have ADHD (Sibley et al., 2011). The overall costs to society

of these outcomes are astronomical if left untreated (Barkley et al., 2002). However, ADHD is

also one of the most researched and most treatable conditions (Barkley et al., 2002).

The question becomes, if we intervene with children who have ADHD earlier by

providing education to parents and teachers, provide an understanding of the underlying

difficulties with Executive Functions and provide tools and techniques to recognize the

deficiencies and address them in a positive and encouraging way, could we impact the long-term

outcomes for these individuals and provide a way for them to be successful and encouraged in

their academic endeavors? (Brown, 2007, p. 27).


Purpose of the Presentation

Given the lack of understanding about ADHD and its effective treatment, the serious and

damaging long-term effects of no treatment and the potential to intervene earlier in children’s

lives, the purpose of the presentation was to provide elementary school teachers and parents with

information about ADHD, about how the brain learns and provide some effective strategies to

intervene both psychologically and academically. The purpose was also to provide hope for

parents and teachers who are dealing with children who have this disorder either diagnosed or

undiagnosed and ultimately improve the chance for success of as many children impacted by

ADHD as possible.

Definition of Terms

Throughout this presentation the term Attention Deficit Hyperactivity Disorder or ADHD

will be used for the overall disorder as defined in the Diagnostics Statistical Manual (DSM-5) as

ADHD which includes both subtypes of 1. Inattention and 2. Hyperactivity and impulsivity or

combined presentation (American Psychiatric Association, 2013, p. 59-66).

Literature Review

The first area of research was an in-depth study of ADHD, what it is, what it isn’t and a

look at the latest scientific findings. There is quite a body of research on ADHD but relatively

few leading researchers on the topic. Dr. Russell Barkley has presented detailed presentations in

Minneapolis to parents and educators for the past several years. His work encompasses his own

research as well as a thorough review of the entire body of research related to ADHD. He

indicates research in the area of ADHD along with research into brain science is currently

exploding. The ability for scientists to run brain scans on the brain to see what happens in

different areas of the brain has allowed them to pinpoint specific brain functions and assign them

to specific brain locations (Barkley, 2012).


In addition, brain scans can help to pinpoint the nature of impairment when individuals

attempt to do a task that challenges the specific brain area that is impacted by ADHD (Loo &

Barkley, 2005). Dr. Barkley and Dr. Thomas Brown have re-defined how ADHD is understood.

They have expanded the original understanding of inattention and hyperactivity to include the

other detailed executive functions such as working memory, emotional self-regulation and self-

awareness and the detailed understanding of the role the inhibitory system plays in ADHD

impairment (Barkley, 1997). Dr. Barkley indicated that the focus of research now is turning to

identifying the gene that is responsible or involved in determining ADHD and with the brain

scanning technologies, practitioners will be able to match medication with the gene and specific

brain area most impacted (Barkley, 2012).

ADHD was originally understood to be a disruptive behavior disorder, almost exclusively

seen in young boys (Brown, 2006, p. 35). Currently, an increasing number of studies report that

“children and adults with ADHD tend to perform more poorly than normal controls on these

purported measures of executive function” (Brown, 2006, p. 36). Therefore, ADHD is now

being described as a disorder of executive function (Brown, 2006, p. 36).

One metaphor to describe executive function is the conductor of the symphony.

“Regardless of how well the musicians in a symphony orchestra may play their instruments, they

are not likely to produce very good symphonic music if they do not have a conductor to select

what piece is to be played, to start their playing together, to keep them on time, to modulate the

pace and volume of each section, and to introduce or fade out various instruments at appropriate

times” (Brown, 2006, p. 37).

As the ADHD research unfolded, the impact of the brain science and how the brain learns

became more interesting and relevant. The book “The Brain that Changes Itself” outlines


miraculous stories of the brain’s ability to compensate for brain damage, loss of brain function

and even missing brain centers (Doidge, 2007). Dr. Doidge outlines extreme cases of brain

damage and in one case half of the brain missing and how the brain is able to compensate and, in

some cases, substitute senses. The book also indicates that learning something new challenges

the brain and helps to create neural pathways. The concept of neuroplasticity and the brain’s

ability to change and grow was detailed (Doidge, 2007). This concept challenges the traditional

concept of IQ and how the brain is fixed and unable to learn and change.

Further investigation into the way that the brain learns led the author to review the book

“Mindset” by Carol Dweck. In her book, Dr. Dweck outlines how an individual’s mindset,

whether it is a fixed mindset or growth mindset, impacts their learning. She discusses the impact

of praise on learning and emphasizes that mindsets can be taught (Yeager & Dweck, 2012, p.

305).

In understanding the impact of mindset on the success of students and applying that to the

ADHD brain, it became a matter of a child’s ability to understand the growth mindset in addition

to understanding their disability and what struggles are able to be attributed to an executive

function impairment. Nonetheless, this information is very applicable to our work with

individuals with ADHD. A growth mindset should be fostered in conjunction with medication

and effective strategy identification and implementation for children with ADHD.

Understanding ADHD and how the brain learns led the research to what types of

interventions have been identified for children of elementary school age. The research was

focused on two specific areas of intervention, psychological and academic interventions. The

psychological interventions were largely derived from Alfred Adler’s works on the universal

goal and Dreikurs’ interventions with children. Dr. Russell Barkley stated that children with


ADHD are disciplined more often than any other group of children. Therefore, encouragement is

one of the most effective interventions for children with ADHD (Barkley, 2012). Alfred Adler’s

work indicates that a misbehaving child is a discouraged child and that can certainly be seen

when working with children of ADHD (Adler, 1988). It is then the job of the parent, teacher or

caregiver to understand the purpose of the misbehavior, match that with their understanding of

ADHD and executive function impairment and then determine how to intervene, support and

help the child develop more useful methods to address their misbehavior.

In addition to the psychological interventions based on Adler’s work, there are several

resources that have been created as a result of the mindset findings. Helping children to

understand the fixed and growth mindsets and how they impact learning can be a great source of

insight. Helping them to see how their brain is a muscle that needs to be challenged and used

and it will grow like any other muscle can give individuals with ADHD great hope (Ricci, 2013;

Yeager & Dweck, 2012). Teaching children a growth mindset and beginning to celebrate

challenges, struggles, and the process of learning as early as possible has a significant effect on a

child’s long-term view. Research has shown that mother’s praise to babies predicted their

mindset and desire for challenge 5 years later. In addition, Mother’s praise to 10 year olds

showed the same result in predicting a child’s mindset later in life (Dweck, July 25, 2013).

Other psychological interventions such as rewards before punishments, talk less and

touch more, mindful parenting and teaching along with ensuring that parents and teachers are

maintaining a disability perspective were all results of the research (Barkley, 2012; Zeigler

Dendy, 2014; Zylowska, 2012).

Additional psychological interventions that were explored were motivation and exercise.

The ability to motivate oneself has not been identified explicitly as an executive function but has


been identified as a significant impairment in individuals with ADHD. Individuals without

ADHD require an average amount of motivation both internally and externally to complete tasks.

This is not true of individuals with ADHD. They require an extraordinary amount of motivation

and have difficulty creating enough internal motivation to help them past the impairment within

their inhibitory system to start tasks and maintain focus. Therefore, motivation must be

externally provided, immediate and provided frequently (Schaub, 1998).

Exercise has been shown to be an effective intervention for many individuals with

ADHD. Exercise raises the dopamine and norepinephrine levels in the brain which can help to

increase the amount of signals that are getting to their intended targets within the brain. Exercise

also improves alertness, attention, mood and motivation. It helps in the preparation and

encouragement of nerve cells to bind to one another and helps to spur the development of new

nerve cells. The same areas of the brain that are involved in exercise are impacted by ADHD

(Ratey & Loehr, 2011).

Education is probably the most important psychological intervention. Education is

important for children that have ADHD to facilitate self-acceptance and understanding as well as

lay the groundwork for self-advocacy. Education is important for care-givers, parents and

educators to ensure that they can provide compassionate and understanding care and help the

child with effective interventions.

Chris Zeigler Dendy presented a lecture on ADHD to the Chicago Public Schools in

March of 2014. In her presentation she shared a slide that indicated that we as adults, educators

and parents sometimes make moral judgments about executive function deficits because children

with these deficits look like they have made a conscious choice to be lazy and unmotivated

(Zeigler Dendy, 2014). Without a clear understanding of ADHD and the effect on executive


functions, it is easy to make this moral judgment and not to give them the benefit of the doubt.

Unfortunately children, adolescents and adults with ADHD face this far too much so they

internalize this message as there is something wrong with them.

In researching the academic interventions the main body of work that has been completed

on intervention protocols specifically for elementary age children is an empirically supported

program that helps systematically lays the groundwork for organizational skills, time

management, materials management and providing external motivation and working memory

support (Abikoff et al., 2012). These issues are fundamental issues when dealing with executive

function impairment and are the foundations of the struggles that individuals with ADHD have in

academic settings and in other areas of their lives. It is possible to begin to lay these

foundational pieces with children in elementary school to help increase their chances for

academic success (Abikoff et al., 2012).

Time Management skills have been shown to be fundamental issues with individuals with

ADHD. Time blindness and the inability to estimate time or plan can begin to be addressed in

elementary school children by helping them understand time as they learn how to tell time,

estimate time that it will take to do certain tasks and make time passage visual (Abikoff et al.,

2012; Barkley, 2012). Learning to tell time and estimate time is part of the general curriculum

in most elementary schools. However, these concepts need to be continually reinforced for

individuals with ADHD and executive function impairment to retain the information and be able

to incorporate it into their daily live (Abikoff et al., 2012).

Another key academic intervention for elementary school children is to externalize

working memory. Working memory is the ability to hold things in mind while recording that

information. This is a fundamental skill in note-taking and recording assignments. Externalizing


working memory is necessary for small children to facilitate their learning. In addition, point of

performance reminders help to support individuals with ADHD so that they do not have to rely

on their impaired inhibitory system and memory (Barkley, 2012). In the research, there are

many good options to externalize working memory that were included in the presentation.

The need for breaks and movement has been highlighted in much of the literature

regarding ADHD and the research supports this. Many children with ADHD, especially the

hyperactive and impulsive subtype, are fidgety and in constant motion. It is essential that these

children are given an opportunity to take a break and move around. In addition, the impairment

of the internalization of speech and internal processing requires them to take a brain break to

allow their brain to process information (Barkley, 2012).

The final intervention that was presented is the puzzle exercise that is an original

intervention that was created by the author. This intervention is both a psychological and

academic intervention. It involves picking a puzzle piece and trying to guess at the picture on

the puzzle by only looking at that one piece. This is difficult and often the participant cannot

identify the picture accurately. The participant is then encouraged to draw a self-portrait on one

side of the paper. On the other side of the paper is an outline of a puzzle, with the outlines of

puzzle pieces but no picture. The participant is encouraged to identify their own many puzzle

pieces. The puzzle pieces represent different attributes of their personality, likes, dislikes,

struggles and strengths. The message to the participant is that ADHD is one puzzle piece of their

whole being but it isn’t the only one. This helps the participant take an honest look at struggles

while putting them into perspective within the whole. This also helps to reinforce the

participants’ strengths and visually show that there are many more strengths than struggles.


Methodology

Design of the Project and Target Population

The design of the project began as a presentation educating teachers on ADHD. The

primary purpose was to educate teachers on the executive functions and their effect on the

individual’s ability to manage themselves and their lives. As the presentation evolved, the brain

training and mindset information seemed to gain importance and were included to add depth to

the topic.

As the presentation began as an informational session for teachers, the primary focus was

on the academic interventions. Concrete interventions that teachers could use immediately when

working with students who have ADHD were also added to ensure that teachers could begin to

recognize and address executive function deficiencies effectively. However, as an Adlerian, the

psychological interventions seemed to gain importance due to their impact on these children who

are very discouraged. With the addition of psychological interventions, the presentation’s target

audience was expanded to include parents and care givers as well as educators.

Project Development

The presentation was developed beginning with an outline of the explanation of executive

functions and big categories for interventions. Dr. Russell Barkley’s “12 Best Principles for

Managing the child or teen with ADHD was used to begin the interventions outline (Barkley,

2012). However, as the research continued, this framework began to restrict what the author felt

was important to emphasize so the outline was quickly changed to incorporate the additional

information found during the research phase.

The presentation was also intended to give as many practical examples, tools and

strategies as possible. The examples were kept out of the physical presentation slides and were


verbally presented during the actual discussion. The practical tools were included in the

presentation slides.

Description of Project Implemented

The presentation was given to parents, teachers and friends at Southview Elementary in

Apple Valley on Tuesday, October 21, 2014 at 6:30 PM. There were 38 people in attendance.

The presentation was advertised through Southview Elementary’s communication channels

including their website, their Friday Folder communication to the parents and Southview

community as well as my introduction at a staff meeting with the school staff.

In addition to the communication to the small Southview community, the presentation

flyer was distributed to other middle school communities where the presenter works with staff on

the implementation of an ADHD Learning Lab throughout the District 196 community. The

presentation flyer was also distributed to interested colleagues, students and friends.

Summary of Outcome

Personal Evaluation

I have walked this path with three children and a husband who have all been formally

diagnosed with ADHD. I understand the difficulties in finding good information and treatment,

wading through the information regarding medication and other interventions, developing my

parenting style to be effective in helping my children, managing daily tasks and stressors while

trying to encourage my children and reinforce positive messages about who they are, who they

can become and how we can deal with their difficulties and struggles without them becoming

completely discouraged.

In addition, I have worked with adolescents who have ADHD, grades 6-8 at a middle

school internship program. I have found that many of them are in the process of determining


whether to give up, because it’s too hard, or to continue to work within a system that is largely

overwhelming, too difficult to manage, and discouraging. They have spent their entire

educational career running up against teachers and parents who punish them, working within a

system that magnifies their natural difficulties, i.e. executive functions and generally working

hard against an unknown issue, ADHD, which is not their fault. They don’t know how to cope

and no one is helping them find their way. They are unaffected by rewards and punishments but

that is the currency of the system they are in (Barkley, 2012).

I have also spent the last 12-13 years trying to glean good positive information about

what I am dealing with, educating the schools, educators and caregivers when working with my

children, advocating for my children and finding practitioners and support that can help me. I

have become very passionate about helping these children become their best selves. I am also in

the process of drastically changing my career from a consultant in mechanical engineering and

software development to ADHD coaching in the hopes that I can help other children, parents and

educators walk an easier path than I have walked.

The process of putting this project together, completing the research and presenting my

findings to the community has been an honor and a personal mission. When my husband was

diagnosed, he indicated that the message he received from his parents, family, friends and school

was that he was stupid. That message cannot be the message that our children get, especially

when this disorder is so treatable. I have become passionate that this information, the real

explanation and understanding of ADHD, needs to be more widely distributed to debunk the

insulting and damaging myths that are so widely distributed in the media.


The responses I have gotten from the children I have worked with during my internship

to the responses I received from participants in my presentation are overwhelming and reinforce

my belief that this information needs to get out to a wider audience.

Participants Evaluation

There were 38 people in attendance for my presentation. 24 of the 38 participants

completed surveys. The majority of the participants who completed the survey, 15 out of 24,

were parents. 2 of 24 were teachers, 5 were both teachers and parents and 5 participants

indicated they were “other”. The other category included a school nurse, a grandparent, a parent

coach and a nanny. Of all of the participants 15 indicated that someone in their family has

ADHD and 2 indicated that ADHD was a possibility in their home.

The evaluation asked questions about the amount of practical knowledge gained from the

presentation, critical questions about the presentation itself and specific questions about the

presenter. In general, 18 of the participants indicated they learned a great deal from the

presentation and 7 indicated they learned some.

The first group of questions was specific to the presentation itself. The participant

responses regarding whether the presentation objectives were clear and the presentation was

interesting and informative showed an overwhelming amount of the participants strongly

agreeing. Only a few of the participants indicating they agreed or were neutral. The questions

regarding whether the format and graphics were easily understandable and complementary to the

topic showed less favorable results with a few more indicating they only agreed or were neutral.

Overall rating of the presentation showed 19 excellent responses and 5 good.

The responses for the presenter evaluations were again overwhelmingly positive for all

questions. Questions ranged from “was the presenter clear, I could understand and hear well” to


evaluating the presenters knowledge, enthusiasm, ability to answer questions and offer concrete

and useful examples. The last two questions regarding the presenter’s pace and style showed a

slightly less favorable response. Overall 22 of 24 evaluators gave the presenter an excellent

review and 2 gave her a good review.

The comments that were included in the evaluations showed that many people got clear

and specific tools or techniques that they can take away from the presentation and use

immediately. These tools included tools to change their child’s mindset and encourage learning,

a deeper understanding of executive function impairment and how to deal with it, mindfulness,

constant and consistent reinforcement, book bag reminder rings, a misbehaving child is a

discouraged child and that a child’s self-worth is so much more than school success.

Positive comments for the presentation included things such as “clear information and

take away tools, learned tried and true strategies, direct and nothing was sugar-coated, complete

information, techniques and tools to deal with ADHD behavior and very well organized”.

Positive comments for the presenter included “great volume, eye contact and energy, your

passion, knowledge and wisdom came through clearly, the humor helped me to understand what

is going on in my son’s brain, wonderfully heartfelt and loved your humor and genuineness.”

Constructive criticism included notes such as “too many slides, needed more open

discussion, show more methods to use, not just pictures, would like a piece on diagnosis and

medication, enlarge slides, some were too small to read, allow moments for questions,

sometimes the difference between what the ADHD brain vs. the non-ADHD brain was not clear,

full-size handouts for worksheets, some handout slide shots have a lot of info and print is hard to

read and provide links to your videos, they were great.”


Proposed Improvements

Based on the feedback that was received, there are several areas that could be improved.

The most constructive feedback was given regarding the clarity of the graphics and the handouts.

The graphics need to be clearly identified and marked for the intended reason they are included

in the presentation. In addition, the presenter notes should include clear explanations for the

slides and graphics. The handouts also need to be clearer and the slides simplified so that

handouts are easily readable for participants. The presenter included 6 slides per handout page

and that could be reduced to 2 or 3 so they are more easily readable.

An easy improvement on the presentation could be to provide more concrete handouts

and curriculum to implement some of the tools and techniques that were presented. In addition,

this audience indicated that they wanted less information presented and more time for questions

and open discussion.

Future Plans for the Presentation

Based on the proposed improvements above, there is a definite need for a support group

and interactive blog type of forum for parents specifically to discuss and commiserate about their

individual struggles. Several participants indicated that they wanted more time for discussion

and to ask questions. One participant suggested a support group and a listserv so that people

could post questions and share information among the community of parents with children with

ADHD.

Additionally, this presentation can be modified slightly to include interventions for older

children or adults. The presentation could then be presented in several other forums and

conferences both in the community of Apple Valley and the larger state or national community.

The presenter intends to look into at least 3 other opportunities to present this information and


continue to expand the group of people that have heard this in-depth look at ADHD. The first

opportunity for this type of expanded presentation occurred when the presenter of this

presentation co-presented similar information to the parents and teachers of the District 196

middle school community as a part of kicking off the ADHD learning labs in 4 of the District

196 middle schools. This ADHD learning lab concept was originally developed by Judy Bandy,

RN, LSN, CSC as a way to support adolescents with ADHD in the Minnetonka, MN school

district and has now been expanded to other middle schools within Minnesota.

The information shared in this presentation is critically important for people to

understand. The stigma that children and adults face who have ADHD is damaging to their self-

esteem and confidence and adds to the likelihood of developing further long-term negative

impacts and the development of comorbid disorders in adults. The more people who understand

the true nature of this disorder, the better able we are to support and care for those individuals

who struggle with it.


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