add/adhd strategies in school. middle school: what works? advance organization advance organization...
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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).
AAP GuidelinesAAP Guidelines
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).
AAP GuidelinesAAP Guidelines
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).
AAP GuidelinesAAP Guidelines
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).
AAP GuidelinesAAP Guidelines
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
School Behavior School Behavior InterventionInterventionHome School NotesHome School Notes
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
School Behavior School Behavior InterventionInterventionHome School NotesHome School Notes
ProceduresProcedures Identify target behaviorsIdentify target behaviors Design school note formDesign school note form
School Behavior School Behavior InterventionInterventionHome School NotesHome School Notes
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
Yes NoYes No Yes NoYes No Yes NoYes No Yes NoYes No
Yes NoYes No Yes NoYes No Yes NoYes No Yes NoYes No
School Behavior School Behavior InterventionInterventionHome School NotesHome School Notes
ProceduresProcedures Identify target behaviorsIdentify target behaviors Design school note formDesign school note form Identify reinforcers and Identify reinforcers and
consequencesconsequences
School Behavior School Behavior InterventionInterventionHome School NotesHome School Notes
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
School Behavior School Behavior InterventionInterventionHome School NotesHome School Notes
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
School Behavior School Behavior InterventionInterventionHome School NotesHome School Notes
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
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