Teaching Students with ADHD
This article summarizes briefly some definitions of attention deficit hyperactivity disorder (ADHD) and what impact it might have on a student. It includes some theoretical discussion of the causes of ADHD and how each cause may impact treatment or behavior modification. It then summarizes suggestions from various sources for how to organize a classroom, assign work, and assist students with ADHD in the public schools.
Keywords Attention deficit hyperactivity disorder; Behavior Modification; Developmental Delay; Executive Function; Functional Behavioral Assessment (FBA); Multi-Sensory Instruction; Peer Tutoring; Positive Behavioral Interventions & Supports (PBIS); Self-Regulation
What is ADHD?
ADHD, or attention deficit hyperactivity disorder, is considered a developmental delay that is possibly based in neurological dysfunction and is considered primarily genetic or congenital, although environmental conditions may have an impact. Children with ADHD may be quite bright and capable, but their behavior can be challenging for the teacher and for other students to deal with.
Children who have ADHD are generally inattentive, hyperactive, and easily distracted. They may also be forgetful and have trouble controlling their impulses. They exhibit limitations dealing with self-regulation or self-control and may have trouble waiting for reward, acknowledgement, or attention. If these symptoms occur across a range of situations (e.g. at home, at school, at play) a diagnosis of ADHD may apply.
Some critics believe that ADHD is not an actual disorder; rather, the expectations of teachers and parents may simply be unreasonable for children to fulfill (e.g. sitting still for a time in a classroom) or that children are developing at different speeds, and those with impulsive tendencies will eventually catch up to their peers. A diagnosis of ADHD can lead to medication and/or therapy for treatment; some critics feel medical responses may be overused. Some are no longer considered to have ADHD as adults, but ADHD may also be under-diagnosed among adults, especially those who have learned to cope with their challenges.
In 2011, approximately 11 percent of children ages four through seventeen were diagnosed with ADAD. Boys were more likely (13 percent) than girls (5.5 percent) to be diagnosed (Centers for Disease Control and Prevention, 2012). Some have stipulated that the difference is in the frequency of diagnosis rather than in actual occurrence (Day et al., 2002). A child living with ADHD can be painful. Brand et al. (2002) note that authors of descriptive and correlational studies have reported that students with ADHD are more likely than others to have a number of problems:
• Grade retention
• Academic underachievement
• Behavioral problems
• School failure
• Drug abuse
• Social and emotional adjustment difficulties and
• Dropping out of school (p. 269).
Challenges of Teaching ADHD Students
Melton (2007) explains that it can be challenging to teach students with ADHD who may be unable to sit still, may blurt out answers or questions impulsively, may distract other students or may be easily distracted by them-and other stimuli in the classroom, or who may find it difficult to organize the tasks and materials needed to accomplish assignments in a timely manner.
What Does Research Say About Teaching Children with ADHD?
Barkley (2007), suggests that sometime during the late 1980s to the early 1990s, it became obvious that ADHD and its related disruptive behavior and academic impairments were not the consequence of faulty contingencies of reinforcement in natural ecologies like classrooms or homes, as some originally claimed in the 1970s (Willis & Lovass, 1977). Such behavior does not need to function to gain positive reinforcement nor escape from aversive situations to be produced and sustained. We now recognize the etiologies of ADHD and its various levels of phenotypic expression to be largely in the realm of neurology and genetics (Nigg, 2006). This is not to say that social environments are irrelevant or that certain contingencies make no contribution in individual cases because they certainly pertain to forms of impairment, risk for comorbidities, and treatment resources. But it does say that no serious investigator today could make the case that ADHD can arise purely out of social causes such as bad parenting, intolerant teachers, faulty social learning, or inappropriately learned cognition. There is simply too much evidence against such ideas (Nigg, 2006) (Barkley, 2007, p. 281).
In other words, Barkley is saying that ADHD appears to be primarily genetic, and is not a result of something wrong in the home or school environment. He goes on to say that it has come to be understood that ADHD is not merely a collection of behaviors such as inattentiveness and impulsivity, but is actually evidence of a broader array or disordered thinking involving self-control and related issues.
Barkley (2007) discusses various treatment programs for ADHD behaviors and suggests that it may be necessary to keep some in place over a length of time because symptoms or specific behaviors do not go away as a result of the treatments but are merely controlled. He states, “Behavioral treatments, like hearing aids, wheelchairs, ramps into public facilities, lower bathroom fixtures, glasses and large-print books, and prosthetic limbs for amputees, are artificial means of altering environments so as to reduce the adverse effect of a biological handicap on the performance of major life activities. No one would rationally claim that physical disabilities arise from the lack of wheelchairs and ramps. Similarly, no one would claim that using a wheelchair or associated ramps for a month or two would result in their either being internalized or so altering the social environment that they would be sustained by changes in naturally occurring contingencies after the chairs and ramps are withdrawn And so no one should now rationally claim that ADHD arises from faulty learning or that several months of contingency management produces sustained benefits for ADHD once treatment is withdrawn. Behavioral methods are prostheses—means of rearranging environments by artificial means so as to yield improved participation in major life activities” (Barkley, 2007, p. 281).
Barkley goes on to suggest that although behavioral interventions may be helpful, they are not necessarily addressing the root of the problem, "ADHD is now thought to be as much a disorder of self-regulation and executive functioning as it is in attention. What we most need now is a theory of how normal self-regulation develops, where it goes awry in producing ADHD, and what this may mean for constructing better interventions" (Barkley, 2007, p. 281).
Thus, although behavioral, medical, and other interventions may address symptoms of ADHD and may make life more manageable for students with ADHD and the people around them, Barkley suggests that more research is needed and that ADHD may need to be addressed from an entirely different perspective:
• Studying the role of self-management and self-regulation;
• Considering the role of genetics;
• Assessing the roles of various medications and other treatments along with their side-effects; and
• Examining the impact of any kinds of treatments (or of packages of treatment combinations) on individual outcomes.
Brand et al. (2002) examined the varied learning styles of children, suggesting that different learning styles may contribute to a label of learning disability, which might, in turn, not adequately reflect a child's capacity to learn well. They report, for example, that:
Despite the negative labels associated with children who learn differently from their same-aged classmates, research reveals that many students officially classified as failing have achieved statistically higher standardized achievement test scores in both reading and mathematics when they were taught with approaches and resources that complemented their learning styles.
For example, after only one year of learning-style-based instruction, Special Education (SPED) high-school students in Buffalo, New York's public schools achieved significantly higher test...
(The entire section is 3776 words.)