School- and classroom-based interventions to support children and adolescents with ADHD: Innovative and promising approa

1. School- and classroom-based interventions to support children and adolescents with ADHD: Innovative and promising approaches Gary Stoner, Ph.D. Email: gstoner@uri.edu University of Rhode Island Presentation for the Coventry Public Schools March 12, 2009

2. ADHD in School Contexts: Reasons for Concern • School success is both critical and potentially elusive for students with ADHD • Increasing numbers of children who are “difficult-to-teach” and “difficult-to-manage” • Reactive support model (i.e., wait to fail) remains prevalent mode of practice in special education and school psychology

3. CHALLENGES TO INTERVENTION IN PUBLIC SCHOOLS • Lack of knowledge about effective supports for students with ADHD • Challenges in designing/implementing individual modifications • Lack of knowledge or experience with behavioral techniques • Support of administration/policies for intervention • Class size • “Fairness” to other students?

4. CHALLENGES TO INTERVENTION AT SECONDARY LEVEL • Multiple teachers/staff • Resistance of faculty • Defiance of student • Student reaction to peer pressure • Competing demands for student time

5. TARGETS FOR TREATMENT • Behavior Control • Staying on-task; Paying attention • Following classroom rules • Anger control • Academic Performance • Class Participation • Homework Completion • Organizational Skills • Note-taking • Studying for exams • Long-term projects • Appropriate Social Behavior • Social Problem Solving

6. Some guiding principles for intervention with ADHD • Apply the group primary, secondary, tertiary prevention/intervention model (RTI), but with individual students • Combine proactive and reactive management strategies (e.g., teach rules and daily report) • Intervention in place at point of performance of target behaviors • Intervene early in the course of problems

7. Some guiding principles for intervention with ADHD(cont.) • Use multiple intervention agents • Link assessment data to intervention • Individualize interventions • Again…deliver interventions at the “point of performance”

8. Academic Systems Behavioral Systems • Intensive, Individual Interventions • Individual Students • Assessment-based • High Intensity • Intensive, Individual Interventions • Individual Students • Assessment-based • Intense, durable procedures • Targeted Group Interventions • Some students (at-risk) • High efficiency • Rapid response • Targeted Group Interventions • Some students (at-risk) • High efficiency • Rapid response • Universal Interventions • All students • Preventive, proactive • Universal Interventions • All settings, all students • Preventive, proactive Designing School-Wide Systems for Student Success (see www.pbis.org) 1-5% 1-5% 5-10% 5-10% 80-90% 80-90%

9. Primary and Secondary Prevention Strategies: Preschool • Home/school/community based support for: • Language development/early literacy/cognitive development • (Read Together/Talk Together) • Social development/socialization • The Incredible Years programs (U. Washington, Carolyn Webster Stratton) • Oregon Resiliency Project: Strong Start Program, a social and emotional development curriculum (Merrell, 2007; Brookes) • School readiness

10. Elementary • Academic • Skills for School Success (Curriculum Associates) • Basic Skills Instruction/Progress Monitoring • Social/Emotional/Behavior • Positive Behavior Support; First Steps Program (Sopris West) • Oregon Resiliency Project: Strong Start/Kids Programs, a social and emotional development curriculum (Merrell, 2007; Brookes) • Mental Health • Oregon Resiliency Project: Strong Kids (Online)

11. Middle • Academic • Advanced Skills for School Success (Curriculum Associates) • Assignment/Work Accommodations • Curriculum-based collaboration and Instructional support (SPED) • Mental Health • Oregon Resiliency Project: Strong Kids Program, a social and emotional development curriculum (Merrell, 2007; Brookes) • Social/Emotional/Behavior • Positive Behavior Support; Teaching Self-Management Strategies to Adolescents (Sopris West)

12. High School • Academic • Advanced Skills for School Success • Assignment/Work Accommodations; • Curriculum-Based Collaboration and Instructional Support (SPED) • Mental Health • Oregon Resiliency Project: Strong Teens Program, a social and emotional development curriculum (Merrell, 2007; Brookes) • Social/Emotional/Behavior • Positive Behavior Support • Teaching Self-Management Strategies to Adolescents (Sopris West) • Dropout prevention • Check and Connect Program, (Christenson, University of Minnesota)

13. Hi Lo Time/Grade/Age

14. The Effects of Computerized Reading Instruction on the AcademicPerformance of Students Identified with ADHD(School Psychology Review, 2005, 34, 246-254) Julie Clarfield and Gary Stoner University of Massachusetts Amherst

15. Children with ADHD are at higher than average risk for: • Behavioral and academic difficulties • Grade retention • Placement in special education programs • School drop out • Lower high school GPA • Enrollment in college degree programs

16. Children with ADHD and academics, continued: • As many as 80% of students with ADHD exhibit academic difficulties, including lower than expected work completion rates • Approximately 20-30% are identified with learning difficulties due to problems with acquisition of academic skills • Recent studies show literacy/reading skill acquisition problems relative to matched peers as early as Kindergarten • These risks and outcomes suggest need for effective educational interventions

17. Computers (CAI) are promising, as students with ADHD perform better: • …when provided with immediate (vs. delayed) feedback • …when stimulus conditions are novel (vs. familiar) • …when provided with one-to-one student-teacher ratio

18. Purpose of present study: • evaluate the effectiveness of a recently developed computerized reading instruction program—Headsprout • …with participants diagnosed with ADHD and experiencing reading problems

19. Research questions: • Relative to teacher directed, small group instruction, what are the effects of the Headsprout reading program on students’ task engagement? • Relative to teacher-directed, small group instruction, what are the effects of the Headsprout reading program on students’ oral reading fluency?

20. Participants: • Tim. 6 yo, repeating Kindergarten. • inattentive subtype of ADHD; 2.5 mg of methylphenidate once a day during the first 7 weeks; then an 18mg dose of Concerta once a day. • Kevin. 7 yo, 1st grade student. • combined subtype of ADHD; receiving Special Education services for math and writing • Joe. 6 yo 1st grade student. • combined subtype of ADHD; 5mg of methylphenidate once a day

21. Methods: • Independent Variable: Headsprout reading program; 3 x week, 20-30 min. each • http://www.headsprout.com • Dependent variables: • Oral Reading Fluency • On- and off-task behavior • Multiple Baseline Design, across participants

22. Features of Headsprout: • internet-based reading program; no adult required • explicit instruction in phonemic awareness and phonics • introduces consistent letters and sounds, fluency building exercises and segmenting and blending strategies • provides explicit instruction in building sight word vocabularies and recognizing and using punctuation cues • student works sequentially through 40 animated lessons, each lasting approximately 20 minutes.

23. Headsprout features (cont.): • highly interactive: students engage in over 180 active learner interactions per 20-minute lesson • lessons are individualized and adapt to a child’s pace • student success rate in each lesson is at least 90% • Completion of most Headsprout activities involve the child moving a character to a desired destination • students keep track of own progress through the use of a colorful progress map • positive feedback is provided after each correct response, and the program rewards the student with brief (10-30 second) humorous movies in between activities

25. Off-task data • Tim. Off-task 24% BL vs. 3% CAI • Kevin. Off task 49% BL vs.6% CAI • Joe. Off task 26% BL vs. 4% CAI

27. Reading fluency data • Tim. 6 WRC in baseline vs. 18 WRC during intervention; Weekly gain .55 before intervention to 1.65 • Kevin. 14 WRC in baseline vs. 33 WRC during intervention; Weekly gain .55 to 2.90 • Joe. 10 WRC in baseline vs. 24 WRC during intervention; Weekly gain .20 to .75

28. Discussion • Positive effects of CAI on task engagement and academic performance, similar to Ota and DuPaul (2002) • Different in that Ota and DuPaul study involved math, drill and practice, and upper elementary students • High degree of social validity • URL: www.headsprout.com

29. Future work • individual Headsprout effects (rather than additive) • home based, parent guided intervention • home/school combinations • group study with more effective instructional comparison; control group?

30. Parent tutoring for students with attention-deficit/hyperactivity disorder: effects on reading performance at home and school Christine Hook and George J. DuPaul School Psychology Review 1999, Vol.28,No. 1;pg.60-75.

31. Procedures • Four children: three 2nd Graders, one 3rd Grader • Parent tutoring in reading, 10 minute sessions • Material from current school stories/reading • Preview, reading aloud, error correction, praise, review of story • Mean Sessions per week, 3 • Mean weeks, 6

34. Peers as intervention agents • Plumer, P. J., & Stoner, G. (2005). The relative effects of Classwide Peer Tutoring and peer coaching on the positive social behaviors of children with Attention Deficit Hyperactivity Disorder. Journal of Attention Disorders, 9 (1), 1-11

38. The Effects of Self-Management in General Education Classrooms on the Organizational Skills of Adolescents With ADHD SAMMI GUREASKO-MOORE, GEORGE J. DUPAUL, GEORGE P. WHITE BEHAVIOR MODIFICATION, Vol. 30 No. 2, March 2006, 159-183.

39. Information • Three 12-year old, 7th Grade boys • Focus on classroom organization, including: • Arrive on time for class • Prepared to begin class (oriented to T_ • Has paper/notebook • Has pen/pencil • Completes homework • Hands in homework on time

40. Procedure: Students provided • Explanation and rationale for self-management • A description of their current classroom functioning based on observation results • An explanation of the importance of responsibility for one’s own behavior • The specific responsibilities one must maintain to be considered prepared for class instruction

41. Monitoring • Students established weekly goals • Initially, daily adult meeting and monitoring and discussions • Daily meetings continued until student met 100% of daily goals on 4 of 5 consecutive days • Fading: every other day with monitor • Maintenance: One time per week monitor

43. Support strategies for Middle and High School Students with ADHD • Steve Evans and colleagues (James Madison U., and now Miami of Ohio) • Organization Checks • Social Problem Solving Skills • Homework Management Plan • EvansADHD.pdf

44. Some guiding principles for intervention with ADHD • Apply the group primary, secondary, tertiary prevention/intervention model (RTI), but with individual students • Combine proactive and reactive management strategies (e.g., teach rules and daily report) • Intervention in place at point of performance of target behaviors • Intervene as early as possible

45. Some guiding principles for intervention with ADHD(cont.) • Expand range of intervention agents beyond teachers, to: • Peers • Computers • Self management • Parents

46. Effective support for students with ADHD: What will it take? • Knowledge • Resources • General education--special education collaboration • Communication • Effort • Persistence • Problem solving • REPEAT