ADHD (Attention Deficit Hyperactivity Disorder) in the classroom

For nearly 20 years I have been providing consultation and training to school districts about how to support the student with ADHD /ADD in the classroom.  This has included ADHD consultation with individual teachers and school wide training on the subject. I've worked in Vancouver, Burnaby, Maple Ridge, West Vancouver, North Vancouver, Coquitlam and throughout BC with individual teachers, and have provided school wide consultation and training on ADHD in BC, California and New York.

The student with ADHD / ADD has special needs that can be supported by some very simple classroom or environmental changes, and some specific individual supports. For an individual teacher I have several info sheets available on my website. You can start here with this sheet on Executive Function, Emotions and ADHD in the classroom (click here),  or you can seek out general information on ADHD from my ADHD / ADD page by clicking here: http://www.relatedmindsbc.com/adhd. Other genreral information on children with anger control issues and difficulty with emotional control can he found here: http://www.relatedmindsbc.com/the-angry-child. Other general information can be found on my websites "Forms" page.

In this first post on ADHD / ADD in the classroom I'd like to review several general rules. In my next post I'll address some simple classroom interventions, and then in the final post on in this series address the issue of reinforcement systems. So here are some basic rules, following the guidelines for Accommodations for Children and Teens with ADHD by Russell Barkley (The complete guide is available free from his web page).

1. Rules and Instructions provided to children with ADHD must be clear, brief and delivered more clearly than to regular students.  Start by making sure the child with ADHD has given you his or her full attention ("Mike, are you ready? Yes.") Have the child repeat the instructions out loud, or to themselves. Support the rules or instructions with visual prompts such as signs. Use prompts such as pointing to your ears, eyes, etc. Don't give multi-part instructions unless they are supported with an external aide such as a list, hand gestures, or picture cues.  Ask yourself, "Did he get enough of a warning? Did he get a prompt to pay attention? Did I have his FULL attention before we started? What could help him focus on what I am saying?

2. Consequences for students with ADHD must be "swift and immediate." ANY delay, even just a couple minutes, in giving a consequence to a student with ADHD significantly degrades the power of the consequence.  It is not the size or harshness of the consequence that matters as much as how quickly it is given after the inappropriate or unwanted behaviour.  Frequent feedback is essential. Token systems, visual cues and prompts and hand signals all can help deliver minor but immediate feedback. Remember, these "consequences" for a student with ADHD are meant to be feedback, not so much punishment.

3. Every consequence should be counted!  Consider how many positive feedback moments the student has compared to negative. If you are giving more negatives than positives, consider how environmental changes can help change this to positive feedback. Too often students with ADHD are given constant, low level, late and ineffective negative feedback that becomes nothing more than a drone to their minds. Then then begin to associate the classroom environment with negative consequences. The classroom should be associated with positive experiences, positive feedback for successful behavioural efforts. Ask, "What supports does my student need to get positive feedback more often?"

4. The type of consequences used with students with ADHD must be "of a higher magnitude" than that provided to regular students. That means that positive reinforcers must be more powerful for the student with ADHD. And they must be more frequent and most important more IMMEDIATE for the student with ADHD. If you need help developing these skills, get feedback or consultation. Avoid going down the negative/punishment only path.

5. Positive Feedback must be more powerful and more frequent than negative feedback. Usually token or other reinforcement systems start with two or three weeks of positive only feedback before any negative feedback or consequences are provided to the student with ADHD / ADD. The rule is "Positives BEFORE negatives." Often students with ADHD do not respond to punishment or time out. If punishment is failing, you should seek out professional and experienced help before increasing the magnitude of punishment for a student with ADHD.

6. Reinforcers work only for a little while. Be ready to change them, increase them, provide them in new ways and provide new types of reinforcers for the child with ADHD. This is significantly different from other students in your class, expect that and be prepared to provide it.

7. Behavioural programs for students with ADHD often only work for a short period of time before needing to be modified. Be prepared. Monitor how the program is working, and when you are no longer seeing success alter the program in a manner that makes it effective. Also remember that for the student with ADHD the behavioural changes occur while the program is in effect, and are very likely not to work when you stop them. Does this mean behaviour programs don't work? No. It means they are an effective technique to use to assist you in finding ways to support the student while learning of other kinds occur. For a program of behaviour modification to work for longer periods you need to develop a program that includes components for decreasing the frequency of reinforcers, to generalize the behaviours to new environments and substitute natural reinforcers, prompts and cues for the artificial ones you have been providing. This may be beyond your knowledge and experience. If it is, ask for consultation with a specialist. These types of behavioural programs have been show to work effectively and are generalizable by those who know the techniques and have the experience. Don't be afraid to ask for help. That's what you expect from your student with ADHD.

These are some of the most basic components of a classroom program that can supports students with ADHD / ADD and other related cognitive and emotional deficits. A good classroom program includes visual supports, a means of tracking behaviour, specialized environmental supports and a systematic method of providing positive feedback or reinforcement. This type of program will help you design a classroom that can support these students, and thereby make teaching all of your students  easier.

There are some excellent books on classroom modifications and individual intervention planning for students with Attention Deficit Hyperactivity Disorder available from Dr. Russell Barkley, as well as some very helpful DVD/video training. I am also available to provide individual teacher/student consultations or school wide training in setting up classrooms that are friendly to and support of those with ADHD. Feel free to contact me for more information.

In the next post I'll address some specific classroom and student interventions. Then I'll address using reinforcement systems (such as token systems) that have been found to be one of the, if not THE most effective means of supporting children with ADHD in the classroom. Finally, I may have a few words to say about writing behaviour plans and completing a  Functional Behaviour Analysis (FBA) with a student with ADHD.