1. School- and classroom-based interventions to support children and adolescents with ADHD: Innovative and promising approaches Gary Stoner, Ph.D. Email: gstoner@uri.edugstoner@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 SystemsBehavioral Systems 1-5% 5-10% 80-90% 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)www.pbis.org

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. Time/Grade/Age Lo Hi

14. The Effects of Computerized Reading Instruction on the Academic Performance 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, 1 st grade student. – combined subtype of ADHD; receiving Special Education services for math and writing Joe. 6 yo 1 st 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.comwww.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 1999School 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