1. Childhood ADHD: A Primer for Home-School Intervention Brandon K. Schultz, Ed.S., NCSP Alvin V. Baird Attention & Learning Disabilities Center James Madison University http://chp.cisat.jmu.edu/presentationsworkshops.html Brandon K. Schultz, Ed.S., NCSP Alvin V. Baird Attention & Learning Disabilities Center James Madison University http://chp.cisat.jmu.edu/presentationsworkshops.html

2. Agenda Diagnosing ADHD ADHD and Schools Home-School Interventions  Behavior Report Cards  Assignment Notebook Tracking  Organizational Skills

3. Diagnosing ADHD

4. Definition & Prevalence (American Psychiatric Association, 2000) Attention Deficit Hyperactivity Disorder (ADHD) is the current terminology  Includes both “Predominately Inattentive” and “Combined” (inattention & hyperactivity) Types Thought to afflict 3-5% of the population, with boys more commonly diagnosed than girls, at a ratio of about 4 or 5:1

5. There is no “gold standard” assessment (i.e., indisputable) for ADHD. Instead, the diagnosis is based entirely on behavioral symptoms… Definition & Prevalence (American Psychiatric Association, 2000)

6. Inattention: 6 or More… (American Psychiatric Association, 2000) Fails to give close attention to details Has difficulty sustaining attention in tasks Does not seem to listen when spoken to Does not follow through on instruc-tions / fails to complete work Has difficulties organizing tasks and activities Avoids/dislikes tasks that require sustained mental effort Loses things necessary for tasks Distractible Forgetful in daily activities

7. Hyperactivity: 6 or More… (American Psychiatric Association, 2000) Fidgets with hands or feet / squirms Leaves seat in class- room / other places Runs about / climbs excessively Has difficulty playing quietly Often “on the go” or acts as if “driven by a motor” Often talks excessively Blurts out answers before question is asked Has difficulty waiting for turn Interrupts or intrudes on others (butts into conversations or games)

8. Diagnostic Concerns (American Psychiatric Association, 2000) Behaviors (previous slides) must:  Be present for 6+ months & be present before age 7  Cause significant impairment in social, academic, or vocational functioning  Not be caused by other disorders, such as Pervasive Developmental Disorder or psychotic disorders  Not be better accounted for by another mental disorder, such as anxiety disorders Must occur in two or more settings

9. ADHD and Schools

10. What Can Parents Expect? GPA in Community Control Sample of Middle School Youth with ADHD

11. Special Education? (Forness & Kavale, 2001) ADHD is not a label that is recognized by IDEA. Instead, other categories may apply in cases where educational performance is negatively impacted…. Learning Disabilities (26%) Learning Disabilities (26%) Emotional Disturbance (43%) Emotional Disturbance (43%) Other Health Impairment (40%) Other Health Impairment (40%)

12. What is ‘Other Health Impaired’? OHI includes health conditions that affect academic performance, including heart disease, asthma, etc. ADHD was officially added to this list of medical conditions. Since that time, the OHI category has grown considerably

13. Special Education? About half of all students with ADHD receiving SPED services can be served effectively in the regular classroom environment. 40% can be served through some combination of regular and special education classrooms. 10% will require a self-contained environment.

14. What is a ‘504 Plan’? Section 504 of the Rehabilitation Act prevents discrimination based on disabling conditions Students not meeting the requirements for SPED may be eligible for a 504 Plan  Must “limit one or more major life activities,” including learning

15. What Interventions Are Used? General & SPED teachers differ in their emphasis, but the interventions are surprisingly similar… InterventionGeneral EducationSpecial Education Changing seats15 Behavior modification21 Time-Out34 Shortened Assignments47 One-to-one instruction53 Special Consultation62 Peer tutoring79 Frequent breaks88 Assignment format96

16. Parents’ Role Parents have the right to request an evaluation for SPED eligibility If the student is found ineligible:  Parents have the right to appeal the decision (due process)  Have child re-evaluated under Section 504  Parent advocacy groups

17. Home-School Interventions

18. Behavioral Interventions (Bear, Cavalier, & Manning, 2005) Behavioral Interventions – general tips:  Consequences should occur soon after behavior  Consequences should be ‘salient’  Don’t give tangible reinforcers for intrinsically motivated behavior (e.g., $ for playing baseball)  Move from contrived reinforcers to natural reinforcers over time (generalizability)  Move from dense reinforcement schedules to thin reinforcement schedules over time  Do not over-rely on punishment!!!  Punishment should fit the crime and be limited in scope

19. Behavior Report Cards (Challenging Horizons Program Treatment Manual, 2004) Daily Behavior Report Card  Determine behavioral goals  Rate child during a “baseline” period  Develop report card with child  Reinforcers at school AND at home  Assess progress over time  Phase out behaviors on report card upon “mastery”

20. Daily Behavior Report Cards (Challenging Horizons Treatment Manual, 2005) Goal: The student will demonstrate improvement in the targeted behavioral and/or academic problem areas. 1 The mentor and student identify target (desired) behaviors (e.g., remaining on task in class) that the student needs to improve. 2 The mentor and/or classroom teacher(s) documents ratings of the student's performance on the target behaviors on a regular basis (at least weekly). 3 The mentor/teacher ratings are communicated in writing to the parents/guardians of the student (at least weekly). 4 Behavioral contingencies are provided at home. Progress is also discussed between the mentor and student in one-to-one meetings at school.

21. Monday Behavior 1: TuesdayWednesday 123412341234 Behavior 2: 123412341234 Behavior 3: 123412341234 Daily Behavior Report Cards 1 = Needs Much Improvement, 2 = Some Difficulty, 3 = Good Job, 4 = Great Job! Turns in work on time Produces high quality work Brings materials necessary for class/subject area BKS

22. Assignment Notebook Tracking (Challenging Horizons Treatment Manual, 2005) Goal: The student will write all assignments accurately and legibly in the appropriate place in his/her assignment notebook without prompting and/or behavioral contingencies 1 The student sets up a written system for documenting academic assignments that they are responsible for. 2 Mentor routinely checks (no less than 1 time per week) the student's assignment tracking for accurateness and legibility. 3 Successful tracking is reinforced (e.g., praise, special activities) and errors are corrected with mentor coaching until the student is independent with this task.

23. Average Percentage of Assignment Notebook Criteria Met Per Day

24. Organization Skills (Challenging Horizons Treatment Manual, 2005) Goal: The student will be able to maintain organization of his/her school related personal belongings (binder, book bag, locker) without prompting and/or behavioral contingencies in place. 1 The mentor helps the student identify areas that are important to keep organized (e.g., locker, desk, bookbag) and teaches the student specific ways to stay organized. 2 The mentor and/or teacher(s) monitor the students ability to maintain organization through regularly scheduled inspections/checks (completed at least weekly) and document progress 3 Student success is reinforced (e.g., praise, points) and problems are corrected with mentor or teacher assistance.

25. Average Percentage of Organizational Criteria Met Per Day

26. References American Psychiatric Association. (2000). The Diagnostic and Statistical Manual and Mental Disorders, Fourth Edition – Text Revision (DSM-IV-TR). Washington, DC: APA. Bear, G.G., Cavalier, A.R., & Manning, M.A. (2005). Developing self-discipline and preventing and correcting misbehavior. Boston, MA: Pearson Education, Inc. Challenging Horizons Program Treatment Manual - Integrated Model. (2004). Harrisonburg, VA: James Madison University. Forness, S. R., & Kavale, K. A. (2001). ADHD and a return to the medical model of special education. Education and Treatment of Children, 24, 224-247.