Teacher Resources

US Department of Education: Identifying and Treating Attention Deficit Hyperactivity Disorder
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US Department of Education: Teaching Children with ADHD
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Introduction

Children who have ADHD may have special needs in the classroom; remaining in their seat, working quietly and concentrating, or listening to what the teacher says can be difficult.

However, much of a child’s time is spent in school and it is where key aspects of growth and development takes place, both academically and socially. As the leader of the classroom, a teacher is ideally placed to help recognize and manage ADHD, both for the benefit of the child, but also their peers in the classroom. The information on this part of the site has been brought together from a variety of sources to serve as a resource for teachers to help children with ADHD and their classmates to get the most out of their time at school. These skills learned at school will be beneficial throughout life.

Teaching a Child with ADHD

Children with ADHD find the classroom a particularly challenging environment. As a teacher you can provide invaluable insights to both parents/caregivers and physicians about a child’s educational and behavioral needs. By identifying and meeting the unique needs of the child, you can play a central role in the successful management of a child’s ADHD.

ADHD Defined

ADHD is a neurobiological disorder attributed to a developmental delay in brain circuitry which impacts on a person’s sense of inhibition and self control.1 Inattention, hyperactivity and impulsiveness are the key symptoms.2 A child with ADHD is easily distracted, may move and speak rapidly and excessively, and may often act inappropriately, as if without thinking. Exhibiting behavior that resembles that of younger children, a child with ADHD may often have problems forming friendships with other children or siblings, and thinking through the social consequences of their actions. If unrecognized and untreated, children and adolescents with ADHD are less likely to complete high school, further their education or remain employed, than their peers.1,3

Diagnosis

All children can be excitable and energetic at times. It is important to check whether the child’s behavior differs greatly from his/her peers or is unusual for his/her age. Children with ADHD exhibit combinations of the following behaviors:4

Inattention:

  • Failing to give close attention to details and avoiding careless mistakes
  • Difficulty sustaining attention in tasks or activities
  • Often does not seem to listen when being spoken to directly
  • Difficulty following through on instructions and in organizing tasks

Hyperactivity:

  • Fidgeting with hands or feet or squirming in their seat
  • Difficulty remaining seated when required to do so
  • Often runs about or climbs excessively in situations when it is inappropriate to do so
  • Difficulty in playing quietly

Impulsivity

  • Blurting out answers to questions before the questions have been completed
  • Difficulty in waiting for a turn in tasks, games or group situations
  • Often interrupts or intrudes on others (e.g. butts into conversations or games)

For more information see American Psychiatric Press: Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).

The process for diagnosis varies from region to region. A physician should be requested to evaluate the child for ADHD. A diagnosis of ADHD must be made by a healthcare professional. In many cases, a child’s teacher is best able to observe how a child with suspected ADHD acts in the classroom and is first aware of the impact of his/her behavior on his/her ability to learn or to interact with his/her peers.

To meet standard diagnostic criteria, some symptoms of ADHD must appear before the age of seven, cause impairment, and persist for at least six months to a degree that is unusual for the person’s age.4

Monitoring Treatment

Research has shown that medication alone can improve ADHD symptoms,5 the current ADHD treatment practices focus on management of symptoms through a multimodal approach6 which may include medical, educational and behavioral approaches.

Treatment plans for ADHD should be tailored to each individual child.7 A healthcare professional should regularly assess the treatment goals using inputs from the child’s teachers, counselors and parents/caregivers, to adapt the therapy as necessary.

It is also important to set realistic treatment goal targets that can be achieved and measured. For example:7

  • Improvements in relationships with peers and teachers
  • Increased self-esteem
  • Increased independence through self-monitoring and completion of assigned tasks
  • Improvements in academic performance.

Teachers, working closely with parents/caregivers and the child’s physician or psychologist play a key role in monitoring the progress and behavior of the child during treatment.

Behavioral Support

Essentially, behavior modification is used to help improve not only a child's behavior but also his or her relationships – by improving interactions with other children and adults. Therapists teach the techniques to teachers as well as parents/caregivers, for use in daily life.7

The three areas in which behavior modification is used, also known as the "ABCs" of behavior modification, are:8

  • Antecedents – things that initiate or precede 'behaviors'
  • Behaviors – undesirable behaviors
  • Consequences – things that occur as a result of 'behavior'

The most important and effective behavioral technique is verbal reinforcement of appropriate behavior, that is praise when a child begins and completes an activity or exhibits a particular desired behavior.9

Praise should be specific for the positive behavior displayed by the student. The comments should focus on what the student did right and should include exactly what part(s) of the student’s behavior was desirable. Rather than praising a student for not disturbing the class, for example, a teacher should praise him or her for quietly completing a math lesson on time.9

Effective teachers praise children with ADHD frequently and look for a behavior to praise before, and not after, a child finishes a task. Inappropriate behavior should be corrected, without suggesting that "he/she is a bad child". Helping the child to understand his/her disorder, and to learn to manage his/her symptoms is critical for life success.

Educational Support

The following techniques can help children with ADHD in a classroom setting:9

General planning

  • Seat the child near the teacher – let the child sit in the front of the room to allow you to monitor and reinforce the child’s on-task behavior.9 One approach to applying this principle is to praise the child often, specifically he/she successfully completes tasks.
  • Tape recorder – ask the student to dictate assignments into a tape recorder, as an alternative to writing them.9
  • State the materials that will be needed in advance – identify all the materials that the children will need during the lesson, for example, pencil, notebook and ruler.9 An additional approach to applying this principle is to have extra work supplies available in case the child forgets his/her own is helpful.
  • Allow for ‘escape valve’ outlets – permit children with ADHD to leave the class for a moment – to run an errand perhaps – to help them settle down.9 Suggestions for facilitating an escape valve include allowing the child to stand while completing work or establishing alternative work stations for a restless student.
  • Signpost milestones / give advance warning in lessons – announce 5 or 10 minutes before the end of the lesson how much time remains.9

Lesson planning

  • Simplify instructions – break tasks down into small bite-size chunks for completion. Provide instructions for the first stage, let the child complete this step, and then provide instructions for the next stage of the task.9
  • Provide follow-up directions – after giving directions to the class as a whole, provide additional oral directions for a child with ADHD, or repeat the instructions in writing on the chalkboard.9 Additional suggestions to help apply the principle is to use picture clues or collective responses to provide these directions.
  • Practice sequencing activities – for older children, provide supervised opportunities to break down a long assignment into a sequence of short interrelated activities.9
  • Highlight key points – highlight key words in the instructions on worksheets to help the child with ADHD focus on the directions.9
  • Proofread compositions – provide the child with a list of items to check against when proofreading his or her own work.9

Specific lessons

  • Make the most of your materials i.e. graph paper – ask the child to use graph paper to help organize columns when doing math.9
  • Take time to re-read problems – encourage the child to read a math word problem twice before beginning to compute the answer.9
  • Use real-life examples i.e. counting/money – set up a class store where children can practice adding up ‘groceries’ and calculating costs and change.9
  • Using storyboards for comprehension – ask the child to make story boards that illustrate the sequence of main events in a story.9
  • Combine learning with movement – with spelling lessons the child could jump rope while spelling words out loud.9

For more information and ideas see Teaching Children with Attention Deficit Hyperactivity Disorder: Instructional Strategies and Practices, by the US Department of Education.

Social Support

Research suggests that 50% of children with ADHD have poor peer relations10. These children are less likely to make friends, are often rejected by their peers, and might be more likely to experience anxiety, behavioral and mood disorders, substance abuse and delinquency as teenagers. You might like to try:

  • Social skills classes9 – encourage children to role-play and model different solutions to common social problems. Discuss how to resolve social conflicts.
  • Identify social cues11 – encourage the child to follow social cues: are other children really listening to him / her? Are others laughing at the wrong times? By learning to notice the reactions of others, children learn to monitor their own behavior.
  • Encourage children to join extra curricular and social activities11. Non-academic activities can help a child discover his or her strengths and build self esteem12.

It is important to set clear goals for the child, and be realistic in your expectations. By using cooperative teaching techniques, it will help the student to become a helper / expert and encourage the child to work in collaboration with others .

Before & After School Activities13

  • Children with ADHD respond well to routines. Work with the child’s parents/caregivers to help include any before of after school activities into a written routine and display the schedule where the child can see
  • Look to include the child in activities that require individual coaching, such as tennis, wrestling or diving.
  • After school activities involving movement are good options for example sports like running or swimming are popular with children with ADHD.
  • Try to avoid sports that have a lot of ‘down time’ such as baseball where the child may end up in a position that doesn’t see much action.
  • Activities which require a lot of divided attention can be difficult for a child with ADHD as they require focus on many things at once. With team games for example, look to break down the activity and coach the sport in a step wise approach.

Working with Parents/Caregivers

As the child’s teacher you are ideally placed to help his/her parents/caregivers understand how the child is at the end of the day, for example they may look upbeat but actually be mentally quite tired13. It is important that parents/caregivers collaborate and partner with teachers to ensure the child’s ADHD is correctly managed and that appropriate support services are made available for the child10.

Teachers and parents need to discuss the expectations to which a child with ADHD should be held in completing his/her homework. Working together with the child, parent and teachers need to establish rules and goals for completing homework. By implementing a reward system, the child can be motivated for the work they complete. Similarly, for work that is not completed, points or rewards can be deducted9. By working together you can help the child reach their potential in the school situation, and help set them up to reach their full potential in life.

Further reading

  1. American Psychiatric Press. Diagnostic and statistical manual of mental disorders (DSM-IV). Washington (DC): The Press; 1994
  2. Barkley R.A. Attention Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment, Guildford Press, 1998
  3. Parents, Provision and Policy – A Consultation with Parents. ADDISS, September 2003
  4. ADHD Background, ADDISS
  5. Attention Deficit Hyperactivity Disorder on www.allaboutkidshealth.ca
  6. A Guide to Organising the Home and Office. National Resource Centre on ADHD (CHADD) at www.help4adhd.org
  7. Specific Learning Difficulties. Factsheets for parents and teachers. Royal College of Psychiatrists 2004.
  8. Educational Rights for Children with ADHD. National Resource Centre on ADHD (CHADD) at www.help4adhd.org
  9. Teaching Children with Attention Deficit Hyperactivity Disorder: Instructional Strategies and Practices, by the US Department of Education.

References

  1. Durston S. 2003. A Review of the Biological Bases of SDHD: What Have We Learned From Imaging Studies. Ment Retard Dev Disabil Res Rev 9:184-95.
  2. Tannock R. 1998. Attention Deficit Hyperactivity Disorder: Advances in Cognitive, Neurobiological, and Genetic Research. J Child Psychol Psychiat 39: 65-99.
  3. de Boo GM and Prins PJM. 2007. Social Incompetence in Children With ADHD: Possible Moderators and Mediators in Social-Skills Training. Clin Psychol Rev 27:78-97.
  4. Barkley RA. 2003. Issues in the Diagnosis of Attention-Deficit/Hyperactivity Disorder in Children. Brain Dev 25:77-83.
  5. Greydanus DE, Pratt HD and Patel DR. 2007. Attention Deficit Hyperactivity Disorder Across the Lifespan: The Child, Adolescent, and Adult. Dis Mon 53:70-131
  6. Global ADHD Working Group, Global consensus on ADHD/HKD, J Eur Child Adolesc Psychiatry14:127–137
  7. American Academy of Pediatrics. Subcommittee on Attention-Deficit/Hyperactivity Disorder and Committee on Quality Improvement. 2001. Clinical practice guideline: treatment of the school-aged child with attention-deficit/hyperactivity disorder. Pediatrics 108:1033-44.
  8. National Resource Centre on ADHD (CHADD). Factsheet: Psychosocial Treatment for Children and Adolescents with ADHD. www.help4adhd.org/ Accessed 3 July.
  9. US Department of Education. 2004. Teaching Children with Attention Deficit Hyperactivity Disorder: Instructional Strategies and Practices. www.ed.gov/about/offices/list/osers/osep/index.html Accessed 3 July 2007.
  10. Without Boundaries Report at www.wfmh.com Accessed 3 July 2007.
  11. Miller SR, Miller CJ, Bloom JS, Hynd GW, and Craggs JG. 2006. Right Hemisphere Brain Morphology, Attention-Deficit Hyperactivity Disorder (ADHD) Subtype, and Social Comprehension. J Child Neurol 21:139 - 144.
  12. National Resource Centre on ADHD (CHADD). Factsheet: Parenting a Child with ADHD. www.help4adhd.org Accessed 3 July.
  13. WebMD. ADHD and After-School Activities: Finding the Right Fit. http://www.webmd.com/content/article/93/102492.htm Accessed 3 July 2007.