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Program for ATTENTION DEFICIT DISORDER ATTENTION DEFICIT HYPERACTIVITY DISORDER ARP INDEPENDENT SCHOOL DISTRICT Research indicates that two to five percent of elementary school children meet the diagnostic criteria for ADD/ADHD (Campbell & Werry, 1986). If these estimates are accurate, approximately one child in every classroom in Texas has ADD/ADHD symptoms. ADD/ADHD shows a gender difference, appearing in three times a many boys as girls. Arp Independent School District has designed a plan which addresses guidelines suggested by the Texas Education Agency for identifying, assessing, and providing services for children with Attention Deficit Disorder. The plan outlines school-based intervention strategies which are flexible enough to tailor assistance to the unique needs of the child. Strategies include:
The diagnosis of ADD/ADHD is based on consideration of the list of symptoms taken from the American Psychiatric Association. The disturbance must have been apparent for at least six months in addition to which a majority of the symptoms must have been present at greater frequencies than one would expect of a child of the same mental age. The items are listed in descending order of discriminating power.
Diagnosis requires the presence of symptoms for at least six months in order to exclude children who may be reacting to stressful events such as parental divorce, death in the family or abuse. Inadequate, disorganized, and chaotic environments, including the classroom, may also exacerbate the presence of these behaviors. The behavior of a child with ADD/ADHD is not consistent across environment or task. For example, a child with ADD/ADHD may act differently from other children in a large group situation as compared to a small group or one-on-one situation. These considerations highlight the importance of a diagnosis based on multiple sources of information from multiple contests. Do children with ADD/ADHD necessarily have deficits in cognitive functioning? No clear evidence to support this is available. In fact, many children with ADD/ADHD perform well on individual intelligence tests while performing poorly in school. Inferior classroom performance is partly a result of poor organization and ineffective problem-solving strategies arising out of attentional difficulties and poor impulse control. Sadly, children with ADD/ADHD experience frequent failure, leading to lower self-esteem and less motivation to perform well academically. Children with ADD/ADHD function much better when tangible and positive reinforcement is consistently given (above and beyond what would be given to a child without ADD/ADHD) and is clearly related to a behavioral expectation. Performance deteriorates quickly when this is not done. Partial or gradual withdrawal of reinforcement is not effective for children with ADD/ADHD. Many children with ADD/ADHD are awkward in interpersonal situations because they are impulsive and do not pick up on social cues from others. This clumsiness interferes with communication and compliance in the home and with sharing and turn-taking with playmates. Rejection by their peers and teachers is frequent, resulting in even fewer opportunities to develop effective social skills. Identifying and diagnosing Attention Deficit Hyperactivity Disorder is not a simple matter, especially since other disorders may be present. Symptoms of ADD/ADHD are generally pervasive over time although they may not manifest themselves in every situation. Because of the complexity of the disorder and its potential effects on all aspects of a child's development, an assessment for ADD/ADHD should be cross-situational and multidimensional. Educators should ask: "How does the child function in different settings and in different areas of development?" Assessing all three dimension of ADD/ADHD (attention, impulsivity, and hyperactivity) is also key. To be comprehensive, the assessment must of course involve parents and teachers as well as a multi-disciplinary team whose members are educated about child development in general and ADD/ADHD in particular. A full assessment of children suspected of having ADD/ADHD and a determination of their needs should be guided by the following general questions:
Since the classroom is the most likely setting for ADD/ADHD manifestations, the school should play an important role in identification, assessment and intervention. A school-based assessment can help ensure that strategies are developed to meet the child's educational needs. Specific to the educational setting, the following questions should also be asked:
The following steps have been taken to answer these questions in a full assessment for ADD/ADHD: The school district has in place an overall regular education referral or screening system (19 TAC 89.232) which can be used for children suspected of having ADD/ADHD (STAR Program). School campuses are currently served by multi-disciplinary teams (STAR Teams serving at-risk students) who are available for ADD/ADHD assessment/intervention planning. The At-Risk Coordinator is designated as a facilitator of the ADD/ADHD identification and assessment process and will work closely with the STAR Team as the committee which reviews ADD/ADHD referrals. The in-school referral and assessment process for ADD/ADHD should include several steps. A referral should be made to the STAR Committee containing demographic details, descriptions of particular behaviors, and an explanation of intervention attempts. A screening process is recommended before full assessment because some children exhibiting ADD/ADHD symptoms may be doing so for reasons other than the disorder. This process typically includes: a parent conference; behavioral observation in structured and unstructured settings; administration of rating scales; and a review of academic performance. Following this initial review, information should be complied by the classroom teacher and/or the Counselor and presented to the STAR Team. At this point, strategies are suggested to use on a trial basis. A referral is made for a comprehensive individual assessment if evidence is presented indicating that the ADD/ADHD characteristics are severely interfering with learning. As in any Special Education referral, classroom modifications must have been tried before initiating a referral for assessment. A comprehensive individual assessment is recommended when the STAR Team agrees that there is a strong possibility of the presence of ADD/ADHD which may be severely interfering with learning. Further assessment may also establish the presence of other factors such as intellectual deficits, learning disabilities, or emotional disturbance. This assessment builds on the screening evaluation by adding the following components:
The educational team evaluates the child's needs in terms of providing an educational plan that will accommodate the child's educational needs. Identification of ADD/ADHD characteristics, their impact on the educational progress of the child, and an educational intervention plan are considered in an educational diagnosis of ADD/ADHD. A medical diagnosis of ADD/ADHD in a child is made under the direction of a licensed medical practitioner or licensed psychologist who are currently knowledgeable and experienced with developmental behavior disorders in general and ADD/ADHD in particular. Medical consultations are considered critical to the comprehensive management of ADD/ADHD. Licensed medical practitioners provide expertise in diagnosis and medical intervention strategies. It is the parent's responsibility to pursue all avenues of intervention for their child. After investigation by the STAR team (and/or an ARD Committee, and/or other assessment teams), the Counselor will discuss the appropriate interventions with the parents. If a child identified as having ADD/ADHD characteristics has other handicapping conditions, he or she may be eligible for existing special education services and an individual education plan will be developed. If the child is not eligible for special education services, an intervention plan (Section 504 or a STAR Remedial Plan) for the child with ADD/ADHD will be formulated. This plan must also include monitoring and evaluation of interventions and an annual review. In either case, the specific attentional deficits of the child with ADD/ADHD will be addressed.
When a child who has already been diagnosed as ADD/ADHD enters or transfers into a school, it should be determined whether an intervention plan was in place at the child's previous school. If so, the appropriate personnel should review the plan to ensure applicability to the child's present circumstances and the resources available at the new school. When an intervention plan for the child is being implemented through a private or community agency, the school, with parental permission, should actively communicate and be in contact with that agency.
The techniques and measures that follow will assist in gathering the information necessary for a full assessment of the possibility of ADD/ADHD. While not a comprehensive listing, it is nonetheless intended to guide educators in assessing ADD/ADHD. Observations The most direct indicator of the presence of ADD/ADHD symptoms is an observation of the child in natural settings, such as the home and school, especially by a professional with training in ADD/ADHD. Needless to say, teachers and parents are valuable observers. When observations are planned, the evaluator should take into account different times periods, alternate activities (structured-unstructured), and diverse settings to produce as complete a picture of the child as possible. Rating Scales Rating scales are often used as supplementary tools in an ADD/ADHD assessment. They are usually given to parents and teachers to complement other measures such as observation and interviews. Rating scales consist of statements about behavior such as "Has trouble sitting still" while the rater uses a point scale to denote applicability. While parents may have more contexts in which to judge a child, they may be less objective than teachers who see a built-in norm group on a daily basis. An example of a rating scale is found in the Appendix. Rating scales are designed to help assess whether a child/student has ADHD or ADD, to what degree, and if so, in which area(s) difficulties are experienced. Individual Assessment Characteristics of ADD/ADHD may severely interfere with learning. Students who demonstrate attentional problems and who score below the 40%ile on the norm-referenced achievement test in reading, language arts, or math, failed to have demonstrated mastery on any section of the TAAS, or are currently failing 2 or more subject areas should be considered for referral to Special Education for a comprehensive individual assessment. Many assessment measures used in a typical psycho-educational evaluation can also assist in assessing ADD/ADHD. These include intelligence tests such as the Wechsler scales, the Kaufman Assessment Battery for Children, and the Stanford-Binet Intelligence Scale, Fourth Edition. A well-trained clinician can gain valuable information from these measures by gauging the child's impulse control, levels of frustration, attention and concentration and by observing the child's approach to problem solving. Individual assessment would also include achievement testing utilizing a test such as the Woodcock-Johnson Psycho-educational Battery. Students who display characteristics of ADD/ADHD which significantly interfere with learning, but do not qualify for Special Education will be served by the STAR Committee (Section 504). Students with ADD/ADHD characteristics which are not significantly interfering with the learning process may be served by the Campus STAR Team using simple classroom modifications. Often it is the STAR Team which determines the need for further evaluation Section 504 or Special Education assessment. A successful intervention plan involves the school and parents working together. Teachers of children with ADD/ADHD must be sensitive to the individual needs of these students and tailor their assistance accordingly. Moreover a successful intervention plan involves both school personnel and parents working together to meet the child's needs. Six general sets of services are identified below form which specific interventions can be developed. Services for children with ADD/ADHD are multi-faceted and may include:
Instructional Strategies
v CHANGE INSTRUCTION STYLE. Another useful approach to classroom management is to alter the style of instruction so that it is more lively, entertaining, and flexible. If ADHD children have difficulty persisting at tasks that are tedious, one solution is to make the curriculum, lesson plan, and mode of delivery more interesting or reinforcing to children. This can be done by allowing frequent breaks, perhaps even letting children exercise briefly near their desks to help replenish their powers of concentration. Teachers can also allow children greater opportunities for active participation in the teaching process itself, using lesson plans and materials that permit the children to teach themselves or each other while assisting the teacher in conveying the concept or skill under consideration. Moreover, curriculum materials that allow for frequent feedback on performance, self-pacing of movement through the lesson, and reinforcement for goal accomplishment ( like computer assisted instruction) work far better for ADHD children than simple didactic instruction via lectures. Have children specify in advance how much of the work they think they can get done during the work period and then reinforce them for their own goal attainment. This can provide an effective alternative to teacher-imposed productivity goals. Greater flexibility in how ADHD children are permitted to learn and demonstrate what they have learned may also be needed along with a more experimental approach to alternative formats for teaching. Also important, avoid rewarding children for the speed of their answering. Emphasize instead that you are only interested in well, thought out answers that explain HOW the problem is to be solved and not what the answer may be. Teachers need to discourage impulsive behaviors and encourage children to learn the correct steps to approaching a type of problem. Rewarding ONLY correct answers does not achieve this goal, as it is very possible that children attain correct answers by chance or by the wrong process.v EXTERNALIZING RULES. ADHD children have difficulties in using rules to guide their behavior through tasks. This is especially true when the rules they must adhere to are those they should have internalized and for which no reminders are given. To deal with this problem educationally, teachers should strive to externalize major sets of rules for classroom behavior and task problem solving when possible. Having a few rules for desk work, for instance, printed on a readily visible sign to remind students as they enter into period of independent seat work can be helpful. Asking the children to recite the rules as they begin a new type of work is another way of "externalizing" rules. Having small file cards at their desk with the rules for different work periods printed on them is a third. As it is for parents, anticipating problem settings for ADHD children can be very helpful. Once this is done, a set of rules to guide the ADHD child can be printed on a card and reviewed by the child before going on to the next activity. Even having cassette tapes with rules reminders recorded on them for different work periods can help. Such "nag tapes" listened to on a "Walkman"-style cassette player are relatively easy to make and can be fun for children to use because they are novel.v SELF-MONITORING. Another modification that may be beneficial for classroom management is to arrange for and encourage opportunities for self-monitoring of behavior and task performance. This can be done by having the child periodically record on a card at their desk the number of problems they have accomplished. If behavior during independent desk-work periods is a problem, a tape recorder that sounds a tone at random, frequent intervals can be used to cue children to stop for a brief moment and ask themselves whether they are following the posted rules for that work period. If so, children can place a mark on a card at their desk, thereby giving a point or token to themselves. If a child is not following the rules, he or she is to take away a point. This frequent prompting of the children to monitor and reinforce their own performance can work wonders for some ADHD children in staying on-task longer and being more productive. Granted, this must occur under teacher supervision to preclude cheating.v IMMEDIATE AND FREQUENCY OF CONSEQUENCE. As discussed earlier in this program regarding parent training in child management, teachers must also increase both the immediacy and the frequency of rewards and other control over a child's ADHD. Again, token, chip, or point systems offer some of the best means by which to arrange for these more influential consequences.v CONTROLLING FREQUENCY OF REMINDERS. In doing these things, teacher must avoid frequent reminders about rules, "moralizing" about why the rules should be followed. ADHD children do not react to "yacking" but respond better to clearly stated rules for which there are immediate and consistent consequences provided.
CLASSROOM INTERVENTIONS School is where children with ADD/ADHD experience their most serious difficulties. Modifications of instructional approaches are often required for these children to succeed. Classroom interventions typically include instructional strategies, environmental structuring, and behavior management. Many of these interventions can be adapted for use by classroom teachers. Materials and guides are available in this Appendix. The following guidelines are taken from Cobb (1987), Copeland (1990), Dupaul (1989), Goldstein and Goldstein (1987), Hallahan et.al., (1982), Kendall and Braswell (1985), Parker (1988), and Williams (1989).
INSTRUCTIONAL STRATEGIES
Provide the child with direct intervention and/or modeling for improved organization and focus. Specific techniques in mathematics include:
Specific multi-sensory strategies in language, reading, and spelling include:
Handwriting acquisition:
The teacher is the focus of the attention in the classroom:
Assignments modification
Provide as much structure, predictability, and regularity as possible, and set strong, consistent limits. Structure or build in opportunities for the child to move around the classroom. Limit visual distractions in the classroom
Limit auditory distractions in the classroom
Placement/arrangement of desks
Placement of the ADD/ADHD student in the classroom
Some children with ADD/ADHD may benefit from direct counseling services to supplement classroom-based interventions. The counseling must be applicable to settings pertinent to the child. For example, the child working on problem-solving or social skills should be able to practice in the classroom. The Counselor may also make recommendations for services not furnished by the school, help communicate with parents and outside agencies, and act as a liaison between parents and teachers. The family with a child with ADD/ADHD has specific needs which should be addressed by joint planning between the professional and educational community. Not all of these needs can be met through school-based service programs, but the role of education professionals in their implementation is nonetheless vital including the need for professionals to provide empathy and support to the parents of the child with ADD/ADHD. An understanding by professionals of the parent's feeling and concerns is an essential element in the treatment of a child with ADD/ADHD. The school counselor will plan, implement, and coordinate a parent service program in cooperation with parents. The following ingredients of a successful school-based parent service program will be included:
The needs of children with ADD/ADHD are unique, and services to address those needs must be adapted to each child. They may require the services of professionals and agencies outside the school, while some of their needs can be met by school or district-based services chosen carefully through planning, coordination, and implementation for the optimum development and access to an appropriate education. Teachers too, need better understanding of ADD/ADHD. They will benefit from an increased awareness of the symptoms and treatment of ADD/ADHD. Teacher have a dual role in referring students for assessment and in subsequently implementing appropriate classroom interventions to meet the needs of students with ADD/ADHD. Therefore, it is vital that training on ADD/ADHD be available for all teachers. School personnel need to have a general awareness of ADD/ADHD, basic information about identification and assessment, and knowledge of accepted techniques for intervention. In addition, counselors and administrators must possess a more in-depth knowledge about the disorder in order to assess, intervene, and consult effectively with teachers who instruct children with ADD/ADHD. Teacher training in behavior management techniques is effective in that it benefits the entire classroom, as does direct training in methods to raise children's self-esteem and social skills competence. GUIDELINES FOR TRAINING Direct inservice training needs for teachers include:
The delivery of inservice education can take several forms depending on local resources. Teachers may also utilize continuing education courses at colleges and universities. Attention Deficit DisorderAttention Deficit Hyperactivity Disorder REFERRAL PROCESS Arp ISD ADD/ADHD REFERRAL PROCESS
6. If the referral to the STAR Team or the Section 504 Committee is deemed appropriate by the teacher, the following steps are followed: a. Notify At-Risk Coordinator b. Section 504 referral follow the referral process outlined in the Section 504 Plan. For STAR referrals, teacher and parent complete the "Copeland Symptom Checklist for Attention Deficit Disorder" (or other appropriate rating scale). c. Gather information to present to the STAR Team * test scores * current grades * "Copeland Symptom Checklist for Attention Deficit Disorder" (or other scale) from teacher and parent * Information regarding strategies attempted, the length of the attempt, and the results of the attempted strategies. 7. The teacher becomes a member of the STAR Team which serves as a multi-disciplinary planning team. a. The STAR Team will involve parents in the planning process by discussing the findings of the STAR committee. The counselor will provide information regarding the intervention plan for the school setting, soliciting input from the parent about the child's educational plan, and consulting with the parent on an intervention plan for the home environment. b. Parents may be encouraged to pursue all avenues of intervention for their child, including appropriate professional consultation. c. At the parent request, the STAR Team will share information with professionals consulted by the parents. A signed release of information form will be obtained by the At-Risk Coordinator and/or the teacher. 8. The teacher will implement appropriate strategies and teaching methods developed in collaboration with the STAR Team. 9. The teacher maintains contact with parents, the At-Risk Coordinator, and other professionals, and notifies the STAR Team for review of the plan if the teacher does not deem the intervention plan to be successful. 10. Students who may have an impairment that significantly interferes with learning or other major life activities should be referred to the Section 504 Committee for evaluation. Copeland Symtom Checklist forAttention Deficit Disorders |
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