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(Antecedent Interventions)
Classroom Interventions for Children with Attention Deficit Disorder

Children with Attention Deficit Disorder (ADD)have difficulty with sustained attention and/or control of behavious in the school setting.  Due to the nature of their deficits and the demands of the school environment, impairment in educational performance is common.  In order to help them compensate for their disability, most children with ADD will require interventions in the school.  The majority of children with ADD can be adequately managed in the regular classroom with modifications; however, some children will require special education services.  Below are intervention suggestions for educators to consider in designing a modification plan.  Based on the research literature, these modifications hold promise as effective interventions.

Classroom Environment:

Closed classroom archetecture
    Open classrooms (minimal physical barriers between classrooms) tend to be noisier and have more visual distractions from activities of nearby classes than closed classrooms (four walls and a door).  Since there is evidence that high noise levels will interfere with performance and increase activity levels, closed classrooms are recommended for children with ADD (Whalen, Hanker, Collins, Finck, & Dotemoto, 1979)

Decrease auditory and visual distractions during difficult tasks
    There is some evidence that stimulating classroom, that is, classrooms with varied visual and auditory stimulation, have positive effects on the behavior of children with ADD.  This could include colored posters, animals, and music.  However, this increase stimulation will likely be distracting during new, complex, detailed, or otherwise difficult tasks.  Therefore, efforts should be made to decrease auditory and visual distractions during difficult tasks. (Zentall 1995)

Use individual, separated desk and move seat closer to the teaching area
    Based on the need of children with ADD for immediate and frequent feedback regarding their behaviour, and the observation that teachers attend most to the children in their proximity, it is advisable to seat children with ADD close to the teaching area.  In these locations, it is relatively easy for the teacher to provide the increased feedback without disrupting other children or the lesson plan.  Some have the child face a corner or wall, or place the child in a three-sided cubicle to reduse distractions;  however, this strategy has been found to be ineffective.  In addition, the desk should be individual and physically separated  from the other children.  This will reduce distractions and possible peer reinforcement for inappropriate behavior (Pfiffner & Barkley 1990).

Classroom Organization and Teaching Style:

Schedule academic tasks in the morning hours
    Children with ADD have been shown to problem solve better in the morning hours (Zager & Bowers 1983).  In  addition, children's behavior tends to escalate as the day progresses (Porrino et al, 1983).  When possible schedule tasks that require attention and control of behavior, such as over learned, repeditive, or difficult tasks in the morning hours.  Classes which involve more active participation, such as physical education and other recreational activities, can be scheduled in the afternoon hours (Pfiffner & Barkley 1990).

Increase structure for initial skill developement and increase specific correct responding
    Structure has been defined as increased information about what behavior or what performance standards are expected.  Research has demonstrated that students with ADD respond worse than comparison students when the setting or task is neutral or ambiguous (unstructured).  Structure allows children to know the expectations and predict the consequences of their behavour, thus, structure serves as a guide for behavior and performance.  However, studies with students without disabilities have shown that classrooms with more choice opportunities, or less structure, have many positive outcomes.  One study found that children tolerated more failure in a choice task than in a nonchoice task.  Another study found that suggestions were related to higher task persistence that directives.

Direct methods of instruction appear to increase the accuracy of specific academic responses.  Whereas, indirect methods and choice appear to increase a wider range of responses, lead to greater task persistence, and increase problem solving.  You would expect to have relatively fast initial progress in skill developement in structured classrooms.

Direct methods are those that provide information to the students about what behavior and performance standards are expected.  Direct methods include direct questions, token programs, corrective feedback, controlled practice with increasingly difficult material, drills of important academic skills, computer-assisted programs, and multiple choice.

Children with ADD may require more structure under conditions where initial skill developement is important, and when specific correct responding and reduced behavior is important;  this would include during new tasks and during transitions.  However, once the behavior is under control, indirect methods have the potential of enhancing task persistence, creativity, and problem solving.  Teachers should experiment with provif\ding opportunities for choice, letting students set their own goals, and determine their own interests (Zentall 1995).

Increase the proportion of time spent on the subject of the lesson
    Inattentive and disruptive behaviors are likely to increase during delays in instruction, such as organizing, distributing resources, and discipline.  In one study, approximately 20% of reading and math classes were consumed by instructional delays, and one third of the day in self-contained classrooms for students with learning disabilities was spent in waiting, management activities, and off-task behavior (Baker & Zigmond 1990).  Effective classrooms are characterized by a high proportion of lesson time spent on the subject of the lesson (Rutter 1983).

Increase student pacing of tasks
    When teachers pace tasks, many times the pace is too slow, resulting in inceased wait-time.  However, for students with disabilities, the pace may be too fast if led by the teacher, especially during difficult tasks.  Teachers may avoid these problems related to pacing by increasing student pacing of tasks (Zentall 1995).

Use a brisk pace of instruction for easy tasks
    There is some evidence that a brisk pace of instruction for tasks that require rote memory is beneficial.  However, a fast pace of instruction does not appear to be beneficial for tasks that require creativity, planning, abstracting principals, or reading comprehension (Zentall 1995).

Increase the quality of instruction and decrease the quantity of
        time on a particular task or setting
    The behavior of students with ADD has been shown to inprove in novel settings and with novel tasks (e.g., tests, films, games, etc.).  However, their behavior would be expected to decline after they adapt to the tasks or setting.  As a rule, you would expect novelty to decrease from morning to afternoon, from beginning to end of tasks, and from earlier to later.  Teachers can take advantage of the effect of novelty by increasing the quality of instruction, thus increasing interest level, and decreasing the quantity of time on a particular task or setting (Zentall 1995).

Increase active participation
    Children with ADD have been shown to perform better during active tasks than during passive tasks.  In addition, studies show that students perfer tasks that involve active responding.  Rather than focusing on decreasing behavior, teachers can channel behavior by changing the nature of the tasks and instructional methods used.  Activity can be channeled both during and between tasks (Zentall 1995).

    Increase opportunities for movement during learning tasks
        Methods such as flash cards and writing answers on cards involve movement between
        responses.  Using colored markers to highlight allows for movement during wait time.
        Finger spelling and math manipulatives allow for task related movement.

    Increase opportunities for physical activity preceding each period of learning
        Studies have shown increases in attention and task completion, and decreases in
        disruptive behaviors when additional opportunities for gross motor activities were
        provided.  This could include a brisk 2-minute walk or run, play time, jumping jacks by
        desk, or foring a line and walking around the room.

    Increase on-task verbal participation
        Studies have also examined the effect of increasing on-task verbal responding.  Reading
        aloud has produced fewer errors and increased comprehension.  Verbalizing math
        problems has reduced errors and increased correct responding.  Choral responding has
        reduced off-task behaviors and increased learning.  It appears to be more useful when it
        is fast paced.

Directed participation
    A student's participation can be self-directed or directed by the teacher or a peer.  Traditionally, instruction is provided by the teacher in a lecture format.  There are several advantages to a teacher-directed lecture.  Studies have shown that there tends to be less social behavior, out-of-seat behavior, and noise and higher engagement during a teacher-directed lecture than during seatwork.  Child-directed seatwork will likely require more attention, persistence, and self-control of behavior than a teacher directed lecture.  However, part of the problem with seatwork may be the lack of feedback from the teacher during this time.  Frequently teachers use seatwork time as a catch-up period for themselves, rather than using it to provide feedback to the children as they work alone in their seats.  Giving and receiving peer tutoring can increase academic performance.  One study found higher attention for peer tutoring than large group instruction (Zentall 1995).

    Intersperse teacher direction with seatwork
        Teachers can rduce the quantity of time spent for any period of seatwork by
        interspersing teacher direction with seatwork (Pfiffner & Barkley 1990).

    Use feedback during seatwork
        During seatwork time, teachers should provide feedback to students regarding their
        performance behavior.

    Use teacher direction during small group instruction
        Teachers are preferred over peers, especially when there is a low student-teacher ratio,
        such as during small group instruction.

    Use peer-tutoring
        One-on-one with a peer tutor is preferable to one teacher with a large group.

Task Characteristics:

Use methods of increasing the salience of improtant task information
    Increasing the stimulation of tasks can enhance attention.  The studies seem to indicate that educators should consider increasing the salient features of the instructional materials by labling,highlighting, underlining, and adding color.  When using these methods, it is important to enhance the salient features of the task, rather than the extraneous or unimportant features.  In particular, this should be done during rote learning tasks and toward the end of tasks (Zentall 1995).

Modify task length
    During individual seatwork, it is common for children with ADD to complete little of their assigned work, particularly with lengthy or multiple tasks.  This is due to their deficit in sustained attention.  It is advisable to modify the length of tasks to fit more within the child's attention span, and to provide frequent feedback to the child regarding their performance (Pfiffner & Barkley 1990).

For example, rather than giving a child 20 minutes to complete 20 math problems, the teacher can divide the 20 problems into 4 "chunks" of five problems each.  The teacher can either cut up the sheet of math problems or use a sheet of paper to cover up all but one row of problems.  The child can be instructed to complete the problems in a smaller period of time (e.g. 5 minutes) and to bring the completed work up to the teacher's desk.  An external timer also can be used as a representation of elapsed time..  When the child finishes the "chunk" of work, s/he can bring the work to the teacher for feedback and reinforcement for task completion.

THis simple modification accomplishes several things.  First, it addresses a unique need of the child with ADD by providing a task that fits within the child's attention span.  Second, it allows for more frequent feedback about performance.  Third, it allows for movement between tasks.

Effective Communication
    Educators can provide an environment that will cue or prompt compliance to teacher commands and class rulles by communicating effectively.

    Use effective commands
        Compliance to teacher requests begins with a command.  Teachers can intervene to increase the likelihood that children will mind by using effective commands.  The qualities of an effective command are listed in the table below (Eyberg & Boggs 1989).

Rule: Reason: Examples:
1.  Requests should be direct rather than indirect A direct requestshould leave no question in the child's mind that s/he is being told to do something, givingno illusion of choice. Indirect Request:
"Let's pick up the toys."
"How about washing your hands?"
"Why don't you open your book?"
"Do you want to throw away that paper?"

Direct request:
""Jimmy, pick up the paper please."

2.  Requests should be positively stated Positively stated request give the child information about what "to do."  Negatively worded requests only tell the child what "NOT to do." Negative request:
"Stop running!"

Positive request:
"Come sit down next to me."

3.  Requests should be specific.  Avoid vague requests Vague requests are so general and nonspecific that the child may not know exactly what to do to be obedient. Vague requests:
"Be good."
"Be careful."
"Clean up your act!"

Specific requests:
"Move away from the door."
"Talk in a quiet voice."

4.  Give only one command at a time.  Avoid "hidden" requests. Some children have a hard time remembering more than one thing at a time.  You do not want to  punish a child for having a short attention span or failing to remember. Stringing requests:
"Go close the door, then turn in your papers, and then go sit in your seat."

Hidden requests:
"Clean up your area."  (This is really several requests, such as, "Put the toys in their place, straighten the chairs, stack your books, etc")

5.  Requests should be simple. The child should be intellectually and physically capable of doing what you are requesting. Too difficult:
"Write the letter A."  (If the child does not have the writing skills or does not know the alphabet)
"Hand me the green block."  (If the child does not know the colors)
"Put the paper under the box."  (If the child does not understand the concept of 'under')

Use warnings effectively
    After an effective command, the five second rule goes into effect.  The five second rule has twso parts.  First, give the child the opportunity to mind by waiting a full five seconds before deciding whether the child has begun to comply.

Second, do not interact with the child during this five seconds.  Interaction during this time, may distract the  child from compliance.

If the  child has begun to comply within the five seconds, wait until the command is completed and reward the child with a labeled praise.  For example, "John, thank you for throwing away the trash like I told you.  I like it when you mind me!"

If, after five seconds, the child has not begun to comply, the child should be given a warning.  A warning is an if-then statement that connects the command with a consequense.  For example, "John, if you don't pick up that paper and throw it in the trash, you will have to go to time out."

After the warning, the five second rule goes into effect again.  Compliance after the warning should be rewarded with a labeled praise.  Failure to begin to comply should be punished immediately.

Use clearly stated rules
    There are some behaviors that are not adequately controlled by direct commands.  These behaviors usually include those that you have said, "no, don't, stop, or quit" to repeatedly.  These behaviors may require a class rule.  Before implementing class rules, make them explicit by discussing them with the children at a neutral time.  Describe the problem behaviors.  Explain the rules, the consequences for violating the rules.  Use a warning on the first violation after establishing a rule.  Subsequent violations receive no warning and are immediately consequented.  It is also helpful to provide visual reminders of the rules and to review the rules prior to problem situations, such as prior to transistions.

Abranowits, A.J. & O'Leary, S.G. (1991).  behavioral interventions for the classroom: Implications for students with ADHD.  School Psychology Review, 20 (2), 220-234.

Baker, J.M., & Zigmond, N. (1990) Are regular education classes equiped to accomodate students with learning disabilities? Exceptional Children, 56 (6), 515-526.

Bryan, T.S. (1974).  An observational analysis of classroom behaviors of children with learning disabilities.  Journal of Learning Disabilities, 7,35-43.

Pfiffner, L, & Barkley, R. (1990)  Educational placement and classroom management.  In R.A.Barkley, Attention Deficit Hyperactivity Disorder:  A Handbook for Diagnosis and Treatment  (pp. 498-539).  New York:  Guilford.

Porrino, L., Rapoport, L., Behar, D., Ismind, D., Bunney, W., (1983).  A naturalistic assessment of the motor activity of hyperactive boys.  Archives of General Psychiatry, 40, 681-687

Rutter, M. (1983).  School effects on pupil progress:  Research findings and policy implications.  Child Developement, 54, 1-29.

Whalen, C.K., Henker, B., Collins, B.E., Finck, D., & Dotemoto, S. (1979).  A social ecology of hyperactive boys:  Medication effects in the structured classroom environments.  Journal of Applied Behavior Analysis, 12, 65-81.

Zagar, R., & Bowers, N. (1983).  The effect of time of day on problem solving and classroom behavior. Psychology in the Schools, 20 (3), 337-345.

Zentall, S.S. (1995).  Modifying classroom tasks and environments.  In S. Goldstein, Understanding and managing children's classroom behavior (pp. 356-374).  New York:  Willey.

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