Teaching Students with ADHD

This article summarizes briefly some definitions of attention deficit hyperactivity disorder (ADHD) and what impact it might have on a student. It includes some theoretical discussion of the causes of ADHD and how each cause may impact treatment or behavior modification. It then summarizes suggestions from various sources for how to organize a classroom, assign work, and assist students with ADHD in the public schools.

Keywords Attention deficit hyperactivity disorder; Behavior Modification; Developmental Delay; Executive Function; Functional Behavioral Assessment (FBA); Multi-Sensory Instruction; Peer Tutoring; Positive Behavioral Interventions & Supports (PBIS); Self-Regulation

Overview

What is ADHD?

ADHD, or attention deficit hyperactivity disorder, is considered a developmental delay that is possibly based in neurological dysfunction and is considered primarily genetic or congenital, although environmental conditions may have an impact. Children with ADHD may be quite bright and capable, but their behavior can be challenging for the teacher and for other students.

Children who have ADHD are generally inattentive, hyperactive, and easily distracted. They may also be forgetful and have trouble controlling their impulses. They exhibit limitations dealing with self-regulation or self-control and may have trouble waiting for reward, acknowledgement, or attention. If these symptoms occur across a range of situations (e.g., at home, at school, at play) a diagnosis of ADHD may apply.

Some critics believe that ADHD is not an actual disorder; rather, the expectations of teachers and parents may simply be unreasonable for children to fulfill (e.g., sitting still for a time in a classroom) or that children are developing at different speeds, and those with impulsive tendencies will eventually catch up to their peers. A diagnosis of ADHD can lead to medication and/or therapy for treatment. Critics feel medical responses may be overused. Some are no longer considered to have ADHD as adults, but ADHD may also be under-diagnosed among adults, especially those who have learned to cope with their challenges.

Between 2016 and 2019, approximately 6 million children ages three through seventeen were diagnosed with ADHD. Boys were more likely (13 percent) than girls (6 percent) to be diagnosed (Centers for Disease Control and Prevention, 2022). Some have stipulated that the difference is in the frequency of diagnosis rather than in actual occurrence (Day et al., 2002). A child living with ADHD can be difficult. Brand et al. (2002) note that authors of descriptive and correlational studies have reported that students with ADHD are more likely than others to have a number of problems:

• Grade retention

• Delinquency

• Academic underachievement

• Behavioral problems

• School failure

• Drug abuse

• Social and emotional adjustment difficulties and

• Dropping out of school (p. 269).

Additionally, students with ADHD are likely to have a comorbidity—behavior or conduct problem (52 percent), Anxiety (33 percent), Depression (17 percent), Autism spectrum disorder (14 percent), or tourette syndrome (1 percent) (Centers for Disease Control and Prevention, 2022).

Challenges of Teaching ADHD Students

Melton (2007) explains that it can be challenging to teach students with ADHD who may be unable to sit still, may blurt out answers or questions impulsively, may distract other students or may be easily distracted by them-and other stimuli in the classroom, or who may find it difficult to organize the tasks and materials needed to accomplish assignments in a timely manner ("ADHD in the Classroom," 2022).

What Does Research Say About Teaching Children with ADHD?

Barkley (2007), suggests that sometime during the late 1980s to the early 1990s, it became obvious that ADHD and its related disruptive behavior and academic impairments were not the consequence of faulty contingencies of reinforcement in natural ecologies like classrooms or homes, as some originally claimed in the 1970s (Willis & Lovass, 1977). Such behavior does not need to function to gain positive reinforcement nor escape from aversive situations to be produced and sustained. We now recognize the etiologies of ADHD and its various levels of phenotypic expression to be largely in the realm of neurology and genetics (Nigg, 2006). This is not to say that social environments are irrelevant or that certain contingencies make no contribution in individual cases because they certainly pertain to forms of impairment, risk for comorbidities, and treatment resources. But it does say that no serious investigator today could make the case that ADHD can arise purely out of social causes such as bad parenting, intolerant teachers, faulty social learning, or inappropriately learned cognition. There is simply too much evidence against such ideas (Nigg, 2006; Barkley, 2007, p. 281; "ADHD in the Classroom," 2022).

In other words, Barkley is saying that ADHD appears to be primarily genetic, and is not a result of something wrong in the home or school environment. He goes on to say that it has come to be understood that ADHD is not merely a collection of behaviors such as inattentiveness and impulsivity, but is actually evidence of a broader array or disordered thinking involving self-control and related issues.

Applications

Behavioral Interventions

Barkley (2007) discusses various treatment programs for ADHD behaviors and suggests that it may be necessary to keep some in place over a length of time because symptoms or specific behaviors do not go away as a result of the treatments but are merely controlled. He states, “Behavioral treatments, like hearing aids, wheelchairs, ramps into public facilities, lower bathroom fixtures, glasses and large-print books, and prosthetic limbs for amputees, are artificial means of altering environments so as to reduce the adverse effect of a biological handicap on the performance of major life activities. No one would rationally claim that physical disabilities arise from the lack of wheelchairs and ramps. Similarly, no one would claim that using a wheelchair or associated ramps for a month or two would result in their either being internalized or so altering the social environment that they would be sustained by changes in naturally occurring contingencies after the chairs and ramps are withdrawn And so no one should now rationally claim that ADHD arises from faulty learning or that several months of contingency management produces sustained benefits for ADHD once treatment is withdrawn. Behavioral methods are prostheses—means of rearranging environments by artificial means so as to yield improved participation in major life activities” (Barkley, 2007, p. 281).

Barkley goes on to suggest that although behavioral interventions may be helpful, they are not necessarily addressing the root of the problem, "ADHD is now thought to be as much a disorder of self-regulation and executive functioning as it is in attention. What we most need now is a theory of how normal self-regulation develops, where it goes awry in producing ADHD, and what this may mean for constructing better interventions" (Barkley, 2007, p. 281).

Thus, although behavioral, medical, and other interventions may address symptoms of ADHD and may make life more manageable for students with ADHD and the people around them, Barkley suggests that more research is needed and that ADHD may need to be addressed from an entirely different perspective:

• Studying the role of self-management and self-regulation;

• Considering the role of genetics;

• Assessing the roles of various medications and other treatments along with their side-effects; and

• Examining the impact of any kinds of treatments (or of packages of treatment combinations) on individual outcomes.

Learning-Style Instruction

Brand et al. (2002) examined the varied learning styles of children, suggesting that different learning styles may contribute to a label of learning disability, which might, in turn, not adequately reflect a child's capacity to learn well. They report, for example, that:

"Despite the negative labels associated with children who learn differently from their same-aged classmates, research reveals that many students officially classified as failing have achieved statistically higher standardized achievement test scores in both reading and mathematics when they were taught with approaches and resources that complemented their learning styles.

For example, after only one year of learning-style-based instruction, Special Education (SPED) high-school students in Buffalo, New York's public schools achieved significantly higher test scores than their counterparts who had not experienced learning-style-responsive teaching. And after two years, many of these special education students achieved almost as well as their nonclassified counterparts" (p. 268).

Brand et al. (2002) concluded after studying 230 students in both elementary schools and secondary schools who had been assessed via a particular learning tool, that learning styles were widely varied among children with ADHD. They did, however, find some commonalities among students, both young and older, and recommended for further study that educators and researchers should try to monitor what happens when children with ADHD are taught new and difficult information under differing conditions, such as:

• In the afternoon as opposed to in the morning

• With tactile and kinesthetic instructional resources rather than lecture and reading

• In soft illumination (or full-spectrum lighting) rather than fluorescent lighting

• With Multisensory Instructional Packages that accommodate all perceptual strengths rather than single- or dual-sensory approaches; and

• With parental supervision (for elementary school children) rather than supervision by the teacher (Brand et al., 2002, p. 273).

The Role of the Teacher

Glass (2001) reports that a child's experience in the classroom can depend on the teacher's tolerance to ADHD behaviors and how that teacher "chooses to work students who display the behaviors related to ADHD" (p. 71). Using a survey of 225 teachers, she examined what factors influenced a teacher's strategies for dealing with children with ADHD in the classroom and found that a teacher's age, their experience in the classroom, and the information provided about ADHD by school administrators all had an impact on teacher classroom behavior towards students with ADHD.

Glass (2001, p. 78) found that older teachers and those who were more experienced were most likely to use positive teaching strategies in the classroom with ADHD students. She also found a strong positive influence on classroom behavior when school administrators distributed information about behaviors associated with ADHD and included guidelines for positive strategies to deal with those behaviors. She also found, however, that many teachers chose not to use some strategies—such as frequent breaks, hands-on activities, and allowing children to work at their own pace—since they believed these would not be helpful to the class as a whole (despite evidence to the contrary cited by Glass).

What Teaching Methods are Helpful to ADHD Students?

A multitude of organizations have addressed ways to help students with ADHD learn. A structured program and classroom can be very helpful to students with ADHD, as is reducing distractions as much as possible and making guidelines for regulation (and assistance with it) very explicit and clear.

Classroom Organization

Proteacher (2007, Room Set-Up) suggests the following arrangements for a classroom to assist with those issues:

• Make rules clear: post them.

• Make a schedule clear: post it

• Seat students with ADHD near the teacher or near a focused child

• Seat students in rows, if possible, rather than at group tables

• Closed classrooms, rather than pod arrangements are helpful

• Students easily distracted by sounds may do better seated in the rear of the room so they don't have to turn around to see the distraction

• Interact personally with the student often

• Seat students with ADHD away from the hall and the windows

• Keep one part of the room relatively distraction-free

• Stand near students with ADHD when presenting a lecture or giving directions

• Individual headphones, classical music, or background white noise may be helpful in reducing distractions

Teaching Strategies

Some strategies to use in the classroom include varying the pace and keeping lessons interesting, using multi-sensory presentations, and involving children with ADHD in the presentation process. Proteacher (2007, Presenting Your Lesson) provides the following suggestions:

• Use peer tutoring, either have older students tutor the student with ADHD or have him/her tutor younger students

• Include a variety of activities in each lesson

• Appeal to a variety of senses during the lesson (visual, audio, tactile, kinetic); include hands-on experiences when possible

• break lessons into short pieces separated by breaks

• Encourage interaction during lessons (answering questions etc.)

• Try role playing and acting out lessons when possible, involving the class

• Use cooperative teams in learning, where each student has a defined role

• Interact verbally with students with ADHD and maintain eye contact when giving directions

• Give directions one step at a time

• Ask the student to reiterate directions to ensure clarity

• Set accuracy goals and encourage the student to take time to complete tasks, rather than rushing to complete them

Teaching Resources

The US Centers for Disease Control and Prevention published a tip sheet on working with students with ADHD in 2022. They focus on behavioral intervention techniques and behavioral classroom management, such as first encouraging verbal reinforcement of appropriate behavior, which means that when the student does something correctly or well, immediate positive praise should be offered. Another focus is on organizational training, which helps the child be more independent and successful with their time management, planning skills, and reduces distractions. Teachers may need to look for opportunities to offer such praise while the student is beginning the tasks. They also recommend some accommodations and special educational services which may prove helpful.

Another avenue for success involves specifically teaching students how to manage their own behavior appropriately. The US Department of Education tract (2007) recommends offering social skills classes involving role playing and discussion of behavior to all students, but suggests it may be especially helpful to those with ADHD.

Similarly, problem-solving sessions are recommended for all students and can be structured to respond to conflicts as they occur. In this case, the participants can be asked to consider how to resolve their differences, and lessons learned can be discussed and generalized to other situations.

The Behavior Management Process

Since structure is very helpful for children with ADHD, many teaching tip sheets include ways to introduce structure in the classroom and in a child’s daily life. The US Department of Education (2007) recommends individual assessment of a child with ADHD, beginning with a Functional Behavioral Assessment (FBA). The FBA process involves teachers, parents, and/or professionals observing the child's behavior to assess what conditions contribute to the behavior and what aspects of the behavior are problematic and to determine the frequency of the behavior. Once the behaviors are clearly identified and defined, a plan can be developed to address problem areas systematically.

After completion of an FBA, a Positive Behavioral Interventions and Supports (PBIS), a research-based method of addressing challenging behaviors, can then be used to develop a plan to assist the child (US Department of Education, 2007). This process is intended to improve behavior and to provide the child with skills to enhance their behavior and experience across environments.

The first step in the process is to develop a contract or plan around managing behavior. The child and parents are usually involved, and the goal is to identify target behaviors and tasks the child will attempt to complete or maintain.

Successful completion of the tasks (getting homework done, following rules in a specific situation) is rewarded by something tangible, such as a sticker or being granted additional privileges, and is something upon which the child has agreed will be motivational. The US Department of Education (2007) also suggests token economies in which a gathering of points (for example) can be successfully exchanged for a larger prize such as computer time or another reward.

Finally, self-management systems are recommended. In this scenario, (US Department of Education, 2007) the teacher selects behaviors that the student will attempt to manage along with a rating scale to indicate how performance will be measured. Both student and teacher grade the student on a given behavior, and when the grades are close, points are awarded to the student to exchange for rewards or privileges. Eventually, the student should learn to master or manage their behavior.

Teaching Older Students

Although some students appear to outgrow a diagnosis of ADHD, perhaps as they find different pathways to self-regulation, others will maintain it through adulthood. Many of the guidelines for teaching older students with ADHD are comparable to those for K–12 students and are based on similar ideas of providing structure, maintaining clarity in instruction, and assisting with organizational skills.

Summer (1999) recommends, for example, that a syllabus with "clear explanations of tasks and specific due-dates" be provided, and that teachers expressly remind students of upcoming deadlines and due dates. In addition, students may need help breaking down assignments into smaller pieces with deadlines for each short piece to be completed. Teachers are encouraged to assign all projects in writing, as students with ADHD may inadvertently miss them.

Another way to incorporate structure is at the beginning of a lecture, for example, to provide a summary of the material that will be covered (Summer, 1999). A printed summary is especially helpful if it includes space for notes to allow the material to be already organized for the student. End-of-class reviews are also very helpful.

Variety in format is highly recommended. Breaks should be permitted during long classes, and to minimize distractions, students should be encouraged to sit near the front of the room and away from hallways and windows.

Conclusion

A student with attention deficit hyperactivity disorder can find it difficult to learn in a traditional classroom situation with the potential for distractions from unrelated stimuli, which can then in turn lead to the student being a distraction to others. ADHD is likely a genetically based condition related to a reduced ability to regulate the self and behavior.

Parents, teachers, and professionals can create environments and conduct activities that will help to enhance the child's learning potential such as

• providing clear, structured directions for behavioral expectations and for work.

• providing an uncluttered, less distracting place to study or work.

• addressing the child directly in class and involving them in classroom discussion and activity.

• helping to break a student’s large tasks into smaller ones with clear, defined goals for completion.

• helping the student develop a behavioral plan that offers rewards of tangible objects or privileges for tasks or goals that are successfully completed.

Having expectations or plans written down can be helpful, as students with ADHD may be distracted and miss verbal instructions.

Terms & Concepts

Attention Deficit Hyperactivity Disorder (ADHD): ADHD is a developmental disorder that results in children or adults being unable to focus for long periods of time on any one topic. Children with ADHD are easily distracted, often disorganized, and sometimes unable to sit still in class.

Behavior Modification: This refers to strategies used in the classroom or at home that are intended to change a child's behavior without necessarily attending to the underlying causes of that behavior.

Executive Function: Executive function refers to the function of the brain that oversees other areas and exerts control over behavior, for example.

Functional Behavioral Assessment (FBA): "FBA is a systematic process for describing problem behavior and identifying the environmental factors and surrounding events associated with problem behavior" (USDOE, 2007).

Multi-Sensory Instruction: Multi-Sensory Instruction means teaching students in ways that allow them to use a variety of senses to process information, such as visual, auditory, tactile, kinetic etc.

Peer Tutoring: Peer tutoring occurs when students teach each other; it can occur between students in the same grade or those who are ahead by several years, but indicates a difference from tutoring by adults, teachers, or parents.

Positive Behavioral Interventions and Supports (PBIS): "This method is an application of a behaviorally based systems approach that is grounded in research regarding behavior in the context of the settings in which it occurs" (US Department of Education, 2007).

Self-Regulation: Self-regulation refers to an individual's ability to control their behaviors, reactions and responses. This is a skill that develops during maturation, but begins relatively early in life.

Bibliography

ADHD in the Classroom: Helping Children Succeed in School. (2022, August 9). CDC. Retrieved June 10, 2023, from https://www.cdc.gov/ncbddd/adhd/school-success.html

Barkley, R. A. (2007). School interventions for attention deficit hyperactivity disorder: Where to from here? The School Psychology Review, 36, 279-86. Retrieved December 11, 2007, from EBSCO online database, Education Research Complete, http://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=25592368&site=ehost-live

Binder, L.M., Dixon, M.R., & Ghezzi, P.M. (2000). A procedure to teach self-control to children with attention deficit hyperactivity disorder. Journal of Applied Behavior Analysis, 33(2), 233–237. http://doi.org/10.1901/jaba.2000.33-233

Brand, S., Dunn, R., & Greb, F. (2002). Learning styles of students with attention deficit hyperactivity disorder: Who are they and how can we teach them? The Clearing House, 75, 268-273. Retrieved December 11, 2007, from EBSCO online database, Education Research Complete, http://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=6872364&site=ehost-live

Centers for Disease Control and Prevention. (2012). Attention-deficit/hyperactivity disorder (ADHD): Data & statistics. Retrieved December 21, 2013, from http://www.cdc.gov/ncbddd/adhd/data.html

Centers for Disease Control and Prevention. (2022). Data and Statistics About ADHD. Retrieved June 21, 2023, from https://www.cdc.gov/ncbddd/adhd/data.html

Dey, A. N., Schiller, J. S., & Tai, D.A. (2004). Summary Health Statistics for U.S. Children: National Health Interview Survey, 2002. National Center for Health Statistics. Vital Health Stat 10. Retrieved December 11, 2007, from Centers for Disease Control and Prevention, http://www.cdc.gov/nchs/data/series/sr%5f10/sr10%5f221.pdf

Glass, C. S. (2001). Factors influencing teaching strategies used with children who display attention deficit hyperactivity disorder characteristics. Education, 122, 70. Retrieved December 12, 2007, from EBSCO online database, Academic Search Premier http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=5570415&site=ehost-live

Langberg, J., Becker, S., Epstein, J., Vaughn, A., & Girio-Herrera, E. (2013). Predictors of response and mechanisms of change in an organizational skills intervention for students with ADHD. Journal of Child & Family Studies, 22, 1000–1012. Retrieved December 20, 2013, from EBSCO Online Database Education Research Complete. http://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=90187278

Markham, E. R. (2012). Behavioral interventions for teachers. Communique (0164775X), 41, 31. Retrieved December 20, 2013, from EBSCO Online Database Education Research Complete. http://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=83291128

McAllister, L. (2012). Positive teaching. American Music Teacher, 61, 18–22. Retrieved December 13, 2013, from EBSCO Online Database Education Research Complete. http://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=71158945

ProTeacher. (2007). Website accessed December 11, 2007, http://www.proteacher.com

Summer, C. (1999). Teaching students with attention-deficit/hyperactivity disorder. Disabled Students Program. Retrieved December 11, 2007, from University of California, Berkeley. http://dsp.berkeley.edu/TeachStudentsWithDisab.html#9

U.S. Department of Education (USDOE). (2007). Teaching for ADHD: Effective Strategies for Teachers. https://files.eric.ed.gov/fulltext/ED495483.pdf

Wilkinson, S., Harvey, W. J., Bloom, G. A., Joober, R., & Grizenko, N. (2013). Student teacher experiences in a service-learning project for children with attention-deficit hyperactivity disorder. Physical Education & Sport Pedagogy, 18, 475–491. Retrieved December 20, 2013, from EBSCO Online Database Education Research Complete. http://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=91698671

Suggested Reading

Abramowitz, A.J. & O'Leary, S.G. (1991). Behavioral interventions for the classroom: Implications for students with ADHD. School Psychology Review, 20(2), 220–234. Retrieved December 11, 2007, from EBSCO online database, Education Research Complete, http://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=9604173869&site=ehost-live

Bender, W.N. (1997). Understanding ADHD: A Practical Guide for Teachers and Parents. Merrill/Prentice Hall.

Bloomquist, M.L., Gerald J. A., & Ostrander, R. (1991). Effects of a school-based cognitive-behavioral intervention for ADHD children. Journal of Abnormal School Psychology, 19(5), 591-605. http://doi.org/10.1007/BF00925822

DuPaul, G. J., & Eckert, T. L. (1998). Academic interventions for students with attention-deficit/hyperactivity disorder: A review of the literature. Reading & Writing Quarterly, 14(1), 59–82. https://doi.org/10.1080/1057356980140104

Storeygard, J. (2012). My Child "Can". Exceptional Parent, 42, 48–50. Retrieved December 20, 2013, from EBSCO Online Database Education Research Complete. http://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=84576009