School- and classroom-based
interventions to support children and
adolescents with ADHD: Innovative and
promising approaches
Gary Stoner, Ph.D.
Email: gstoner@uri.edu
University of Rhode Island
Presentation for the Coventry Public Schools
March 12, 2009
ADHD in School Contexts: Reasons for
Concern
• School success is both critical and
potentially elusive for students with ADHD
• Increasing numbers of children who are
“difficult-to-teach” and “difficult-to-manage”
• Reactive support model (i.e., wait to fail)
remains prevalent mode of practice in
special education and school psychology
CHALLENGES TO INTERVENTION IN
PUBLIC SCHOOLS
• Lack of knowledge about effective supports
for students with ADHD
• Challenges in designing/implementing
individual modifications
• Lack of knowledge or experience with
behavioral techniques
• Support of administration/policies for
intervention
• Class size
• “Fairness” to other students?
CHALLENGES TO INTERVENTION AT
SECONDARY LEVEL
•
•
•
•
•
Multiple teachers/staff
Resistance of faculty
Defiance of student
Student reaction to peer pressure
Competing demands for student time
TARGETS FOR TREATMENT
• Behavior Control
•
•
•
•
•
•
•
Staying on-task; Paying attention
Following classroom rules
Anger control
Academic Performance
Class Participation
Homework Completion
Organizational Skills
•
•
•
Note-taking
Studying for exams
Long-term projects
• Appropriate Social Behavior
• Social Problem Solving
Some guiding principles for
intervention with ADHD
• Apply the group primary, secondary, tertiary
prevention/intervention model (RTI), but with
individual students
• Combine proactive and reactive management
strategies (e.g., teach rules and daily report)
• Intervention in place at point of performance
of target behaviors
• Intervene early in the course of problems
Some guiding principles for
intervention with ADHD(cont.)
•
•
•
•
Use multiple intervention agents
Link assessment data to intervention
Individualize interventions
Again…deliver interventions at the
“point of performance”
Designing School-Wide Systems for Student
Success (see www.pbis.org)
Academic Systems
Behavioral Systems
Intensive, Individual Interventions
•Individual Students
•Assessment-based
•High Intensity
1-5%
Targeted Group Interventions
•Some students (at-risk)
•High efficiency
•Rapid response
Universal Interventions
•All students
•Preventive, proactive
5-10%
80-90%
1-5%
Intensive, Individual Interventions
•Individual Students
•Assessment-based
•Intense, durable procedures
5-10%
Targeted Group Interventions
•Some students (at-risk)
•High efficiency
•Rapid response
80-90%
Universal Interventions
•All settings, all students
•Preventive, proactive
Primary and Secondary Prevention
Strategies: Preschool
• Home/school/community based support for:
– Language development/early literacy/cognitive development
• (Read Together/Talk Together)
– Social development/socialization
• The Incredible Years programs (U. Washington, Carolyn
Webster Stratton)
• Oregon Resiliency Project: Strong Start Program, a social and
emotional development curriculum (Merrell, 2007; Brookes)
– School readiness
Elementary
•
•
•
Academic
– Skills for School Success (Curriculum Associates)
– Basic Skills Instruction/Progress Monitoring
Social/Emotional/Behavior
– Positive Behavior Support; First Steps Program (Sopris West)
– Oregon Resiliency Project: Strong Start/Kids Programs, a social
and emotional development curriculum (Merrell, 2007; Brookes)
Mental Health
– Oregon Resiliency Project: Strong Kids (Online)
Middle
• Academic
– Advanced Skills for School Success (Curriculum Associates)
– Assignment/Work Accommodations
– Curriculum-based collaboration and Instructional support
(SPED)
• Mental Health
– Oregon Resiliency Project: Strong Kids Program, a social and
emotional development curriculum (Merrell, 2007; Brookes)
• Social/Emotional/Behavior
– Positive Behavior Support; Teaching Self-Management
Strategies to Adolescents (Sopris West)
High School
• Academic
– Advanced Skills for School Success
– Assignment/Work Accommodations;
– Curriculum-Based Collaboration and Instructional Support
(SPED)
• Mental Health
– Oregon Resiliency Project: Strong Teens Program, a social and
emotional development curriculum (Merrell, 2007; Brookes)
• Social/Emotional/Behavior
– Positive Behavior Support
– Teaching Self-Management Strategies to Adolescents (Sopris
West)
• Dropout prevention
– Check and Connect Program, (Christenson, University of
Minnesota)
Hi
Lo
Time/Grade/Age
The Effects of Computerized Reading
Instruction on the Academic
Performance of Students Identified with ADHD
(School Psychology Review, 2005, 34, 246-254)
Julie Clarfield and Gary Stoner
University of Massachusetts Amherst
Children with ADHD are at
higher than average risk for:
• Behavioral and academic difficulties
• Grade retention
• Placement in special education
programs
• School drop out
• Lower high school GPA
• Enrollment in college degree programs
Children with ADHD and
academics, continued:
• As many as 80% of students with ADHD exhibit
academic difficulties, including lower than expected
work completion rates
• Approximately 20-30% are identified with learning
difficulties due to problems with acquisition of
academic skills
• Recent studies show literacy/reading skill acquisition
problems relative to matched peers as early as
Kindergarten
• These risks and outcomes suggest need for effective
educational interventions
Computers (CAI) are
promising, as students with
ADHD perform better:
• …when provided with immediate (vs.
delayed) feedback
• …when stimulus conditions are novel
(vs. familiar)
• …when provided with one-to-one
student-teacher ratio
Purpose of present study:
• evaluate the effectiveness of a recently
developed computerized reading instruction
program—Headsprout
• …with participants diagnosed with ADHD
and experiencing reading problems
Research questions:
• Relative to teacher directed, small group
instruction, what are the effects of the Headsprout
reading program on students’ task engagement?
• Relative to teacher-directed, small group
instruction, what are the effects of the Headsprout
reading program on students’ oral reading
fluency?
Participants:
• Tim. 6 yo, repeating Kindergarten.
– inattentive subtype of ADHD; 2.5 mg of
methylphenidate once a day during the first 7 weeks;
then an 18mg dose of Concerta once a day.
• Kevin. 7 yo, 1st grade student.
– combined subtype of ADHD; receiving Special
Education services for math and writing
• Joe. 6 yo 1st grade student.
– combined subtype of ADHD; 5mg of
methylphenidate once a day
Methods:
• Independent Variable: Headsprout reading
program; 3 x week, 20-30 min. each
• http://www.headsprout.com
• Dependent variables:
– Oral Reading Fluency
– On- and off-task behavior
• Multiple Baseline Design, across participants
Features of Headsprout:
• internet-based reading program; no adult required
• explicit instruction in phonemic awareness and
phonics
• introduces consistent letters and sounds, fluency
building exercises and segmenting and blending
strategies
• provides explicit instruction in building sight word
vocabularies and recognizing and using punctuation
cues
• student works sequentially through 40 animated
lessons, each lasting approximately 20 minutes.
Headsprout features (cont.):
• highly interactive: students engage in over 180 active
learner interactions per 20-minute lesson
• lessons are individualized and adapt to a child’s pace
• student success rate in each lesson is at least 90%
• Completion of most Headsprout activities involve the
child moving a character to a desired destination
• students keep track of own progress through the use
of a colorful progress map
• positive feedback is provided after each correct
response, and the program rewards the student with
brief (10-30 second) humorous movies in between
activities
Baseline
60
CAI
% of Intervals Off Task
Tim
50
40
30
20
10
0
60
% of Intervals Off Task
Kevin
50
40
30
20
10
0
60
Jo e
% of Intervals Off Task
50
40
30
20
10
0
0
10
20
30
40
School Da ys
Figure 1. P ercentage intervals of off task behavior as a function of typical reading
instruction and computer assisted reading instruction.
50
Off-task data
• Tim. Off-task 24% BL vs. 3% CAI
• Kevin. Off task 49% BL vs.6% CAI
• Joe. Off task 26% BL vs. 4% CAI
45
Words Correct Per Minute
CAI
Baseline
40
35
Tim
30
25
20
15
10
5
0
45
Words Correct Per Minute
40
35
Kevin
30
25
20
15
10
5
0
45
Words Correct Per Minute
40
Joe
35
30
25
20
15
10
5
0
0
10
20
30
40
50
S chool Days
Figure 2. Words read correctly per minute as a function of typical reading instruction
and computer-assisted reading instruction.
60
Reading fluency data
• Tim. 6 WRC in baseline vs. 18 WRC during intervention;
Weekly gain .55 before intervention to 1.65
• Kevin. 14 WRC in baseline vs. 33 WRC during
intervention; Weekly gain .55 to 2.90
• Joe. 10 WRC in baseline vs. 24 WRC during intervention;
Weekly gain .20 to .75
Discussion
• Positive effects of CAI on task engagement
and academic performance, similar to Ota
and DuPaul (2002)
• Different in that Ota and DuPaul study
involved math, drill and practice, and upper
elementary students
• High degree of social validity
• URL: www.headsprout.com
Future work
• individual Headsprout effects (rather
than additive)
• home based, parent guided intervention
• home/school combinations
• group study with more effective
instructional comparison; control group?
Parent tutoring for students with
attention-deficit/hyperactivity disorder:
effects on reading performance at
home and school
Christine Hook and George J. DuPaul
School Psychology Review 1999,
Vol.28, No. 1; pg. 60-75.
Procedures
• Four children: three 2nd Graders, one 3rd
Grader
• Parent tutoring in reading, 10 minute
sessions
• Material from current school stories/reading
• Preview, reading aloud, error correction,
praise, review of story
• Mean Sessions per week, 3
• Mean weeks, 6
Peers as intervention agents
• Plumer, P. J., & Stoner, G. (2005).
The relative effects of Classwide Peer
Tutoring and peer coaching on the
positive social behaviors of children
with Attention Deficit Hyperactivity
Disorder. Journal of Attention
Disorders, 9 (1), 1-11

Table I
Results
Percent of intervals
observed containing
positive social
interactions
Participants
Heidi
Colin
Samantha
Baseline
3%(2-3%)
5%(2-8%)
10%(0-25%)
CWPT
87%(80-99%)
93%(87-97%)
98%(95-100%)
CWPT and Peer
94%(80-100%)
99%(97-100%)
100%(No range)
Baseline
45%(42-48%)
45%(12-63%)
68%(42-95%)
CWPT
32%(3-75%)
46%(0-77%)
69%(15-100%)
CWPT and Peer
62%(27-93%)
75%(63-87%)
90%(77-98%)
Academic Activity
Mean and range
Coaching
Recess and Lunch
Mean and Range
Coaching
The Effects of Self-Management in
General Education Classrooms on the
Organizational Skills of Adolescents With
ADHD
SAMMI GUREASKO-MOORE, GEORGE J.
DUPAUL, GEORGE P. WHITE
BEHAVIOR MODIFICATION, Vol. 30 No. 2,
March 2006, 159-183.
Information
• Three 12-year old, 7th Grade boys
• Focus on classroom organization, including:
–
–
–
–
–
–
Arrive on time for class
Prepared to begin class (oriented to T_
Has paper/notebook
Has pen/pencil
Completes homework
Hands in homework on time
Procedure: Students provided
• Explanation and rationale for selfmanagement
• A description of their current classroom
functioning based on observation results
• An explanation of the importance of
responsibility for one’s own behavior
• The specific responsibilities one must
maintain to be considered prepared for class
instruction
Monitoring
• Students established weekly goals
• Initially, daily adult meeting and monitoring
and discussions
• Daily meetings continued until student met
100% of daily goals on 4 of 5 consecutive
days
• Fading: every other day with monitor
• Maintenance: One time per week monitor
Support strategies for Middle and
High School Students with ADHD
• Steve Evans and colleagues (James
Madison U., and now Miami of Ohio)
• Organization Checks
• Social Problem Solving Skills
• Homework Management Plan
• EvansADHD.pdf
Some guiding principles for
intervention with ADHD
• Apply the group primary, secondary, tertiary
prevention/intervention model (RTI), but with
individual students
• Combine proactive and reactive management
strategies (e.g., teach rules and daily report)
• Intervention in place at point of performance of target
behaviors
• Intervene as early as possible
Some guiding principles for
intervention with ADHD(cont.)
• Expand range of intervention agents
beyond teachers, to:
• Peers
• Computers
• Self management
• Parents
Effective support for students
with ADHD: What will it take?
• Knowledge
• Resources
• General education--special education
collaboration
• Communication
• Effort
• Persistence
• Problem solving
• REPEAT