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ADHD in schools; an overview of what can be done to help Part 2

It’s clear by now that when left unmanaged, ADHD poses real challenges to children when they’re in school, either by directly impacting upon student achievement and/or a wider impact on self-esteem and wider social and emotional issues.

A question we’re often asked is, “What can we, as teachers/educators, do to help those in our classroom with ADHD?”

The answer, unfortunately, isn’t so straightforward and it’s important to point out that classroom interventions aren’t intended – and don’t function – as alternatives to medication. In other words, they’ve been shown to have much less of impact on core symptoms, compared with medical options. That said, treatment should be multi-modal, some children may experience delays whilst waiting for a referral, they might be sub-clinical threshold and yet still impaired to some extent, or their parents/caregivers might not want to go down the medical route. In all of these cases and more, there’s a role for non-pharmaceutical help. I think it’s important to bear in mind that severity of symptoms and the presence of behavioural issues etc varies from one person to another. It’s also important to point out that as children get older, hyperactivity and impulsivity decrease, whereas inattention appears to remain more constant and of course, expectations of children change as their age increases. Consequently, the sorts of interventions appropriate for primary settings might differ from those in secondary settings.

To those who work in education, it likely won’t come as a surprise that there isn’t a lot of research looking at ADHD in the classroom, given the many challenges and barriers to carrying out research in school settings. A recent meta-analysis published in 2019 found that there have only been 27 studies published on this topic since 1971 that met modern design standards (Harrison et al., 2019). Also, almost all has been published in the USA. However, there are still lessons we can draw from this evidence base. Broadly speaking, there are three types of intervention; Consequence based interventions, Antecedent-based Interventions, and Self-management/self-regulation interventions. There’s evidence that all three types are at least moderately effective at improving educational attainment and behavioural outcomes.

Consequence based interventions Overall behavioural interventions have been found to have a positive impact on educational and behavioural outcomes, albeit with smaller effects than Antecedent-based and Self-management options (DuPaul et al., 2012).

As an example, the use of Daily Report Cards has attracted some attention (Moore et al., 2016). The idea behind daily report cards is that they contain positive targets for improvement, rather than negative descriptions of things the child did wrong. So for example, “I sat in my seat during desk work”. Teachers keep an eye out for when these targets are met and rewards the behaviour. You can see how this could be catered to a specific child’s needs. This information can also be shared with the parent, so that they may reward the child too. Importantly, the evidence shows that teachers rate this intervention positively and it has been found to be fairly easy to implement (e.g., Richardson et al., 2015). It also gives the parents (who may be used to hearing negatives about their child) some positives, which can increase their engagement with schools. There is however the issue of stigma. Carrying this out in class can draw attention to the child in question. But, by focusing on the positives, it is hoped that ADHD may be seen less as a flaw by other pupils.

Antecedent-based Interventions

These aim to modify how the child is instructed in the classroom and have mainly focused on delivering education via software packages, now that computers and laptops are quite common in classrooms. Such Computer-Assisted Instruction (CAI) has been shown to be moderately effective at improving educational and behavioural outcomes. One example is “Math Blaster”, which is suitable for ages 6-9. There’s evidence that children might find these more engaging than traditional teaching methods and more importantly, allow them to progress at their own rate. One study, albeit an older one (Kleiman et al., 1981) found that children with ADHD spent twice as much time working and completed twice as much work when using technology, compared to when they were in seats.

However, singling out the children with ADHD to work on a computer whilst their classmates aren’t, can lead to stigma. For that reason, it might be better to do this intermittently, or after school/during breaks, for short periods once or twice a week, or to recommend software to parents. Alternatively, there may be times when all children, or at least more than just those with ADHD, can work on computers.

Self-management/self-regulation interventions

Often based on cognitive-behaviourism, self management strategies have been shown to be moderately effective in improving educational and behavioural outcomes. One such approach is known as the Self-Regulated Strategy Development (SRSD). SRSD was originally developed for children with learning difficulties, but has been applied to children with ADHD in more recently years. The major goals of SRSD are (a) student mastery of the higher-level cognitive processes used in writing; (b) development of self-regulation and independent use of the strategies; and (c) development of positive attitudes about writing (Graham & Harris, 1993). SRSD is a specific way of teaching writing which has been shown to help children in general and especially those with ADHD. The approach is outlined well in a paper by Jacobson and Reid (2010). In their paper, they describe the core stages, which are:

Develop background knowledge; in this first step, children are introduced to two mnemonics. One related to planning; STOP (Suspend judgment, Take a side, Organize your idea, Plan more while you write) and a second related to writing DARE (Develop their topic sentence, Add supporting ideas, Reject possible arguments for the other side, End with a conclusion).

Discuss it; memorising the above mnemonics via discussing them and by the teacher reading a story aloud and asking students to highlight the relevant sections. Model it; here the teacher demonstrated to the class how they used the above mnemonics to plan and write an essay, with assistance from the pupils. All the while, the teacher is modelling thinking through the writing process, e.g., asking “What do I do next?”.

Support it; here the teacher aids the pupils in planning an essay using STOP and writing it using DARE.

References

DuPaul, G. J., Eckert, T. L., & Vilardo, B. (2012). The effects of school-based interventions for attention deficit hyperactivity disorder: A meta-analysis 1996–2010. School Psychology Review, 41, 387–412.

Graham, S., & Harris, K. R. (1993). Self-regulated strategy development: Helping students with learning problems develop as writers. The Elementary School Journal, 94, 169–181.

Harrison, J. R., Soares, D. A., Rudzinski, S., & Johnson, R. (2019). Attention deficit hyperactivity disorders and classroom-based interventions: Evidence-based status, effectiveness, and moderators of effects in single-case design research. Review of Educational Research, 89(4), 569-611.

Jacobson, L. T., & Reid, R. (2010). Improving the persuasive essay writing of high school students with ADHD. Exceptional Children, 76(2), 157-174.

Kleiman, G., Humphrey, M., & Lindsay, P. H. (1981). Microcomputers and hyperactive children. Creative Computing, 7, 93-94.

Moore, D. A., Whittaker, S., & Ford, T. J. (2016). Daily report cards as a school‐based intervention for children with attention‐deficit/hyperactivity disorder. Support for Learning, 31(1), 71-83.

Richardson, M., Moore, D. A., Gwernan-Jones, R., Thompson-Coon, J., Ukoumunne, O., Rogers, M., … & Taylor, E. (2015). Non-pharmacological interventions for attention-deficit/hyperactivity disorder (ADHD) delivered in school settings: systematic reviews of quantitative and qualitative research. Health technology assessment (Winchester, England), 19(45), 1.

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