students with ADHD instructional strategies best practices

Part One: At-Risk Preschoolers and ADHD
At-Risk Preschoolers and Early Developmental Delays
Because early intervention can be critical for optimizing student outcomes, identifying at-risk students in preschool has become built into the Individuals with Disabilities Education Act (IDEA). In fact, IDEA also offers guidelines for identifying possible developmental delays in infants and toddlers who are under age three and who would be “likely to experience a substantial developmental delay if early intervention services are not provided,” (Taylor, Smiley & Richards, 2009, p. 413). For preschoolers, the terminology used in IDEA changes from “at risk,” to more straightforward terminology based on exhibited developmental delays in terms of cognitive, social, emotional, physical, or other constructs of development. However, this is not to say that special education teachers and administrators do not use the term “at risk” when it comes to identifying those preschoolers who are exhibiting developmental delays and also have environmental triggers that could exacerbate the problems such as trauma or adverse socioeconomic conditions (Taylor, Smiley & Richards, 2009). Special educators are therefore legally and ethically obliged to provide all at risk preschoolers with the programs and services they need, including those based on instructional strategy and design. Being at risk can include children who have already been diagnosed with any type of disability but have yet to exhibit any externalizing or internalizing behaviors. Defining and identifying at risk preschoolers is going to be a collaborative effort involving interactions with members of the medical team, counselors, social workers, and parents.
Characteristics of at risk preschoolers vary too much to generalize. Special educators may notice possible signs of physical, emotional, sexual or psychological abuse: all of which are risk factors. Other risk factors the special educator may use to characterize students as being at risk include instability in the home, extreme poverty or homelessness, substance abuse in the home, or exposure to violence in the community (Taylor, Smiley & Richards, 2009). In addition to these characteristics, a preschooler who is at risk may also have been considered at risk in infancy or as a toddler according to the IDEA definitions, thereby warranting additional assessments and interventions (Taylor, Smiley & Richards, 2009). When students fall behind their peers in terms of language or literacy development, or exhibit externalizing behaviors like aggressions, the special educator may characterize the preschool student as being at risk for early developmental or cognitive delays.
The key to working with at risk preschoolers is early intervention. However, special educators also have the opportunity to identify the structural supports and other protective factors that can promote resilience in the child and mitigate risk (Taylor, Smiley & Richards, 2009). In terms of best practice instructional practices, content should be adapted to suit the needs of the child. Children who are at risk or who exhibit early developmental delays will be steered in the direction of the general curriculum, albeit with special education supports in subjects like mathematics, literacy, or social skills (Taylor, Smiley & Richards, 2009). Reaching out to at risk students in preschool, or those with early developmental delays, can reduce risk factors and even lead to the child no longer needing special literacy instruction by kindergarten (Taylor, Smiley & Richards, 2009). Although many of the factors that precipitate early developmental delays due to environmental triggers like trauma are due to an unstable or unhealthy home environment, research does show that family support in early intervention instructional strategies promotes successful student outcomes (Taylor, Smiley & Richards, 2009). In fact, engaging the parents of an at risk preschool student might reduce the risk factors by providing the parents with opportunities to access community resources they need. Research also shows that parent training can be an efficacious means of helping preschool at risk students or students with early developmental delays (Rimestead, Lambek & Christiansen, 2016).
Attention Deficit/Hyperactivity Disorder (ADHD)
Although special education teachers will invariably address the needs of students with ADHD in their classrooms, ADHD is not one of the conditions covered under IDEA. Therefore, there is no legal definition of ADHD (Taylor, Smiley & Richards, 2009). Definitions are based on psychiatric descriptions of the symptoms associated with the diagnosis. Psychologists have, therefore, operationalized a definition of ADHD based on empirical research. The definition of ADHD is based on symptoms and symptom persistence, with characteristics like inattentiveness and poor impulse control that interfere with the student’s performance in the classroom (Taylor, Smiley & Richards, 2009). To be diagnosed with ADHD, the symptoms need to be present for at least six months and also be “persistent, frequent, and severe,” in order to avoid erroneous diagnoses (Taylor, Smiley & Richards, 2009, p. 444).
The characteristics of students with ADHD follow from the psychiatric definition, with inattentiveness or inability to concentrate or focus a major feature. Other characteristics of students with ADHD include being impulsive or hyperactive, acting without thinking in ways that are developmentally inappropriate. However, special education teachers need to realize that not all children will exhibit the same symptoms. Some will be characterized more by the inability to concentrate, and demonstrate few impulse control or hyperactive signs and other students may be the opposite (Taylor, Smiley & Richards, 2009). Older students and adolescents might exhibit more inattentive characteristics and younger students more hyperactive ones (Taylor, Smiley & Richards, 2009). Hyperactive or impulsive characteristics include excessive talking, inability to play quietly, inappropriate running or other activities, and impatience when waiting in line or for one’s turn in class (Taylor, Smiley & Richards, 2009). Characteristics may also be age and gender-dependent, as well as impacted by sociocultural factors (Kvande, Belsky & Wichstrom, 2017). Regardless of how the symptoms cluster and manifest in children with ADHD, the disorder does impact social and academic performance. Therefore, special education teachers and administrators need to be aware of best practices instructional strategies that support students with ADHD.
Best practices in instructional strategies when working with students with ADHD will be individualized. Some students may require pharmacological interventions and counseling services in addition to instructional strategies, and teachers may be aware of these interventions. Direct instructional strategies like mnemonics may help students with ADHD master the core curriculum, as they are not entitled to an individualized education plan under IDEA. Special education teachers are nevertheless ethically obliged to provide the students with ADHD with the least restrictive environment that suits their unique needs, while also embracing diversity and the principles of inclusion in the classroom (Freedman, 2016). Therefore, special education teachers may work in a collaborative teaching environment to help the general education teacher with direct instruction or promoting student self regulation to aid with classroom management (Taylor, Smiley & Richards, 2009). Self-monitoring techniques and self-reinforcement strategies can provide the student with the cognitive tools they need to cultivate desirable behaviors (Taylor, Smiley & Richards, 2009). Research on parent training of students with ADHD has also been promising, encouraging special education teachers to suggest parent training as an additional intervention (Rimestead, Lambek & Christiansen, 2016). In addition to direct instruction, other methods that have been proven effective when working with students with ADHD include precision teaching, which is a systematic means of adapting instructional strategies (Taylor, Smiley & Richards, 2009). The special education instructor can become familiar with multiple tools and techniques and apply them accordingly to students with ADHD.
Part Two: Best Practice Instructional Strategies
At Risk Preschoolers and Early Developmental Delays
Best practice instructional strategies are evidence-based but also individualized to suit the needs of each student. When working with at risk toddlers, and those with early developmental delays, the key component to effective instructional strategy and classroom design is early intervention. Early intervention entails early identification, via astute monitoring of each child, taking into account the sociocultural and family factors that may make the child at risk for further emotional or developmental delays. Special education teachers can approach at-risk preschoolers or preschoolers with early developmental delays by focusing both on instructional content and on instructional design, pedagogy, or procedures. Based on the principles and parameters of IDEA, special education teachers are also guided towards adaptations or accommodations that allow at risk preschoolers and those with early developmental delays to participate fully in the general education curriculum. IDEA makes a wide range of early intervention services available to administrators, teachers, and parents of students in preschool or early childhood education.
Prevention being the key to best practices with at risk preschool students or students with early developmental disorders, teachers may recognize the different stages at which prevention and intervention takes place. Primary prevention focuses on harm prevention, while secondary prevention focuses on reducing the effects of a harm that has already occurred, and tertiary prevention refers to more intensive cases in which the child needs to build resilience through accessing additional community resources (Taylor, Smiley & Richards, 2009). The special education teacher may consider working with social workers as part of the overall instructional strategy, as identifying the family factors or environmental variables that are placing the child at increased risk are ones that are beyond the jurisdiction of the teacher. Instructional strategies are less about specific modifications to course content and curriculum, or even adaptations to teaching strategies, and more about working closely with the preschooler and the family members.
Even so, IDEA does guarantee that early intervention will be coupled with specific instructional strategies for reducing risk and improving student performance. Focusing on literacy skills development is one of the most important means of adapting both instructional content and methods (Taylor, Smiley & Richards, 2009). To evaluate the effectiveness of literacy instruction, the teachers can continue to monitor student progress in reading and writing. With the support of school administrators, teachers can receive specialized professional training in strategies that support students with early developmental delays. Likewise, general education teachers can receive professional training in offering early interventions like social and behavioral control strategies and methods to involve the family more in the student’s education (Taylor, Smiley & Richards, 2009). Teachers can practice different communications approaches with students who are at risk, such as asking more open-ended questions to stimulate the child’s interest in sharing, or to make reading activities more enjoyable and fun (Taylor, Smiley & Richards, 2009). Administrators may also consider additional means of training general education instructors in meeting the needs of students with early developmental delays, such as using Enhanced Milieu Teaching (Hancock, Ledbetter-Cho, Howell & Lang, 2016). IDEA does guarantee the right to early intervention among preschoolers who have been identified as being at risk, too.
Unfortunately, IDEA does not provide the same guarantees for students with ADHD. Therefore, special educators need to develop best practice instructional strategies in accordance with emerging psychiatric literature. General education teachers might not know much about best practices, especially given the lack of legal supports for students with ADHD (Blotnicky-Gallant, Martin & McGonnel, 2014). One of the most important ways of improving instructional design in the classroom is by training all general education teachers in best practices and classroom management. States vary in their legal regulations and financial programs designed to support parents, and special education instructors also need to take such issues into account (Morrill, 2018). Some states may offer financial supports for early identification of ADHD or financial support for medications used to treat ADHD symptoms, but others will not, impacting instructional strategies and their overall effectiveness (Morrill, 2018).
The behavioral components of ADHD do have a strong bearing on student academic and social performance in the classroom. Monitoring student progress over time requires a concerted collaborative effort, working with general education teachers, counselors, and parents. Specific instructional strategies should focus on helping the student develop self-monitoring and self-management skills, which may result in improved performance academically and socially (Taylor, Smiley & Richards, 2009). Direct instruction, cognitive-behavioral modification strategies, behavioral intervention, and precision teaching are also best practices instructional strategies that can be used, even without IDEA support (Taylor, Smiley & Richards, 2009). Finally, teachers may consider modifying the environment to minimize distractions or to promote prosocial behaviors. For example, students with ADHD may perform better in a “highly structured environment,” and one that lacks order or routine (Taylor, Smiley & Richards, 2009, p. 463). Students with ADHD may not perform well on group exercises, which means that teachers may want to focus more on instructional strategies using independent learning. Teachers are also advised to keep their lectures focused, while offering students with ADHD recordings or digital copies they can review later in their own time in case their concentration waned (Taylor, Smiley & Richards, 2009). This way, teachers support the unique cognitive needs of students with ADHD while still maintaining their inclusion in the general education classroom. Technology can also help students with ADHD process course content in ways that are meaningful to them. In some cases, peer mediated instruction may be an instructional strategy that helps students with ADHD (Taylor, Smiley & Richards, 2009).
Some students with ADHD may have comorbid conditions such as developmental or intellectual disabilities that do warrant their coverage under IDEA and the use of an IEP. In cases like these, instructional strategies will vary depending on the comorbidity and the assessment of the student. For example, research on students with ADHD comorbid with reading disorders benefitted from an intensive reading instruction intervention—whether or not the children were on medications (Tannock, Frijters & Martinussen, 2016). Evidence-based instructional strategies like intensive reading instruction and precision teaching can be taught to general education teachers or implemented by special education teachers in the collaborative teaching environment to ensure inclusivity.
As with at risk preschool students, students with ADHD benefit from additional supports and not only instructional strategies applied in the classroom. Involving the family, and techniques like parent training, help to provide the ongoing support the student needs. Parents who are engaged in their student’s education can learn how to apply the instructional strategies at home to promote student academic success and overcome the challenges associated with memory and content mastery that some students with ADHD experience. When special educators focus on early intervention, they have a much greater chance of helping students with special needs.
References
Blotnicky-Gallant, P., Martin, C. & McGonnel, M. (2014). Nova Scotia teachers’ ADHD knowledge, belief, and classroom management practices. Canadian Journal of School Psychology 30(1): 3-21.
Freedman, J.E. (2014). An analysis of the discourses on attention deficit hyperactivity disorder (ADHD) in US special education textbooks, with implications for inclusive education. International Journal of Inclusive Education 20(1): 32-51.
Hancock, T.B., Ledbetter-Cho, K. Howell, A. & Lang, R. (2016). Enhanced milieu teaching. In Early Intervention for Young Children with Autism Spectrum Disorder, Springer.
Kvande, M.N., Belsky, J & Wichstrom, L. (2017). Selection for special education services. European Journal of Special Needs Education 33(4): 510-524.
Morrill, M.S. (2018). Special education financing and ADHD medications. Journal of Policy Analysis and Management 37(2): 384-402.
Rimestead, M.L., Lambek, R. & Christiansen, H.Z. (2016). Short- and Long-Term Effects of Parent Training for Preschool Children With or at Risk of ADHD. Journal of Attention Disorders, https://doi.org/10.1177/1087054716648775
Tannock, R., Frijters, J.C. & Martinussen, R. (2016). Combined modality intervention for ADHD with comorbid reading disorders. Journal of Learnign Disabilities 51(1): 55-72.
Taylor, R.L., Smiley, L.R. & Richards, S. (2009). Exceptional Students. New York: McGraw-Hill.