Special Education

Teaching Students with Attention-Deficit/Hyperactivity Disorder

How Can AD/HD Be Effectively Managed?

Students with AD/HD may benefit from adjustments to several aspects of their lives. If parents and educators, along with other service providers, are able to work together to help these students, they are more likely to become independent adults. A combination of individual and family counselling, parent training and support groups, appropriately structured educational programs, and sometimes medication may be recommended.

On a case by case basis, effective management should include some of the following components:

Increasing Understanding of AD/HD

The most fundamental element in effectively managing this disorder is increasing the understanding of AD/HD in teachers, parents, and the students with AD/HD themselves. Providing information to each of these groups about the nature of AD/HD and strategies that have proved useful is critical. Building empathy in teachers and parents will increase their ability to be effective and view the student's difficulty in the context of a disorder rather than purposeful misbehaviour or lack of effort. Students need to be helped to develop a positive attitude about learning to deal with AD/HD rather than to lean on the label as an excuse for lack of effort and learned helplessness.

Enhanced Skills for Managing Students with AD/HD

When educators have a thorough understanding of AD/HD management strategies, they can plan and provide day to day activities that successfully include the student with AD/HD. Many teacher professional development activities teach skills for managing and reinforcing appropriate behaviour. Recently published books and videos about AD/HD can be valuable resources (see Appendix 1).

In addition to learning about managing the disorder, teachers of students with AD/HD may benefit from the experiences of others who have worked with students with AD/HD. Many communities around the province have local chapters of provincial and national support groups that may be able to provide parents and educators with information about locally available supports. See Appendix 1 for a listing of these organizations.

Strategies to Enhance Self-Esteem in Students

The student with AD/HD also need to develop an understanding about the disorder. Teachers may be part of the support system to assist students in self understanding and acceptance. A supportive relationship with a teacher has proven to be one of the most significant positive influences on students with AD/HD. Often, students who lack important social skills and/or have difficulty learning suffer from a loss of self-esteem. As students with AD/HD grow older, they may need help with issues of peer acceptance and walking the fine line between independence and belonging. On a case by case basis, some of the following may be planned to enhance a student's self esteem:

participation in a structured, disciplined activity such as karate, cadets or ballet,
involvement in an individual sport such as swimming, running or racquet games,
volunteering in the community (e.g. Boys and Girls Clubs, soup kitchens, senior citizens' homes, hospitals),
a part-time job or work experience placement, and/or
individual or group counselling.

Restructuring the Environment

Students with AD/HD typically have underdeveloped self management skills which affects their ability to plan and carry out tasks to completion. This deficit could result in students having difficulty with the following skills:

time management,
finding materials,
beginning independent work,
maintaining on-task behaviour long enough to complete work,
remembering the requirements and time frame for handing in assignments, and
attending school regularly.

External structures such as those listed below can assist students to compensate for their limited self management skills:

checklists of required materials,
agenda to keep track of requirements,
classroom routines to provide consistency for students,
"learning how to learn" and study skills strategies that provide structures for completion of assignments, and
breaking assignments down into manageable parts that can be checked and reinforced.

Only by teaching and reinforcing the above noted strategies can educators increase their effective use. Staff and/or students (including the case manager, a teacher's assistant, the homeroom teacher, a study partner, or a child care worker) can assist the student with AD/HD to use these strategies to keep on track at school. The ultimate goal should be to help the student to develop self monitoring strategies that will assist them to function effectively on their own. ( See Appendix 2).

Enhanced Home-School Communication

For greatest effectiveness, teachers are encouraged to work with parents to support students with AD/HD. For example, a communication book signed by parents can be used to ensure that parents are aware of issues that arise in class and teachers are aware of issues that arise at home. Both should ensure that positive messages are included frequently, as parents and teachers can grow discouraged when negative comments dominate communication. An agenda for older students can be used to ensure clear communication about assignments, projects and upcoming tests. An extra set of text books at home can reduce the number of lost or misplaced books. For student with severe difficulties, daily or weekly progress reports to parents can assist teachers to involve parents in ongoing support. In some cases, teachers and parents may wish to establish a reward system in which points that are awarded for school behaviours are used to earn home-based reinforcers.

School Based Support Services

Students with AD/HD should receive school based support services if the disorder significantly affects their school performance. An estimated 25% of students with AD/HD also have learning disabilities. When students with AD/HD have academic difficulties, they may be supported through Learning Assistance programs or services for students with Severe Learning Disabilities. Students who need behavioural support in order to achieve success at school may be supported through programs for students with moderate or severe behavioural disorders. For further information on supporting students with special needs, see Special Education Services: A Manual of Policies, Procedures and Guidelines (Ministry of Education, Skills and Training, 1995).

Specific examples of academic and behavioural support will follow in the Case Studies section of this book. For further suggestions see Teacher Students with Learning and Behavioural Differences: A Resource Guide for Teachers (Ministry of Education, Skills and Training, 1996).

Medical Intervention

An intervention plan for some students with AD/HD may include pharmacological treatment. While the media has described much controversy about using medication to treat AD/HD, scientific research describes medication as one of the most effective treatments for the disorder. The use of medication should be supervised regularly by the prescribing physician. The doctor, parent, child and school staff should all contribute important information to establish a baseline of symptoms and assist in monitoring the effects of medication on behaviour and academic performance. Medication alone should never be the sole intervention. While medication may assist the student to focus on learning, it will not compensate for skills and knowledge that have not been acquired.

The decision whether to use medication or not is one that should be made on a case by case basis by the family of the student with AD/HD and their physician. Student involvement in the decision is important. At times, parents may call upon teachers to provide information or opinions about medication. Teachers should not provide recommendations to parents regarding medications; they should direct these queries to a physician trained to deal with AD/HD and other childhood disorders. Teachers can provide observational data describing the student's behaviour to assist in monitoring medication. Because medication must be administered regularly, the family may request that the school administer medication. Teachers should be aware of district policies and procedures related to the administration of medication, including confidentiality for the student. Accurate records should be kept of medication administration. Stimulant medications are often prescribed in the treatment of AD/HD. Many people question why stimulants would be used for students who already appear to be over stimulated. Some research shows certain areas of the brain of students with AD/HD which control circulation are not as active as those of other children. These medications stimulate the areas of the brain which control concentration which allows the child to stop and think before acting.

Other medications or combinations of medications may be prescribed for students with AD/HD.

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