Social Functioning in Children - Research Paper Example

ADHD & Teacher Knowledge Introduction and ment of the Problem Since the beginning of time, teachers have held very influential positions in thelives of students. They somehow have the power to make or break a student in terms of his academic performance. There are teachers who rigidly stick to their planned objectives, that disruptions such as a student’s erratic behavior can upset their teaching modes. There are those who, blessed with a broader understanding of child development and psychology, are more considerate of student’s backgrounds and life circumstances and how these affect their learning. The incidences of learning disabilities have increased in recent years. The most common of which is Attention Deficit Disorder (ADD), or its derivative, Attention Deficit Hyperactivity Disorder (ADHD). Such disorders cause students to be disruptive in class and behave in ways that would greatly affect teacher performance. Research Questions and Hypotheses This study is an attempt to investigate the current status of teachers knowledge of AD/HD? How does their knowledge impact their ability to work with their students? How does teacher efficacy relate to student outcomes? In reviewing the literature on teacher knowledge, it is hypothesized that teachers of regular children easily suspect inattentive and disruptive children as having ADHD. “Teacher ratings are often utilized because teachers have the opportunity to observe children in different school settings for long periods of time. One difficulty with utilizing teacher reports is that they tend to identify a higher proportion than the 3%–5% suggested in DSM–IV. For example, as many as 15% of the sample in one study would have been labeled ADHD by teachers (Weiler et al., 1999). Glass and Wegar also (2000) found that teachers identified 6% to 15% of students as having ADHD.” (Havey, Olson, McCormick and Cates, 2005). This paper likewise explores the reasons for such discrepancies. Definitions of Theoretical Constructs Attention Deficit/Hyperactivity Disorder (ADHD) is a behavioral disorder characterized by inattention, impulsivity, and hyperactivity (American Psychological Association. APA. 2000). It is complex syndrome of impairments related to the development of brain cognitive management systems or executive functions. It affects a person’s organization skills, concentration, focus and prolonged attention on a task, processing speed, short-term working memory and access recall, sustained motivation to work and the appropriate management of emotions. Brown (2007) has enumerated the executive functions of the brain that work together in various combinations as thus: Activation – the process of organizing, prioritizing and activating for work Focus – focusing, sustaining and shifting attention to tasks Effort – regulating alertness and sustaining effort and processing speed Emotion – managing frustration and modulating emotions Memory – using working memory and accessing recall Action – monitoring and self-regulating action . Recent research on AD/HD gives evidence that it is not a problem of will power but a chronic impairment in the chemistry of the management system of the brain. “Evidence now shows that /\DD is a highly heritable disorder, with impairments related to problems in the release and reloading of two crucial neurotransmitter chemicals made in the brain: dopamine and norepinephrine. These chemicals play a crucial role in facilitating communication within neural networks that orchestrate cognition. “(Brown, 2007). Certain medications have been manufactured to compensate for the inefficient release and reloading of essential neurotransmitters at countless synaptic connections in the brain. Individuals with the ADHD disorder have experienced remarkable improvement in their functioning when they are treated with appropriate doses of such medications. These medications alleviate symptoms only for the time when the medication is active in the brain, thus helping the individual in most self-management tasks. For children, management of ADHD should not be limited to medication and should be given a combination of interventions. Typically, ADHD symptoms manifest in early childhood before age seven. Most symptoms are observed in the school setting. Due to the fact that the behaviors that define inattention are related to academic activities, classrooms require children to focus their attention and demonstrate self-application and self discipline (Jensen, et al, 1999; Hawkins, Martin, Blanchard & Brady, 1991). However, AD/HD may or may not be accompanied by hyperactivity or other readily observable symptoms. Some students may appear to be paying attention to the discussion in class but they are actually drifting off and thinking of unrelated things. Others may be diligent in reading assignments but shortly after, will be unable to recall what had just been read. Teachers are instrumental in identifying some children who manifest symptoms of ADHD and recommend them for professional evaluation and its corresponding intervention. Hence, they should be knowledgeable enough to recognize and deal with the disorder. As a means of soliciting teacher perceptions in the process of identifying students with ADHD, rating scales are often used. There have been many that have been developed. One particular scale, the ADHD Rating Scale-IV (School Version) corresponds with the descriptions of ADHD symptoms in the Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM-IV) . It obtains teacher ratings of the frequency of the manifestation of symptoms in class. “The standardization sample of ADHD Rating Scale–IV yielded gender, age, and ethnic differences. Boys were reported to engage in more ADHD behaviors than girls, younger children received higher ratings of ADHD than older children, and African American children obtained higher ratings of ADHD than Caucasian and Latino children (DuPaul et al., 1998). Teachers also overidentified ADHD in every age group for both genders in the standardization sample.” (Havey, et al, 2005) The study of Glass and Wegar (2000) found out that most teachers believed there was a biological cause to ADHD and chose a combination of medication and behavior modification to best manage the disorder. Private school teachers with larger class sizes reported higher rates of ADHD. The study also concluded that limited resources may contribute to the over-identification of students with ADHD. Many other researches on teacher perception yielded generally similar results as that of Glass and Wegar’s study. Most teachers in the survey believed that the best intervention aside from behavioral modification includes the introduction of medication to control impulsive behavior. Glass and Wegar (2000) concluded that this preference for medical intervention is due to their observations of apparent improvement of behavior and focus of children after being medicated. These teachers may also have been influenced by media’s sensationalizing of the medication to be “miracle” pills or “quick fixes” They are usually the subjects of media hype, alluring them to be “brokers” of such medication with the promise of calmer and more manageable classes. However, they should be discerning enough to sift through information that is safe and relevant for their students. “Teachers should be trained to decode and question marketing strategies used by the pharmaceutical industry, just as medical students are.” (Phillips, 2006) In addition, recent studies (Abikoff et al., 2004a, 2004b; Hechtman et al., 2004; Klein, Abikoff, Hechtman, & Weiss, 2004) strongly suggest that adding time-consuming psychosocial interventions to intervention with methylphenidate does little to improve symptom presentation, academic functioning, emotional status, and social functioning among children with ADHD. Havey, et al (2005) found that teachers were more likely to predict larger numbers of students with ADHD if their classroom size was bigger, and contained more than the mean number of students. It was suggested that larger classrooms contain many distractions for ADHD students, and that they perform better in smaller classes with fewer distractions (Jensen, et al, 1999). “Likewise, teachers with larger class sizes may have less time to devote to students with behavioral concerns, thereby increasing the likelihood of labeling and identifying a cause for misbehavior that is “internal” to the child.” (Havey, et al, 2005). Another finding is that ethnicity affects teachers’ perceptions. Teachers of classes with mixed backgrounds had a tendency to rate children from according to their cultural expectations. If ADHD characteristics are more accepted in one culture, the incidences of ADHD will be less frequently reported (Pineda et al., 1999). For example if students from one culture are viewed as more talkative and energetic, their classmates from another culture not expected to be quite the same but exhibits talkativeness and great energy nonetheless, these latter classmates may have a higher rating of ADHD. Brown (2007) has identified three specific groups of students with ADD that tend to be overlooked namely the bright students, female students and students under stress. Bright students who underachieve are merely thought of as lazy, as it seems inconsistent to think that one is bright and at the same time have significant ADD impairments. ADD is indeed possible to affect all IQ levels. Female students with ADD may be harder to spot because young girls do not generally call attention to themselves with dramatic misdemeanors. Students under stress like those affected by social stressors such as divorce, unemployment, poverty and multiple relocations, are believed to perform poorly due to such stressors. “Teachers may assume that poor achievement is just the students reaction to these difficulties. They may not realize that ADD is more common in families under psychosocial stress.” (Brown, 2007) The problem in relying too much on teachers’ reports is the likelihood of subjectivity. “While there can be no doubt about the potential importance of teachers, critical questions about their role have been asked. Several studies have attempted to ascertain the degree to which teacher reports are based on student behavior in the classroom, and some have questioned whether teacher reports may be subject to the halo effect or other biases” (Lauth, Heubeck and Mackowiak, 2006). It is likely that a defiant student will be rated by a teacher with ADHD regardless of the observed level of activity or attentiveness. Hence, beyond teacher reports, the direct observation of students in their actual classrooms, rather than laboratory studies or clinical interviews, provides a very important window to researchers who want to understand the extent and the ramifications of the disorder. (Lauth, et al, 2006) With a prevalence rate of 3% to 5% teachers will undoubtedly encounter a student with ADHD in the course of their teaching practice. Therefore, it is imperative that they become aware of effective interventions that help alleviate some of the difficulties students with ADHD may present. Apart from specialized individual interventions, there have been developed class-wide behavioral and academic interventions which are more cost-effective and efficient and may not only help one student perform better in the classroom, but its use may benefit the performance of the whole class itself. (Harlacher, Roberts & Merrell, 2006). (See Appendix) Behavioral Interventions include: Contingency Management; Therapy Balls; Self-Monitoring; Peer Monitoring and Instructional Choice. Academic Interventions include: Classwide Peer Tutoring; Instructional Modification and Computer-Assisted Instruction The process of acquiring knowledge and skills in ADHD and its management will greatly help students concerned. The teachers’ continued search for knowledge entails a lot of hard work and commitment. “Teachers should contribute to documenting educational and other outcomes of children with ADHD, through participating in formal collation of data across school regions about outcomes.” (Phillips, 2006) In doing so, the necessary research and development in the area of ADHD is expected to grow to reach out to more and more children being hampered in their learning. Research Design Like other studies before this current one, intensive survey and interview methods shall be used in the methodology of gathering data. Teacher rating scales that correspond to the Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM-IV) descriptions of AD/HD will be disseminated to teachers of public and private elementary schools to determine the status of teacher knowledge on AD/HD. Results from the analysis of data will be the guide in developing a module of teacher training to correct misconceptions, elevate teacher knowledge and empower teacher with skills in managing ADHD in their classes. Implementation of class-wide interventions suggested by the study of Harlacher, Roberts & Merrell (2006) will be monitored for at least a month to validate its effectivity in the improvement of class performance of children with AD/HD. Reports of teachers on this implementation process shall likewise be gathered and collated for further analysis. Analysis and Potential Confounding Variables Based from the review of literature, this study is subject to the biases and pre-conceived notions of teachers regarding ADHD which may affect their participation in the study. The choice of subjects may either be selective or randomized. Although the main point of interest of the study is the status of teacher knowledge of ADHD, several variables must likewise be considered, with reference to the review of literature. These variables are: class size, ethnicity of students, presence of clinically-diagnosed ADHD students, gender distribution of students, age and level of students, IQ levels of students and years of teaching experience. Significance and Limitations. The main significance of a study exploring the status of teachers’ knowledge of AD/HD is to help them in the management of their classes with AD/HD students, or if they do not have one in their class, equip them with necessary knowledge and skills in the even that they encounter an AD/HD student. The main beneficiaries of such an endeavor are truly the children who are impaired with the disorder, as they will be the recipients of specialized attention and support in their learning. Foreseen limitations may be the cooperation of schools to allow their teachers to take part in the study, as school officials may perceive it to be disruptive in the operations of the school; the hesitation of the school and parents to try out the class-wide interventions, as in everything else, attempts towards change creates instability as people are pulled out of their comfort zones. References Abikoff, H., Hechtman, L., Klein, R. G., Gallagher, R., Fleiss, K., Etcovitch, J., et al. (2004). “Social functioning in children with ADHD treated with long-term methylphenidate and multimodal psychosocial treatment.” Journal of the Academy of Child and Adolescent Psychiatry, 43, 820–829. Abikoff, H., Hechtman, L., Klein, R. G., Weiss, G., Fleiss, K., Etcovitch, J., et al. (2004). “Symptomatic improvement in children with ADHD treated with long-term methylphenidate and multimodal psychosocial treatment. “Journal of the Academy of Child and Adolescent Psychiatry, 43, 802–811. Brown, T. E. (2005). “Attention deficit disorder:The unfocused mind in children and adults.”New Haven. CT: Yale University Press. Brown, T.E. (2007) “New approach to attention deficit disorder.” Educational Leadership Feb. 2007 DuPaul, G. J., Power, T. J., Anastopoulos, A. D., & Reid, R. (1998).ADHD Rating Scale–IV Checklists, Norms, and Clinical Interpretation.New York: Guilford. Glass, C. S., & Wegar, K. (2000). “Teacher perceptions of the incidence and management of attention deficit hyperactivity disorder.” Education, 121, 412–420. Harlacher, J.E., Roberts, N.E., Merrell, K.W. (2006) “Classwide interventions for students with ADHD.” Teaching Exceptional. Children. Nov/Dec 2006 Council for Exceptional Children Havey, J.M., Olson, J.M., McCormick, C., & Cates, G.L., (2005) “Teachers’ perceptions of the incidence and management of attention-deficit hyperactivity disorder.” Applied Neuropsychology 2005, Vol. 12, No. 2, 120–127 Hawkins, J., Martin, S., Blanchard, K. M., & Brady, M. P. (1991).”Teacher perceptions, beliefs, and interventions regarding children with attention deficit disorders.” Action in Teacher Education,13, 52–59. Hechtman, L., Abikoff, H., Klein, R.,Weiss, G., Respitz, C., Kouri, J., et al. (2004). “Academic improvement and emotional status of children with ADHD treated with long-term methylphenidate and multimodal psychosocial treatment.” Journal of the Academy of Child and Adolescent Psychiatry,43, 812–819. Jensen, P. S., Mrazek, D., Knapp, P. K., Steinberg, L., Pfeffer, C., Schowalter, J., et al. (1999). “Cultural issues in diagnosis and treatment of ADHD.” Journal of the American Academy of Child and Adolescent Psychiatry, 38, 1591–1597. Klein, R. G., Abikoff, H., Hechtman, L., & Weiss, G. (2004). “Design and rationale of controlled study of long-term methylphenidate and multimodal psychosocial treatment in children with ADHD.” Journal of the Academy of Child and Adolescent Psychiatry, 43, 792–801. Lauth, G.W., Heubeck, B.G. & Mackowiak, K. (2006) “Observation of children with attention-deficit hyperactivity (ADHD) problems in three natural classroom contexts.” British Journal of Educational Psychology (2006), 76, 385–404 Pineda, D., Ardila, A., Rosselli, M., Arias, B. E., Henao, G. C.,Gomez, L. F., et al. (1999). “Prevalence of attention-deficit/hyperactivity disorder symptoms in 4- to 17-year-old children in the general population.” Journal of Abnormal Child Psychology, 27, 455–467. Phillips CB (2006) Medicine goes to school: “Teachers as sickness brokers for ADHD.” PLoS Med 3(4): e182. Weiler, M. D., Bellinger, D., & Marmor, J. (1999). Journal of the American Academy of Child and Adolescent Psychiatry, 38, 1139–1147. Appendix Class-wide Interventions for Students With ADHD by Harlacher, Roberts & Merrell (2006) Read More