Academic Interventions for Students with ADHD - Essay Example

Academic Interventions for Students with ADHD ABSTRACT The current paper aims to evaluate the efficacy of academic interventions for students with attention deficit hyperactivity disorder (ADHD). ADHD is a developmental disorder affecting the behavioral, learning and social skills of children and continues to affect them even in the adulthood due to lack of proper management. Several behavioral techniques and medications have been used for its management, but they have little impact on the improvement of academic performance. Academic performance along with behavioral and social skills reportedly improve by academic interventions such as self monitoring, peer tutoring, instructional modifications, strategy training and computer aided instructions. Academic interventions have been studied for the improvement of working memory, attention spans and reducing hyperactivity, inattentions and aggressiveness often observed in children with ADHD. During the recent decades, technological advances have led to the development of strategies that affect multiple sense organs by using varied audio visual tools. Further modifications in the conventional approaches of peer tutoring and self monitoring too have added to the efficacy of these academic interventions. academic interventions for students with ADHD Introduction Attention Deficit Hypersensitivity Disorder (ADHD) has been known to be a disorder impairing the learning ability and social skills of individuals affected by it. Recently it has been identified to be a neurobiological disorder that results as a consequence of disturbances of the dopamine system (Hughes & cooper, 2007). The American Psychiatric Association (APA) defines ADHD as “a persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequently displayed and more severe than is typically observed in individuals at a comparable level of development” (APA, 2000). Recent estimates of prevalence of ADHD by US Centers for Disease Control report that up to 8.4% of American children in the age group of 6-17 years have been diagnosed with the disorder at some stage (Parens & Johnston, 2009). Global estimates of prevalence are difficult to determine due to heterogeneity of the symptoms and terminology. The definition and diagnosis of the disease is complex due to the multidimensional nature of the ADHD symptoms. The definition provided by APA (2000) lists a set of 18 core behavioral symptoms divided into two subsets; inattention and hyperactivity-impulsivity. Each of these is further characterized by nine symptoms. On the basis of symptomatic profile the Diagnostic and Statistical Manual of Mental Disorders (DSM) classifies ADHD into three subtypes viz. predominantly inattentive (ADHD-IA), predominantly hyperactive impulsive (ADHD-HI) and combined type (ADHD-CT) (APA, 1994). The individuals diagnosed with ADHD form a highly diverse group with most children being assigned the zone of ambiguity (Parens &Johnston, 2009). A positive diagnosis is confirmed by the observation of at least six of the core symptoms in a child below the age of 7, the presence of which must lead to a disturbed function in any two settings (McClellan & Werry, 1997). ADHD leads to substantial impairment of academic performance of the affected individuals as a consequence of its adverse impact on working memory (WM), response inhibition and temporal processing ((Castellanos & Tannock, 2002). Due to improper management the problem continues till adolescence and even adulthood affecting the interpersonal relationships, occupational and social life of the individual (Biederman et al., 1997). The management strategies for ADHD involve behavioral treatment alone or along with medications such as methylphenidate and dexamphetamine (Wright et al., 2009). Though quite effective for other symptoms of ADHD, neither of these treatments are able to improve academic performance of the child (Rabiner et al., 2008). Besides these individualistic academic interventions comprising of specially designed teaching learning materials and techniques suited to individual child needs have been found to be effective in bringing about enhancement of cognitive abilities of the child (Kerns et al., 1999). The current paper aims to explore the academic interventions and their impact on the learning abilities of the individuals with ADHD. Academic Problems and ADHD ADHD have been often found to co-occur with academic underachievement, with researches reporting a co occurrence as high as 80% and approximately one third of individuals with ADHD also diagnosed with learning disabilities ((Barkley, 2006). These children often achieve poor grades, have lower IQ, are often recommended for special schools, and have high high school dropout rates (DuPaul et al., 2011). The core symptoms of inattention, impulsiveness and hyperactivity associated with ADHD have a negative impact on the academic skills such as reading writing and mathematics. Inattention causes increased off task behavior, frequent distractions and hence, lower work output. Hyperactivity is associated with fidgeting and lower probability of task completion. Due to impulsivity the child reacts before considering the alternatives, fails to foresee and plan. Therefore, the child fails in completion of long term goals (Raggi and Chronis, 2006). The mechanism underlying the low academic underachievement in students with ADHD is incompletely understood, but several theories have been proposed attributing it to executive function deficits (EFDs), WM deficits, deficits associated with neural networks controlling attention etc. Unified theory proposed by Barkley attributing ADHD to the deficiencies in pre-frontal cortex, the mediators of behavioral inhibitions (primary deficit in ADHD) and executive functions (EFs) has been frequently supported by experimental evidences (Wright et al., 2009). Academic Interventions Multiple researches during the last decade have been directed at the development of academic interventions for ADHD that aim to improve the cognitive ability of the child by repeatedly activating and stimulating the attention system of the child (Kerns et al., 1999). Some of the major academic interventions devised for students with ADHD include self monitoring, peer tutoring, instructional modification, strategy training and computer assisted instruction. i. Self Monitoring Interventions based on self monitoring and self regulations are intended to ensure complete involvement of child with the benefit of self selection of goals and tasks, planning the steps for goal achievement, stepwise monitoring of achievements, and in certain designs even grading for the achievement rewarded by the child. It is expected that as a consequence of minimizing guidance levels of independence and discipline can be improved leading to enhancement of behavioral and academic skills. A study exploring the comparative efficacy of methylphenidate, self monitoring and a combination of the two on reading and learning skills was conducted by Chase and Clement (1985). The study involved six participants, and five of these exhibited significant improvement in academic skills as a consequence of self monitoring intervention exclusively. The intervention has been found to be more effective when employed in combination with other interventions like positive feedback and task stimulations. However, self monitoring interventions are limited by the initial cognitive ability of the child. This is not effective for younger children or children with very low cognitive levels (Chase and Clement 1985). i. Peer Tutoring Peer tutoring is a strategy devised to overcome the problem of lack of individualized attention in a class of large strength. The intervention successfully provides individualized attention to the child and enables the maintenance of pace in accordance with the child’s need along with the added benefit of prompt feedbacks (Raggi and Chronis, 2006). A recently used modification of peer tutoring termed as Classwide Peer Tutoring (CWPT) has been found to be further effective. It involves training and involvement of regular students in tutoring procedure followed by their random pairing with ADHD students. The ‘tutor’ in the pair is provided with academic material along with stepwise instructions to be followed during various sessions for the learning of particular subject. He provides feedbacks according to the progress of the course, while the teacher oversees the proceedings. After several repetitions of the material, the tutor student roles are interchanged; and the procedure is repeated with the new roles (Maheady & Gard, 2010). One of the preliminary studies directed at investigating the efficacy of CPWT using ABAB reversal design showed significant increase in on task output along with lowered inattention, hyperactivity and enhanced accuracy in mathematical problem solving (DuPaul and Henningson 1993). During another study also based on ABAB reversal design, involving 18 participants with ADHD and 10 regular students the weakest academic field of the child was targeted. The participants showed a mean rise in on task behavior from 29% at baseline to 80% during intervention period was reported, with simultaneous fall in off task behavior as a consequence of the intervention. However the higher variability in academic improvement was reported compared to behavioral improvements during this study. Peer tutoring is a rationalized and evidence supported intervention, with added advantage of requiring readily available classroom resources. It is therefore easy to implement and monitor. Involvement of entire class in CWPT ensures that there is no demarcation among children with and without ADHD thus preventing development of stigmas associated with other individualized interventions. It also improves the social skills of the child by providing opportunity of interaction with peer. The intervention has also been reported to be effective for home settings. Intensive studies are however required for the planning and designing of this intervention to ensure maximum results (Raggi and Chronis, 2006). ii. Instructional Modification Interventions based on instructional modification aim to simplify multistep tasks by dividing them into simpler component steps that are easier to accomplish with shorter attention span and impulsivity characteristic of children with ADHD. Every step is accompanied by its own set of clear and precise instructions that are easy to follow and remember. To enable the child to attend to the instructions and help in remembering them, the instructions use colors, textures and patterns. The instructions and tasks are modified according to the cognitive level and pace of the individual child. Thus not only task completion is achieved, frustration levels are lowered and confidence as well as motivational levels are boosted as a consequence of this technique (Raggi and Chronis, 2006). Several versions of this group of interventions have been studies mainly with references to use of varied audio and visual techniques for modification of instructions. Enhanced rates of achievement during reading and writing tasks have been reported as a consequence of addition of colors to the instructional material. Further addition of color later during the learning tasks enhances performance more in ADHD children compared to situation where it was added during the early stages of learning. In the early stages color can be a distractive factor especially for longer or complex tasks (Belfiore et al., 1996). However these modifications need to be reviewed and improvised routinely since with loss of novelty, the stimulating effect also reduces. Though the instructional modification intervention has shown promising results in certain studies, yet its efficacy remains to be backed by scientific evidences. iii. Strategy Training Strategy training involves imparting specific skill to the child that can be applied in various situations and can lead to improved performance. A study to assess impact of directed note taking activity during classroom lecture used extensive guidance and instructions to divide the lectures into main points and supporting materials. Gradually the instructions were reduced. Significant improvement in note taking with improved on task attention higher levels of comprehension was observed. However, ultimate academic performance is determined by utilization of the high quality notes for continued studies. Limited literature available on strategy training prevents confirmation of its efficacy. However its use in combination with other academic interventions can be expected to provide significant results as is evidenced by a multicomponent student training program employing psychosocial as well as academic interventions studied by Evans et al (2004). iv. Computer Assisted Instruction (CAI) Computer aided training methods have shown gradual enhancement of WM and alter anterior cingulated activity (Shalev et al., 2007). A computerized progressive attentional training (CPAT) program, comprising of four sets of tasks, each targeted at training one of the four attentional networks namely, sustained attention, selective attention, orienting attention and executive attention was devised (Shalev et al.,2007). The 16 session 8 week training program resulted in remarkable enhancement of academic and behavioral skills. Besides direct stimulation of attention networks the training programs also involve specific guidelines for gradual progress to higher complexity level. This has multiple impacts on the attention enhancement as well as other aspects controlling the child’s performance such as self regulation and control. Success during the training program as a consequence of achievable goals, along with gradual progress to higher levels also contributes to improving the self esteem of the children, and has a motivational impact. However, the study neither assesses any objective attentional measure, nor does it include teacher’s assessment. Moreover in absence of long term follow up, the persistence of the observed attention enhancement cannot be ascertained. Conclusion Academic interventions are beneficial for improvement of academic, behavioral and social skills in children with ADHD. At least some of the features of interventions reported in the literature can safely be claimed to provide immense benefit. Evidences available from peer tutoring, self monitoring and self regulation, choice making and self verbalizations of the instructions gave better results compared to conventional modes of teaching. However, most studies on academic interventions are short term and involve small sample size. In absence of an evaluation of long term consequences, and lack of fidelity and integrity of the experimental procedure, conclusion’s credibility is compromised. Being based on certain common approaches, academic interventions can be significantly beneficial if implemented after thorough evaluation and planning. Moreover, implementation of single intervention can be more effectively replaced by a multimodal approach. REFERENCES Read More