Classroom interventions for students with attention deficit hyperactivity disorder in inclusive primary school

Abstract. A boy with attention deficit hyperactivity disorder (ADHD) in inclusive primary school who we have been teaching often shows problem behaviors in writing tasks, which his teacher often struggles to manage. But he can show better in other lessons. This case study describes some classroom interventions were applied for him in inclusive primary school such as antecedent-based interventions (seating rearrangement, visual rules, breaking writing task into small components, using mind map, changing the way of instruction) and consequence-based intervention (token economy system). Evidence supports the use of classroom interventions in reducing hyperactivity (not stay on seat), offtask (not finish work) and inattention (not listen teacher’s directions) behaviors in writing tasks of a child with ADHD.

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115 HNUE JOURNAL OF SCIENCE Social Sciences, 2020, Volume 64, Issue 4D, pp. 115-121 This paper is available online at CLASSROOM INTERVENTIONS FOR STUDENTS WITH ATTENTION DEFICIT HYPERACTIVITY DISORDER IN INCLUSIVE PRIMARY SCHOOL Nguyen Thi Hoa Faculty of Special Education, Hanoi National University of Education Abstract. A boy with attention deficit hyperactivity disorder (ADHD) in inclusive primary school who we have been teaching often shows problem behaviors in writing tasks, which his teacher often struggles to manage. But he can show better in other lessons. This case study describes some classroom interventions were applied for him in inclusive primary school such as antecedent-based interventions (seating rearrangement, visual rules, breaking writing task into small components, using mind map, changing the way of instruction) and consequence-based intervention (token economy system). Evidence supports the use of classroom interventions in reducing hyperactivity (not stay on seat), off- task (not finish work) and inattention (not listen teacher’s directions) behaviors in writing tasks of a child with ADHD. Keywords: ADHD, classroom intervention, inclusive primary school, student with ADHD. 1. Introduction Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by symptoms of inattention, hyperactivity and impulsivity that are inconsistent with a child’s developmental level and cause impairment to their functioning. Behavior problems make students have difficulties in taking part in inclusive classroom. To reduce their challenge behaviors, teachers need apply some classroom interventions. Some researches in this area such as: DuPaul et al (2011) in their article ADHD in the Classroom: Effective Intervention Strategies described effective school-based intervention strategies including behavioral interventions, modifications to academic instruction, and home-school communication programs [1]. DuPaul and Weyandt (2006) reviews empirical findings regarding the effects of classroom interventions for students with ADHD. Three major types of interventions include behavioral (e.g., token reinforcement, response cost), academic (e.g., peer tutoring), and social (e.g., social skills training). Relatively strong evidence supports the use of behavioral interventions in reducing disruptive, off-task behaviors in children with ADHD [2]. In Vietnam, Hoa Nguyen Thi and Ngoc Toan Trinh (2019) synthesized some effective learning supports for students with ADHD in inclusive primary classroom such as environmental accommodations, basic skills training, teaching method accommodations [3]. Nga Nguyen Thi Hong (2004) in her research Cognitive Behavior Therapy- Apply in therapy for students with ADHD in secondary school selected three students with Predominantly Inattentive Presentation and apply Cognitive Behavior Therapy for them [4]. Researches on classroom interventions for students with ADHD in inclusive primary class are not common in Received April 11, 2020. Revised April 4, 2020. Accepted May 5, 2020. Contact Nguyen Thi Hoa, e-mail address: nguyenthihoa2983@yahoo.com Nguyen Thi Hoa 116 Vietnam. This article shows the concrete classroom interventions that suite a student with ADHD in inclusive primary classroom in Vietnam. It will be beneficial for teachers who are teaching students with ADHD in primary schools. 2. Content 2.1. Main concepts in research Attention-deficit/hyperactivity disorder (ADHD) is one of the most common mental disorders affecting children. Furthermore, ADHD also affects many adults. Symptoms of ADHD include inattention (not being able to keep focus), hyperactivity (excess movement that is not fitting to the setting) and impulsivity (hasty acts that occur in the moment without thought) (DSM 5, 2013) [5]. Classroom interventions are strategies to accommodate environment and adapt academic tasks suite to student’s need and ability helping student with ADHD more exciting, thus ADHD student’s proper behavior will be improved, and inappropriate behavior will be reduced. Inclusive education is an ongoing process aimed at supplying a quality education for all, respecting the diversity and differences in needs, abilities, characteristics and expectations of learning of students and the community and eliminate all forms of discrimination (UNESCO, 2013) [6]. 2.2. Symptoms and common behaviors of students with ADHD 2.2.1. Symptoms of ADHD Inattention: • Fails to give close attention to details • Make careless mistakes • Cannot sustain attention to task or activities • Doesn’t seem to listen well • Doesn’t follow through on instructions • Fails to finish work • Cannot organize activities well • Avoids or seem reluctant to engage in things requiring sustained effort • Lose things necessary to complete tasks or activities • Is easily distracted • Forget things Hyperactivity- Impulsivity: • Fidgets with hands or feet or squirms in seat • Leaves seat when expected to remain seated • Runs about or climbs on things where inappropriate to do so • Is unable to play quietly • Often seems to be ”on the go” or ”driven by a motor” • Talks to much • Blurt out answer prematurely • Cannot wait • Interrupts or intrudes on others’ activities [4]. 2.2.2. Common behaviors of students with ADHD in inclusive primary classroom Students with ADHD in inclusive classroom usually have common inappropriate behaviors such as: do not follow classroom rules, do not listen teacher’s directions well, do not complete tasks or homework on time, do not pay attention, talk when not to be permissed, moving around class, physical or verbal aggression to others,... 2.3. Description of subject Name: Tuan Minh Nguyen ; Class:3B 2.3.1. Result on diagnose We used Attention Deficit Hyperactivity Test (ADHDT) for him and the result shows that Minh has ADHD, combined type with ADHD score is 96 and has ADHD with moderate level. Classroom interventions for students with attention deficit hyperactivity disorder in 117 2.3.2. Result on intelligence test We used WISC IV for him and the result shows that Minh is at average intelligent level. Subtests Total of standard scores Composite score Verbal Comprehension Index 119 High average Perceptual Reasoning Index 91 Average Working Memory Index 95 Average Processing Speed Index 98 Average Full Scale Intelligence Quotient 102 Average 2.3.3. Results on functional behavior assessment Day/time Antecedent Behavior Consequence Monday 3pm Teacher asked Minh to write a passage into his notebook. Minh sat on his seat. After 10 minutes, teacher checked the notebook and found out that he had only written the title (not doing the task). He picked his pencilcase (distracted). After that he left the seat and went out of classroom (avoiding, hyperactivity). Teacher asked him to come back to the classroom and showed him how to do his task. Tuesday 3pm After 30 minutes break time, Minh knew that he had to write. Minh said he didn’t want to write. Then, he did it for 5 minutes and got up to go (avoiding, distracted, hyperactivity) . His teacher let him go away for 3 minutes and then asked him to come back. Wednesday 3pm Minh and all students were asked to write. While all the students are writing, Minh hold and played with his toy. He did not listen to his teacher’s direction (avoiding, distracted). Teacher asked him to give the toy to her. Thursday 3pm The teacher had to go to the meeting room. Thus, she asked all students to copy one passage from blackboard to their notebooks. Minh only wrote a sentence and left his seat. He went around the classroom (avoiding, hyperactivity). After 10 minutes, the teacher came back to the class and she found that Minh had not finished his task. She asked him to complete it at home and she would check on the next day. Friday 3pm The teacher wanted Minh to complete a short passage which told about his grandfather. Minh said it was too difficult and asked her to help him. Then, he wrote some words and lied down on the table (avoiding). After 45 minutes, Minh did not complete his task and then it was time to go home. Nguyen Thi Hoa 118 Minh usually exhibits inappropriate behaviors in writing tasks, especially in long writing tasks. But he shows better in other tasks. So we observed his behaviors in writing lessons. The following results that when using weekly behavior report in writing lessons, each spot shows an inpropriate behavior. Behavior Monday Tuesday Wednesday Thursday Friday Average (time) Not stay on seat      3 Not finish work      1 Not listen to teacher      1.6 2.3.4. Conclusions about Minh’s behaviors After a week observing him in writing tasks at classroom, we find out that Minh has some inappropriate behaviors such as: inattention, leaving seat (3 times per writing lesson in average), not listening when teacher gives direction (1 times per writing lesson in average), easily being distracted, avoiding to engage in writing activities (1.6 times per writing lesson in average). Purpose of his behaviors is to avoid the tasks he does not like and to sastify his moving. Reasons for these behaviors: writing tasks are too long for him to write and not interesting, teacher did not support him frequently, his seat was not suitable for him (far from teacher), the way of expression writing tasks is so abstract for him. Behavior goals for Minh: (1) Minh stays on seat to do a task in 15 minutes; (2) Minh can finish his work with teacher’s support; (3) Minh listens to the teacher when she gives directions. 2.4. Classroom interventions for Minh In order to support Minh, we applied some classroom interventions below: 2.4.1. Seating rearrangement At present, Minh sits on the fifth row of tables. Therefore, the teacher is difficult in monitoring him. Minh cannot concentrate on what teacher is saying and doing. Thus, teacher should let Minh sit at the first row of tables and near her desk to easily observe her teaching actions. In addition, he can hear teacher’s instructions clearly and the teacher can fully monitor his work. 2.4.2. Illustrate visual rules Stay on seat Finish work Listen to teacher Because of attentive deficiency, Minh has difficulties in listening and understanding the rules which are in verbal. Thus, rules given to Minh must be well defined, specific and frequently reinforced through visible modes of presentation. The visual rules as image above. Classroom interventions for students with attention deficit hyperactivity disorder in 119 Before each lesson, teacher gives expectations for Minh’s behaviors with above visual rules or when Minh is going to do misbehaviors, teacher attracts Minh and points to these pictures and Minh can modify his behaviors. 2.4.3. Creat a reward system (token economy system) Minh can understand the connection of what he does and consequences he receives. Hence, we use token economy system. This system is an example of a behavioral strategy proven to be helpful in improving both the academic and behavioral functioning of students with ADHD. The system typically involved in giving Minh tokens (smile faces) when Minh displays appropriate behaviors. These tokens are in turn ex-changed for tangible rewards at specified times. Minh’s favourites are potato chips, watching video on Youtube and playing on the school playground. The number of smile faces can be exchanged based on appropriate behaviors Minh displays. For example, each writing task Minh finishes, he can earn a smile face. Once Minh earns three smile faces he can watch a 5-minute video he likes. 2.4.4. Break writing task into small components The teacher usually gives Minh long writing tasks, so he feels tired of it. In order to accommodate to his short attention span, academic assignments for him should be brief and the teacher should give feedback regarding accuracy immediately. Longer tasks should be broken up into manageable parts. It can also be helpful to allow Minh to take breaks during long periods of class work. Short time limits for task completion should be specified and can be enforced with timers. A long passage is broken into small components. Each task is respectively given to Minh. After completing one card, the teacher will give Minh another one. After completing a writing card, Minh will receive a smile. Smiles are exchanged with tangible rewards. 2.4.5. Use mind map to support expressive writing Minh can write when teacher reads and can copy from blackboard or textbook to notebook but express writing is actually difficult for him. To help his express writing, we use mind map to support. Sample mind map supports him to write about his uncle. Nguyen Thi Hoa 120 Minh has to write five sentences for this writing task by answering five questions in the mind map. 2.4.6. Change the way of instruction Because Minh has difficulty in following multi-step directions, it is important for instruction to be short, specific and direct. Moreover, to ensure his understanding, it is helpful if Minh is asked to rephrase directions in his own words. Additionally, Minh should be repeated directions frequently. For example, after giving the direction ”Turn on page 35 and do excercise 3”, teacher divides it into two steps: (1) Turn on page 35, after Minh turning on page 35, teacher points to excercise 3 and say (2) Do excercise 3. Or after giving the direction ”Turn on page 35 and do excercise 3”, teacher asks Minh ”What do you have to do now?” and asks Minh to repeat the direction. 2.5. Results and recommendations After a month applying these classroom interventions for Minh, there are many significant changes in his behaviors. (1) Minh could stay on seat to do writing tasks in 15 minutes and more. Out of seat behavior dropped from 3 times in average to twice per writing lesson. After letting Minh sit at the first row of tables and near teacher’s desk, between two students, Minh had less chance to go out, his peers modeled good behavior and teacher could monitor him better so Minh could sit and do tasks longer. Before the lesson, teacher gave him visual rules and told Minh her desire. She also observed Minh more. When Minh was going to go out, she showed visual rules and Minh could accommodate his behavior. Next time we want to adapt Minh’s chair that enable Minh to move while sitting still by adding fidget band in his chair. So, Minh’s out of seat behavior can reduce. (2) Minh’s on-task behavior increased. He can finish his work with teacher’s support. Although Minh could not complete some assignments (one task card on writing task, one sentence on express writing task) but Minh could finish much more work with his teacher’s and friend’s support. He did not give up all tasks. At the beginning the average of behavior “Not finish work” is 1 time per writing lesson and now it is 0.6 time. If the teacher had given Minh a long writing task that made Minh unable to do it, we recommend the teacher to divide the writing task into small steps. It was easy for Minh to do each small step and It made him comfortable. We think that Minh’s teacher should break task into small components in some other tasks and his parents need to apply this intervention at home. Minh also found it easy to do express writing tasks with mind map. He alternately answered the 4 questions. So, mind map should continue to use to support Minh in writing. Besides that, token economy system also motivated Minh to complete writing tasks. It is essential to use reward to encourage Minh. Classroom interventions for students with attention deficit hyperactivity disorder in 121 Minh’s teacher and parents should use reward system suite Minh both at school and at home. (3) Previously, the teacher only used words when giving directions for Minh. So Minh was difficult to concentrate and understand. Based on our advices, the teacher not only attracted Minh before talking, spoke more briefly but also showed suitable gestures. She sometimes gave him written directions. Besides that the teacher gave a minimal number of directions or steps at a time and ask Minh to repeat back directions if she found him difficult to understand or not starting his work. So Minh listened to teacher when she gave directions more frequently. He was not distracted when his teacher spoke to him. The average of behavior ”Not listen to teacher” dropped from 1.6 times in average to 0.8 time per writing lesson. We can find that changing the way of instruction help student with ADHD understand and do better. So everyone include Minh’s teachers, parents, siblings and his peers should change the way they talk to Minh. In conclusion classroom interventions that we mentioned above helped Minh complete writing tasks better and become a member of inclusive classroom. However, the teacher need apply these interventions in much more writing lessons and some other lessons to affirm intensive effect of these interventions. Furthermore, it is important to have a stable cooperation between Minh teacher and parents in applying some interventions together. 3. Conclusions Students with ADHD have many inappropriate behaviors. Teachers have to assess and find out what students’ behaviors are and what teachers’ strategies are to reduce students’ inappropriate behaviors and improve their appropriate behaviors. Teachers can apply some classroom interventions such as illustrating visual rules, creating token economy system, breaking writing task into small components, using mind map, changing the way of instruction... Further researches on this area should be discussed to help students with ADHD success at inclusive classroom. It also requires more studies on the application of classroom interventions to students with ADHD in inclusive primary school in Vietnam. REFERENCES [1] DuPaul et al, 2011. ADHD in the Classroom: Effective Intervention Strategies, Journal of Theory Into Practice, ISSN: 0040-5841 print/1543-0421 online DOI: 10.1080/00405841.2011.534935, p.35- 42. [2] George DuPaul, Lisa L Weyandt, 2006. School‐based Intervention for Children with Attention Deficit HyperactivityDisorder: Effects on academic, social, and behavioural functioning. International Journal of Disability, Development and Education, Vol. 53, No. 2, June 2006, p. 161–176. [3] Nguyen Thi Hoa, Trinh Ngoc Toan, 2019. Effective learning support for students with attention deficit hyperactivity disorder in an inclusive elementary classroom, Journal of Hanoi National University of Education, Vol 64, Issue 9AB, pp.166-175. [4] Nguyen Thi Hong Nga, 2004. Cognitive behavioral therapy - applied to the treatment of attention deficit hyperactivity disorder of secondary school students in Hanoi, Journal of Psychology, No. 7, pp 35-38 [5] American Psychiatric Association, 2013. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. [6] United Nations Educationals Scientific Cultural Organization, 2013. Promoting inclusive teacher Education- Introduction, UNESCO Vietnam.
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