School Is Here: Helping Kids With ADHD Start Out Right

Thomas J. Power, PhD, ABPP

Disclosures

August 30, 2019

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It's back-to-school time. Helping kids with attention-deficit/hyperactivity disorder (ADHD) start the year right and do well both at home and at school usually requires the combined efforts of school professionals and primary care providers. We asked Thomas Power, PhD, ABPP, a psychologist and director of the Center for Management of ADHD at the Children's Hospital of Philadelphia to share with us his tips for school interventions for children with ADHD.[1]

The foundation of an effective approach to school intervention is fostering a strong teacher-student relationship, which will help students to be more engaged in school and learning, relate more effectively with their peers, and regulate their behavior more effectively.

There are a few strategies that teachers can use to improve their relationships with students. They can spend some classroom time each week trying to get to know the student as a person—not just as a learner in their classroom—and they can affirm the child frequently for independent, responsible, and respectful behavior. In addition, teachers can make an effort to get to know the parents and establish a strong partnership with them.

The ABC Approach

I encourage teachers to use an ABC approach to behavior change in the classroom: Antecedents, Behaviors, Consequences.

Identify the antecedents. It is important to focus first on the antecedents. Teachers need to set the child up for success in the classroom. This can be done by seating the child near the teacher, which may better enable the child to pay attention. If the teacher is trying to get the child to listen better to instructions, the teacher could approach the student, establish eye contact, give the direction in a concise and clear way, and check for understanding.

Select the behaviors to address. Next, the teacher needs to select target behaviors. The teacher should try to target only two or three behaviors. Define the behaviors in a way that is specific, and indicate what the student should do more often. In the beginning, try to select behaviors that are not too difficult so as to get off to a good start.

Remember the consequences. Finally, establish consequences. It is important for teachers to administer very frequent positive reinforcement by targeted behaviors, such as praising the child for responsible and respectful behaviors.

Verbal correction is useful as a consequence, but it is important for teachers to provide at least four times more positive reinforcement than verbal correction. Students with ADHD often are not as responsive to the typical kinds of positive reinforcement that are administered to other learners. It is usually important for teachers to increase the strength of reinforcement by using token reinforcements systems, whereby tokens can be exchanged for privileges.

A particularly useful approach to behavior change that can be used by the teacher is a daily report card. This involves collaboration between the teacher and the parents to identify two or three target behaviors for change. Teachers are asked to evaluate the student, usually one or more times during the course of the day, using a rating scale that might vary from 1 to 4, with 1 referring to "work harder" and 4 referring to "tremendous job."

For example, the teacher could evaluate the student on a daily report card with two or three target behaviors, complete the checklist at the end of each class period, and at the end of the day, the student would take that report card home. The student and the parent would tally up the number of points earned that day, which would be compared with an established goal. Parents should establish a goal that will ensure at least an 80% success rate. If the child reaches the goal, the child can earn a privilege or a token.

For Older Kids: Organization Skills Training

For older children and adolescents with ADHD who are highly disorganized, the ADHD program at CHOP recommends organization skills training, which teaches students to keep track of homework assignments, organize materials, manage time during homework, and plan for tests and long-term assignments. Students receive repeated practice during and between sessions, and they receive performance feedback about how they are doing in those areas.

Organization skills training can be provided by school professionals, such as a guidance counselor or a special education teacher, who have been trained to use the intervention. These are relatively brief interventions. Typically, the intervention includes about 15 sessions at approximately 30 minutes per session.

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