Transcript SPED 310: Teaching Students with Learning Disabilities

Kathy Kelker, Ed.D.
Topic 9:
SPED 310:
Teaching Students
with Learning
Disabilities
Behavior
Management
Week 6
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Advance Organizer #9
• When and why do children with learning
disabilities have behavior problems?
• What do students with AD/HD need to be
successful in school?
• What are effective treatments for ADD?
• How can positive behavioral
interventions be used to modify the
behavior of LD students?
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Terms to Know
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stimulant medications
Hewitt’s Triangle
Premack Principle
planned ignoring
proximity control
hurdle lessons
mutual contracts
multi-modal treatment
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Do LD Students Have Behavior Problems?
Generally speaking, having an academic learning
disability does not necessarily cause a child to have
behavior problems. Of children who have learning
disabilities, the ones who are most likely to display
inappropriate behavior in school are the children who
have attention deficit disorder. Children with learning
disabilities who do not have AD/HD may display some
social problems related to their disability. These issues
will be covered in Topic #14 which deals with social
competence.
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Why Do Students with AD/HD
Have Behavior Problems?
The behavior problems that children with AD/HD display
are definitely related to the disability itself. Because of the
differences in the ways their brains function, these
children are…
• Less aware of social norms (e.g., boundaries)
• Less able to follow expected routines
• Less able to inhibit impulses
• Less able to respond appropriately to authority
figures
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Needs at School of AD/HD Students
In many ways school is an
unfortunate environment for
children with AD/HD. At
school, what these children
are good at--paying
attention to lots of things at
once, being creative, having
high energy--is often not as
valued as what they are not
good at--sitting still, paying
attention to one message,
being persistent, doing one
thing at a time.
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Can AD/HD Children
Ever Be Successful in School?
Often unintentionally, children with
AD/HD get into constant trouble at
school. They experience school as a
place where they can never be successful,
even when they try their hardest to “be
good.” However, school can be
successful for children with AD/HD if
their needs are met.
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What Works with AD/HD Students?
Because they act impulsively and often do
not attend well to directions, these
children benefit greatly from a school
environment where there are 1)more
clues to guide them in how to behave, and
2) richer, more immediate rewards for
compliance with behavioral expectations.
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Needs of Children with AD/HD
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Clarity of expectations
Structuring of work
environment, tasks, and
materials
Assistance through transitions
External assistance in helping
to get and maintain attention
Cueing, prompting, and
reminders
Active learning
High-response opportunities
Help with organization and
study skills
Multi-sensory instruction
Learning-style
accommodations
Written output modifications
• Escape valve outlets
• Predictability of schedules and routines
• Extra time to process information and
perform tasks
• Extra space
• Creative, engaging curriculum
• Help with coping skills and feelings of
frustration
• Adaptations and modifications of the
curriculum and environment
• Modeling and teacher-guided instruction
• Meaningful learning experiences
• Choices (e.g., Hewitt’s Triangle)
• Teaching strategies that build on strengths
and help bypass their weaknesses
• Teachers in their lives who are positive and
flexible
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Research Supports Behavior
Modification Techniques
Research conducted by Dr. Russell Barkley at the
University of Massachusetts has shown
conclusively that certain behavior modification
techniques are highly effective in helping
students with AD/HD do well behaviorally in
regular classroom settings.
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Principles for Behavioral Intervention with
AD/HD Students
1. Immediacy of consequences
2. Frequency of consequences
3. Saliency of consequences
4. Act, don’t yak
5. Positives before negatives
6. Anticipate potential problems
7. Maintain a sense of priorities
8. Keep a disability perspective
9. Don’t personalize the problems
10. Practice forgiveness
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Incompetent vs. Noncompliant
Students with AD/HD can be very annoying
children to have in a classroom. The
recommendation to “keep a disability
perspective” is important because there is a
tendency to become frustrated with AD/HD
students and see their behavior as intentional
noncompliance when in reality their misbehavior
is a result, at least in part, of their disability.
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AD/HD List of “Don’ts”
DON’T assume the student is being lazy. There are reasons why the
student is underachieving.
DON’T be fooled by inconsistency or assume the student is
deliberately not performing because you have observed that at times
he or she is able to do the task.
DON’T give up on any student. These challenging students often try
the patience of both parents and teachers.
DON’T be afraid to modify, make exceptions, and alter assignments
for students, as needed. Your goal is the student’s success. You
want the student to keep responding so be flexible and make
special arrangements with some students.
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Address Learning Disabilities Too
It is important to keep in mind that many
children with AD/HD also have academic
learning disabilities (commonly in reading,
written language, or math). Their academic
difficulties must also be addressed as well as their
behavioral problems. Often relieving the
difficulties in academic areas first has the
unexpected and pleasant side effect of
improving behavior as well.
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“Pure” AD/HD
Students who have only AD/HD and have no
academic learning disabilities cannot be identified
for special education under the category of
“learning disabilities.” They may, however,
qualify for special education under the
category of “other health impaired” (OHI). The
OHI category fits if the child’s inattentiveness
is so extreme that it has an adverse effect on
learning.
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Balky Behavior
Children with AD/HD can be very balky about
following “direct orders” from teachers,
particularly when they are being told to “get to
work” or “finish an assignment.” When the
child refuses to get to work, the teacher’s
natural reaction is to be more insistent. This
response
usually backfires, leading to an escalation in the
student’s inappropriate behavior and a power
struggle between student and teacher.
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To avoid power struggles and resolve situations when an
AD/HD student becomes balky, try using Hewitt’s
Triangle. This technique is described for you in
Activity
9.1. Read about Hewitt’s Triangle and then answer these
questions:
• What behavioral principles make Hewitt’s Triangle a
successful technique?
• Why do you suppose some teachers might feel
uncomfortable using this technique?
• What does Hewitt’s Triangle tell us about “winning”
and “losing” between teacher and student?
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Tricks of the Trade
We have already learned about the basic
behavior management techniques that work well
with students who have AD/HD. There are also
some quick management techniques that can be
added to a basic behavior management
program. These “tricks of the trade” can help a
teacher
solve specific problems that occur sporadically
with an AD/HD student.
(See Activity 9.2)
(See Tricks of the Trade in Document Sharing. This ideas provided by your instructor).
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Multi-Modal Treatment
AD/HD is a complex disorder that usually
requires a multi-faceted approach to treatment.
As we have been learning, behavior management
and educational interventions can be helpful.
Sometimes children also benefit from counseling
that helps them to understand their disability
and how it affects their relationships with other
people.
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Besides educational intervention, behavior modification, and
psychological counseling, some children with AD/HD require
medical intervention in the form of medication.
Behavior
Modification
Educational
Planning
Treatment
for AD/HD
Psychological
Counseling
Medical
Management
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Use of Medication Is Controversial
Medication for the treatment of AD/HD
symptoms has been used in the United States for
over 30 years and has been found to be effective
in many cases. But the use of medication to
modify behavior remains controversial. Parents
typically are reluctant to use drugs. School
officials are sometimes over zealous in
recommending medication.
See Up Close: The Medication Debate at …
http://www.pbs.org/wgbh/misunderstoodminds/attention.html
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The most commonly prescribed medications for
treatment of AD/HD are stimulants, particularly
Ritalin.
Methylphenidate (Ritalin)
•Extremely safe
•Highly effective
•Dose = .3-.10 mg/kg/dose
•Higher doses modulate activity
•Actions: Nonspecific increase in attention
and cognitive functions: memory, recall, writing,
calculations
•Side effects: decreased appetite, insomnia, growth
disturbance, tics, emotional lability, headaches,
stomach- aches
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Dextroamphetamines (Dexedrine, Adderal)
are also used, but less commonly because
amphetamines are “street drugs” and
may be more prone to abuse.
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Newer Medications
In 2001 some newer medications with state-of-the
art delivery systems came on the market. These
medications are designed to deal with some of
the problems encountered with the older drugs.
Ritalin, for example, has a very short
effectiveness period (2 to 4 hours), so school-age
children must take Ritalin at school in order to
have the positive effects throughout the school
day. The new drugs are more long acting and
eliminate the need to take medications at
school.
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Concerta and
Extended Release Adderall
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In addition to stimulant medications, sometimes tricyclic
antidepressants and other psychotropic medications are
used to treat AD/HD.
Pros and Cons of Nonstimulant Drugs
Drug
Advantages
Disadvantages
Bupropion
May decrease
hyperactivity and May decrease
aggression
May improve
cognitive
performance
Few studies in ADHD
May have better
response in cases stimulants
of comorbid anxiety
or depression
May be useful in
patients with
tic disorders
Longer duration
of action
Efficacy less than
Tricyclic
Clonidine
seizure threshold
May exacerbate tics
Serious potential
cardiac effects
in children
Need for cardiac and
blood monitoring
May be useful to Maximum clinical effects
treat very hypermay take several
active or aggressive
weeks
patient
Does not affect
Improves ability
inattention
to fall asleep
symptoms
May be useful in
Sedation
patients with tic
Risk of adverse
disorders
cardiovascular
effects, depression, and
decreased glucose
tolerance
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Are Medications Effective?
Research has shown that stimulant medications
are effective in helping children pay better
attention and in curbing hyperactive behavior.
The medications have some positive cognitive
effects on memory and organizational skills as
well. Use of medication seems to help some
children be more amenable to instruction, but
the medications alone do not “teach” academic
or social skills.
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Effectiveness of stimulant medications has actually been
reported in the medical literature since the 1930s. Over
the long period in which stimulant medications have been
used, they do not appear to have dangerous or long lasting
side effects.
“Possibly the most striking change in behavior during the
week of Benzedrine therapy occurred in the school activities
of many of these patients….There appeared a definite drive
to accomplish as much as possible during the school period,
and often to spend extra time completing additional work.
Speed of comprehension and accuracy of performance were
increased in most cases. The improvement was noted in all
school subjects.”
Bradley, 1937
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Below are examples of similar art projects done
by a child with AD/HD without medication and
then with medication. There is a notable
difference in organization and completeness.
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Probably the most interesting study of the effectiveness of stimulant
medications versus other treatments for AD/HD was published by the
National Institute of Mental Health in 1999. In this study, medication alone
was compared with the effectiveness of behavior modification, counseling, or
the combination of medication and behavioral and
counseling interventions. The results are in the table below.
Results of the MTA Study
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Medication and combined treatment groups did equally well with respect
to ADHD core symptoms
Both groups did better than the behavioral treatment-alone group
Behavioral treatment-alone group did better than the community control
group
Children with ADHD and anxiety disorder responded as well to medication
as the children with ADHD without anxiety disorder
Children with ADHD with anxiety in the combined treatment group did
better than those in the medication-only group
Adapted from Arnold LD, Abikoff HB, Cantwell DP, et al.
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Teachers’ Role in AD/HD Treatment
With respect to working with students who have AD/HD, a teacher’s role is to
be a teacher.
• Teachers should not suggest to parents that their children should
take medication.
• If children with AD/HD also have learning disabilities, teachers
should make sure that the learning disabilities are addressed and
that educational interventions occur.
• Teachers should use research-based behavior modification
techniques to manage the behavior of students with AD/HD in the
classroom.
• Teachers should collect objective data about a child’s behavior in
the classroom and share that data with parents.
• When a child is being treated for AD/HD by a physician, teachers
should work closely with the physician and provide objective
information about how the child is performing in the classroom.
On the next slide, there is a case study for a student named Brent. Read the case study and do the activities that
follow on slides #18 and #19.
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Case Study: Brent
Directions: Read the following case study and then do the activities that follow.
Brent is a seventh grader who is constantly in trouble at school. He is often tardy to class and annoys teachers
and fellow students with disruptive clowning. Brent always acts as though he were “wired.” He is fidgety when
sitting down and constantly on the move between classes. In the hallways, he bumps into other people and
doesn’t seem to notice the disruption.
As far as academics go, Brent’s performance is erratic. He has great difficulty completing assignments, tuning
in to salient information, and performing consistently on examinations and written reports. However, he
participates well in class discussions and brings up interesting and creative ideas. Brent’s teachers think he is
quite bright and should be performing better. Brent’s counselor has noted that Brent was once in the gifted and
talented program in elementary school and his tested IQ was 138. Despite impressively high intelligence scores,
Brent continues to exhibit a discrepancy between his verbal fluency, level of thinking, and creativity and his
ability to get ideas down on paper.
Brent himself says that he prefers concepts and theories to details. He finds school “boring” and teachers “dull
and unimaginative.” Brent thinks he is brighter than his teachers and that he has better insights than his
classmates.
The reality is that Brent dabbles in a lot of interests (e.g., reading science fiction, motor repair) but he doesn’t
care about school and he can’t wait to drop out and join the Navy.
(See Activity 9.3)
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Using the information in the case study, list the characteristics of AD/HD that Brent exhibits .
Hyperactivity
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Impulsivity
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Inattentiveness
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
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Imagine that you are a member of team that is developing a plan to help Brent do better in school. Think about the
strategies and recommendations that work for students with AD/HD. Using the form on the next page, develop a
written plan for Brent that includes research-based strategies designed to manage the annoying or dysfunctional
symptoms of AD/HD. Be sure that your plan focuses on objective data (behaviors that have been observed). The
form below has been used in many school districts. If the plan is well devised and implemented properly,
improvement in behavior is usually noted within two weeks.
AD/HD Management Plan
Student's Strengths (list 4-5)
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Areas of Concern (list 4-5 of the most important)
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Academic Strategies (choose 3-5)
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Behavioral Strategies (choose 3-5)
_______________________________________________________________________________________________
_______________________________________________________________________________________________
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Reflections
“The energy which makes a child hard to
manage is the energy which afterward
makes him a manager of life.”
Henry Ward Beecher
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