Transcript Supporting Students with ADHD Executive Functioning Disorders (Presented 10 13 14)

Who’s Who?
• Kim Ferguson, Director of Student Support Services and
College and Career Readiness
• Rebecca Rider, Director of Special Education
• Beth Lambert, Student Support Team (SST) and 504
Facilitator
• Dr. Margaret Kidder, Coordinator of Psychological
Services
• Deborah Somerville, Coordinator of Health Services
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Our Objectives:
•Discuss the continuum of support
in BCPS for students with ADHD
and executive functioning needs
•Share strategies and supports
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ADHD Defined
• ADHD is a neurobehavioral disorder
characterized by a pattern of
inattention and/or hyperactivityimpulsivity that is present prior to age
12 years, in two or more settings,
where the symptoms interfere with, or
reduce the quality of, social academic,
or occupational functioning.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders,
Fifth Edition, VA , American Psychiatric Association, 2013.
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ADHD Diagnoses
• Attention Deficit/Hyperactivity
Disorder, Combined Type
• Attention Deficit/Hyperactivity
Disorder, Predominantly Inattentive
Type
• Attention Deficit/Hyperactivity
Disorder, Predominantly HyperactiveImpulsive Type
Executive Functioning Defined
• Executive Functioning involves the use of
higher level cognitive functions to select
and achieve goals, or develop problem
solutions, such as:
• Planning
• Organization
• Time Management
• Working Memory
• Metacognition
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Executive Functioning Defined
• Executive Functioning also includes cognitive
functions that guide our behavior in order to
reach goals and problem solutions, such as:
• Response inhibition
• Emotional control
• Sustained attention
• Task initiation
• Flexibility
• Goal directed persistence
Dawson, Peg, and Guare, Richard, Executive Skills in Children and Adolescents: A Practical Guide to
Assessment and Intervention, Second Edition, New York: The Guilford Press, 2010.
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Prevalence
•Approximately 11% of children 4-17 years of age (6.4
million) have been diagnosed with ADHD as of 2011 as
reported by parents
•The percentage of children with an ADHD diagnosis
continues to increase, from 7.8% in 2003 to 9.5% in 2007
and to 11.0% in 2011
•Boys (13.2%) were more likely than girls (5.6%) to have
ever been diagnosed with ADHD
1 in 5 high school boys
1 in 11 high school girls
Source: Center for Disease Control and Prevention http://www.cdc.gov/ncbddd/adhd/data.html
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Prevalence
•The average age of ADHD diagnosis was 7 years of age,
but children reported by their parents as having more
severe ADHD were diagnosed earlier
•Prevalence of ADHD diagnosis varied substantially by
state, from a low of 5.6% in Nevada to a high of 18.7% in
Kentucky
Source: Center for Disease Control and Prevention http://www.cdc.gov/ncbddd/adhd/data.html
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Prevalence
•In Maryland, parents reported approximately 11.8% of
children have been diagnosed with ADHD by a health
care provider at one point in time
•In 2011, 8.9% of children in Maryland had current
ADHD reported by parents ---a decrease from 9.1% in
2007
•5.8% of children in Maryland were reported to be
taking medication compared to 6.1% nationally
Source: Center for Disease Control and Prevention http://www.cdc.gov/ncbddd/adhd/data.html
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Multi-Disciplinary Task Force
•In 1999, BCPS assembled a multidisciplinary task force, including
parents and community members,
to address the issue of ADHD and
learning
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Goals of the Task Force
• Develop processes to better screen, identify, and intervene with
students exhibiting behaviors of inattention, hyperactivity
and/or impulsivity
• Maintain students who exhibit behaviors of inattention,
hyperactivity and/or impulsivity in general education
• Reduce the number of inappropriate referrals to IEP Teams for
special education services for students with ADHD
• Differentiate instruction to meet the learning needs of students
with ADHD
• Provide resources for students, families, and school staff
• Strengthen the collaboration with parents while improving
outcomes for students
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ADHD Identification and
Management Guide
•Purposes:
• Provide an outline of the SST process for supporting
students
• Provide information for teachers and staff in meeting
the needs of students
• Promote collaboration between school staff and
parents in the use of evidence-based interventions that
support student behavior and student achievement in
the school setting
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ADHD Identification and
Management Guide
• August 2000 - First edition of the guide
• Revisions in 2001, 2006, and 2012
• More broadly accepted NICHQ Vanderbilt
Assessment Scale (VAS) replaced DuPaul-IV in
the 2012 edition of the guide as the screening
tool used in schools
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Access to ADHD Identification and
Management Guide
•Click on “Our System”
•Click on “Offices”
•Click on “Student
Support Services”
•Go to “Manuals” on
bottom left side bar
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Tier 3:
Intensive Interventions
Tier 2:
Targeted Interventions
Academic
Behavior
Tier 1:
Prevention and
Early Intervention
Organization of
Academic
materials
Skills
Behavioral/
Social/
Time management Emotional
Work Completion
Skills
Frequency, Intensity, Duration
A Continuum of Support
Instructional Practices and Interventions
Teacher Level Teams
• Review observable and measurable data to
help clarify the concern, set a goal, and
identify an intervention
• Collaborate with the parent
• Implement individual interventions
consistently for approximately 30-60 days
• Maintain observable and measurable data to
periodically monitor the student’s response
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The Facts
• First grader struggled with following
classroom routines and expectations
• Did not complete classwork consistently or
accurately
• Left homework materials at school
• Struggled with using and managing
materials and physical space
• Often could not keep hands and feet to self
• Few positive peer relationships
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Turn and Talk!
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Problem Solving
• Teacher met with school counselor and parent
• Implemented a system of visual cues for basic
classroom routines
• Parent and teacher developed a consistent
method for monitoring homework and
student progress
• Provided extra space and opportunities for
movement within the classroom
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Problem Solving
• Set a timer with specific goals for work
completion paired with a brief break to engage
in preferred activity
• Provided positive reinforcement and social
acknowledgement when goals were met
• Provided leadership roles
• Counselor met with the student and a few
friends several times in a lunch bunch group to
teach and reinforce specific social skills
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Positive Outcomes
• Student is completing work
• Has established several positive peer
relationships
• Able to follow morning and afternoon
routine as well as classroom
expectations without direct teacher
support
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Tier 3:
Intensive Interventions
Tier 2:
Targeted Interventions
Academic
Behavior
Tier 1:
Prevention and
Early Intervention
Organization of
Academic
materials
Skills
Behavioral/
Social/
Time management Emotional
Work Completion
Skills
Frequency, Intensity, Duration
A Continuum of Support
Instructional Practices and Interventions
Student Support Team (SST)
• General education, problem solving team
• Addresses the complex needs of students who
have not adequately responded to classroombased interventions matched to individual needs
over time
• Reviews any relevant information and data
regarding behavior, learning, and response to
interventions provided by teachers, parents, and
health care providers
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Student Support Team (SST)
• May request the Vanderbilt Assessment Scale
(VAS) for screening of inattentive, impulsive,
and/or hyperactive behaviors
• Results of the VAS may be used to develop a SST
Plan, which is a general education intervention
plan
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Elementary SST Plan Example
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Secondary SST Plan Example
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Who Can Diagnose ADHD?
• ADHD may be diagnosed and documented
for educational purposes in BCPS by the
following qualified professionals:
• Licensed Physician
• Licensed Nurse Practitioner
• Certified School Psychologist
• Licensed Psychologist
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Section 504
• Section 504 is a federal civil rights statute that
protects students with disabilities from
discrimination
• Schools and institutions that receive federal
funding must provide eligible students with
disabilities equal opportunity to participate in all
academic and non academic services the school
offers
• Students who are eligible receive instruction
through the general education curriculum
• Schools must also provide appropriate
accommodations based on individual needs
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Who’s Eligible?
• Student must have a:
• Documented physical or mental impairment
• Substantial limitation to one or more major life
activities
• Decisions about 504 eligibility should be
made without considering the effects of
mitigating measures, such as:
• Medication
• Assistive Technology
• Other reasonable accommodations
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504 or IEP for ADHD
Section 504
IDEA
Functional definition
Thirteen disability categories
Formal assessments are not generally
necessary
Specific evaluation procedures
General education with
accommodations
Specialized instruction and
supplementary aids and services
Periodic review
Annual review
General educator is generally the case Special educator is generally the case
manager
manager
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The Facts
• Intermediate student struggled with
organization and completion of assignments
• Diagnosed with ADHD
• SST considered 504 eligibility and developed
and implemented a 504 Plan
• SST met again to determine additional
supports due to a decline in classroom
performance and behavior
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Turn and Talk!
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Problem Solving
• SST considered accommodations to address the
amount of work and type of assignments that were
“essential” for grading
• Incorporated morning “check in” with homeroom
teacher and afternoon “check out” with last period
teacher
• Used “outside the box” thinking to provide non
traditional instruction
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Problem Solving (Cont’d)
• Implemented a “negotiation” strategy for teachers
and student to set specific and agreed upon goals
for work completion
• Peer support for agenda and materials (“Buddy
Checks”)
• Provided teachers professional development
specific to the student’s learning characteristics
and best practices
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Positive Outcomes
• Student appears motivated by use of
technology and the non traditional classes
• Teachers and students regularly negotiate and
develop short term goals for work completion
• Overall grades have increased when
compared to last year
• Positive working relationship between
teachers, students, and parents
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Strategies and Supports
•Organization and Planning
• Check in/check out
• Agenda assistance
• Use of electronic calendars
• Dropbox for assignments
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Strategies and Supports
•Work Completion
• Prioritize “essential” assignments that
demonstrate mastery of concepts/skills and
must be graded
• Provide alternative ways to respond for
written assignments when appropriate
• Reduce the amount of work, but not
complexity of the assignment
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Strategies and Supports
•Attention to Task
• Utilize auditory signals such as a timer set
to random intervals
• Shorten work periods to coincide with
student’s length of attention and pair with
movement breaks
• Technology
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Strategies and Supports
•Memory
• Daily student checklists for routines,
materials, tasks to complete, etc,
• Pair written and oral instructions with a
visual cue to help with retrieval of
information
• Use device to take pictures of important
information
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Strategies and Supports
•Impulse Control
• Pre-corrections
• Private cuing and conferencing
• Daily progress sheets
• Supervise students closely during
periods of transitions
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Strategies and Supports
•Control of Motor Activity
• Provide structured breaks
• Planned, purposeful movement
• Fidgets
• Use of word processing device for
assignments and note-taking
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Strategies and Supports
•Social/Emotional Needs
• Morning, mid-day, afternoon check ins
• Teach and reinforce self-regulation strategies
• Teach and reinforce emotional regulation
strategies
• Cool down zones
• Social stories
• Meet with school counselor one-on-one or in
groups
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Teacher Training
• New Teacher Training
• Countywide Training
• School-Based Training
• Training for individual teachers as follow-up
to specific cases
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Turn and Talk
• In your group, discuss the following:
• What’s working at home and school
• Personal success stories
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Contact Information
OFFICE
PHONE
Student Support Services
and College and Career
Readiness
410-887-0238
Special Education
410-887-3660
Psychological Services
410-887-0303
Health Services
410-887-6368
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Thank You!
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