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Introduction:

Attention Deficit Hyperactivity Disorder (ADHD) is a persistent disorder characterized by
significant problems with attention, impulsiveness and overactivity. (Reiber & McLaughlin,
2004) Even if not diagnosed as a Learning Disability (LD), a child affected by ADHD also
suffers a great deal in the classroom. His/hers impulsiveness, inattention and sometimes
hyperactivity are highly visible in the classroom and interfere with their learning and well-being.
The disruptive behavior displayed by students with ADHD frequently interrupts the
concentration of their peers and often results in poor peer relations. In addition, these problems
often are accompanied by other associated problems (e.g.,low self-esteem and depression) that
may further affect these students academic performance. (Gardill et.al., 1996)
It is estimated that 3-7% of our school-age population is affected by ADHD (Sherman
et.al.,2008) It is also estimated that between 85 and 90% of students diagnosed with ADHD will
be placed in the regular classroom for at least part, if not all of the school day. (Such is the case in
our NB classrooms.) (Montague & Wargner, 1997)
Symptoms/Characteristics of ADHD

While characteristics of ADHD vary across people, there are three characteristics that are
common to most. First, as its name states, a key characteristic is attentional deficits. (These
children thus have a very low attention span.) Second, children with ADHD tend to exhibit
impulsivity in tasks. Finally, hyperactivity is the third major feature of ADHD. (While many
children do exhibit high levels of hyperactivity; two things must be remembered: 1. The levels of
hyperactivity are not the same for all ADHD children. 2. Not all children with ADHD display
hyperactivity.) It is now thought that a key characteristic common to most is behavioral
"#$%&'()%* +,-#)&#,-'(,. 1
inhibition. Children with ADHD exhibit problems talking out of turn, concentrating, staying in
their seat and working independently. (Gardill et.al., 1996)
Diagnosing ADHD:

There are three types of ADHD: 1. predominantly inattentive, 2. predominantly
hyperactive, 3. combined. In referring to the Diagnostics and Statistical Manual-4th edition(DSM
IV); a child must exhibit 6 of symptoms listed either in the hyperactivity/impulsivity and/or
inattentive categories for at least six months to be diagnosed as AD/HD. Children with ADHD
usually exhibit symptoms before the age of seven. Additionally, the symptoms must manifest
themselves in at least two settings such as at home and school. Moreover, the symptoms must
interfere with their social and academic functioning. Finally, the symptoms cannot be the result
of another psychological disorder. (Refer to annex A for the DSM IV criteria in diagnosing
AD/HD)
ADHD can co-exist with other conditions such as a learning disability, behavioral disorder
and mental retardation. (UNB Blackboard, ED 6016, 2011) Korkman and Personen (1994) state:
Classroom teachers may tend to interpret the academic failures of children with dyslexia as
being due to attention problems because children who cannot follow the teacher become restless
and distractible. It is thus important to fully complete a formal assessment so that the child
diagnosed with ADHD and/or another condition may receive adequate interventions.
During the diagnostic process, several resources are used. Among the many; parents,
teachers, physicians, psychiatrists work together in the diagnostic process. Such tools as medical
evaluations, interviews, observations, clinical assessments, questionnaires and rating scales are
all tools used to complete a formal diagnosis. (Refer to annex B for an example of the Connors
Rating Scale)
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Treatment Options & Teachers Role:

There are many interventions out there for treating ADHD children such as: behavior
modification, classroom management and structure, medication and all the facets within them.
Researchers found that the combination of psycho-stimulant medications and behavioral
interventions receive the best results. The American Academy of Pediatrics (AAP) recommend
that treatments of ADHD should be both educational and behavioral. They also warrant against
using only medication as an isolated treatment. (Reiber & McLaughlin, 2004) Unfortunately,
many of our classroom teachers do not possess the knowledge and skills necessary to adequately
accommodate the ADHD child in their classroom. Vereb & DiPerna (2004) found that variables
such as teachers knowledge of a students problem and/or the intervention as well as their
acceptability of the intervention may affect the treatments effectiveness. Ideally, free training
and assistance should be readily offered by our school districts and Resource Teachers.
In this paper, I will focus on implementing behavior modification techniques applicable and
beneficial not only to the ADHD child but to all children in an inclusive classroom. Beforehand,
it is important to briefly explain one probable treatments used in an intervention plan, medication.

Medication:
Montague and Wargner (1997) highlight the need for educators to understand and be part of
the childs medication program (if any). A study conducted in the United States has found that
approximately 1.5 million children (2.5 % of the school-aged population) are treated with
stimulant medications for the treatment of ADHD. ( Neef et.al.,2005) It is also estimated that 60-
90% of ADHD children will be prescribed a stimulant such as Ritalin or Dexedrine. (Montague
& Wargner, 1997)
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Medications help the child focus their attention and control their behaviors. When properly
administered and monitored, medication helps many children become less distractible (and
therefore less likely to exhibit disruptive behaviors), more focused, better able to concentrate and,
thus, have a greater chance of learning and retaining material. However, as stated earlier,
Montague and Wargner (1997) and the AAP (Reiber & McLaughlin, 2004) accentuate that taking
medication alone for the symptoms of ADHD does not increase academic success. What
medication can do, in conjunction with other interventions by educational professionals, and the
involvement of parents or guardians, is provide the child with focus and attention that is required
to give him/her greater opportunity for academic and social success.
Behavioral Interventions:

Given its characteristics, a child with ADHD can keep a classroom in a continuous uproar
if nothing is done to counteract his/her trouble with attention, organization, time and social
acceptance. Due to the increasing rates of ADHD children in the classroom; many professionals
ranging from teachers to parents to psychologists , etc., have devised several methods for
educating the child with ADHD. Behavioral and class-wide interventions have been successful in
increasing the levels of on-task behaviors, improving academic performance, decreasing
disruptive behaviors and increasing compliance to directions. (Gardill et.al., 1996) & (Harlacher
et.al.,2006)
Behavior modification techniques aim to identify the behaviors that are causing a persons
problems and then tries to replace them with more appropriate ones. The process includes
identifying and modifying antecedents, behaviors and consequences. The very goal of behavior
modification is the continuation of target behaviors even after the reinforcement for the target
behavior (e.g. a sticker for raising their hand or whatever it may be for that particular child) is
removed of faded. (Armonstrong, 1996)
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In designing a behavioral modification plan; it is important that 1. The child is implicated.-
The ADHD child must be as much part of and observer of and a participator in the behavioral
intervention plan and process as the teacher, for that is the key to behavior therapy success.
(Vereb & Di Perna, 2004) 2. The team working with the child (parents, teachers, psychologists,
etc.) maintain open communication lines and meet frequently to discuss the assessment and
diagnosis of ADHD, the strategies used to enable the child in and out of the classroom, and the
efficacy of those strategies and modifications to treatment interventions. (Montague & Wargner,
1997)
Step1: Identifying Antecedents
According to the behavioral model, a persons behaviors are caused by events that occur
before and after the behaviors have been performed. Antecedents are behaviors that occur, or are
present, before the behavior is performed. (Spiegler & Guevremon, 1998, p.33)
When identifying antecedents, teachers can use checklists or daily logs to measure the
frequency of maladaptive behaviors and the antecedents that have provoked them. (Refer to
annex C for an example of a daily log) After the antecedents are identified, the teacher can then
plan and implement intervention techniques to avoid (or control) the maladaptive behavior from
being performed.
It is also important that the classroom teacher is proactive in his/her instructional and class
management approaches. As mentioned earlier, the ADHD child is easily distracted by
extraneous factors. Such things as a light buzzing, a bird flying by the window or a student
sharpening their pencil can be very distracting to the ADHD child.
Stimulus reduction is a technique used in the classroom that avoids or eliminates extraneous
stimuli. Among others, recommended modifications include such things as: soundproof walls,
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bare walls, closed classroom architecture (four walls and a door) and the use of cubicles for
completing work. ( Reiber & McLaughlin, 2004) Knowing that this setup is not always the case
in all classrooms; we can try to minimize as much possible extraneous stimuli by de-cluttering,
sitting the ADHD child in the front of the room away from distractions, and adhere to the Fire
Marshal's regulations stating that only 20% of our walls should be covered (Thus eliminating an
overflow of distractions on the walls.)
Structure in the classroom is a good technique to prevent maladaptive behaviors from
arising. Because student in the classroom are so much at the mercy of their impulses, their
educational program should be heavily structured [...] It is advocated that the teacher maintain a
tightly prescribed schedule of educational activities for the student so that they would have very
little opportunity to engage in nonproductive behaviors. (Halahan, Kauffman and Lloyd, 1999)
It is favorable to all students to have a clearly defined set of rules and guidelines in
performing work, being attentive in the classroom and behaving themselves at school. Such rules
should be clear, self-explanatory and visibly posted. (Refer to Annex D for an example of a
school-wide code of conduct) This brings us to our next discussion: modifying or eliminating
undesired behaviors.
Step 2: Behaviors
When targeting behaviors; a compromise must be allowed in the case of the ADHD
hyperactive child. The later can, contrary to popular belief, tolerate nonphysical tasks such as
waiting in line (so long as other facets of hyperactivity are permitted during the interim). (Zentall,
1993) Offering these children a manipulative such as a stress ball can help alleviate some of their
hyperactive symptoms.
Using Relaxation as an Incompatible Response: Relaxation is a technique that can be used
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to cope with a wide variety of problem situations as well as during or before transition periods.
(Fachin, 1996) Relaxation is both a mental and physical response, a feeling of calmness and
serenity, and a state of muscular release and passivity. (Evans, 1999) When the ADHD child feels
tense, unable to cope, restless or distracted; relaxation can help them get back on track. (Refer to
annex E for Progressive Muscle Relaxation Exercise beneficial for the ADHD student.)
Peer Tutoring is an instructional strategy where two students work together on an activity.
Students take turns providing assistance, instruction and feedback to the other. In a study by Du
Paul et.al., 1998, on task behaviors increased from 29 to 80% in the ADHD students observed.
The results of this study indicated that peer-tutoring not only increased the ADHD students
engagement in on-task behaviors but also decreased disruptive off-task behaviors. Additionally,
the students involved where required to actively responds to academic material.
Greenwood (1997) developed a ClassWide Peer Tutoring Model (CWPT) that includes
reinforcers distributed by both the tutors and teacher. The CWPT has been proven beneficial in
four areas: 1. It does not create extra work for the teacher. 2. It benefits all students in the class. 3.
It uses materials and resources found in existing instructional programs. 4. It supplements current
instruction. (Maheady & Gard, 2010) (Refer to annex F for a sample CWPT spelling session)
Depending on their placement and appropriateness, external stimulants can be favorable,
or unfavorable in educating the ADHD child. Stimulants can guide performance when it is added
to increase important task features. (e.g., Having students label and color the different continents
on a map.) However, Zentall (1993) warns that stimulations can disrupt performance when it is
placed on unimportant task features. Students will seek out other stimulants when the ones
offered are repetitive, overly familiar, too easy or too difficult. (Refer to annex G for examples of
stimulants to use in the classroom.)
Using novelty in the lessons: Children with ADHD have both a need for active responding
"#$%&'()%* +,-#)&#,-'(,. 7
and an attention span solely for things innovative to them. (Zentall, 1993) (Tips on getting,
focussing and maintaining the ADHD childs attention are listed in annex G.) Nevertheless, the
teacher should be careful not to include unimportant and redundant information in their lessons,
since this increases the risk of losing their attention. The lessons should be clear and long enough
to ensure that all students in the class benefit and, at the same time, make sure that the lesson is
not overemphasized or overlapped to such extent that the ADHD child loses focus.
A good way to keep all children (especially the ADHD child) interested in the curriculum
is by giving them choice. Before beginning a new unit, the teacher might ask students to fill out a
survey on preferences as to what the majority in the class wish to learn about. (Refer to annex H
for a class survey and assignment choice questionnaire.)
Modelling: It is often necessary to teach the ADHD child new behaviors for his/her success
in school and in everyday life. Learning through observation of models is one of the basic
processes by which learning occurs-for everyone from infants to adults. The observation of
models increases self-confidence, perceived self-efficacy, and willingness to begin a self-
improvement program. (Spiegler & Guevremont, 1998 p.124) It is a good idea for teachers to
discretely point out to the ADHD child how different children in the classroom behave, work and
do well. The teacher can ask the ADHD child to observe how other students in the class gain the
teachers attention, how they work at their desk, how they work in groups and so on. From then
on, the teacher and the ADHD child can get together and design a plan for reaching the desired
behaviors. In designing this plan, shaping is the method of choice.
Shaping: Whatever the child and teachers goals are, the teacher should keep in mind that
they should not anticipate mastery on the first try. For example, Johnny never raises his hand and
loves to scream out the answers to questions he knows. The teacher would talk to Johnny and
explain that he must raise his hand before answering the question giving a fair chance to all the
"#$%&'()%* +,-#)&#,-'(,. /8
children in the classroom to think of the answer and respond. If immediately after instructing
Johnny about raising his hand, the teacher asks a question and Johnny screams out the answer
while raising his hand; the teacher must keep in mind that even though he screamed out the
answer, he still raised his hand. It is thus important that the teacher does not punish Johnny but
reinforce him and instruct him again on what he should have done. Thus shaping involves taking
small steps towards a bigger goal or desired behavior and using reinforcers in the process.
Shaping also involves the gradual raising in standards. If the child is not showing progress, the
reinforcers have to be eliminated. This method avoid the greatest hazard of not learning, failure
and discouragement in the early stages. (Spiegler & Guevremont, 1998)
In cases of inattention, cues to redirect attention are of great help in keeping the child on
task without disrupting the other students in the classroom (Posovac et.al.,1999). Acknowledging
that poor impulsivity control is often manifested in disruptive classroom behavior, Posovak et.al.
1999, studied four ADHD boys to determine whether teacher cues were sufficient reducers of
inappropriate classroom behaviors. It was found that each of the children involved in this study
significantly increased his hand-raising and decreased the number of times they spoke out of turn
after the implementation of cues. (Refer to annex I for visual cues cards)
Finally, it is important to discuss that students with learning disabilities (such is often the
case of some students with ADHD) tend to have problems with metacognition. Metacognitional
problems often lead to emotional and motivational problems because the child thinks that they
cannot succeed either academically or socially. These students appear to let events occur
without attempting to take control. Their motivational problems stem from three interrelated
areas: external locus of control (blaming failures on unrelated external events or stimuli),
negative attributions (attributing success to luck or something other than their efforts), and
learned helplessness (believing that their effort will not result in success). (Hallahan et.al., 1999
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p.275-6)
Self-defeating statements and irrational beliefs often cause stress, motivational problems
and depression. (Ellis, 2002) Replacing them with effective coping statements such as in Rational
Emotive Behavior Therapy works in eliminating self-defeating statements. Throughout the
therapy, there is an emphasis on the idea that if the student wants to change a behavior, he/she
must change how he thinks and feels about it. (Refer to annex J for an example of Rational
Behavior Therapy)
Step 3: Consequences
In order for the student to understand consequences, class and school rules as mentioned
earlier, have to be clearly stated and reinforced. Discipline should immediately follow suit when
a rule is broken. Montague and Wargner, 1997 introduced the idea of What should I do next
time. When a rule is broken, the student should be placed at a workstation (Ultimately with a
teacher or supervisor to help with the task and discussion.), explained the rule that has been
broken and discuss or write about what they should do next time. This system avoids the risk of
punishing in a way that is unrelated to the misbehavior.
In supervising or disciplining an ADHD student, the Educational Resources Information
Center (1998) offers the following guidelines for teachers: 1. remain calm, 2. state the infraction,
3. avoid debating or arguing with the student, 4. have pre-established consequences for
misbehaviors, 5. administer consequences immediately, 6. monitor proper behavior frequently, 7.
enforce classroom rules consistently.
As mentioned above, behaviors, desired or undesired have consequences. In behavior
modification, reinforcement is given after, and only after, a certain response has been performed.
The reasoning behind this is that you can only gain the reward by performing the behavior.
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Hence, that behavior will be strengthened and will be more likely to occur again. It is the
contingency that is important and not the positive reward alone. You can use any behavior that
you engage in everyday life to reinforce a desired behavior. Choosing reinforcers to reward the
ADHD student for performing a desired task (or something close to the desired task) is usually
done by discussing with the child about his/her preferences. Moreover, the child can fill out a
questionnaire or rating scale such as in annex K.
Using others to dispense reinforcers:When people close to the child other than the teacher
(friends, family members) become involved in reinforcing a desired bahavior, long term
maintenance of the behavior is more likely. Just as the child needs to be involved in the
intervention plan, so do the parents/caregivers. It is important to keep in mind that if a behavior
is only reinforced in the classroom, the chances of it extending onto other parts of everyday life
are quite slim.
Praise is a very strong reinforcer. The power of praise coming from those we care about
cannot be overestimated. Sometimes, a contract agreement (Refer to annex L) needs to be signed
by the parents/caregivers or another teacher educating the child, in order to remember what to do
and how. Keep in mind that in order for reinforcers to work, there are seven general rules that
have to be followed. (Refer to annex M)
Last but not least, a token economy can be used with the whole classroom. In a token
economy, the child earns tokens for adaptive behaviors and loses tokens for maladaptive
behaviors. The tokens are then exchanged for actual reinforcers. The token economy includes
detailed procedures and rules for earning, losing and spending tokens. (Reiber & Mc.Laughlin,
2004) (See annex N for an example of rules for a token economy) One problem with
administering a token economy with the whole class is that well-adjusted students earn more
reinforcers than the ADHD child. We must then modify the rules a bit for the ADHD child. (E.g.,
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Giving the ADHD child a token for staying seated during the whole class.) A token economy is
also beneficial in that parents can use it in the home as well. Finally, tokens can be given for
covert behaviors as well (E.g., completing an assignment).
Concepts for teachers to keep in mind:
Apart from using intervention techniques in the classroom, there are some important
concepts that we must keep in mind when dealing with ADHD and learning disabled child. For
the sake of length to this research paper, such concepts as performance inconsistency,
questionable practices, preventive discipline, the broken record technique, praise, corrective
discipline and the idea of a childs self-esteem as poker chips are all discussed in annex N.
Conclusion and Discussion:
Although it may seem that we have mostly focussed on overt behaviors, this paper was
written so that the reader could select the strategies that he/she thinks would be of benefit in
designing an intervention plan for the ADHD student in their class. Keep in mind that in
designing an intervention plan for a student, we must not only design interventions for overt
behaviors, but for emotional, social and academic domains.
Another thing to mention, and perhaps the most important is that any intervention plan
needs: observation, follow-up and modifications. We need to see if the intervention plan actually
works and sometimes need to change certain things. We also need to be prepared to face the fact
that the child may need medication if the interventions are not satisfactory.
Finally, I would like to emphasize that teachers should not work alone. Sometimes, the
stress of dealing with an overly disruptive or defiant student can lead to frustration and despair.
Teachers need to speak, consult and ask for help when necessary. Local associations (NBTA),
coworkers, social workers, principals , etc., are all there at our disposition to offer help and
"#$%&'()%* +,-#)&#,-'(,. /2
guidance when necessary. Teachers who demonstrate patience, knowledge of intervention
techniques, an ability to collaborate with an interdisciplinary team, and a positive attitude towards
children with special needs can have a positive impact on students success. (Sherman,
Rasmussen, Baydala, 2008)






































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