Focusing on Instructional Choices

• Introduction
• Facilitating the academic success of students with ADHD

Introduction

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Many factors, including the student's academic skills and learning behaviours (such as reading and writing, task engagement, and study skill abilities) contribute to a student's academic competence.¹ However, the development of these skills and behaviours is also a function of the student's learning environment — specifically, the "degree of support, opportunities to learn, and resources available to the child".^{2 3} That is, student learning depends in part on both the extent to which instructional supports are provided and the degree to which activities are at an appropriate level of difficulty.³ Students are most successful when provided with instructional supports, strategies, and tasks that match their needs and abilities.

As mentioned in previous chapters, research indicates that children with ADHD are at considerable risk for academic underachievement^4-6 and that these difficulties are also associated with factors other than the behavioural symptoms of ADHD.^7-9 In addition, we know that poor academic achievement in literacy and numeracy has significant negative outcomes for the student later in life.¹⁰

Hence, school-based interventions need to go beyond focusing solely on the reduction of behavioural symptoms.¹¹ Intervention approaches need to also take the cognitive and learning difficulties associated with ADHD into account in order to improve the academic achievement of these students.

In addition, interventions should target multiple areas that affect achievement, including:

• academic skills and productivity
• adaptive functioning (for example, communication skills, peer relations)
• academic enablers (for example, learning strategies, engagement in learning)

One of the overarching themes of the TeachADHD method is the need for educators to use a proactive approach to manage classroom learning and behaviour.¹² That is, the teacher proactively creates a classroom environment, lesson activities, and behavioural expectations that help the student acquire adaptive learning skills.

This does not mean that a teacher will be able to prevent every lapse in behaviour control by the child. Rather, a proactive approach means that the teacher considers a range of antecedent factors (including aspects of the learning task, student skills, and prior knowledge) that may affect how a student acts or responds in a given situation.

Research regarding the factors that affect student success in the class can guide teachers in planning more effective teaching approaches and interventions for their students.

For example, several studies have used functional behavioural assessment procedures with children with ADHD to examine factors that affect student behaviour and academic achievement.^{13 14}

Studies using this technique have generally found that the student engagement improved when teachers modified:¹¹

• the level of difficulty of assignments (that is, not too easy, but not beyond the student's ability)
• the length of the assignment (including breaking long assignments into chunks)
• the student's awareness and use of effective learning strategies
• the learning context (for example, group vs. small group or peer-to-peer instruction, rates of engagement, and opportunities to respond)

Moreover, modifications to these factors resulted in children with ADHD exhibiting increased academic productivity and accuracy.

Generally, the types of instructional modifications that have been found effective in facilitating on-task behaviour, productivity, and/or academic success for students with ADHD include:^17-19

• instructional procedures that increase academic engagement (for example, structured peer tutoring, response cards, choral response, active vs. passive response modes)
• altering lesson delivery (for example, rate, type of instructional language, use and frequency of prompting with verbal and visual cues, variations in tasks)
• increasing the frequency and specificity of feedback
• altering the difficulty level of tasks (that is, ensuring task is within the student's capability and not too easy or too hard, either of which can cause frustration)
• varying response requirements (oral, written, computer-assisted)
• specific strategy instruction (for example, note-taking, writing strategies)

Facilitating the academic success of children with ADHD

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TeachADHD identifies four key variables to consider when planning differentiated instruction for these students. These four variables are shown in Figure 6-1.

Figure 6-1: Key Instructional Choices

Instructional decisions in each of these areas should take into account:

• the nature of the academic task or content area (see Chapter 5, Step 1: "Analyzing the curriculum")
• the student's strengths and weakness (see Chapter 5, Step 2: "Developing the student profile")
• the student's identified goals (see Chapter 5, Step 3: "Setting goals")

The following sections describe each of the four areas within which instructional choices can be made to address individual student goals. Following the description, each section then provides information about the instructional choice and ADHD.

1. The learning context

The learning context encompasses a range of factors that may influence the nature of the learning experience for the students in the classroom. These factors include:

• instructional approach such as teacher-directed (for example, modelling) or student-based (for example, inquiry, project-based learning) and whether instruction is more explicit or implicit. For example, the following are different instructional approaches that vary in the role of the teacher and the amount of explicit instruction that may be provided to students:
  • expository: lectures, explanations
  • demonstration: modelling, think-aloud
  • activity-oriented: role-plays, games, experiments, projects
  • inquiry-based: discovery learning, problem-solving
• the size of the group (for example, whole- or small-group, one-on-one instruction, peer or cross-age tutoring):
  • This factor can affect the intensity of the instruction and the frequency of teacher-student and student-student interaction.^{20 21}
• number of opportunities for students to provide response:
  • This factor is important because fewer opportunities to respond are associated with lower levels of student engagement.^{22 23}
• layout and seating considerations:
  • This factor reflects how the classroom is organized physically (for example, rows of desks, tables) and where students are located relative to each other, the teacher, and other components of the classroom (blackboard, centres, windows).¹⁸

The learning context is a critical consideration in the design of lessons or activities, because all four of the preceding contextual factors will play a role in how well a student is able to understand the lesson and/or participate in the lesson or activity. The type of approach selected depends on a range of factors such as knowledge of student profiles, curriculum content, and familiarity of students with the task, content, or skill.

For example, a student may be cognitively overwhelmed if asked to complete a discovery learning task in a small group context with a group of highly verbal and rapid-thinking peers, when he or she has little prior knowledge of the topic, difficulty in processing information rapidly and making notes, and social interaction difficulties. In more implicit learning contexts, some students may need greater supports (for example, instructional supports, strategies) to facilitate learning. Importantly, research has shown consistently that struggling students often require more explicit, teacher-directed approaches when learning a new skill and that more implicit approaches can be used once the students have grasped the key concepts and skills.²⁵

The specific layout of the classroom may reflect the needs of the type of instructional approach or size of the group. Students may be seated individually, in pairs, or in groups at tables. In addition, certain students may need to be seated in specific areas (for example, close to the teacher) to facilitate their learning and behavioural success.

The following characteristics of the learning context will generally promote sustained attention in students with ADHD and so are useful to keep in mind when designing the instructional context for specific lessons or activities:^{11 17}

• instructional approaches
  • receiving instruction in more structured settings with explicit goals and objectives
  • receiving instruction that is targeted to the level and needs of the learner
• size of the group
  • working one-on-one with an individual
• number of opportunities to provide a response
  • continuous prompting of academic responses (that is, provide more frequent opportunities to respond)

The following sections discuss how modifications of the four learning context factors may influence learning and productivity in students with ADHD.

Instructional approaches

Students with ADHD often benefit from instructional approaches that are explicit in their specific objectives, actions, and goals.¹⁷ For example, in teaching writing strategies, students with ADHD benefit from instruction that is highly explicit and incorporates think-aloud procedures with guided practice in applying the strategies.²⁶ The level of explicitness may be faded as students become more competent in the particular skill area.

Given the cognitive (for example, working memory) and possible language-related weaknesses (for example, pragmatic language skills, inferencing, comprehension monitoring) associated with ADHD, these students may have difficulty independently completing more lengthy and complex project-based learning activities and assignments that require higher levels of multi-tasking, skill integration, and self-regulatory skills.²⁷

However, this is not to say that they should not be involved in such tasks. Such tasks can often be tailored to the student's interests and may involve more "active" learning (creating, designing, experimenting, etc.). Rather, it is important to remember that students with ADHD will often need to be provided with specific instructional supports that reduce the cognitive load of such tasks and optimize their ability to complete the task in the context in which the learning activity takes place. The types of supports chosen by the teacher will vary by context and according to other targets of the instructional planning tool.

Size of the group

The size of the instructional group is an important variable to consider when designing the learning context.²⁰ Smaller instructional groups can increase the intensity of instruction, the amount of opportunities students have to respond, and the specific feedback that students receive regarding their performance.²³ Hence, depending upon student needs, teachers may use multiple grouping procedures throughout the day.

When working with students with ADHD, it is particularly important to implement strategies that permit more individualized instruction and feedback. One way for teachers to help all students in the classroom receive more one-on-one instructional interactions is to use peer tutoring.^{19 23}

Opportunities to respond

Overall, research has shown that students with ADHD are more engaged when they participate in learning contexts in which they:³⁰

• receive cues or prompts for responses
• have many opportunities to respond
• experience high rates of specific and immediate feedback

Teachers may decide to modify aspects of particular learning contexts to increase student engagement and rates of feedback. For example, teachers can increase the frequency of student responses during large-group instruction by asking students to provide choral or non-verbal (for example, thumbs up, thumbs down) responses or by asking them to jot down their answer on response cards. Small group instruction and individualized instruction (such as peer tutoring or volunteer tutors) also provide students with increased opportunities to respond and receive immediate and specific feedback.

Layout and seating considerations

In addition to the instructional context of the classroom, teachers may also reflect upon the physical environment of the classroom relative to student needs. Students with ADHD may exhibit less severe symptoms and more attention to task when they are seated in proximity to the teacher or to peers that exhibit appropriate classroom behaviour. Having the student sit close to the teacher may also facilitate the student's ability to request help when it is needed.

Teachers may also wish to examine whether the student copes better when seated at an individual desk or at a table. Another factor to consider is whether the student is seated in a high-traffic area (for example, close to the door or where students drop off supplies or materials). Students may need to be in areas in which disturbances can be kept to a minimum. Each student's response to these factors will be different and it is important to consider how each of these factors may affect the student's behaviour and academic success.

2. Instructional language

Instructional language is specific to the classroom context. It differs from everyday language in a number of ways (see Table 6-1).^31-34 Generally, instructional language imposes more of a cognitive load for all children,^35-36 but produces greater challenges for children with ADHD.

Table 6-1: Comparison of Everyday Language and Instructional Language

Instructional language is used for both spoken and written communication. Instructional language has specific functions in the classroom (see Table 6-2 for examples of the functions of spoken language), which include:

• management of behaviour
• transfer of knowledge
• promotion of inquiry

Table 6-2: Examples of the Different Functions of Teacher Language in the Classroom

Classroom spoken language is also very recognizable in terms of its language features (vocabulary, sentence forms, lengthy verbal exchanges, and sound patterns of "teacher-talk") and its stylistic conventions (conversational patterns).

Classroom spoken language is primarily teacher-led talk. It can represent up to 80% of classroom conversation.³⁷ It is one of the main modalities through which students learn. Therefore, appropriate classroom behaviour and successful learning is often dependent on students' full understanding of the messages encoded in instructional language.

Yet, instructional language often relies on conventions and subtle cues that demand that children infer meaning. Teachers who recognize what constitutes instructional language are better able to make adjustments when communication is failing.

Some characteristics of spoken instructional language are:

• Teachers often guide and control conversations:
  • Teachers often establish the rules for discussion, nominate which student will speak, and initiate and terminate topics.³⁸
• Spoken instructional language has characteristic prosodic features:
  • Intonation patterns, inflection of key words, and pace of delivery are used for classroom management, to highlight key information, and for the immediate evaluation of student performance.³⁸
• Ritualized patterns of conversation:
  • At both the discourse level and sentence level, teachers tend to use scripted patterns of language that require students to recognize both explicit and implicit information. For example, at the sentence level, a teacher may say "Do I have to use my special voice?" which implicitly suggests "Please stop talking and pay attention." At the discourse level, teachers commonly use a three-part scripted instructional exchange to both promote inquiry and evaluate learning ("teacher's question, student's response, teacher's evaluation").³⁹

Children with ADHD tend to experience a variety of language difficulties. (See Chapter 4 for more information.) Identified weaknesses in pragmatic skills can be especially problematic during classroom instruction. For example, children with ADHD tend to experience difficulties in the following areas of conversation:⁴⁰

• Difficulty with speech exchange:
  • They have problems initiating conversation, they speak out of turn, or they overlap onto other speakers.
• Difficulty with conversational style:
  • They tend to speak louder than required for the situation, they shift topics without identifying change, and they are verbose with their speaking turn.
• Difficulty with content management:
  • They have difficulty with the conventions of both narrative and expository genres.
• Difficulty processing long and complex sentences (in written texts) or utterances (in spoken language)
  • For example, students with ADHD would have difficulty processing the teacher's utterances used for task instruction and classroom management in Table 6-2. This is because the order in which actions are mentioned (start math...finish practice problems) does not correspond to the order in which those action should be completed (finish math problems on board, THEN start math sheet). Thus the correct interpretation of this utterance relies totally on the listener's ability to attend to, process, and understand the meaning of the word "before." Many students with ADHD would also have difficult with those utterances because their length is likely to exceed their working memory capacity (task instruction: 14 words; classroom management: 18 words).

Hence, the typical characteristics of spoken instructional language often conflict with the common language weaknesses associated with ADHD. This mismatch can then act as a barrier to learning.

For example, the high degree of control in classroom discussions compounds the problems of poor speech exchange skills that often characterize children with ADHD. In addition, children with ADHD may not recognize the prosodic features of classroom language (such as intonation and inflection), which then may limit their access to the implicit information conveyed by the teacher. Finally, students with ADHD often have problems initiating conversations, which may have implications for question and answer sessions. Children with ADHD may in fact know the answer, but not respond in the limited time frame for these teacher-led exchanges.

It is important that instructional language be sensitive to the potential weaknesses in students' language skills. When in doubt, state objectives and intentions in as explicit a manner as possible. Both coaching and modelling clear language usage can also facilitate communication.

Instructional language can also serve as a powerful scaffold to student learning by providing support through dialogue, questioning, and feedback. This role of instructional language is discussed in more detail in the following section on the topic of instructional supports.

Tips on modifying instructional language to reduce cognitive load:⁴¹

• Give one direction at a time.
• Make directions clear, short, and specific.
• Chunk and repeat the important parts of long explanations and instructions.
• Demonstrate the task and guide the student through the steps.
• Provide visual supports for instructions (for example, checklist of "to do" items).
• Always check for understanding (student can repeat instruction).
• Give frequent feedback to child regarding his/her completion of task steps.

3. Instructional supports

What is scaffolding?

Scaffolds are instructional supports or interactions that help the student acquire or extend his or her knowledge, reduce task complexity, and support the student's move towards being able to work independently providing emotional support and encouragement.⁴² Scaffolded instruction involves different types of supports including:^43-44

• helping the focus and maintain interest in the task
• helping the child control frustration
• helping the student keep the goal in mind
• helping the student identify critical task features
• providing the student with a range of supports to facilitate understanding of how to perform and complete the task

Scaffolded instruction that utilizes a range of supports can help children process complex information or complete tasks that require the integration of multiple processes or elements such as:⁴⁵

• presenting the key ideas of an expository text in a graphic organizer
• providing prompts or "think sheets" to help students identify key steps in the writing process and to provide a permanent reminder of the steps
• teaching a complex task using information or content that is already familiar to the student (for example, teaching a reading comprehension strategy on content with which the student is familiar)

These types of support systems can act to reduce the amount of "cognitive load" that may be present during a task and facilitate the child's ability to acquire new knowledge and skills.

Types of instructional supports that can be used to scaffold learning

Instructional supports can be teaching techniques or more concrete tools that the student uses to acquire, organize, or process information.^45-46 These supports are temporary and are adjustable. That is, as the student becomes more proficient in the use of the skill or technique, the teacher provides less and less support in order to foster the child's ability to become an independent learner.

Hence, if a child begins to experience difficulty completing a task, there should be an immediate increase in the amount of support provided to the child (for example, tip, prompt, modelling of thinking process). Instructional supports are gradually faded as the student gains more competence in the academic skill or strategy in order to promote the student's ability to be an independent and self-regulated learner.

Alternatively, success should be met with a slight decrease in the amount of support provided to the child (for example, the child may try to independently implement a learning strategy once he or she has received enough guided practice to exhibit some success with the strategy). In each case, there is also considerable positive feedback and emotional support recognizing the effort of the child to tackle the task.

Figure 6-2 displays some examples of different types of instructional supports that can be used to scaffold learning for all students.

Figure 6-2: Examples of Types of Instructional Supports

Verbal scaffolding: a key element of instructional teaching supports

Verbal scaffolding is a critical component of scaffolded instruction. Verbally based instructional support is often used to guide the student toward improvement in a given learning outcome or skill through supportive dialogue.47 Scaffolding can be provided individually or during lessons and group discussions.

Verbal scaffolding is used when teachers think aloud, provide guided practice with questioning and expansion of ideas, and so on. Verbal scaffolding can support a student's action and thinking and can explicitly demonstrate key cognitive activities or actions.

Verbal feedback that is explicit and directly tied to the task effectively supports learning. It is helpful for feedback to be accompanied by other instructional supports, such as visual cues demonstrating what is correct or incorrect. In addition, it may be helpful to provide students with small chunks of information at a time when giving feedback. Finally, it is helpful to identify clear reference points for the issues being explained and ask supportive questions to check comprehension.

Teacher feedback fosters the student's own ability to self-monitor and self-evaluate his or her performance and involves executive functions essential for higher-level learning. Therefore, teachers should purposely model the language they want students to acquire and use when assessing their progress or performance on a task ("How am I doing? How did that idea work? What else can I try? I did well because I...").

Just as with all instructional supports, it is important that the verbal scaffolds take into account the student's background knowledge and language skills (such as vocabulary and pragmatic language abilities) in order to provide an optimal support system. There are many ways to adapt verbal scaffolds to student needs.⁴⁵ First, concrete tools can be used to support discussions and feedback. For example, when teaching students about the concept of chunking words into parts they know, the teacher could at the same time demonstrate the concept by physically chunking a whole into parts (for example, breaking a plasticine block into several chunks). Instructional supports such as graphic organizers, think sheets, cue cards, and posters are also ways to provide concrete supports for instructional dialogues.⁴⁸

Example of providing scaffolded instruction when teaching a decoding strategy

For example, students who are learning a new strategy for decoding words will benefit from lessons in which:⁴⁶

• the teacher models the strategy and explains the purpose of the strategy (when, why, and where it is useful)
• the teacher provides several examples of applying the strategy and the thinking process that goes on while the strategy is being applied (think-aloud)
• there is a concrete reminder of the strategy (for example, steps on a poster or think sheet with either a mnemonic or pictures to help the student remember each of the key steps)

In order to reduce errors in applying the strategy, the teacher would then provide the student with guided practice in applying the strategy, with close attention to providing specific feedback regarding accuracy or misunderstandings.^45-46

Guided practice may mean that the teacher models the strategy for the student and then asks the student to use the strategy to decode a word. Then the student applies the strategy with the teacher acting as the coach by commenting on what the student is doing correctly and giving feedback when the student makes an error or is unsure what to do next.

Here is an example of a teacher providing guided practice of a particular decoding strategy that was developed as part of a remedial program for students with reading disorder.⁴⁹ The teacher has provided several other instructional supports such as using think-aloud, sequencing the task for the student, providing supportive dialogue (that is, prompting, questioning, specific feedback). The teacher has also provided the student with concrete instructional supports such as a poster of key words to further scaffold the learning process.

As the students become more proficient at using the strategy, they are asked to apply the strategy more and more independently; the teacher gradually reduces the amount of support and the students rely less and less on the more "concrete" instructional supports.

4. Student learning strategies

What are strategies?

"By equipping them (students) with a repertoire of strategies for learning — ways to organize themselves and new material; techniques to use while reading, writing, and doing math and other subjects; and systematic steps to follow when working through a learning task or reflecting upon their own learning — teachers can provide students with the tools for a lifetime of successful learning." ⁵⁰(p. 2)

Students benefit when they realize that they can use certain techniques and/or strategies to help them learn more efficiently. It is important for all students to realize that there is a connection between what they do (actions taken) and outcome (for example, test score). In addition, it is important for students to understand that while there are many ways to solve a problem or reach a goal, some methods are more efficient than others. Students need to become self-aware and think about what they know, what they want to know, and what specific strategy can be used to reach their goals.

Learning strategies can be simple (for example, making a chart) or complex (a set of strategies used interdependently to accomplish a task such as writing a narrative). They include what we do and what we think when accomplishing a task.⁵⁰

Many strategies make explicit the processes that "experts" go through when solving problems and reaching a goal such as comprehending a text. Students become more effective learners when they are taught these strategies and when, where, and why to use them.⁴⁵

Strategies can be cognitive strategies that help a person process, retrieve, or manipulate information (for example, guided notes, reading by analogy, clarifying text comprehension). In addition, strategies can be metacognitive. Metacognitive strategies are strategies that foster self-regulation and self-awareness of the learning process. Examples of metacognitive strategies are those that help the student with:

• goal-setting
• self-monitoring
• planning
• evaluation of learning and strategy implementation

Effective intervention programs often integrate both cognitive and metacognitive strategy instruction.^{49 51}

Teachers should teach strategies that are useful to the students and meet their needs. In addition, different strategies may need to be taught for specific academic domains (for example, reading comprehension strategies, mathematical problem-solving strategies) whereas other strategies can be fostered across academic domains (goal-setting, problem-solving, planning, evaluating progress).

Strategies and ADHD

Students with ADHD may have a limited repertoire of cognitive and metacognitive strategies. They may find it difficult to independently exhibit strategic thinking, as this often requires high levels of self-regulation (including planning, monitoring, and self-evaluation). Giving strategy instruction to students with ADHD can help them improve specific academic skills (for example, note taking,⁵² reading, writing, or numeracy skills^{26 53-54}) and learn general metacognitive strategies.⁵⁵

Research has shown that providing students with domain-specific strategies, rules, and procedures to help them learn, process, store, and retrieve information is highly effective. It can help both typically achieving students and students with learning difficulties become more independent and self-regulated learners.^{45 56-57} Hence, strategy instruction may be useful for many students in the classroom.

Examples of evidence-based strategy intervention programs

Written expression

To address the needs of students with attention, behaviour, and learning disorders, researchers developed the Self-Regulated Strategy Development (SRSD) program.58 SRSD has been effectively used to boost the writing skills of at-risk and normally achieving students.^59-60 SRSD combines strategy instruction with self-regulation through explicit instruction, guided practice, and peer practice. Teachers teach SRSD through the following stages:

1. develop student's background knowledge regarding the strategy
2. discuss the strategy and why and where it is useful
3. model the strategy
4. help students apply it by working collaboratively with students
5. provide students with opportunities to apply the strategy independently (with support as needed)

What are the strategies?

Two integrated strategies that are used to develop story writing skills in struggling writers are: POW and WWW - What = 2, How = 2.⁵⁹ These two SRSD strategies are taught to students concurrently. The teacher explains how the first strategy, POW, helps students to add power to their writing and use more detail and exciting words. POW guides children to do the following steps:

The second strategy, WWW - What = 2, How = 2, provides students with an organizer for a narrative. This strategy is used during the "O - Organize notes" part of the POW strategy. "WWW - What = 2, How = 2" stands for the following components of a story:

After the students use the second strategy to organize their notes, they then use the last step of POW, which is to "Write and say more." The teacher demonstrates how students can add details and make better word choices when they are composing their stories.

To teach students the strategies, teachers are encouraged to utilize a variety of instructional supports such as:

• explicitly teaching the strategies using mnemonics (posters and visuals highlighting steps and components)
• modelling and guided practice of strategies

Teachers are encouraged to:

• describe the strategies
• explain why they are useful
• have students identify why stories that have each of the components highlighted in the WWW -What = 2, How = 2 strategy would be good stories

To help the students understand the steps to strategy, the teacher can read developmentally appropriate stories aloud and the teacher and students can fill out a graphic organizer highlighting each of the seven components (with picture cues if necessary).⁵⁹ This process can be repeated on subsequent lessons to help students see how the books they read incorporate these elements.

Another key component of the SRSD instructional approach is to help students remember the steps of the strategy.⁵⁹ For example, the teacher can help the student remember the sequence through oral review or peer practice and provide the students with a visual reminder (for example, a poster or graphic organizer) of the steps to support the verbal dialogue.

The SRSD approach also encourages teachers to help students determine how well they already incorporate key elements of the writing strategy.⁵⁹ For example, the researchers suggest that the teachers have students identify key story components. (For example, where the story takes place) in their previously written stories. Then students can graph how many parts they had in the story and set a goal to write a story that includes all of the key components.

Another key SRSD instructional approach is for teachers to model the application of the writing strategy. For example, the teacher may say the following (adapted from Mason, Harris, & Graham (2002)⁵⁹):

Subsequent lessons can focus on using the strategy and self-regulation procedures collaboratively and then graphing the product — how many story elements are present and so on. Then, as students become more adept at using the strategy, they can begin to apply it more independently and continue to graph their progress. Some students may require more guided practice than others. For lesson plans and examples of the graphic organizers and graphing sheets, please visit the following web site: www.vanderbilt.edu/CASL.

In addition to the above story writing strategies, researchers have found expository strategies to be useful in improving expository essays in children with behaviour and/or language learning problems.²⁶ For example, one strategy is called PLAN. This strategy supports students' ability to incorporate main ideas and details into their text.

What do to before you write? PLAN

Students would be taught in the same manner as for the story-writing. Students could also develop cue cards for the PLAN and also for remembering transition words, remembering different kinds of sentences, using synonyms, and so forth. Each of these types of instructional supports helps the student stay on track and focus on the steps to success. Using these supports fosters students' ability to internalize the approach and put the majority of their effort into the process rather than on remembering each of the steps. As students gain practice and skill they can gradually phase out the support systems and/or begin to adapt to the strategy to other uses.

Math strategies

As described in Chapter 4, children with ADHD often have difficulty with numeracy skills. One of the first steps in facilitating success for the student is to determine whether the student lacks any of the prerequisite skills needed for a given mathematical concept. If the student has the pre-skills, then the teacher needs to help the student use the information in a systematic and efficient manner.

For example, teachers can:

• Provide students with an organizational framework (a metacognitive strategy) for solving mathematical problems.^{53 57 61}
• Help students discriminate between relevant and irrelevant information by teaching them how to determine what the important ideas are in the question or problem.
• Explicitly teach the steps to effective strategies such as using a picture, making a table, working backwards, making a list, and so forth.

Teachers can therefore provide students with the tools and supports they need in order to take an "active learner" approach.⁵³

Examples of various math strategies can be found at the following web site: http://coe.jmu.edu/LearningToolbox.

General metacognitive strategies

Metacognitive strategies are those strategies that we use to guide our thinking and actions. Students need to be aware of their own thinking processes (thinking about thinking) and be aware of how to regulate these processes.⁵³ One program that has been used with children with ADHD is the Think Aloud program.^{54-55 62} In this program, students are provided with a series of lessons that guides them to use a four-stage questioning process to help them solve problems. The students first learn the difference between a question and an answer and then learn, using developmentally appropriate picture prompts (a bear for younger children and a dragon for older children), the four questions:

What am I supposed to do?

"I need to identify what is the same and different about these two Attribute Blocks."

What are some plans?

"One plan I could use is to first list the ways that they are the same and then think of ways that they are different."

"Another plan is to describe one block and then describe the other block and then see what is the same and what is not the same."

How is my plan working?

"I decided to first list the ways that they are the same. This plan is working okay. I have figured out that the blocks are the same colour and size."

How did I do?

"I think I did well because I was able to figure out how the blocks were the same and different by using my plan."

The lessons use "think-aloud" procedures to model using the four questions to solve both cognitive and social problems. The students are encouraged to orally state each question and then provide the answer. One of the most important ideas that children can receive from this process is that it is a good idea to come up with more than one plan, as some plans do not work and thus you need to select a new plan (hence, don't give up). In addition, students learn to attribute success to specific actions that they took. That is, students learn that there are certain plans or strategies that they can use that will increase the likelihood of success.

Organization and study strategies

Students with ADHD often struggle with organization of both objects (such as books and papers) and time (for example, thinking ahead to plan a project or scheduling time for tasks).⁶³ Object management can be facilitated by providing the student with structure and routines.⁶⁴ For example, teachers can teach students routines for:

• handing in work (for example, having a consistent place and time to hand in assignments)
• writing down assignments
• organizing desks or workspaces (teach students how to organize desk with labels for different items)

Students can also be provided with checklists listing the items they need for specific activities. Students may also benefit from coding schemes (for example, colour coding) of materials and notebooks to help them keep track of papers and assignments.⁶⁴

Time management can be facilitated by helping the student break larger assignments into short-term objectives with set deadlines. In this case, the teacher would explicitly provide the student with guidance regarding how to break the assignment into manageable chunks and how to set goals for each objective. For daily work, the student may benefit from a countdown timer on the desk to quietly illustrate how much time is left for a given activity, or an agenda listing daily work that is posted on the student's desk or in the appropriate binder/notebook.

Finally, it is important to remember that some students may have trouble understanding the "language of instruction" regarding time management. Students may need explicit instruction in vocabulary such as "first, next, last" or guided practice in locating dates using calendars (for example, locating the day that is next Thursday or the day after tomorrow).

Explicit instruction in study and organization skills is often essential for the student with ADHD. For example, teachers can clearly articulate the steps needed to complete assignments. Students can be taught the following steps to help them complete an assignment:⁶⁵

• Read the directions carefully and think about what is being asked.
• Identify key words or phrases that tell you what you need to do. Box or circle them.
• Before starting the assignment, figure out what materials you will need and get them all out.
• Before starting, tell yourself (in your own words) what you are supposed to do.

The teacher would model the steps (for example, state steps and use think-aloud procedures) and provide the student with guided practice in applying the steps. As students become proficient, they can begin to independently practice the strategy.

Other key skills that may need to be taught to students include:

• how to write entries into an assignment calendar
• how to organize and use notebooks
• how to organize assignments on paper
• how to organize desks and other materials

The Skills for School Success series⁶⁵ teaches these skills and also includes instruction for students in test-taking and study skills, learning strategies for content, reading and interpreting graphics, and using reference books.

For older students struggling with organization and study skills, the book Academic Success Strategies for Adolescents with Learning Disabilities and ADHD⁵³ provides several strategies that can be used by students. It also provide a questionnaire to help students better understand their areas of difficulty. Strategies can then be selected that focus on improving the student's performance in this area.

¹ DiPerna, J.C., & Elliott, S.N. (2002). Promoting academic enablers to improve student achievement: An introduction to the mini-series. School Psychology Review, 31, 293-297.

² Pianta, R., & Walsh, D.B. (1996). High-Risk Children in Schools: Constructing Sustaining Relationships. New York: Routledge.

³ Christenson, S.L., & Anderson, A.R. (2002). Commentary: The centrality of the learning context for students' academic enabler skills. School Psychology Review, 31, 378-393.

⁴ Curry J, Stabile M (2004). Child Mental Health and Human Capital Accumulation: The Case of ADHD. National Bureau of Economic Research; Working Paper 10435. Retrieved April, 2004, from http://www.nber.org/papers/w10435

⁵ Rabiner, D., & Coie, J.D. (2000). Early attention problems and children's reading achievement: A longitudinal investigation. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 859-867.

⁶ Todd, R.D., Sitdhairaksa, N., Reich, W., et al. (2002). Discrimination of DSM-IV and latent class attention-deficit/hyperactivity disorder subtypes by educational and cognitive performance in a population-based sample of child and adolescent twins. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 820-828.

⁷ Biederman, J., Monuteaux, M.C., Doyle, A.E., et al. (2004). Impact of executive function deficits and attention-deficit hyperactivity disorder on academic outcomes in children. Journal of Consulting and Clinical Psychology, 72, 757-766.

⁸ DuPaul, G.J., Volpe, R.J., Jitendra, A.K., Lutz, G., Lorah, K.S., & Gruber, R. (2004). Elementary students with AD/HD: Predictors of academic achievement. Journal of School Psychology, 42, 285-301.

⁹ Rapport, M.D., Scanlan, S., & Denney, C.B. (1999). Attention-deficit/hyperactivity disorder and scholastic achievement: A model of dual developmental pathways. Journal of Child Psychology and Psychiatry, 40, 1169-1184.

¹⁰ Shalla, V., & Schellenberg, G. (1998). The Value of Words: Literacy and Economic Security in Canada (Highlights). Ottawa: Statistics Canada. Retrieved October 31, 2005, from http://www.statcan.ca/english/freepub/89F0100XIE/value.htm

¹¹ DuPaul, G.J., & Stoner, G. (2003). ADHD in the Schools: Assessment and Intervention Strategies. (2nd Ed.). New York: Guildford Press.

¹² Darch, C., & Kameenui, E. (2004). Instructional Classroom Management: A Proactive Approach to Behavior Management (2nd ed.). Upper Saddle River, NJ: Pearson-Merrill Prentice Hall.

¹³ Northup, J., & Gulley, V. (2001). Some contributions of functional analysis to the assessment of behaviors associated with attention deficit hyperactivity disorder and the effects of stimulant medication. School Psychology Review, 30, 227-238.

¹⁴ Ervin, R.A., DuPaul, G.J., Kern, L., & Friman, P.C. (1998). Classroom-based functional and adjunctive assessments: Proactive approaches to intervention selection for adolescents with ADHD. Journal of Applied Behavior Analysis, 31, 65-78.

¹⁵ Olympia, D.E., Heathfield, L.T., Jensen, W.R., & Clark, E. (2002). Multifaceted functional behavioral assessment for students with externalizing behaviour disorders. Psychology in the Schools, 39, 139-155.

¹⁶ Scott, T.M., Liaupsin, C.J., Nelson, C.M., & Jolivette, K. (2003). Ensuring student success through team-based functional behavioral assessment. Teaching Exceptional Children, 35, 16-21.

¹⁷ DuPaul, G.J., & Eckert, T.L. (1998). Academic interventions for students with attention-deficit hyperactivity disorder: A review of the literature. Reading and Writing Quarterly: Overcoming Learning Difficulties, 14, 59-82.

¹⁸ Gardhill, M. C., DuPaul, G.J., & Kyle, K.E. (1996). Classroom strategies for managing students with attention-deficit hyperactivity disorder. Intervention in School and Clinic, 32, 89-94.

¹⁹ DuPaul, G.J., Ervin, R.A., Hook, C.L., & McGoey, K.E. (1998). Peer tutoring for children with ADHD: Effects on classroom behavior and academic performance. Journal of Applied Behavior Analysis, 31, 579-592.

²⁰ Vaughn, S., Hughes, M. T., Moody, S.W., & Elbaum, B. (2001). Instructional grouping for reading for students with LD: Implications for practice. Intervention in School and Clinic, 36, 113-137.

²¹ Rohrbeck, C.A., Fantuzzo, J.W., Ginsburg-Block, M.D., & Miller, T.R. (2003). Peer-assisted learning interventions with elementary school students: A meta-analytic review. Journal of Educational Psychology, 95, 240-257.

²² Sutherland, K.S., & Wehby, J.H. (2001). Exploring the relation between increased opportunities to respond to academic requests and the academic and behavioral outcomes of students with emotional and behavioral disorders: A review. Remedial and Special Education, 22, 113-121.

²³ Fuchs, D., Fuchs, L.S., Mathes, P.G., & Simmons, D.C. (1997). Peer-assisted learning strategies: Making classrooms more responsive to diversity. American Educational Research Journal, 34, 174-206.

²⁴ Manset-Williamson, G., & Nelson, J.M. (2005). Balanced strategic reading instruction for upper elementary and middle school students with reading disorder: A comparative study of two approaches. Learning Disability Quarterly, 28, 59-74.

²⁵ Torgesen, J.K. (2002). The prevention of reading difficulties. Journal of School Psychology, 40, 7-26.

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³⁰ Pffifner, L.J., & Barkley, R.A. (1998). Treatment of ADHD in school settings. In R.A. Barkley (Ed.), Attention-Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment (2nd ed., pp. 458-490). London: Guildford Press.

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³³ Westby, C. (2002). Beyond decoding: Critical and dynamic literacy for students with dyslexia, language learning disabilities (LLD), or Attention Deficit-Hyperactivity Disorder (ADHD). In K.G. Butler & E.R. Silliman (Eds.), Speaking, Reading, and Writing in Children with Language Learning Disabilities. (pp. 73-107). Mahwah, N.J.: Lawrence Erlbaum Associates.

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⁴⁴ Stone, A.C. (1998). The metaphor of scaffolding: Its utility for the field of learning disabilities. Journal of Learning Disabilities, 31, 344-364.

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⁵⁰ Sturomski, N. (1997). Teaching students with learning disabilities to use learning strategies. NICHY News Digest, 25. Retrieved May 2, 2002, from http://www.nichcy.org/pubs/newsdig/nd25txt.htm

⁵¹ Harris, K.R., & Graham, S. (1996). Making the Writing Process Work: Strategies for Composition and Self-Regulation. Cambridge, M.A.: Brookline Books.

⁵² Evans, S.W., Pelham, W., & Grudberg, M.V. (1995). The efficacy of notetaking to improve behavior and comprehension of adolescents with attention deficit hyperactivity disorder. Exceptionality, 5, 1-17.

⁵³ Minskoff, E., & Allsopp, D. (2003). Academic Success Strategies for Adolescents with Learning Disabilities and ADHD. Baltimore, Maryland: Paul H. Brookes Publishing Co.

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⁶⁵ Archer, A., & Gleason, M. (1999). Skills for School Success. North Billerica, MA: Curriculum Associates, Inc.