Feeds:
Posts
Comments

Archive for the ‘ADD/ADHD’ Category

In light of all the discussions this week regarding ADHD and medication, Using ABA to Address ADHD, and a research study on Addressing ADHD in Classrooms, this cartoon seems relevant!

Thank you Hank Ketcham for your brilliance all these years!

Dennis and Impulsivity

Read Full Post »

Teacher and SudentsHere at Applied Behavioral Strategies, the mission is to improve the quality of life through effective intervention. One way we hope to do that is by reviewing research articles for our readers. Today’s research review continues the discussion this week on using principles of ABA to address ADHD. See Monday’s post and Tuesday’s post for additional information.

Researchers from a variety of institutions collaborated to author “Peer Tutoring for Children with ADHD: Effects on Classroom Behavior and Academic Performance“. Authors included: George DuPaul, Ruth Ervin, Christine Hook, and Kara McGoey. The Journal of Applied Behavior Analysis (JABA) published the study. Readers may download the entire article here.

Background

Children with ADHD need two types of intervention. First, teachers and parents must provide reinforcement for appropriate behaviors and research has shown this to be effective. However, reinforcement alone is not enough. Teachers and parents must also concurrently address academic behaviors. One method for addressing academic behaviors is peer tutoring. Peer tutoring consists of two or more students working together on an activity with one student providing assistance, instruction, and feedback to the other. Various models of peer tutoring have been studied by great educational researchers such as Charlie Greenwood and Doug and Lynn Fuchs.

ClassWide Peer Tutoring

One model of peer tutoring is Classwide Peer Tutoring (CWPT). Classwide Peer Tutoring is an evidence based instructional practice based on principles of Applied Behavior Analysis (e.g., prompting, reinforcement, modeling). In CWPT, students work together in pairs taking turns tutoring each other. Students address skills that have been previously taught by their teacher. The teacher also develops appropriate teaching materials for the students to use. This approach provides students with more opportunities for asking questions and getting answers.

Study Purpose

The purpose of the study was to examine the effects of CWPT on  the task engagement, activity level, and academic performance of children with ADHD and children without ADHD.

Study Methodology

Participants. Eighteen students with ADHD who were not taking medication participated in the study. Children ranged between 6 and 10 years of age. Additionally, 10 comparison children participated in the study. These children were matched to the other children on age, gender, and class (i.e., in the same class as one of the targeted students).

Measures. Researchers measured classroom behavior (on task, off task, and fidgety) using a 15-second partial interval recording. Researchers also measured academic performance using teacher-developed pre- and post-tests each week. Finally, researchers also measured social validity by asking teachers and students to rate the intervention at the end of the study.

Design. Researchers used an ABAB (or reversal) design to determine intervention effectiveness. In this design, researchers measure behaviors with no intervention. Then they measure behaviors during intervention. Then the intervention is terminated while researchers continue to measure behaviors. And finally, the intervention is reinstated while behaviors continue to be measured.

Study Validity. The researchers took two additional steps to measure the validity of the study. First, they monitored accuracy of implementation using fidelity checks. Second, the researchers measured inter-observer agreement to ensure that data collection was consistent and accurate.

Results

During baseline, students with ADHD were on-task about 29% of the intervals. This increased to 80% of intervals during intervention. When the intervention stopped, this behavior decreased down to an average of 21% of intervals but when the intervention was reinstated, it increased again to 83%. Changes in fidgety behavior were observed in some but not all students. It is important to note that even without intervention, the occurrence of fidgety behaviors was low (i.e. 6% of intervals). Pre-and Post-test scores improved with intervention for almost half of the students with ADHD. Finally, the intervention received high marks of satisfaction across both teachers and students.

Comments

In the discussion section of the paper, the authors note how the results of their study compared to the results of studies on stimulant medication. Essentially, effective instructional practices work just as well as medication without all the side effects. The authors also noted that anecdotal data suggested that student engagement increased as well. Use of stimulant medication does not necessarily result in increased engagement. Interestingly, the comparison peers also showed improvements in on-task behaviors and academic performance.

Readers, do any of your children engage in CWPT? Behavior analysts, is this an intervention that you teach others to use in classrooms? Teachers, how difficult is it to implement CWPT in your class?

 

Read Full Post »

English: A child not paying attention in class.

After yesterday‘s post regarding the use of ABA to treat ADHD, readers expressed interest in learning more. So today, one intervention to address ADHD behaviors will be discussed.

Reinforcement

Readers should not be surprised to hear that reinforcement is a recommended intervention. Reinforcement is a key topic in almost every single post on this blog. The important thing to remember is that reinforcement must be individually designed and administered in order to obtain maximum results. Individualization is not easy for teachers or parents. However, if appropriate reinforcers and correct schedules of reinforcement are utilized, great changes in behavior will be observed.

Differential Reinforcement

There are many types of differential reinforcement:

  • differential reinforcement of other behavior (DRO)
  • differential reinforcement of incompatible behavior (DRI)
  • differential reinforcement of alternative behavior (DRA)
  • differential reinforcement of higher rates of behavior (DRH; designed to increase desirable behaviors!)
  • differential reinforcement of lower rates of behavior (DRL)

Essentially, differential reinforcement is the use of reinforcement for one behavior and not for others. Differential reinforcement requires implementors to reinforce one behavior while withholding reinforcement for another.

Differential Reinforcement of Alternative Behavior (DRA)

In this intervention, reinforcement is provided when an alternative behavior is observed but not when inappropriate behaviors are observed. Specifically, if a child is engaging in off task and distractable behaviors, alternative behaviors would be identified. It is important to know why (e.g., to get out of work, to get teacher attention, etc). An assessment must first be conducted to know why a behavior is occurring. To read more on assessment, check here, here, and here. Once the assessment has been completed, then alternative behaviors to obtain the same reinforcers are identified.

If a child is trying to get out of work, an alternative behavior is to work faster so that play and non-work time may be accessed. If a child is trying to gain teacher attention, then the child is taught to use appropriate behaviors to get teacher attention.

The next step is to reinforce the new/alternative behavior. If the child is working quickly, she needs to be reinforced with a nice long work break or play time. If the child appropriately recruits teacher attention, the teacher needs to come over quickly to give attention.

Thin Reinforcement

As with any intervention, the goal is to get appropriate behavior then to thin or reduce reinforcement so that the child may function like the rest of children in the class or home. It is important to thin reinforcement at a pace that will prevent the ADHD-type behaviors from escalating.

I hope this helps readers better understand one way that ABA may be used to address ADHD.

Related articles

Read Full Post »

ADHDHi and welcome to Ask Missy Mondays where I respond to a question from readers. Today’s question comes from Andrea who asks,

“I have a 4-year-old who was diagnosed with autism within the last 6 months. He is extremely hyperactive and inattentive. What medication do you find to be most helpful?”

Hi Andrea, and thanks for taking the time to write. I am sorry to hear about your child being diagnosed with autism but he is young so there is ample time to get appropriate intervention to help him.

Please know that as a behavior analyst and special educator, I am not licensed to practice medicine. So, making recommendations about medication is out of my preview.

However, as behavior analysts, we are trained to address all types of behaviors, including hyperactive and inattentive behaviors.

Assessment

Before we address any behaviors, we first complete assessments to better understand why the behaviors are happening. The assessment includes record reviews, interviews, and asking those who know the child to complete rating scales. The assessments also include observations of the child to better understand when the behaviors are good versus when the behaviors are bad. Finally, we may even conduct analyses to determine which environmental conditions directly affect the behavior.

Intervention

Once the assessments have been completed, the behavior analyst will help design interventions to address the behaviors of concern. Behavioral interventions can be designed to address attentive behaviors, impulsive behaviors, and skills related to following instructions.

Health Interventions

In addition to behavioral intervention, parents should also consider whole body interventions that address the overall health of the child. Children need daily physical activity and I am not talking about using their fingers to control the remote or the iPad. Children need full body physical activity every single day.

Children also need a healthy diet. If your child eats mostly processed foods full of sugars, fake color, and other artificial ingredients, then you should change the diet before considering the use of medication to treat behaviors that may very well be caused by foods.

Finally, children need far more sleep than they are getting. Children need at least 10 hours of sleep each night. Children (nor adults) can make up for lost sleep so make sure that your child goes to bed early and sleeps as late as possible.

When All Else Fails

If you have followed all of the other advice above (consistently) and your child continues to have behavioral issues, then consider seeing a behavioral pediatrician to assist you in determining if medication is the right thing for your child. Medication should not be your first stop, it should be your last.

If you have a behavioral question for me, email askmissy at applied behavioral strategies dot com.

Read Full Post »

%d bloggers like this: