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Teaching Children with\
Attention Deficit\
Hyperactivity Disorder:

Instructional Strategies and Practices

**2004**

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height="1.0833333333333333in"}

This report was produced under U.S. Department of Education Contract No.
HS97017002 with the American Institutes for Research under the direction
of Stephanie Jackson. Kelly Henderson served as technical representative
for this project.

**U.S. Department of Education\
**Rod Paige\
*Secretary*

**Office of Special Education and Rehabilitative Services\
**Troy R. Justesen\
*Acting Deputy Assistant Secretary*

**Office of Special Education Programs\
**Stephanie Lee\
*Director*

**Research to Practice Division\
**Louis C. Danielson\
*Director*

February 2004

This report is in the public domain. Authorization to reproduce it in
whole or in part is granted. While permission to reprint this
publication is not necessary, the citation should be: U.S. Department of
Education, Office of Special Education and Rehabilitative Services,
Office of Special Education Programs, *Teaching Children with Attention
Deficit Hyperactivity Disorder: Instructional Strategies and Practices,*
Washington, D.C., 2004.

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Contents

[**Introduction 1**](#introduction)

[Identifying Children with ADHD 1](#identifying-children-with-adhd)

[An Overall Strategy for the Successful Instruction of Children with
ADHD
3](#an-overall-strategy-for-the-successful-instruction-of-children-with-adhd)

[How to Implement the Strategy: Three Components of Successful Programs
for Children with ADHD
3](#how-to-implement-the-strategy-three-components-of-successful-programs-for-children-with-adhd)

[Academic Instruction 4](#academic-instruction)

[Introducing Lessons 4](#introducing-lessons)

[Conducting Lessons 5](#conducting-lessons)

[Concluding Lessons 7](#concluding-lessons)

[Individualizing Instructional Practices
7](#individualizing-instructional-practices)

[Organizational and Study Skills Useful for Academic Instruction of
Children with ADHD
12](#organizational-and-study-skills-useful-for-academic-instruction-of-children-with-adhd)

[Behavioral Interventions 13](#behavioral-interventions)

[Effective Behavioral Intervention Techniques
14](#effective-behavioral-intervention-techniques)

[Classroom Accommodations 17](#classroom-accommodations)

[Special Classroom Seating Arrangements for ADHD Students
17](#special-classroom-seating-arrangements-for-adhd-students)

[Instructional Tools and the Physical Learning Environment
18](#instructional-tools-and-the-physical-learning-environment)

[Conclusion 19](#conclusion)

[References 20](#references)

Teaching Children with Attention Deficit Hyperactivity Disorder:
Instructional Strategies and Practices

# Introduction

Inattention, hyperactivity, and impulsivity are the core symptoms of
Attention Deficit Hyperactivity Disorder (ADHD). A child's academic
success is often dependent on his or her ability to attend to tasks and
teacher and classroom expectations with minimal distraction. Such skill
enables a student to acquire necessary information, complete
assignments, and participate in classroom activities and discussions
(Forness & Kavale, 2001). When a child exhibits behaviors associated
with ADHD, consequences may include difficulties with academics and with
forming relationships with his or her peers if appropriate instructional
methodologies and interventions are not implemented.

## Identifying Children with ADHD

There are an estimated 1.46 to 2.46 million children with ADHD in the
United States; together these children constitute 3--5 percent of the
student population (Stevens, 1997; American Psychiatric Association,
1994). More boys than girls are diagnosed with ADHD; most research
suggests that the condition is diagnosed four to nine times more often
in boys than in girls (Bender, 1997; Hallowell, 1994; Rief, 1997).
Although for years it was assumed to be a childhood disorder that became
visible as early as age 3 and then disappeared with the advent of
adolescence, the condition is not limited to children. It is now known
that while the symptoms of the disorders may change as a child ages,
many children with ADHD do not grow out of it (Mannuzza, Klein, Bessler,
Malloy, & LaPadula, 1998).

The behaviors associated with ADHD change as children grow older. For
example, a preschool child may show gross motor overactivity---always
running or climbing and frequently shifting from one activity to
another. Older children may be restless and fidget in their seats or
play with their chairs and desks. They frequently fail to finish their
schoolwork, or they work carelessly. Adolescents with ADHD tend to be
more withdrawn and less communicative. They are often impulsive,
reacting spontaneously without regard to previous plans or necessary
tasks and homework.

According to the fourth edition of the *Diagnostic Statistical Manual of
Mental Disorders (DSM-IV)* of the American Psychiatric Association (APA)
(1994), ADHD can be defined by behaviors exhibited. Individuals with
ADHD exhibit combinations of the following behaviors:

• Fidgeting with hands or feet or squirming in their seat (adolescents
with ADHD may appear restless);

• Difficulty remaining seated when required to do so;

• Difficulty sustaining attention and waiting for a turn in tasks,
games, or group situations;

• Blurting out answers to questions before the questions have been
completed;

• Difficulty following through on instructions and in organizing tasks;

• Shifting from one unfinished activity to another;

• Failing to give close attention to details and avoiding careless
mistakes;

• Losing things necessary for tasks or activities;

• Difficulty in listening to others without being distracted or
interrupting;

• Wide ranges in mood swings; and

• Great difficulty in delaying gratification.

Children with ADHD show different combinations of these behaviors and
typically exhibit behavior that is classified into two main categories:
poor sustained attention and hyperactivity-impulsiveness. Three subtypes
of the disorder have been described in the *DSM-IV*: predominantly
inattentive, predominantly hyperactive-impulsive, and combined types
(American Psychiatric Association \[APA\] as cited in Barkley, 1997).
For instance, children with ADHD, without hyperactivity and impulsivity,
do not show excessive activity or fidgeting but instead may daydream,
act lethargic or restless, and frequently do not finish their academic
work. Not all of these behaviors appear in all situations. A child with
ADHD may be able to focus when he or she is receiving frequent
reinforcement or is under very strict control. The ability to focus is
also common in new settings or while interacting one-on-one. While other
children may occasionally show some signs of these behaviors, in
children with ADHD the symptoms are more frequent and more severe than
in other children of the same age.

Although many children have only ADHD, others have additional academic
or behavioral diagnoses. For instance, it has been documented that
approximately a quarter to one-third of all children with ADHD also have
learning disabilities (Forness & Kavale, 2001; Robelia, 1997; Schiller,
1996), with studies finding populations where the comorbidity ranges
from 7 to 92 percent (DuPaul & Stoner, 1994; Osman, 2000). Likewise,
children with ADHD have coexisting psychiatric disorders at a much
higher rate. Across studies, the rate of conduct or oppositional defiant
disorders varied from 43 to 93 percent and anxiety or mood disorders
from 13 to 51 percent (Burt, Krueger, McGue, & Iacono, 2001; Forness,
Kavale, & San Miguel, 1998; Jensen, Martin, & Cantwell, 1997; Jensen,
Shertvette, Zenakis, & Ritchters, 1993). National data on children who
receive special education confirm this co-morbidity with other
identified disabilities. Among parents of children age 6--13 years who
have an emotional disturbance, 65 percent report their children also
have ADHD. Parents of 28 percent of children with learning disabilities
report their children also have ADHD (Wagner & Blackorby, 2002).

When selecting and implementing successful instructional strategies and
practices, it is imperative to understand the characteristics of the
child, including those pertaining to disabilities or diagnoses. This
knowledge will be useful in the evaluation and implementation of
successful practices, which are often the same practices that benefit
students without ADHD.

## An Overall Strategy for the Successful Instruction of Children with ADHD

Teachers who are successful in educating children with ADHD use a
three-pronged strategy. They begin by identifying the unique needs of
the child. For example, the teacher determines how, when, and why the
child is inattentive, impulsive, and hyperactive. The teacher then
selects different educational practices associated with academic
instruction, behavioral interventions, and classroom accommodations that
are appropriate to meet that child's needs. Finally, the teacher
combines these practices into an individualized educational program
(IEP) or other individualized plan and integrates this program with
educational activities provided to other children in the class. The
three-pronged strategy, in summary, is as follows:

• **Evaluate the child's individual needs and strengths.** Assess the
unique educational needs and strengths of a child with ADHD in the
class. Working with a multidisciplinary team and the child's parents,
consider both academic and behavioral needs, using formal diagnostic
assessments and informal classroom observations. Assessments, such as
learning style inventories, can be used to determine children's
strengths and enable instruction to build on their existing abilities.
The settings and contexts in which challenging behaviors occur should be
considered in the evaluation.

• **Select appropriate instructional practices.** Determine which
instructional practices will meet the academic and behavioral needs
identified for the child. Select practices that fit the content, are age
appropriate, and gain the attention of the child.

• **For children receiving special education services, integrate
appropriate practices within an IEP.** In consultation with other
educators and parents, an IEP should be created to reflect annual goals
and the special education-related services, along with supplementary
aids and services necessary for attaining those goals. Plan how to
integrate the educational activities provided to other children in your
class with those selected for the child with ADHD.

Because no two children with ADHD are alike, it is important to keep in
mind that no single educational program, practice, or setting will be
best for all children.

# How to Implement the Strategy: Three Components of Successful Programs for Children with ADHD

Successful programs for children with ADHD integrate the following three
components:

• Academic Instruction;

• Behavioral Interventions; and

• Classroom Accommodations.

The remainder of this document describes how to integrate a program
using these three components and provides suggestions for practices that
can help children with ADHD in a classroom setting. It should be
emphasized that many of the techniques suggested have the additional
benefit of enhancing the learning of other children in the classroom who
*do not* have ADHD. In addition, while they have been used most widely
with children at the elementary level, the following practices are
useful for older students as well.

## Academic Instruction

The first major component of the most effective instruction for children
with ADHD is effective academic instruction. Teachers can help prepare
their students with ADHD to achieve by applying the principles of
effective teaching when they introduce, conduct, and conclude each
lesson. The discussion and techniques that follow pertain to the
instructional process in general (across subject areas); strategies for
specific subject areas appear in the subsequent subsection
"Individualizing Instructional Practices."

### Introducing Lessons

Students with ADHD learn best with a carefully structured academic
lesson---one where the teacher explains what he or she wants children to
learn in the current lesson and places these skills and knowledge in the
context of previous lessons. Effective teachers preview their
expectations about what students will learn and how they should behave
during the lesson. A number of teaching-related practices have been
found especially useful in facilitating this process:

• **Provide an advance organizer.** Prepare students for the day's
lesson by quickly summarizing the order of various activities planned.
Explain, for example, that a review of the previous lesson will be
followed by new information and that both group and independent work
will be expected.

• **Review previous lessons.** Review information about previous lessons
on this topic. For example, remind children that yesterday's lesson
focused on learning how to regroup in subtraction. Review several
problems before describing the current lesson.

• **Set learning expectations.** State what students are expected to
learn during the lesson. For example, explain to students that a
language arts lesson will involve reading a story about Paul Bunyan and
identifying new vocabulary words in the story.

• **Set behavioral expectations.** Describe how students are expected to
behave during the lesson. For example, tell children that they may talk
quietly to their neighbors as they do their seatwork or they may raise
their hands to get your attention.

• **State needed materials.** Identify all materials that the children
will need during the lesson, rather than leaving them to figure out on
their own the materials required. For example, specify that children
need their journals and pencils for journal writing or their crayons,
scissors, and colored paper for an art project.

• **Explain additional resources.** Tell students how to obtain help in
mastering the lesson. For example, refer children to a particular page
in the textbook for guidance on completing a worksheet.

• **Simplify instructions, choices, and scheduling.** The simpler the
expectations communicated to an ADHD student, the more likely it is that
he or she will comprehend and complete them in a timely and productive
manner.

### Conducting Lessons

In order to conduct the most productive lessons for children with ADHD,
effective teachers periodically question children's understanding of the
material, probe for correct answers before calling on other students,
and identify which students need additional assistance. Teachers should
keep in mind that transitions from one lesson or class to another are
particularly difficult for students with ADHD. When they are prepared
for transitions, these children are more likely to respond and to stay
on task. The following set of strategies may assist teachers in
conducting effective lessons:

• **Be predictable.** Structure and consistency are very important for
children with ADHD; many do not deal well with change. Minimal rules and
minimal choices are best for these children. They need to understand
clearly what is expected of them, as well as the consequences for not
adhering to expectations.

• **Support the student's participation in the classroom.** Provide
students with ADHD with private, discreet cues to stay on task and
advance warning that they will be called upon shortly. Avoid bringing
attention to differences between ADHD students and their classmates. At
all times, avoid the use of sarcasm and criticism.

• **Use audiovisual materials.** Use a variety of audiovisual materials
to present academic lessons. For example, use an overhead projector to
demonstrate how to solve an addition problem requiring regrouping. The
students can work on the problem at their desks while you manipulate
counters on the projector screen.

• **Check student performance.** Question individual students to assess
their mastery of the lesson. For example, you can ask students doing
seatwork (i.e., lessons completed by students at their desks in the
classroom) to demonstrate how they arrived at the answer to a problem,
or you can ask individual students to state, in their own words, how the
main character felt at the end of the story.

• **Ask probing questions.** Probe for the correct answer after allowing
a child sufficient time to work out the answer to a question. Count at
least 15 seconds before giving the answer or calling on another student.
Ask followup questions that give children an opportunity to demonstrate
what they know.

• **Perform ongoing student evaluation.** Identify students who need
additional assistance. Watch for signs of lack of comprehension, such as
daydreaming or visual or verbal indications of frustration. Provide
these children with extra explanations, or ask another student to serve
as a peer tutor for the lesson.

• **Help students correct their own mistakes.** Describe how students
can identify and correct their own mistakes. For example, remind
students that they should check their calculations in math problems and
reiterate how they can check their calculations; remind students of
particularly difficult spelling rules and how students can watch out for
easy-to-make errors.

• **Help students focus.** Remind students to keep working and to focus
on their assigned task. For example, you can provide follow-up
directions or assign learning partners. These practices can be directed
at individual children or at the entire class.

• **Follow-up directions.** Effective teachers of children with ADHD
also guide them with follow-up directions:

> --- *Oral directions*. After giving directions to the class as a
> whole, provide additional oral directions for a child with ADHD. For
> example, ask the child if he or she under­stood the directions and
> repeat the directions together.
>
> --- *Written directions*. Provide follow-up directions in writing. For
> example, write the page number for an assignment on the chalkboard and
> remind the child to look at the chalkboard if he or she forgets the
> assignment.

• **Lower noise level.** Monitor the noise level in the classroom, and
provide corrective feedback, as needed. If the noise level exceeds the
level appropriate for the type of lesson, remind all students---or
individual students---about the behavioral rules stated at the beginning
of the lesson.

• **Divide work into smaller units.** Break down assignments into
smaller, less complex tasks. For example, allow students to complete
five math problems before presenting them with the remaining five
problems.

• **Highlight key points.** Highlight key words in the instructions on
worksheets to help the child with ADHD focus on the directions. Prepare
the worksheet before the lesson begins, or underline key words as you
and the child read the directions together. When reading, show children
how to identify and highlight a key sentence, or have them write it on a
separate piece of paper, before asking for a summary of the entire book.
In math, show children how to underline the important facts and
operations; in "Mary has two apples, and John has three," underline
"two," "and," and "three."

• **Eliminate or reduce frequency of timed tests.** Tests that are timed
may not allow children with ADHD to demonstrate what they truly know due
to their potential preoccupation with elapsed time. Allow students with
ADHD more time to complete quizzes and tests in order to eliminate "test
anxiety," and provide them with other opportunities, methods, or test
formats to demonstrate their knowledge.

• **Use cooperative learning strategies.** Have students work together
in small groups to maximize their own and each other's learning. Use
strategies such as Think-Pair-Share where teachers ask students to think
about a topic, pair with a partner to discuss it, and share ideas with
the group. (Slavin, 2002).

• **Use assistive technology.** All students, and those with ADHD in
particular, can benefit from the use of technology (such as computers
and projector screens), which makes instruction more visual and allows
students to participate actively.

### Concluding Lessons

Effective teachers conclude their lessons by providing advance warning
that the lesson is about to end, checking the completed assignments of
at least some of the students with ADHD, and instructing students how to
begin preparing for the next activity.

• **Provide advance warnings.** Provide advance warning that a lesson is
about to end. Announce 5 or 10 minutes before the end of the lesson
(particularly for seatwork and group projects) how much time remains.
You may also want to tell students at the beginning of the lesson how
much time they will have to complete it.

• **Check assignments.** Check completed assignments for at least some
students. Review what they have learned during the lesson to get a sense
of how ready the class was for the lesson and how to plan the next
lesson.

• **Preview the next lesson.** Instruct students on how to begin
preparing for the next lesson. For example, inform children that they
need to put away their textbooks and come to the front of the room for a
large-group spelling lesson.

### Individualizing Instructional Practices

In addition to the general strategies listed above for introducing,
conducting, and concluding their lessons, effective teachers of students
with ADHD also individualize their instructional practices in accordance
with different academic subjects and the needs of their students within
each area. This is because children with ADHD have different ways of
learning and retaining information, not all of which involve traditional
reading and listening. Effective teachers first identify areas in which
each child requires extra assistance and then use special strategies to
provide structured opportunities for the child to review and master an
academic lesson that was previously presented to the entire class.
Strategies that may help facilitate this goal include the following
(grouped by subject area):

Language Arts and Reading Comprehension

To help children with ADHD who are poor readers improve their reading
comprehension skills, try the following instructional practices:

• **Silent reading time.** Establish a fixed time each day for silent
reading (e.g., D.E.A.R.: Drop Everything and Read and Sustained Silent
Reading \[Manzo & Zehr, 1998 and Holt & O'Tuel, 1989\]).

• **Follow-along reading.** Ask the child to read a story silently while
listening to other students or the teacher read the story aloud to the
entire class.

• **Partner reading activities.** Pair the child with ADHD with another
student partner who is a strong reader. The partners take turns reading
orally and listening to each other.

• **Storyboards.** Ask the child to make storyboards that illustrate the
sequence of main events in a story.

• **Storytelling.** Schedule storytelling sessions where the child can
retell a story that he or she has read recently.

• **Playacting.** Schedule playacting sessions where the child can
role-play different characters in a favorite story.

• **Word bank.** Keep a word bank or dictionary of new or "hard-to-read"
sight-vocabulary words.

• **Board games for reading comprehension.** Play board games that
provide practice with target reading-comprehension skills or
sight-vocabulary words.

• **Computer games for reading comprehension.** Schedule computer time
for the child to have drill-and-practice with sight vocabulary words.

• **Recorded books.** These materials, available from many libraries,
can stimulate interest in traditional reading and can be used to
reinforce and complement reading lessons.

• **"Backup" materials for home use.** Make available to students a
second set of books and materials that they can use at home.

• **Summary materials.** Allow and encourage students to use published
book summaries, synopses, and digests of major reading assignments to
review (not replace) reading assignments.

Phonics

To help children with ADHD master rules of phonics, the following are
effective:

• **Mnemonics for phonics.** Teach the child mnemonics that provide
reminders about hard-to-learn phonics rules (e.g., "when two vowels go
walking, the first does the talking") (Scruggs & Mastropieri, 2000).

• **Word families.** Teach the child to recognize and read word families
that illustrate particular phonetic concepts (e.g., "ph" sounds,
"at-bat-cat").

• **Board games for phonics.** Have students play board games, such as
bingo, that allow them to practice phonetically irregular words.

• **Computer games for phonics.** Use a computer to provide
opportunities for students to drill and practice with phonics or grammar
lessons.

• **Picture-letter charts.** Use these for children who know sounds but
do not know the letters that go with them.

Writing

In composing stories or other writing assignments, children with ADHD
benefit from the following practices:

• **Standards for writing assignments.** Identify and teach the child
classroom standards for acceptable written work, such as format and
style.

• **Recognizing parts of a story.** Teach the student how to describe
the major parts of a story (e.g., plot, main characters, setting,
conflict, and resolution). Use a storyboard with parts listed for this
purpose.

• **Post office.** Establish a post office in the classroom, and provide
students with opportunities to write, mail, and receive letters to and
from their classmates and teacher.

• **Visualize compositions.** Ask the child to close his or her eyes and
visualize a paragraph that the teacher reads aloud. Another variation of
this technique is to ask a student to describe a recent event while the
other students close their eyes and visualize what is being said as a
written paragraph.

• **Proofread compositions.** Require that the child proofread his or
her work before turning in written assignments. Provide the child with a
list of items to check when proofreading his or her own work.

• **Tape recorders.** Ask the student to dictate writing assignments
into a tape recorder, as an alternative to writing them.

• **Dictate writing assignments.** Have the teacher or another student
write down a story told by a child with ADHD.

Spelling

To help children with ADHD who are poor spellers, the following
techniques have been found to be helpful:

• **Everyday examples of hard-to-spell words.** Take advantage of
everyday events to teach difficult spelling words in context. For
example, ask a child eating a cheese sandwich to spell "sandwich."

• **Frequently used words.** Assign spelling words that the child
routinely uses in his or her speech each day.

• **Dictionary of misspelled words.** Ask the child to keep a personal
dictionary of frequently misspelled words.

• **Partner spelling activities.** Pair the child with another student.
Ask the partners to quiz each other on the spelling of new words.
Encourage both students to guess the correct spelling.

• **Manipulatives.** Use cutout letters or other manipulatives to spell
out hard-to-learn words.

• **Color-coded letters.** Color code different letters in hard-to-spell
words (e.g., "receipt").

• **Movement activities.** Combine movement activities with spelling
lessons (e.g., jump rope while spelling words out loud).

• **Word banks.** Use 3\" x 5\" index cards of frequently misspelled
words sorted alphabetically.

Handwriting

Students with ADHD who have difficulty with manuscript or cursive
writing may well benefit from their teacher's use of the following
instructional practices:

• **Individual chalkboards.** Ask the child to practice copying and
erasing the target words on a small, individual chalkboard. Two children
can be paired to practice their target words together.

• **Quiet places for handwriting.** Provide the child with a special
"quiet place" (e.g., a table outside the classroom) to complete his or
her handwriting assignments.

• **Spacing words on a page.** Teach the child to use his or her finger
to measure how much space to leave between each word in a written
assignment.

• **Special writing paper.** Ask the child to use special paper with
vertical lines to learn to space letters and words on a page.

• **Structured programs for handwriting.** Teach handwriting skills
through a structured program, such as Jan Olsen's Handwriting Without
Tears program (Olsen, 2003).

Math Computation

Numerous individualized instructional practices can help children with
ADHD improve their basic computation skills. The following are just a
few:

• **Patterns in math.** Teach the student to recognize patterns when
adding, subtracting, multiplying, or dividing whole numbers. (e.g., the
digits of numbers which are multiples of 9 \[18, 27, 36 . . . \] add up
to 9).

• **Partnering for math activities.** Pair a child with ADHD with
another student and provide opportunities for the partners to quiz each
other about basic computation skills.

• **Mastery of math symbols.** If children do not understand the symbols
used in math, they will not be able to do the work. For instance, do
they understand that the "plus" in 1 + 3 means to add and that the
"minus" in 5 -- 3 means to take away?

• **Mnemonics for basic computation.** Teach the child mnemonics that
describe basic steps in computing whole numbers. For example, "Don\'t
Miss Susie's Boat" can be used to help the student recall the basic
steps in long division (i.e., divide, multiply, subtract, and bring
down).

• **Real-life examples of money skills.** Provide the child with
real-life opportunities to practice target money skills. For example,
ask the child to calculate his or her change when paying for lunch in
the school cafeteria, or set up a class store where children can
practice calculating change.

• **Color coding arithmetic symbols.** Color code basic arithmetic
symbols, such as +, --, and =, to provide visual cues for children when
they are computing whole numbers.

• **Calculators to check basic computation.** Ask the child to use a
calculator to check addition, subtraction, multiplication, or division.

• **Board games for basic computation.** Ask the child to play board
games to practice adding, subtracting, multiplying, and dividing whole
numbers.

• **Computer games for basic computation.** Schedule computer time for
the child to drill and practice basic computations, using appropriate
games.

• **"Magic minute" drills.** Have students perform a quick (60-second)
drill every day to practice basic computation of math facts, and have
children track their own performance.

Solving Math Word Problems

To help children with ADHD improve their skill in solving word problems
in mathematics, try the following:

• **Reread the problem.** Teach the child to read a word problem *two
times* before beginning to compute the answer.

• **Clue words.** Teach the child clue words that identify which
operation to use when solving word problems. For example, words such as
"sum," "total," or "all together" may indicate an addition operation.

• **Guiding questions for word problems.** Teach students to ask guiding
questions in solving word problems. For example: What is the question
asked in the problem? What information do you need to figure out the
answer? What operation should you use to compute the answer?

• **Real-life examples of word problems.** Ask the student to create and
solve word problems that provide practice with specific target
operations, such as addition, subtraction, multiplication, or division.
These problems can be based on recent, real-life events in the child's
life.

• **Calculators to check word problems.** Ask the student to use a
calculator to check computations made in answering assigned word
problems.

Use of Special Materials in Math

Some children with ADHD benefit from using special materials to help
them complete their math assignments, including:

• **Number lines.** Provide number lines for the child to use when
computing whole numbers.

• **Manipulatives.** Use manipulatives to help students gain basic
computation skills, such as counting poker chips when adding
single-digit numbers.

• **Graph paper.** Ask the child to use graph paper to help organize
columns when adding, subtracting, multiplying, or dividing whole
numbers.

### Organizational and Study Skills Useful for Academic Instruction of Children with ADHD

Many students with ADHD are easily distracted and have difficulty
focusing their attention on assigned tasks. However, the following
practices can help children with ADHD improve their organization of
homework and other daily assignments:

• **Designate one teacher as the student's advisor or coordinator.**
This teacher will regularly review the student's progress through
progress reports submitted by other teachers and will act as the liaison
between home and school. Permit the student to meet with this advisor on
a regular basis (e.g., Monday morning) to plan and organize for the week
and to review progress and problems from the past week.

• **Assignment notebooks.** Provide the child with an assignment
notebook to help organize homework and other seatwork.

• **Color-coded folders.** Provide the child with color-coded folders to
help organize assignments for different academic subjects (e.g.,
reading, mathematics, social science, and science).

• **Work with a homework partner.** Assign the child a partner to help
record homework and other seatwork in the assignment notebook and file
work sheets and other papers in the proper folders.

• **Clean out desks and book bags.** Ask the child to periodically sort
through and clean out his or her desk, book bag, and other special
places where written assignments are stored.

• **Visual aids as reminders of subject material.** Use banners, charts,
lists, pie graphs, and diagrams situated throughout the classroom to
remind students of the subject material being learned.

Assisting Students with ADHD with Time Management

Children with ADHD often have difficulty finishing their assignments on
time and can thus benefit from special materials and practices that help
them to improve their time management skills, including:

• **Use a clock or wristwatch.** Teach the child how to read and use a
clock or wristwatch to manage time when completing assigned work.

• **Use a calendar.** Teach the child how to read and use a calendar to
schedule assignments.

• **Practice sequencing activities.** Provide the child with supervised
opportunities to break down a long assignment into a sequence of short,
interrelated activities.

• **Create a daily activity schedule.** Tape a schedule of planned daily
activities to the child's desk.

Helpful Study Skills for Students with ADHD

Children with ADHD often have difficulty in learning how to study
effectively on their own. The following strategies may assist ADHD
students in developing the study skills necessary for academic success:

• **Adapt worksheets.** Teach a child how to adapt instructional
worksheets. For example, help a child fold his or her reading worksheet
to reveal only one question at a time. The child can also use a blank
piece of paper to cover the other questions on the page.

• **Venn diagrams.** Teach a child how to use Venn diagrams to help
illustrate and organize key concepts in reading, mathematics, or other
academic subjects.

• **Note-taking skills.** Teach a child with ADHD how to take notes when
organizing key academic concepts that he or she has learned, perhaps
with the use of a program such as Anita Archer's Skills for School
Success (Archer & Gleason, 2002).

• **Checklist of frequent mistakes.** Provide the child with a checklist
of mistakes that he or she frequently makes in written assignments
(e.g., punctuation or capitalization errors), mathematics (e.g.,
addition or subtraction errors), or other academic subjects. Teach the
child how to use this list when proofreading his or her work at home and
school.

• **Checklist of homework supplies.** Provide the child with a checklist
that identifies categories of items needed for homework assignments
(e.g., books, pencils, and homework assignment sheets).

• **Uncluttered workspace.** Teach a child with ADHD how to prepare an
uncluttered workspace to complete assignments. For example, instruct the
child to clear away unnecessary books or other materials *before*
beginning his or her seatwork.

• **Monitor homework assignments.** Keep track of how well your students
with ADHD complete their assigned homework. Discuss and resolve with
them and their parents any problems in completing these assignments. For
example, evaluate the difficulty of the assignments and how long the
children spend on their homework each night. Keep in mind that the
*quality*, rather than the *quantity*, of homework assigned is the most
important issue. While doing homework is an important part of developing
study skills, it should be used to reinforce skills and to review
material learned in class, rather than to present, in advance, large
amounts of material that is new to the student.

## Behavioral Interventions

The second major component of effective instruction for children with
ADHD involves the use of *behavioral interventions*. Exhibiting behavior
that resembles that of younger children, children with ADHD often act
immaturely and have difficulty learning how to control their
impulsiveness and hyperactivity. They may have problems forming
friendships with other children in the class and may have difficulty
thinking through the social consequences of their actions.

The purpose of behavioral interventions is to assist students in
displaying the behaviors that are most conducive to their own learning
and that of classmates. Well-managed classrooms prevent many
disciplinary problems and provide an environment that is most favorable
for learning. When a teacher's time must be spent interacting with
students whose behaviors are not focused on the lesson being presented,
less time is available for assisting other students. Behavioral
interventions should be viewed as an opportunity for teaching in the
most effective and efficient manner, rather than as an opportunity for
punishment.

### Effective Behavioral Intervention Techniques

Effective teachers use a number of behavioral intervention techniques to
help students learn how to control their behavior. Perhaps the most
important and effective of these is **verbal reinforcement** of
appropriate behavior. The most common form of verbal reinforcement is
**praise** given to a student when he or she begins and completes an
activity or exhibits a particular desired behavior. Simple phrases such
as "good job" encourage a child to act appropriately. Effective teachers
praise children with ADHD frequently and look for a behavior to praise
before, and not after, a child gets off task. The following strategies
provide some guidance regarding the use of praise:

• **Define the appropriate behavior while giving praise.** Praise should
be specific for the positive behavior displayed by the student: The
comments should focus on what the student did right and should include
exactly what part(s) of the student's behavior was desirable. Rather
than praising a student for not disturbing the class, for example, a
teacher should praise him or her for quietly completing a math lesson on
time.

• **Give praise immediately.** The sooner that approval is given
regarding appropriate behavior, the more likely the student will repeat
it.

• **Vary the statements given as praise.** The comments used by teachers
to praise appropriate behavior should vary; when students hear the same
praise statement repeated over and over, it may lose its value.

• **Be consistent and sincere with praise.** Appropriate behavior should
receive consistent praise. Consistency among teachers with respect to
desired behavior is important in order to avoid confusion on the part of
students with ADHD. Similarly, students will notice when teachers give
insincere praise, and this insincerity will make praise less effective.

It is important to keep in mind that the most effective teachers focus
their behavioral intervention strategies on *praise* rather than on
*punishment*. Negative consequences may temporarily change behavior, but
they rarely change attitudes and may actually increase the frequency and
intensity of inappropriate behavior by rewarding misbehaving students
with attention. Moreover, punishment may only teach children what not to
do; it does not provide children with the skills that they need to do
what is expected. Positive reinforcement produces the changes in
attitudes that will shape a student's behavior over the long term.

In addition to verbal reinforcement, the following set of generalized
behavioral intervention techniques has proven helpful with students with
ADHD as well:

• **Selectively ignore inappropriate behavior.** It is sometimes helpful
for teachers to selectively ignore inappropriate behavior. This
technique is particularly useful when the behavior is unintentional or
unlikely to recur or is intended solely to gain the attention of
teachers or classmates without disrupting the classroom or interfering
with the learning of others.

• **Remove nuisance items.** Teachers often find that certain objects
(such as rubber bands and toys) distract the attention of students with
ADHD in the classroom. The removal of nuisance items is generally most
effective after the student has been given the choice of putting it away
immediately and then fails to do so.

• **Provide calming manipulatives.** While some toys and other objects
can be distracting for both the students with ADHD and peers in the
classroom, some children with ADHD can benefit from having access to
objects that can be manipulated quietly. Manipulatives may help children
gain some needed sensory input while still attending to the lesson.

• **Allow for "escape valve" outlets.** Permitting students with ADHD to
leave class for a moment, perhaps on an errand (such as returning a book
to the library), can be an effective means of settling them down and
allowing them to return to the room ready to concentrate.

• **Activity reinforcement.** Students receive activity reinforcement
when they are encouraged to perform a less desirable behavior before a
preferred one.

• **Hurdle helping.** Teachers can offer encouragement, support, and
assistance to prevent students from becoming frustrated with an
assignment. This help can take many forms, from enlisting a peer for
support to supplying additional materials or information.

• **Parent conferences.** Parents have a critical role in the education
of students, and this axiom may be particularly true for those with
ADHD. As such, parents must be included as partners in planning for the
student's success. Partnering with parents entails including parental
input in behavioral intervention strategies, maintaining frequent
communication between parents and teachers, and collaborating in
monitoring the student's progress.

• **Peer mediation.** Members of a student's peer group can positively
impact the behavior of students with ADHD. Many schools now have
formalized peer mediation programs, in which students receive training
in order to manage disputes involving their classmates.

Effective teachers also use *behavioral prompts* with their students.
These prompts help remind students about expectations for their learning
and behavior in the classroom. Three, which may be particularly helpful,
are the following:

• **Visual cues.** Establish simple, nonintrusive visual cues to remind
the child to remain on task. For example, you can point at the child
while looking him or her in the eye, or you can hold out your hand, palm
down, near the child.

• **Proximity control.** When talking to a child, move to where the
child is standing or sitting. Your physical proximity to the child will
help the child to focus and pay attention to what you are saying.

• **Hand gestures.** Use hand signals to communicate privately with a
child with ADHD. For example, ask the child to raise his or her hand
every time you ask a question. A closed fist can signal that the child
knows the answer; an open palm can signal that he or she does not know
the answer. You would call on the child to answer only when he or she
makes a fist.

In some instances, children with ADHD benefit from instruction designed
to help students learn how to manage their own behavior:

• **Social skills classes.** Teach children with ADHD appropriate social
skills using a structured class. For example, you can ask the children
to role-play and model different solutions to common social problems. It
is critical to provide for the generalization of these skills, including
structured opportunities for the children to use the social skills that
they learn. Offering such classes, or experiences, to the general school
population can positively affect the school climate.

• **Problem solving sessions.** Discuss how to resolve social conflicts.
Conduct impromptu discussions with one student or with a small group of
students where the conflict arises. In this setting, ask two children
who are arguing about a game to discuss how to settle their differences.
Encourage the children to resolve their problem by talking to each other
in a supervised setting.

For many children with ADHD, *functional behavioral assessments* and
*positive behavioral interventions and supports*, including behavioral
contracts and management plans, tangible rewards, or token economy
systems, are helpful in teaching them how to manage their own behavior.
Because students' individual needs are different, it is important for
teachers, along with the family and other involved professionals, to
evaluate whether these practices are appropriate for their classrooms.
Examples of these techniques, along with steps to follow when using
them, include the following:

• **Functional Behavioral Assessment (FBA).** FBA is a systematic
process for describing problem behavior and identifying the
environmental factors and surrounding events associated with problem
behavior. The team that works closely with the child exhibiting problem
behavior (1) observes the behavior and identifies and defines its
problematic characteristics, (2) identifies which actions or events
precede and follow the behavior, and (3) determines how often the
behavior occurs. The results of the FBA should be used to develop an
effective and efficient intervention and support plan. (Gable, et al.,
1997)

• **Positive Behavioral Interventions and Supports (PBIS).** This method
is an application of a behaviorally based systems approach that is
grounded in research regarding behavior in the context of the settings
in which it occurs. Using this method, schools, families, and
communities work to design effective environments to improve behavior.
The goal of PBIS is to eliminate problem behavior, to replace it with
more appropriate behavior, and to increase a person's skills and
opportunities for an enhanced quality of life (Todd, Horner, Sugai, &
Sprague, 1999).

• **Behavioral contracts and management plans.** Identify specific
academic or behavioral goals for the child with ADHD, along with
behavior that needs to change and strategies for responding to
inappropriate behavior. Work with the child to cooperatively identify
appropriate goals, such as completing homework assignments on time and
obeying safety rules on the school playground. Take the time to ensure
that the child agrees that his or her goals are important to master.
Behavioral contracts and management plans are typically used with
individual children, as opposed to entire classes, and should be
prepared with input from parents.

• **Tangible rewards.** Use tangible rewards to reinforce appropriate
behavior. These rewards can include stickers, such as "happy faces" or
sports team emblems, or privileges, such as extra time on the computer
or lunch with the teacher. Children should be involved in the selection
of the reward. If children are invested in the reward, they are more
likely to work for it.

• **Token economy systems.** Use token economy systems to motivate a
child to achieve a goal identified in a behavioral contract (Barkley,
1990). For example, a child can earn points for each homework assignment
completed on time. In some cases, students also lose points for each
homework assignment not completed on time. After earning a specified
number of points, the student receives a tangible reward, such as extra
time on a computer or a "free" period on Friday afternoon. Token economy
systems are often used for entire classrooms, as opposed to solely for
individual students.

• **Self-management systems.** Train students to monitor and evaluate
their own behavior without constant feedback from the teacher. In a
typical self-management system, the teacher identifies behaviors that
will be managed by a student and provides a written rating scale that
includes the performance criteria for each rating. The teacher and
student separately rate student behavior during an activity and compare
ratings. The student earns points if the ratings match or are within one
point and receives no points if ratings are more than one point apart;
points are exchanged for privileges. With time, the teacher involvement
is removed, and the student becomes responsible for self-monitoring
(DuPaul & Stoner as cited in Shinn, Walker, & Stoner, 2002).

## Classroom Accommodations

The third component of a strategy for effectively educating children
with ADHD involves physical *classroom accommodations*. Children with
ADHD often have difficulty adjusting to the structured environment of a
classroom, determining what is important, and focusing on their assigned
work. They are easily distracted by other children or by nearby
activities in the classroom. As a result, many children with ADHD
benefit from accommodations that reduce distractions in the classroom
environment and help them to stay on task and learn. Certain
accommodations within the physical and learning environments of the
classroom can benefit children with ADHD.

### Special Classroom Seating Arrangements for ADHD Students

One of the most common accommodations that can be made to the physical
environment of the classroom involves determining where a child with
ADHD will sit. Three special seating assignments may be especially
useful:

• **Seat the child near the teacher.** Assign the child a seat near your
desk or the front of the room. This seating assignment provides
opportunities for you to monitor and reinforce the child's on-task
behavior.

• **Seat the child near a student role model.** Assign the child a seat
near a student role model. This seat arrangement provides opportunity
for children to work cooperatively and to learn from their peers in the
class.

• **Provide low-distraction work areas.** As space permits, teachers
should make available a quiet, distraction-free room or area for quiet
study time and test taking. Students should be directed to this room or
area privately and discreetly in order to avoid the appearance of
punishment.

### Instructional Tools and the Physical Learning Environment

Skilled teachers use special instructional tools to modify the classroom
learning environment and accommodate the special needs of their students
with ADHD. They also monitor the physical environment, keeping in mind
the needs of these children. The following tools and techniques may be
helpful:

• **Pointers.** Teach the child to use a pointer to help visually track
written words on a page. For example, provide the child with a bookmark
to help him or her follow along when students are taking turns reading
aloud.

• **Egg timers.** Note for the children the time at which the lesson is
starting and the time at which it will conclude. Set a timer to indicate
to children how much time remains in the lesson and place the timer at
the front of the classroom; the children can check the timer to see how
much time remains. Interim prompts can be used as well. For instance,
children can monitor their own progress during a 30-minute lesson if the
timer is set for 10 minutes three times.

• **Classroom lights.** Turning the classroom lights on and off prompts
children that the noise level in the room is too high and they should be
quiet. This practice can also be used to signal that it is time to begin
preparing for the next lesson.

• **Music.** Play music on a tape recorder or chords on a piano to
prompt children that they are too noisy. In addition, playing different
types of music on a tape recorder communicates to children what level of
activity is appropriate for a particular lesson. For example, play quiet
classical music for quiet activities done independently and jazz for
active group activities.

• **Proper use of furniture.** The desk and chair used by children with
ADHD need to be the right size; if they are not, the child will be more
inclined to squirm and fidget. A general rule of thumb is that a child
should be able to put his or her elbows on the surface of the desk and
have his or her chin fit comfortably in the palm of the hand.

# Conclusion

This guide has outlined a series of instructional strategies that have
proven to be successful in educating children with ADHD. However, it
should be emphasized again that these techniques are also highly useful
for *all* children. The three main components of a successful strategy
for educating children with ADHD are *academic instruction*, *behavioral
interventions*, and *classroom accommodations*. By incorporating
techniques from these three areas into their everyday instructional and
classroom management practices, teachers will be empowered to improve
both the academic performance and the behavior of their students with
ADHD. In doing so, teachers will create an enhanced learning environment
for all students.

This guide is the second in a series of three publications that address
issues related to the instruction of children with ADHD. The first is
*Identifying and Treating Attention Deficit Hyperactivity Disorder: A
Resource for School and Home*. Coming soon is *A Resource Directory for
ADHD*. Teachers and others are encouraged to consult these publications
and to use them in conjunction with *Teaching Children with Attention
Deficit Disorders: Instructional Strategies and Practices*. As the
documents become available, they will be listed on the Office of Special
Education and Rehabilitative Services/Office of Special Education
Programs Web site (http://www.ed.gov/about/
offices/list/osers/osep/index.html).

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