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Old 05-31-13, 01:17 PM
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Re: Accommodations for Children and Teens

Classroom Accommodations for Children or Teens with ADHD Russell A. Barkley, Ph.D.

During my workshops on ADHD, I share with educators a list of more than 80 recommendations, most from research, that they can use to help manage ADHD in school settings for children and teens with the disorder apart from or in addition to using ADHD medications. Behind these recommendations lie 9 principles that need to be considered in planning management programs for children and teens with ADHD in school settings (Pfiffner, Barkley, & DuPaul, 2006). Here are those 9 principles followed by the 80 suggested accommodations.

1. Rules and instructions provided to children with ADHD must be clear, brief, and often delivered through more visible and external modes of presentation than is required for the management of normal children. Stating directions clearly, having the child repeat them out loud, having the child utter them softly to themselves while following through on the instruction, and displaying sets of rules or rule-prompts (e.g. stop signs, big eyes, big ears for "stop, look, and listen" reminders) prominently throughout the classroom are essential to proper management of ADHD children. Relying on the child's recollection of the rules as well as upon purely verbal reminders is often ineffective.

2. Consequences used to manage the behavior of ADHD children must be delivered swiftly and more immediately than is needed for normal children. Delays in consequences greatly degrade their efficacy for children with ADHD. As will be noted throughout this chapter, the timing and strategic application of consequences with children with ADHD must be more systematic and is far more crucial to their management than in normal children. This is not just true for rewards, but is especially so for punishment which can be kept mild and still effective by delivering it as quickly upon the misbehavior as possible–Swift, not harsh, justice is the essence of effective punishment.

3. Consequences must be delivered more frequently, not just more immediately, to children with ADHD in view of their motivational deficits. Behavioral tracking, or the ongoing adherence to rules after the rule has been stated and compliance initiated, appears to be problematic for children with ADHD. Frequent feedback or consequences for rule adherence seem helpful in maintaining appropriate degrees of tracking to rules over time.

4.The type of consequences used with children with ADHD must often be of a higher magnitude, or more powerful, than that needed to manage the behavior of normal children.
The relative insensitivity of children with ADHD to response consequences dictates that those chosen for inclusion in a behavior management program must have sufficient reinforcement value or magnitude to motivate children with ADHD to perform the desired behaviors. Suffice it to say, then, that mere occasional praise or reprimands are simply not enough to effectively manage children with ADHD.

5. An appropriate and often richer degree of incentives must be provided within a setting or task to reinforce appropriate behavior before punishment can be implemented. This means that punishment must remain within a relative balance with rewards or it is unlikely to succeed. It is therefore imperative that powerful reinforcement programs be established first and instituted over 1 to 2 weeks before implementing punishment in order for the punishment, sparingly used, to be maximally effective. Often children with ADHD will not improve with the use of response cost or time out if the availability of reinforcement is low in the classroom and hence removal from it is unlikely to be punitive. "Positives before negatives" is the order of the day with children with ADHD. When punishment fails, this is the first area which clinicians, consultations, or educators should explore for problems before instituting higher magnitude or more frequent punishment programs.

6. Those reinforcers or particular rewards which are employed must be changed or rotated more frequently with ADHD than normal children given the penchant of the former for more rapid habituation or satiation to response consequences, apparently rewards in particular. This means that even though a particular reinforcer seems to be effective for the moment in motivating child compliance, it is likely that it will lose its reinforcement value more rapidly than normal over time. Reward menus in classes, such as those used to back up token systems, must therefore be changed periodically, say every 2 to 3 weeks, to maintain the power of efficacy of the program in motivating appropriate child behavior. Failure to do so is likely to result in the loss of power of the reward program and the premature abandonment of token technologies based on the false assumption that they simply will not work any longer. Token systems can be maintained over an entire school year with minimal loss of power in the program provided that the reinforcers are changed frequently to accommodate to this problem of habituation. Such rewards can be returned later to the program once they have been set aside for a while, often with the result that their reinforcement value appears to have been improved by their absence or unavailability.

7. Anticipation is the key with children with ADHD.This means that teachers must be more mindful of planning ahead in managing children with this disorder, particularly during phases of
transition across activities or classes, to insure that the children are cognizant of the shift in rules (and consequences) that is about to occur. It is useful for teachers to take a moment to prompt a child to recall the rules of conduct in the upcoming situation, repeat them orally, and recall what the rewards and punishments will be in the impending situation before entering that activity or situation. Think aloud, think ahead is the important message to educators here. As noted later, by themselves such cognitive self-instructions are unlikely to be of lasting benefit but when combined with contingency management procedures can be of considerable aide to the classroom management of ADHD children.

8. Children with ADHD must beheld more publicly accountable for their behavior and goal-attainment than normal children. The weaknesses in executive functioning associated with
ADHD result in a child whose behavior is less regulated by internal information (mental representations) and less monitored via self-awareness than is the case in normal children. Addressing such weaknesses requires that the child with ADHD be provided with more external cues about performance demands at key “points of performance” in the school, be monitored more closely by teachers, and be provided with consequences more often across the school day for behavioral control and goal attainment than would be the case in normal children.

9. Behavioral interventions, while successful, only work while they are being implemented and, even then, require continued monitoring and modification over time for maximal effectiveness. One common scenario is that a student responds initially to a well-tailored program,but then over time, the response deteriorates; in other cases, a behavioral program may fail to modify the behavior at all. This does not mean behavioral programs do not work. Instead, such difficulties signal that the program needs to be modified. It is likely that one of a number of common problems (e.g., rewards lost their value, program not implemented consistently, program not based on a functional analysis of the factors related to the problem behavior) occurred.
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