When students are diagnosed with attention-deficit/hyperactivity disorder (ADHD), approaches that were once excluded from the classroom are now considered a valid option for helping them focus and learn.
While the most common solution is medication, school district leaders have become increasingly aggressive in using other measures to improve the learning experience. Exercise balls, sensory kits and exercise breaks are among the approaches schools are taking to support students with ADHD as diagnosis of the disorder continues to increase in U.S. schools.
From experimenting with classroom interventions to standardizing administrative procedures, various strategies have earned positive assessments in a number of studies. And while specific steps vary, many of the successful approaches combine behavioral flexibility with efforts to help students focus on academics.
In recent years, medical research and practical experience have brought greater understanding of ADHD and have also led to the development of more effective classroom coping strategies, says Linda Gardner, director of special services for Hopkins Public Schools in Minnesota.
“As we understand the true nature of ADHD, we come to design more effective and efficient accommodations,” she says. “As teachers become more adept at these accommodations, their own experience leads them to more precise strategies.”
About 2 million additional U.S. children had been diagnosed with ADHD in 2011 than had been diagnosed in 2003.
The approaches favored by some go beyond the traditional interventions of medication or behavior modification. Perhaps most effective are those designed to help kids focus on the subject at hand while allowing for the restlessness typical of those with ADHD. Using exercise balls in place of desk chairs, for instance, has been shown to help increase the attention span of students by keeping children’s bodies engaged.
Exercise balls work because the added movement requires students to concentrate on staying in place by using their core muscles, Gardner says. “This helps them by keeping them from needing to get up and move around the room or interrupt with verbal outbursts,” she says. “The general idea is that they fidget without looking like they are fidgeting.”
Students may also elect to sit on move-n-sit cushions or Hokki stools, both of which allow movement. The stools, typically made of durable plastic with a heavy convex base, allow movement in multiple directions while students remain seated. Researchers have found this type of controlled physical diminishes urges for getting up and moving around.
All Hopkins schools also have kits for sensory integration activities. The kits, known informally as “motor break boxes,” contain miniature slinkies, stretch bands, plastic balls and other items. One theory is that in squeezing a ball or stretching bands, children’s brains are “rewired” temporarily for increased attention.
Another approach involves using software and online tools to help students improve key skills. Some districts are finding success with programs that address reading proficiency and develop cognitive skills such as memory, attention, processing and sequencing. While some software may not be specific to ADHD, proponents argue that students with the disorder are among those most likely to benefit.
Other ADHD accommodations that may be used in any district include preferential seating, movement breaks, flexible grouping, visual timers, heavy lifting or other physical activities. Since exercise can increase levels of neurotransmitters, such as norepinephrine and dopamine, physical activity of any type may have a positive effect on a student’s sense of well-being and foster positive attitudes.
Gardner also recommends frequent coaching or encouragement. She adds that designating space in a classroom for specific activities, such as a corner reserved exclusively for homework where students won’t be distracted, can also be effective.
Some districts are reviewing processes for identifying the disorder and providing effective interventions. Kenosha Unified School District in Wisconsin has developed a comprehensive process for serving students who have ADHD or other behavioral or academic concerns.
In “collaborative student intervention,” a team of people connected to the student—including parents or grandparents, mentors, teachers and principals—develop intervention ideas that are student-specific. The team then creates an action plan that focuses on the child’s unique interests, says Susan Valeri, director of special education and student support.
More than one in 10 children ages 4-17 suffers from the disorder
“We ask the student, ‘What do you like? What are you good at?’” Valeri says. A teacher uses that information in adjusting assignments or classroom rules. “If they’re into cars, that interest is built into a writing activity or reading project,” she says. “If they love music, we might let them wear headphones in class to listen to music while working.”
The Houston Independent School District relies on school-based specialists who are licensed in school psychology, says Sowmya Kumar, assistant superintendent in the district’s office of special education services. The specialists work with doctors to assign the federal government’s Other Health Impaired (OHI) label to students with ADHD.
Once a student is diagnosed, a comprehensive series of measures is used to determine the best accommodations or interventions. Assessment methods include reviewing a student’s testing data, direct observations in school settings, and use of behavior rating scales specific to ADHD. Interviews with parents, teachers and mental health professionals may also prove helpful.
“What we know in the medical field is that ADHD often does not exist alone. Children diagnosed with ADHD often may have a learning disability, and vice versa,” says Dr. Marilyn Benoit, chief clinical officer at Devereux, a nonprofit behavioral health organization headquartered in Villanova, Pa.
In such cases, interventions should be designed that focus on each facet of the student’s learning needs. At the same time, she adds, some of the same identifiers or symptoms of ADHD are similar to those of a child with depression or anxiety. Thorough evaluations can help lead to proper diagnoses that can, in turn, help educators take all conditions into account as they work with children.
Experts also recommend that districts invest in appropriate professional development to help teachers and administrators best serve students with ADHD. Training might range from district-sponsored college classes for teachers to less costly measures, such as bringing speakers into the district or setting up mentoring programs.
Robert Myers, assistant clinical professor of psychiatry and human behavior at UC Irvine School of Medicine, suggests that training topics include effective behavior management techniques and strategies for helping ADHD students improve their planning and organization abilities.
Training for teachers and other staff can also help promote positive attitudes toward children with such needs, including an openness to recognizing traits in students that may be considered valuable to learning, says Thomas Armstrong, executive director of the American Institute for Learning and Human Development, a consulting firm in California.
“Teachers should receive training on how to take the strengths associated with ADHD, such as a preference for novelty and an inclination toward creative expression, and develop learning strategies that embrace those strengths,” Armstrong says. Such measures could include using more in-class role playing, providing interactive computer games, or taking students on field trips.
For administrators, providing support for teachers and others is a key to progress, Myers says. “School administrators have a great opportunity to provide leadership to the teaching staff in helping them to understand the perspective of the student with ADHD and his or her parents,” he says.
Mark Rowh is a freelance writer based in Virginia.