Critical Thinking

There of the symptoms displayed by those afflicted

There is a
prevalence of myths and misconceptions currently associated with Attention
Deficit Hyperactivity Disorder (ADHD) in the wider community and within the
education system.  This report will
outline some of the current understandings regarding ADHD and subsequent
implications for student learning.  Explicit
Teaching and Universal Design for Learning teaching methods will be explained
including strategies to enhance learning opportunities for ADHD students.

 

ADHD Statistics

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The
Department of Health’s “Mental Health of Young People
in Australia” report in 2000 states that
11.2% of all children and adolescents are diagnosed with ADHD with an alarming
19.3% of all males aged 6-12 years being impacted.  Whilst ADHD is often regarded as being more
prevalent in male children there is growing evidence of greater numbers of females
and undiagnosed adults also experiencing ADHD.

 

ADHD
misconceptions

 

Some
of the many myths and misconceptions associated with ADHD (Attention Deficit
Hyperactivity Disorder) include the perception that those afflicted are
naughty, disruptive, badly behaved, hyperactive, poorly parented, only boys, who
will outgrow it and/or that it is not even a real condition (Morin, n.d.).

 

Whilst
some of these beliefs lead people to believe that ADHD is a behavioural
disorder, these behaviours are often indicators of an underlying physical and
neurological dysfunction that has significant, subsequent impacts on cognitive
and behavioural capabilities.

 

What is ADHD?

 

A
small minority of researchers believe that ADHD is a behavioural conditional,
however there is greater consensus that ADHD is a developmental,
neurobiologically based spectrum disorder (Daley &
Birchwood, 2010).  According to
the ADHD Institute, ADHD is a “diverse condition characterised by symptoms of
inattention, hyperactivity and impulsivity” that are associated with structural,
functional and neurotransmitter alterations in the brain (ADHD Institute, xxxx). More specifically, there
appear to be structural and developmental elements affecting the pre-frontal
cortex of the brain which in turn is associated with Executive Function (EF)
skill deficits.  Executive Function
impairment and developmental delay are predominant factors in ADHD directly
associated with many of the symptoms displayed by those afflicted by the
disorder.

 

What are the
indicators of ADHD?

 

The
main identifier of ADHD is:

 

“a
persistent pattern of inattention and/or hyperactivity-impulsivity more
frequent and severe than in other individuals at a similar developmental stage”.

 

Telethon Kids Institute (2015)

 

There
are 3 main subtypes of ADHD:

 

·        
Inattentive
(formerly known as Attention Deficit Disorder or ADD)

·        
Hyperactive-Impulsive

·        
Combined
(combinations of Inattentive and Hyperactive-Impulsive types)

 

The Learning
and Attentional Disorders Society of WA (Inc.) (LADS) provide the
following outline of symptoms associated with each subtype.

 

Inattentive Symptoms

 

·        
Fails to
give close attention to detail, makes careless mistakes

·        
Has
difficulty in sustaining attention in tasks or activities

·        
Does not
appear to listen when spoken to directly

·        
Often does
not follow through on instructions or fails to complete tasks

·        
Often has
difficulties organising tasks and activities

·        
Often
avoids, dislikes, or is reluctant to engage in tasks that require sustained
mental effort

·        
Often loses
things necessary for tasks or activities

·        
Is easily
distracted by extraneous stimuli

·        
Is often
forgetful in daily activities

 

Hyperactive-Impulsive Symptoms

·        
Often
fidgets with or taps hands or feet or squirms in seat

·        
Often leaves
seat in situations where remaining in seat is expected

·        
Often runs
about or climbs in situations where it is inappropriate (restlessness in
adolescents and adults)

·        
Often unable
to play or engage in leisure activities quietly

·        
Is often “on
the go” acting as if “driven by motor”

·        
Often talks
excessively

·        
Often blurts
out answers before the question has been completed

·        
Often has
difficulty waiting their turn

·        
Often
interrupts or intrudes on others

·        
 

From

 

Many
of these symptoms can be attributed to deficits in Executive Function skills.

                                               

Executive
Functions

 

According
to Diamond and Funahashi & Andreau, the
pre-frontal cortex, or frontal lobes, of the brain control the Executive
Functions responsible for many attentional and behavioural skills. The ability
to co-ordinate these functions is an essential component of many cognitive
functions (Diamond, 2013 and Funahashi & Andreau,
2013, p. xx).  Thomas Brown, from Yale University’s School
of Medicine, explains that Executive Functions comprise “six clusters of
cognitive functions that tend to be impaired in individuals with ADHD” (Brown, 2008, Pg 407). 
They are: activation, focus, effort, emotion, memory and action.  Simply put, executive functioning refers to
the ability to get things done or “execute” a task (e.g. classwork, homework,
chores) through to completion. Individuals with ADHD may not have all the
necessary skills to achieve this. It is not that they won’t but can’t. If they
could they would.

 

Impact of
Executive Function deficits

 

When
Executive Functions are impaired or delayed in development, cognitive and
behavioural consequences ensue. These consequences often have a profound influence
on how sufferers are perceived by family, friends, teachers and peers. These
perceptions impact the type of relationship that can be developed and the subsequent
opportunities for engagement, learning and socialisation with these
individuals. Without a thorough understanding of how these impairments and
developmental delays impact sufferers we are more likely to simply respond to
the symptoms being displayed rather than the causes.

 

Outlined
below are the six Executive Functions, as noted by Brown (2008), a brief
outline on what skills/capabilities they effect and how that can be evident in
daily life and the classroom. Later, we will explore strategies that can be
implemented to accommodate for these, and other cognitive and behavioural
dysfunctions, that may enhance student engagement and learning.

 

Activation:

Encompasses
skills such as the ability to organise and prioritise tasks, gather suitable
materials, initiate the task and estimate and manage their time to complete the
tasks. Consequently, students with ADHD are prone to procrastination because
the task can seem insurmountable.  Some
students will overcome these difficulties once the task deadline looms closer,
others will simply succumb to the overwhelming anxiety and fail to complete the
task.

 

Focus:

Focus
is not simply attention. It is also the ability to sustain that focus or shift
the focus as necessary or when required. 
Brown notes that is has been described as comparable to a weak radio
being transmitted to a car radio. The signal drops in and out so some
information is received but not everything. 
This is often evident in students. 
They listen to the instructions for a task but only pick up on some
parts of it and don’t necessarily recall the correct order. Students are also
easily distracted by others, events around them or their own wandering
thoughts.  Reading can be difficult as
words often need to be read repeatedly to be remembered, understood and
interpreted effectively. Writing is also often problematic as students can
having difficulty ordering, sustaining and outputting information.  Thinking can be rapid, scattered and/or
interrupted by other thoughts making sustained focus challenging.

 

Effort:

Refers
to the ability to regulate attention and sustain effort, including processing
speed. Students will experience challenges with maintaining effort over lengthy
periods due to constant focus interruptions the physical effort required to
sustain attention and the brains ability to retain information in short and
long-term memory. ADHD is also frequently associated with low processing
speeds.  As a result, information
received takes longer to go through standard memory and manipulation processes
before it is interpreted, understood and can finally be acted upon.  These factors make timely completion of tasks
difficult, especially written tasks which require activation, focus and effort
for success.

 

Emotion:

This
covers the ability to understand, manage and control emotions and emotional
reactions.  Many with ADHD struggle to
manage the more negative emotions such as: anger, anxiety, disappointment and
frustration.  Emotional responses are
often heightened and longer lasting than in non-ADHD individuals.  Emotions can often overtake all other
thinking making reasoning near impossible at the time.  It can be like being hit by a massive wave.
Until the wave breaks and reaches the shore there is no opportunity for it to
recede. It can also be difficult for an ADHD child in particular to see things
from someone else’s perspective.

 

Memory:

This
encompasses accessing, utilising and recalling information from short term and
working memory.  Short term memory is
regarded as recall of information, where working memory involves manipulation
and reasoning of stored information to guide behaviour and decision making.
Individuals with ADHD generally have better long-term memory.  Short term memory such as following
instructions, remembering where you placed something, writing down all your
homework is less reliable. For students, the ability to recall information from
a passage they just read and interpret that information to answer questions can
be very challenging.

 

Action:

Action
relates to the ability to observer, monitor and control your actions.
Impulsivity can often be a dominant behaviour in ADHD. Often individuals will
act before thinking or considering the consequences of their actions.  Consideration of the suitability of
behaviours and responses within certain situations can also be inhibited.
Impulsive behaviours in the classroom often include calling out, being too
talkative, interrupting teachers and other students, annoying other students
through unnecessary physical contact, etc. 
Action also incorporates knowing when to speed up or slow down to complete
a task. Completing creative writing tasks are often challenging for students as
they become wrapped up in their many ideas, failing to reach a conclusion
before time runs out.

 

Given
the multitude of factors that can impact an individual’s Executive Functions, it
is little wonder that ADHD has such a profound impact on behaviours and
learning.

ADHD and Education

Professor
Rosemary Tannock, a leading ADHD researcher at the University of Toronto, stated
that “if classroom teachers better understood what we now know about how the
brains of ADHD children work differently, then children with ADHD and other
learning difficulties might have more success at school.” (ABC Radio National, 2009).

Many
students exhibiting behavioural and learning challenges have underlying mental,
physical, emotional and neurobiological conditions that need to be taken into
consideration when Educators plan and implement classroom activities and lesson
plans.

 

The
implementation of one, or more, of the following management strategies may heighten
the ability of students with learning difficulties to engage with their
learning more effectively.  By adapting
teaching strategies, expectations and delivery methods

 

Explicit
Instruction

 

Explicit instruction is regarded as a highly
effective teaching strategy for ADHD students as this method reduces the demand
on working memory and associated executive functions that are required when
“keeping track of relevant information that accumulates over extended periods
of time” (Smith, Sáez and Doabler, 2016, Pg 275). 

 

Researchers describe Explicit Instruction as a
systematic, guided approach to instruction that incorporates the use of simple,
plain language for direction, detailed modelling of the learning process and
anticipated achievement outcomes through scaffolding and frequent revision of
both the task and student progress to ensure accuracy in concept learning (Archer & Hughes, 2011, Hughes, Morris, Therrien, & Benson, 2017 and Smith, Sáez and Doabler,
2016). 

 

Some students need to be
stepped through the process that needs to be achieve. This is not a sign that
they cannot do the work but is a signal that the process is more challenging
for them. When provided with explicit information about how task is to be
achieved and the expected outcome or product the students are generally more
than capable of demonstrating their knowledge.

Key
features:

 

·        
Simple,
uncomplicated language to avoid overload.

·        
Review of
prior learning to ensure basic concepts are understood.

·        
Tiered
structure to learning content so that students can grow their knowledge
incrementally.

·        
Frequent
revision to ensure accurate consolidation of learning and concepts.

·        
Often
supported with visual aids to support memory recall.

 

Specific teaching strategies can include:

 

·        
Role
modelling – demonstrating the behaviour or learning that is expected.  This can be achieved using puppets, student
role play, teacher demonstration, observation of student behaviours in everyday
situations.  For example, using puppets
to model appropriate behaviour when approached by a stranger or the correct way
to respond to inappropriate behaviours from strangers.

·        
I do, we
do, you do – the teacher provides a demonstration of the activity, the student
and teacher/peer then work together through the activity with the student
gradually taking over more responsibility for the steps within the activity and
culminating in the student being able to undertake the activity without teacher
support.  For example, when learning about
equivalent fractions he teacher could use concrete materials to demonstrate
equivalences to the student.  The teacher
would then work alongside the student to work out other equivalent fractions
together using verbal or concrete prompts when necessary until eventually the
student to capable of achieving the result independently.

·        
Think
aloud – involves verbally describing your thinking process in detail when
working on an activity or solving a problem. 
This can be articulated through the teacher or by getting students to
share their thinking processes.  This can
be a highly effective method for showing how there may be more than one way to
achieve the same result.  For example, getting
students to talk through or write on the board their way of working out the
answer to 12 x 15.

·        
Visuals –
the use of visual supports can reduce the physical demands on working memory by
providing basic information or steps to be followed that would otherwise need
to be stored in short-term or long-term memory. 
For example, a graphic organiser displaying the structure of a
persuasive text.

·        
Buddy
work – whilst not specifically explicit instruction, the use of buddy work can
take the pressure off students to recall and implement all the learning
concepts and skills independently. By watching one another and working together
content, skills and concepts can still be developed.

 

Universal Design
for Learning

 

Universal design creator
Ron Mace was an advocate, designer and educator for building accessibility,
having experienced firsthand the difficulties experienced by people in
wheelchairs in accessing and navigating within traditional buildings.  His visionary ideas lead to building
modifications and changes to the code of practice to ensure that building
accessibility was viable for all individuals regardless of abilities.  Mace realised that by making changes to the
environment and building structures to accommodate the needs of individuals
with disabilities also gave easy access to those without disabilities. For
example, automatic doors allow easy access for all individuals including those
on crutches, in wheelchairs, with vision impairments, etc.

 

A similar principle is
being applied to educating students. 
Instead of only catering to the needs of the average student, we need to
cater for the needs of all students including those with physical, mental and
emotional challenges, as well as the needs of gifted students.  Universal design for learning (UDL)
encourages teachers to create learning environments and teaching principles
that satisfy the educational needs of all individuals, regardless of their
abilities and diversities.

 

There are three main principles
for UDL:

 

·        
Provide Multiple Means of Representation

·        
Provide Multiple Means of Action and Expression

·        
Provide Multiple Means of Engagement

 

Within these principles
there are additional guidelines and checkpoints to ensure the diverse learning
needs of individuals are considered and accommodated for. A brief summary of
the National Centre on Universal Design for Learning’s principles and
guidelines are outlined below. More explicit and detailed information can be
found on the National Centre on Universal Design for Learning website (www.udlcentre.org).

 

MULTIPLE MEANS OF REPRESENTATION:

The way information is
perceived and comprehended varies widely dependent upon student learning styles
and challenges. Considerations need to be made for cultural, physical,
neurological and emotional difficulties when delivering information and
instructions to students. 

 

The guidelines include:

·        
Perception

·        
Language, expression and symbols

·        
Comprehension

 

Perception: 

Providing options in the
way information is displayed and delivered, both aurally and visually.  Considerations include size of text, text
style (especially for dyslexia or visually impaired), background colour, rate
of speech, volume, male or female voice 
and use of text, video, powerpoint, animation.

 

Language, expression and symbols:

Providing options to seek
further information on elements such as the meaning of symbols, definitions of
words, structural formats, mathematical symbols and formulas and inferential
concepts.

 

Comprehension:

Providing options to
establish, develop, consolidate and reinforce comprehension skills such as
reviewing background knowledge, highlighting key features and outlining essential
information.

 

An example of how this
can be applied is allowing an ADHD student to view a story book online where
they can listen to the story whilst following the written text.  Being able to get definitions of unfamiliar
words or to highlight the main features of the story as they are reading it
would also be beneficial.

 

MULTIPLE MEANS OF ACTION AND EXPRESSION:

This area encompasses a
student’s ability to move around and engage within a classroom as well as their
ability to express their knowledge in diverse ways.

 

The guidelines include:

·        
Physical action

·        
Expressive skills and fluency

·        
Executive function

 

Physical Action:

Providing options for
mobility within the classroom, manipulation and interaction with materials and
equipment and the use of assistive technologies and tools.

 

Expressive skills and fluency

Providing options in how
students can demonstrate their knowledge and understanding, the use of
assistive technologies to support output and the level of support provided
during acquisition and demonstration of learning.

 

Executive Functions

Providing options to
support goal setting skills, planning and strategy development, managing
information and resources and monitoring progress.

 

For a student with ADHD to
learn a mathematical concept such as equivalent fractions, they may require
tiered support initially utilising concrete materials (fraction pies) and
visual guidelines (student workbook) for the steps involved. Watching a video
outlining the process may also be beneficial. 
To demonstrate their knowledge, they may create a craft representation
of the concept (plasticine model of 1/6 and 2/3).

 

MULTIPLE MEANS OF ENGAGEMENT

Utilising student
interests, allowing choices, encouraging independent and collaborative means of
learning, developing self-motivation strategies and fostering reflective
practices are components of Engagement.

 

The guidelines include:

·        
Recruiting Interest

·        
Sustaining effort and persistence

·        
Self-regulation

 

Recruiting Interest

Provide options for
personal choice and control over aspects of their learning, opportunities to
relate learning to real life situations and experiences as well as theoretical
and non-fictional situations.  Options to
relate their learning and experiences to their culture, age group, gender,
personal interests, society and social groups.

 

Sustaining Effort and Persistence

Providing options to
initiate and sustain attention to learning goals and objectives, to alter the
level of challenge and performance, to work independently or collaboratively
and to reflect and analyse their own performance and possible improvements.

 

Self-Regulation

Providing options for
students to develop and utilise skills to reflect on the management and success
of their learning and to develop appropriate coping skills and strategies.

 

If a student with ADHD is
asked to explain animal adaptations to a specific environment it may be effective
to offer a choice of animals and environments to be considered, the option to
work with a buddy, graphic organiser supports to create a plan for working together
and establishing time frames for work completion and a buddy reflection sheet
so that the students can assess each other’s work and their own.

 

Personal reflection

 

Explicit Instruction is
an effective strategy to support young students with ADHD as learning places an
immense demand on their impaired or developmentally delayed executive functions.  Explicit instruction techniques reduce this
workload by providing structured, tiered, clearly demonstrated supports that
guide the student through their learning to the expected outcomes.  Universal Design for Learning also has many
advantages through the accommodations of many learning styles and strategies, application
of personal interests to guide learning and multimodal outputs to demonstrate
knowledge.  However, too much choice and variability
can also tax the executive function skills of ADHD students as the multitude of
options and possibilities can also be overwhelming.

 

Whilst the principles and
guidelines of UDL are extensive and provide enormous opportunities for
supporting student learning the sheer volume of considerations and adjustments
may be overwhelming for both new graduates and experienced teachers to implement.
Explicit Instruction, as a whole class approach, also has deficiencies as not
all students require a structured format that offers little flexibility for
independent, self-guided learning.

 

In education, there is
not a one size fits all approach that can encompass all the learning needs of
all students.  Instead, there needs to be
consideration of many different methodologies to support students. Flexibility,
adaptability and combinations of strategies will provide more effective environments
and opportunities for students.

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