The World of Inclusion Classrooms with a Prevalence of
A.D.H.D. Students
& How Behavior Modification Treatment Has
Improved Attention
June 14, 2011
EAB 4703
Bernadette Harris
University of North Florida
College of Education & Human Services
Graduate School
With the onset of the No Child Left Behind (N.C.L.B.) Act of 2001, federal mandates have dictated for educators that ALL children are entitled a free and appropriate public education and schools in the United States are being held to greater accountability standards in providing a quality education, presented by degreed professional educators in a data driven, high achievement and performance based environment. Much of this high achievement is measured through standardized assessment, such as the F.C.A.T. (Florida Comprehensive Assessment Test). In addition to N.C.L.B, there is I.D.E.A. (Individuals with Disabilities Education Act) of 2004. This act calls for the same free and appropriate public education for students with disabilities as for those without them. It also states the students with disabilities must receive this education “in the least restrictive environment” (Wright 2007). So came the birth of inclusion education (the practice of including students with special education needs in the mainstream classroom as opposed to “self-contained” special education classes of the past).
Although students come with a large variety of physiological and emotional special needs, perhaps one of the most prevalent special needs identified by researchers in today’s American classrooms is that of Attention Deficit Hyperactivity Disorder (A.D.H.D.). According to Rabiner, Skinner, Murray & Malone (2009), more than 16% of the total student population in U.S. elementary schools have problems with inattention and impulsivity, and 80% of A.D.H.D. students have problems with academic performance, placing them at high risk for grade retention and dropping out of high school.
Even though A.D.H.D. is more prevalent than most other student disabilities, teachers receive very little, if any, training in meeting the educational and emotional needs of students with A.D.H.D. in their classrooms. Frequently parents of A.D.H.D. will obtain prescription psycho stimulant medications from their pediatricians in order to treat their child’s condition and lessen their inattentiveness and impulsivity in school. This can be highly effective for some students. However, many students seem to build a physiological resistance to the medication over time and either require an increased dosage, change in medication, or develop depression symptoms and cease taking the medication altogether. In addition, many parents fear the side effects of some A.D.H.D. medications, or cannot afford the cost of them due to restrictions from insurance companies. All of these variables leave a large number of A.D.H.D. students untreated and in need of other interventions to help them be successful.
Martin & Pear (2007) mention the use of functional assessments to identify the causes of behavior problems, and the process of using observations, notes and formal evaluative data to identify antecedents and effective consequences for many behaviors. They mention specific behaviors such as face scratching (Martin & Pear 2007, p. 290), obsessive toilet flushing, (Martin & Pear 2007, p. 291) and treatments using reinforcements to improve desired behavioral results. They also mention, in Chapter 23, action research that educators can and do perform in identifying effective reinforcers, such as multiple baseline designs (Martin & Pear 2007, p. 302-303). In these types of interventions, the educator (or behavior modifier) would use a treatment, such as a reinforcer, either across different behaviors, or different reinforcers with the same behaviors, or similar reinforcers across different behavioral situations in order to determine the most effective consequences that will become conditioned reinforcers to bring about desired behaviors or the extinction of undesired behaviors. Although there is no specific mention of A.D.H.D. as a problem behavior, certainly many of the impulsive behaviors associated with A.D.H.D. could be modified using such methods.
Perhaps one of the most frequent behavior modification treatments that educators use on a regular basis is the use of token economies (Martin & Pear 2007, p. 323). In a token economy, a patient (or student) can earn “tokens” for a variety of desirable behaviors. These tokens can then be exchanged for different reinforcers, usually from a list of choices. This method is somewhat effective as a classroom management tool in the regular education classroom, and with students without special needs. However, it is limited in its effectiveness with special needs students such as those with A.D.H.D. Because of this, I have sought out studies where behavior modification treatments were used specifically to treat A.D.H.D.
Computer Attention Training (CAT) and Computer Assisted Instruction (CAI)
A recent study sought to answer the following question: “Can attention be trained?” (Rabiner, Skinner, Murray & Malone 2009, p.2). In the study, 77 random first grade students with A.D.H.D. were selected. In this instance, the functional analysis assessment (Martin & Pear 2007) was not implemented, but rather the use of specific assessments to determine IQ, impulsivity and inattention and literacy achievement levels. The assessments used to measure these attributes were the Conners’ Teacher Rating Evaluation, the Woodcock Johnson Academic Achievement Test, the Dynamic Indicators of Basic Literary Skills (DIBELS) test, and the Kaufman Brief Intelligence Test. The students were then randomly split up into three groups. One group was a control group and received no treatment. One group received CAT and one group received CAI. CAT is a computer program with exercises in cognitive skills. As each exercise is completed, the next exercise will require increased attention from the student. CAI through Riverdeep is a computer program that targets literacy and math skills. It also progresses in difficulty, but assignments are chunked into smaller pieces so that increased periods of attention are not as stringent as CAT. Both groups participated in Project CLASS, a token economy intervention program where students earned rewards based on their ability to follow rules.
The post assessment results showed that the behavior modification treatments decreased inattention in 50% of the participants, meaning that CAT and CAI can improve attentiveness.
This type of treatment, used in the classroom on a regular basis, seems that it would be very effective in targeting individual needs and helping the students overcome many of the behaviors associated with A.D.H.D. This approach allows the student to self-regulate their progress, and to monitor and adjust their attention to tasks, with tasks progressing in a manner that requires more and more attentiveness in CAT, and also to be able to master levels of “chunked” tasks in CAI. Rogers (1961) refers to such methods as “non-directive” or student centered teaching. Rather than the teacher taking a blanketed approach to directive instruction, through lecture, demonstration, drill, etc., the student has the opportunity to direct his/her own learning through activities that are engaging and interesting to the student.
Modification to an Existing Behavior Modification Classroom Plan
In a second study, a third grade African American boy was diagnosed with A.D.H.D. and placed on an Individual Education Plan (I.E.P.) that called for behavior modifications in the regular classroom. One facet of the I.E.P. was a daily behavior chart leading to the student earning weekly rewards (reinforcers) for demonstrating appropriate classroom behavior. This student was not on any prescription A.D.H.D. medications. The student had problems completing assignments, interrupting the teacher frequently, talking back, and social problems with his peers, such as name calling and teasing. He was often off task throughout the day and had trouble following directions. Daily the student and teacher met and completed his behavior chart together, assessing whether or not he successfully reached his behavior goals. He did not often earn any rewards at the end of the week, making the modification somewhat ineffective in motivating the student ( Fabiano & Pelham 2003).
Interobserver data was gathered through comparing the student to other students and marking at several intervals the student’s level of inattentiveness and/or disruptive behaviors in class. The observers then spoke to the child about the reinforcers and rewards available through his current behavior plan. They then met with the teacher and modified the student’s current plan. They decreased the latency period for receiving rewards, having found that the student was losing motivation from having to wait an entire week to be rewarded. They also changed the reinforcers by including hand held computer games that the student indicated he really enjoyed playing. They also had the teacher increase the frequency of feedback the student received for engaging in appropriate behaviors, instead of waiting for an end of day meeting to receive feedback. The changes to the behavior modification plan resulted in a 20% decrease in undesirable behaviors. The student’s on-task (desirable) behaviors increased 24%.
Identifying the correct antecedents (Martin & Pear 2007) which were the motivators for these students’ disruptive behaviors allowed the team to make modifications to the reinforcers and consequences of those behaviors that would be more effective in producing positive behaviors. As seen in the study, the teacher did not have enough training or knowledge of the principles of behavior modification to differentiate the modifications, condition the reinforcers to increase positive behavior, or adjust consequences in order to reduce or extinguish disruptive behaviors.
Functional Assessment & Behavior Modification of Two A.D.H.D. Students
In a third study, two second grade students were selected and given the SSBD (Systematic Screening for Behavior Disorders) and DIBELS testing. Functional assessment interviews with the teachers showed that the students had trouble following directions, talked out in class, were often off task and out of their seats and had trouble completing assigned work. One of the students also made noises and fidgeted a lot. Both students were performing below grade level in reading and mathematics.
Researchers conducted observations of the students and coded their disruptive behaviors, antecedents and consequences on a chart. From this they formed a hypothesis regarding the effectiveness/ineffectiveness of the consequences and causes in the antecedents. A consultative meeting between the researchers and teachers was held to develop an intervention plan. The observations indicated that teacher reinforcement of disruptive behaviors such as mentioning class rules increased the behaviors instead of decreasing them. Praise and rewards increased on task behaviors, and escape conditioning by ignoring incomplete work or not responding maintained off task behaviors. Modeling was effective in increasing on task behavior.
This functional analysis approach (Martin & Pear 2007) allowed for a very comprehensive assessment of the specific behaviors that were hindering classroom management and individual student academic and social progress. This gave the teacher a very clear perspective of her own responses which were becoming antecedents to negative behaviors. An example of this was the observation that the teacher reminding the students of class rules before certain activities ended up reinforcing rather than diminishing disruptive behaviors. During the observations, escape conditioning (Martin & Pear 2007, p. 167) was noted as well. During group activities, the students wanted to avoid drawing attention from their peers because they were having difficulty completing the assignments or did not understand the material and did not want their peers to recognize this.
The following modifications were made: increased teacher attention and positive reinforcement for on task behaviors, increased tangible reinforcers, self-recorded student responses, less reminders of class rules, more modeling, implementing the use of “help tickets” (Kamps, Wendland & Culpepper 2006, p. 7) to ask for help, and self-management strategies such as counting responses in group work.
The post intervention assessment results showed a significant increase in on task behavior in both students of almost 50%, and an approximate 20% decrease in disruptive behaviors. In order to further pinpoint specific academic or social difficulties in the students, the teacher could also implement multiple baseline designs, such as a “multiple baseline across behaviors” (Martin & Pear 2007. P. 302) by recording the students’ ability to complete tasks in various subject areas with or without using escape conditioning tactics and disruptive behaviors. She could also frequently use a changing criterion design (Martin & Pear 2007. P. 305) in order to further measure specifically the level of difficulty and/or amount of time each student could give their attention to various tasks, in order to get a better idea of their level of mastery as well as how often and how far they could be challenged before becoming off task or disruptive.
Conclusion:
In researching the depth that each of the studies presented had to involve in order to facilitate positive changes in attentiveness and academic progress for these students, I recall Carl Rogers’ statement (1961 p. 276) about his reason for losing his desire to teach. “When I look back at the results of my past teaching, the real results seem the same—either damage was done or nothing significant occurred.” Isn’t it fair to assume, with all of the research we now have in front of us, that perhaps many educators continue to have this same sense of failure at the end of any school year, due to their inability to bring about significant academic and emotional growth in students with special needs such as A.D.H.D. students, who populate 16(+)% of their class?
In reviewing the results of all of the aforementioned studies and the behavior modification procedures suggested by Martin & Pear, it is clearly evident to me that most regular education teachers are probably not amply prepared to make effective behavior modification plans for A.D.H.D. students without course study or professional development in behavior modification.
The regular classroom management tools and interventions that most teachers use tend to take a “one size fits all” approach to managing student behavior. We use the same reinforcers and consequences for all students, in what we term “fairness and equity.” We require that all students sit for the same standardized assessment each year, regardless of their physiological limitations unless they are diagnosed with “extreme” exceptionalities.
Our academic system measures student mastery of subject area content by their performance on standardized tests. The very modifications for behavior, including environmental and situational adjustments, chunking of assignments into manageable pieces, limiting the amount of time required to be spent on a task, etc. are not implemented during tests such as these unless mandated by an I.E.P. The majority of A.D.H.D. students in our classrooms do not have I.E.P.s because many school districts do not recognize this as a disability under the “other health impaired” category (Wright 2007).
Teachers are required to differentiate and individualize education for each student, which requires an empathetic approach (Rogers 1961) to addressing each child and learning what their specific needs are. For the A.D.H.D. child, clearly this also involves very specific methods of behavior modification along with non-directive teaching.
It is alarming to me that our government is mandating systems and measurements that effect student progression, state and local funding for schools, teacher salaries and job security, as well as whether or not students actually learn effectively using methods and tools that are incapable of producing accurate data! They are also unmanageable for at least 16% of the students being assessed, since that is the approximate number of A.D.H.D. students in our schools today.
Redesigning teacher education programs to include significant coursework and practical internship in psychology and behavior modification is certainly essential if we are to make any progress in meeting the goals of NCLB or the requirements outlined in I.D.E.A. More importantly, it is essential if we are going to give the true best opportunity for learning to all students in our schools and classrooms.
References:
Fabiano, G.A. & Pelham, W.E., Jr. (2003). Improving the effectiveness of behavioral classroom
interventions for Attention Deficit/Hyperactivity disorder. Journal of Emotional &
Behavioral Disorders (11)122-128.
Kamps, D., Wendland, M. & Culpepper, M. (2006). Active teacher participation in functional
behavior assessment for students with emotional and behavioral disorders risks in
regular education classrooms. ProQuest Psychology Journal Behavior Disorders (31)
128-147.
Martin, G. & Pear, J. (2007). Behavior modification: what it is and how to do it. NJ: Pearson
Prentice Hall.
Rabiner, D.L., Skinner, A.T., Murray, D.W. & Malone, P.S. (2009). A randomized trial of two
computer based interventions for students with attention difficulties. Journal of
Abnormal Child Psychology (38)131-142.
Rogers, C.R. (1961). On becoming a person. NY: Houghton Mifflin.
The No Child Left Behind Act of 2001. Retrieved June 14, 2011 from: http://www2.ed.gov/policy/elsec/guid/states/index.html#nclb.
Wright, P.W. & Wright, P.D. (2007). Special education law: 2nd edition. N.Y: Harbor House.
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