[W4] - L4 Flashcards
Types of School Interventions
Behavioural interventions [which can be antecedent, or consequence based]
Academic Interventions.
Neuropsychological Interventions [i.e., cognitive training;
strategy training; mindfulness and physical activities]
ADHD can manifest as off-task and disruptive behavior in the classroom, and lower academic achievement. Different interventions can be used to address these different components (i.e., neuropsychological for executive functions, behavioral to reduce off-task and disruptive behaviour & increase task engagement)
Antecedent-Based Interventions
These are interventions implemented BEFORE the target behaviour occurs. One manipulates environmental events/elements that precede and may trigger the occurrence of a specific behaviour. Examples include class rules, class structure, assignments and availability of choice.
Classroom rules: Should be minimal, clear, repeated frequently, reinforced, positively formulated (do x; as opposed to don’t do y), and visual rule reminders help.
Classroom Structure: Group seating vs. solo seating, seated close or further from the teacher, motor breaks (provide desks that children can move to, to hand in work etc.). The class schedule can also be structured so that the most difficult tasks take place when focus is highest (i.e., after medication consumption)
Assignments: Task duration can be made shorter (gradually increase length based on task completion and praise completion), make tasks more novel and engaging (with colour, shape, texture etc.), allow students to respond differentially (cross-modality responding) – with either written or oral responses.
Choices: Allow students to choose between assignments; or allow them to choose task order or choose their partner.
Consequence-Based
These are interventions implemented AFTER a target behavior occurs. This is done by manipulating environmental events following a given behaviour to alter its frequency (i.e., either discouraging or reinforcement).
The use of reward/reinforcement and punishment is of particular relevance for the reward pathway. A characteristic of ADHD is delay aversion – so frequent and immediate reinforcement is preferrable. Plus, immediate rewards allow the child to clearly link the desired behaviour with the reward. Use individualised rewards and rotate/vary them (too many of the same limits its reward capacity).
Ignoring a behaviour can be a consequence as not attending to disruptive behaviour stops the process of reinforcing it through giving it attention.
Other examples include token reinforcement (whether or not its combined with response-cost: where disruptive behaviours result in token removal also), time-out can be effective but ONLY if the classroom is perceived as a positive environment.
If used, punishment should be mild (i.e., response-cost with token removal; calm reprimands) and always combined with positive reinforcement. Punishment should be added, as opposed to used alone.
Academic Interventions
Aim: To improve academic skills and increase academic achievement.
One way to do this is a teacher-mediated approach (direct instructions on note taking), computer-mediated (computer-assisted instruction; can be more individualized than class wide instruction), or peer-mediated (peer tutoring).
Peer Tutoring: Students are divided in pairs, a tutor and tutee. Tutor explains and helps out the tutee. It’s more effective when the pairings are of the same gender, and the tutor has higher academic and behavioral skills. The materials used should be challenging for the tutee. Frequent teacher feedback should feature, and just 20 minutes of peer tutoring per day is sufficient for beneficial effect.
Neuropsychological Interventions
Aim: To improve neuropsychological functioning through targeting executive functions.
Examples include: Cognitive training, Strategy training, Mindfulness and physical activities.
The Principles of EF Training
Executive Functions are brain functions that allow us to control our behaviour, emotions, and attention, and to be goal-directed (inhibition, working memory, flexibility/shifting, planning)
Principles:
- Those who most need improvement benefit the most
- Transfer effects from EF training are narrow
- EFs should be challenged throughout training (i.e., demands must
continue to increase to see effects)
- Repeated practice is key
- Whether EF gains are produced depends on HOW an activity is done
- Outcome measures must test the limits of the children’s EF abilities to
see a benefit from training
Computerized Cognitive Training
Digital cognitive tasks that target working memory/attention typically. It is seeking to produce structural changes in the brain with repeated practice/reinforcement: through increasing/decreasing activity in certain areas - or through functional reorganization/redistribution.
Strategy Training
A student-centered approach that supplies struggling learners with the tools to learn new skills, while allowing for the direct and immediate application to practice (the skills learned can be applied across other tasks as well, ideally - throughout the lifespan)
Strategy training can:
- Help the child to understand own weaknesses
- Give them tools to remediate those deficits themselves (don’t give the solution to the child but give them the support/tools to get there themselves)
- Targets cognitive processes in context
- Makes use of motivation and self-understanding in the child.
Strategy training is more effective as an academic intervention than a behavioral intervention would be as the child is in control and the effects are long-term (a consequence-based behavioral intervention might have short-term effects as the child may revert to previous practices without the presence of rewards)
Mindfulness and Physical Activity
Mindfulness: self-regulation of attention and adoption of a particular orientation toward one’s experiences in the present moment.
Activities that integrate mindfulness and physical activity include: meditation, yoga, martial arts etc.
Self-Regulation as an intervention
Self-monitoring accurately for rewards can be helpful (reducing the matching with a teacher’s rating element as the child becomes better at accurately rating themselves) — It can be extended to the child rewarding themselves if their behavior matches a required behavior (self-reinforcement)
Evaluating the Effectiveness of Varying Interventions for Students with ADHD
Meta-analysis of students with ADHD symptoms; looking at intervention outcomes via rates of on/off-task or disruptive behaviours. Larger effects were observed in general classrooms over special education classrooms (perhaps due to the severity of the symptoms initially or that interventions already existed in special ed classrooms). There was limited or inconsistent evidence of moderating effect for age or mediation.
- Conclusion: Consequence-based and self-regulation interventions are most effective for improving classroom behaviour. These are applicable to special as well as general education, and irrespective of medication use.
- Limitations: Low methodological quality, most research in children over adolescents, gender imbalance in studies in favour of boys, child/teacher factors not investigated – open question as to what teachers do in practice
Academic interventions most effective for academic achievement (DuPaul et al., 1997, 2010)
Moderate effects were observed for cognitive training on ADHD inattention ratings (greater when the children engaged in multi-process training as opposed to JUST working memory training) and working memory performance.
- Conclusion: CT improves WM performance but does not improve other cognitive functions or academic performance. Its effect on ADHD symptoms is limited, particularly when raters are blinded.
How teachers manage pupils with ADHD in practice in both primary and secondary school environments:
- Results: Antecedent strategies were used most often, then consequence, then self-regulation. Antecedent strategies were used more often with ADHD students than with the typical student. Primary school teachers used them more often, but only for students with ADHD (no diff. for typical students)
- Results on perceived effectiveness: The more frequently used strategies were rated as more effective (naturally). Antecedent based were rated as more most effective. Primary school teachers rated self-regulation and antecedents as more effective than secondary teachers did.
- Teacher Characteristics: For exclusively secondary school teachers, the more positive their attitude was about ADHD the more frequently they used strategies for ADHD (small effect). There was no significant influence of years of teaching experience, knowledge of ADHD, teacher efficacy in classroom management, or prior training in managing behavioural problems.
- Conclusion: Teachers use simple, class wide, antecedent strategies most frequently. CMSs = classroom management strategies. Primary school teachers adapted their classroom management for ADHD students, while secondary school teachers did not seem to.
Teacher training to improve strategy use: Teachers had individual sessions with a trained psychologist on psychoeducation, functional behaviour assessment for a given child (why are they behaving like this), developed intervention plan (how would we improve it?).
- Results: in antecedent and consequence conditions the target, problem behavior reduces early on and are sustained at T3 – the long-term. The effects were large and did not differ across intervention.
- Short-term reduction of ADHD symptoms and impairment in both intervention conditions as compared to waitlist control. Long-term effects on teacher ratings of ADHD symptoms; but no intervention effects on ODD symptoms.
- Conclusion: Teacher training works, regardless of the strategy category.
