Baltimore County Public Schools. ADHD Identification and Management Guide

Transcription

1 Baltimore County Public Schools ADHD Identification and Management Guide Dale R. Rauenzahn Executive Director, Student Support Services Patsy J. Holmes Director, Student Support Services Deborah Somerville, R.N., M.P.H. Coordinator, Health Services Margaret G. Kidder, Ph.D. Coordinator, Psychological Services Department of Student Support Services Prepared under the direction of S. Dallas Dance, Ph.D. Superintendent Towson, Maryland 2000, 2001, 2006, 2012 revised

2 Board of Education of Baltimore County Towson, Maryland Lawrence E. Schmidt, Esq. President Michael H. Bowler Michael J. Collins Ramona N. Johnson Valerie A. Roddy Vice President James E. Coleman Rodger C. Janssen George J. Moniodis H. Edward Parker David Uhlfelder Olivia Adams Student Representative S. Dallas Dance, Ph.D. Secretary-Treasurer and Superintendent of Schools Baltimore County Public Schools Towson, Maryland

3 Committee Members Marilyn Healy, R.N., N.C.S.N., Specialist, Health Services, Co-chair William Flook, Ph.D., Supervisor, Psychological Services, Co-chair Jennifer Abbe, School Counselor Monica Addison, School Psychologist Linda Grossman, M.D., Baltimore County Department of Health William Flook, Supervisor, Office of Psychological Services Kathleen Hynes, Pupil Personnel Worker Beth Lambert, SST/504 Facilitator Catherine Lowe, School Counselor Jennifer Lynch, School Psychologist Patricia Mustipher, School Social Worker Lisa Pinsky, School Nurse Nancy Quick, School Nurse Lisa Vanderwal, School Nurse Aaron Wheeler, Psy.D., School Psychologist Erika Wood, School Psychologist Acknowledgements Millie Brown, Administrative Secretary, Health Services

4 ADHD Identification and Management Guide 2012 Edition TABLE OF CONTENTS I. Introduction Page A. Background 1 B. Overview of ADHD 2 II. Screening and Intervention for Inattentive, Impulsive and/or Hyperactive Behaviors through Student Support Team A. BCPS Student Support Team Model 5 B. Teacher-level Teams 6 C. Student Support Team 7 Tiered Response to Intervention, Problem Solving Flowchart 11 D. Student Behavior Plans 12 E. Procedures for Monitoring Student Progress 14 III. Implementing Interventions and Supports for Students with Inattentive, Impulsive, and/or Hyperactive Behaviors or ADHD A. Positive Behavior Planning for the Classroom 15 B. Positive Behavior Planning Strategies and Techniques for Students with 16 Inattentive, Impulsive and/or Hyperactive Behaviors C. Additional Interventions in Consultation with Student Support Services 21 Staff D. General Accommodations for Behaviors and Skill Areas Attention to Task Memory Impulse Control Control of Motor Activity Daily Organization Following Directions Handwriting Reading Mathematics Written Expression 36 IV. Clinical Treatment for Children with ADHD A. Medical Management 37 B. Counseling and Therapy 38 V. Promoting Parent Involvement

5 A. Role of the Parent 38 B. Strategies that Promote Parent Involvement 38 VI. ADHD Resources 40 A. Web Sites 41 B. General Resources 42 C. Resources for Children and Adolescents 43 D. Handouts from the National Association of School Psychologists 44 E. 25 Good Things About Having ADHD 45 F. Study Suggestions VII. References 47

6 I. INTRODUCTION The purpose of the ADHD Identification and Management Guide is to outline a process through which the Student Support Team (SST) can conduct screening, assessment, identification, intervention, and evaluation of students who exhibit inattention, impulsivity, or hyperactivity that interferes with academic performance. The guide is designed to provide information to teachers and other school staff to meet the needs of students who exhibit weaknesses and deficits in attention, impulsivity, or hyperactivity by differentiating instruction, providing needed accommodations, and utilizing school resources. The guide promotes collaboration between school staff and parents in the use of evidence-based interventions that support student behavior and student achievement in the school setting. A. Background The ADHD Identification and Management Guide is consistent with the mission of the Baltimore County Public Schools (BCPS). The Baltimore County Public Schools mission statement is to provide a quality education for all students; one that develops the content knowledge, skills, and attitudes that will enable all students to reach their maximum potential as responsible, life-long learners and productive citizens. In 1999, BCPS assembled a multi-disciplinary task force, including parents and community members, to address the issue of ADHD and learning. The goals of the ADHD Task Force were to improve the education and outcomes for students with ADHD by: Developing processes to better screen, identify, and intervene with students exhibiting behaviors of inattention, hyperactivity and/or impulsivity. Maintaining students who exhibit behaviors of inattention, hyperactivity and/or impulsivity in general education. Reducing the number of inappropriate referrals to IEP Teams for special education services for students with ADHD. Differentiating instruction to meet the learning needs of students with ADHD. Providing resources for students, families, and school staff. Strengthening the collaboration with parents while improving outcomes for students. The ADHD Task Force produced the first edition of the ADHD Identification and Management Guide in August of 2000, with a revised edition in February Information was added by a multidisciplinary committee during the summer of 2005, with a revised edition in February This revision integrated the screening, identification, and management of students who exhibit weaknesses and deficits in attention, impulsivity, or hyperactivity within the Student Support Team process. It also assisted school staff and parents in the provision of a continuum of early intervention, targeted intervention, and more intensive intervention on the basis of student 1

7 response and need. Throughout this period, the guide included the use of a screening tool for identifying the degree to which student behaviors of inattention, hyperactivity and/or impulsivity reached threshold levels requiring intervention. That screening tool was the DuPaul ADHD Rating Scale, 4 th Edition (DuPaul-IV) (DuPaul & colleagues, 1998). With the 2012 edition of the Guide, the DuPaul-IV is being replaced by the more broadly accepted NICHQ Vanderbilt Assessment Scale (2002). It is expected that the use of this instrument will enhance the Student Support Team s capacity to identify and provide interventions for students who exhibit varying levels of inattention, impulsivity, or hyperactivity in the general education setting. B. Overview of ADHD Definition Attention Deficit/Hyperactivity Disorder (ADHD) is a condition that impairs functioning according to the U.S. Department of Education, National Institutes of Health, the US Congress, the U.S. Centers for Disease Control and Prevention, and all major medical and psychiatric, psychological, and educational associations. According to the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision (DSM-IV-TR, (ref.), ADHD is a neurobehavioral disorder diagnosed on the basis of the following criteria: Symptoms of inattention and/or hyperactivity-impulsivity have persisted for at least six months to a degree that is maladaptive and inconsistent with the child s developmental level. Some inattentive and/or hyperactive-impulsive symptoms that have caused impairment were present before age seven. Significant impairment from the symptoms is present in two or more settings (home, school, social). Clinically significant impairment is clearly evident in social, academic, or occupational functioning. Symptoms do not occur exclusively during the course of a pervasive developmental disorder, schizophrenia, or other psychotic disorder, and are not more appropriately accounted for by another mental disorder (e.g., mood disorder, anxiety disorder, dissociate disorder, or a personality disorder). Prevalence ADHD has been researched extensively, and a significant body of literature exists about the condition. The following selected data describe some of the known information. The American Academy of Pediatrics (July, 2005) reports that: 2

8 ADHD is the most commonly diagnosed mental health disorder of childhood. 4-12% of school-age children are affected by ADHD. Boys are diagnosed three times more often than girls. Wolraich and his colleagues (Pediatrics, June 2005) report that research studies indicate that up to one third of all children and adolescents diagnosed with ADHD also meet the diagnostic criteria for other co-occurring disorders such as oppositional defiant disorder, conduct disorder, learning disorders, anxiety disorders, obsessive-compulsive disorders, depression, and substance use disorders. Annual reports of school nurses compiled by the Office of Health Services from 2006 to 2011 indicate that: Approximately 9% of students enrolled in Baltimore County Public Schools are known to have been diagnosed with ADHD. During these five years, there has been an increase of 435 students with known ADHD diagnoses. An increasing number of students with ADHD have received interventions and accommodations through student support plans and 504 plans. Diagnosis The DSM-IV-TR recognizes three types of ADHD: 1. ADHD, Predominately Inattentive Type 2. ADHD, Predominately Hyperactive-Impulsive Type 3. ADHD, Combined Type ADHD, Predominately Inattentive Type is characterized by at least six of the following: Fails to give close attention to details or makes careless mistakes. Has difficulty sustaining attention in tasks or play activities. Does not seem to listen when spoken to directly. Does not follow instructions and fails to complete schoolwork, homework, and chores. Has difficulty organizing tasks and activities. Avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort. Loses things necessary for tasks or activities. Is easily distracted by extraneous stimuli. Is forgetful in daily activities. ADHD, Predominately Hyperactive-Impulsive Type is characterized by at least six of the following: Fidgets with hands or feet or squirms in seat. Leaves seat in classroom or in other situations in which remaining seated is expected. Runs about or climbs excessively in situations in which it is inappropriate. 3

9 Has difficulty playing or engaging in leisure activities quietly. Appears on the go or acts as if driven by a motor. Talks excessively. Blurts out answers before the questions have been posed. Has difficulty awaiting turn. Interrupts or intrudes on others. ADHD, Combined Type is characterized by at least six symptoms from each type. ADHD is diagnosed and documented for educational purposes in BCPS by the following qualified professionals (See PS 107 and PS 114): Licensed Physician Licensed Nurse Practitioner Certified School Psychologist Licensed Psychologist According to the National Association of School Psychologists (NASP) Position Statement on Attention Deficit Hyperactivity Disorder (2011): The evaluation of attention issues should be carried out with care and the understanding that attention problems may reflect normal development, environmental conditions (i.e., instructional match, home stress, social factors), other psychological and medical conditions, or some combination of these factors (Wolraich and DuPaul, 2010). A multi-tier system of support should be part of evaluation and intervention since attention problems can coexist with other disorders or be symptomatic of a variety of problems. When a student does not respond to initial supports, then a multi-method, multi-setting, multi-informant evaluation can be conducted as part of diagnosis and treatment. The evaluation should consider the function(s) of the problem behavior(s) in the design of interventions. Evaluation of ADHD-related concerns should be linked to interventions, and it is recommended that intervention assistance to students, teachers, and parents be provided early and for as long as such support is necessary to ensure optimal student behavior and school performance (Tobin, Schneider, Reck, Landau, 2008). Treatment Outcomes for students with ADHD are improved if treatment is a collaborative effort among the student, parents, school personnel and health care providers. There are four recognized components of ADHD treatment: Behavioral interventions Counseling 4

10 Educational accommodations Pharmacologic therapy It is not the place of the school system to make recommendations regarding pharmacologic therapy. Through the use of this Guide, the SST can identify and develop supports for students in the first three domains in order to enhance their success in school. II. SCREENING AND INTERVENTION FOR INATTENTIVE, IMPULSIVE, AND/OR HYPERACTIVE BEHAVIORS THROUGH STUDENT SUPPORT TEAM A. BCPS Student Support Team Model Baltimore County Public Schools has developed a SST model that brings together the knowledge and competencies of administrators, teachers, and student support staff to address problems and reduce barriers related to student achievement and safe learning environments. Emerging over time has been an SST model that is characterized by a three-tiered problem solving process. This process promotes schoolwide prevention and early intervention for all students and determines the need for additional interventions on the basis of student response and systematic progress monitoring. The development of the SST model is consistent with the Maryland State Board of Education (MSDE) regulation mandating the provision of a coordinated pupil services program for all students, including the use of preventive and remedial approaches to meet student needs, as well as alternative and supplemental programs for students at risk (COMAR: 13a ). The SST model is consistent with the MSDE document, A Tiered Instructional Approach to Support Achievement for All Students: Maryland s Response to Intervention Framework (MSDE, 2008). The following page shows a representation of the SST model that organizes the development, implementation, and monitoring of interventions and teams by the three tiers. 5

11 Tier 1: Universal Interventions Monitored by Teacher-level Teams 5-12% 8-15% Tier 3: Intensive Interventions and/or Special Education Services Monitored by the SST or IEP Team Tier 2: Targeted Interventions Monitored by the SST 80% of Students Tier 1 refers to core instruction and universal academic and behavioral interventions provided to all students across all settings. Tier 1 interventions are generally monitored by teacher-level teams. Tier 2 refers to targeted interventions provided to individual students, groups of students, or settings on the basis of more complex needs. Tier 2 interventions are generally monitored by the SST. Tier 3 refers to more intensive interventions and/or special education interventions that are generally monitored by either the SST or IEP Team. B. Teacher-level Teams The teacher-level teams monitor student behaviors that are inattentive, impulsive, and/or hyperactive and interfere with learning and achievement. These teams implement interventions over a period of time to determine response to intervention. Inattentive behaviors can include: fails to pay attention to details; makes careless mistakes; has difficulty sustaining attention in tasks or play; does not seem to listen when spoken to directly; fails to follow instructions and complete tasks; has difficulty planning and organizing; loses things necessary for tasks and activities frequently; is distracted by noises or extraneous stimuli; is forgetful during activities. Impulsive behaviors can include: blurts out answers before the questions have been asked; has difficulty waiting for turn; interrupts or intrudes on others. Hyperactive behaviors can include: fidgets with hands, feet or other objects; moves in seat; leaves seat; runs about or climbs excessively; has difficulty playing or engaging in leisure activities quietly; appears on the go or acts as if driven by motor; talks excessively. 6

12 The teacher level teams may: Review and analyze student data regarding behavioral and academic progress. Review whether behavioral expectations are being communicated to the student as code of behavior and classroom rules. Review whether academic content is being presented at an appropriate instructional level with differentiation strategies. Consult with the school nurse regarding health issues. Consult with school counselor, school social worker, or school psychologist regarding academic expectations and adjustment issues. Consult with or refer to the PPW for family issues. Recommend specific instructional interventions to address behaviors. Support teacher in monitoring interventions. Communicate with parents. Refer to the Student Support Team when lack of response to Tier 1 interventions has been documented. C. Student Support Team Students with inattentive, impulsive, and/or hyperactive behaviors are referred to the SST when they do not respond to classroom management and interventions within the classroom and these behaviors continue to interfere with learning and achievement. The process of screening students for attention concerns or ADHD through the SST begins with a request by the parent or a referral by a teacher-level team. A school staff member from the teacher-level team should request the Referral to SST Form from the SST chair. (All SST forms are available on TIENET.) The form should be completed and submitted to the SST chair. The SST chair or designee will: Screen the referral information in consultation with appropriate support staff and determine if an initial SST meeting needs to be scheduled. Some referrals to SST may not require an initial SST meeting. The concern may be addressed through individual case management and/or by a teacher-level team. Consult with the parent and invite the parent to the initial SST team meeting if warranted. 7

13 Distribute the SST Teacher Input Form to all of the student s teachers in the case where an initial SST meeting is scheduled. Refer to IEP team if the student has not responded adequately to Tier 1 and Tier 2 interventions, is suspected of disability as defined by IDEA, including adverse educational impact, and need for specially designed instruction and services. Refer to IEP Team when a parent orally or in writing suspects a disability as defined by IDEA, including adverse educational impact and need for specially designed instruction and services. Initial Meeting The SST will: Review all data regarding behavior, learning, and response to interventions provided by teachers and parents. Review any information provided by health care providers. Review relevant information from the student record including educational, developmental, health, and social history. Determine if the Vanderbilt Assessment Scale (available from the school nurse) should be completed for screening of behaviors. Parents should be invited to the SST meeting and be involved in decisions regarding the use of the screening measure. The school nurse will disseminate, collect, and score the home and school versions of the Vanderbilt Assessment Scale (see the Response to Intervention, Problem Solving Flowchart). Parents may request completion of the Classroom Teacher Behavior Checklists (BEBCO 0782) at any time to provide information to the student s health care provider. If health care providers prefer other rating scales, school nurses will comply as requested by parents. Decisions to consult with a health care provider regarding ADHD-like behavior are a parental decision. The team should not direct or suggest to a parent that a medical evaluation for ADHD is needed. Determine if additional information or classroom observation is needed. Determine follow up steps, including referral to school staff for individual case management or development of a student support plan. Use the SST Plan Form in TIENET to specify measurable goals, interventions, accommodations, strategies, and supports to be implemented in the classroom and school settings. 8

14 Refer to IEP team if the student has not responded adequately to Tier 1 and Tier 2 interventions, is suspected of disability as defined by IDEA, including adverse educational impact, and need for specially designed instruction and services. Document outcomes of the SST meeting and necessary follow-up using the SST Summary Form in TIENET. Progress Review Meeting The SST will: Review any new data regarding behavior, learning and response to interventions provided by teachers, parents, health care providers, or others. Review the results of the Vanderbilt Assessment Scale for screening of behaviors. If the student meets the ADHD screening criteria the SST may: Develop or revise a Student Support Plan utilizing the information from the Vanderbilt Assessment Scale and response to interventions, accommodations, strategies, and supports being implemented in the classroom and school settings. Progress towards goals on the Student Support Plan should be noted on the SST Plan Form (i.e., goal achieved, progress made, no progress) when reviewing and revising student support plans. Based on progress, goals and/or interventions may need to be revised. Identify additional assessments to be conducted (e.g., observations, rating scales, curriculum-based assessments, Functional Behavioral Assessment). Required parent permission for assessments will be obtained using the Parent Permission for Student Support Team Assessment Form. If the school psychologist is involved in these assessments, the SST Chair or designee will complete the Referral to Psychological Services For (available on TIENET). If standardized, norm-referenced testing appears necessary, it may be appropriate to consider a referral to the IEP team. Document outcomes of the SST meeting and necessary follow-up using the SST Summary Form in TIENET. Send information to the health care provider, if requested by the parent. The parent will complete the Consent for Release of Records (BEBCO 0907) and the school nurse will send the Vanderbilt Assessment Scale Summary, accompanied by the Vanderbilt Assessment Scale Letter to Health Care Provider. Supporting data from the team meeting may also be sent. If the student does not meet the screening criteria, the SST may develop additional interventions, develop or revise a Student Support Plan, and/or consider the need for additional assessment 9

15 information. The result of the VAS and other information may be sent to the health care provider with written permission of the parent. Provision of school services or attendance in school may not be made contingent on the parent obtaining an evaluation or treatment from an outside provider. Regardless of the parent s decision regarding medical treatment, the school must offer appropriate services or programming for a student. Additional Progress Review Meeting(s) The SST may: Review assessment results. Review/revise the Student Support Plan in TIENET and note progress towards goals and changes in interventions, accommodations, strategies, and supports. Consider Section 504 eligibility for students diagnosed with ADHD and manifesting a substantial limitation to a major life activity as outlined in the Pupil Services Manual, PS 114. Develop a 504 Plan for eligible students diagnosed with ADHD and manifesting a substantial limitation to a major life activity, such as learning. Develop a Behavior Intervention Plan as an outcome of a Functional Behavioral Assessment. Identify the timeline for implementation, monitoring, and review of the Student Support Plan, 504 Plan or Behavior Intervention Plan. Provide feedback to the health care provider, as appropriate. The school nurse will distribute the Classroom Teacher Behavior Checklists (BEBCO 0782) to all teachers and send to the health care provider and parent as requested. Refer to IEP team if the student has not responded adequately to interventions, is suspected of disability as defined by IDEA, including adverse educational impact, and need for specially designed instruction and services. 10

16 Tiered Response to Intervention, Problem Solving Flowchart Teacher notes concerns about inattentive, impulsive, or hyperactive behaviors exhibited by student. Step 1: The teacher differentiates instruction, implements effective classroom organization and management strategies, and teaches and reviews behavior expectations and classroom routines. Step 2: The teacher discusses concerns at a teacher-level team, reviews data to help clarify the problem(s), and identifies interventions as needed. The teacher communicates concerns with parent (ex. parent-teacher conference). Step 3: The teacher implements individual interventions consistently for days. The teacher collects and maintains data to help monitor student response to interventions. Continue to differentiate instruction, implement interventions, and monitor student progress. YES Progress Made? NO Step 4: The teacher refers the student to the Student Support Team (SST). The SST screens the referral and determines if an initial SST meeting is needed. Step 7: The SST reconvenes to review: -The student s response to interventions and progress toward measurable goals, and the results of the Vanderbilt Assessment Scale, if administered. -Parents may consider sharing results of the scales and outcomes of the SST meeting with a physician or other medical provider. Note: The results of the Vanderbilt Assessment Scale can be used to develop/revise a Student Support Plan. Step 6: Outcomes of the initial SST meeting are implemented. For example: -Additional interventions and/or Student Support Plan are implemented. -Vanderbilt Assessment Scale are distributed to teachers and parents by the school nurse. Step 5: Initial SST meeting SST reviews data and determines if the following are needed: -Additional interventions -Development of a Student Support Plan -Additional data collection, such as the Vanderbilt Assessment Scale Is the Vanderbilt screen positive? NO Continue to implement the Student Support Plan, monitor student progress, and revise plan as needed. Note: If limited progress has been made, it may be necessary to recycle through the databased, problem-solving process to further clarify the problem, revise the plan as needed, and determine next steps. YES In some cases, a parent will consult with a physician or other medical provider and the student may receive a diagnosis of ADHD. In some cases, the SST may consider the need to evaluate/assess for ADHD. In some cases, the student should be referred to the IEP Team for evaluation and consideration of need for formalized assessments. If a student has a documented impairment, the SST may need to consider the student s 504 eligibility, if there is substantial limitation and need for specific accommodations. It should be noted that a diagnosis alone does not automatically equate to a 504 disability. If there is no substantial limitation or only minor adjustments are needed, a Student Support Plan may be more appropriate. The SST may need to reconsider the student s 504 eligibility in the future, as needed. 11 Note: The student should be referred to the IEP Team if the student has not responded adequately to interventions and is suspected of a disability as defined by IDEA. Suspicion of an IDEA disability includes adverse educational impact and need for specially designed instruction/services.

17 D. Student Behavior Plans Individual student behavior plans are positive behavior plans for students who exhibit challenging behaviors that impact on learning and achievement and do not respond to schoolwide, setting-specific, or classroom plans, programs, or services. Student behavior plans include individualized interventions, supports, accommodations, or strategies that are implemented in the classroom and other school settings and monitored for student response and progress over time. Individualized classroom interventions, Student Support Plans, 504 Plans, Individualized Education Programs (IEP), and Behavior Intervention Plans (BIP) are types of individual student behavior plans currently developed, implemented, and monitored in BCPS as outlined in the Pupil Services Manual, PS 122, Student Behavior Plans. Student Support Plans Student Support Plans are developed through the SST to address complex academic and/or behavior concerns that have not been resolved adequately by other classroombased interventions, setting interventions, and/or schoolwide interventions. Student Support Plans include one or two specific measurable goals, interventions to address the goals, and identification of data points that will be used to monitor student progress over time. Student Support Plans may include strategies and interventions to address academic needs that are impacting the student s behaviors. Student Support Plans cannot include testing accommodations for districtwide assessments or statewide assessments such as MSA or HSA. Student Support Plans are developed, reviewed, and monitored by the SST. 504 Plans Section 504 of the Rehabilitation Act of 1973 is major federal legislation involving the civil rights of persons with disabilities that prohibits discrimination or exclusion on the basis of disability alone and provides students with disabilities equal access to general education programs and services. Section 504 impacts all programs and activities that receive federal funding. See Pupil Services Manual, PS 114, Procedures for Providing Accommodations and Services to Students Under Section 504 of the Rehabilitation Act of Plans are developed for students with diagnosed a physical or mental impairment that substantially limits one or more major life activities to ensure equal access to general education programs and services and provide Free and Appropriate Public Education (FAPE). 12

18 504 Plans may include instructional accommodations, materials, testing accommodations, physical facility accommodations, and necessary related services. Instructional accommodations may include behavioral interventions, supports, or strategies that are specific to the student s diagnosed physical or mental impairment. Testing accommodations for MSA or HSA can be included. The selection of testing accommodations must be guided by data, specific to the student need and diagnosed impairment, and derived from daily classroom accommodations as outlined in the Pupil Services Manual, PS eligibility determination and 504 Plans are developed, reviewed, and monitored by the SST. Individualized Education Programs IEPs are developed for students who have a disability as defined by the Individuals with Disabilities Education Act (IDEA) and require specially designed instruction and related services. IEPs may include individualized goals and objectives, direct services, supplemental aids, services, and program modifications, instructional and testing accommodations, and special considerations and accommodations. Individualized goals address specific skill or performance deficits that significantly interfere with the learning and educational performance of the student. Direct services include counseling services, social work services, psychological services, school health services, parent counseling and training, and other services as specified by MSDE. Supplementary aids, services, program modifications and supports may include, but are not limited to, behavior interventions and supports, instructional adaptations, curriculum accommodations and modifications, and individualized supports. Examples may include: consultative services, access to behavior intervention services, behavioral supports, contracts, and/or point sheets. Additional assessments and plans, such as a Functional Behavioral Assessment and a Behavior Intervention Plan, may not be necessary if the student s behavior planning needs can be met in the IEP document. IEPs are developed, reviewed, and monitored by the IEP team. Functional Behavioral Assessments/Behavior Intervention Plans A Functional Behavioral Assessments (FBA) is needed when individualized classroom interventions, Student Support Plans, 504 Plans, or IEPs are not effectively managing the students behaviors. The FBA gathers specific information about challenging behaviors. A FBA is a systematic process of gathering and analyzing information about the purpose and the context of the student s behavior pattern. This information is used to guide the 13

19 development of an effective and efficient BIP to reduce problem behaviors and facilitate positive behaviors in the school setting. FBAs and BIPs are developed, reviewed, and monitored by the SST or IEP team as appropriate. E. Procedures for Monitoring Student Progress The review of a Student Support Plan or 504 Plan may take place during a teacher-level or grade level meeting if the student is making progress and no changes are required to the plan. A student should be referred to the SST when there is poor response to the interventions and accommodations included in the Student Support Plan, the 504 Plan or the BIP. The SST should meet to engage in problem-solving, determine if changes to the plan are required, and identify necessary follow-up. It is recommended that the SST chair periodically run a report in TIENET to maintain an accurate list of students with Student Support Plans, 504 Plans, and BIPs. The confidential list of students with individual student plans should be shared with school staff through teacher-level teams, or other contacts as appropriate. Individual student plans should be reviewed by school staff at the beginning of the school year, and throughout the school year as appropriate. It can be helpful to notify parents at the beginning of the year regarding the student s case manager and the name and phone number of a contact person at the school. By simply communicating this at the beginning of each school year, parents are informed and know who to contact if questions or concerns arise throughout the school year. A brief form letter can be created to identify the case manager or contact person with phone number or . Consider maintaining documentation of this contact in the student s folder. It is important that individual student plans are articulated to subsequent schools and teachers when students move to a new school or during transition from elementary to middle or middle to high school. SST chairs or other school staff of the sending school should highlight students with Student Support Plans, 504 Plans, and BIPs during the articulation with the receiving schools. School nurses consult with the receiving school nurses regarding medical management. Students diagnosed with ADHD with IEPs are transitioned through special education procedures. 14

20 III. IMPLEMENTING INTERVENTIONS AND SUPPORTS FOR STUDENTS WITH INATTENTIVE, IMPULSIVE, AND/OR HYPERACTIVE BEHAVIORS AND ADHD DIAGNOSES A. Positive Behavior Planning for the Classroom Diversity is an asset for any school system or school. As diverse populations grow within schools, so does the need to implement interventions that specifically address the needs of students from various backgrounds. In BCPS, the student population represents a multitude of racial, ethnic, and religious groups who are further diversified by geographical area, local community identity, socioeconomic status, gender and age. In order to make interventions most effective, it is necessary to recognize the impact of cultural differences in areas such as multiple intelligence, discipline, student learning styles, and student learning preferences. Diversity within the classroom should stimulate educators and school-based personnel to use relevant techniques and strategies to enhance success for students with ADHD from all backgrounds. Systems of positive behavioral interventions and supports for students manifesting behaviors of inattention, impulsivity, and/or hyperactivity should extend and support the schoolwide system so that all students may be successful across variations in curriculum, instructional styles, classroom routines, and in all school settings. Research demonstrates that there are some basic principles of effective instruction and positive classroom management systems that produce results. Behavioral principles that are applied by teachers in managing students with inattentive, impulsive, and/or hyperactive behaviors are largely the same principles used to manage the behavior of all students. To effectively meet the needs of these students in managing their behaviors, teachers need to be systematic in the applications of behavioral principles and consistent in providing positive and corrective strategies. At the same time, teachers need to be attentive to the changing needs of the student for positive, preferably intrinsic, reinforcement. To establish a classroom system of positive behavior interventions and supports: Keep students engaged in learning. Clearly state behavioral expectations. Positively reinforce appropriate behavior. Encourage consistent family support. Utilize developmentally and culturally appropriate interventions. Adopt classroom management and disciplinary practices that combine proactive, instructive, and corrective strategies. Consider environmental support. 15

21 Establish predictable routines. Provide advance organizers/precorrections. Consistently enforce school/class rules. Correct rule violations and social behavior errors proactively. Promote cooperation among students rather than competition. Promote student involvement. Display warmth and acceptance toward students. Collect data to monitor intervention effectiveness and student outcomes. Request assistance for students who exhibit chronic and/or serious behavior problems. B. Positive Behavior Planning Strategies and Techniques for Students with Inattentive, Impulsive and/or Hyperactive Behaviors In the process of establishing a classroom system of positive behavior interventions and supports, teachers should consider a variety of strategies or techniques to manage inattentive, impulsive, and/or hyperactive behaviors of individual students or groups of students. A number of strategies or techniques are suggested below for implementation by teachers in the classroom and other school settings. It is recognized that the list is not all inclusive and can be used with most students, but the following may be particularly effective with the students who are the subject of this guide. Use peer involvement Promote tutoring (study buddies). Monitor, mentor, and/or mediate with peers. Establish cooperative learning groups. Provide positive reinforcement Be specific about the behavior being reinforced. Label the behavior you like. Reinforce behavior immediately and frequently. 16

22 Reinforce effort. Reinforce improvement. Keep reinforcement uncontaminated by qualifiers or put-downs. Be sincere and appropriately enthusiastic; no backhanded compliments (it s about time you finished that assignment!). Positively reinforce at a ratio of four positives to one negative. Respond to inappropriate attention-seeking behavior Ignore behaviors that do not bother other students. Use P.E.P. (Proximity, Eye contact, and Privacy) to avoid embarrassment, confrontations, and public criticism, thereby preserving student integrity. Always be conscious of culture when making eye contact. Always address student by name. Make eye contact and be aware of your non verbal behavior when addressing the student. Use verbal and non verbal cues to help students comply with expectations. Validate the student by providing unconditional, positive regard. Change student's seat. Use humor and provide student the opportunity for laughter. Use spontaneity to maintain attention and control. Turn off the lights Play music Intentionally lower your voice almost to a whisper Change your voice Stop teaching temporarily Redirect the student from undesirable behavior. Ask the student a simple, pertinent question Ask a favor (an errand, chore) Change the activity (works for many students). Give choices (amount, location, time). 17

23 Communicate clear and explicit behavioral expectations State If/Then, "When you have completed the task, then you may use the computer." Use Target-Stop-Do, "John, stop making noise, look at the test." Catch him/her doing something good and say, "I like the way you are... Thank you." Only set rules that you can enforce when making a request of the student. Be direct, firm, and respectful. Use natural and logical consequences when offenses occur. Consequences should be respectful, reasonable, reliably enforced. Help students clarify choices and the consequences of those choices, and encourage students to make good decisions. Allow students the opportunity for self-expression and validate students feelings. Prepare students for successful transitions throughout the school day Give short prompts. Provide clear rules and expectations. Model desired behavior. Have the student lead the group or walk with a partner. Reinforce success often. Provide motor or tactile stimulation. Avoid power struggles Acknowledge the student's power. Monitor rate and volume of speech. Realize you cannot "make" anyone do anything. Encourage delayed gratification by designating a time and place for discussion and problem solving. 18

24 Schedule a student/parent conference. Use empathy (agree, yes, I am, you may be right). Validate student's point of view and assist student with other points of view (to you it may seem stupid, to me it is very important). Avoid circular debating. Express confidence in student's ability to meet expectations. Use a closing statement, "We can talk later if you like." Rephrase, reflect, and review student's consequences of choices. Remove the audience. Be flexible. Model negotiating skills such as compromise and decision-making skills. Avoid giving ultimatums. Provide time-out periods Allow time for the student to calm down, reflect, and make appropriate choices with the goal of returning to instruction. Use the Language of Choice when implementing a time out, "John, you may stop arguing or you may go to the chill out area. You decide." Individualize time out according to student need. Make the time out as brief as possible, two to five minutes. Have a designated area. Ignore the student while in the time out, if appropriate. Have an alternative time-out area outside the room. Document the antecedents to the behavior and any consequences related to the behavior according to the school/classroom designated system. Reconnect with the student after the time out is completed. 19

25 Reinforce positive behavior as soon as possible after the time-out. Structure a token economy Explain the concept of a token economy to the student. Target the problem behavior with the assistance/input of the student. Select a secondary reinforce (tokens, poker chips, stickers). Utilize social reinforcers (praise, special tasks, social lunches). Assign value to the tokens (number of tokens earned for a desired behavior during a designated period of time). Make a reinforcement list for which the tokens can be exchanged, with student input. Agree upon a time frame to exchange tokens for primary reinforcers. The time frame for cashing in should be short initially and gradually lengthen. Assess the student s understanding of the entire system. Evaluate the effectiveness of the token economy system on an ongoing basis. Construct behavioral contracts Discuss the nature, purpose, and motivation for beginning a contract. Select jointly two to three target behaviors identifying only those behaviors over which the student has some control. Demonstrate the behaviors and ask the student to role play the behaviors. Decide how you will measure and record data. Decide jointly on the reinforcer list. Create a contract. Spell out student and teacher expectations and consequences. Build in expectations of all parties: teacher/staff, student, and parent. Review/revise the contract daily and weekly as needed. 20

26 Implement individual monitoring strategies Expect the student with ADHD to develop adequate levels of self-control and selfdiscipline. - Self-Monitoring: the student learns to observe and record his/her own target behaviors. - Self-Reinforcement: the student reinforces his or her own positive performance. - Self-Instruction: assist the student in using "stop-look-listen" skills to complete a task. Model positive skills that the student will exhibit. Support the student s performance with constructive feedback. C. Additional Interventions in Consultation with Student Support Services Staff Students with significant inattentive, impulsive, and/or hyperactive behaviors with or without diagnosis of ADHD may benefit from additional interventions and supports in consultation with student support services staff. Techniques can be included in a Student Support Plan or 504 Plan as appropriate. It is important for teachers, parents, and other student support team members to work together to keep a focus on academic achievement and to implement interventions and supports that will improve academic achievement. Selected interventions and supports are suggested below that can be implemented in the classroom, other school settings, or across settings within the school as a whole. Social Skills Training Social skills training involves teaching students with ADHD appropriate social skills in a general education classroom or small group setting. Content should include: - Empathy awareness - Impulse control - Anger management - Self-esteem promotion - Problem solving - Organizational skills - Interpersonal relationships 21

27 Self-Management Systems Train students to monitor and evaluate their own behavior without constant feedback from the teacher. The teacher and the student collaborate to identify behaviors that will be managed by the student. The teacher provides a written rating scale that includes the performance criteria for each rating. The teacher and student separately rate student behavior during a class and compare ratings. The student can earn bonus points if the ratings match or are within one point. Points can be exchanged for tangible rewards. Teacher involvement is faded over time and the student becomes responsible for selfmonitoring. Check-In/Check-Out Programs Provide students time in the morning to check in with an assigned teacher/staff member before going to their homeroom to ensure that the student is prepared and ready to learn. At the end of the day, the student returns to the same teacher to check out to make sure that the student has all needed materials to complete homework and to review the student s behavior chart or point sheet. Positive Behavioral Interventions and Supports (PBIS) PBIS is a positive behavior planning process that creates safe school environments that are conducive to learning and achievement. The PBIS process establishes consistent schoolwide and classroom behavioral expectations that are communicated, taught, practiced, and reinforced by administration, school staff, students, and parents. School-based PBIS teams review attendance, discipline, and other behavioral data to implement interventions that support positive school climate, increase attendance, decrease disciplinary incidents, and increase time for classroom instruction. Refer to the BCPS Positive Behavior Planning Guide (2003) as an additional resource. 22

28 D. General Accommodations for Behaviors and Skill Areas The student with inattentive, impulsive, and/or hyperactive behaviors needs more frequent and continuous interactions and feedback that are both positive and redirective to task. The following evidence-based accommodations reflect educational theories and neurobehavioral principles and are designed to assist teachers with the complex task of managing behavior and improving student performance in specific skill areas. These General Accommodations and Assistive Technology tools provide a means for supporting students in the general education setting by facilitating student access to the content. The following charts include suggestions for individualized strategies. Strategies are not necessary for all students. Some suggested strategies are appropriate for test taking (see MSDE Accommodations Manual, February 2008, at 23

29 1. General Accommodations/Assistive Technology: ATTENTION TO TASK Concern in Skill Area Method Accommodations Material Accommodations Low Tech Tools Assistive Technology High Tech Tools Fails to give attention to detail Makes careless mistakes Has difficulty sustaining attention Difficulty following multi-step directions Does not listen when spoken to directly Fails to follow through on instructions Fails to complete work Avoids tasks requiring sustained mental effort Often misplaces objects necessary for tasks and activities Forgetful in daily activities Is easily distracted by extraneous stimuli Seat the student in a quiet area/or near a good role model Seat the student near a study buddy to provide peer assistance in note-taking and checking work Seat the student away from distracting stimuli Allow the student extra time to complete assigned work Shorten assignments or work periods to coincide with the student s attention span Break longer assignments into smaller components Give assignments one at a time to avoid overwhelming the student Pair written instructions with oral instructions and make instructions clear Ask the student to repeat directions Study carrel Desk and chair should be the right size and free from needed repair Timers Copies of overheads Highlighters Block or frame work Remove pages from workbook Have materials partially filled in with information not being assessed Use clipboards Provide photocopied pages rather than requiring copying from the board or book Individualized chalk boards or dry erase boards Give reminders on post-it notes Provide desk examples as a reference Provide motivating computer programs for specific skill building and practice; programs should include frequent feedback and selfcorrection Allow use of computer to complete assignments CD/tape recorder/mp3 and Play Always to record work, taped lessons, read aloud, listen to prerecorded lessons or readings Use of computers with screen enlargement programs or a larger monitor Screen reading software for verbatim reading that converts text to speech List of approved Assistive Technology Software (January, 2010) from BCPS Assistive Technology Office h/pdf/at_software.pdf 24