CA Dept. of Education


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Attention Deficit Hyperactivity Disorder Archive 2010


Shari Gent, M.S.,
Educational Specialist

Shari Gent, M.S. is an education specialist with eighteen years of teaching experience. She has taught a diversity of students including those with learning handicaps, mental retardation, and autism spectrum disorders in both urban and rural environments. Her special interest is working with children with attention deficit disorder and associated mental health conditions. Shari has appeared on National Public Radio with leading experts in the field of attention deficit disorder. In addition to her professional work, she is a chapter coordinator for Children and Adults with Attention Deficit Disorder (CHADD) and parents a teenager with AD/HD.

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  • What is the difference between a 504 Plan and being in Special Education? Are they interchangeable?



My son has ADHD and ODD.  He was evaluated in Jr High and we were told he did not qualify for Special Ed but could get a 504 Plan based on a specific learning disability.  The High School now says they do not have the 504 in High School and are calling him Special Ed.  Can they do this? Does it make a difference?

Thanks – Sally


Dear Sally;

Perhaps some explanation about the difference between Section 504 accommodations and special education will shed light on your son’s situation.  Section 504, part of Rehabilitation Act of 1973 is a federal civil rights law that prohibits discrimination against individuals with disabilities.  The purpose of the law is to provide equal access to educational programs, services and activities and to prevent discrimination because of disability.  Part of the intent of this legislation is to level the playing field to provide equal access to the core curriculum.  Currently, this means that all children should have access to instruction directed toward their grade level standards.  Section 504 applies to preschool, elementary, middle, and high schools.  Public schools and private and parochial schools that receive federal funding are required to comply with Section 504, however, schools do not receive funding to implement the law.  In addition, each school district with fifteen or more employees is required to appoint a Section 504 coordinator to assist in implementation.  School districts are required to annually attempt to locate students with disabilities.

Special education, as defined under IDEA 2004, on the other hand, is publically funded individualized education.  To receive special education, a student must qualify under one of thirteen handicapping conditions and his condition must adversely impact his education.  Once a student qualifies for special education, he also automatically qualifies for Section 504 accommodations.

The type of support a student receives under Section 504 and in special education differs significantly.  “Adaptations” is the general term describing changes to instruction for the benefit of a child with a disability.   Under Section 504, a student is eligible to receive a type of adaptations to instruction known as “accommodations.”  Accommodations may alter the form instruction takes, but do not alter the content or grade level standards.   When a student qualifies for special education, he is eligible for both accommodations and “modifications.”  Modifications are another type of adaptation that can involve changes to the typical grade level standards.  For example, if your student is in the ninth grade but performing at the fourth grade level in mathematics, the ninth grade math standards might be scaffolded to include skills at his instructional level. 

From your description, you son appears to be eligible for Section 504 accommodations.  If you or the school is concerned that he may need an individualized education program, further assessment by the school district will likely be needed.  I would suggest talking further with the administrator at your son’s school and perhaps with your school district’s Section 504 coordinator to determine which type of instruction is most appropriate. 

The Diagnostic Center, Northern California provides a free online training about Section 504 that includes a link describing special education under IDEA 2004.  You and/or the school district may want to visit this site for further information:

Thank you for your valuable question.  I would be interested in hearing how your son does in the future. 

Shari Gent, M.S.

  • Strategies for students who are predominantly Inattentive Subtype of AD/HD with learning disabilities.


Dear Ms. Shari Gent,

I have a question regarding Attention Deficit/Hyperactivity Disorder: what interventions or compensatory strategies do you teach students with the Predominantly Inattentive Subtype of AD/HD that also have a learning disability, which affects their storage function (i.e., working memory)? Please let me know at your earliest convenience.



Dear Maria;

A boy with inattentive type ADHD aptly described his ADHD when he remarked , "ADHD is being able to lose something without moving." There are three types of ADHD:  ADHD Inattentive Type (ADHD-I), ADHD Hyperactive-Impulsive Type (ADHD-H), and ADHD Combined Type( ADHD C).  Of these, the combined type is the most common and the inattentive type the least.  ADHD-I is difficult to diagnose because symptoms are similar to those demonstrated by many children with learning disabilities and by children with central auditory processing disorder. 

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision  (DSM-IV TR) lists symptoms of ADHD-I.  Below are those that pertain to the classroom.

The child often:

  • Fails to give close attention to details or makes careless mistakes in schoolwork, work or other activities
  • Has difficulty sustaining attention in tasks or play activities
  • Does not seem to listen when spoken to directly
  • Does not follow through on instructions and fails to finish schoolwork
  • Has difficulty organizing tasks and activities
  • Avoids, dislikes or is reluctant to engage in tasks that require sustained mental effort
  • Loses items necessary for tasks
  • Is easily distracted
  • Is forgetful

A child is diagnosed with ADHD if she or he demonstrates at least six symptoms.  The child who has ADHD-C shares these symptoms and many of the interventions available for the ADHD child in general will apply to the child with inattentive type ADHD.

Children with ADHD of any type may have difficulty with executive functions, including working memory, but working memory has been shown to be more related to inattention than to hyperactivity and impulsivity.  Children who do not have ADHD can also have working memory weaknesses.  Working memory has often been described as the “RAM” or “countertop” for the thinking process.  Working memory is a system for temporarily storing and managing the information required to carry out complex cognitive tasks such as learning, reasoning, and comprehension.  We retrieve information, place it in our working memory and hold it there, while we search for additional information and finally perform an operation involving the items placed on our “countertop.” 

Working memory is different from short-term memory which allows us to store information for short periods of time, then repeat that information in the same sequence.  In contrast, working memory involves holding information and manipulating it to reach a goal.  The capacity of our working memory is limited, allowing us to remember only a few bits of information at one time.  When students are required to keep in mind multiple bits of information, for example, a series of directions, as they simultaneously complete a task, they may have difficulty completing the task or fail to monitor their work for accuracy.   Most of the symptoms of ADHD-I involve working memory deficits.  Whether working memory itself can be improved is controversial.  However, classroom adaptations and interventions can help children compensate for working memory difficulties and develop life skills.

Research links working memory with academic success and behavioral regulation.  Specific school related skills impacted by working memory include:

  • Following directions

As discussed above, significant working memory is required to follow complex directions.   The student needs to hold the directions in mind as he completes the task.

  • Remembering and organizing instructional materials

Making a smooth transition requires working memory.  As a student is thinking about the next task, she must keep in mind what items are needed to perform the task and retrieve the items one by one.

  • Reading comprehension

Skilled reading comprehension requires that the student have automaticity with decoding skills and be able to hold these in mind while they operate on meaning.  Students with ADHD often have difficulty with reading fluency.  Even when they have the phonological skills, they make many careless errors when reading which can lead to comprehension errors.  In addition, because of working memory weaknesses, they tend to have more difficulty recalling sequences for narratives.  They recall fewer story events than typical students.

  • Organizing for written composition

Written language is the most complex academic task and the area in which children with ADHD are most likely to have a learning disability.  In order to organize ideas for written production, students rely on working memory to hold the text structure in mind as they compose their thoughts.  In addition, they need automaticity with letter formation or keyboarding.  Students with ADHD have the additional challenge of sequencing problems.

  • Math computation and problem-solving

Mathematics is a hierarchical subject. Acquiring each skill depends on building on those previously learned.  For example, in order to multiply, addition facts first must be mastered.   Adequate working memory is essential.

Many strategies have been developed to support each of these areas.  Most of these revolve around providing external structure to relieve burden of recall of the process for the student with working memory difficulties.  Some of my favorites are:

Following directions

  • Check for attention by getting eye contact before giving a direction.
  • Provide step-by-step directions, no more than three at a time.
  • Use the same words consistently over time.   For example, “Today is ___, yesterday was ___.”
  • “Sing-song” directions, or use rhythm.
  • Chunk information and intersperse with clapping or tapping
  • Check for comprehension by asking the student to restate in his/her own words.


Remembering and organizing classroom materials

  • Color-code assignments according to subject. 
  • To prevent losing papers that often tear out of binder rings, experiment with binder alternatives such as portable files.

Example color-coded binder alternative

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  • Provide checklists.  To be effective, checklists must be meaningful to the student.  Some students may need a checklist template but many students are more likely to use checklists they have personally designed.  Seize teachable moments, such as when a student forgets to pack a pencil, to have that student compose his/her own checklist.
  • Clearly mark where homework is to be turned in.  Have a regular time of day and routine for turning in work.  Chart student progress.
  • Have students bring in additional materials to use in the event that materials are forgotten.
  • Set up a mailbox for each student. 
  • Implement regular backpack and desk checks.

Reading comprehension

  • To engage students who have difficulty sustaining attention, involve them emotionally in the material.  One way to do this and to support reading fluency for comprehension is to use Readers’ Theater activities.  Readers’ Theater helps students link written language with spoken language and supports fluency by providing auditory feedback.  The student hears him/herself reading in the context of a meaningful activity and relates abstract concepts in history, science, or other subjects, to real life activities.  In addition, the student is involved kinesthetically in the narrative.
  • Partner reading is an excellent way to engage the ADHD-I reader in the act of comprehension.  If the struggling student is not a proficient decoder, s/he can participate by asking questions and restating material read by the peer.

Written composition

  • Provide consistent visual organizers for each of the text types.  Encourage brainstorming first and allow the student to record keywords.
  • Have students create a proofreading checklist they can use in the final stages of writing.  Allow them to get their ideas down quickly first.
  • Try quick writes.  For example, have students write down as much as they can in one minute.  This helps them to focus their attention on ideas first.


  • Students with working memory difficulties may require frequent review to maintain material learned and progress to new skills.  Students with ADHD-I may have difficulty focusing on boring drill and practice activities.  Spice these up with interactive games and computer assisted instruction.
  • To help students remember the rule, color-code words indicating then needed process in word problems.
  • Use mnemonic strategies to help students recall the sequence for mathematical processes.  For example, the process for long division can be taught with the acronym:  Dead Monsters Smell Badly (Divide, Multiply, Subtract, Bring down.)


Thank you for your interesting question. This is just a start on the many strategies available to support students with working memory difficulties and ADHD-I.  For details and for further ideas, some additional sources are:

Mather, N. & Goldstein, S. (2008) Learning Disabilities and Challenging Behaviors, Second Edition. Baltimore, MD: Paul H. Brookes.
This book provides a checklist to help you analyze the individual needs of your students, then correlates these to specific strategies. The book is based on the “Building Blocks” conceptual framework.

Packer, L. &Pruitt, S. (2010) Challenging Kids, Challenged Teachers. Woodbine House.
Includes chapters on executive dysfunction, attention, and memory problems.

  • What do you suggest is the proper educational interventions for a child whose medical condition is affecting his education?


I have a 16 year-old child who is in special education at a local high school here in northern California.  He has been diagnosed with acute asthma, ADHD, and dyslexia by a neuropsychologist.  This school year he has missed approximately three weeks of class time due to asthma attacks and complications therein.  Subsequently, our child is left to attempt to make up such assignments as Algebra II assignments on his own. 

Well, as I am sure you are aware, this is not going very well, and his RSP instructors are constantly complaining to me and are suggesting that I further discipline my child.  We all know that those with dyslexia try everything possible to avoid reading and math.  However, I am unable to convince the school district to provide our child with proper FAPE with regards to dyslexia intervention.  Though our child’s RSP instructors have no problem continuously complaining about our child being behind in assignments missed due to asthma attacks.

What do you suggest is the proper educational interventions for a child whose medical condition is affecting his education?



Dear Pete;

Making up missed assignments and completing homework is often a struggle for most high school students!  The key to having your son complete the missed school work or homework is to guarantee success.  I suggest that you, or better yet, your son meet with his teachers and develop a plan for the work completion.  He is at an age where he should be taking responsibility for his education and this provides you with the opportunity to increase his independence.  When developing the plan they should consider:

  • Breaking up the late assignments into manageable chunks, each with a separate due date.  Because your son is completing these assignments at the same time he will need to complete the usual daily homework, completion may take longer than usual. Giving him two days to complete one make-up assignment could be reasonable.


  • Secondary age students often have difficulty accepting help from their parents.  Many schools have an afterschool homework “club” where students can go to complete work with support from a teacher and many schools have tutoring programs in which teachers are available to answer questions about assignments.   Another alternative might be for your son to work with his special education teacher for a short period of time during  his special education class or study skills period to complete the work. 
  • Another alternative might be for the school to provide a student mentor or for you to find a high school or community college student to help your child with the homework.  Many students just need a role model to sit with them in order to stay focused on and complete their work.  This can range from a peer buddy to a professional tutor.  When choosing a peer buddy, include your son in the decision but be sure the peer will set a good example for your son. 


  • Your son and his teachers can create a behavioral contract that stipulates which assignments he will complete, how much time he will spend daily, and what supports he will receive.  Be sure to include positive consequences, possibly daily, for assignment completion. 
  • Keep track of your son’s daily progress in completing the assignments.  Use a chart or simple graph such as the one below so he can see his progress. The chart can be combined with the contract.



  • At home, help your son design a daily schedule that he commits to follow for daily homework completion.  Put the most challenging assignments at the beginning of the homework period.  Many students enjoy creating electronic schedules on their cell phones or other devices.  Many of these can be programmed to warn them of upcoming events or specific assignments due. 
  •  Your son may need frequent breaks to complete his work.  Consider the 20:10:20 plan.  Have him work on homework for 20 minutes, take a ten minute activity break, and  then return to work for 20 more.  When helping him to plan an activity break, be sure the activity is one that is easy for him to give up at the end of 20 minutes and is one that helps him relax. 


  • In general, a good first step for homework  completion is to designate an area at home or school for homework completion.
  • Be sure that your son has appropriate materials readily available to complete his homework.  With him, make a list of the materials he needs and be sure that these are available in the designated study area.


I hope this is helpful in getting your son back on track.  

  • Non-traditional interventions that could help a student not be bored in class, and to improve his behavior.


Dear Shari,

I am a graduate student and have a case load of 8 students.  One of them is a 5 th grade boy with ADHD.  Recently he has been disrupting class and talking back more often.  He says he is “bored” in class, however his grades do not reflect that the work might be too easy for him.  Are there any newer or non-traditional interventions that could help him not be bored in class, and to improve his behavior?


Erin M.


Dear Erin;

Boredom is a common complaint from children with ADHD because their complaints have a neurological basis, a reduction in dopamine levels compared to typical children. Dopamine affects brain processes that control movement, emotional response, and ability to experience pleasure and pain. Thus, dopamine influences the reward system associated with motivation. When a student with ADHD engages in disruptive behavior, this is often due to a need to stimulate the dopamine system, providing relief of restlessness.

While medication that improves dopamine transmission is often helpful, most students require additional classroom accommodations to maximize their motivation and attention. Although a variety of instructional strategies address this difficulty, the key is to engage your student’s emotions and incorporate his personal interests into the learning process. Encourage your student to begin to take responsibility for his own learning.

Develop a relationship with him. Make yourself available for private conversations through e-mail or notes. Consider posting a “Personal Moment” board where students can sign up to talk with you for five minutes.

Interview or survey your students to determine their own perceptions about their strengths and interests. An interview can go something like this:

Name _______________________ Date _____________

At home, I am really good at ___________________.

At school, I am really good at ___________________.

My friends like to spend time with me because ____________.

If I learn just one thing at school it would be ______________.

What most makes me want to do well at school is __________.

My favorite equipment in the classroom is _______________.

When I work hard, I want the teacher to _________________.

I can do written work if I _____________________.

The thing I most want to learn outside of school is ________.

I have a special interest in _______________ and would like to _______________________.

I know how to _____________________________________.

You can also get a lot of information about appropriate accommodations for your student by asking him/her to draw, write about, or describe his ideal class. Compare this “dream class” with the one in which you teach. How are they the same and different? Is there anything you can do to incorporate your student’s dreams into his current class?

Another way to engage your student is to ask him to list his goals for the year. Some students have difficulty with these so I like to offer them a checklist to help jog their thinking.

My School Goals

Name: _____________________ Date:_______________

□ Improve my listening and attention skills in class.

□ Improve my study skills.

□ Improve my grades.

□ Take control of my frustration, anger and other feelings.

□ Recognize my strengths.

□ Improve my friendships.

□ Feel better about who I am; improve my self- esteem.

□ Learn about jobs where I can be successful.

□ Learn about how to complete my homework.

□ Learn how to talk to people in different situation so that I am accepted and they listen to me.

My top three goals:

1. I would like to __________________________________.

2. I would like to __________________________________.

3. I would like to __________________________________.

Adapt instruction to allow you student to be successful. For example, after finding out about his personal interests, allow him to be a classroom “expert” in that area. This need not be a demanding position. If he has an interest in science, he could be in charge of checking out the science lab equipment or be the science librarian. When introducing a lesson, talk about your experience with and personal interest in the subject matter. Look for ways to relate the material to your student’s life. Ask yourself, “Why would he need to know this?”

Instruction should be provided in short, intense bursts, with preferred activities following challenging ones. Be sure that independent work and classroom activities are at your student’s success level. Your student will need positive reinforcement that is frequent and intense accompanied by with fast-paced instruction. Reward effort over achievement.

Use novelty, social interaction and drama. For example, when students need to complete timed math drills, instead of using a timer, hold an ice cube in your hand. Students have to complete as many problems as possible before the ice cube melts. During instruction, use student-centered active learning strategies that engage your student. A few of these are listed below. For additional ideas, see the Resources section.

Take a Guess

Pair your students up and have them create a list of three to six important facts about the topic they are about to study. Make a list of the facts on chart paper or on a whiteboard at the front of the room. As you discuss the topic, have a student circle the item.

Pass It!

After about ten minutes of classroom discussion on a topic, have students write down a question or fact they just learned on an index card. Have the students pass the cards around so they are “shuffled” in the room. Using popsicle sticks with student names, randomly choose a student ot share what is on the index card they are holding.

Graffiti Wall

Post chart paper by the door as students are about to leave. Have them write a comment, fact, or question (depending on your intent) on the paper as they leave the room. Return to discuss these the following day.

Pick Your Post

Rather than giving students a worksheet or test to demonstrate learning, post papers at several stations around the room. Each paper has details of an alternate assignment such as “write a poem”, “prepare a skit”, or “draw a poster.” Have student pick a post or draw a card corresponding to the color of the post paper from a box. Students then work in cooperative groups at their selected posts.

After completing an assignment, have your students chart their progress. These charts should be private and allow students to see their growth rather than foster competition. These are just a few ideas to use to increase motivation, particularly for ADHD students. Good luck in your teaching career!


“Dopamine: A Sample Neurotransmitter.” University of Texas.

Ansaro, J. Tips: Great Active Learning

Bruff, D. (2009) Teaching with Classroom Response Systems: Creating Active Learning Environments.Jossey-Bass. This book outlines methods for using electronic “clickers” that students use to respond during class activities. This method allows the teacher to create charts and graphs of student responses.

Morris, R. New Management Handbook. Rick Morris is a teacher and trainer who specializes in interactive learning strategies. His books and materials are available at

Silberman, M. (2005) Teaching Actively. Allyn & Bacon.


  • Suggestions to help a student have more confidence in her own interpretation of directions?


Dear Shari;

I am a teacher with a 7-year student in the 2 nd Grade. She is extremely bright and does well in class, but is constantly asking questions she already knows the answer to. Before, during, and after every activity, she is always raising her hand or shouting out questions about the process or assignment. It is to the point where it is becoming excessive, ranging from 8-14 times per hour.

I spoke with her mother in our parent-teacher conference, and she told me that her daughter has been diagnosed with AD/HD and does take medication everyday before school. She also said that her daughter practices similar behavior at home, and she thinks it is because the student does not have the confidence to process the information on her own, even though she is presented the information and has shown the ability to internalize it.

Could this behavior be a result of her AD/HD, and do you have any suggestions to help her have more confidence in her own interpretation of directions?

Thank you



Dear Cynthia;

You may be both right. Your student is likely impulsive enough that she raises her hand to ask a question before she has a chance to think of the possible answer. In addition, she may be using this questioning technique as a strategy to focus her attention.

  • Be sure she actually understands the directions c onsider these guidelines:
  • Check for eye contact to be sure that she is attending before giving directions.
  • Give no more than three directions at a time and give these one step at a time. Each of these should be simple and lead to observable behavior. Avoid figurative, ambiguous, and idiomatic speech.
  • Use the same words consistently over time when giving instructions or going over an activity. For example, if a calendar activity is started by saying, “Today is Monday, yesterday was ______” the activity should be continued for the rest of the week using the same format.
  • To support memory, incorporate rhythm by “sing songing” directions and using motor movement.
  • Chunk information and directions in clusters or groups interspersed with clapping, drumming on the desk, or use rap or music.
  • Check your for comprehension before she begins a task. Whenever practical, have her restate the directions in her own words to be sure she really understands rather than simply having him repeat.

To improve your student’s ability to focus, reinforce directions by using activities that promote interaction. Try strategies like these:

  • Think, Pair, Share – After posing a question to the class, ask students to find a partner, make eye contact, share their response to the question and remember their partner’s response.
  • KWL (What students know, what they want to know and what they’ve learned) -- At the beginning of a unit students travel to charts posted around the room and write or draw their current knowledge on the subject on the charts. For example, if the subject is the rain forest, one chart may be titled “weather”, another “animals”, etc. Resources by the charts can be used as easy reference guides. At the end of the activity, students again use the charts to record new knowledge and change incorrect information.
  • Free-write, free-tell or write-alongs – Stop an activity for 5 minutes and have students write or tell about any items that confuse them, what they’ve learned, and their questions.

If your student is still having difficulty, implement a behavior management system to help her build confidence and independence and learn to inhibit her impulsivity. You do not necessarily have to single her out from the group. Consider using the same system with the entire class and follow these steps:

  1. Instead of trying to take on the whole day, decide which period of the day you will target. For example, unnecessary questions may be particularly numerous in the afternoon during social studies. 
  2. With your student, or the class, choose a reinforcer for which she and others are willing to work. The simplest solution is to use an edible such as small candies, chips or crackers. This can be fun to try once. For extended practice, you and the students’ parents may prefer to use prizes rather than food. In that case, choose prizes that students can earn by trading in tickets or tokens. Collect the tokens or tickets you want to use. 
  3. Decide on the number of questions you will accept from the participating students. Give each student an equivalent number of tokens or edibles plus one more. 
  4. During the activity, students must surrender one token or edible for each question they ask or each time they request help. 
  5. At the end of the activity, students can keep any unused tokens or enjoy any unused edibles.

Variations: A similar strategy can be used when students are grouped or paired during cooperative projects.

Thank you for your interesting questions. I hope these strategies can help your student begin to believe in and rely on her own resources.

  • How would I incorporate a child with disruptive behavior into a cooperative group?


Dear Shari; 

I am in a teacher credentialing program. We are given scenarios about chlidren (5th grade) who have AD/HD and their ability to be a part of small group learning; given a history of aggressiveness and disruptive behavior, how would I incorporate such a child in cooperative groups and still have a productive outcome for all ? 

Veronica S


Cooperative learning is an excellent opportunity for reinforcing and generalizing social skills. Small groups allow an up-close view of children’s social interaction and the chance to mediate interaction. However, cooperative learning was designed for typical students in general education. Because cooperative learning has been shown to be effective with typical children, many teachers try cooperative learning with children who have learning and behavioral difficulties. Research on whether cooperative learning produces similar academic and behavioral gains for students with learning and behavioral difficulties has shown mixed results.

To maximize the possibility that your student will have the best experience, incorporate suggestions from both the creators of cooperative learning and from research about effectiveness for students with disabilities. As cited by Mc Master and Fuchs, according to Johnson and Johnson (1994), designers of the cooperative learning concept, five elements are critical for structure and student involvement:

  • Positive Interdependence: Students must realize that group performance depends on contributions from each member
  • Face to face interaction: Students must encourage and facilitate each other’s efforts to achieve
  • Individual and group accountability: Students need to be held accountable for their performance, both individually and as a group.
  • Interpersonal and small group skills: Students must use effective interpersonal skills.
  • Group processing: Groups must be able to engage in processing to reflecting on how well the group is performing.

When students with learning and behavioral needs are included in groups, McMaster and Fuchs (2005) recommend that additional factors be considered:

  • Students need to be carefully assigned to groups. Students with learning and behavioral challenges will do best if groups are heterogeneous and members are supportive and helpful.
  • Assigning roles to individual students will increase their engagement.
  • The teacher should communicate clear objectives and criteria for mastery as well as clear behavioral expectations.
  • Student progress should be systematically monitored.

In summary, cooperative groups need to be highly structured to be effective. Many teachers find the level of structure needed difficult to implement. I caution you about implementing unstructured cooperative groups, particularly if you are including a child who can be aggressive, as the groups are likely to be ineffective.

If you are implementing cooperative learning with the inclusion of a student with AD/HD, consider simultaneously implementing a whole class response-cost system for the duration of the activity. Response-cost systems have been shown to be highly effective with students who have AD/HD. When implementing this type of system, modify the traditional response-cost concept to guarantee at least partial success. This requires taking data to determine a baseline for target behavior(s) and determining realistic goals based on your results.

Countdown to Free Time (Rappaport, cited by Rathvon, 2008), is an example of a whole-class cost response system. Here is a version I have adapted:


  • Erasable whiteboard with the numbers from 20 to 1 listed.
  • One index card for each student
  • Tape
  • Posterboard displaying a small number (3-4 at most) of behavioral expectations, for example:
    • Stay in your own space.
    • Work quietly.
    • Speak politely.
  • Paper bag, basket or box containing slips of paper with classroom activity rewards such as “classroom basketball”, “computer time”, “read to first graders.”


  • Using a simple frequency recording form, record the number of instances of target behaviors for the whole group during the instructional time for at least 3 days.


    1. Show the class numbers 20-1 on the board and explain that they can earn up to 20 minutes of free-time or special activity time for successfully demonstrating appropriate behavior during the cooperative learning time.
    2. Explain that you will be looking around the room at regular intervals. If students are following the rules, no time will be deducted. If one or more students are not working, a number will be erased from the board to deduct one minute of reward time.
    3. Pass out the index cards to each student. Explain how to number the cards in the same way as on the board. Check for accuracy and comprehension.
    4. Instruct the students to occasionally glance at the whiteboard and cross off numbers on their own charts to match the class chart.
    5. Have the class practice to check for understanding.
    6. Review the behavioral expectations for the cooperative learning period.
    7. Have the class do their cooperative group as usual. Erase numbers on the board as needed. 
    8. At the end of the period, praise the class for working hard and award the amount of freetime on the display. Alternatively, have a student draw a slip of paper from the container and permit the class to engage in the designated activity for the time specified on the chart.

Variations: Set a timer to sound at intermittent intervals. Check behaviors when the timer goes off. Play short pieces of quiet classical music. Check behavior after each short piece. Have a student be in charge of erasing the number.

Good luck with your studies and future teaching career. To learn more, check out these resources:

Kagan, S. & Kagan M. (2008) Kagan Cooperative Learning. San Clemente, CA: Kagan Publishing. Available at

McMaster, K. & Fuches, D. Cooperative Learning for Students with Disabilities. Current Practice Alerts. Issue 11, Spring 2005. Available

Rathvon, N. (2008) Effective School Interventions, second edition. New York, New York: The Guilford Press.


  • Should I recommend he be tested for AD/HD?


Dear Shari,

I am student teaching in the first grade, and there is a young boy who I feel may have AD/HD.  Although he is young, 5 years old, he has a hard time standing still or focusing during activities.  He also has a hard time transitioning from one activity to another.  This failure to concentrate results in a build up of unfinished work.  Are there any strategies that you could provide me with to help him? Or should I recommend he be tested for AD/HD?

Thank You,



Hello, Greg,

There are some great strategies you can try with your young student to help him concentrate and make transitions. First grade is the time to teach school behaviors and since your student is young for the grade, he may just need some additional support until he matures.

First, look over the types of activities you are requiring him to do. Are these:

  • Primarily hands-on rather than pencil and paper activities?
  • Do they incorporate movement?
  • Are the time expectations an appropriate length for his age? Ten minutes would be the maximum length; most experts suggest one minute per year of age.

Adapt the activities as needed to encourage focus and concentration.

Second, most students this age need training in making transition and benefit from pacing and warnings ahead of time. Some strategies for transition include:

  • Alert students five minutes before the transition is to occur and have them rehearse the steps they need to do to put away their materials and move to the next station.
  • Try playing a short cut from a favorite song to pace the transition. By the time the song is over, the students should have followed the steps to move to the new station.
  • One teacher I’ve worked with uses the “FREEZE” strategy. She has pre-recorded funny sounds on a tape. A few minutes before the time to transition, she asks a student to push the button to play a sound. When the students hear the funny sound, they are to “freeze” in position, and when she says go, they take steps to make the transition.
  • Oftentimes, students with attending difficulties have trouble transitioning from informal to structured settings, i.e., returning from recess or music class to an academic setting. Try a transition activity or game when your students return. One fun game is “Car Wash.” Before the students return, write some sight words or letter sounds for review on an outline of a car on the whiteboard. When students take their seats, have them take turns recognizing the word or sound. Erase each as it is correctly identified. When the car is completely “washed” it’s time for academics.

Finally, be sure to refer to your classroom schedule for each transition. If your student seems to need more, try giving him an individual picture schedule. If your student needs help to remember the steps for transition, try a cue card or “mini task schedule”. The example format below could be used as a personal schedule or as a mini-task schedule for transition procedures.

  • Cut out appropriate pictures showing what you want him to do and paste them on cardboard squares.
  • Put Velcro on the back of the picture squares and on the back of the corresponding squares on the card.
  • As he completes each activity or each step of the routine, have him move the square to the end of the arrow.

To Do  

I hope these ideas will get you started in improving your student’s class participation. If, after you try these, your student still has difficulty, the next step would be to contact your school psychologist or your Student Study Team for support. Whether a student should be assessed for AD/HD is a team decision, not one to be made by the classroom teacher alone.

Good luck with your student teaching and let me know how your student does.


  • Finding the right combination of strategies.


Dear Shari and John:

My question is regarding a second grade student in an elementary school LD class of thirteen students who has been diagnosed with severe ADHD. His parents do not believe in medication, partially for cultural reasons. I normally do not advocate for medication unless it is necessary, but feel this child has great potential. He is extremely verbal and intelligent. Consequently, his disruption to the class is an ongoing distraction. This behavior is affecting his progress as well as the progress of each student in the class. A reward system for good behavior, tied to computer use which he enjoys has been implemented, but it is not enough. Any help you could give with communication to parents as well as finding the right combination of strategies to help this child would be greatly appreciated.

Thank you for your time and expertise.

Sue Kitson


Dear Sue:

What a great question! We have collaborated to answer your question from our respective areas of expertise; Shari, a special education educator and John, a behavioral pediatrician. We have generated our response the concerns you expressed in your question:

  • Communicating with your second grade student’s parents
  • Developing strategies to optimize his learning.


It would be helpful to identify the basis of the parents’ rejection of medication for a chronic medical condition. Some parents have the view that medications are used to “control” their child’s behavior, and that the medication will “change who he is.” Another perspective is that medications help to restore a normal balance to a biochemical system which has become out of balance. Once that existing imbalance is corrected, then the child will have new options with respect to their behavior and the choices they make. The options chosen by the child can be affected by a variety of non-medication interventions, including the parenting approaches used and making the best use of positive reinforcement to obtain desired choices and behaviors.

It might be helpful for you to encourage the parents to meet with a physician experienced in diagnosing and treating AD/HD, who could explain to the parents:

  • The neurobiological basis of AD/HD, especially its impact on the “executive function” aspect of the brain,
  • How changes in brain function can affect behavior in ways that are not under the control of the child,
  • That adults often assume that the behaviors of an AD/HD child are entirely volitional and indicate willful non-compliance which should be punished,
  • That the child with AD/HD may perceive the world around them as unfair and at times hostile, and may adopt behaviors to help them deal with that perception,
  • How medications can help to normalize the biochemistry in parts of the brain where it may be abnormal,
  • That an increase in neurotransmitter concentration in the tiny space between neurons can allow communication between neurons to improve, and thereby lead to improvements in both brain functioning and in performance,
  • What potential side effects can occur and how to manage them effectively,
  • That AD/HD patients off medication are about three times more likely than AD/HD patients on medication to develop substance abuse disorders,
  • That there are now multiple medication options available, so that the specific needs of the child can be used to guide the physician’s choice of which medication is most likely to result in maximum improvement with acceptable side effects for that child,
  • That the dose and even the choice of medication will often be changed as a result of the child’s response to a medication trial, and
  • That the medications can always be discontinued if deemed necessary.

Parents typically want “the best” for their children. Helping these parents to enter into a therapeutic relationship with a physician who is both knowledgeable about and experienced in the diagnosis and treatment of AD/HD in children may help the parents to redefine what is “the best” treatment for their child.


Regarding behavioral strategies, we often assume that children with AD/HD should respond to these in the same way as typical peers. However, research has demonstrated that, because of their unique neurological make-up, children with AD/HD respond differently than typical peers. Behaviors consist of a sequence of three events, often referred to as the “ABC’s” of behavior: the antecedent, or events preceding the behavior; the behavior itself; and the consequences produced or affected by the behavior. Students engage in behaviors, both appropriate and maladaptive, as a way to communicate needs and produce specific results or consequences- generally to “get” or “reject” objects, activities, or situations. Consequences provide feedback about the appropriateness or correctness of a response, social attention, and stimulation.

Dr. Sydney Zentall suggests that because of an internally driven need for stimulation, students with AD/HD find positive and negative stimulation alike to be reinforcing. Many forms of emotional arousal have the effect of normalizing the under perfusion of oxygen and nutrients to the frontal lobe regions of the brain (which is characteristic of the AD/HD child’s brain when he is bored). Yelling, for example, will tend to increase the probability that inappropriate behavior in the child with AD/HD will increase because:

  • yelling produces conflict and its accompanying emotions,
  • the emotional response results in increased perfusion of blood to the frontal lobe areas,
  • this results in a decrease in dysphoric feelings, and
  • satisfies the AD/HD child’s need for intense stimulation.

For students with AD/HD, positive consequences or rewards must immediately follow the behavior and be more intense and frequent than those for typical peers. In addition, children with AD/HD tend to become bored with specific rewards as soon as the stimulus is no longer novel. If your behavior plan provides time on the computer as an activity reinforcer, consider if the reward is being offered frequently enough. Also ask if your student might be bored with that particular activity. Try varying the reward frequently – for example, change the software or website activity, or change the actual activity reward. Try providing the reward at shorter intervals, such as offering time on the computer for short intervals multiple times during the day.

Immediate Rewards:

In addition, research has demonstrated that when students with AD/HD are offered a choice of delayed or immediate rewards, they choose to complete fewer problems for a smaller reward given more immediately. Typical classmates tended to choose to complete more problems for a bigger, but more delayed reward. When all rewards were given immediately, the children with AD/HD worked more problems for the larger rewards just like their peers. So, when thinking about immediacy, you may have the option to offer a shorter computer time or an activity such as taking a short walk that may not be as rewarding as the computer time that you are currently offering. However, the reward may need to be given at shorter intervals.

Positive Praise:

Shower your student with frequent positive praise. Studies indicate that five positive statements to every corrective statement is generally optimal. Students with AD/HD respond best when their effort is recognized promptly, rather than waiting for them to achieve a desired goal. When you see your student focused and working, even for a few minutes, compliment him. Use intense praise that provides specific feedback about what your student is currently doing – for example, “You are really working like gangbusters on that math!”

Response Cost Strategy:

Finally, you might want to consider a modified “response cost” strategy, shown to be a powerful intervention for many children with AD/HD. We all experience response cost in our daily life - we must pay a fine when we have a traffic violation, pay fees for overdrawing our checking account, and in football, infractions result in yardage penalties. These can be powerful deterrents. However, emotionally fragile children can become upset when reinforcers are taken back. Children with AD/HD may react explosively when punished with fines or deductions of points or tokens already earned. In the modified cost response strategy, termed “free cost response” by school psychologist Dr. Terry Illes, removal of a token serves as a warning rather than a punishment.

To implement free cost response, start by taking a baseline of how often the target behavior occurs in a given period of time. Baseline data is essential for this strategy because it sets the bar for success. Start by targeting one observable behavior such as poking other students. Teach your student a replacement behavior such as holding a fidget or whispering to a partner. Then follow these basic steps:

  1. Determine the number of tokens to be given to the child initially.
  2. Determine the length of time the child’s behavior will be monitored. Plan to start with a short period of time and gradually lengthen the time as the child improves.
  3. Introduce the program. Remove one token for each occurrence of inappropriate behavior.
  4. At the end of the session, if at least one token remains, provide the reinforcement.
  5. As the child’s behavior improves, the sessions can be lengthened or the number of tokens can be decreased.

This sample monitoring card for kindergarten students was designed by a local kindergarten teacher.

I will keep my hands to myself

Each large square represents one ten minute activity. By taking data during a formal observation, this teacher determined that her student poked others about three times on average in a ten minute period. She decided that it was realistic for the student to restrain touching others to twice during each short work period. If the student inappropriately touched another student, one happy face was crossed off. At the end of the ten minute period, if one happy face remained, the student received her reward, in this case a scented sticker.

We hope this explanation is useful in modifying behavioral support for your student, and wish you success in your efforts on behalf of this child. For additional information, consult these resources:

Shari Gent, MA Education Specialist

John L. Digges, MD, PhD, FAAP Behavioral Pediatrician



National Resource Center on AD/HD

  • Website:
    This invaluable resource includes comprehensive and reliable information about all aspects of AD/HD. The website also includes a series of printable pamphlets entitled “What We Know” (WWK) about all aspects of AD/HD. Links to the latest news about AD/HD are available.

American Academy of Pediatrics

The American Academy of Child and Adolescent Psychiatry

  • Website:
  • Pamphlet: “Facts for Families” available in English, Spanish, Deutsch, Malaysian, Polish, Icelandic, Arabic, Urdu and Hebrew and includes information on AD/HD and on psychiatric medications in general.


  • Book: CHADD Educator’s Manualby Chris Dendy, CHADD (2006) *The chapter “Advanced Strategies for Challenging Behaviors” by Illes, T. & Weiss, S will be particularly helpful. Available at
  • Book: ADHD and Education by Sydney Zentall, Upper Saddle River, NJ: Pearson Education, Inc. (2006)