Attention Deficit Hyperactivity Disorder Archive 2013
Shari Gent, M.S.,
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.
Click a topic below to expand the full question and answer.
ADHD and Food Dyes- A Historical Perspective
Do food dyes cause ADHD?
Sylvia, SDC teacher
A flurry of discussion took place about food additives following research published in 2007 in the British journal, The Lancet, which found evidence that some food colorings increase hyperactivity. Following this study, the European Union made a policy decision to add a label to foods containing artificial food dyes. In 2011, the U.S. Food and Drug Administration convened a meeting to discuss the scientific evidence and make recommendations about the use of food additives in relation to ADHD.
The Lancet study, conducted at the University of Southampton (UK), looked at behavior in children in two age groups, three year-olds and eight to nine year-olds. The children were healthy and did not have ADHD. The study focused on the effect of a mix of six food dyes combined with sodium benzoate, a common preservative. The researchers noted that removing this preservative from food could cause problems in itself by increasing spoilage. The dose of additives consumed by the children was equivalent to one or two servings of candy per day. The children’s diet was otherwise controlled to avoid additional sources of additives.
The Southampton study found a mild short-term but significant increase in hyperactivity in both age groups. The effect size replicated an earlier meta-analysis by researchers at Columbia University and Harvard University. The investigators of this study estimated that the additives might explain about 10% of the difference between a child with ADHD and one without the disorder. The American study analyzed fifteen trials evaluating the impact of artificial food coloring and suggested that removing these from the diets of children with ADHD would be about one-third to one-half as effective as treatment with methylphenidate. (Harvard Mental Health Letter, 2009)
Although the European Union subsequently required labeling in foods containing dyes, the United Kingdom did not ban the use of these dyes. The 2011 study by the FDA resulted in a vote to take no action on the use of food dyes. The FDA currently requires that FD&C Yellow No. 5 must be clearly labeled. Lack of legislation reflected the opinion that the effect size was extremely small and that only a small percent of children were sensitive. In addition, the Southampton study included a mix of several dyes and sodium benzoate, so it was impossible to determine which substance was responsible for the change in behavior.
A perusal of authoritative medical advice from the Mayo Clinic and British National Health Service (NHS) websites indicates that the following food additives may be implicated in hyperactive behavior:
- Sodium benzoate
- FD&C Yellow No. 6 (sunset yellow)
- D &C Yellow No. 10 (quinolone yellow)
- FD&C Yellow No. 5 (tartrazine)
- FD&C Red No. 40 (allura red)
If you are a parent of a child with ADHD, consider that eliminating food dyes from your child’s diet may improve hyperactive symptoms but not enough to replace possible medication. In addition, not all children are sensitive to the dyes so your child may or may not show improvement. A healthy diet improves functioning in all children and will support optimal function in children with ADHD.
British National Health Service (NHS) http://www.nhs.uk/conditions/food-additive-intolerance/Pages/Introduction.aspx
Harvard Mental Health Letter. Diet and Attention Deficit Hyperactivity Disorder. June, 2009. http://www.health.harvard.edu/press_releases/Jury-still-out-on-foods-additives-and-ADHD
Hughes, R. Research Briefs: Artificial Food Dyes and ADHD. Attention Magazine, June 2011.
McCann, D.; Barrett, A; Cooper, A; et al. (2007) Food additives and hyperactive behavior in 3-year-old and 8/9-year-old children in the community: a randomized, double-blinded, placebo-controlled trial. Lancet, 370(9598): 1560-7.
Regulating Inappropriate Voice Loudness
I attended your workshop yesterday. Thank you for providing so many ideas and references. Sometimes it’s great to review and renew what is in the toolbox!
Coincidentally, when I returned to work, a teacher at one of my sites was wondering about how to deal with some social issues with one of her fourth grade students who has ADHD. It seems he talks constantly, in a loud voice disrupting her class. As a result of his socializing, he hardly completes any work. She prompts him constantly, but nothing seems to work. I didn’t think kids with ADHD were so social. Do you have any suggestions?
I’m glad you enjoyed the workshop. The behavior you describe is quite common in children and teens with ADHD and sometimes even with adults. Children with ADHD tend to speak before they think about the consequences. Talking to a peer provides a much more immediate reward than taking turns to participate in a discussion or quietly completing seat work. Children with ADHD are often sensory seeking and so a loud voice is much more reinforcing to them than a softer one. They tend to have about a thirty percent delay in social skills. If you go to a kindergarten or preschool class on the first days of school, you will probably notice many children who have difficulty regulating the appropriate loudness of their voice for the situation.
Start to solve this problem by considering some whole class strategies. Observe the class and note if other children also talk at inappropriate times in a loud voice. You might consider taking some baseline data on how frequently your student with ADHD talks out during instruction, under what conditions, and how his talking out compares to that of other students in the class.
If you find other students also have trouble talking during instruction, consider suggesting to the teacher that he or she discuss the issue with the class. Suggest that the class practice talking in loud and very soft tones of voice. Students who have difficulty with self-regulation often respond best when the behaviors are made concrete – when they can see what they are doing. Have the teacher create a display such as a “volume control” regulator on electronic devices, and see if the students can regulate the volume of their voices out of context of a daily activity. Have other students practice using the volume controls or meter to turn up or down the volume in the classroom. Then, during a specific activity such as independent work, set the volume control. Periodically, recognize and reward the class for maintaining the appropriate volume for that activity. When the class has mastered one activity, the teacher should move on to another. The teacher should check his or her own voice to be sure he or she is modeling appropriate volume. Some teachers find that when they raise their volume to be heard over the classroom noise, the noise actually increases. One first grade teacher I’ve worked with whispered throughout the entire day. Amazingly, so did all her students. Her student with ADHD occasionally talked a bit louder, but his voice was still within the normal range. If you need support for coming up with a visual, some great ones are listed in the Resources.
Another idea is a sort of positive response-cost. Suggest that the teacher purchase an inexpensive music box and wind it up in the morning. Whenever the volume gets too loud, he or she will turn on the music. If there is any music left on the box at the end of the day, the class gets a reward. Another option is to use a nonverbal sign or “signal.” Teachers can be creative about what this will be. A more high tech visual is also available for about seventy five dollars. The “Quiet Light” (see Resources) looks like a stoplight. The adult sets the light for a decibel level appropriate to the situation. Be sure to give positive recognition to students who are working quietly.
If the student seems to be the only one in the class who persists, avoid constantly correcting and thus, humiliating him in front of the rest of the class. Instead, he may benefit from an individualized program. One way to do this is to provide him with an individual point card or other way of recognizing appropriate volume. This should be individualized to reflect the student’s interests. For example, a popular activity right now in the schools is creating bracelets out of small, colorful rubber bands. Placing a cup on the student’s desk and dropping in rubber bands for appropriate volume control may be motivating for that student. Set a timer for short periods of time or play short stints of quiet background music. When the timer goes off or the music stops, reward the student for using the appropriate volume. The student may benefit from having a volume regulator image at his desk. Set the volume for the appropriate activity.
E-Learning. http://visuals.autism.net/visuals/main.php?g2_itemId=135 Although this website says that the visuals are for children with autism, they can also be useful for other children.
The “Quiet Light”. Acoustical Services, Inc. http://www.acousticalsurfaces.com/talklight/quiet_light.html
What to look for in a class for a child with ADHD and significant behavioral difficulties
My seven year-old son has ADHD. When he was in kindergarten, he started to show behavioral difficulties at school and as he has gone on to first and second grade these have gotten worse. It’s gotten to the point where the school wants to put him in a special class for kids with behavior problems. They say he needs “more structure.” I’m worried that he’s going to be exposed to other kids with worse problems that he has. I’m also worried about whether they will be able to handle his behavior. I’ve heard so many horror stories about these types of classrooms. How do I know the class they have in mind will be good for him?
I would like to suggest that, as a member of the I.E.P. team, you take an active role in the choice of a classroom for your son. Talk to his teacher and the program specialist or other administrator who is responsible for checking out his placement, and request to visit the classrooms they have in mind. The solution is different for each child, but research has identified some basic components that characterize quality programs for students with emotional difficulties. These include:
- A focus on developing healthy interpersonal relationships between students and supporting adults and between students and their peers
- A highly structured and predictable environment
- Evidence-based academic instruction aligned with regional or national standards.
- Appropriate accommodations for individual needs.
- Positive behavioral supports. Check to see that all personnel, including instructional assistants receive periodic training.
- Opportunities for social and emotional learning experiences
- A curriculum that includes life skills/career education
- Frequent communication between home and school
- Collaboration between all treating professions and the family
Before visiting a potential general classroom or a special education placement, draw up a list of questions to ask to be sure the placement will meet your child’s needs. Some general suggestions:
- Is the classroom environment well organized? Is there a specific area for each type of activity? Is there a quiet area where students can go to take a break? Are the exit pathways clear of clutter?
- Is student work displayed?
- Is the daily schedule clearly posted and does the teacher refer to it? Are the classroom behavioral expectations (rules) clearly posted and referred to?
- How does communication with parents about daily behavior take place? About special events? What if my child loses his note home, is there an alternative way to communicate?
- What is the homework policy? Will my child be penalized for forgetfulness if he can otherwise demonstrate mastery?
- What type of positive classroom behavior system is in place? Many self-contained classrooms use a “level” system. This sort of system can be effective, but must be implemented to minimize risks that a child may get “stuck” at the bottom rung. To encourage growth, there should be a way for a child to make progress even at the lowest level. To compensate, some classrooms also incorporate a point system at this level.
- How are individual behavior plans (Behavior Intervention Plans or BIPs) implemented by staff? Is there evidence of behavioral data-keeping or behavior logs?
- What procedures are used for a behavioral emergency?
- If this is a self-contained classroom, is there a “time-out” room? If so, this should be used as a last resort and definitely be without a door and unlocked. Find out when and why it might be used.
- What accommodations are available? Will these meet my child’s needs? For example, if my child has difficulty waking up in the morning because of his mental health condition or medication, can his schedule accommodate a late start without penalty? If my child needs shortened work periods, is an activity provided when the work is completed?
- How much time is spent on academic instruction? How is this individualized? Are hands-on, multi-sensory activities that appeal to an active learning style regularly available? Even older students need opportunities for experience-based learning.
- Is there a social skills or social-emotional learning curriculum in place? Is this a published curriculum? If so, what are the components? Some schools provide this experience in the general class, some in a lunch group. Does communication with parents take place about topics being covered?
- What is the adult to child ratio? Do all staff receive training in behavioral principles?
- Can my child have access to a trusted adult when he or she needs time to debrief or talk about a troubling experience?
- How long are the work periods? Are movement breaks available? Relaxation activities?
- What about recess? If my child is easily threatened by the noisy playground, is an alternative quiet recess available? If my child is boisterous and benefits from exercise, is recess withheld to manage behavior or as a consequence for failure to complete work? If so, what alternatives can be arranged?
Following your visit, meet with the program specialist and the potential teacher to clarify your observations. Keep in mind that no classroom is a perfect fit for every child. Changes and accommodations may need to be made even after you find a class that you think will be a good fit. Your son will probably have a transition period that hopefully will be a “honeymoon”. Remember that you know your child’s needs and be sure to remain an active member of the team throughout the process.
ADHD and OHI eligibility
Students with ADHD do not automatically qualify for special education, so how does the school psychologist determine an Other Health Impairment (OHI) eligibility?
Anita, school administrator
You are correct. Students with ADHD do not automatically qualify for special education under Other Health Impairment. Of course, in addition to OHI, students with ADHD often are found eligible under the categories of Severe Learning Disability (SLD) or Emotional Disturbance (ED). However, (OHI) is a common category under which students with ADHD can qualify for special education under IDEA 2004. Eligibility criteria in California reflect the federal criteria:
“C.C.R. Title 5, Sec 3030: A pupil has limited strength, vitality, or alertness, due to chronic or acute health problems … which adversely affects his/her educational performance. This health problem is not temporary in nature as defined by Section 3001 (v) of the Education Code.
C.C.R. 300.7 (9): Other health impairment means having limited strength, vitality or alertness, including a heightened alertness to environmental stimuli, that results in limited alertness with respect to the educational environment that – (I) is due to chronic or acute health problems such as asthma, attention deficit disorder or attention deficit hyperactivity disorder, diabetes, epilepsy, a heart condition, hemophilia, lead poisoning, leukemia, nephritis, rheumatic fever, and sickle cell anemia; and (ii) adversely affects a child’s educational performance.”
Our school psychologists often use a checklist such as the one below to clarify eligibility:
ELEMENTS- all four elements listed below must be checked to establish eligibility.
- Documented health impairment due to _________________(may include but not limited to: heart condition, cancer, leukemia, rheumatic fever, chronic kidney disease, cystic fibrosis, severe asthma, attention deficit disorder or attention deficit hyperactivity disorder, diabetes, epilepsy, lead poisoning, diabetes, tuberculosis, an infectious disease, a hematological disorder, such as sickle cell anemia, hemophilia.)
- This health problem adversely affects the pupil’s educational performance.
- It has been observed and documented that this pupil cannot be adequately served through other regular or categorical services offered within the regular instructionalprobrem. (E.C. Sec. 56337)
- These deficits adversely affect the pupil’s educational performance, and the pupil’s needs cannot be solely met within the regular classroom setting.
According to Part 300, A, Section 300.39 of IDEA 2004, special education is defined as:
“Special education means specially designed instruction, at no cost to the parents, to meet the unique needs of a child with a disability...”
Line 3 further defines “specially designed” instruction:
“Specially designed instruction means adapting, as appropriate to the needs of an eligible child under this part, the content, methodology, or delivery of instruction--
(i) to address the unique needs of the child that result from the child's disability; and
(ii) To ensure access of the child to the general curriculum, so that the child can meet the educational standards within the jurisdiction of the public agency that apply to all children.”
This means that students who require an “Individual Education Plan”, better known as an I.E.P., are those who cannot access the CORE curriculum without personally-tailored instruction. Please note #4 in the OHI checklist.
Individualized instruction may seem like a cure-all. In reality, learning under a specialized curriculum can be highly restrictive and limit participation with same age peers. The intent of the law is to allow all students access to the same quality educational instruction and standards. Therefore, a student would have to demonstrate that he or she cannot benefit from instruction typical for his or her grade level before qualifying for special education.
This can be done in a number of ways, depending on school district policy. Under the Response to Intervention (RtI) or multi-tiered systems of instruction model, successive interventions in large group (the whole class) and in small group settings would need to be tried and demonstrated to fail before that student would be eligible for special education. A student diagnosed with ADHD who is not eligible for individualized instruction may still qualify for Section 504 accommodations under the Civil Rights Act. For example, if a student has difficulty concentrating on independent work for more than ten minutes, he or she may receive and accommodation for frequent breaks. The intent of accommodations is to provide the student access to the CORE curriculum.
Best of luck!
Providing help to a resistant student
One of the students in my fourth grade class has AD/HD but is very sensitive about accepting help from me or from any of the other students even though he needs it. He lashes out whenever someone tries to offer a suggestion. What can I do?
Many students with AD/HD are self-conscious about accepting help. Many have experienced social rejection and have a strong desire for acceptance by their peers. They have a need to appear competent and to have the ability to contribute to the classroom community. A basic rule to follow when accommodating anxious and sensitive students is to avoid singling them out by drawing attention to their mistakes and weaknesses. Simultaneously, build their self-esteem by providing recognition for their strengths and by catching them “being good” whenever possible.
Studies have demonstrated that students are more likely to comply when they receive significant positive reinforcement. For students with AD/HD, the optimal level for positive recognition vs. correction is 5:1- that is, five positive comments for every correction. You may have to recognize behaviors in your AD/HD student that are common in your typical students. Be alert for those times when your student is doing something right, such as getting his books out on time, putting his name on his paper or other simple improvement.
Some students will even resist verbal praise. If this is the case, considering delivering the praise in some form other than a compliment in front of his peers. Some suggestions are giving him a short written note or “well-done!” ticket, whispering praise, having a peer offer the praise, or speaking with him outside the classroom.
Class Wide Peer Tutoring (CWPT) is an evidence-based way to provide support for your student without singling him out. If your student is the only one to be receiving help from his peers, he may feel resistive, but if all students are working together to improve their skills, your student will likely feel part of the community. The basic principles of a peer tutoring program include:
- Peer tutoring programs should be used to reinforce skills not teach new skills
- Tutors should be assigned in a purposeful way
- Peer tutors need to be carefully trained before tutoring commences
- Integrity checks by supervising adults are essential to be sure that appropriate positive feedback and correction procedures are being followed and that all students are operating under principles of mutual respect
- Academic progress should be frequently monitored. Curriculum-based measures are highly effective to measure learning facts and practicing skills
There are several ways to offer Class Wide Peer Tutoring (CWPT): cross-age tutoring, peer-assisted learning, and reciprocal peer tutoring. Each of these strategies has a large body of research supporting efficacy in students with learning and behavior difficulties. At least twenty-five studies published to date have found CWPT to improve student outcomes more effectively than traditional teacher-led instruction. (ERIC) CWPT must be implemented with fidelity to be effective and requires some in-service training to provide maximum outcomes. (see The Access Center).
Cross-age tutoring involves pairing older, more mature students as tutors for younger students. Your student might be tutored by an older student in an area of need. Conversely, he might serve as a tutor for younger students in an area in which he excels. Teaching others has been demonstrated to one of the most effective methods for consolidating learning and is also useful for developing leadership skills. Tutors should receive some training in setting goals, problem-solving procedures and providing appropriate reinforcement and feedback. Students who participate in cross-age tutoring improve their social skills and self-esteem as well as their academic skills.
Although this may seem counterintuitive, research indicates that same age tutors are as effective as cross-age tutors as long as students of different ability levels are paired. (see NEA.) Basic steps for one type of CWPT program include:
- Teach students the tutoring and correction procedures.
- On the first day, two competing teams are chosen. One way to do this is to have each student select either a red or blue slip of paper from a covered box. Students who draw the same colored paper are on the same team and are divided into tutoring pairs. Teams and pairs typically stay together for a week, then are regrouped the following Monday.
- Paired students function both as tutors and tutees and follow a highly-structured tutoring procedure. After the students get their tutoring materials, the teacher sets the timer for ten minutes and one student begins tutoring. The tutor presents constructed curriculum items and provides feedback contingent on the tutee’s response.
- Tutors award two points for each correct response.
- If the tutee responds incorrectly, the tutor provides the correct response. The tutee then corrects their errors by positive practice, for example by saying and writing a spelling word three times. If they complete the correction procedure appropriately, the tutor awards one point. Refusal or failure to correct results in 0 points. Students earn points both for themselves and their team.
- When the timer goes off, students reverse roles.
- The teacher rewards bonus points on a daily basis when students are caught engaging in appropriate tutoring roles. Bonus points are awarded in a different color pen by the teacher as s/he circulates around the room during the activity.
- Following the second phase, students total their points and write the total on the front of their papers. Both individual and team points are displayed on a scoreboard at the front of the room.
- On Fridays, students are evaluated individually using the assessment procedure typical for the subject content, i.e., spelling test, math time trial. Students earn five points for each correct answer.
- Point earnings are added to cumulative point totals for each team to determine a weekly winning team. Team of the Week certificates are presented and signed by each member of the winning team, then displayed in or outside the room. Each week new teams and pairs are formed.
One structured program that uses same age tutors is Peer Assisted Learning Strategies (PALS) awarded “best practice” status by the U.S. Department of Education Program Effectiveness Panel. Review of recent research by the What Works Clearinghouse Program confirms that PALS can be an effective program, with stronger evidence for the reading than mathematics component. Basic steps for the PALS reading program include:
- Partner Reading: the higher achieving student while the student who needs more support follows along. After five minutes, the students change roles and re-read the same selection.
- Paragraph Shrinking: Students take turns stating the main idea, ideally in ten words or less while taking turns reading one paragraph at a time.
- Prediction Relay: A partner predicts what information will be in the next half page of text, and then reads out loud to find the information.
Pairs can earn points for every correct prediction and for correct summaries.
Reciprocal Teaching or Reciprocal Peer Tutoring (RPT). In RPT, students alternate between roles of tutor and tutee. Points are awarded for the whole group based on total progress for the group. In addition, students are accountable for monitoring and evaluating performance. This strategy was originally developed for urban elementary schools. LD OnLine describes the typical steps for RPT as:
- Peer tutors present a flashcard with the answer on the back. The student computes the problem on a worksheet.
- If the student is correct, the tutor offers praise.
- If the student is incorrect, the tutor offers coaching and instruction indicated on the back of the flashcard and proceeds to a second trial.
- If the tutee is unable to solve the problem on the second try, the teacher or other adult assistant is called to provide coaching. If the tutee is correct, the tutor offers praise and goes on to the next problem.
- On the third try, if the student is correct, the tutor gives praise and then on to the next problem. After ten minutes, the pairs switch roles and work for another ten minutes.
- Following the practice sessions, students take an assessment on the material they practiced.
- Individual goals are combined with group goals and are rewarded. Once five goals are achieved the pair can select a reward.
Institution of Educational Sciences (IES) What Works Clearing House. Peer Assisted Learning Strategies. http://ies.ed.gov/ncee/wwc/default.aspx
Intervention Central. “Kids as Reading Helpers: An Intervention Training Model.” www.interventioncentral.org
LD OnLine. Reciprocal Teaching or Reciprocal Peer Tutoring (RPT). www.ldonline.org
NEA (National Education Association). Research Spotlight on Peer Tutoring.
PALS (Peer Assisted Learning Strategies) Vanderbilt University. http://kc.vanderbilt.edu/pals/
Scruggs, T.; Mastropieri, M.; & Berkeley, S. (2010) Peer Tutoring Strategies. Available at: http://www.education.com/reference/article/peer-tutoring/
How to address impulsivity in elementary school
I have two second grade students in my class who are extremely impulsive. They are always out of their seats and say and do things all the time without thinking. Their families refuse to give them medication. What can I do to help them?
Sara, Resource Specialist
Thank you for your excellent question. According to Daniel Goleman, author of Emotional Intelligence, “There is perhaps no psychological skill more fundamental than resisting impulse. It is at the root of all emotional self-control, since all emotions, by their very nature lead to one or another impulse to act.”
Most children learn to develop self-control between the ages of 3 and five years. Children with ADHD tend to have a 30% delay in maturity so, a child with ADHD, age seven to eight years, like your second-grader, is likely to have difficulty in this area.
There is no instant fix for impulsivity. Impulsivity is a neurologically-based problem that can’t be “cured” through behavioral intervention, but can be managed, and over a long period of time, as your student experience success in getting their needs met by making conscious choices, she will do this independently. For students with ADHD, hyperactive behaviors usually become less of a problem in adolescence and young adulthood. They tend to become more internalized as an inner sense of restlessness.
So, what can you do now?
Of importance in learning to control impulsivity is the ability to discriminate between emotions and actions. An emotion can be a signal that indicates that it’s time to think rather than to act. The first step in learning to control impulsivity is often learning to identify the physical manifestations of emotions. Whole class activities can be helpful in for helping students develop more conscious awareness of their feelings. Have your students stop in the midst of the moment and identify some of the signs in their body that indicate they are mad, sad or glad. Have them create body outlines and draw in areas where they feel basic emotions. Role-play situations to identify feelings that occur in common situations. Research at Stanford University indicates that impulsivity can decrease through practice using games.
Introduce a simple strategy for self-regulation such as “Stop-Breathe-Think.”This simple strategy is a way to interfere with sudden progression of disruptive or destructive behavior and is the first part of an overall social problem-solving strategy.
Here are the basic steps:
STOP BREATHE THINK
With your student create a visual prompt to illustrate each of the steps. Help the student label how he feels at the time that behavior occurs. This is what he needs to do when he “stops.” A fun way to do this is to rehearse the strategy with your student and take a digital photo of her engaged in each step. Then mount the photos on a board with the words underneath. For example:
STOP BREATHE THINK
Just teaching the strategy will not be enough. Your student needs to identify times when the strategy is appropriate and then use it. Ask yourself, what does my student do when she is impulsive? Start by taking data about events that occur before the impulsivity, the behavior you observe, and what the payoff is for the student. If possible, determine one particular behavior to work on such as increasing waiting to be called on in order to decreasing blurting out. What does the student get by engaging in the behavior? This is referred to as the “function” for the behavior. Impulsivity often gets the student attention. Help the student choose an appropriate behavior that will get him the same thing. For example, taking deep breaths while waiting for a few seconds to be called on should earn him praise for participating.
Don’t forget to recognize and reward the student for using the strategy. Using the strategy is more important than giving the right answer. Depending on the severity of the behavior, you may want to set a specific goal with the student. Keep track of the number of times he has used the strategy or have him do it so he can see his progress.