ADHD in class

How does the teacher reduce ADHD symptoms in the

classroom?
Alba Romero Temporal

Department of Child and Youth Studies

Degree paper, 15 cr, Fisrt cycle
Child and Youth Studies
Children, Culture, Globalization 15 cr
Autumn term 2013
Supervisor: Frankenberg, Sofia
Examiner: Payne, David

ADHD in class

How does the teacher reduce ADHD symptoms in the classroom?

Alba Romero Temporal

Abstract
The ADHD (attention, deficit, hyperactivity, disorder) is not a new disorder, although
nowadays it is a controversial issue that involves our society. Children are constantly in
contact with other infants who suffer this problem during their schooling and they have
to learn and to accept them on equal terms. For this reason, the teachers and parents
have to know the disorder to help these children. These kind of pupils as a consequence
of their disorder often have learning disabilities such as problems associated with
readings, writings and calculation skills, among others.
For these reasons, the teacher has the role to integrate and include these pupils inside the
ordinary class with the other classmates because the motivate state, instead of and to
feel part of a group and to be accepted is one of the main goals to improve the lives of
these children. This is part of the inclusive education that tries to educate children in
class with Special Needs.
So, the main goal of this study is to investigate and describe what the teacher has to do
when she or he has a pupil with this disorder, because the teacher has to be trained and
has to follow some strategies and methods in class to get a positive development in the
social, personal and academic context to children with ADHD. Some methods that
teacher uses to minimize the symptoms of ADHD and to help to pay attention in class
are: positive reinforcement, token economy, extinction process, time-out, response-cost
program and turtle technique.
Keywords

ADHD (attention, deficit, hyperactivity, disorder) Role of the teacher Inclusive

education Special Needs Skills Symptoms of ADHD Methods to minimize the
symptoms

La decisi de desenvolupar una intervenci no deu basar-se exclusivament en un

diagnstic de TDAH, sin en les necessitats individuals del nen
"The decision to develop an intervention should not be based solely on a diagnosis of
ADHD, but on the individual needs of the child"
Ana Miranda i Cols (2011)

Contents

1. Introduction...
2. Methods Section.........
3. Findings..
3.1 Literature Review
3.2 Results and findings.
4. Conclusions

1. Introduction

The number of detected children with ADHD is thus increasing and for these children
and people in their immediate environment neuro-psychiatric disorders cause huge
problems with regard to learning, teaching and social interaction (Brodin J. , 2012). This
has resulted in an increasing demand for special classes in school and today we can note
that there are special classes for children with for instance ADHD. This disease in
general affects to 3 to 7 per cent of the infantile and adolescent population (American
Psychiatric Association, 2010).This trend is global in spite of the fact that most
countries for the time being are promoting inclusion of all children in a school for all
(Norwich, 2008).
It is for this reason to start this thesis I have seen fit to look for what are their origins
and to conduct an historical review. In this review we are going to see quickly how
theories have developed and changed during these last years. This paper is going to
describe the main characteristics of children with ADHD and their origins. Furthermore,
it is important to know how many different kinds of this disorder there are.
Finally, I am going to talk about the behaviour of children with ADHD in class, how
they are integrated inside the normal class with the other classmates and the techniques
and methods that the teacher uses in class to promote their integration. It is estimated
that the prevalence of attention deficit disorder with hyperactivity stands at the 3 and
5% in school-age children (American Psychiatric Association, 2013).Another important
data is As Jane Brodin, 2012 said in her article the prevalence of ADHD in Sweden is
estimated to 3 to 6 per cent of all school-age pupils (Brodin J. , 2012).
Also, it is true the educational system has searched some solutions to integrate and to
care for pupils with special educational needs (SEN) in general, but even though there is
still a lot of work to do because the idea to integrate this kind of pupils inside the
normal class is relatively actual and it demands both careful teacher training and time to
make changes (Brodin & Lindstrand, 2007).
Therefore, there is no doubt the educational system has to adapt and must ensure the
specific needs of these pupils if it wants to get their social integration goal from the
beginning of their schooling (Molina & Holland, 2010) because if it is not in this mode,
these infants are going to be doomed to the school failure.

In this project is going explain what are the interventions that teachers can do in case
that they find a child with this disorder inside the regular class, which treatment
methods exist and how with them we can foment childrens self-esteem and self-control.
ADHD is an issue that involves society and concerns it and it is good to explain and to
know the strategies that teachers use to improve the lives of children with ADHD in the
ordinary class.
Children with ADHD frequently have difficulties about reading, orthography, writing,
mathematics and the language (Mena , Nicolau, Salat, Tort, & Romero, 2006).
Consequently, their results are below their intellectual capabilities because they have
many problems, such as to pay attention, to memorize something and to control their
impulses. For these reasons, the probabilities of school failure of these children are very
high.
The intention of this paper is to give a description of this disorder explaining their
symptoms, their consequences and their treatment in class. Furthermore, the most
important is to keep in mind that ADHD is a disorder that society, parents and in this
case the classmates and teachers have to live together with these pupils. It is important
that teachers have capacities to teach, motivate, guide and transmit to pupils their
technic, social and personal knowledge (Mena , Nicolau, Salat, Tort, & Romero, 2006).
They have to develop their role like professionals in the best way possible.
As Inmaculada Moreno said, 2008, the environmental influence on the behaviour of
children is important. The therapeutic actions have to take place at home and at school
and, have to do them with motivation and with the involvement of adults. Furthermore,
it is hardly likely significant changes are obtained if treatment is developed problems in
contexts outside its natural range (Moreno, 2008)
Finally, Ive chosen this topic, first of all, because I think that it is a burning issue in the
actuals time and teachers, parents, and sometimes some professionals that conduce and
take part of a psychological intervention, have some difficulties and complications to
work and intervene with pupils with ADHD. For these reasons, and because I want to be
a teacher I was excited to know and to research about this topic and methods that
concern it.

Aims:
How does the teacher reduce ADHD symptoms in the Classroom?
1. To describe different theories and explanatory concepts of ADHD.
2. To describe the role of the teacher
3. To describe different methods by the teachers to develop in class to improve the
knowledge of the pupils with ADHD.

2. Methods section
This method section is based on Bryman writings (Bryman, 2004). This thesis is a
scientific work made through a qualitative research. So, the topic presented is about
social research, specifically an explicative research because it intends to investigate
what ADHD is and how these children can be integrated in the normal class with the
other peers. Also, it can be called as monograph because it is about a specific topic
described in order (Manzo , 1971).
This paper intends to answer to the following questions: How does the teacher manage
to promote and to include children with ADHD in class and which are the methods that
they use to do it?
How does the teacher reduce ADHD symptoms in the Classroom?

In order to answer these questions I have done a literature review.

First of all I had some problems to create my research questions, but finally I decided on
the research questions that I wanted to research. For this reason, the first step was to
create a research design that consisted in selecting the articles, documents, books and
webpages about ADHD. I was looking for some keywords in some articles such as:
ADHD, symptoms of this disorder, integration, children, role of the teacher in class,
inattention, impulsivity, hyperactivity It was essential to read and compare some
different documents from different authors. In the same time, was important to think
about the aims of the thesis to select the best resources to do it:
1. To analyze different theories and explanatory concepts of ADHD.

2. To show different methods by the teachers to develop in class to improve the

behavior of the pupils with ADHD.
The documents have to be clears and strategically selected. As I said before, I looked for
articles related with some keywords. These articles were found in the online library,
some printed in paper and other I found them on Internet.
Some articles have been scientific papers written by doctors or psychologists. Other
articles have been written by some ADHD associations or hospitals (Hospital Sant Joan
de Du). Finally, some of the methods to minimize the ADHD in class were described
by some teachers in different manuals to teach children with ADHD.
To develop my paper I used a logical procedure. First of all was introduced the topic
and the theory of ADHD with the chronological historical context, explaining the main
characteristics of the disorder, different ideas of ADHD authors, their different
symptoms and types and their treatment. Subsequently, the next point of this research
was the explanation and answer about the research question, the findings and results.

3. Findings
Historical evolution
ADHD is one of the most diagnosed, studied and treated child and adolescent
psychiatric disorders and, nowadays, it is common to hear people in the street talking
about this problem. There has been a controversial issue regarding its diagnosis,
ethology, treatment and methods to improve the life of children (Brodin J. , 2012).
Nowadays to talk about the phenomenon of attention, deficit, hyperactivity disorder
(ADHD) is also necessary to look back hundred years ago. This is because it is not just
a disorder characteristic of XXI century, if not it has always existed even if currently it
is more often diagnosed (NICE, 2013).

The ADHD was described for the first time almost 100 years ago and for over half a
century the known beneficial effects of stimulant drugs for this treatment (Brown ,
2002). This paper will describe how some of the past terms have included hyperkinetic
disease, minimal brain damage and minimal brain dysfunction, among other
wrong conceptions to describe this disorder.
The ADHD, disorder for inattention with or without hyperactivity, is the term known as
syndrome characterised by three symptoms of disorders such as inattention,
hyperactivity and impulsivity, even if

these symptoms do not always have to be

presented all together (American Psychiatric Association, 2013).

The first description we know about ADHD was told by Hoffman, a German doctor and
writer who tried to describe the symptoms of ADHD though a book written in 1845. So,
the main character of the book showed some signs of having ADHD. He was called
Phil, a restless child that could not be seated and he was moving constantly (Mark &
Wolraich, 2006). In that book Hoffman was describing Philip with the hyperactive
symptom, the movements excess, but the child did not seem to show inattention.
In this block of the text can be seen how Hoffman tried to describe the symptoms of
ADHD because Philip was constantly moving and his parents told him if he could sit
well on the chair. The author described him as rude and wild child because he was
restless.

"Let me see if Philip can

Be a little gentleman;
Let me see if he is able
To sit still for once at the table."
Thus Papa bade Phil behave;
And Mama looked very grave.
But Fidgety Phil,
He won't sit still;
He wriggles,
And giggles,
And then, I declare,

Swings backwards and forwards,

And tilts up his chair,
Just like any rocking horse-"Philip! I am getting cross!"
See the naughty, restless child
Growing still more rude and wild,
Till his chair falls over quite.
Philip screams with all his might,
Catches at the cloth, but then
That makes matters worse again.
Down upon the ground they fall,
Glasses, plates, knives, forks and all.
How Mama did fret and frown.
When she saw them tumbling down!
And Papa made such a face!
Philip is in sad disgrace . . .
(Hoffman, 1854)
After that, the English paediatrician Still in 1902, unveiled the first description of
impulsive, aggressive and inattentive behaviour. He described them as behaviour
problems that he called defect in moral character (Mark & Wolraich, 2006). Still
assumed that this kind of social deviance was a neurological disease and not for a bad
parenting. It was rather the product of heredity or an injury at birth (Martin, 2010).
The relation between the hyperkinetic disorder mainly based on overactivity and
restlessness and a defect in the central nervous system was the first current during the
first half of the XX century; Hohmann, 1922 said that children had a cerebral
dysfunction. In the 60s most researchers noticed that children with hyperactive
symptoms had not any brain injury and they called the problem as minimal brain
damage or cerebral dysfunction (Mark & Wolraich, 2006). Thus, the ethology wouldnt
be a specific brain injury; if not a general dysfunction in what the brain is normal. This
term was getting more important by Clements and Peters in 1966 who described that
symptomatology: motor disorders, hyperactivity, impaired coordination, perceptive and
attention disorder, school learning difficulties, difficulties in the control impulses,

impaired interpersonal relationships, affective disorders, ability, aggressively (Wright,

2002).

The DSM manual

DSM, Diagnostic and Statistical Manual of Mental Disorders of the American
Psychiatric Association in the United States, is a compendium of mental disorders, first
released in 1952 as DSM-I.
It takes four revisions and the fifth, the DSM- V, was published in 2013. In each one of
these publications are ratified and correcting some definitions of disorders or their
features.
It is developed based on observations, experience data described in a neutral way with
the intention that they can be used by specialists trained in different streams:
psychoanalysis, humanism, cognitivist
The concept of ADHD appeared for the first time in the diagnostic and statistical of
mental diseases DSM II manual, published by American Association of Psychiatry, in
1968 with the name of hyperkinetic reaction of childhood (American Psychiatric
Association, 1967).
Virginia Douglas, in the 70 years, argued the basic deficiency of hyperactive children
isnt the excessive level of activity, but the incapacity to pay attention and the
impulsivity, therefore, an insufficient self-regulation that is closer to the actual meaning
(Mark & Wolraich, 2006). Douglas was a key person because the American Association
of Psychiatry changed in 1980 the description of ADHD in DSM III, where it included
new criteria and changed the meaning to attention deficit within and without
hyperactivity (American Psychiatric Association, 1980).
Between the 80 and the 90 years they began to make a lot of studies and researches. In
these last years the OMS made a diagnostic and statistical manual of mental disorders
DSM-IV-TR based in the research made in the 80 and 90 years. In this recent manual
there was argued that children should present the symptoms of ADHD before to be 7
years (American Psychiatric Association, 2010).

Nowadays, there is published the last manual DSM 5

argues that several of the

individuals ADHD symptoms must be present prior to age 12 years, compared to 7

years as the age of onset in DSM-IV (Association, 2013). This change is supported by
substantial research published since 1994 that found no clinical differences between
children identified by 7 years versus later in terms of course, severity, outcome, or
treatment response (American Psychiatric Association, 2013).
After this historical review until nowadays and after to see the different criteria and
topics that people used throughout history to refer ADHD, the next step is to define this
disease.

Definitions of ADHD
ADHD is a neuro-psychiatric disorder characterized by a pattern of behaviour. It is
divided in two categories related with their symptoms: inattention according with their
stage of development, and hyperactivity and impulsivity (American Psychiatric
Association, 2013). This disorder includes behaviors like failure to pay close attention
to details, difficulty organizing tasks and activities, excessive talking, fidgeting, or an
inability to remain seated in appropriate situations (American Psychiatric Association,
2013).
After to talk about what ADHD and their origins are, it is important to know what the
causes are. It is difficult to give direct or immediate causes about ADHD (Mena ,
Nicolau, Salat, Tort, & Romero, 2006). However, in general, and according to the
Hospital Sant Joan de Du, 2010, the causes can be divided in 80 % of
genetic/biological factors and the rest from acquired factors (Hospital Sant Joan de Du,
2010).
-

Biological cause: is by disequilibrium chemical or a deficiency of certain

substances on the brain that are located in the brain area charge of attention and

activity (problems about chemical and structural level) (Barkley, 1999).

Heritage: A lot of biologic parents of children with ADHD shown signs of

ADHD when they were children (Hospital Sant Joan de Du, 2010).
Other causes / acquired factors: In some cases, the complications during the
childbirth can be involved in the manifestation of the disorder or the

environmental factors can influence too. Also, the fact to spend a lot of hours in
front of the television or computer can contribute to have symptoms of ADHD.
(Mena , Nicolau, Salat, Tort, & Romero, 2006), (Hospital Sant Joan de Du,
2010).
Also, Barkley in 1999 argued that could have social causes related with ADHD, such as
the social development or the familys context (unstructured families or divorced
parents can affect to the behavior of the child). However, these reasons are not enough
to attribute that the ADHD is caused by social context (Barkley, 1999).

The main symptoms that this disorder gathers are basically, inattention, hyperactivity
and impulsivity. To have a more completed definition of this disorder, it is good can
classify it in:
Inattentive symptom: problems when the child has to start some activities or to pay
attention until to finish their tasks (WebMD, 2013). In this type are gathered some
skills, such as the selection of a stimulus in a concrete time, to pay attention in a
stimulus in a concrete period of time, to be able to inhibit stimulus and the capacity to
change stimulus to finish a task and starting another one. The characteristic of these
children is that the difficulty of pay attention is present in a little but intense mode
(Fundacin ADANA, 2009).
Hyperactive symptom: not always is present in people with attention disorders, but for
the majority it is true that they are excessively restless (WebMD, 2013). The
restlessness grade can vary depending on the situation they find themselves and the
level of interest that an activity has for them. Sometimes, there are evident motor
behaviours, such as walking on the table when the other mates are sitting on their chairs;
others, the movements are made by muscles (to hit with a pen on the desk constantly,
playing with the projects that they have in front and touching everything). Not all
movements of these children are hyperactivitys indicators and just we can call them
when the movements do not have any proposed, they are given in inappropriate
circumstances and are made without any reason (Fundacin ADANA, 2009).
Impulsive symptom: is associated manifested in two ways: cognitive level, when the
difficulty appears at the moment to think conscious about one thing and argue about a

situation and, on the other hand, behaviour level, appears when there is incapacity to
avoid behaviour or a verbal answer (Fundacin ADANA, 2009).
It

is

evident

that

difficulties

to

maintain

attention/concentration

and

hyperactivity/impulsiveness are the most common problems, for these reasons and for
these three symptoms called before; there are established three different types or
subtypes of ADHD:
Inattentiveness and hyperactivity mainly inattentiveness (AD) (First, 2009): It is
difficult for the child to organize or to finish their tasks, to pay attention to some details,
or to follow some instructions or a speech. The affected person is constantly and easily
distracted or does not remember some details of everyday.
Inattentiveness and hyperactivity mainly hyperactivity/impulsivity (HD) (First,
2009): The child is restless and speaks little; to be quiet is difficult for him or her when
he is eating or doing homework; the infant is impatient and has some impulsivity
problems. He or she interrupts the others, speaks in inappropriate moments and is
difficult to wait for his or her turn. They can have more accidents, incidents and injuries.
Inattentiveness and hyperactivity in combination (ADHD): The affected person
experiments the symptoms of both types before called in equal mode.

Informative data
It is should also be noted that ADHD presents differently depending on a childs age,
maturity and as the environment requirements for sustained self-control change. During
school years a child may make excessive movements during situations when they are
expected to be calm (Fundacin ADANA, 2009). During the adolescence hyperactivity
may present as excessive fidgetiness rather than whole body movement. Often
inattention diminishes and attention span usually increases with age (Taylor & SonugaBarke, 2008).

How is it diagnosed and treated?

ADHD sometimes is easy to identify because differs from the normal spectrum because
there are high levels of inattention or hyperactivity/impulsivity (NICE, 2013).
The symptoms of this disorder are often detected by parents of children with ADHD
because often they do not know what to do with their children because their behaviour
is not at all correct. Also, the symptoms are usually detected in the school, although in
some cases they have been diagnosed in younger ages. The teachers realize that some
pupils do not follow the rhythm of the other peers.
The diagnostic can be given by medical professionals (paediatrician, psychology or
psychiatrist) (Mena , Nicolau, Salat, Tort, & Romero, 2006). It is important to know the
diagnostic criteria in DSM-IV or ICD-10 (hyperkinetic disorder) (NICE, 2013).
An appropriate intervention to a pupil with ADHD it is important to keep in mind 2
basic aspects: to have clears the symptoms of this disorder and the effect of these
symptoms to the personal equilibrium, the social relations and the academic
performance (Primria & Batxillerat, 2013).
The treatment has to be established from a holistic perspective and trying to follow
these aims:
-

Optimize the steps and the educative context.

Avoid the emotional and behavioural impairment for the difficulties that ADHD

generates.
To give some positive strategies to the child to confront the adversities, develop
compensation strategies, accepted him or herself and enhance his or her

qualities.
Avoid the secondary pathologies such as oppositional defiant disorder or
dissocial disorder (Primria & Batxillerat, 2013).

The best treatment for his effective results until nowadays has been evaluated in a
controlled study and has been called Multidisciplinary treatment/Multimodal
Treatment of Children with ADHD to look for solutions for the problem. It is a
combination of treatment between parents (family), teachers (school), psychologist
(professionals). It has to include:
-Information to the child or young boy, family and teachers.

-Pedagogical support inside the school.

-Psychological treatment (individual or familiar).
-Pharmacologic treatment (if it is necessary for his or her symptoms) (Primria
& Batxillerat, 2013). The use of pharmacological treatment for ADHD is effective in a
very high proportion of affected at any age. However, when it is administrated before to
appear second disorder problems, the effectiveness is significantly improved.
Effectiveness

educational

treatment

when

combined

with

drug

treatment

is much higher. The two drugs more common used for ADHD are the methylphenidate
and the atomoxetine. The first one is the first-line drug in used in ADHD. This is a
stimulant and it produces an increased level of neurotransmitters, especially dopamine.
The other one acts mainly on the noradrenalines neurotransmitters. It is common to
administrate it once per day and his action persists for a long time, some hours. It is
useful to children that present many problems in the early and late hours of the day
(Hospital Sant Joan de Du, 2010).

Results or findings
In the previous section the meaning of ADHD with their types, main characteristics and
the historical review; an overview of children with ADHD has been presented. From
here, this paper will present the main findings regarding the social relations with the
other people, especially in class, with their schoolmates and teacher and how the
teachers manage to improve the educational live of these pupils.
Behaviour and learning problems are not exclusive of ADHD, because all people have
them but have lesser level, and for this reason when the specialist have to diagnose a
child with ADHD, he or she has to be sure that the infants behaviour and his or her
level are much lower than the rest of the mates of the class; it has to be a significant
difference (Mena , Nicolau, Salat, Tort, & Romero, 2006).

Aspects related with the academic live of children with

ADHD:
Children with ADHD and with the same intellectual capacity that other mates, they have
more probability to fail in the school because they have more difficulties to keep

concentration. To follow the lessons and the indications that teacher gives is necessary
to have concentration during a long period of time in the same activity, although more
often there are stimulus that cause distractions (Mena , Nicolau, Salat, Tort, & Romero,
2006).
To have a good behaviour and efficiency in schools tasks by children is required by the
teacher control processes, establish some priorities with the child and to know how to
organize their time together. If children feel confidents with an appropriate level of selfefficacy and self-esteem to do a task, they are more predisposed to do another one and
they get personal motivation. The next time that they are going to do a task, they are
going to work harder and with high level of persistence and they will get better yields
(Fundacin ADANA, 2009).
The main goal of a child with ADHD is to be responsible for his or her behaviour, to get
educative level and to become a contributing person in the society. As Bonet and other
authors in 2007 said, the school is the place where is important to keep in mind in our
society because children spend there a lot of hours learning and trying to acquire
knowledge, and it is the institution where the adults (teachers, professionals, parents)
have to implicate on their lives with resources to improve them. For these reasons it is
important to help and support the adults that are working with these children.
[] in the school sphere is where less help, orientations, publications, programs, etc.
exists and, however, it is the place where there are more difficulties of ADHD, where the
pupil needs more self-control, to follow-up rules, relations with peers and, above all, to
pay needed sustained attention to learn. There are many bibliography and
documentation to parents, to those children, specific programs of individual
psychological and pedagogical treatment. Also, it has been progress in understanding
the neurological and pharmacological treatment. [] . However, we understand that
there is just the teacher support and teacher that day and hour after hour is working
with the child in the classroom, and the rest of the class at a time. It is clear to all
professionals who work with this disorder; only intervening in an interdisciplinary way
is how you can get consistent changes. This is a team effort where everyone has their
place of intervention, with specific objectives and not just a mere coordination, which in
itself would already be very important".

TRINIDAD BONET, YOLANDA SORIANO y CRISTINA SOLANO. Aprendiendo

con los Nios Hiperactivos. Un reto educativo. Thomson editores. Madrid 2007

ADHD in class
-

What happens when a child with ADHD arrives at school with their
characteristics and symptoms?

It is important that teachers and the professionals that work in the school have
knowledge about ADHD and how to act with the pupils inside the classroom (Mena ,
Nicolau, Salat, Tort, & Romero, 2006). However, sometimes there are teachers not good
qualified to do and manage this task with these children. Many teachers do not have
clear the idea of ADHD because they are old teachers and their knowledge is based in
many years ago (traditional perspective of education); for these reasons, nowadays,
these kind of teachers unknown the strategies to use in class with children with more
needs (Brodin J. , 2012).
For this reason, the schools should have some guidelines to guide teachers in case to
find a child with ADHD in class such as (Martin, 2010):

Give clear and concise instructions: the rules must be clearly stated and if it is
possible, graphically and visually. In younger children work well with a paper
called self- instructions time and work to do. In older children work well with

contracts.
Be sure that they understand the tasks without making them feel different from

the rest of the class.

Give them a physical space or time to move: make him run errands outside of

the classroom.
No change inappropriate behaviour all at once, it would be better to agree with
him three goals that the teacher wants to achieve during the classroom and

ignore other behaviours.

Physical contact is important: a soft touch on the shoulder when he or she is

"turned off "or be nervous can be enough.

The experimental and manipulator methodology will be better than theory.
It is preferable to use prizes before punishment.

Avoid situations that the child cannot control : wait a long time in the queue, let

him participate in class ...

It is better to disregard inappropriate behaviours and strengthen opposite.
They must be aware of its limitations: the pace of education of these children is
different.

Another important aspect to control their behaviour is establish some good rules or
limits. Generally children or youth have an excessive list of NO (not run, not
shout). Therefore, it is necessary to make rules and limits in a positive way (walk
slowly, speak softly).

School inclusive education

During the last decades one of the most important goals by professionals, family and
institutions has been to ensure a quality education to pupils. So, to have a good quality
in the education of children it is important to focus on the current about inclusive
education.
An inclusive school or an inclusive class are words called where in a concrete place can
learn different pupils from different backgrounds, believes and cognitive level too
(Pujols i Maset, 2006).
In an inclusive center, the pupil with Special needs to go to the normal class where the
other mates of the same age follow the lessons. Perhaps, the child sometimes needs a
support teacher to help him in some tasks with some adapted tasks to the curriculum.
However, the pupil with special needs often follows some lessons in other classes
during a short part of time.
It is important by the teacher to give participation to the child, the diversity is crucial
and natural; implicate him on the centers activities and all the tasks lived inside the
ordinary class (Konza, 2008).
These thoughts are defensed also in two articles in the UNCRC. According to the
articles 23 and 28 about children with disabilities and the right to education respectively,
in the United Nations Convention on the Rights of the Child, 1989 (UN., 1989):

Article 23: If you have a disability, you should receive special care and support so that
you can live a full and independent life.
Article 28: You have a right to an education. Discipline in schools should respect
childrens human dignity. Primary education should be free.

Classroom organization
This refers to create a favourable environment. This comfortable context is organized so
that pupils are stimulated and to reduce the symptoms that impede the learning and
adaptation process (Primria & Batxillerat, 2013).
The child with ADHD gives the better of him or herself when he or she works in a quite
atmosphere with a teacher. In choosing a class, the most important is to reduce the
distractions to a minimum.
The best place to these children inside the class is to sit them in the first tables in front
of the teacher that gives them confidence and help and in the same time in front of the
white or blackboard to look better what the teachers writes on it. Also, if the teacher has
close to him the pupil with ADHD is easier to control their tasks and to maintain a
visual contact. Thus, if the teacher realizes that the child does not pay attention, he or
she can make a signal to return the concentration to the child quickly. Also, the teacher
has to ensure the students timetable or schedule is easily accessible to them in an
understandable form and also making organizational structures, rules and routines
simple and easy to follow and recall too.The classroom should have a good lighting. It
is preferably to sit these children between two calm classmates, they could be their
guides. Always sit them with pupils, avoiding the exclusion of children with ADHD.
However, the teacher has to avoid organizing the tables gathering them as a square,
because they have to pay attention to teacher and not to other mates. Further, it is
important to sit the children far away from the window and from the other possible
distractions such as murals on the wall, the door, colourful posters or toys. (Mena ,
Nicolau, Salat, Tort, & Romero, 2006).

Methods

Child with ADHD used to have problems in the school; their symptoms make hard that
these children are calm in class, without annoying the other mates and they are able to
finish their tasks correctly and on time (E. Brock, 2002).
However, the teacher can help them with his or her effective practice. The role of the
teacher is to minimize the childs weakness and to maximize their strengths.
First of all it is important that teacher knows what is the behavior that child with ADHD
has to improve or what the disruptive behavior is. Also, it is important to know the
frequency and the intensity of that behavior and where, with who and when it appear.
Also, there are some strategies to decrease certain behaviors before to modify them
because it is necessary to spend more time to do it.
In this section we can find the most common behavioral techniques and cognitivebehavioral intervention approaches for addressing the treatment of attention deficit
disorder with hyperactivity (ADHD) in the school context.

Behavior therapy techniques:

One of the longest established procedures and demonstrated greater persistence with
their short-term positive results is the use of behavior modification techniques. Behavior
modification is especially recommended for students in kindergarten and primary
education, since students at this age have not yet acquired sufficient cognitive
development to implement self-regulation techniques, but need external help or
guidance (teacher), to remind them what the right behaviors in school are. These
techniques are used when the teacher wants to reinforce, modify or increase behaviors:
praise, positive reinforcement, token economy, extinction, time-out and response-cost.

Positive reinforcement: the role of the teacher consists on to praise, reinforce or

reward children with ADHD after a good behavior. The consequence of the
positive reinforcement is children are more motivated to maintain a good
behavior and to increase the frequency to do it well (Mena , Nicolau, Salat, Tort,
& Romero, 2006).

The object that teacher gives to child as a reward in front of their good behavior
is called positive reinforcement.
There are four steps that teacher has to follow:
-Identify the behavior that he or she wants to reinforce.
-Plan which type of reinforce he or she wants to use.
-Reinforce immediately and continuously.
-Observe the childs success in relation to the desired behavior.
Depending on the factors such as the age of the child, their interests or the
moment, the teacher can give different reinforcements:
-Social reinforce: Attention by the teacher, mates and professionals
working in the school.
-Verbal reinforcement: Praise the child and tell him specifically what is
thing he or she did well.
-Contact reinforcement: touch his shoulder, make him a hug
-Prize reinforcement: award the child with a break to let him rest a little
bit or to use another method called Token economy.

Token economy: As Barkley 1990 said the main goal of this technique is to
encourage and motivate the child with ADHD to learn and to foment positive
behaviors (Mena , Nicolau, Salat, Tort, & Romero, 2006). This method was
formalized by T. Ayllon y N.H.Azrin in the decade of the 70s. The token
economy system consists on to establish some rules based on goals that teacher
wants to improve on his or her pupils. The result will be to achieve the goals
established (good student behavior in some specific tasks) and also, the pupil get
a desired and agreed prize. It is called token economy because the child
before to get a prize, he or she has to collect a number of points or token that are
marked on a paper. The role of the teacher is to give to the child some cards or
points when he or she does things rights (Reiber & McLaughlin, 2004). The
prize can change in function of the interests of the child. For example, the pupil
with ADHD sometime wants to choose sweets as the prize.

The teacher has to keep in mind that their pupil with ADHD has clear the rules
of this system and also, the teacher has to focus on just two or three simple goals
to achieve, not more in the same time (Bans, 2012) Also, it helps them to
increase his or her self-esteem.

Extinction process: As the Hospital Sant Joan de Du in 2012 said that this
method is used to know what the origin of the behavior is to decrease it,
avoiding their repetition. This method consists on focus on a behavior of the
child with ADHD to decrease and modify it. To do that, the teacher should not
pay attention to the bad behavior that the pupil is doing (not look, not listen to
him), so, acting as in a normal context. For example, if the child with ADHD
raises his hand to ask teacher some questions without any reason, the teacher can
propose if he or she is able to ask just 10 times during a day. The other times the
child will not be attended (Mena , Nicolau, Salat, Tort, & Romero, 2006). The
teacher will try to teach and transmit the pupil that only the important doubts
have to be asked. After that, the teacher can decrease the times to raise the hand
it be required. When the child knows how to use his behavior, the teacher should
congratulate him.

The punishment: As Kazdin said in 1971, the punishment should be to remove

the positive reinforcements. It is important to avoid the punishments because is
better that teacher reduces the positive reinforcements before to punish the child
with ADHD (Mena , Nicolau, Salat, Tort, & Romero, 2006). The punishment
can become by the pupil to hate the class, the teacher or the other mates and
also, because a punishment involves emotional instability in the future (MD,
2002). The teacher can use the Token economy System or the next strategies
(time-out or response-cost programs) as a punishment to improve the behavior
of the child.

Time-out: This methodology consists on isolate the child during a concrete and
short time into a place without distractions. It is important to choose a good

place to remove the child (in another class, in a corner of the same class)
(Mena , Nicolau, Salat, Tort, & Romero, 2006). This technique is used when the
pupil with ADHD has a bad behavior about a specific task or because the child
was aggressive with the objects of the class or with the other mates (E. Brock,
2002). Once the time-out is finished, the teacher gives the instruction to the
pupil to continue following the lesson. Perhaps, the teacher needs to talk about
what happened, and, for this reason, the kid and the teacher can talk about the
disruptive behavior.

Response-cost Programs: It happens when there are disruptive behaviors in

class. That bad behavior has consequences in class. There were some activities
given to pupil as a positive reinforcement when his or her behavior was correct.
So, when the child with ADHD does not want to follow correctly the goals
established, those positive reinforcements or prizes that teacher gave, now the
teacher gives less of them (E. Brock, 2002)

Another kind of method is the turtle technique. The aim of this method is to teach the
child with ADHD to control their emotions through relaxing processes to solving their
problems (internal control of behavior).

Turtle technique

The turtle technique is a method designed by Schneider in 1974 to self-control the

impulsive behavior in class. It was written in a manual called Turtle Manual. As
everyone knows the turtle is an animal that can keep her head inside her shell and for
this reason, and in the same way, the teacher teaches the pupil to fall within the
imaginary shell when he feels threatened because he or she cannot control their
impulses and emotions in front of environmental stimulus
The turtle method is described through a story. There was a young turtle that hated to go
to the school because sometimes their mates insult her. One day this turtle found an old
turtle that told her a secret; when she was angry with someone, she had to keep her
heard inside her shall. The young turtle trusted the old turtle and all the times that she

had a problem kept her head inside her shall. In this mode she can be relaxed and
without problems, ignoring them.
For carrying out this kind of method is important to follow two phases:
1. Tension and release: the child should close their hands, stretch their arms and
legs, tightening the lips, close the eyes
2. Relaxation: this phase consists on to be relaxed with no body tension. The
teacher gives the instructions with his soft voice.
This technique can help children to learn to express feelings. When the impulsive child
with TDAH hits wherever he or she wants, he or she can express feelings but in a
negative way, so, the consequences will be negatives. With the Turtle technique the
teacher tries to lead the feelings of children so that they have good behavior.
When the child uses this technique in class, the teacher has to reward him with positive
reinforcements or with prizes, because if the teacher does not do it, the pupil maybe
does not follow the practice of this technique (Schneider & Robin, 1974).

Which method is best to carry it out in a classroom and why?

It is impossible to choose just one method, because to get the perfect integration of the
child is necessary to gather all of them and act with one of with another depending of
the circumstances, the context and the characteristics that the child with ADHD
presents. So, the best way is to combine them.
If the teacher cannot follow the technique is better does not use it. The positive
reinforcement technique is one of the most used by teachers because it increases the
probability to get a good behavior. The fact to get a prize motivates the child to work
with a positive dynamic and with a better self-esteem.
The extinction technique is very effective to decrease disruptive behaviors. It is sometimes
related with positive reinforcements.
Also, the response-cost program is good to decrease disruptive behaviors. It consists on to
delete or to remove a privilege and in this mode the child tries to maintain a good behavior to
get a prize. Response cost interventions have been shown to be effective in reducing task-

behavior and increasing work completion. The teacher must guard against becoming overly
critical by overemphasizing an inappropriate behavior.
On the other hand, time-out is useful to correct challenging behaviors of child with ADHD. This
technique has to be carried out immediately after the inappropriate behavior. The child should
go to another part of the classroom to think and to have a time to reinforce him or herself.

Time-out is an effective strategy for ADHD kids if it's used judiciously," said George
Lynn, author of Survival Strategies for Parenting Your ADD Child. Other authors such
as Judy Arnall said that time-out can promote rebellion, retaliation and getting even
behaviors from the child (Arnall, 2009).
The three last techniques described before should be the punishments methodology.
The Therapeutic Assistance Center of Barcelona (2008) described that the systematic
punishment with children with ADHD is ineffective and harmful to children with
ADHD because these children have academic difficulties in general caused for their
disorder and for this reason they cannot be punished. As Kazdin (1971) said it is better
if the punishment is changed to positive reinforcements.
Token economy program is one of the most important and powerful behavioral
interventions for improving school behavior. This was described by two authors in the
70s, Ayllon and Azrin. Further, token method allows to incentive and to participate the
child with ADHD in class and to give him positive reinforcements and other behavior
strategies. In addition, token programs have some advantages such as providing
immediate rewards and to use some behavior strategies in the same time. Moreover, a
limitation could be that the teacher needs to know how to apply the method because
sometimes it is difficult to use in class.
Finally, the Turtle method is a good technique to relax and to channel the behavior of
children with ADHD. Schenider 1974 argued that it was the best strategy to solve the
problems, but sometimes there are some limitations related with the context. To carry
out this method is important to have good feelings with the class (teacher and mates).
Also, the teacher should continue this technique during a long period of time because
maybe can appear some new problems. We must pay special interest in the turtle child
because if the teacher forgets this technique, we will ensure that the child will have
problems again.

Conclusions
Once read and analyzed a lot of articles, chapters of books and some documents in
general from many authors and associations, personally I can say that ADHD is a
common diagnostic in childhood and lasting into adulthood. It is difficult to attribute a
specific cause about the origin of this disorder, because there are a lot of factors that
involves it, although, as many researches explain, the most important cause is from
genetic/biological factors.
To act from the school it is much important the multidisciplinary intervention of the
family, school and other professionals to improve and help the lives of these children.
So, as a future teacher I think that our society has to try to help the pupils with ADHD
and involve us on the integral development of these kids. It is important the role of the
teacher, but further, it is clear that the effort must be set by all the people that live
around children with ADHD.
In this project I have tried to introduce the ADHD disorder explaining a brief about the
historical evolution. Also, I have looked for the causes, symptoms and types of ADHD
before to focus my paper on the methods that the teacher uses to integrate these pupils
in the normal class with the other mates.
So, I think that it is important to:
-

Integrate the child in all contexts that society concerns us.

Implicate the child in their own personal objectives to get on, according with his

or her level, age, schooling, family

Create routines and habits following the schedule.
Avoid the stimulus that causes distraction.
Observe the child and follow different methods according to the task, moment
and preference of him or her.

Also, the ADHD in the educational context involves primarily a functional impairment
in the student's life suffering from the disorder to academic, social and recreational
level. Further, the interventions must be adapted and customized according to the
individual needs and characteristics of each child and for this reason the teacher has to
select the best method of behavior in each moment or context.

In the same way, the positive reinforcement is a good technique to modify the behavior
of children with ADHD. It is important that teacher and pupil establish the goals to
achieve before to act because the child will have more clearly what he or she has to do
to get a prize.
The token economy is another method that can involves some techniques such as
positive reinforcement. This strategy gives motivation to child and allows him to
participate in class.
We must be present the idea that if the teacher promises a reward, he has to fulfill the
deal. Moreover, the punishment should be prohibited because the child with ADHD
feels that he or she cannot do the tasks like the other mates and they are punished and
they become frustrated and angry, for these reasons, it is better decrease reinforcements
before to punish.
Another important method is the Turtle technique that tries to help children to relax and
to keep the concentration with a good behavior.
Finally, to help these children we have to spend time with them and act like a guide
because I think that for them, we are a model to follow. For this reason, the teacher must
be consistent, flexible and dynamic with his work. With some patience and dedication
from everybody around children with ADHD and from the own children, they are able
to achieve their challenges and to acquire an adequate academic level like the other
mates.
To conclude the conclusion is crucial to talk about the limitations of the thesis. The
ADHD is a disorder and sometimes it is difficult to research about it because there are a
lot of authors and articles talking about different concepts. Also, the English language is
not my first language and to look for some documents when I was collecting data
became difficult and hard, however, I think that I have improved a lot during my
Erasmus program.
Another limitation was the fact to have limited time to carry out the project. I had never
done a project of this magnitude in English language.
Finally, I think that was difficult to search and find the methods and to try to analyze
them. There are many and different strategies that authors prefer to develop in class with

children with ADHD and it is complicated to know what is better to use because it
depends of the child, the context and the moment.

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