TABLE OF CONTENTS
LIST OF TABLES xi
LIST OF FIGURES xii
LIST OF ACRONYMS xiii
LIST OF APPENDICES xiv
1Chapter 1 Orientation 1
1.1Background 1
1.2Analysis of problem 2
1.2.1Awareness of the problem 2
1.2.2Investigation of the problem 3
1.2.3Problem statement 8
1.3Aims of research 9
1.3.1General aim 9
1.3.2Specific aim 10
1.4Research design 10
1.4.1Research problem and aims 10
1.4.2Formulation of hypotheses 11
1.4.3Research setting, paradigm and method 11
1.4.4Data collection and sampling 12
1.4.5Revised Conners’ Teacher Rating Scale 12
1.4.6Validity and reliability 13
1.4.7Ethical considerations 13
1.4.8Analysis of data 13
1.5Significance of the study 13
1.6Demarcation of the research 14
1.7Clarification of the concepts 14
1.7.1Attention Deficit Hyperactivity Disorder (ADHD) 14
1.7.2Behaviour management strategies 15
1.7.3Contingency Management (CM) 15
1.7.4ADD-H Comprehensive Teacher Rating Scale – 2nd Ed (ACTeRS-2) Profile 15
1.8Research programme 16
1.9Summary 16
2Chapter 2 Overview: ADHD learners’ behaviour, consequences and management thereof, in the classroom 18
2.1Introduction 18
2.2The nature of ADHD 18
2.3The behaviour of learners with ADHD in the classroom and its observed impact 22
2.4Behaviour management strategies 26
2.4.1Behavioural interventions 28
2.4.1.1Contingency Management (CM) 28
2.4.1.2Token economies 30
2.4.2Cognitive-behavioural modifications 31
2.4.3Educational (academic) interventions 33
2.5Programme of behaviour management strategies (compiled for this study) 36
2.5.1Introduction 36
2.5.2Behavioural interventions 36
2.5.2.1Do’s: 37
2.5.2.2Don’ts: 37
2.5.3Cognitive interventions 37
2.5.3.1Do’s: 38
2.5.3.2Don’ts: 38
2.5.4Educational interventions 38
2.5.4.1Do’s: 39
2.5.4.2Don’ts: 39
2.5.5Instructional modification 39
2.5.5.1Do’s: 39
2.5.5.2Don’ts: 40
2.6Conclusion 40
3Chapter 3 Research design 41
3.1Introduction 41
3.2Research problem, aims and rationale of the empirical research 41
3.3Hypotheses 42
3.3.1Hypothesis 1 42
3.3.2Hypothesis 2 42
3.3.3Hypothesis 3 43
3.3.4Hypothesis 4 43
3.4Research setting, research paradigm and research method 44
3.4.1Research setting 44
3.4.2Research paradigm 44
3.4.3Research method 46
3.5Data collection and sampling 47
3.5.1Selection of teacher 47
3.5.2Selection of learners with ADHD 48
3.5.3Revised Conners’ Teacher Rating Scale (CTRS-R) 48
3.5.4Intervention 49
3.6Validity and reliability 49
3.7Ethical considerations 49
3.7.1Harm to experimental subjects and/or respondents 50
3.7.2Informed consent 50
3.7.3Deception of subjects/respondents 51
3.7.4Violation of privacy/respecting the privacy of research participants 51
3.7.5Actions and competence of researchers 52
3.7.6Release or publication of findings 52
3.7.7Restoration of subjects or respondents 53
3.8Analysis of the data 53
3.9Conclusion 54
4Chapter 4 Results and discussion of results 55
4.1Introduction 55
4.2Research problem and hypotheses 55
4.3Analysis of raw scores 56
4.3.1Baseline scores 56
4.3.2Test scores obtained before the intervention was applied 56
4.3.2.1Pre-test scores for attention 59
4.3.2.2Pre-test scores for hyperactivity 59
4.3.2.3Pre-test scores for social skills 60
4.3.2.4Pre-test scores for opposition 60
4.3.3Test scores obtained after the intervention was applied 61
4.3.3.1Post-test scores for attention 63
4.3.3.2Post-test scores for hyperactivity 63
4.3.3.3Post-test scores for social skills 64
4.3.3.4Post-test scores for opposition 64
4.3.4Comparison of raw data of pre- and post-tests 65
4.3.4.1Analysis of pre-test to post-test change in scores 68
4.3.4.1.1Changes in attention 70
4.3.4.1.2Changes in hyperactivity 70
4.3.4.1.3Changes in social skills 71
4.3.4.1.4Changes in opposition 72
4.4Statistical significance of changes in pre- and post-test scores 72
4.4.1Normality of distribution 73
4.4.1.1Attention 74
4.4.1.2Hyperactivity 75
4.4.1.3Social skills 76
4.4.1.4Opposition 77
4.4.1.5Summary of normality of distribution 78
4.4.2Statistical significance of change 79
4.4.2.1Statistical significance of change in attention scores 79
4.4.2.1.1Testing of hypothesis 1 79
4.4.2.2Statistical significance of change in hyperactivity scores 80
4.4.2.2.1Testing of hypothesis 2 80
4.4.2.3Statistical significance of change in social skills scores 81
4.4.2.3.1Testing of hypothesis 3 82
4.4.2.4Statistical significance of change in opposition scores 83
4.4.2.4.1Testing of hypothesis 4 83
4.5Summary of statistical significance of change in behaviour of learners with ADHD 84
4.6Assessment of the reliability of the CTRS-R as the instrument of measure 85
4.6.1Attention 85
4.6.2Hyperactivity 86
4.6.3Social skills 87
4.6.4Opposition 88
4.7Summary of Cronbach alpha test results 89
4.8Results and discussion of results 90
4.8.1Changes in scores 90
4.8.1.1Attention 91
4.8.1.2Hyperactivity 92
4.8.1.3Social skills 93
4.8.1.4Opposition 94
4.9Summary 95
5Chapter 5 Conclusions and recommendations 96
5.1Introduction 96
5.2Summary of the findings of the literature study 96
5.2.1The nature of ADHD 96
5.2.2The impact of the behaviour of learners with ADHD in the classroom 97
5.2.3Behaviour management strategies 98
5.2.4Programme of behaviour management strategies 99
5.3Summary of the findings of the empirical study 100
5.3.1Research problem and hypotheses 100
5.3.2Data collection 101
5.3.3Statistical techniques 101
5.3.4Results 101
5.4Conclusion 102
5.5Recommendations 104
5.6Limitations of the study 104
5.7Summary 105
5.8A final word 105
6Bibliography 107
7Appendices 119
7.1Appendix 1 – An example of the Consent Form as signed by each learner and his parent granting permission for participation 119
7.2Appendix 2 – An explanation of the behaviour management strategies given to the learners 120
7.3Appendix 3 – Behaviour management strategies as outlined to the selected teacher 121
7.4Appendix 4 – Statistical Consulting Services 122
7.5Appendix 5 – Editing Services 123
LIST OF TABLES
Table 4.1 Pre-test raw scores 58
Table 4.2 Post-test raw scores 62
Table 4.3 Pre- and post-test raw scores 67
Table 4.4 Pre- to post-test change in scores 69
Table 4.5 Shapiro-Wilk test results for changes in attention 75
Table 4.6 Shapiro-Wilk test results for changes in hyperactivity 76
Table 4.7 Shapiro-Wilk test results for changes in social skills 77
Table 4.8 Shapiro-Wilk test results for changes in opposition 78
Table 4.9 Summary of test results for pre- to post-test changes 79
Table 4.10 Wilcoxon Sign-Rank calculations for changes in attention 80
Table 4.11 Wilcoxon Sign-Rank calculations for changes in hyperactivity 81
Table 4.12 Statistical t-test for changes in social skills 82 Table 4.13 Wilcoxon Sign-Rank calculations for changes in social skills 83
Table 4.14 Wilcoxon Sign-Rank calculations for changes in opposition 83
Table 4.15 Summary of statistical significance of pre- to post-test changes in scores 84
Table 4.16 Interpretation of Cronbach alpha values 85
Table 4.17 Multivariate correlations for attention 85
Table 4.18 Cronbach alphas for attention question set 86
Table 4.19 Multivariate correlations for hyperactivity 86
Table 4.20 Cronbach alphas for hyperactivity question set 87
Table 4.21 Multivariate correlations for social skills 87
Table 4.22 Cronbach alphas for social skills question set 88
Table 4.23 Multivariate correlations for opposition 88
Table 4.24 Cronbach alphas for opposition question set 89
Table 4.25 Summary of Cronbach alpha test results 90
LIST OF FIGURES
Figure 4.1 Histogram of pre- and post-test scores in attention 65
Figure 4.2 Histogram of pre- and post-test scores in hyperactivity 66
Figure 4.3 Histogram of pre- and post-test scores in social skills 66
Figure 4.4 Histogram of pre- and post-test scores in opposition 66
Figure 4.5 Histogram for distribution of change in attention 75
Figure 4.6 Histogram for distribution of change in hyperactivity 76
Figure 4.7 Histogram for distribution of change in social skills 77
Figure 4.8 Histogram for distribution of change in opposition 78
Figure 4.9 Matched pairs for social skills 81
LIST OF ACRONYMS
ADHD Attention Deficit Hyperactivity Disorder
CM Contingency Management
ACTeRS-2 ADD-H Comprehensive Teacher Rating Scale – 2nd Edition
DSM-IV-TR Diagnostic and Statistical Manual of Mental Disorders 4th Ed
Text Revised
CTRS-R Revised Conners’ Teacher Rating Scale
LIST OF APPENDICES
Appendix 1 An example of the Consent Form signed by each learner and his parent.
Appendix 2 Behaviour management strategies given to the learners.
Appendix 3 Behaviour management strategies as outlined to the selected teacher
Appendix 4 Statistical Consulting Services
Appendix 5 Editing Services
1 Chapter 1 Orientation
1.1 Background
Attention Deficit Hyperactivity Disorder or ADHD as it is commonly known is a neurological condition affecting children, adolescents and adults. The brain circuitry’s failure to develop results in reduced monitoring of inhibition and self-control (US Department of Education 2003:1).
Focusing on the identification and treatment of Attention Deficit Hyperactivity Disorder, the most distinctive characteristics are seen as the deficits in both inhibitory control and behavioural inhibition. Learners with ADHD commonly display poor sustained attention and/or hyperactivity-impulsiveness. The resulting behaviour often appears to be purposeful non-compliance whereas it can be a manifestation of the disorder, which requires specific interventions.
The US Department of Education (2003:1) further unpacks Attention Deficit and Hyperactivity Disorder, explaining that learners with ADHD displaying hyperactivity will show excessive motor activity such as fidgeting and jumping out of their seats. Inattention displayed by learners with ADHD is reflected in their failure to attend to detail, their misplacing of items and their inability to sustain attention for the duration of a task. Impulsivity displayed by learners with ADHD includes the inability to regulate their behaviour resulting in their moving from task to task without completion of any one task and not waiting their turn in the answering of questions. These behaviours must be prevalent in two locations such as home and school, and be age-inappropriate, to warrant a diagnosis of ADHD (Ek, Fernell, Westerlund, Holmberg, Olsson & Gillberg 2007:756).
Learners’ ADHD symptoms can be detrimental to their academic performance and impact upon the other children in the classroom (Junod, DuPaul, Jitendra, Volpe & Cleary 2006:88; Moonsamy, Jordaan & Greenop 2009:326). Their productivity in class can be impaired in terms of the amount of work they manage to complete as well as the accuracy of that work (US Department of Education 2003:15). The fact that, to date, no permanent cure for ADHD has been discovered or implemented does not, however, mean that there are no effective treatment options available. According to Abramowitz and O’Leary (1991:229), behaviour strategies, medication and indeed multimodal methods are frequently inspanned to treat this disorder. For the purpose of this study, behaviour management strategies and their effects on learners in a classroom situation are to be investigated. Behaviour management approaches focus on the modification of both the physical and social environment, in order to change a learner’s behaviour.
1.2 Analysis of problem
Analysing the problem begins with a growing awareness thereof. To explore the problem, a preliminary literature study will be done, culminating in the formulation of the problem statement, and research question.
1.2.1 Awareness of the problem
As school counsellor, I have many referrals of learners, every week, by staff complaining of the following:
• Learners’ disruptive ways,
• Learners’ inattention
• Learners’ negative impact upon other members of the class.
Often, a poor academic record is also cited. Most of the learners being referred for counselling are found to be those already diagnosed as having ADHD, and who are often taking prescribed medication for the disorder each day. This behaviour leads to impatience, frustration and even anger in staff members who at times feel that they are making no progress academically, with learners exhibiting ADHD-type symptoms in a classroom situation.
When I contact the parents of these learners, they are usually aware of the poor academic performance and also often experience similar feelings towards their children, as those experienced by staff – particularly as regards homework. Thus, the main role players in the learner’s environment appear to share the frustration of handling the learner and are aware of the problems associated with academic learning.
As the number of cases being referred to me has remained consistently high over the past three years, research into the problem raised the possibility of utilising special management techniques on learners with ADHD, operating in a classroom environment. This study will entail establishing certain behaviour management techniques as practical strategies, to be utilised by the selected teacher on learners with ADHD in the classroom.
Resulting from this, the following questions arise:
• Which behaviour management strategies are found to be effective?
• What aspects of the classroom situation do they improve eg academics or adaptation to norms within the classroom?
• Are teachers able to sustainably harness behaviour management strategies in a classroom setting?
1.2.2 Investigation of the problem
The literature study will allow the exploration of the questions posed above. By focussing on behaviour management strategies – how they are implemented and what results have been shown to date – a clearer picture will emerge regarding their efficacy.
Firstly, an accepted premise of this study is that learners with ADHD are indeed posing a problem in a classroom setting. This belief is upheld by Pelham, Wheeler and Chronis (1998:190) “ADHD children and adolescents have serious impairments in many domains of functioning, including academic achievement and deportment in school…” More recently, Webb and Myrick (2003:108) describe the ADHD learner as problematic in a school situation, where there is a need for them to remain focussed and in-seat as a result of classroom rules and academic tasks. Moonsamy et al. (2009:326) refer to the poor academic performance of learners with ADHD, citing cognitive processing deficits as a cause. Most recently, Erchul, DuPaul, Bennett, Grissom, Jitendra, Tresco, Volpe, Junod, Flammer-Riviera and Mannella (2009:29) have conducted extensive research based on documented evidence that learners with ADHD experience considerable difficulties that have vital educational implications. Based on this evidence, learners with ADHD can be seen to be struggling in multiple areas in the classroom setting.
Those suffering from ADHD battle with distractibility and impulsivity which can result in extremely disruptive behaviour in the two settings in which they spend most of their lives – at home and in the classroom. Gordon and Asher (1994:79) found that parents and teachers agree that this can impact negatively on family members and peers. Some problems are typically experienced in the classroom situation for learners with ADHD, where certain behaviours often contrast sharply with what is expected and acceptable within classroom parameters.
Loe and Feldman (2007:647) have noted that given the significant impact of ADHD on academic and educational performance, treatment plans should be developed in consultation with teachers and other educational staff. Similarly, Junod et al. (2006:88) have stated that attention and behavioural difficulties are known to seriously impair scholastic functioning among learners with ADHD. For these learners, academic success is unlikely. Research by Vanoverbeke, Annemans, Ingham and Adriaenssen (2003:79) suggests that the use of medication is usually the first treatment option, but it is often followed by a switch to behavioural therapy or, at least, combined treatment. Concannon and Tang (2005:625) assert that behavioural intervention has been under-utilised despite its documented positive role.
It is possible that many school problems experienced by learners with ADHD do not result solely from the biological factors underlying the disorder, but from a mismatch between the child and his environment. Pellegrini and Horvat (1995:15) have researched this ‘fit’ or lack thereof and have suggested that success or failure in the classroom setting depends largely on how well within-child variables interact with environmental variables.
Rather than assuming that the child is the problem and keeping in mind the fact that within-child variables are difficult to change, intervention programmes can alter environmental variables, attempting to meet individual learning needs. Evaluating the effects of behaviour management strategies could lead to the extension of current methods being used to alleviate the problems associated with learners with ADHD in the classroom. If behaviour management strategies prove to impact positively upon the classroom behaviour of learners with ADHD, they could serve as a useful addition to medication or possibly replace medication in some cases.
Studies comparing behaviour of learners during periods on and off behaviour therapy show the effectiveness of behaviour therapy (Pelham and Fabiano 2001:316). Research as early as 1996 reflects evidence of behavioural training, where teachers are taught child management skills which equip them to use direct teaching and reinforcement strategies.
This has shown to engender positive behaviour and discourage inappropriate behaviour. Research by Gureasko-Moore, DuPaul and White (2006:160) has shown the current philosophy in the school system to be, that if learners with ADHD symptoms are properly medicated and participate in teacher-run contingency management programs, then their academic and social difficulties will largely correct themselves.
Behaviour modification techniques, according to Kirby and Kirby (1994:143) can be beneficial in improving behaviour of children diagnosed with ADHD. Also referred to as ‘adjustments in environment’ by Stevens (1997:187), strategies in behaviour management have been seen to counteract many of the problems associated with ADHD, such as inattention, impulsivity and social acceptance, at classroom level. With this in mind then, researching strategies in a classroom situation can lead to a better handling of ADHD learners in the educational context.
Research by Holz and Lessing (1999:237) further supports this premise by acknowledging that teachers’ knowledge of the manifestations of ADHD will enable them to appreciate and accommodate the learners with ADHD in their classrooms by adapting their teaching programmes and methods. Research by DuPaul and Stoner (1994:5) into classroom behaviour problems commonly reported for learners with ADHD, has identified difficulties in completing independent seat work, disorganized school materials, frequent out-of-seat behaviour and talking with classmates at inappropriate times.
Harlacher, Roberts and Merrell (2006:6) maintain that individualised school-based interventions are too time-consuming and taxing for the teacher, however, class-wide interventions targeting learners with ADHD may be an effective alternative. Other advantages include allowing the learners with ADHD to remain anonymous as well as allowing the performance of all students to be enhanced, with special reference to academic performance and behaviour.
Class-wide interventions can be categorised into academic and behavioural, for targeting academic deficits associated with ADHD as well as the behavioural manifestations of the disorder. Contingency Management (CM) is one such behavioural intervention which has produced positive results according to Harlacher et al. (2006:6-12). Defined as the application of consequences contingent on specified behaviours by Wolery, Bailey and Sugai (1988:494), this strategy involves positive reinforcement for particular, appropriate behaviours in order to increase their frequency. CM can involve learners earning tokens for specific behaviours that can in turn be exchanged for selected rewards that serve as greater reinforcers. Any subsequent removal of those tokens is contingent on inappropriate behaviour. Abramowitz and O’Leary (1991:221) have drawn conclusions from extensive research into CM that highlight class-wide interventions combining various strategies, as having the highest efficacy when promoting positive behavioural and academic performance. They, too, have focused research on classroom management strategies from contingent teacher attention, through classroom token economies to peermediated interventions.
This strategy can be widened to include an entire class’s behaviour resulting in rewards for learners. Other disruptive behaviours associated with ADHD, like out-of-seat behaviour and talking out-of-turn have also been reported by Abramowitz and O’Leary (1991:221) to have decreased due to CM.
Academic performance including accuracy and task completion has also reportedly increased for the whole class, according to Trout, Ortiz Lienemann, Reid and Epstein (2007:224). CM appears to enable a teacher to effectively manage a large group of learners at once, working to improve academic performance and to minimise disruptive behaviour in the classroom setting. Classroom interventions target areas like academic instruction, materials or the environment. The frequency with which learners with ADHD (Daly, Creed, Xanthopoulos and Brown 2007:77) struggle with academic achievement is correlated to the high incidence of learning disabilities these learners present with. Research shows that a majority of learners with ADHD, in fact up to eighty percent, present with learning problems (Trout et al. 2007:207). Webb and Myrick (2003:109) describe the learning skills of sustained attention, listening and the following of instructions that learners with ADHD lack, which are required for any form of academic achievement.
Other direct CM strategies include verbal praise, time-out and daily report cards which reflect a number of clearly defined, positive behavioural goals. Teachers utilize these behavioural modification techniques in the classroom setting due to their efficacy in targeting traditional areas of difficulty with ADHD learners.
A second classroom management technique which has reportedly been used successfully in manipulating behaviour is teaching learners the technique of self-management. This is a more individualised intervention which includes self-monitoring and involves agreement between learner and teacher, on certain learner behaviours up to a maximum of three that the learner must monitor, then evaluate and record. Similarly, the teacher rates the learner too and their evaluations are compared. Harlacher et al. (2006:8) have researched this classroom management strategy and found that, over time, a learner comes to report a rating that matches the reality of his/her behaviour. Learners might monitor, for instance, their increased time on-task, after which teacher and learner both independently rate the level of performance of that particular behaviour on a Likert scale. At this point, the teacher withdraws her input and the learner is left to independently self-monitor.
Another strategy, class-wide peer tutoring, has been shown by Harlacher et al. (2006:9) to demonstrate an increase in on-task time and an improvement in academic performance in learners with ADHD. This instructional manipulation strategy involves learners being paired up on an academic task, where each, in turn, provides assistance, instruction and feedback to the other (Greenwood, Maheady & Carta 1991:179). Learners seem to benefit from the one-on-one method with immediate feedback. Spin-off from this intervention appears to be the promotion of pro-social behaviour. Peer relationships – the formation and maintenance thereof – also present potential stress for learners with ADHD. Evidence of difficulties in this realm is well-documented (Daly et al. 2007:78) and being paired with a ‘buddy’ has resulted in learners with ADHD demonstrating improved academic performance and enjoying higher-quality friendships. Similarly, task and instructional modification has also been found to target learners’ academic needs. It involves changes being made to an assignment as in formulating more frequent deadlines or modifications being made daily within the classroom setting. It can also increase opportunities for learners to make a choice between possible alternatives or substituting oral responses for written, formal responses. This strategy has been found to enhance the academic and behavioural performance of learners with ADHD.
There is no doubt that an holistic (multimodal) approach to the treatment for ADHD is needed (Sherman, Rasmussen & Baydala 2008:348), an essential part of which must be classroom management in the form of interventions as detailed in this literature search.
1.2.3 Problem statement
From my own work perspective, it is clear that learners with ADHD struggle to conform to behaviour considered appropriate and acceptable in the classroom setting. The learner often performs poorly, academically, and the class as a whole is often impacted upon negatively which leads to learners with ADHD being labelled and simply remaining a problem for themselves and others around them.
The preliminary literature study documents the use of behaviour management strategies in the classroom setting. Given the significant impact of ADHD on academic and educational performance generally, it is clear that classroom management of learners with ADHD is considered to offer the practical assistance that they require. Positive class-wide interventions include smaller class sizes, reduced distractions and increased choicemaking as well as CM, self-management and peer tutoring, all of which could be beneficial to such children as a solution to their classroom-based difficulties.
The problem is that learners with ADHD experience both social and academic problems in the classroom. Teachers need strategies to overcome these problems in order to assist these learners to succeed in the classroom and to minimise any disruption to other learners. The question underpinning this research is:
‘Will a programme of behaviour management strategies used on learners with ADHD significantly reduce their disruptive and associated negative behaviour in the classroom?’
1.3 Aims of research
There is firstly a general aim relating to the findings of the literature study, followed by a specific aim of the empirical research undertaken.
1.3.1 General aim
The general aim of this research is to complete a literature study which will investigate behaviour management strategies used on learners with ADHD in the classroom setting. This will inform the subsequent process of designing a programme of effective and successful behaviour management strategies that can be used by teachers of ADHD learners in the classroom on a daily basis. To achieve this aim, the following questions are posed in order to direct this research:
• What is the nature of ADHD? (see 2.2)
• What problems are experienced (see 2.3)
- by teachers associated with ADHD learners in an educational context?
- by learners with ADHD in a classroom setting?
• Which behaviour management strategies (see 2.4) - have been utilized by teachers in the classroom situation?
- have been found to be most effective?
