Ana Parra Martin

ED142
8/9/14
CASE STUDY & RESEARCH ON ADHD
1. Student Profile
My cousin David is 10 years old and lives in Madrid, Spain, with his parents and
younger sister. He has just finished 5th grade at a private school that receives state
subsidy. His birthday is in December so, because of how the Spanish education system
organizes grade-levels, he is always one of the youngest of his class. He has been
diagnosed with Attention Deficit with Hyperactivity Disorder (ADHD) since he was 6
years old.
David is a very bright and lively child. His intelligence is apparent through his
curious, detailed questions and well-reasoned arguments on many topics. Since he was
very little, I have been blown away countless times by the richness of his analytical
thought and complex vocabulary. He started walking at only 8 months and began talking
quickly, using a wide range of words. He was a very energetic and restless baby who ate
very well but slept irregularly. His parents placed him in daycare starting at 6 months,
until he was 3 years old. His teachers observed that he followed simple directions well,
was an active participant in classroom activities, and was empathetic towards his peers.
However, he struggled to remain attentive to things that he was not very interested in.
When David began preschool, his teacher acknowledged that he had difficulty
sitting still in class and listening without interrupting. Over the following two years, his
parents were told that his attitude towards work improved, but he had trouble
distinguishing the graphemes of written language. He was given homework to do over the

summer and, at home, his parents unsuccessfully tried to have him sit at his desk 5 min a
day to draw or do short exercises.
Once David began elementary school, and after meetings with the school
psychologist, his parents were informed that he had learning difficulties. David got
distracted and sidetracked often, and his educators insisted on the necessity of signing
him up to in-school support lessons as well as extra tutoring in language. The school also
suggested they visit a behavioral and speech therapist to gain a deeper understanding of
the causes of Davids problems. Based on the results of a battery of tests to evaluate his
learning strengths, difficulties and interests, the therapist recommended an intervention
program for the 2010-2011 school year. This included weekly therapy visits, to learn and
practice helpful study and concentration strategies and skills.
Davids parents decided to get a second opinion from a medical team, to rule out
any health issues that could be impeding his learning. A psychiatrist diagnosed David
with ADHD, with a predominance of the inattentive-type symptoms. He began
pharmacological treatment with Rubifen, later Concerta, and finally Strattera, in
parallel with the special education services suggested by the school and therapist. In
addition, following his diagnosis, my aunt and uncle went to a parent education course
offered by Madrids Mental Health Department so as to learn more about how to treat
and live with ADHD patients. They learned strategies of positive reinforcement, how to
discipline and how to curb Davids impulsive behavior. They also took part in a
pharmacogenetic study of ADHD at the Hospital Fundacin Jimnez Daz.
Today, David is a smart, kind and loving child with whom it is a delight to
interact. Although at times his obstinate behavior can be trying, he is maturing into a

reasonable and good-natured boy. In school, his favorite subjects are science and social
studies. He still seems to have most trouble in Spanish class, particularly with
orthography. Similarly, he is also having difficulties and least enjoys learning English (as
a foreign language). However, this year he has obtained good academic results and his
parents are pleased with his evolution. David has been signed up to a number of
afterschool activities, which he requested himself and in which he has excelled. He is
very proud of his evolution in judo (which has earned him a green/blue belt), he really
enjoys his chess lessons, and has a lot of fun learning to ski in the winter. He is a popular
member of his class and has many friends. His parents are in constant communication
with the school, including Davids current teacher, and believe that without this support
system these positive results would not have been possible. My aunt and uncle believe
Davids battle with ADHD to be a success story so far.

2. Identifying the Disability

In the State of Massachusetts, ADHD falls under the educational disability
category of health impairment. This defines ADHD as A chronic or acute health
problem such that the physiological capacity to function is significantly limited or
impaired and results in one or more of the following: limited strength, vitality or alertness
including a heightened alertness to environmental stimuli resulting in limited alertness
with respect to the educational environment.1. Originally named Attention Deficit
Disorder (ADD), the term ADHD was adopted in 1994 and is now typically broken down
into three sub-types: inattentive, hyperactive-impulsive and combined. The inattentive
type ADHD is characterized by symptoms such as difficulty paying attention to details,

distractibility and poor organization. The hyperactive-impulsive type shows signs of

fidgeting or squirming, excessive energy and difficulty calming down. The combined
type is the most common, presenting symptoms from both other categories. In the
classroom, a child with this disability will have trouble focusing, following directions,
sitting still and may engage in disruptive behavior. Overall, ADHD is thought to affect 810% of school-age children, with boys being more frequently diagnosed than girls2.
Treatment often involves behavioral therapy, as well as medication using psychotropic
drugs such as stimulants that alter the brain chemistry to help improve concentration. One
of the biggest current debates surrounding ADHD is whether or not children should be
medicated to control their symptoms.

3. Research Question
Part of Davids success in combating ADHD has been due to the medication he
has been taking for several years. However, there are side effects to taking these drugs at
such a vulnerable period in development. In Davids case, his growth rate has been
reduced and he is a small child for his age. His parents had a difficult decision to make
about whether or not to give David medication to manage his symptoms, and this is a
common dilemma for many parents with children that are diagnosed with ADHD. I
believe Davids school system could have implemented more supports to help him in the
classroom, instead of relying mostly on the medication to control his behavior.
>> What intervention strategies can teachers use to support elementary-aged children
with ADHD, to reduce the need for medication?

4. Research
Johnson & Reid (2011) state that students with ADHD often have difficulties with
the cognitive processes involved in executive functioning and evidence suggests that
these deficits contribute to the academic struggles of many of these children3. They argue
teachers can scaffold the development and implementation of planning and goal-setting
strategies for various activities by providing direct instruction. Students should know the
steps involved, be aware of the value of the strategy and have continuous practice. In
addition, the most effective goals are those that are specific, proximal, and moderately
challenging, and they should be incorporated frequently into class assignments. Johnson
& Reid recognize that children with ADHD often lack persistence in their engagement
with tasks and, as teachers, we can aim to minimize their frustration by providing quality
instruction to ensure students master the skills required to succeed at the task. Positive
encouragement and opportunities for students to evaluate their own improvement can be
strong motivators.
DuPaul et al (2011) claim that school-based intervention strategies addressing
behavior, modifications to teaching practices and home-school communication can be
successful in improving the academic success of children with ADHD4. They suggest
strategies that decrease the triggers for disruptive or inattentive behavior, such as visibly
posting the classroom rules, reducing assignment length and allowing guided choice in
activities. They promote positive reinforcement as the main behavioral consequencebased strategy, however they specify it should be provided frequently, based on real
student interests and be proximal to the occurrence of the target behavior. DuPaul et al
also argue one overlooked aspect of treatment of children with ADHD is the need to

form partnerships among school professionals who can work collaboratively on

interventions. Teachers and school psychologists should work together to ensure the
success of any academic interventions.
Fowler (2010) states, Most ADHD management is not a problem of knowing
what to do. Its a matter of doing what we know5. That is, being on task is a major
difficulty due to poor self-control, and she terms these difficulties as being at point of
performance. She invites teachers to be flexible in their teaching practices, and to
provide the scaffolding, ongoing monitoring, positive feedback ADHD students need.
Fowlers strategies for addressing stimulation-seeking behaviors involve introducing
stimulating elements in the classroom, such as: encouraging movement during frequent
breaks, using manipulatives or stress balls, and making lessons interactive. To address
distractibility and hold students attention, she suggests: adding interest and novelty into
activities, breaking down tasks, giving specific and clear directions and allowing students
to self-monitor their performance. In addition, Fowler recommends we support students
working memory by using: models or graphic organizers, color to categorize information,
mnemonic strategies and peer support.
All articles mention positive reinforcement as an important component of
behavioral interventions for ADHD. I believe this is the first step in helping any child
succeed. Negative feedback and constant punishments can only damage a childs selfesteem and motivation to learn, and unfortunately students with ADHD often experience
these reactions from tired teachers and parents. Appropriate positive feedback can be
much more powerful and is certainly more beneficial to a childs self-image. They also
all encourage student self-monitoring as a successful behavior strategy. Students with

ADHD are not intentionally disruptive or off-task, but engaging them in their own
learning process and allowing them to measure their own improvement can be a potent
motivator.
I believe the strategies mentioned can be easily implemented and will work in any
classroom. However, although DuPaul et al mention pharmacological treatment is rarely
sufficient in addressing the multiple, chronic difficulties faced by students with ADHD,
these articles fail to mention if the strategies they suggest could be successful without
medication. Part of the difficulty with resolving the medication vs. no medication
controversy in general is the severity of the symptoms of ADHD varies greatly from child
to child. Some children may do just fine with purely behavioral interventions and slight
modifications to their school and home environments, whereas others may require
medication to even reach a baseline that can be worked with.
Finally, it is also important to note that the nature of ADHD is chronic. Fowler
reminds us these problems often arise from environmental expectations, conditions, and
triggers. Thus, ADHD interventions cannot be one-time solutions; the scaffolds must be
in place for the long run if we want our students to be successful.

5. Reflection
Whether or not, even with these school-based strategies, David would have still
needed medication to combat his ADHD successfully is not an easy question to answer.
There is much I dont know about exactly how limiting his behaviors were at home or at
school prior to beginning his treatment. What does seem clear is there is much that we
can do as teachers to help these children succeed in our classrooms. Transition activities

such as calming games, yoga, meditation or even a few minutes of reading can help all
children settle down after the intensity of lunch or recess and prepare them to focus on
the lesson ahead. Sometimes more physical and interactive activities can be a good way
for highly energetic students to blow off a little steam as well as learn control over their
bodies (judo is certainly helping David achieve this). Peer models and supportive
partnering within the classroom can help many children stay on track, just like
organization strategies such as posting visible checklists of materials or steps to follow,
or even finding alternative ways to make sure assignments get home and parents can
become involved. Finally, focusing on students strengths and interests is a valuable way
to highly engage them in their learning. In fact, many of these strategies can benefit all
learners, not just students with ADHD, and I will aim to incorporate them into my
personal practice.

Bibliography
1. Massachusetts Department of Education:
http://www.doe.mass.edu/sped/definitions.html
2. Kids Health: http://kidshealth.org/parent/medical/learning/adhd.html#
3. Johnson, J., & Reid, R. (2011). Overcoming executive function deficits with
students with ADHD. Theory into Practice, 50(1), 61-67.
4. DuPaul, G. J., Weyandt, L. L., & Janusis, G. M. (2011). ADHD in the classroom:
Effective intervention strategies. Theory into Practice, 50(1), 35-42.
5. Fowler, M. (2010). Increasing on-task performance for students with ADHD.
Education Digest: Essential Readings Condensed for Quick Review, 76(2), 44-50.