The School Psychologist s Role in Diagnosing and Intervening with ADHD in the Classroom. Heather DeMarr (Psychology) Submitted as a St.

Transcription

1 The School Psychologist s Role in Diagnosing and Intervening with ADHD in the Classroom By Heather DeMarr (Psychology) Submitted as a St. Mary's Project in Partial Fulfillment of the Graduation Requirements for the Degree of Bachelor of Arts in Psychology May, 2009 St. Mary's College of Maryland St. Mary's City, Maryland Laraine Glidden, Psychology Project Mentor

2 The School Psychologist s Role 2 Abstract The behaviors associated with ADHD can cause many problems in the classroom. Detecting ADHD is integral to maintain an environment conducive to learning. School psychologists assess children and plan interventions to eliminate negative behaviors associated with ADHD. This study aimed to examine what behaviors are associated with ADHD and whether those behaviors stand out in a classroom setting. It was hypothesized that children with possible ADHD would exhibit higher levels of off-task behaviors and out of seat behavior and there would be grade level differences. Results show that children with possible ADHD do demonstrate more behaviors as well as out of seat behavior but only out of seat produced a grade level difference. Implications, limitations and future research are discussed.

3 The School Psychologist s Role 3 The School Psychologist s Role in Diagnosing and Intervening with ADHD in the Classroom Attention Deficit Hyperactivity Disorder (ADHD) is a condition that has become prevalent in today s classrooms. ADHD affects between 3 and 7 percent of school-aged children today, (DSM IV-TR, 2000) or about one in every 20 to 30 students (Vile Junod, DuPaul, Jitendra, Volpe, & Cleary, 2006). As defined by the Diagnostic and Statistical Manual for Mental Disorders IV Revised (DSM IV-TR), ADHD is, a persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequently displayed and more severe than is typically observed in individuals at a comparable level of development (p. 85). Many children, especially children with ADHD, experience behavioral, social or emotional problems in the classroom. If those problems begin to hinder the classroom environment, a process is started to help solve those problems. First, a School Support Team (SST) is formed where a number of faculty meet to review the file of the child and they problem solve ways for interventions to be used in the classroom and school setting. The child is then monitored for their response to intervention (RTI) (M. Ross-Gray, personal communication, March 23, 2009). RTI is a multi-tiered intervention where students are first identified as at risk for a problem. If this does not help the child succeed, he or she either receives more intensive intervention, or referral for special education services (National Center on Response to Intervention). At the level where special education services are referred, another team, including the school psychologist is formed. It is also at this level where the child would get testing and intensive assessment to see where the problems are specifically (M. Ross-Gray, personal communication, March 23, 2009). If a child is found to have an educational disability according to the Individuals with Disabilities Education Improvement Act-2004 (IDEIA-2004), professionals will meet to discuss the need for an Individualized Education Plan (IEP). The IEP

4 The School Psychologist s Role 4 is created to set goals for the child, such as behavioral or academic goals as well as teacher or testing accommodations. School psychologists play a key role both in diagnosing a disorder as well as designing interventions to ameliorate its effects. School psychologists will consult teachers, parents and students as a team when a child has encountered a problem, to come up with strategies to improve the student s situation, both at home and in school. School psychologists also create programs and educate school faculty on prevention of behaviors and teaching strategies (National Association of School Psychologists). In terms of ADHD, school psychologists are one of the key authorities on not only alleviating the behaviors associated with ADHD, but they help students socially and emotionally as well. School psychologists are specifically involved in the assessment of the disorder and from that the school psychologist and other team members will evaluate ways in which to help that student cope and succeed in school and at home. Children with ADHD often have behavioral problems or cannot concentrate on their work while in school. These children may fall behind academically or become a distraction in the classroom to both the teacher and the other students. Thus, it is important to understand how school psychologists and teachers discriminate those children from the rest of the students, qualify them for a disorder and find ways to alleviate those problems in the classroom (National Association for School Psychologists). Researchers asked school psychologists about their beliefs of ADHD (Cushman, LeBlanc, and Porter, 2004). Most believed that ADHD was a valid disorder that could be reliably diagnosed. The best interventions for children with ADHD are behavioral, and parent training is integral. Because school psychologists believe that ADHD is valid and can be

5 The School Psychologist s Role 5 diagnosed reliably, researchers suggest it will continue to be diagnosed because of this, so there should be no decline in prevalence rates because of this belief. However, according to school psychologist Mary Ross-Gray (personal communication, March 23, 2009), the school process should be emphasized so as not to over diagnose the disorder. Types of Problems in the Classroom Because behavioral problems usually associated with ADHD generally go undetected until children are in a controlled school setting, ADHD is often first noticed when a child enters school. Classroom environments demand more behavioral control than most home environments; therefore children with ADHD will demonstrate more behaviors associated with ADHD more often in this situation. Also, teachers would be more willing to admit that a student has a problem because teachers usually have a less biased view of their students than do parents. This is because they do not have as strong an emotional connection to the children, and they have experience with many children and thus are more likely to conclude that certain behaviors are atypical (Atkins & Pelham, 1991). These behaviors disrupt the classroom, so it is necessary to examine these problems, so that steps can be taken to alleviate them. Off-task behavior. Many boys in school disrupt the classroom at some point in their early education, but, compared to control boys, boys with ADHD exhibit several significant behavioral problems in the classroom. Abikoff, Jensen, Arnold, Hoza, Hechtman, Pollack, et al. (2002) examined these differences as part of their study. Boys with ADHD (Combined Type) showed higher levels of off-task behavior, noncompliance, physical and verbal aggression, gross motor, minor motor, out of chair, and interference (i.e. interrupting). The only measure where comparison boys and boys with ADHD scored similarly was solicitation of the teacher. This study paints a vivid picture of what it is like to have boys with ADHD in a classroom setting. In

6 The School Psychologist s Role 6 almost all types of behavior exhibited by students in the class, boys with ADHD were significantly higher on all negative behaviors, but were significantly lower on absence of behavior (i.e.no codable behavior occurred during sampling), telling researchers that movement is a key problem for children with ADHD Combined Type. On-task behavior. One area where children with ADHD have trouble in the classroom is engagement, or on-task behavior. Teachers need their children to be engaged in the material in order for the children to learn. If children cannot pay attention to the material, due to inattention or hyperactivity, then it makes it harder for students to learn. Vile Junod et al. (2006) studied this concept of engagement in children with ADHD in the classroom. They observed children with ADHD to test to see if these children spent less time actively and passively engaged in the class. Active engagement includes behaviors such as writing, reading out loud or other times when the student is answering or asking questions. Passive engagement includes activities such as listening, silently reading or looking at material. The researchers found that students with ADHD do have significantly lower rates of active and passive engagement than children without ADHD. This study also examined off-task behavior, which is one of the most significant problems children with ADHD face in school. They found that students exhibited higher rates of off-task behavior in motor movement (e.g. moving inappropriately, out of seat, etc), verbal behavior (e.g. any words or noises that were not appropriate to the situation) and passive off-task (e.g. not paying attention to the material or teacher for more than three seconds). Factors that Relate to Problems in the Classroom Setting. There may be other factors that influence disruptive behavior in the classroom other than simply the classroom itself. Others settings may influence how the child behaves in the classroom; one such instance is recess. As a result of the rise and pressures of standardized

7 The School Psychologist s Role 7 testing, many schools are beginning to cut some of the day s activities so that they can focus on material for the tests. In the past, recess was created to give children an outlet for their energy during school. A study by Ridgway, Northrup, Pellegrin, Larue, and Hightshoe (2003) examined the effects that recess had on the class, especially on children with ADHD, to see if this was in fact true. This school in which the authors conducted the study had removed recess from its curriculum, so as the observers watched the behavior of the children in class, recess was added on alternating days to see if the children behaved differently with the addition of recess. The results of the study found that inappropriate behavior (e.g. off-task, inappropriate vocalization, out of seat, fidgeting, and playing with objects) of children with ADHD increased significantly on days when there was no recess. Results also indicated that children without a diagnosis of ADHD demonstrated inappropriate behavior over time as well when recess was removed. Age. One factor which may influence behavior in children, both with and without ADHD, is age. Hart, Lahey, Loeber, Applegate, and Frick (1995) used a longitudinal model to demonstrate levels of ADHD symptoms over the span of four years. It was noted that as children with ADHD aged, they still demonstrated symptoms of hyperactivity-impulsivity, but the symptoms declined over time. Inattention declined, but only after the first year of the study. The authors noted, however, that ADHD symptoms continued, meaning that ADHD is a chronic condition, at least into adolescence. This suggests that different age groups present different symptomatology, indicating that when observing children, it is important to look for differences in presentation of ADHD. Subtype. Another factor which may cause behavioral problems in the classroom is the different subtypes of ADHD themselves. There are three subtypes: Predominantly Inattentive, Predominantly Hyperactive-Impulsive, and Combined Type. Each has its own set of criteria

8 The School Psychologist s Role 8 according to the DSM IV-TR. The child who demonstrates Predominately Inattentive Type, displays symptoms such as not paying attention to details, not listening when someone is talking, is distracted or forgetful, and not staying on-task. The child who demonstrates Predominantly Hyperactive-Impulsive Type displays symptoms such as being fidgety, being out of seat, running or climbing excessively, blurting out answers, and not waiting for his or her turn. The child who displays Combined Type includes symptoms of both inattention and hyperactivity-impulsivity. Many investigators have postulated that there may be differences among the three subtypes of ADHD. Riley, DuPaul, Pipan, Kern, Van Brakle, Blum, (2008) examined whether or not functional impairment was evident in preschool children, when observing and testing children with either ADHD Hyperactive-Impulsive or ADHD Combined Type. The researchers had parents and children take several tests, including the Conners Parent and Teacher Rating Scale (for parents) and the Diagnostic Interview Schedule for Children-Young Child Version (for children) to measure this impairment, coupled with direct observation of the children. There were no significant differences found between the two subtypes, suggesting that there may not be a difference between the types. Knowing that there may not be observable differences in the hyperactive-impulsive and combined types may be useful when trying to tease apart (or not tease apart, as the case shows) the differences between each type. Hodgens, Cole, and Boldizar (2000) examined peer interactions and peer acceptance of children with either ADHD Combined Type or ADHD Predominantly Inattentive. They measured the children using direct observation, and obtained peer nominations from their schools. They also used the Teacher Report Form from the Child Behavior Checklist (Achenbach & Edelbrock, 1986) which they used to measure aggression, inattention and overactivity. The children were allowed to free play for several sessions, during the

9 The School Psychologist s Role 9 observational period. The results of the study indicated that boys with the Predominantly Inattentive subtype spent significantly more time engaged in solitary behavior than sustained interaction with other children. These children were also labeled as being shy or more often teased by their peers. Also both subtypes had significantly lower social preference scores than did the control group. The results of the two previous studies indicate that there may be differences between the Predominately Inattentive subtype of children with ADHD, and the other two subtypes, Combined Type, and Hyperactive-Impulsive. But there may not be a difference in behavior between Combined Type and Hyperactive-Impulsive. By merely observing children in a classroom setting, it may be difficult to find and label a child with ADHD, predominantly inattentive type, because they are not generally overt in their actions. They tend to be more passive, while the other two subtypes tend to be very active in their presentation of ADHD. Diagnosing ADHD The teacher s role. Teacher ratings of ADHD are an important first step in the process of diagnosis. Obtaining ratings from teachers is one of the easiest and most efficient ways of obtaining information about a child (Atkins & Pelham, 1991). Teacher ratings are easily obtained, and the teacher is the person who spends the most time with the child in academic situations. Because the teacher is the first step in identifying the disorder, several rating scales have been created to aid in the diagnosis of ADHD. Reliability and validity are important components in gaining accurate information from the measures that are being used. Reliability involves consistency in the results of a measure after repeated usage, while validity involves measuring what the test is supposed to measure. Having both reliability and validity in a study is important, because without both in a measure,

10 The School Psychologist s Role 10 the results may not indicate what is really occurring. If parent scales are not reliable, they would be useless in aiding to diagnose ADHD in their children. Milich and Landau (1988) found that teacher ratings and direct observation reliably cross-validated each other. Therefore, it would be useful to use a multi-method approach (Atkins & Pelham, 1991) in order to get the greatest overall diagnosis. Some schools use parent rating scales as well, but they have not been found to be as reliable as teacher rating scales (Platzman et al, 1992). The school psychologist s role. According to Koonce (2007), school psychologists spend most of their working hours in assessment of children for any given disorder, and in a given year, school psychologists see 31 to 70 cases. Koonce gave hypothetical situations of children who are presenting with ADHD symtomatology and asked school psychologists how they would proceed with the case. Most school psychologists suggested using multiinformant, multimethod, multisetting assessments, and suggested using interviews, direct observation, rating scales, as well as other tests. Koonce also noted that the school psychologists chose a variety of direct observations, showing that this is an integral part of the diagnosis, and validates other forms of assessment. This validates the previous literature in that multimethod approaches are the best way to correctly diagnose a child with ADHD. Classroom Intervention When a student misbehaves in school, it becomes a distraction not only for the student, but for everyone in the class. A child with ADHD would have a difficult time attending to the information and sitting still long enough to take in the information. Because of this, both the student with ADHD and the students surrounding him or her will not be able to focus on the teacher or the material. That is why several types of classroom interventions have been created to counteract these problem behaviors.

11 The School Psychologist s Role 11 Behavioral Intervention. DuPaul and Weyandt (2006) emphasize that schools should use a variety of interventions when intervening with a student. An intervention is a way of decreasing problem behaviors, while increasing positive behaviors. The most popular type of intervention used to alleviate ADHD symptoms in schools, is behavioral strategies, and in most cases, is the only type of intervention used in schools for children with ADHD. Balanced behavioral approaches use antecedent strategies, which examine events that occur before a behavior occurs. They also use consequent strategies, which look at events that occur after an event occurs, and these approaches also use self management strategies, where the child designs and implements the strategy. By looking at antecedents and consequences, a teacher or school psychologist can see what events occur before and after a child performs a behavior, and then procedures can be implemented to stop the behavior. To examine this strategy, psychologists would look at the antecedents, the behaviors and the consequences of a given event. An example behavior is that a child skips class every Wednesday. The antecedent is that there is a quiz every Wednesday. The consequence is that the child does not have to take the quiz. Another type of behavioral intervention used in many schools across the country is Positive Behavioral Interventions and Supports (PBIS). This intervention program is used universally in the school by every student and is a positive reinforcement tool to prevent problem behaviors from occurring by supporting positive behavior. Each school uses their own school rules as a part of the program, and the students are given examples of how to follow the positive behavior. If a student is caught demonstrating these behaviors they are given a token or reward for their positive behavior (M. Ross-Gray, personal communication, March 23, 2009). In the school where school psychologist Mary Ross-Gray practices (personal communication, March 23, 2009), they use pretend Dollars which the children can earn and use to buy items such as

12 The School Psychologist s Role 12 school supplies or use them to go to school events. Since this program has been implemented in the Charles County School System, student suspensions have gone down from previous years, where as in Maryland as a whole, suspensions are increasing from previous years (Advocates for Children and Youth). Academic Interventions. Another type of intervention used in schools is academic interventions. DuPaul and Weyandt (2006) say that behavior modification alone may not be enough to increase academic skills. Academic strategies include modifications to teacher instruction and peer tutoring. One method of modifying teaching is direct instruction. This method allows teachers to easily see where the deficits in their students are. Teachers can also alter how they present materials to students to illuminate the easiest ways for students to understand the material. Peer tutoring can be as simple as two students working together or there is the ClassWide Peer Tutoring intervention, where the class is divided up, paired off, and uses positive reinforcement. Using academic interventions allows the child to change not only his or her behaviors in the class, but learn the material as well, which is what the child is there for (DuPaul & Weyandt, 2006). Social Relationship Intervention. The last intervention that can be used is social relationship intervention. In this intervention, the child learns how to interact with other peers and teachers properly, which a child would need in order to become well-balanced in school. This is difficult because children with ADHD understand the rules of behavior, but do not follow them. There are types of therapy designed to ameliorate these problems such as group and social skills training (DuPaul & Weyandt, 2006).

13 The School Psychologist s Role 13 All of these strategies alleviate the deficits that children with ADHD encounter in school situations. However, most interventions in schools today focus on behavioral intervention, which alleviates only the main deficits a child with ADHD would encounter in school. Direct Observation. In order to diagnose a student and intervene to help him or her, a school psychologist would have to observe the child to see if the behavioral problems are present for this disorder. There are several ways to approach observation and almost every article has a different variation. They use different sampling procedures and the location the study takes place in differs. Most of the research conducted using observation of ADHD has been done on children from preschool ages to 12 years of age and has been conducted primarily on males. Many of the studies were conducted in laboratory settings, but several were conducted in natural classroom contexts, or a combination of both. Several studies have used behaviors such as: offtask and/or attention span, vocalization and activity measures. Many of the behaviors identified indicated significant differences when in the classroom setting only (Platzman et al, 1992). In other words, the researchers did not find differences in off-task behavior, vocalization or activity when in the laboratory context. One reason for this may be that the laboratory is not a setting children are used to being in; therefore, they may act different because this is a new situation. Time sampling. Overwhelmingly, most studies conducted on ADHD employed some sort of time sampling procedure to guide their observations (e.g. Ridgway et al, 2003; Hoff, Ervin, & Friman, 2005). The basic structure of this procedure involves observing on and off for certain time periods, (e.g. maybe 5 seconds to observe and 3 seconds to code) looking for specific behaviors a child will perform. For example, if you are trying to see how much a student gets out of his or her seat you could use this procedure. You would watch that student for 5 seconds for this behavior, and then stop for 3 seconds to record the behavior, if it occurred. Then you

14 The School Psychologist s Role 14 would repeat the process. This usually will continue for minutes. Each study will use a different variation of the procedure, but the basic structure is usually the same. Alternatively, researchers will use event sampling to code for only one behavior, but code that behavior every time a child performs that behavior during a given period. It is different from time sampling because you must record every instance of the event. Time sampling would be used when the event occurs too frequently for effective event sampling. Biographies of different sorts can be created as another method of observation by following one child over an extended period of time and recording many of the low frequency actions or verbalizations of the child. Case Studies. Several case studies have also been completed to try and change the negative behavior of children with ADHD to more productive behavior (i.e. Hoff, Ervin & Friman, 2005; Fabiano and Pelham, 2003). Most case studies use time sampling as a mode of collecting data. Case studies will also give you in-depth information about one particular person. This is helpful for children with ADHD because it will be easier to look at behaviors, antecedents and consequences if a case study has been complied. After diagnosis of ADHD has been confirmed, teachers and school psychologists must investigate ways of improving the behavior of these children. Many refer the child to a doctor to prescribe stimulant medication to curb the effects of ADHD. Other remedies for the disorder include behavior modification, or Functional Behavior Analysis. According to Fabiano and Pelham (2003), most teachers use behavior interventions in their classroom almost everyday. In this study, Fabiano and Pelham assessed an individual boy with ADHD, who was in elementary school. This boy was receiving special education services and had an Individualized Education Plan to help improve his progress in school. The teacher was already using a behavior intervention with the child, but the reward was not immediate and therefore, did not change his behavior. The researchers observed this

15 The School Psychologist s Role 15 child for a period of time, recorded his off-task behavior and then implemented a procedure to change his behavior. Instead of delayed gratification in a reward, the boy was given more feedback on his behavior and more rewards when he demonstrated positive behavior. Another case study was conducted using a 12 year old boy (Hoff, Ervin & Friman, 2005) who was so disruptive to class that he had already been removed to a residential treatment facility where he attended school. The child had a dual diagnosis of ADHD and Oppositional Defiant Disorder and took medication for ADHD. Baseline sessions were created to gauge his off-task and disruptive behaviors. It was hypothesized that there were three aspects of the classroom setup which were making the child behave inappropriately. Proximity to peers was a hypothesis, which meant that he acted out when being close to his peers. Another hypothesis that was generated was having less preferred reading material would cause him to act out as well, and a combination of the two was also hypothesized. The investigators then tested their hypotheses by altering the child s classroom setting. They moved him away from his peers and gave him more stimulating reading material. After implementation of the hypotheses, the child significantly decreased his disruptive behavior. Thus, the two studies indicate that behavior modification yields positive outcomes in stopping unwanted behavior resulting from ADHD. When specific cases of problem behavior and disruption arise in the classroom, teachers and faculty go through a process in which they identify, assess and observe, and evaluate these children to try and lessen or remove the problems in the classroom to make an environment conducive to learning. With ADHD, these problem behaviors can critically cripple the learning environment. School psychologists are integral in the assessment of these children and the implementation of interventions to stop the behaviors from occurring. The present study aims to answer the question: with all of the information gathered, can I identify a child with ADHD by

16 The School Psychologist s Role 16 observing them in the classroom? I will observe the children using time sampling procedures and criteria for ADHD behaviors to see if I can find a child matching the criteria I set forth. This would be one small step in the process that the school psychologist would go through to alleviate the problem behavior children would display in the classroom. I hypothesize that children with possible ADHD will display more behaviors related to ADHD than comparison children. I also hypothesize that children in first grade will display more behaviors than children in fifth grade. Method Participants Eight boys, four each from grades 1 and 5, participated in this study. Four of the boys had possible ADHD and four of the boys were for comparison data. They were recruited from an elementary school in Southern Maryland. All children were given pseudonyms to protect their confidentiality. The first participant was Aidan. He was a Caucasian first grader, who was often off-task as soon as the teacher looked away from him. He always spoke to other students and easily got bored with his work. But when the teacher was watching him, he diligently did his work. Bailey was an African American first grader, who always tried to move ahead with his work before the teacher would tell him to move on. He liked putting his fingers and other things in his mouth as well as fidgeting in his seat, but would always complete his work. Connor was an African American fifth grader, who seemed to have many conduct problems. He was often on-task when encouraged but would stare at the wall or at the other students after a few minutes of working. Some days he wouldn t even do his work, but would put his head on the desk.

17 The School Psychologist s Role 17 The last participant was David. David was a Caucasian fifth grader, who loved to answer questions, but did not raise his hand to speak. He often tried to get out of his seat to do something inappropriate, and he always had something in his hands. Materials Observational Data. The data were collected using materials that I created. The children were observed for the following behaviors: Off-Task Motor, Off-Task Passive, Off-Task Verbal and Out of Seat. Off-Task Motor was defined as any movement of the body (hands, legs, or head) which took attention away from being on-task. This included fidgeting/shaking/moving of the hands or feet for more than 3 seconds, and having something inappropriate in hands or mouth. Off-Task Verbal was defined as any audible noise not related to the on-task activity. This included calling out answers without raising hands, talking to friends, and making noises or laughing. For example, if the child was talking to himself about the activity or was counting or reading aloud, this was considered on-task behavior. Off-Task Passive was defined as looking around the room or staring at an object not pertaining to the task for more than 3 seconds. Out of seat was defined as the child completely removing his buttocks from the chair for more than 3 seconds. This included the child walking away from his chair, standing next to his chair or kneeling in his chair, with buttocks off of the chair. Procedure This study took place in the classrooms of the students participating in this study. Each class, as a whole, was observed at first by informally scanning the entire class for signs of the four behaviors until one child in each classroom was chosen who may show symptoms of ADHD. I did this by looking for overt behaviors in the children that made them stand out from the rest. I observed a control child from each classroom as well and chose the children who did

18 The School Psychologist s Role 18 not display overt behaviors related to ADHD. Each chosen child was then observed for behaviors associated with ADHD using the observational data system that was created. Each child with possible ADHD and his comparison child were observed for a total of 20 minutes. There were 60 intervals consisting of 15 seconds of observation, looking for the four behaviors indicated, followed by 5 seconds of recording time. On every fifth interval, I observed a control child for comparison data. This process occurred eight times over the course of three weeks. Results The descriptive statistics are shown in Table 1 for mean percentages of behavior exhibited and grade as a function of possible ADHD versus comparison data. For Off-Task Motor behavior, possible ADHD students in first grade (M = 14.97, SD = 9.04) scored higher than first grade comparison students (M = 2.08, SD = 3.73). Fifth grade possible ADHD students (M = 16.67, SD = 10.37) again scored higher than comparison students (M = 3.13, SD = 5.99). For Off-Task Passive behavior, possible ADHD students in first grade (M = 12.76, SD = 5.86) scored higher than comparison students (M = 6.25, SD = 6.46). For fifth grade, the students with possible ADHD (M = 21.48, SD = 22.91) scored higher than comparison students (M = 7.81, SD = 5.67). For Off-Task Verbal behavior, first grade students with possible ADHD (M = 13.41, SD = 7.09) scored higher than comparison children in the same grade (M = 1.56, SD = 3.36). In fifth grade, the possible ADHD students (M = 8.72, SD = 6.86) scored higher than comparison students (M = 6.24, SD = 6.46). For Out of Seat behavior, the first grade students with possible ADHD (M = 8.07, SD = 9.65) scored higher than the first grade comparison students (M =.52, SD = 2.08). And lastly, the fifth grade students with possible ADHD (M = 3.78, SD = 5.17) again scored higher than the comparison students in the same grade (M =.00, SD =.00).

19 The School Psychologist s Role 19 A 2 x 2 x 8 (disorder x grade x session) between subjects Analysis of Variance (ANOVA) with repeated measures on session was conducted for Off-Task Motor behavior, which showed a significant main effect of disorder, F(1,7) = , p <.05. This indicates that children in the possible ADHD category displayed significantly more Off-Task Motor behaviors than children in the comparison category. There was no significant main effect for grade, F(1, 7) =.64, p >.05. There was also no significant main effect for session, F(1, 7) =.94, p >.05. There was no significant interaction of disorder and grade, F(1, 7) =.05, p >.05. There was no significant interaction of disorder and session, F(1, 7) = 1.23, p >.05. There was also no significant interaction of grade and session, F(1, 7) = 1.39, p >.05. Lastly, there was no significant interaction of disorder, grade, and session, F(1, 7) =.46, p >.05. A 2 x 2 x 8 (disorder x grade x session) between subjects Analysis of Variance (ANOVA) with repeated measures on session was conducted for Off-Task Passive behavior which showed a significant main effect of disorder, F(1,7) = 8.48, p <.05. This indicates that children in the possible ADHD category displayed significantly more Off-Task Passive behaviors than children in the comparison category. There was no significant main effect for grade, F(1, 7) = 1.71, p >.05. There was also no significant main effect for session, F(1, 7) =.48, p >.05. There was no significant interaction of disorder and grade, F(1, 7) = 2.18, p >.05. There was no significant interaction of disorder and session, F(1, 7) = 2.04, p >.05. There was also no significant interaction of grade and session, F(1, 7) = 2.63, p >.05. Lastly, there was no significant interaction of disorder, grade, and session, F(1, 7) =.66, p >.05. A 2 x 2 x 8 (disorder x grade x session) between subjects Analysis of Variance (ANOVA) with repeated measures on session was conducted for Off-Task Verbal behavior which showed a significant main effect of disorder, F(1,7) = 40.50, p <.05. This indicates that

20 The School Psychologist s Role 20 children in the possible ADHD category displayed significantly more Off-Task Verbal behaviors than children in the comparison category. A significant interaction of disorder and grade was also found, F(1, 7) = 9.99, p <.05. This indicates that at the first grade level, the children with possible ADHD are much higher in Off-Task Verbal behavior than comparison children but in fifth grade, the children with ADHD are only slightly higher than comparison children. Also, the fifth graders who have possible ADHD display more Off-Task Verbal behaviors than the fifth graders while the comparison children in fifth grade demonstrate more Off-Task Verbal behaviors than first graders. There was no significant main effect for grade, F(1, 7) =.00, p >.05. There was also no significant main effect for session, F(1, 7) = 6.26, p >.05. There was no significant interaction of disorder and session, F(1, 7) =.58, p >.05. There was also no significant interaction of grade and session, F(1, 7) =.91, p >.05. Lastly, there was no significant interaction of disorder, grade, and session, F(1, 7) = 1.27, p >.05. Finally, a 2 x 2 x 8 (disorder x grade x session) between subjects Analysis of Variance (ANOVA) with repeated measures on session was conducted for Out of Seat behavior which showed a significant main effect of disorder, F(1,7) = 11.17, p <.05. This indicates that children in the possible ADHD category got out of their seats significantly more than children in the comparison category. A significant main effect for grade was also found, F(1, 7) = 5.88, p <.05, which indicates that children in first grade got out of their seats significantly more than children in fifth grade. A significant interaction of disorder and session was found, F(1, 7) = 4.18, p <.05. There was also no significant main effect for session, F(1, 7) =.92, p >.05. There was no significant interaction of disorder and grade, F(1, 7) = 5.19, p >.05. There was no significant interaction of grade and session, F(1, 7) = 1.44, p >.05. There was also no significant interaction of disorder, grade, and session, F(1, 7) =.34, p >.05.

21 The School Psychologist s Role 21 Discussion This study aims to examine what behaviors are associated with ADHD and whether those behaviors stand out in a classroom setting. It was hypothesized that, by observing in a classroom, I would be able to identify children with possible ADHD by viewing the behaviors they exhibit in class compared to other children in the class. The results indicate that children with possible ADHD exhibit higher levels of being off-task in motor movement, in verbal language and in passive inattention compared to the other children in the class. These children were also out of their seats more than other children in their classes. It seems that it is possible to use a coding system that I created, along with direct observation, to identify children with possible ADHD in the classroom. I also hypothesized that the grade level would produce a different amount of behaviors, but that is not the case. Both first and fifth graders exhibited the same amount of behaviors, except in Out of Seat behavior. For Out of Seat, the children in first grade got out of their seats more than the children in fifth grade. I thought that younger children would display more behaviors than older children, because most young children are more active than older children are. But the results do not support this idea, except for Out of Seat behavior. This shows that children in first grade are more inclined to move around the room or stand at their seat than fifth graders are, but they are not more likely to fidget in their seats, call out or look around the room. I may not have found a difference for grade level in the other behaviors due to the teaching styles of the teachers. Both first grade teachers were very strict in their enforcement of the rules; they did not allow the children to misbehave or speak out without consequences. An interaction of disorder and session for Out of Seat behavior was found, but no obvious reason was found for this interaction. This could be due to the small sample size and short time

22 The School Psychologist s Role 22 frame of the study. If one of the children behaved out of the ordinary for one session, then it could have a big impact on the data. There are many implications for this study. The observational material I created examines behaviors well-known to be present in children with ADHD. If I could find a child with ADHD using these behaviors to observe, then it would be easier for teachers and other professionals to know what to look for in their classrooms. Instead of the teacher getting frustrated with a student for misbehaving and then punishing them for that behavior (i.e. not knowing why the child behaves in that manner), the teacher can see that their behavior is related to ADHD and can put in effect measures to alleviate those problems. By knowing what behaviors to look for they can accommodate these behaviors to create an atmosphere more conducive to learning. School psychologists use this behavioral information, as well as other information, to help those students cope with their problems both in school and at home. Behavior management plans can be put into place to help the student in school. Some plans that are used are organizational plans such as having a set of books at home and school so they are not lost or forgotten (M. Ross-Gray, personal communication, March 23, 2009). This way the student can succeed in academic areas without the negative side effect of losing work materials. Another type of plan used are classroom accommodations, such as sitting near the front of the classroom so the child can be near the teacher so he or she can redirect the child (M. Ross-Gray, personal communication, March 23, 2009). If this is done the child will be less able to display behaviors related to ADHD because he or she will have more attention from the teacher, and thus, the classroom will be disrupted less often.

23 The School Psychologist s Role 23 One of the PBIS selected intervention strategies used by school psychologist Mary Ross- Gray (personal communication, March 23, 2009) is the Check-in/Check-out system. This is where the child will meet with a mentor before school starts so that he or she can motivate the child to succeed for the day. The child then receives a behavior chart with behavioral goals throughout the day. The child s teachers will fill out the chart and the child returns to his or her mentor at the end of the day to go over the days events. A similar system was in place at the school where I conducted observations, and one of the children I observed used this behavior chart throughout the day to stay on-task and motivated in all of his academic areas. There are, however, several limitations to this study. I do not know if these children actually have been labeled as having ADHD because of confidentiality reasons. So, I could not corroborate my data with actual records of diagnoses to see if my results matched the real cases. There is also the possibility that there are other health/behavioral issues that are present in the children. This could have given the impression that the child had ADHD, but really had another disorder unrelated to ADHD. One of the children I observed may have had concurrent conduct problems which may have masked as ADHD because of his refusal to work. One serious limitation is that I had no other colleague to corroborate my data. I chose the children, and I observed the children, so I may have been biased in my data collection because I knew what behaviors each child should have displayed. This study also only demonstrates that there are significant differences between the possible ADHD and comparison groups, but it does not demonstrate that the children would display enough behaviors to qualify for having ADHD. Several of the children may be more hyperactive or inattentive than other children, but that does not mean that they have ADHD. Also, in this study, this observation only accounts for one small step in the school process.

24 The School Psychologist s Role 24 Observation is a way to monitor RTI prior to and after interventions as a pre-post test measure of RTI (M. Ross-Gray, personal communication, March 23, 2009). The current study does not follow this school process. I only conducted observations for a given time, but did not go through the RTI monitoring process. I could only observe the children in the classroom, but could not follow the proper school channels for qualifying a child with ADHD. In the future, this study could be implemented using a double-blind procedure to mitigate the potential of coder bias. If the coders do not know which children have possible ADHD, then the coders will not consciously or unconsciously code the children differently based on the condition they are in. There should also be more participants to obtain more reliable results. Also, the study could be conducted using several coders to get inter-coder agreement, which would allow the coding structure to be more consistent. This means that the data will have higher validity because all of the coders will be coding the behaviors the same way for all children, each session. In sum, school psychologists are key players in the involvement of alleviating negative behavior in the classroom, as well as helping to lessen social and emotional problems in the classroom and at home. More specifically, school psychologists are integral in the assessment of ADHD in the classroom. They meet with other professionals and conduct assessments of the children to qualify them for a disorder and plan strategies to lessen those behaviors. It is possible to use the behaviors that are most associated with ADHD to diagnose those children, as was done in this study. They are behaviorally different from the other students in their class, making their behavior not conducive to a learning environment. Behavior management plans would be created for these children and teacher accommodations may be made to lessen the problem behaviors. If teachers and other professionals use this information to

25 The School Psychologist s Role 25 locate children in their classrooms who may demonstrate these problem behaviors, then the school psychologist and other professionals could meet to strategize ways to alter these behaviors and help those children succeed in school.

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28 The School Psychologist s Role 28 Vile Junod, R. E., DuPaul, G. J., Jitendra, A. K., Volpe, R. J., & Cleary, K. S. (2006). Classroom observations of students with and without ADHD: Differences across types of engagement. Journal of School Psychology, 44, What do school psychologists do? National Association of School Psychologists. Retrieved November 23, 2008, from: What is RTI? National Center on Response to Intervention. Retrieved March 30, 2009, from: