I completed my observation at Kerkstra Elementary School, located in Oak Forest, Illinois, which serves grades 1-5 in the Forest Ridge School District 142. Kerkstra has received a Great Schools Rating of 7 out of 10, based on its performance on state standardized tests. One of Forest Ridge School District 142's four public schools, G. Kerkstra focuses on a portion of the district’s first- through fifth-grade student population. Kerkstra educates 402 students; 33 of those participate in the district's special education co-ops. Kerkstra currently employs 20 Fulltime teachers; which creates a student/teacher ratio of 19.9. The school prides itself on an environment that promotes respectful, open, friendly and caring attitudes in its well-rounded students. Students are also eligible for the STAR program (Students' Talents and Abilities are Recognized). The program is designed to identify students who have mastered areas of the regular curriculum. Those students then are encouraged to participate in small group classes, special activities and projects. Student
The student I was fortunate enough to observe is currently in the Second Grade, with her chronological age being 7.2. This student will be identified by her pseudonym name “Sarah Jones” to protect the student’s privacy.
Sarah, a 7yr, 2 month old female has been diagnosed with Attention Deficit/Hyperactivity Disorder (ADHD) Combined type: Both inattention and hyperactivity impulsivity symptoms, .and is classified within her IEP as (OHI) Other Health Impairment. Sarah’s classroom teacher’s concerns included poor comprehension of stories, difficult following directions, delayed response to directions/questions, cannot generalize Her mother’s concerns included she “spaces out” and that her falls have decreased her balance plus concern regarding an auditory processing delay. Sarah received speech and language scores all within the average range of ability except for her receptive vocabulary taken from the PPV III. was a (SS 75). Her IEP outlines that she would benefit from language therapy that focuses on expanding and strengthening her vocabulary use along with other special education services to help improve her success in the school setting. Health History
Janet Jones, Sarah’s mother, provided the information for this health history. She stated that she was 31 years old and Father was 32 years old when Sarah was born. She was on blood thinners during pregnancy due to a previous still born birth. Mother has been diagnosed with Asthma and took class C steroids approved for use during pregnancy and used an inhaler when necessary. She denied alcohol and drug use during pregnancy, but did use cigarettes. Sarah was born by scheduled Cesarean Section. Her birth weight was 6lbs. 15 oz. She received oxygen for 1 hour after birth and received regular nursery care. During her first year she did have multiple ear infections and Bronchitis. She was given Good Start Formula for the first year. Developmental milestones that Mom recalled were as follows: She sat unsupported at 6months old, crawled at 10 months old, and walked at 17months old. She was potty trained at 4yrs old. At 2 years old she was only saying 3-4 words, she was not talking at 26 months old, so she began speech therapy at that time. Sarah began to successfully put words together in sentences at 3 yrs. old. The speech therapist reported to Mom that she felt Sarah was not talking due to laziness and because she had older siblings. Concern was expressed to the pediatrician regarding delay in walking and talking. Sarah was seen in the E.R for an allergic reaction to Omnicef, an antibiotic she was given for an ear infection and Bronchitis. At 17 months old she sustained a concussion by bumping her head on a post and was seen in the E.R. Follow up review revealed no complications were found.
Sarah was diagnosed with ADHD by Dr. Karen Vanderplough Booth. Sarah has been noticed to “space-out” usually for less than a minute and not on a regular basis. She was given a 23 hour EEG to rule out Petit Mal Seizures. The EEG was normal. Mom also noticed that Sarah is “clumsy” and will just fall. She seems to have a problem with balance. Mom also stated that they are concerned about an auditory processing delay. She appears to have trouble with balance.
Sarah takes no medication. She is allergic to Omnicef. Sarah has a good appetite, but does not eat vegetables well. She drinks 2% milk and V8 Splash Juice. She sleeps 10 hours at night. Mother also reported that she has no difficulty falling or staying asleep. However, she stated that on several occasions Sarah will wake up with nightmares. She gets at least as hour of physical activity daily. She does not play any team sports at this time. Disability Area/Educational Needs
Other Health Impairment (OHI). Specifically, she is diagnosed with Attention Deficit/Hyper Active Disorder (ADHD) Combined Type: Both inattention and hyperactivity-impulsivity symptoms. Sarah requires some specialized instruction in a small group setting in the areas of reading, writing, and mathematics. Additionally, Sarah requires social work services to support her social skills development. Adverse Effects
Sarah has great difficulty maintaining the necessary level of attention and focus within the classroom setting. As a result, she has difficulty accessing the general education curriculum and often struggles with academic and social tasks. Sarah’s educational team determined that she meets eligibility as a student with a disability under Other Health Impairment. Sarah’s Attention Deficit/Hyperactivity Disorder, and poor executive functioning skills significantly and consistently impact Sarah’s progress both academically and socially. Sarah’s issues of inattention, inability to focus, and impulsivity have consistently impacted her learning based upon assessment and teacher data has difficulty focusing and maintaining friendships in school, has difficulty keeping her materials organized, completing and turning in assignments according to timelines, and her impulsivity has affected her behavior patterns. In addition, the school districts Special Education team determined that Sarah has had appropriate instruction in reading and math but her ADHD characteristics have impacted her rate of learning compared to peers because of their lack of task completion. Sarah’ determined that she requires specially designed instruction to support his ability to focus and attend to direct instruction and independent learning activities including homework and class projects. Sarah requires additional support for her executive functioning skills and social skills with peers.
What is Attention-deficit hyperactivity disorder (ADHD)?
Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood disorders and can continue through adolescence and adulthood. Symptoms include difficulty staying focused and paying attention, difficulty controlling behavior, and hyperactivity (over-activity) (Tomlinson C., 2008, p. 65). Most psychologists, psychiatrists, and pediatricians diagnose ADHD based on a series of inattention and hyperactivity symptoms outlined in the Diagnostic & Statistical Manual for Mental Disorders-Fourth Edition-Text Revision (DSM-IV-TR). For someone to be diagnosed with ADHD, the behaviors must have lasted for at least six months, and be severe enough to disrupt school and other aspects of the individual's life. Inattention symptoms of ADHD include: not paying attention to detail; making careless mistakes; failing to pay attention and keep on task; not listening; being unable to follow or understand instructions; avoiding tasks that involve effort; being distracted or forgetful, and losing things that are needed to complete tasks (Spitzer, Isquith, & Gioia, 2008, p. 53). Hyperactivity-impulsivity symptoms of ADHD include: fidgeting; squirming; getting up often when seated; running or climbing at inappropriate times; having trouble playing quietly; talking excessively or out of turn, and interrupting (The American Psychiatric Association). Based on the above symptoms listed in its Diagnostic and Statistical Manual, the American Psychiatric Association has identified three subtypes of ADHD: Combined Type: Both inattention and hyperactivity-impulsivity symptoms; Predominantly Inattentive Type: Inattention, but not enough (at least 6 out of 9) hyperactivity-impulsivity symptoms; Predominantly Hyperactive-Impulsive Type: Hyperactivity-impulsivity, but not enough (at least 6 out of 9) inattention symptoms (Babinski & Hartsough, 2003, p. 348). ADHD is a chronic disorder, meaning that it affects an individual throughout life. The symptoms are also pervasive, meaning they occur in multiple settings, rather than just one (VanGarderen & Whittaker, 2006, p. 14). Attention-deficit hyperactivity disorder (ADHD) is the current term for a specific developmental disorder seen in both children and adults that is comprised of deficits in behavioral inhibition, sustained attention and resistance to distraction, and the regulation of one’s activity level to the demands of a situation (hyperactivity or restlessness). This disorder has had numerous different labels over the past century, including hyperactive child syndrome, hyperkinetic reaction of childhood, minimal brain dysfunction, and attention deficit disorder (with or without hyperactivity) (Tomlinson C., 2008, p. 121). Children with a clinical diagnosis of attention deficit hyperactivity disorder (ADHD) are at high risk for academic impairment, special education, grade repetition, and high school dropout (Biederman et al., 2004; Currie & Stabile, 2006; Deshazo-Barry, Lyman, & Klinger, 2002; DuPaul et al., 2004; Rapport, Scanlan, & Denney, 1999; Spira&Fischel, 2005). Children with ADHD display developmentally inappropriate symptoms of inattention and/or hyperactivity in more than one context (American Psychiatric Association, Diagnostic and Statistical Manual, 4th ed., TR, 2000).
Primarya. .Attention deficits (distractibility; inconsistency in focus) b. I impulsivity c. Over activitySecondarya. low frustration toleranceb. sleep problemsc. personality disorders d. disorganization in time and place e. poor self-esteem, moodiness and depression f. learning problemsEducational Issues a. Poor time management skillsb. Executive function difficultyc. Reading comprehension difficulties d. Difficulty with math problems requiring changes in action, operation, and ordere. Inability to listen selectively during lectures, resulting in problems with note takingf. Lack of organization in work, especially written work and essay questionsg. Limited elaboration skills, both speaking and writing h. problems learning foreign languages| The following figure and notes are adapted from Biederman, J., Monuteaux, M.C., Doyle, A.E., Seidman, L.J., Wilens, T.E., Ferrero, F., et al. (2004). Impact of executive function attention deficit/hyperactivity disorder.
Figure 1. Typical Characteristics of Attention Deficit/Hyper Activity Disorder.
Academic Achievement Observation and Test Analysis
In addition to my visual observation of my student I was granted permission by Sarah’s Parents to interview both the School Psychologist and her parents and to review her assessment scores and IEP to better understand where Sarah fit in with her peers in regards to her abilities and social skills. Evaluation
Sarah was administered a set of tests from the Woodcock Johnson III Tests of Achievement. Sarah’s oral language skills are low average (SS86) when compared to the range of scores obtained by others at her age level. Her oral expression skills (SS96) are average; her listening comprehension skills (SS86) are low average.
When compared to others at her age level, Sarah’s academic Knowledge (SS96) and skills (SS100) are both within the average range. Her fluency (SS87) with academic tasks and her ability (SS81) to apply academic skills are both within the low average range.
Sarah’s performance in basic reading (SS103), reading comprehension (SS96) and basic writing skills (SS105); low average in math calculation skills (SS88) and math reasoning (SS90); and low in written language.
Information regarding Sarah’s academic abilities was gleaned from her performance on the WJ-III (administered by School’s School Psychologist), and an analysis of Sarah’s performance on a recent district-wide assessments including the Measure of Academic Progress (MAP), and Aims web benchmarking. On the WJ-III, Sarah obtained a Total Achievement standard score of 88 (81-94) which falls within the Low Average range of achievement and indicates that she performed as well as or better than 20% of individuals her age.
Physical Environment of the Classroom
Arranging the physical environment of the classroom is one way to improve the learning environment and to prevent problem behaviors before they occur. Research on the classroom environment has shown that the physical arrangement can affect the behavior of both students and teachers and that a well-structured classroom tends to improve student academic and behavioral outcomes (VanGarderen & Whittaker, 2006, p. 115).
In addition, the classroom environment acts as a symbol to students and others regarding what teachers’ value in behavior and learning (Savage, Weinstein, & Evans, 1999). If a classroom is not properly organized to support the type of schedule and activities a teacher has planned, it can impede the functioning of the day as well as limit what and how students learn. However, a well-arranged classroom environment is one way to more effectively manage instruction because it triggers fewer behavior problems and establishes a climate conducive to learning (Ratey, 2008, p. 69). Spatial
The spatial structure of the classroom refers to how students are seated, where the students and teacher are in relation to one another, how classroom members move around the room, and the overall sense of atmosphere and order. The research on classroom environments suggests that classrooms should be organized to accommodate a variety of activities throughout the day and to meet the teacher’s instructional goals (Savage, Weinstein, & Evans, 1999). In addition, the classroom should be set up to set the stage for the teacher to address the academic, social, and emotional needs of students (VanGarderen & Whittaker, 2006, p. 13)). Most researchers agree that well-arranged classroom settings reflect the following attributes:
Clearly defined spaces within the classroom that are used for different purposes and that ensure students know how to behave in each of these areas (Quinn, Osher, Warger, Hanley, Bader, & Hoffman, 2000; Stewart & Evans, 1997; Walker, Colvin, & Ramsey, 1995; Walker & Walker, 1991). For instance, classrooms will contain a high-traffic area around commonly shared resources and spaces for teacher-led instruction or independent work, such as rows of desks. Seating students in rows facilitates on task behavior and academic learning; whereas more open arrangements, such as clusters, facilitate social exchanges among students (MacAulay, 1990; Walker & Walker, 1991). Interventions
Classroom interventions for the student with ADHD should be based upon a solid foundation of general behavior intervention principles. While students with ADHD do have a core of common problems, this group is fairly heterogeneous. Thus, instead of focusing on ADHD symptoms, management should first directly target the specific problem behavior. Next, an alternative behavior, incompatible with the problem behavior, should be selected. It is important to keep both behaviors in mind. Not only do we want to make it clear to students what behavior is unacceptable (what we don't want them to do), but we also want to make it clear what behavior is acceptable (what we want them to do). These behaviors should be carefully defined so that the teacher will be able to accurately monitor them (MacAulay, 1990; Walker & Walker, 1991).
I was impressed by the nice displays the teacher had on the wall. They were very detailed and colorful. One could tell that much preparation went into them. The desks were arranged in rows with space between each desk. This also allowed room for the learning centers that were set up around the room. These were also a wonderful asset to the room!
The arrangement of desks and working space, the attractiveness and appeal of bulletin boards, the storage of materials and supplies created an organized and functional space. The room had personal touches with plants, art, rugs, posters, and some cozy pillows for the reading corner to create a comforting atmosphere.
In addition to having desks in rows (plenty of space for teacher to walk in between) the teacher individualized, self-paced curriculum, by setting up individual spaces.
To make her students feel like they are in a “real life work setting” (and to keep students who are having focus issues that day the teacher set up an area like an office, with cubicle stations and a “lounge” where students go to relax and take a moment to re coop when becoming over stimulated.
To accommodate Sarah and other students who are “pulled out” during a lesson for special services (counseling, speech/language instruction), the teacher made a conscience decision to arrange her seating so that she is nearest to the door. For example, when Sarah is summoned by the occupational therapist during learning center time would be assigned to the center closest to the door. When Sarah would be leaving during “rug time” (when students gather and sit on a rug to engage in a learning activity) the teacher would have her sit on the outside of the group and closest to the door.
The teacher’s goal in creating the physical environment was to promote attention, structure, access, and orderly movement. Consequently, the spacious, organized and welcoming classroom minimized distractions and enabled the students to feel comfortable in their learning environment.
An additional contributing factor in the classroom is the environmental aspect (climate) of the room. Temperature preferences vary dramatically, and most students can't concentrate when they are either too cool or too warm. Teacher has bulletin board with Care Bears dressed differently with the weather which help students become aware of their own temperature preferences and encourage them to dress accordingly. Interventions
From the beginning of my observation I was excited to see that the teacher was extremely focused on creating a “comfortable” emotional environment for students to learn. Below are a few of the strategies that I observed on a daily basis. Students appeared to feel comfortable mainly because the teacher consistently appeared comfortable and genuinely happy to be with the students. Class Rules and Consequences lists are placed in Large Bright colors in room with Visual Cues to help students with poor reading skills or short attention span to understand. I observed on several occasions when a student was acting inappropriately the teacher would make eye contact with the student and clearly point to the classroom rules (specific picture depending on students behavior) so the student understands what behavior they are doing that is inappropriate without having the teacher stop her lesson to address the student (mainly Sarah).
Students with Emotional disabilities have different learning styles and rates, strengths and weaknesses. The Individuals with Disabilities Education Act (IDEA) requires that an Individualized Education Program (IEP) be developed for each child with a disability so that these individual differences can be addressed. Accommodations are alterations in the way tasks are presented that allow children with learning disabilities to complete the same assignments as other students. Accommodations do not alter the content of assignments, give students an unfair advantage or in the case of assessments, change what a test measures. They do make it possible for students with LD to show what they know without being impeded by their disability (Savage, 1999; Weinstein, 1992)
It's no secret that a typical classroom is an overwhelming place for a child with ADHD. It is overloaded with sensory input and distractions, extraordinary challenges, and peers who seem smarter and more capable than themselves. Diagnosis itself can help with self- esteem in a child who is old enough to understand the basics of their ADHD when explained to them. However, the parents, child, and school staff acknowledging the child has ADHD does nothing to cultivate their school success. Modifications must be made to expectations and to classroom management.
Traditionally, special educators are trained to provide individualized instruction to each student on their caseloads. They create individual education programs (IEPs) based on students’ needs and align goals and objectives with grade-level curriculum and state standards as much as possible. Rarely is there time or the opportunity for special educators to teach large groups of students. Special educators differentiate instruction routinely; it is their job and what they are trained to do. On the other hand, general educators are trained in teaching methods and content area subjects (English, mathematics, science, and reading). They teach large groups of students; rarely, is there time for individualized instruction. As a result of the No Child Left Behind Act and Individuals with Disabilities Education Improvement Act - 2004, general educators are now being asked to, design materials and activities that can meet the needs of all students initially, rather than make modifications after the (Tomlinson C., 2008, p. 23).
Specific Accommodations/Modifications Outlined in IEP
As outlined in Sarah’s IEP it is deemed necessary for supplementary aids and services to be provided to/or on behalf of Sarah in order for Sarah to make progress towards attaining her annual goals, to be involved and make progress in the general education curriculum and participate with other children. The supplementary aides include; pacing and timing; environment and/or setting, and response and presentation. Placement Option: Resource Level Programming
While this program removes Sarah from her general education classroom, her instruction for her needs can be addressed without having to remove Sarah from her classroom and her peers for long periods of time. Sarah is removed from her classroom for small durations throughout the day (as outlined on first page) to accommodate Sarah’s needs. However, she is not placed in an Instructional Level Program due to the harmful effects of removing Sarah from her general education peers for long periods of time will have on her social adaptation skills. Educational Needs
Sarah requires some specialized instruction in a small group setting in the area of reading, writing and mathematics. Additionally, Sarah requires social work services to support her social skills development. The individualized time frame of her IEP Special Education Services are provided on the figure below.
| Min. Per Week| Daily Minutes| Frequency|
Gen Ed. Classes| 1625| 45| Daily|
SPED Resource| 300| 30| Daily|
Speech Therapy| 45| 45| Once Weekly|
Social Work | 30| 30| Once Weekly|
Figure 3. Services provided by Sarah’s IEP (Individualized Education Plan).
Tomlinson (1999) indicates, There is no one 'right way' to create an effectively differentiated classroom; teachers craft responsive learning places in ways that are a good match for their teaching styles, as well as for learners' needs (p. 3). Sometimes all students will be working on the same assignment with different assessment criteria. Sometimes students will be working on different assignments that focus on the same concept. Teachers may not differentiate instruction all of the time; only when they observe a need to do so (Smutny, 2003). Figuring out how to differentiate instruction depends on knowing students' learning and thinking styles (Smutny, 2003, p. 8). Teachers may observe or interview their students to determine their interests (books, talking, technology), learning styles (auditory, visual, tactile/kinesthetic), and learning preferences (large group, small group, individual). Teachers differentiate instruction by building on student strengths, providing options in content material and assessments, and aligning instructional strategies with student learning styles (Spitzer, Isquith, & Gioia, 2008). Differentiated instruction must give all students challenge and incentive to apply them in new ways (Garald, 2012, p. 732)). Therefore, teachers need to incorporate a variety of teaching techniques or pedagogical strategies that provide students with a variety of opportunities to engage in the learning process. A sampling of pedagogical strategies include: whole group discussions; small, collaborative learning groups; individual contracts; self-paced learning centers; literature circles; or team technology projects. Providing numerous opportunities for students to engage in classroom activities, makes students less competitive with each other... (Smutney, 2003, p. 3) and helps to prevent underachievement among these students by giving them more choices in the way they process information and in the kinds of activities and materials they use to show what they understand (p. 8).
Classroom Management Techniques: Adapted from Walcot-Gayda, 2004 Following are the top classroom management techniques and accommodations adapted from Walcot-Gayda; 2004, which is compiled of top experts and physicians in behavioral specialties. Keep in mind; it is crucial that all adjustments be made in a way as to not draw negative attention to the student. Avoid public identification; it is important not to embarrass the child. Positive behavior plan
Focus on praising and rewarding positive behaviors so they will seek out that positive attention again and again. This should be implemented in all classrooms, not just those with ADHD students. Often children with ADHD require immediate rewards but elementary classroom discipline programs offer long-term rewards. Daily Schedule
Everyone with ADHD needs structure. For elementary students, post a daily schedule on the wall where the children can reference it at any time. Also, be sure a transition warning is given when the current activity is coming to a close -- "5 more minutes before we clean up and go to P.E." (VanGarderen & Whittaker, 2006) Proximity
Seat the student close to the teacher and away from heavy traffic areas such as doors, windows, pencil sharpeners, etc. Repeat instructions
Whether a teacher in the classroom or a parent in the home, have the child repeat instructions back to you to ensure they were paying attention when instructions were given but to also be sure they understood the instructions. Simplify instructions and tasks -- complex, multi-part instructions will be very difficult for the ADHD child. Another great tip that falls into this category is to place your hand lightly on the child's shoulders when giving instruction. This is a physical cue to listen up. We are implementing this at home with great success. Leadership and accountability
The ADHD child struggles with their reputation among classmates and, unfortunately, often with school staff as well. They should be given tasks/jobs within the classroom and especially within small peer groups that they are easily capable of succeeding in. This will improve their self-image and the approval of others (Barkley, 2004).
Classroom Methods Observation
Positive behavior plan
On one occasion Sarah’s teacher handed out play money based on the behavior of each student at the end of each day. At the end of the week they can "purchase" items from the treasure box -- the more they earned during the week, the better the prize. This however did not motivate Sarah to change her behaviors -- she appeared to need more immediate rewards. Therefore her teacher created a behavior chart just for her based on the behaviors she most needed to improve. At the end of each day she gets to choose an item from the treasure box if she received enough total stickers that day. I found this to be very beneficial to motivate Sarah. Promote Leadership and Responsibility Throughout my observation I focused in on how very friendly, cooperative and was engaged in each activity. She understood the directions that were given to her on tasks and I observed that she was giving her best effort. Every day the teacher would give Sarah a task to complete that helps the teacher and her fellow classmates. For example, on one occasion the teacher asked Sarah to pass out tests to the students in the classroom. Sarah beamed with excitement and took great care and effort to ensure that every student received their test. She made eye contact with each student and smiled at everyone as she passed out the papers. This not only allowed Sarah to move around the classroom but also helped build on her responsibility role. Proximity
Throughout my observation I became increasingly aware of Sarah’s inability to “sit still” in her desk. She appeared to continuously fidget, squirms in her seat and was easily distracted by anyone sharpening their pencil or entering or leaving the room. To combat this issue the teacher placed her off to the side of the bulk of the students and gave her own area (delineated with tape on the carpet around her desk) within which she was allowed to move and still be considered "staying in her seat." This way she is not distracting the other students with her fidgeting but still allowed moving around a bit, something out of her control.
Research conducted in the 1980s and more recently has suggested that children with ADHD have difficulties with reading comprehension that are the result of broadly based language problems and not limited to simple difficulties with word recognition. Since reading comprehension is crucial to school success, it is essential to understand the difficulties children with ADHD face as they encounter new text and to identify instructional approaches that focus on learning and using the many skills that are needed for successful reading. Students with ADHD often show signs of giving up too quickly when faced with a difficult passage. This so-called task persistence, a skill that must be acquired by all readers, is especially important for successful reading of expository text, such as history and science textbooks, newspapers, and voter pamphlets (Savage, 1999; Weinstein, 1992). Children with ADHD, who have a history of academic difficulties, have documented gaps in grade-appropriate knowledge of history, geography, and other subjects (Savage, 1999; Weinstein, 1992). Students with ADHD may often exhibit problems with reading, particularly in the area of reading comprehension. However, these problems are different from those the result from a reading disability. The table below provides a summary of reading differences between students with reading disabilities and those with ADHD. While many students with ADHD are often characterized as having a Reading Disability, there are significant differences between students with a Reading disability and students with ADHD. For example, a learning disability is a language based disability and ADHD is not (Weiler, Bernstein, Bellinger, &Waber, 2002). In addition, Students with ADHD tend to have more deficits in visual search tasks but not on auditory processing tasks (Weiler, 2009, p. 85)et. al.,2002). Reading disabilities have recognition problems associated with poor word attack scores (e.g., decoding nonsense words) (Lyon, 1992; Stanovich, 1993). On the contrary students with ADHD have reading comprehension problems especially with long and uninteresting passages- associated with sustained inattention (Babinski & Hartsough, 2003, p. 352). In addition, students with ADHD have poorer listening comprehension than reading comprehension (for a review, see Aaron, Joshi, Palmer, Smith, & Kirby, and 2002). Reading Disabilities is a Phonological skill deficit and ADHD does not (Foorman, Liberman, & Stanovich, 1998, p. 73). Lastly, students with ADHD have Slower and less accurate in naming letters and even in naming colors than their peers, even when controlling for phonological skills and vocabulary (Babinski & Hartsough, 2003, p. 349).
Written Expression Research
It has been estimated that as many as 60% of students with ADHD also meet the criteria for the condition known as “disorder of written expression” (Tannock and Brown, 2009). Students with this disorder test well below the expected level of written expression based on the student’s age, ability, physical disabilities, or education. The condition is characterized by difficulties such as communicating in writing; organizing thoughts; reproducing words and or letters; correct spelling; correct punctuation; correct grammar and legible handwriting. Children with attention problems may be more likely to have written expression difficulties than children without attention problems because they often exhibit weaknesses in executive functions (EF) and working memory (WM) (Tomlinson C., 2008)). Developing writers need high levels of attention and memory resources, as well as linguistic and transcription skills in order to hold thoughts about content in mind while remembering and writing letter forms, identifying correct spellings, and thinking of suitable words and phrases (Berninger, Cartwright, Yates, & Swanson, 1998). Specifically, the writing process draws heavily on EF and WM to coordinate, execute and regulate a number of component writing skills all at once (Altemeier, Abbott, &Berninger, 2007; Berninger, 1999; Bourke & Adams, 2003; Hayes, 2005;by children with ADHD in previous studies are due to coexisting weaknesses in reading skills. Common features of written expression difficulties are: Spelling errors, grammatical errors, Punctuation errors, Poor paragraph organization, and poor handwriting Tomlinson, C. (1999).
Written/Language Expression Observation
When it comes to Sarah’s academic problems, I feel her ADHD is a major contribution to her poor academic performance. One of the characteristics he has as do most other children with ADHD is problems with language learning and written work. I feel this contributes to substantial frustration in Sarah with classroom learning. Some examples of Sarah’s problems with written language can be seen in her work. Sarah has very poor handwriting and struggles with her spelling. I have seen a variety of her spelling tests and it appears she is still in the emergent literacy phase. She would benefit from one on one instruction focusing in on her phonics and phonemic awareness. When the teacher asks her to spell a specific word by sounding it out, she struggles on putting together the correct letters to make the correct sounds. This illustrates her need to improve on her phonemic awareness and therefore leads me to believe that she is still in the emergent literary phrase.
An additional concern that I observed in regards to her written language is that she has a difficulty putting her thoughts into words and sometimes stutters when under stress. For example, each day the students are required to have “open journal time” every morning which consists of the students writing their thought freely in a journal for five minutes. The first day of my observation I noticed that Sarah would pull her journal out of her desk (which took over a minute to locate due to the disorganization of her desk). Upon finding her journal she began to fidget in her desk, chew on her pencil and spent over one minute drawing circles on her paper rather than writing. The aide noticed that Sarah was doodling on her paper instead of journaling and sat down next to Sarah to speak with her. Sarah’s Aide proceeded to tell Sarah “just write about what you did last night.” Sarah replied “I don’t remember” and continued to doodle on her paper. Sarah’s Aide began asking Sarah about what activities did she do after school and Sarah replied “we played.” This demonstrated not only a memory issue but illustrated an inability to express herself both verbally and written.
Many different disabilities can affect children’s math learning and performance, but none more than disabilities that affect cognition—mental retardation, traumatic brain injury, attention-deficit/hyperactivity disorder, and learning disabilities, to name a few. Attention Deficit Hyper Activity Disorder is one specific area of disability which is clearly connected to math learning difficulties. Visual processing, visual memory, and visual-spatial relationships all impact math proficiency in that they are threads in the fabric of conceptual understanding and procedural fluency (Kilpatrick et al., 2001). Specific math learning difficulties associated with ADHD also can affect a student’s ability to formulate, represent, and solve math problems (known as strategic competence). According to the McAuley, Chaban, and Tannock (2009), research has shown that some students with ADHD have math weaknesses such as commixing procedural errors; work slower than peers; have trouble retrieving number facts that should be easily remembered; cannot comprehend work problems; have difficulty ignoring non-relevant data in word problems; have trouble with problems with a number of multiple procedures or steps. Mayes and Calhoun (as cited in Platt, n.d.) noted that 26% of students with ADHD also have a math learning disability. It is not clear why so many ADHD students have math difficulties but it is a problem when teaching students with ADHD.
The Broad Math Cluster on the WJ-III provides a comprehensive measure of achievement in mathematics. Sarah’s performance on this domain reflects her level of skill in problem solving, number facility, automaticity and reasoning. Broad Math Score
Sarah’s SS score was 89 (82-95) which falls within the higher bounds of the Low Average range of achievement. This indicates that Sarah performed as well as or better than 23%of her same aged peers. Observation
Throughout my observation I noticed that Sarah expressed anxiety when it came time for her math course work. Every day I noticed that she would begin to fidget in her seat, chew on her pencil and tap her leg uncontrollably when the teacher announced that they were switching to their math coursework. Her anxiety would continue throughout the lesson (in which she would space out and doodle on her paper rather than pay attention). As a result of her anxiety her teacher collaborated with her resource teacher and she was subsequently placed in Resource throughout Math in which she received one on one instruction with the resource teacher.
After Sarah was moved to her Resource room for instruction and time to work on her math I observed that Sarah’s anxiety (i.e. fidgeting in her seat, tapping of her leg and biting pencil) subsided drastically. Furthermore, after the first week of being placed in her Resource Room Sarah would become excited to work on her math with her teacher. I observed that the Resource room provided less distraction while both the Resource Teacher and Aide in the classroom worked to keep her on track.
In addition, Sarah has difficulty telling time, especially if it is not a digital clock. She struggles when it comes to learning sequenced information or tasks. In math she can rarely put numbers in order from least to greatest if the numbers are not simple whole numbers. Calculations
Sarah’s Standard score was (SS:87). On a task requiring her to perform a variety of calculations from simple to complex Sarah performed in the low average range (SS:87). Observation
In this area of I observed that Sarah was able to correctly solve Single digit problems (both addition and subtraction) that were presented both vertically and horizontally. After successfully completing four items on the worksheet however, Sarah began to make mistakes on sign-reversal. I observed her adding (correctly) on items that required subtraction. Throughout my observation she continuously demonstrated the ability to us subtraction with single-digit numbers, I concurred that these errors are suggestive of a lapse in attention to detail, rather than an inability to use the targeted academic skill. However, I noticed that Sarah performed slightly better on a math quiz that assessed the students’ ability to solve simple addition and subtraction problems with accuracy and speed.
Cognitive Executive Functions Research
Memory involves many different skills and processes such as encoding (the ability to organize information for learning). Students with Emotional disabilities may experience deficits in working memory which affects their ability to store new information and to retrieve previously processed information from long-term memory (Tomlinson, C. (1999). Very often, people with ADHD will report that they have adequate or exceptional memory for things that happened long ago, but great difficulty in being able to remember where they just put something, what someone just said to them, or what they were about to say. They may describe difficulty holding one or several things "on line" while attending to other tasks. In addition, persons with ADHD often complain that they cannot pull out of memory information they have learned when they need it (Thomas E. Brown, 2005, p. 34). Students with Emotional disabilities are often characterized by certain cognitive problems that contribute to the difficulties they have learning academic content. One of the most frequently noted problems among students with ADHD is a memory deficit. Many students with Emotional disabilities have difficulty with long-term memory and experience great frustration in attempting to learn basic information and rapidly retrieving this information during school activities. For example, many students with Emotional disabilities who have problems with math have difficulty learning math facts. Moreover, they may remember facts one day and forget them the next. Much the same can be said about learning to spell for a significant number of students with learning disabilities. The most frequently investigated aspect of memory for students with Emotional disabilities is working memory (Siegel, 2003). Working memory is the ability to see something, think about it, and then act on this information. For example, when reading, a student sees a word he does not know, retrieves information from his long-term memory regarding the letters in the word and the sounds they represent, blends these sounds into a word, and then says the word while retaining information regarding the context of what is being read. Obviously, this is a complex process and is made more difficult by the fact that a fundamental problem that many students with learning disabilities face is a deficit in working memory. Evidence indicates that working memory problems contribute to learning disabilities in the areas of reading, mathematics, and written expression (Swanson & Saez, 2003).
In addition, students with Students with ADHD recall fewer items in short term memory tasks, but they also allocate less time to rehearsing information and do not select more efficient methods to memorize (i.e., categorizing information). When information is pre-categorized they can recall as much as their peers (Altemeier, L.E., Jones, J., Abbott, R. D., &Berninger, V. W. (2006).
Cognitive Functions Observation
Sarah demonstrated on a continuous basis difficulty with her working memory. For example, one morning Sarah’s teacher played the movie “Narnia” as a reward for the classes’ exceptional behavior. Upon the completion of the movie the teacher asked the teacher to write a short journal about which character she enjoyed the best and why. When the students began writing I noticed that Sarah began fidgeting in her desk and chewing on her pencil. The teacher went over to assist her and she explained to the teacher that she doesn’t remember all the characters and she can’t think of one that she likes. Her inability to hold information in mind (sustain attention) and to ignore non relevant interfering information demonstrated typical ADHD behavior in regards to short term memory in addition to her working memory. In response to Sarah’s difficulty remembering, she created an organizational chart which had the characters on one side of the chart (with a picture for visual a visual cue) and left a space for Sarah to describe each character. Organizing and categorizing the information enabled Sarah to simplify her thinking and allow her to focus on one character at a time.
Instructions are a very difficult area for Sarah. For example, when working on an arts and craft assignment (which required four simple directions) Sarah struggled through each step. The teacher explained the directions using a visual demonstration. Throughout the teacher’s explanation Sarah was not paying attention and spent the time playing with the scissors that were to be used only for the project at hand. Furthermore, when Sarah’s teacher wrote out the instructions for the students she became confused when trying to transition between step 1 and 2. Sarah was able to successfully complete the art project only when the Teacher’s Aide and physically walked Sarah through each step. Spelling Difficulties
While I noticed that Sarah struggled with her spelling, I do not feel that she had any issues with her pronunciation of words while reading. I observed Sarah taking two spelling tests and I noticed that she would speed through the test in a very short time period (even though her IEP allows for extra time). It appeared that her main focus was to just complete the test. Sarah received 5 out of 8 incorrect on her first test and 3 out of 8 n her second test. Sarah was given opportunities on both tests to re-take her test in the Resource room (which provides minimum distraction). While taking the spelling tests in the resource room I observed that Sarah did not fidget in her chair and remained focus for the 5 minute duration time of her test. However, her scores only increased minimally, which gives me the impression that her spelling abilities need to be addressed. Sight vocabulary and Reading Difficulties
While watching Sarah read both out loud in the classroom and during the 15 minute SSR (Silent, Sustained Reading) I found that Sarah loves to read. She becomes ecstatic when it’s reading times and jumps out of her seat (teacher has had to correct her numerous times for getting out of her seat too early). As I stated above her pronunciation does not appear to be a difficult issue and she seems to be at level with the majority of students within her class. Therefore, I do not believe that her reading ability is an issue.
Short Term Memory
Sarah struggles immensely with memorization. For example, I observed Sarah in her music classes on two consecutive occasions. While Sarah immensely enjoyed dancing around to the lively music and was able to keep on beat with the music she was unable to sing the song that the class had been practicing for two weeks prior. Sarah would remember the first few words and would begin to hum to herself and chime in when she remembered a part of the song. In addition, I noticed that when the students recite The Pledge of Allegiance” every morning that Sarah again struggled through remembering the words. These examples have led me to infer that Sarah does have difficulty with memorization of material. Forgetfulness
Forgetfulness is one of the main concerns that both her parents and her teacher expressed with me upon interviewing them. I witnessed her forgetfulness on several occasions. For example, I witnessed Sarah placing her library book in her back pack and putting it back on the hook with her hook. Within five minutes Sarah was frantically looking throughout the classroom, under her desk, by the window etc. looking for her library book. On a separate occasion Sarah was given a note to put in her folder to give to her mother when she got home. Sarah proceeded to put her note in her desk (rather than follow directions to put in folder) and shut the top of her desk. At the end of the day the teacher reminded the students about the importance of ensuring that the note was given to all of their parents and be returned to school the next day. While Sarah was completely oblivious to the fact that she needed to take her note home, she didn’t even make an effort to take the note out of her desk to put in folder. When her teacher asked the students for their notes the following day Sarah stared at the teacher in confusion. She proceeded to tell the teacher that she never received a note to give to her mother. This behavior not only displays her forgetfulness but is also an example of her disorganization skills (also a side effect to ADHD).
Executive Functioning Research
Executive functioning is the brain's ability to absorb information, interpret this information, and make decisions based upon this information. A primary function of the executive system is directing, sustaining and coordinating attention (Tomlinson, C. (1999). Individuals with ADHD often have difficulty with executive functions and may display high levels of physical activity, inappropriate physical responses to others, a tendency to interrupt and disrupt group activities, or trouble with emotion regulation (Swanson &Saez, 2003). Deficits in “executive functioning” include planning, organizing, and time management. According to the National Resource Center on ADHD (2008), teens with ADHD often have deficits in “executive functioning,” which are the functions within the brain that “allow individuals to foresee longer-term consequences for actions, plan accordingly, evaluate progress, and shift plans as necessary” (p.1). In other words, executive functioning is the overall ability people possess that is similar to how an executive of a company or business must function. Bailey (2009) noted that executive function gives us the ability to monitor our behaviors through Planning and organization; keeping track of time; being able to accomplish more than one thing at a time; recalling past knowledge and using it in a current situation; evaluating progress and changing direction when needed; completing tasks or work on schedule; understanding and engaging in group dynamics, including waiting turns during conversations; seeking out additional resources or information or asking for help when needed; controlling emotions (Bailey, 2009, ¶2).
Moreover, disorganization is a very common problem for students with ADHD. It is not classified as a separate learning disability under the Individuals with Disabilities Education Act (IDEA), but problems associated with disorganization can affect every area of a person’s life including organizing materials such as homework papers, books, and notes (e.g., forgetting, misplacing, or losing them); following instructions; sequencing numbers, facts, and other information; planning and implementing projects and assignments (Barkley, R.A. (1997) pg. 121). Activation
This includes organizing tasks and materials, estimating time, prioritizing tasks, and getting started on work tasks (Thomas E. Brown, 2005, p. 31). Patients with ADD describe chronic difficulty with excessive procrastination. Often they will put off getting started on a task, even a task they recognize as very important to them, until the very last minute. It is as though they cannot get themselves started until the point where they perceive the task as an acute emergency (Thomas E. Brown, 2005, p. 32). Action/Motion
According to the National Resource Center on ADHD (2008) Emotions include managing frustration and modulating emotions. Although DSM-IV does not recognize any symptoms related to the management of emotion as an aspect of ADHD, many with this disorder describe chronic difficulties managing frustration, anger, worry, disappointment, desire, and other emotions. They speak as though these emotions, when experienced, take over their thinking as a computer virus invades a computer, making it impossible for them gives attention to anything else. They find it very difficult to get the emotion into perspective, to put it to the back of their mind, and to get on with what they need to do (Ratey, 2008, p. 45). Furthermore, Action includes monitoring and regulating self-action. Many persons with ADHD, even those without problems of hyperactive behavior, report chronic problems in regulating their actions. They often are too impulsive in what they say or do, and in the way they think, jumping too quickly to inaccurate conclusions (Thomas E. Brown, 2005, p. 33). Persons with ADHD also report problems in monitoring the context in which they are interacting. They fail to notice when other people are puzzled or hurt or annoyed by what they have just said or done and thus fail to modify their behavior in response to specific circumstances. Often they also report chronic difficulty in regulating the pace of their actions, in slowing self and/or speeding up as needed for specific tasks (Thomas E. Brown, 2005, p. 33).
Sarah struggled immensely with organizational skills (including materials and time management. For example, from the first day of observation I took notice that her desk was filled with torn papers, markers without caps, open glue sticks, broken pencils, spiral notebooks with torn out pages and an array of folders with papers thrown in them with no form of organization. When Sarah entered the classroom on my first day of observation (8am) she ran into the classroom with both shoes untied and threw her back pack (which was half open and spilling out a spiral notebook and a black pen. While the other students in the classroom appeared to be organizing their homework from their bags to place on the teacher’s desk, Sarah stuck her hand in her bag and pulled out a handful of crumpled papers from a pocket in her back pack. She appeared confused as to what each paper contained and proceeded to empty the contents of her folder on her desk frantically looking for a math homework that needed to be handed in. Sarah’s chronic disorganization however, was not limited to the classroom. As I stated previously I was able to observe Sarah in her home to view how her behavior transitioned from the classroom environment to her home. Sarah’s room was continuously a disaster. Her closet was filled with clothes, shoes, socks, toys etc. Through this observation I was able to infer that Sarah demonstrates typical ADHD characteristics in regards to organization. Sarah also struggles with procrastination. Sarah has difficulty with starting tasks. For example, I observed Sarah in her Resource Room on several occasions. On one occasion Sarah was given a math worksheet to complete (four problems). She was given instruction that if she did not complete her worksheet that she would not be able to go out for recess. As I stated previously, Sarah struggles with math (but immensely enjoys recess). Instead of beginning the worksheet Sarah stared at the worksheet and began to fidget and chew on her pencil. Next, she raised her hand and told the teacher that she had to use the washroom. The teacher told her that as soon as she finished the first problem that she could use the washroom. Instead of working on her math problem, Sarah began rocking in her chair, and drew circles all over her papers. This behavior continued until the other students were being released for recess. As soon as Sarah saw the other students leaving for recess and she had to stay in and complete her homework she began to frantically write on her paper to complete the task as quickly as possible (incorrect problems). Action/Motion
Sarah’s impulsiveness and inability to self-regulate is a contributing factor to Sarah’s struggling social skills. When it comes to Sarah’s emotional and social development, I feel she has difficulty “fitting” in with other children in her classroom and age group. While Sarah is a friendly and polite child in the school setting, she is often easily distracted in the classroom and has difficulty maintaining her attention on tasks and has self-regulation issues. For example, one morning Sarah entered the classroom in the morning and was told to put her coat and backpack away and retrieve her assignments out for the day. While rummaging through her bag to retrieve her assignments for the day Sarah became distracted by two little girls talking next to her. She immediately dropped her book bag and became fixated on the two little girls talking to each other, forgetting about the task at hand. However, instead of joining in on the girl’s conversation Sarah just stood with her mouth open and stared her fellow students. This made the girls extremely uncomfortable and they subsequently walked away from her. This behavior was consistent throughout my observation and was not limited to the classroom. This behavior was an example of Sarah’s inability to self-regulate and understand that her behavior was inappropriate and not being able to correct her behavior by identifying and implementing social cues. Another example of self-regulation issues that I observed is that Sarah struggles with personal space. When she speaks to someone she will walk right up to their face and begin to talk loudly. For example, one morning Sarah needed to sharpen her pencil at the front of the classroom. While Sarah was waiting in line she stood directly behind the student who was sharpening her pencil (blocking her arm to rotate the pencil). The student sharpening her pencil tried to move around Sarah to give herself room to complete sharpening her pencil and Sarah just moved closer. Furthermore, Sarah began fidgeting behind the student and asking her to “hurry up” and “why was she taking so long” oblivious to the other student’s nonverbal cues. Sarah doesn’t really interact with her peers in social situations (i.e. recess). She often is more of an observer than an active participant. However, I feel that Sarah’s self-esteem is not an area of concern, even though she struggles socially. When she doesn’t have to sit still and learn she is a very content young girl. She really takes pride and pleasure in knowing the right answer. Sarah will become elated when she knows the answers to any of the teacher’s questions. Sarah becomes so excited to the point that she will raise her hand while almost jumping out of her seat and wave his hand back and forth and say, “Ooo, Pick Me, Pick me!” When the teacher calls on her and she answered the question correctly she gets so elated and will either shout out “yes” and/or have a big smile on her face. While this behavior demonstrated Sarah’s elevated self-esteem, it also revealed her impulsivity problem. An additional support of Sarah’s great self-esteem is when she makes an effort to complete a task and fails; she does not give up until she finally succeeds. She becomes elated and just beams with pride.Nevertheless, there were several occasions throughout my observation that she demonstrated learned helplessness (prevalent with many students with ADHD). For example, Sarah was struggling with a mathematic equation and put the pencil down and yelled “I don’t know how to do this and I’m not doing it.” Throughout the 40 minute math class Sarah flat out refused to even try the math problem and spent the time doodling on her paper and ignoring all efforts of instruction. In regards to Sarah’s self-concept, I feel that Sarah has a strong sense of her own abilities and skills. As stated previously, Sarah will tell her teacher that she will not try something because she “doesn’t know how.” However, upon observation at the playground I noticed that she liked to play either basketball or four-square. When I asked her why she only plays these two games at recess, she replied “well that is what I’m good at.”
Furthermore, I believed that she has a good sense of her autonomy. When it comes to Erickson’s theory of industry, Sarah does take pleasure in contributing to the class or being productive. When she does know the answer to the teacher’s question she will bounce up and down in his desk chair to get the teacher’s attention and he will take pride in contributing and getting the right answer. This makes her feel like he has succeeded in something. Additionally, one example of her feeling pleasure in being productive is when I observed her being tutored. She was working really hard for once and getting the right answers. When I asked her why she was doing so well, she told me she wanted to get her assignment done along with all her other work that day so she could go to a friend’s birthday party. She used that reasoning to get herself motivated so that she would be productive that day in school. Sarah’s inferiority can be seen in that she knows what’s he is good and not good at. As I stated before, Sarah will engage herself in the self-fulfilling prophecy of learned helplessness if she does not know how to do something. This was shown in one of my preceding examples when I conferred how Sarah told me that when she does not know how to do something, he will stop trying and will not do it. This usually happened when the fear of failure would either cause her to avoid the opportunity to succeed or make an attempt to succeed due to her anxiety of knowing her own abilities to perform a certain task. Sarah, as with most school age children, is in Erikson’s fourth stage of human development and probably will stay in this stage long into her adolescences, unless he gets some more help and changes her attitude.
Throughout this case study, I reflected on this child’s personal growth in three areas: physical, intellectual, and social development. I used my own observations and experiences working with her to reflect on his growth and to come to some conclusion about this child. This experience has given me the opportunity to realize that no two children are alike and my lessons need to reflect my understanding of my students’ learning abilities and styles. Elementary school students can and will struggle as they grow throughout the learning process and this fast rate of growth can make it difficult for them to adjust.
In particular, this experience has shown me that in the future I must make sure I reach all students who have problems socially. A student’s ability to be accepted socially can affect their ability to become a life-long learner. Students want to be accepted socially and want to do well in the classroom. Coming to this realization, I will assess my ability to better connect with these struggling children.
My future prediction about Sarah is that she will have to overcome many obstacles in order to succeed in school and in life. With many of the classical signs of ADHD such as: difficulty sustaining attention, forgetfulness, distractibility, avoidance of sustained mental effort, loses things necessary for tasks and/or activities, inability to sit still, always moving, fidgety and restless when trying to sit still, Sarah will have to get help from many of the school’s resources as well as tutors. I believe this to be true because as of right now she can’t even do some of the basic school work and has continuous social adaptive issues. With much of the learning taking place through scaffolding, if Sarah doesn’t learn the strategies needed to build a solid foundation for what she will learn later in her academic career, she will experience increased difficulty learning in school. However, if Sarah and her family work consistently to utilize and learn from all of the resources available to her she has the ability to overcome her disability and thrive in both education and society. Overall, I do feel that Sarah has the potential to succeed in school if she continues with assistance for her poor academics due to her ADHD. Sarah also understands that she struggles, and is eager to please those around her. Therefore, I feel the help she would receive for her academic work and his ADHD which would be beneficial. Furthermore, as of right now I feel Sarah will continue to struggle socially in school. Overall Sarah’s: physical, emotional, and social development are developmentally low for her age. But Sarah will definitely have the ability to make great strides in her cognitive development if she is determined to succeed in school and life. I believe that with proper instruction, medication, counseling and much more one-to-one contact, Sarah can and will develop successfully cognitively. References
Abbott, R., &Berninger, VB. (1993). Structural equation modeling of relationships among developmental skills and writing skills in primary and intermediate grades. Journal of Educational Psychology, 85, 478-508. Alloway, T.P, Gathercole, S.E, Adams, A., Willis,C., Eaglen, R, Lamont, E. (2005).Working memory and phonological awareness as predictors of progress towards early learning goals at school entry. British Journal of Developmental Psychology, 23, 417–426 Altemeier, L.E., Abbott, R. D. &Berninger, V.W. (2007). Executive functions for reading and writing in typical literacy development and dyslexia. Journal of Clinical and Experimental Neuropsychology, 30, 588- 606. Babinski, L. M., & Hartsough, C. S. (2003, October 13). The Jounal of Child Psychology and Psychiatry. Childhood Conduct Problems, Hyperactivity-impulsivity, and Inattention as Predictors of Adult Criminal Activity, 40(3), 347-355. Barkley, R. D. (2004). Compprehensive evaluation of Attendion deficit disorder with and without hyperactivity as defined by research criteria. Jounal of Consulting and Clinical Psychology, 65-94. Berninger, V., Cartwright, A., Yates, C., & Swanson, H. (1998). Reading and Writing: An Interdisciplinary Journal. Developmental skills related to writing and reading acquisition in the intermediate grades, Journal 6 161-196. Foorman, A., Liberman, A., & Stanovich, L. (1998). Handbook of Learning Disabilities. Preventing written expression disabilities through early and continuing assessment and intervention for handwriting and/or spelling problems., 73, 86-96. Garald, J. A. (2012). Journal of the American Academy of Child & Adolescent Psychiatry. Behavioral and Cognitive Subtypes of ADHD, 739-748. Ratey, N. (2008). The Disorganized Mind. New York: St. Martin's Press. Savage, 1., Weinstein, F. L., & Evans, C. (1999). Inventing better schools. An action plan for educational reform. San Francisco: Jossey-Bass. Spitzer, R. L., Isquith, P. K., & Gioia, G. A. (2008). The Diagnostic and Statistical Manual of Mental Disorder (5 ed., Vol. 4). Washington D.C: American Psychiatric Association. The American Psychiatric Association. (n.d.). Diagnostic and Statistical Manual for Mental Disorders Fourth Edition. Thomas E. Brown, P. (2005). Attention Deficit Disorder: The Unfocused Mind in Children and Adults. New Haven, CT: Yale University Press. Tomlinson C., B. C. (2008). A review of literature Jounal of the Education of the Gifted. Differencing instruction in response to student readiness interest, and learning profile in academically diverse classrooms., 119-145 . VanGarderen, D., & Whittaker, C. (2006). Teaching Exceptional Children. Planning differentiated, multicultural Instruction for inclusive classrooms, 12-20. Weiler, e. a. (2009). Structural equation modeling of relationships among developmental skills and writing skills in primary and intermediate grades. Journal of Educational Psychology, 85, 478-508.