Rehab

Managing ADHD
in School
The Best Evidence-Based
Methods
Russell A. Barkley, Ph.D.

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 Managing ADHD
in School
The Best Evidence-Based
Methods
Russell A. Barkley, Ph.D.

Rehab

ZNM049085
9/18
Copyright © 2018

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 MATERIALS PROVIDED BY

Russell A. Barkley, Ph.D., is a Clinical Professor of Psychiatry at the

Virginia Treatment Center for Children and Virginia Commonwealth
University Medical Center, Richmond, VA. He is a Diplomate (board
certified) in three specialties, Clinical Psychology (ABPP), Clinical Child
and Adolescent Psychology, and Clinical Neuropsychology (ABCN,
ABPP). Dr. Barkley is a clinical scientist, educator, and practitioner
who has published 23 books, rating scales, and clinical manuals
numbering 41 editions. He has also published more than 270 scientific
articles and book chapters related to the nature, assessment, and
treatment of ADHD and related disorders.

He is the founder and editor of the bimonthly clinical newsletter,

The ADHD Report, now in its 25th year of publication. Dr. Barkley
has presented more than 800 invited addresses internationally
and appeared on nationally televised programs such as 60 Minutes,
the Today Show, Good Morning America, CBS Sunday Morning, CNN,
and many other programs on behalf of those with ADHD. He has
received awards from the American Psychological Association,
American Academy of Pediatrics, American Board of Professional
Psychology, Association for the Advancement of Applied and
Preventive Psychology, American Professional Society for ADHD and
Related Disorders, New England Educational Institute, the Wisconsin
Psychological Association, and Children and Adults with ADHD
(CHADD) for his career accomplishments, contributions to research
in ADHD, to clinical practice, and for the dissemination of science. His
websites are www.russellbarkley.org and www.ADHDLectures.com

Speaker Disclosures:
Financial: Dr. Russell Barkley is employed by the Medical University of South Carolina. He is
on the speaker’s bureau for Eli Lilly and receives compensation. He has an advisory board
relationship with Theravance and receives compensation. He is an author for Guilford Press and
receives royalties. He is an author for Jones and Bartlett Publishers and receives royalties. He is a
speaker for J&K Seminar and receives royalties. He is a speaker for PsychContinuingEd.com and
receives royalties. He is a speaker for ContinuingEdCourse.com and receives royalties. He is a
speaker who receives an honorarium for PESI, Inc.
Nonfinancial: Dr. Russell Barkley has no relevant nonfinancial relationship to disclose.
Materials that are included in this course may include interventions and modalities that are beyond the
authorized practice of mental health professionals. As a licensed professional, you are responsible for
reviewing the scope of practice, including activities that are defined in law as beyond the boundaries of
practice in accordance with and in compliance with your professions standards.
 10/5/2018

School Management of ADHD

Russell A. Barkley, Ph.D.
Clinical Professor of Psychiatry
Virginia Treatment Center for Children
Virginia Commonwealth University Medical Center
Richmond, VA

©Copyright by Russell A. Barkley, Ph.D., 2018

Sources:
Barkley, R. A. (2015) Attention deficit hyperactivity disorder: A handbook for
diagnosis and treatment (3rd ed.). New York: Guilford.
Barkley, R. A. (2016). Managing ADHD in School: The Best Evidence-Based
Methods for Teachers. Eau Claire, WI: PESI

Email: drbarkley6769@comcast.net
Websites: russellbarkley.org, ADHDLectures.com

Touchstone Principles for

School Management
ADHD and its executive deficits are largely
biologically based problems
Teachers are Shepherds, Not Engineers
Consider ADHD Medications
ADHD is a problem with doing what you know, not
knowing what to do
Intervene at the “Point of Performance”

ADHD causes time blindness

Externalize time (clocks, timers, counters, etc.)
Reduce delays to consequences
Break up long term projects into small daily ones
Anticipate problem settings – Make a transition
plan

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More Touchstone Principles

ADHD Causes Poor Self-Motivation
Externalize Motivation (tangible rewards)
Think Win/Win
Use Immediate Feedback
Increase Frequency of Consequences
Use Rewards Before Punishment
Use More Salient & Artificial Rewards
Change Rewards Periodically
Increase Accountability to Others

More Touchstone Principles

Mental and Verbal Information Do Not
Guide Behavior Very Well
Touch More, Talk Less
Act, Don’t Yak
Externalize Critical Information & Cues
Mental Information Cannot Be Easily
Manipulated and Held in Mind
Externalize Problem-Solving – make it
manual in form as much as possible

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More Touchstone Principles

Self-Awareness is Deficient
Video self-modeling
Random “stop and report” check ups
Turtle technique (cued self-monitoring)
Nonverbal cued self-monitoring
Self-rated daily behavior report cards
Emotional Self-Regulation is Weak
Video self-modeling of good emotional control
Video recording of outbursts using smartphone
Cued de-escalation (counting, visual imagery,
and motor rituals)
Chill out (quiet) locations
Social skills training (???)

Basic Considerations
Have a school ADHD liaison for parent-
teacher coordinated care
Don’t retain in grade!
Harmful to children – don’t delay treatment
Use Sept to establish behavioral control
Use traditional desk arrangement
Seat child close to teaching area
Use this opportunity to provide more
frequent feedback to child
Touch child on shoulder while teaching if
child seems restless or inattentive

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Ideas for Desk Work

Target productivity first, accuracy later
Decrease total workload, or
Give smaller quotas of work at a time
Allow child to choose the initial quota
Use participatory teaching methods
Child actively involved in teaching the lesson
Practice skills drills on computers
Allow some restlessness at work area
Consider having child sit on balance ball
Give frequent exercise breaks

About That Homework

Reduce/eliminate homework – grades 1-6
Overall correlation with achievement is just .15-.25 (just 2-6%
of variance in achievement) across all grades and weaker in
elementary grades*
For high school, best amount was 1.5-2.5 hrs/night; more
hours had no further benefits*
Don’t send home unfinished class work for
parents to do - home is not the “point of
performance” for class work
Give weekly homework assignments in
advance for better parent preparation
During homework: Some noise or music
benefits work performance (but deteriorates it
in normal kids)**
*Cooper, Robinson, & Patall (2006). Review of Educational Research, 76(1), 1-62.
**Soderlund et al. (2007). Journal of Child Psychology and Psychiatry, 48, 840-847.

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Instructional Tips:
Be more animated and theatrical
Personalize praise, reprimands, or
instructions
Make eye contact, touch child on shoulder or arm, have child
repeat back any instructions

To help with self-monitoring, use the “Turtle

Technique” for early elementary grades
For teens consider nonverbal cueing
Don’t encourage impulsive answering - Try
using laminated work slates for writing down
and displaying answer, not hands in air and
fastest responder wins
Schedule most difficult subjects in AM
Intersperse low with high appeal activities

More Classroom Suggestions:

Require continuous note-taking
during lectures & while reading
Use the SQ4R system for improving
reading comprehension
Survey, questions, read, recite, write,
review
Get color-coded binders & other
organizing systems for classwork
Give after-school help-sessions,
tutoring, books on tape, videos, etc.
Train keyboarding in early grades
Establish “behavioral contracts”

5
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Components of Behavioral Contracts

Sets forth academic work and behavioral
goals explicitly and clearly
I agree to complete all of my written math and language arts
work with at least 80% accuracy
I will remain quiet, follow directions, and listen

Specifies rewards to be earned explicitly

15 extra minutes of playtime at end of school day
Access to special “reserved” toys or play activities
Use class computer for play or work for 15 extra minutes
Receive 10 points for every task completed accurately
Help my teacher by completing some errands or in-class jobs
If I have a successful week, I will earn a special activity with my
parents

Specifies punishment explicitly

Loss of 10 points or tokens for each task not completed
5 Sheets of “do a task” in time out

Peer Tutoring
Create & distribute scripts (work sheets)
Teach any new concepts and skills to class
Provide initial instructions for work, then
Break class into dyads
Have one student tutor & quiz the other
Circulate, supervise, and coach dyads
Alternate tutor/student roles in dyad
Re-organize into new dyads weekly
Graph & post quiz results
Allow peer tutoring for homework – find child
a “study-buddy” in their neighborhood

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Increasing Incentives
Increase praise, approval,
appreciation
Be a 1-minute manager
Use a token or point system to
organize consequences – to increase
available rewards:
Get parents to send in old games/toys
Get a video game donated to the class
Allow access to rewards often each
day
Keep reward - punishment ratio 2:1+
Remember – its an incentive program

More on Incentives
Try team-based (group) rewards
4-5 students work as a team on assignments
and to earn rewards
Be careful to change team composition every
day or two and rotate ADHD child frequently to
different teams
Try a tone-tape with self-rewards
Variable interval schedule of tones played
during desk work periods
When tone sounds, child self-rewards points on
record sheet
Teachers monitor for cheating
Increase intervals between tones each week
Eliminate after 3-4 weeks – replace with
standard point system

7
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Using School-Home Reports

with Home-Based Consequences
Daily goals stated in positive manner
Specifies behavioral and academic goals
Targets a small number of goals
Teacher provides quantitative feedback
Feedback provided at end of each class
Regular communication with parents (daily)
Consequences at home are tied to school
behavior and performance (short & long-term)
Solicit parental cooperation before starting
Student input into goals is solicited for older
children and teens
Review weekly for modifications

A Daily Behavior Card

Each teacher rates each behavior at end of each class; 1=Excellent (+25), 2=Good
(+15), 3=Fair (+5), 4=Poor (-15), 5=Terrible (-25)

Subjects 1 2 3 4 5 6 7
Class
Participation
Performs assigned
classwork

Follows class rules

Gets along well
with others
Completes home-
work assignments
Teacher’s
Initials

8
 10/5/2018

School-Home Notes
• Name_______________________ Date________
• Subject____________ Teacher_______________

• Was prepared for class Yes No NA

• Used time well Yes No NA
• Handed in homework Yes No NA
• Followed class rules Yes No NA
• Homework or Test Grade (circle one): ____________
• Teacher’s Initials_______
• Homework Assignment:

• Comments:
From Kelly, R. (1990). School-home notes: Promoting children’s classroom success. New York: Guilford Press

Problem Transitions? Make a Plan

Before entering a new situation, STOP! (in school
this might be the next class, recess, going to lunch
room)(at home, this would be any transition to a
new task or situation (homework, bedtime, chores,
shopping trip, dining out, church, visiting others,
etc.)
Review 2-3 rules child needs to obey
Child repeats them back
Establish an incentive or reward
Establish the punishment to be used
Be sure child has something active to do
Enter the new situation, follow your plan
Reward throughout the activity
End by evaluating success with the child

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Externalizing Rules and Time

Post rules on posters at front of class for
each work period,
Use 3-sided stop sign for rules for young
kids. Show the appropriate side for each
activity: red side = lecture rules; yellow side = desk work
rules; greenside = play rules
Laminated color-coded card sets placed on
desk with each card listing the basic rules or
steps to be followed for each subject or
class activity in school or each recurring
task (i.e. homework) or chore (clean up).
Child reviews the posted rules or steps and
then verbally restates them at the start of
each activity. Child can also place a
checkmark next to each step as it is done.
Use timers, watches, large clocks, etc. if the
task has a time limit.

Large 12” Timer

addwarehouse.com

The Large Time Timer is designed to be

wall hung for classroom and group
activities. It’s large size (12 inches square)
and bold dial numerals make this timer
easier to read for visually impaired users,
as well. How it works:
To set the Large Time Timer, move the red
disc counterclockwise to the desired time
interval. The disc diminishes as time
elapses until no red is visible on the timer
face. The disc may be moved clockwise or
counterclockwise without harming the
mechanism, however gentle handling will
prolong the life of the timer.

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Disciplinary Tactics
Incentives for appropriate behavior must be
present for punishment (loss of reward
access) to be effective
But all-reward programs do not last long with
ADHD children unless accompanied with
punishment tactics
Swift justice is the key to discipline
Mild, private, direct reprimands work –
personalize it
Response Cost (loss of tokens)
“Do A Task” (a variation on time out)
Desk at back of class with worksheets
Child told what they did wrong and given a number
Child does that number of worksheets while timed out

More Punishment Tactics

Threaten to use your smart phone to
record outbursts or tantrums that will
be emailed to parent
Moral essays – “Why I will not hit
others”
Establish a “chill out” location – for
recovering self-control
Formal time out in class room
Hallway time outs don’t work
In-school suspension

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Keys to Effective Time Outs

Implemented only when there is a
reinforcing environment to be removed from
Used when function of child’s behavior is
attention-getting
Employed swiftly upon rule infraction (10
sec.)
Uses smallest amount of time out
1-min./year of age
Location is to be visible to teacher
Terminate when:
Time out interval has been served
Child is quiet for brief period of time
Child agrees to obey rule that was broken

Other Tips for Teens

As needed, use ADHD medications
Find a “Coach” or “Mentor” (Just 15 min.)
The Coaches’ office is the student’s “locker”
Schedule in three 5-minute checkups across
each day
Use behavior report card to monitor teen across
classes
Use daily assignment sheets requiring teacher
initials
Cross temporal accountability is the key to
success
Keep extra set of books at home
Tape record important lectures – check out the
Smart Pen that digitally records lectures or other
conversations at livescribe.com

12
 10/5/2018

The SmartPen
Livescribe.com
A computer in a pen that
helps you never miss a
word™. Pulse™ records
everything you hear, say
and write, and links your
audio recordings to your
notes. Find the most
important information from
your meetings or lectures
just by tapping on what you
wrote.
2GB of memory can hold
over 200 hours of audio.
Actual recording time
varies by audio quality
setting.

More Tips for Teens

Get a Week-at-a Glance calendar, a
journal, or other organizing notebook
Extra time on timed tests ???
No evidence it preferentially benefits disabled
students – at most 20-30 minutes maximum
Better to have distraction free test setting and
breaks after short testing periods (time off the
clock)
Get written syllabus as handouts
Require continuous note-taking to pay
attention to lectures or during reading
assignments

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Still More Tips for Teens

Use SQ4R for reading comprehension
Find “fall-back” classmates (swap
phone, e-mail, & fax numbers) for lost
or missing assignment sheets
Require teen to attend after-school
help-sessions
“Bucks for Bs” system – parents pay
money for grades on assignments
Schedule parent-teacher-teen review
meetings every 6 weeks (not at 9 week
grading period)

Conclusions
The school is the setting most impaired for children
and teens with ADHD
ADHD symptoms can be effectively managed in
school using numerous behavior modification
methods and classroom accommodations
These can result in significant improvements in the
child’s academic performance, behavior, and peer
interactions
The keys to success include teacher attitude toward
and knowledge of ADHD and the willingness to
implement and sustain these interventions
In some cases, however, medications may need to
be combined with school management methods to
achieve maximum benefits

14
NOTES
NOTES