Strategies for Teaching Students with ADHD

Daniel Noll

American College of Education

CI6103 - Curriculum and Instructional Design for Diversity

Dr. Timothy Hinchman

September 14th, 2024

The Problem

As an ESL teacher, I was trained in language acquisition principles and understand how to meet most most of my English language learners’ needs. Over the years, however, I often didn’t know what to do when faced with English learners who also had special learning needs, such as ADHD. ADHD - and similar conditions affecting focus or organization - can greatly impact student learning outcomes, especially among English learners (Rodríguez & Rodríguez, 2017).  Not having a good understanding of techniques for teaching students with ADHD, I set out on a fact finding mission to learn more so that I may better help students struggling with inattention.  I sought to develop a basic awareness of key features of ADHD as well as strategies, interventions, and lesson modifications for teaching students struggling with attention issues.

Some Insights From the Literature

To understand this issue, I looked into three key areas of research. Before making instructional  modifications for students with ADHD, I felt a basic knowledge of relevant traits of this disorder needed to be understood. To address these traits, I wanted to find an established framework or teaching system to guide lesson design. Additionally, I thought it would be beneficial to identify specific techniques for modifying my teaching practice.

Understanding key features of ADHD

When I brought this topic up with a family member who is a medical professional, she suggested that I look into the DSM-5. The DSM-5 is the diagnostic manual put out by the American Psychiatric Association to clarify the specific features of different mental conditions as well as methods of diagnosis (APA, 2013).

A major barrier for teachers seeking to address issues related to an attention deficit or hyperactivity disorder is that some may not fully understand the key aspects of ADHD spectrum disorders. Describing a student as being easily distracted is not enough to merit a true diagnosis. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) offers clear guidance for understanding ADHD (APA, 2013).

The DSM-5 describes ADHD as having two key components — inattention and hyperactivity (APA, 2013; SAMHSA, 2016). To receive a diagnosis, a person must meet at least six criteria inattention or hyperactivity criteria (SAMHSA, 2016). While a psychiatric professional needs to make a real diagnosis, the DSM-5 can be useful for teachers considering whether or not to make a referral. It can also help teachers consider different instructional techniques to reach struggling students.

Many teachers have heard of ADD as well as ADHD. It should be noted that the DSM-5 now marks many mental disorders on a spectrum. In the DSM-IV, there was a separate diagnosis for attention deficit disorder (ADD) and ADHD. In the DSM-5, ADD is now described as ADHD prominently inattentive, or ADHD without hyperactivity.

The inattention component of ADHD can manifest in several ways (SAMHSA, 2016). An inability to sustain attention during tasks, being easily distracted by extraneous stimuli, or not listening when spoken to are easy to conceptualize as being inattentive, but there are several other features of the inattention component of ADHD. Not paying attention to details or making careless mistakes on schoolwork can greatly disrupt students’ studies when out-of-class work is required. This can manifest as a persisting failure to complete school work and assigned tasks. Difficulty organizing tasks and materials, losing materials, or being forgetful of daily activities are also key features of inattention and greatly disrupt classroom instruction. Avoiding or being reluctant to engage in tasks that require mental effort can significantly impact language acquisition, as tasks like quiet reading and vocabulary study our key elements of a balanced language curriculum (Nation, 2020).

Similarly, hyperactivity-impulsivity consists of several traits (SAMHSA, 2016). Traits of hyperactivity include fidgeting, trouble staying seated, running or climbing in inappropriate situations, an inability to play quietly, being unable to stay still and always being on the go, and talking excessively. Impulsivity traits include blurting out answers before questions are completed, frequently interrupting others, and having trouble waiting for one's turn. In the context of the classroom, any combination of these traits can be especially bothersome without proper considerations.

Teachers can adapt their instructional practice by considering any of the above-mentioned traits (Mani & Kristunsson, 2024), but observations from early childhood and life outside of school must be taken into account before a true diagnosis can be made in cooperation with the child's parents (APA, 2013). That said, some students may exhibit one or two of the ADHD traits enumerated by the DSM-5 — such as difficulty organizing tasks and materials or trouble maintaining focus for extended periods — but not meet the threshold for a full diagnosis. Knowing the various spectrum traits of ADHD along-side appropriate instructional interventions can benefit teachers seeking to meet the learning needs of a wide range of students (Langberg et al., 2012).

An Instructional Framework for Supporting Students With ADHD 

Universal Design in architecture (UD) provides a framework for designing buildings that are universally accessible to those with special needs; the Universal Design for Learning (UDL) similarly provides a framework for creating universally accessible learning environments (Frolli et al., 2023). The UDL provides a structure for enhancing student engagement, representation of information, and action and expression, the UDL framework can be used to create instructional experiences that activate a student’s entire brain (CAST, 2024). For students with ADHD, a robust, multifaceted learning environment can greatly support focus and attention.

Regarding the key traits of ADHD, the UDL provides meaningful guidance for structuring lessons. In a systematic literature review conserning ADHD and ESL learners, Mani and Kristensson (2024) identified three areas shown to be effective for improving language learning experiences for students with ADHD, all aligning with the UDL guidelines (CAST, 2024). These include multimodal learning, strategies for self expression such as drama and visual arts, and a focus on goal-setting. Considering that UDL aligned lessons have been shown to benefit language learners with ADHD (Frolli et al., 2023), a multi-faceted approach to instruction  engaging different learning modalities should benefit students with ADHD and those with similar traits.

How to Provide Information More Effectively

Even without a background in psychology, most would define ADHD as being "easily distracted." Distraction due to extraneous stimulation is a key feature of ADHD (APA, 2013). Providing both visual and auditory information can help students grasp new content more easily is through (CAST, 2024; Cavanaugh & Kiersch, 2022). Mayer’s (2021) Cognitive Theory of Multimodal Learning (CTML) can help teachers design the lesson materials more effectively to help learners with ADHD — and anyone for that matter — better understand the content.

In Mayer’s (2021) model of multimodal learning (see Figure 1), a learner creates knowledge by processing both visual and auditory inputs. Images and sounds enters the eyes and ears. Selected information enters working memory — a very short-term processing step — is organized into models, and enhanced with prior knowledge. Considering that everyone has a limited attention span, focus on multiple sensory inputs can be challenging.  Lessons meant to serve students with ADHD thus need to consider how content is delivered (Cavanaugh & Kiersch, 2022). Working with the CTML framework, a teacher can consider how to best arrange auditory and visual inputs to help learners better acquire information (Cavanaugh & Kiersch, 2022).

Figure 1

The Cognitive Theory of Multimodal Learning

(Mayer, 2021)

 

Strategies for Visual Organization

Mayer (2021) identifies several principles for effective communication applicable to classroom settings. The multimodal principal holds that images are most useful for learning when they help form a meaningful narration. This is contrasted with a trend for textbooks to use images that are decorative but do not support understand content (Cavanaugh & Kiersch, 2022). For purposes of learning and building knowledge, a narrative comic strip would better support class content than a decorative or more general image.

Of particular relevance to teaching students with ADHD, Mayer’s (2021) coherence principle holds that learners have limited processing capacity. Thus, extraneous information — like stimulating attention grabbers or side stories — may affect learners’ ability to absorb what’s really being taught.

Additionally, Mayer’s (2021) redundancy principal holds that writing should support narration rather than a teacher just narrating a text. Certainly, everyone has attended a presentation in which a speaker simply read paragraphs of text off of PowerPoint slides. This is an obvious example of breaking the redundancy principal. For a student with attention difficulties, they may have trouble knowing what to focus on when they can see and hear identical content presented this way.

The signaling principle holds that calling attention to important points can help students remember them more easily (Mayer, 2021). While traditional techniques like arrows or highlights are useful, a teacher taking time to point at an item being talked about and pausing briefly can be extremely effective for calling attention to that concept (Ray and Seely, 2018). Focusing on content relevant to learning objectives — and minimizing extraneous information — can greatly help to address common issues related to distraction (Cavanaugh & Kiersch, 2022).

Strategies for Content Pacing and Content Interaction

Students with ADHD often have difficulty focusing on an activity very long (APA, 2013). Mayer’s (2021) segmenting principle holds that information broken into smaller chunks is absorbed more easily. A familiar example is the way that YouTube videos are typically 10 minutes or less, supporting focused concentration within a limited timeframe. Teachers can intersperse short activities, conversations, or quizzes within lectures to help maintain student attention and supports information synthesis (Cavanaugh & Kiersch, 2022). Giving students opportunities to explain lessons in their own words helps them deepen their understanding of the lesson in real time.  This support long-term memory building, giving students a chance to use what they learned outside of the classroom (Cavanaugh & Kiersch, 2022). To mix it up, teachers can also let students draw lesson concepts to show how they understand the material (Bawa & Osei, 2020; CAST, 2024).

Linking Concepts Through Drawing

Providing accessing information through different modalities is a great way to support diverse learners (CAST, 2024). Bawa and Osei (2020) found that creating visual art gives students a way to link previously acquired knowledge with new concepts. In their work with students with learning disabilities, they found that creating art significantly aided students in acquiring new vocabulary items and concepts in the second language. The authors also found that incorporating drawing in the second language classroom reduced the number of outbursts and disruptions among students with an ADHD diagnosis. While there are many excellent ways to make in-class instruction more accessible for students struggling with inattention, helping these students set goals and follow through should be a high priority (APA, 2013; CAST, 2024; Lanberg, 2011).

A System of Accountability and Goal Setting

ADHD affects the executive functions of a young learner’s brain (Lanberg, 2011). Self-regulation, memory, effort, and taking action are all executive functions that relate to a person’s academic success (CAST, 2024, Lanberg, 2011). Fortunately, there are techniques to help students with executive function. The Homework, Organization, and Planning Skills (HOPS) intervention is a way to improve learning and planning outcomes for students with ADHD or with similar learning struggles (Lanberg et al., 2012). This system helps students with planning, organization, and completing tasks. While the HOPS method was originally designed for one-on-one sessions between a student and a specialist, this system can benefit teachers seeking to help all students improve their organizational skills (Lanberg, 2011).

With typical homework assignments, a teacher assigns work; students need to record the work in a planner; relevant materials need to be brought home; students need to manage their time after school to do the homework. When they finish, the work needs to be filed away to return to school, and upon returning class the student hands the homework in to the teacher (Lanberg, 2011). At any point along this journey, one laps in judgement can result in a missed assignment. Consistent homework woes of this nature can be a major source of consternation for students with ADHD, their parents, and teachers (Lanberg et al., 2012).

With the HOPS intervention (Lanberg, 2011), students meet with a teacher or specialist once or twice a week. Together, they check to see that students study material, planner, and assignments are in optimal condition. This involves working with a student to set up a standard binder organization system including an attached pencil case, an assignment planner, dividers for each class, looseleaf paper, and two assignment folders — one for pending assignments and another for assignment to turn in,. Standards for locker organization are also established. Teachers participate in the system by marking a checklist for the student when assignments are completed.

A major component of the HOPS intervention involves rewards and student goal-setting (Lanberg et al., 2012). Through active participation in the HOPS intervention, students earn points for maintaining their study materials and turning in assignments. Positive reinforcement is used by giving students opportunities to use these points for material rewards or preferred activity time. Additionally, students are guided in making personal and meaningful goals related to organization, work completion, and academic performance (Lanberg, 2011). The HOPS emphasis on planning skills, organization, monitoring progress, and personal goal-setting closely aligns with the UDL guidelines regarding strategy development and can do much to support students with ADHD (CAST, 2024; Lanberg, 2011).

These teaching strategies are just a short list of ways to better teach students with ADHD. This is not an exhaustive list. My hope is that this list of tools and techniques can give fellow teachers a starting point for helping students struggling to pay attention. After asking fellow teachers about their knowledge of techniques for teaching students with ADHD, I believe that all teachers should know what tools are out there to help these students.

Surveying Fellow Teachers

Using an online survey, I asked four teacher friends questions about teaching students with ADHD — the defining features of ADHD, techniques for supporting students, and personal learning goals related to this subject. Teachers rated their familiarity with different concepts on a scale of one to four (see Figure 2).

Figure 2

Sample Survey Questions

Though only four teachers took the survey, some general trends emerged. The two teachers with masters degrees in education appeared more confident on questions about teaching techniques for students with ADHD (see Figure 3), expressing that they use different techniques to support students who struggle with attention. The two teachers with bachelor’s degrees felt they had limited knowledge of these topics overall. All of the teachers surveyed expressed an interest in learning more about ADHD and ways to provide support.

Figure 3

Participants’ Familiarity With Techniques for Teaching Students with ADHD

In defining the key features of ADHD, most of the teachers surveyed used words related to the familiar acronym — such as poor focus, hyperactive, impulsive. Though they were aware of some key features, they all reported having little knowledge of appropriate diagnostic procedures.

When asked about specific teaching techniques for assisting students with ADHD, the teachers’ responses correlated closely with their levels of education and past teaching experience (see Figure 3). This trend may have more to do with confidence than capability.  Despite reporting the lowest scores on questions concerning specific teaching techniques, the youngest teacher surveyed had the most robust written answer about specific techniques she uses currently to aid students with ADHD. In describing her current teaching practice, she described:

-Having specific goals set with the student and planning it together

-Keep distractions away such as phones

-Have a routine

-Check in constantly (provide feedback)

-Have clear expectations

While there are currently a wealth of studies examining the use of technology to support students with ADHD (Mani & Kristensson, 2024), this teacher found limiting phone use in the classroom to be beneficial. Her response is important because much of the education research conducted over the past decade appears to be looking at ways to use technology in the classroom; comparatively little is being done to look at what happens when teachers dial back on tech in classroom and look for tech-minimalist solutions to the difficulties they face.

Asking an Expert

While looking into this topic, I had the good fortune of interviewing a special education intervention specialist with nearly four decades of teaching experience. In her experience, the key to teaching any student is to know their interests and motivations. With this knowledge teachers can provide reading materials, educational videos, and personalized lessons to meet the needs of diverse learners.

This veteran teacher described different archetypal students that she encountered — ranging from the shy and self-conscious to the rambunctious rascals. She found that by providing content related to their interests her students we're more engaged and had an easier time imagining success both at school and in life. For example, she described a shy student who loved horses. The teacher gave the student access to lots of books about horses, videos about potential careers working with animals, and even took the whole class to the local equestrian center, so that this girl could show her classmates what she knew about horses.

While this form of student-centered lesson planning may not fit within an established system with an acronym to match, this teachers’ attention to her individual learners demonstrates the power of caring for each individual learner. One tool this veteran teacher uses to establish a rapport with students is an interest inventory (see Figure 4). This is a quick and simple way to get to know students and help teachers consider how to reach them where they are.

Figure 4

Interest Inventory

What Now?

While most teachers have heard of ADHD, specific traits and relevant teaching techniques may not be as well known. Changing the way information is displayed and expressed can make lessons more accessible for students struggling with inattention. Providing guidance on goal-setting and organization can also be beneficial.  A great way to get started with goal setting is by letting students fill out an interest inventory.  By learning, experimenting with, and practicing these techniques, teachers can create a learning environment that better meets the needs of diverse learners — including those struggling with inattention.

 

References

American Psychiatric Association. (2013). Attention-Deficit/Hyperactivity Disorder. In Diagnostic and Statistical Manual of Mental Disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596.CautionaryStatement

Bawa, A., & Osei, M. (2020). Integrating Drawing in Teaching English Language at Yumba Special School for Children with Intellectual Disabilities. Journal for Learning through the Arts, 16(1). http://dx.doi.org/10.21977/D916142462

Cavanagh, T. M., & Kiersch, C. (2023). Using commonly-available technologies to create online multimedia lessons through the application of the Cognitive Theory of Multimedia Learning. Educational technology research and development, 71(3), 1033-1053. https://doi.org/10.1007/s11423-022-10181-1

CAST. (2024). Universal Design for Learning guidelines version 3.0. Retrieved from http://www.udlcenter.org/aboutudl/udlguidelines

Frolli, A., Cerciello, F., Esposito, C., Ricci, M. C., Laccone, R. P., & Bisogni, F. (2023). Universal Design for Learning for children with ADHD. Children, 10(8), 1350. https://doi.org/10.3390/children10081350

Langberg, J.M. (2011). Homework, Organization, and Planning Skills (HOPS) Interventions: A Treatment Manual. National Association of School Psychologists.

Langberg, J. M., Epstein, J. N., Becker, S. P., Girio-Herrera, E., &Vaughn, A. J. (2012). Evaluation of the homework, organization, and planning skills (HOPS) intervention for middle school students with attention deficit hyperactivity disorder as implemented by school mental health providers. School Psychology Review, 41(3), 342–364. https://doi.org/10.1080/02796015.2012.12087514

Mayer, R. E. (2021). Multimedia learning (3rd ed.). Cambridge University Press.

Mani, A.-A. & Kristensson, J. (2024). What does current research say about the teaching strategies used to support students with ADHD in English as a second language classrooms? [Masters thesis, Malmö University] https://www.diva-portal.org/smash/get/diva2:1860759/FULLTEXT02.pdf

Ray, B., Seely, C. (2018). Fluency through TPR storytelling (TPRS) teaching proficiency thru reading & storytelling: Achieving real language acquisition in school (7th ed.), TPRS Books.

Rodríguez, A., & Rodríguez, D. (2017). English learners with disabilities: What is the current state? Insights into Learning Disabilities 14(1), 97-112. https://eric.ed.gov/?id=EJ1165743

Uchihara, T., Webb, S., & Yanagisawa, A. (2019). The effects of repetition on incidental vocabulary learning: A meta-analysis of correlational studies. Language Learning, 63(3), 559-599. https://doi.org/10.1111/lang.12343

Substance Abuse and Mental Health Services Administration (US). (2016). Table 7, DSM-IV to DSM-5 Attention-Deficit/Hyperactivity Disorder Comparison - DSM-5 Changes - NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t3/