Helping Students with ADHD Stay Focused

by Gary Flowers, Pharm.D., PGY1 Pharmacy Practice Resident, Suburban Hospital

According to the Centers for Disease Control and Prevention (CDC), 9.5% of school children between the ages 4 and 17 have been diagnosed with ADHD, and this number is rising.¹  Undiagnosed, untreated ADHD can wreak havoc in an individual’s life and in the lives of loved ones.²  I’ve watched my brother’s daily struggles as they tried to improve his son’s grades at school.  My brother tried many methods at home to help his son but to no avail.  After much frustration, my brother sought help.  My nephew was diagnosed with ADHD.

ADHD is commonly treated with psychostimulant medications.  Psychostimulants have shown to be beneficial in the majority of people with ADHD by helping to diminish hyperactivity as well as improve attention problems which cause many of the behavioral symptoms.  Long-term studies have shown that these medications have protective effects against later psychopathology and reduced the chances of substance abuse in adolescents with ADHD.³

After evaluation of the individual’s needs, a teacher can devise a lesson plan built around the student’s needs and strengths.  These accommodations are incorporated in educational activities with other students in the class. These lesson plans are best constructed with the input of a multidisciplinary team and the parents of the child.  Teachers can often use assessment tools, such as learning style inventories, to better understand how to instruct the student and enhance his or her learning.  For consistency, there should be one designated teacher that is used as an advisor or coordinator for the student to rely on and report.

Short-term and long-term goals should be set for the student with ADHD and reassessed periodically over time (i.e. quarterly) and edited as needed to adjust for advancements or emerging deficits.  The goals should be written in the SMART format: specific, measurable, attainable, realistic, and timely.

Students with ADHD benefit from the teaching best practices we’ve all learned.  For example, teachers should explicitly explain learning objectives at the beginning of the lesson so students know what is expected.  At the beginning of each class the teacher should review previous topics and then connect that information with the information being covered that day or week.  Using a variety of audiovisual materials can help reinforce concepts.

Simplifying and breaking work into smaller units makes information easier and more palatable for students with ADHD to digest.  Time limits during tests may need to be relaxed or eliminated in order for the student with ADHD to successfully demonstrate what he or she has learned and retained.⁴  

Although the media typically focuses on children, many adults have ADHD too.  Adults tend to have similar challenges as children, such as, disorganization and staying attentive for long periods of time.  Unfortunately, it is more difficult to diagnose ADHD in adults due to the variability and vagueness of their symptoms.  Moreover, the symptoms must have began in childhood and persisted into adulthood in order to make the diagnosis of ADHD.⁵ 

Combination treatment, medications plus behavioral interventions, work best for the majority of people with ADHD.  Adjustments may need to be made throughout life to control one’s actions and minimize the urge to take unnecessary risks.  Teachers (and parents) need to remember that it’s important to be patient, experiment with different strategies, and seek support.

Fortunately, my brother sought help early and my nephew received the help he needed.  They tried medication but focused on behavioral modification using positive and negative feedback.  Teachers at his school and my brother set short and long term goals for my nephew.  He is now seventeen and has plans to join the military after graduation!

References

1.  Centers for Disease Control and Prevention (US). Attention-deficit/hyperactivity disorder (ADHD). [Internet]. 2011 Dec 12 [cited 2013 Mar 10].

2.  Pliszka S. Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/ hyperactivity disorder. J. Am. Acad. Child Adolesc. Psychiatry  2007 46(7):894-921.

3.  Albert P. Drugs for kids: Good or bad? J Psychiatry Neurosci 2012; 37(5):293-5.

4.  U.S. Department of Education. Teaching children with attention deficit hyperactivity disorder: Instructional strategies and practices. [Internet]. 2004 Feb [cited 2013 Mar 10].

5.  National Institute of Mental Health. Attention Deficit Hyperactivity Disorder (ADHD). [Internet]. 2009 Jan 23 [cited 2013 Mar 10].

Academic Help-Seeking Behaviors - Any Questions?

by Troy Z. Horvat, Pharm.D. PGY1 Pharmacy Practice Resident, Johns Hopkins Bayview Medical Center

From a young age, I was often told, “There are no stupid questions.” My parents employed this strategy to encourage me to ask questions and to not be embarrassed about seeking help. However, as I progressed through my undergraduate and doctoral curriculums I saw students asking fewer questions. As information became increasingly more complex, why weren’t students asking MORE questions? Now that I am a pharmacy resident with a career goal of becoming a faculty member at an academic institution, the question has become not only why are questions not being asked, but more importantly, what can I do as an educator to encourage this behavior.

Asking questions during or after class is an academic help-seeking behavior.  Academic help-seeking has been formally defined as “an achievement behavior involving the search for and employment of a strategy to obtain success.”¹ Historically, students displaying academic help-seeking behavior had been viewed as immature, dependent, and unintelligent.² Research now shows that there is a correlation between help-seeking behavior and academic success.³  Unfortunately, students who are struggling academically often don’t seek academic help and may display help-avoidance behavior. Whether a student displays academic help-seeking or help-avoidance behavior appears to be related to internal and external factors.

Internally, self-motivation, ego-achievement goals, and the perceived view of the instructor all play an important role in dictating which behavior will be expressed.²  Students that lack motivation or display ambivalence towards learning are more likely to display help-avoidance behavior.  However, not all behavior can be explained by ambivalence and lack of motivation. Some students do not seek academic assistance because it contradicts their desire for autonomy.⁴  The student’s perception of the instructor may also have a major impact on help-seeking behavior. If the student perceives the instructor as cold and unavailable, the student will be more likely to display help-avoidance behavior.⁵  Conversely, as a recently published study by Payakachat et al. illustrates, faculty who are perceived by the student to be respectful, accessible, approachable, and friendly increase help-seeking behavior.⁷

External factors such as social norms, the goal structure of the classroom, and the instructor’s approach (e.g. openness and flexibility) can positively or negatively impact academic help-seeking behavior.²  From a social point of view, students who ask questions in class are often criticized by their peers for their lack of understanding or unnecessarily extending the length of the class.  If students feel socially threatened by their peers, they will be more likely to display help-avoidance behavior.⁵  Additionally, asking for help is contrary to the importance that Western cultures place on self-reliance and independence.⁴  The goal structure of the classroom also plays a role in developing academic help-seeking behavior.  Learning environments that place a strong emphasis on grades and competition among students may discourage help-seeking behavior.  Conversely, learning environments that place a strong emphasis on effort and understanding, foster it.⁶  The instructor’s approach, openness, and flexibility may play the biggest role in developing a help-seeking culture. Research has shown instructors that use positive encouragement and set aside “student hours” (a more positive term for formal office hours) have better relationships with their students.⁸  Forming a better relationship with students will increase the students’ positive perception of their instructors and, as Payakachat showed, facilitates help-seeking behavior.⁷

Based on what we know about help-seeking and help-avoidance behaviors, what we can do as educators to facilitate a culture of help-seeking among students?  Perhaps the easiest strategies for an instructor to implement relate to their personal approach.  Instructors should display behaviors such as: respect, accessibility, approachability, and a friendly demeanor as these have been linked to the enrichment of academic help-seeking behavior.  Additionally, educators can restructure their learning environment to one that does not emphasize competition and grades, but focuses more on understanding. Finally, trying to be more interactive and engaging may help to increase student’s motivation and decrease ambivalence toward a topic or content area.

Looking back at my educational journey, I can point to a select few instructors who really fostered my help-seeking behavior.  While these instructors taught me at different times in my life, they had common qualities. They praised me for asking questions, discouraged others from teasing me when I asked questions, allotted enough time at the end of class for questions, were available outside of class (both in person and via email), and displayed a dedication to helping me achieve success.  As I progress through my career, I hope to incorporate these strategies into my own practice and facilitate a new generation of help-seekers.

References:

1. Ames R, Lau S. An attributional analysis of student help-seeking in academic settings. J Educ Psychology 1982;74:414-23.

2. Nelson-Le Gall S. Help-seeking behavior in learning. Rev Research Educ 1985;12:55-90.

3. Lee CJ. Academic help seeking: Theory and strategies for nursing faculty. J Nurs Educ. 2007;46:468-75.

4. Butler R. Determinants of help seeking: Relations between perceived reasons for classroom help-avoidance and help-seeking behaviors in an experimental context. J Educ Psychology 1998 00/00;90(4):630-43.

5. Ryan AM, Pintrich PR. "Should I ask for help?" The role of motivation and attitudes in adolescents' help seeking in math class. J Educ Psychology 1997;89:329-41.

6. Ryan AM, Gheen MH, Midgley C. Why do some students avoid asking for help? An examination of the interplay among students' academic efficacy, teachers' social-emotional role,and the classroom goal structure. J Educ Psychology 1998;90:528-35.

7. Payakachat N, Gubbins PO, Ragland D, et al. Academic help-seeking behavior among student pharmacists. Am J Pharm Educ. 2013;77: Article 7.

8. Harnish RJ, Bridges KR. Effect of syllabus tone: Students' perceptions of instructor and course. Social Psychology of Education: An International Journal. 2011;14:319-30.