A short guide to... teaching children with ADHD

This short guide will describe the impacts attention deficit, impulsivity, and hyperactivity can have on a young person's life, then explore ways in which teachers and TAs can mitigate these impacts through their work in schools. It is based on my expertise as a classroom teacher, and leader of SEND rather than medical knowledge or scientific research. 

The symptoms of ADHD are well known and include difficulty focussing and concentrating, as well as constantly moving and acting without thinking. A more comprehensive summary can be found on the NHS website (all references and links can be found below). There are many young people in our schools who display some these symptoms, only some of whom are or will ever be diagnosed with ADHD. Other factors such as trauma, mental health conditions, or learning difficulties can lead to attention deficit and hyperactivity, although may not result in a diagnosis. Nonetheless, for all young people subjected to at least some of these symptoms, the impacts on their daily life can be severe. Forming and maintaining relationships can be difficult. If a young person is often interrupting others, and cannot focus well on what their peers are saying it makes friendship hard to sustain. Independence may also develop slowly or intermittently as being distracted, forgetful and liable to risky behaviour means a child needs more support for longer as they make their way in the world. 

In education young people with ADHD (and others whose attention is limited and hyperactivity is present) are more likely to be subject to school sanctions, underperform academically, and hold negative views of themselves as learners. This is unsurprising. So much time in school is spent expecting children to sit still and listen. Tasks in classrooms can often be tedious or time consuming. We expect young people to process complex information and regularly follow a series of instructions. Every one of these examples is a huge challenge for a young person with attention deficit and hyperactivity so they can either be unable to comply, or it takes such force of will to meet the expectations that there is little space left for learning. 

As a result we see a disproportionate number of students with ADHD being subject to sanctions including internal exclusion and suspension. Similarly this group of young people is less likely to make good academic progress compared to their peers. These gaps are a national issue, and students with SEND as a whole have much worse educational outcomes than those with no identified special need. But surely, if we secure the right support (at the right time) then these students need not suffer. They should be expected to do just as well as any other student, so long as an appropriate level of additional and/or different provision is in place. 

The EEF report into meeting the needs of learners with SEND in mainstream schools identified five classroom strategies that proved to have a positive impact. This short guide focusses on three of these, detailing some examples for everyday classroom use and explaining why they are beneficial. These are; scaffolding, explicit instruction, and cognitive and meta-cognitive strategies. 

Scaffolding is temporary support used by the adult to build skill and confidence in the learner, so that over time the support is gradually removed. This first requires an accurate understanding of what a learner knows and can do, because putting scaffolding in place where it is not required is not only wasteful but also damaging as it hinders independence. Examples that are common in the classroom include sentence starters, writing frames, and prompts. A step by step approach to learning new information or practising a new skill is also a form of scaffolding< and can sometimes be described as 'chunking'. These approaches are proved to be beneficial as they reduce cognitive load, allowing a student to focus on the the key aspect of learning that the teacher/adult needs to be at the forefront of the their thinking. They can also mitigates losses in concentration by providing a structure that makes the return to learning more accessible. 

Explicit instruction is a term for teacher led approaches which see the teacher as the expert in the room. This may result in the teacher talking to students, demonstrating a skill, or modelling the learning in other ways. It can be very helpful for teachers to support their communication with visual aids and prompts, such as diagrams or icons. Similarly, artefacts or real world examples can bring meaning to the content in the classroom and it is of course imperative to deploy clear, unambiguous language. All of these elements are essential for young people with attention deficits because they provide multiple opportunities to access new information and help to eliminate extraneous detail. It can benefit teachers to practise their explanations, and even record them so that they cover precisely what is intended and avoid distractions and diversions. Research reveals that following explicit instruction with guided practice and rehearsal helps students to take on board new learning and begin to assimilate it into their existing schema. 

Cognitive and meta-cognitive strategies can be summarised as approaches that teach students how they are learning. There is good evidence that reveals the impact this has on learning when deployed well with high levels of subject specificity. Generic strategies that detach the process of learning from the subject content tend to be less successful. For example, solving a problem such as simplifying an equation is better served by teaching about resolving algebra in Maths than coverage of 'problem solving' in general. By teaching students how to learn (in your subject) they are much more likely to become increasingly independent as historians / biologists / designers. It will also, alongside retrieval practice and a well planned curriculum, support the transfer of knowledge from short term to long term memory. 

These three approaches are all elements of high quality teaching. They are already a part of many teachers' ways of working, or can be assimilated into existing practice so that small tweaks are required rather than wholesale change. It is important for teachers to be aware of their approaches, and deploy them purposefully. The remaining two strands of the approaches identified by the EEF as having a positive impact for students with SEND are flexible grouping and the use of technology. I will cover these in future short guides. 

References:

NHS summary of ADHD

(http://www.nhs.uk/conditions/attention-deficit-hyperactivity-disorder-adhd/symptoms/)

EEF blog: Improving SEND outcomes 

(https://educationendowmentfoundation.org.uk/news/eef-blog-five-a-day-to-improve-send-outcomes)

EEF report on special educational needs in mainstream schools

(https://educationendowmentfoundation.org.uk/education-evidence/guidance-reports/send)

SEND review summary: right support, right place, right time

(https://www.gov.uk/government/publications/send-and-ap-green-paper-responding-to-the-consultation/summary-of-the-send-review-right-support-right-place-right-time) 

ADHD Foundation 

(https://www.adhdfoundation.org.uk/) 

In praise of Teaching Assistants

 

Teaching Assistants play an essential role in delivering high quality education and many students could not succeed without them. In more normal times their work is certainly varied but in responding to the difficulties caused by the pandemic they have proved themselves to be more adaptable, resilient, and compassionate than ever. They are quite simply absolute gold.

For students with special educational needs, and others, a teaching assistant acts as a key worker. They really connect and are able to unlock young people’s potential through building trusting relationships. These are developed through daily one to one conversations, regular calls and meetings with families, and TAs being a consistent presence day to day, term to term and indeed year to year. This means that every young person  has a member of staff who is an expert in their strengths and needs. Teaching Assistants are specialists in many fields, but most importantly they are expert specialists for every child they lead.

Every term Teaching Assistants review the progress made by those students for whom they act as keyworkers. This demands detailed knowledge of the student based on time spent with them and discussion with family. It also requires co-ordinating feedback from teachers and collating information from assessments to review the progress made and what the next steps should be. This is essential work that binds the triad of school, home and child. It also directly influences the level of support arranged by the SENDCo and the approaches taken by teachers.

In classrooms Teaching Assistants play an active role in making sure students can access learning. This takes many forms and includes activities such as reading text aloud, breaking down information into manageable chunks, or providing models and scaffolds that over time increase students’ independence. It is always the aim of teaching assistants to start with the least amount of help that is possible. Research confirms this is the most effective approach to securing rapid progress, increasing confidence, and developing students’ autonomy. SENDCOs should work closely with TAs and teachers to embed strong communication; teachers who liaise closely with TAs about the needs of students and how these can be met in the classroom see the greatest success.

This short article can only begin to explain the diversity of tasks TAs undertake. Whether checking for and removing nits, managing those in fight / flight mode, or giving up lunch time to speak with a psychologist or offer advice to a colleague, Teaching Assistant s always keep the children’s interests at the heart of what they do.

Inclusive organisations  are committed to adapting and increasing the level of support students require to meet high standards and Teaching Assistants are an essential part of this good quality practice. Without them some of the most vulnerable students would be further disadvantaged but the care, professionalism, and humility that TAs display mean they are an asset to schools.  

A new year as SENDCo

As a new SENDCo I am just getting used to the complex and conflicting demands of meeting the needs of pupils with SEND in a mainstream secondary school. In this first week of the new school year, there have been three issues that stand out; young people's anxiety, funding for schools, and the importance of leadership.
Almost all of us are nervous on the return to school following a break, especially a long one. However for some young people this week those common nerves and worries are the thin end of a very large wedge of anxiety. The busyness of corridors, and walking in to a room of 30+ people many of whom are strangers have been overwhelming for some children. So overwhelming that even with skilled adult support they are not able to enter the room. There was a time when this would have lead to sanctions, isolation from lessons, and exclusions from school all of which only serve to exacerbate the difficulties. Instead this week, we have taken three key steps very deliberately to address the children's needs whilst maintaining a focus on learning and emphasising the value of being in the classroom. Firstly we have spent time with pupils describing what will happen during each part of the day, verbally rehearsing what to expect. Secondly we have used an emotion coaching approach, ensuring that we really clearly start by recognising the emotion in the child and continue to focus on this which brings a very human connection beyond that of the relationship between teacher or TA and pupil. Thirdly we have set out small steps to take towards being in the room, beginning with sitting on a chair outside yet in view of the teacher and attempting some of the learning. These steps and the impressive patience of TAs and co-operation of teachers have not yet led to anxieties diminishing. They have shown that we are listening to young people, trying to understand their difficulties, and treating people with fairness. This is helping to build trust and show there is a way forward together.
The funding crisis in schools is serious, and for young people with SEND it is proving increasingly difficult to provide resources that meet their needs. The government's announcement of a cash injection is of course welcome, but inevitably this will take time to arrive on the ground and is likely to impact on services elsewhere. We have a new Year 7 cohort this year with wide ranging and complex needs. There are nearly 20% of pupils with an identified special need, and many more who will need additional and different provision in the new setting. The Year 11 who have just departed had a much smaller proportion of pupils with SEND so it is quite obvious that in order to stand still and maintain our current provisions we will require further funding. Even where the local authority has agreed to top up funding to meet needs, in some cases this money has not arrived in school. With just 7 teaching assistants in a large secondary school that has well over 200 pupils on the SEND register we have very limited resources. I will be working hard to make the best of these, but I am fearful that despite a coherent, efficient suite of provisions, we will not even be able to meet our statutory obligations.
Leadership has been on my mind this week too. I was given an extract from 'Radical Candor' by my headteacher. It is a book about leadership written by a former employee of Apple and Google. This style of book is usually a turn off for me, and indeed I shan't be going to buy a copy to read the whole thing. However there were some ideas in the introduction that resonated. The author writes about 'direct feedback' and the importance of honesty, clarity, and collaboration between leaders and employees. With these features, she writes, comes productivity built on pleasure in work and motivation. How true for leaders of young people in the classroom I thought. Another key message in the start of the book is that in her experience at the highest levels, the best bosses employ people to tell them what to do. I feel lucky because I believe my Headteacher employed me in May for exactly this reason. This feels empowering. She believes I can lead SEND in the school, trusts me to do it well, and knows that the school needs someone with expertise. Despite a tough start, and looking ahead to what will be a tough year, this realisation has left me further energised, and confident.

A short guide to....Motivational Interviewing

Staff in schools are constantly having dialogue with pupils about behaviour, stretching from a quick word outside the classroom to meetings with Governors. The aim of these by and large is to eliminate undesired behaviour and increase the frequency, duration, and understanding of desired behaviour. Motivational Interviewing provides an approach that supports this change. Adults at all levels in school can use its key principles and suggested strategies support changes in behaviour.

Motivational Interviewing is a form of therapy that has good success rates with individuals suffering from alcoholism, bulimia and substance misuse.  It should be remembered that adults and students in school cannot engage in therapy as there is an imbalance of power (which should be avoided in therapy). However, therapeutic approaches are very helpful in supporting students to make positive changes. 

Motivational Interviewing should be characterised by an approach that is collaborative, avoids the ‘righting reflex’ (where the teacher instructs or informs the student therefore trying to solve problems) and produces autonomy/independence in the student.  There are three key principles; 

a) It is focussed on behaviour change

b)  It emphasises and encourages personal reasons for change therefore increasing motivation to change. 

c) It links to the ‘trans-theoretical model of change’ which has five stages. These are pre-contemplation (not even thinking about change), contemplation (thinking about change), determination (having reasons for change and motivation to change), action (the process of change), maintenance and habit (the change becoming natural behaviour). 

Below are some suggestions about how to put these principles into practice for an adult working with a pupil following a display of undesired behaviour.

·         Thank the student for attending a meeting. This helps to demonstrate that you respect the fact the student may be considering a change. It also helps to build a more positive relationship.  

·         Ask open ended questions to elicit student experience of the incident/behaviour.  ‘Can you tell me about…’ ‘Describe to me when…..’ ‘What was it like for you when….’ ‘What happened….’.  This gives the student the opportunity to share their views and avoids judgement or confrontation.

·         Show empathy and understanding of the student’s perspective. Try to see if they can understand how someone else might feel or react in that situation. Re-iterate the key points the student made and summarise. Check then that the student agrees with the summary.  ‘So what you’re saying is….’ ‘If I understand correctly you mean…’ ‘Someone else might say that….’ ‘On the one hand you say that…..on the other….’ This helps to reassure the student and provides a value and acceptance of their feelings about the event.

·         Establish what a good outcome might look like. Again use very open ended questions focussed on the student’s views. Try to avoid the ‘righting reflex’ whereby the adult provides answers and solutions. Emphasise and re-iterate student’s own statements about what they are looking for in the future. ‘What would you hope to be different in…..’ ‘What might be the results if you changed something in…..’ ‘How would you like things to be in…..’ ‘What is the BEST thing you can imagine happening in….’ This helps to move the student on to focusing on a change and the potential benefits for them as well as others.

·         Identify actions (small steps first of course) that could lead to the desired outcome. Again, try to avoid the ‘righting reflex’ by making suggestions or over-directing. Over emphasise student’s own statements about change and how to get there.  ‘What do you think you could do differently…. ‘What might help the situation….’ These could then become specific targets for the pupil or actions for others to take that can be measured.

·         Restate and summarise key actions, checking for agreement. Thank the student for attending and contributing. This helps to make it clear that the meeting is the basis for agreement about desired outcomes and behaviours.

Motivational Interviewing is more than a set of techniques. To be successful it should be characterised by a specific way of being that is collaborative, avoids a didactic, expert centred style and produces autonomy/independence in the student.  

Acknowledgements and wider reading:

·         Article summarising Motivational Interviewing in British Journal of Psychiatry

http://apt.rcpsych.org/content/10/5/331  

·         Website of Stephen Rollnick, the first professional to write about Motivational Interviewing. 

http://www.stephenrollnick.com/about-mi.php  

·         Article from Bill Rogers, a renowned education consultant. 

 https://www.teachermagazine.com.au/article/how-to-follow-up-with-disruptive-students-beyond-class-time

·     Article from the website of @TeacherToolkit, winner of ‘Best Education Blog’ and Deputy Headteacher. 

 http://www.teachertoolkit.me/2012/11/06/ttkitthunks-ferrr80/  

Using praise (in brief)

Praise seems such an obvious part of a teacher’s role that it is often overlooked. However, like all tools the use of praise does need constant practice and planning in order for it to become a positive habit. With care, its use can be a highly effective intervention that supports young people with social, emotional or mental health needs as well as benefitting all pupils.

All schools encourage staff to praise children and have formal rewards schemes in place. This guide will focus on the use of praise in the classroom, but the principles highlighted below are important to consider when devising or reviewing existing systems.

Before describing a handful of specific types of praise, it is important to explain why praise should form a fundamental part of a teacher’s ‘toolkit’. Our brains form connections in response to what those around us are doing. These pathways are built very quickly in early infancy as children become attached to their primary care giver. The connections continue to be formed throughout childhood and during adolescence there is another period of rapid extension of the pathways. Throughout its development, the brain prefers existing neural pathways to developing new connections. The brain also prefers to make positive connections that bring a reward rather than developing a pathway that leads to harm. All of this psychology therefore reveals that a consistently positive experience is likely to engender a positive relationship and attitude. Of course, many pupils have not had positive experiences in early infancy so it is harder to develop or embed strong, positive neural pathways. However, the effective use of praise can be an important tool to strengthen or create connections that lead to more desirable, positive behaviours. Below are six simple strategies to support adults in schools make best use of the praise they employ.

·         3:1 ratio. For every criticism they make, adults provide to pupils three specific, targeted examples of praise.

·         Proximal praise. Adults deliberately and specifically praise those pupils who are displaying desired behaviours, especially when in the proximity of those displaying undesirable behaviour.

·         Positive reinforcement. Adults specifically mention the behaviours they observe which are desired and praise the pupils who display them.

·         Academic and social. Adults employ praise equally for social and learning behaviours as they do for academic or subject related matters.

·         Praise in public. Adults emphasise positive behaviours publically, yet provide criticism privately.

·         Growth mindset. Adults praise effort, process and progress of learning rather than only the final outcome of learning (e.g. the final test result).

This is of course not an exhaustive list and is designed as a reminder of tools that commonly have high impact for limited input. Like all tools, they do require practice and repetition to embed them.

High Challenge, Low Stress

The aim of this article is to consider the benefits of learning that brings high levels of challenge alongside low levels of stress for both staff and students. Many of the specific tasks described here I have used myself or seen at first hand but it is by no means exhaustive. The examples I provide below are designed to reveal the principles of high challenge, low stress learning rather than to offer 'off the peg' activities that can be seen as a means by themselves to bring about good quality learning.

Before and after. 

The activity is a very simple one. Start with an image and simply ask pupils to discuss what came in advance of that moment and what they know or think might have followed. For example, an image of a banana could lead pupils to consider plants and their reproduction, globalisation or even the digestive system of mammals. Teacher questioning and guidance can reshape answers towards those that are most relevant but from the very first moment all pupils are able to make suggestions. At the same time the task encourages pupils to think deeply about the content and explore the possibilities for learning.

Hexagons.

It is very common for teachers to ask pupils to 'make notes', 'record the most important issues, 'think about links', 'brainstorm ideas' or 'work together on this one'. Using hexagons is a simple but effective way to do all of these things at the same time without extensive instructions or complicated rules to follow.

There is a need to make a resource for this which is a little time consuming but once created it will last a very long time so it is time well spent. Teachers will need to provide a set of laminated hexagons for each group. Each shape should be roughly the size of one quarter of A4 paper and laminated. Then, with a stimulus such as a video, image, audio clip or text, ask students to record their ideas on hexagons; one idea or point on each shape, so you will need to have many hexagon shapes prepared. Finally, through discussion, pupils move their hexagon to reveal links, create groups or organise the information/ideas in another way. The hexagons help to provide a structure for he conversation about links and connections. Any point a student has recorded has six possible links through each of the sides of the shape, so there are many possible good answers, none of which are in the teachers' head or online meaning that students find their own meaning and understanding. This helps to limit stress and anxiety as there is almost no wrong answer, yet at the same time the task can challenge students to create their own 'big picture' and justify its structure. 

Planning for talk

Providing students with ways of finding their own way to understand an idea is an important step between dependence on instruction and independent learning. Both are important elements in high quality teaching of course but here I will just describe some methods of structuring discussions for learning that do not rely on the will and  personality of the teacher. 

Think-pair-share is a very common strategy but works well by ensuring students have time to process information and consider their own thoughts (think), opportunities to explore them safely with a partner (pair) before takin these to a wider audience such as a small group or whole class (share). The teacher has time to listen in to many pupils, identifying misconceptions and using questions to extend thinking.  Studnets also have opportunities to explore ideas, make and correct mistakes and practice language before bringing their answers to an audience or committing them to a page. 

When walking around the class in discussion or to check on work, let students know that you will pick on them when it comes to q and a/feedback because they have such good understanding. Anxiety levels tend to be minimised by giving prior warning, especially when it is simply to repeat a point that has already been made in front of two or three others.

Another simple structure for effective talk is for students to work in pairs taking it in turns to talk about their work/the topic/a stimulus for two minutes with no interruptions. This is followed by one minute of questions. Partners then swap over. End with an open conversation relating to a big question or issue. 

These are just a handful of examples of ways in which to create an atmosphere that is challenging but does not raise anxiety levels. I will write in future about the learning zone which is found between the comfort zone and the panic zone, but this article provides some simple tools that colleagues can use or adapt to bring about a high challenge, low stress environment. 

On leaving the classroom

After nearly ten years in one school I have recently left the classroom and moved on to a new role as an Advisory Teacher in a local authority. In the time I worked at the school, it moved from being in danger of closure due to underperformance and financial mismanagement to being judged as Outstanding by Ofsted and becoming the heart of a pyramid of schools in the community. The school's journey has been a remarkable one and I am sad to leave so in thinking hard about why I am making this decision I have attempted to find common themes that link to the issues of teacher recruitment and retention.

Quite rightly, much is expected of teachers and school leaders. The skills that are needed to succeed as a classroom teacher are extremely varied and complex. The colleagues with whom I worked are extremely dedicated, professional and genuine yet a feeling has begun to spread that it is becoming increasingly difficult to maintain the highest standards. For example, more students are being referred to child and adolescent mental health services yet there is significantly less capacity available. This means that schools are forced to tackle hugely challenging and complex cases and therefore have fewer resources to continue with the imprtant and valuable work they are already undertaking. Similarly, support for students with SEN is becoming more stretched and where budgets are pressurised the services and structures dedicated to the emotional well-being of pupils can be first in line for reduction. In all of these cases staff do everything in their power to support students. Yet put simply there is less capacity available currently to deal with increasing demand for services.

Also in my experience teachers do not have sufficient opportunities to pursue dedicated and sustained professional development. With a teaching load of 80% or more,  occasions to observe good practice or perhaps team teach are few and far between. In addition, too often meeting time in schools is spent delivering information rather than engaging in learning that will support teachers'  needs or the interests of pupils. These factors mean that many teachers in schools do not have enough capacity to step back from the daily events and review their own work or that of others. As a result the progress made by teachers in adapting and improving their practice is slowed which becomes demotivating and a downward spiral.

Finally, although there is clearly a need to evaluate the work of teachers and schools, the expectation of showing progress through data can be damaging. In the search for a target, students become percentage points and lose their individuality. Whilst identifying gaps, students become part of a sub-group and lead staff away from seeing the 'whole' child. Also, in order to achieve positive outcomes from inspection, schools tend to prioritise exam results above and beyond everything else, except perhaps safeguarding. Good Ofsted reports, the use of targets and tackling inequalities in attainment are all valuable priorities but schools in some cases lose focus on individual children. My frustration lies in the fact that if schools prioritise the needs of individual children first then all the other concerns (progress, attendance, inspections, destiantions on leaving etc.) will follow, If schools value the 'whole' child then learning is likely to be more effective, pupils are more likely to want to be in school and teachers maintain positive, motivating relationships. When schools prioritise 'secondary' issues (Ofsted, A*-C, Pupil Premium etc.) then teachers tend to lose motivation as they can feel like hamsters in a wheel rather than autonomous, caring professionals who are trusted to make good decisions in the interests of children and their families.

 

I have sought here to identify some of the key elements that I found common to staff in schools. There are many other complex and inter-related factors that meant I left the classroom which are personal, specific and as such do not really inform the debate on teacher shortages. In my experience, colleagues are finding that they take more on yet have less opportunity to develop skills and are working in an environment that tends to forego the idea of students as 'whole' and unique. I believe this balance should be addressed at all levels from middle leaders to senior management to trustee/governor level and of course in government.