#775632 Topic Don Quixote6.1 What Are Speech and Language Imp.docx

#775632 Topic: Don Quixote
6.1 What Are Speech and Language Impairments?
Students receive services for SLI more than any other disability
except for SLD. This section discusses the difference between a
speech impairment and a language impairment. It presents the
definition for SLI as outlined by IDEA and discusses the
prevalence of SLI in schools in the United States.
Defining SLI
Speech and language impairment (SLI) refers to a group of
disorders that affect a student's speech or language skill and
development. Language refers to the systems that people use to
communicate with each other; it also refers to the meanings of
words, and how words are assembled into meaningful thoughts.
It can be oral (spoken), written, or even gestural. For example,
in the United States, the gestural language of a "high five"
usually signals "Congratulations!" Speech, which refers to the
oral aspect of language, is how people express ideas or thoughts
through sounds. Speech is the main form of communication for
people around the world.
A language impairment is a disorder that affects how people
understand or use words. This can mean that they have
difficulty understanding what people say (receptive language)
or that they have difficulty constructing thoughts or ideas
(expressive language), or both. Receptive language refers to
how people organize and understand information provided
through oral, written, or visual means. Expressive language
refers to how people construct the words, symbols, or gestures
they want to communicate to others. A speech impairment is a
disorder that affects the production of sounds and words.
The category of SLI incorporates a wide variety of difficulties,

including difficulties related to articulation (pronunciation),
fluency (flow of speech), voice, and language (which includes
putting words and sentences into meaningful forms). Students
with SLI may experience difficulties with speech or language,
with approximately half of diagnosed students experiencing
both (Seeff-Gabriel, Chiat, & Pring, 2012).
In the field of medicine, SLI often falls under an umbrella
category called communication disorders or communicative
disorders (as do hearing difficulties; Chapter 10 discusses
hearing impairments in detail, as they have their own IDEA
2004 category.) Evaluations or diagnoses from medical
professionals may use the term communication disorder, but
schools will use the term SLI.
Students with SLI may have academic skills that are below
average, average, or above average, but researchers have
demonstrated that they often perform below students without
SLI on assessments of intelligence, language, and literacy
(Ferguson, Hall, Riley, & Moore, 2011). The effects of an SLI
on educational outcomes vary and are dependent upon the
student's specific difficulties. For some students, the
impairments do not hinder learning new material or
participating in classroom activities. Other students with SLI,
however, have difficulty with working memory, which
influences how they process information and store knowledge.
Evidence of a strong association between SLI and problems
with working memory continues to grow (Montgomery,
Magimairaj, & Finney, 2010).
Other students may have difficulty understanding new material
or participating in class. Reading difficulties are common
because of the connection between language and reading
(Pennington & Bishop, 2009). If students struggle with
understanding spoken language (i.e., what words mean) then it
can be difficult to understand the meaning of words read on the
page. Students may also have difficulty with speech and with

communicating through language, and speech difficulties can
contribute to reading difficulties (Gosse, Hoffman, &
Invernizzi, 2012). The need for support depends on the degree
to which the impairment affects the ability to succeed in the
general education curriculum setting.
SLI and IDEA 2004
Speech and language impairment is one of the 13 disability
categories under IDEA 2004. The passage of PL 94-142 in 1975
mandated that to be eligible for special education services
related to SLI, students had to be "speech impaired" (Triano,
2000). Because of the 1997 reauthorization, however, IDEA
2004 considers SLI to be a communication disorder: "Speech or
language impairment means a communication disorder, such as
stuttering, impaired articulation, a language impairment, or a
voice impairment, that adversely affects a child's educational
performance."
Note that for students to receive special education services for
SLI under IDEA 2004, the impairments must adversely affect
educational outcomes, such as reading or mathematics
performance. If a student's academic performance is not
adversely affected by the SLI (e.g., the student's only difficulty
is with speech), it is possible for the student to receive special
education accommodations under Section 504.
Once students are identified with SLI, the school assigns a
speech-language pathologist (SLP) or other certified specialist
to provide instructional services. Most school districts employ
SLPs to help students diagnosed with SLI because they are
trained to work specifically with these impairments.
Additionally, some families send their children to work with an
SLP outside the school day.
If SLI is the student's only disability, the SLP is considered to
be their primary service provider and is responsible for ensuring

that annual IEP goals are achieved. If a student has multiple
disabilities that affect educational performance, a special
educator may be considered the primary service provider and
work in collaboration with both the general education teacher
and the speech-language pathologist.
Regardless of the IEP arrangement, all educators must
collaborate and communicate regularly about student strengths,
needs, and academic progress. Instructional services provided
by the SLP should be reinforced both in the classroom and at
home. For example, if a student has difficulty pronouncing the
/r/ sound, the parents and the teacher should employ the same
techniques as the SLP to remind the student about the /r/ sound
and provide opportunities to practice it.
Prevalence of SLI
SLIs affect approximately 3% of, or more than one million,
school-age students. Boys tend to have slightly higher rates of
SLI than girls (Viding et al., 2004).
About 6% of students with an SLI experience a reading SLD, as
shown in Figure 6.1 (Gosse et al., 2012). In fact, students with
SLI share many characteristics of students with dyslexia
(Robertson, Joanisse, Desroches, & Ng, 2009). A small
percentage of students with SLI may be diagnosed with other
disabilities, such as autism, intellectual disabilities, ADHD,
EBD, or SLD (Cleland, Wood, Hardcastle, Wishart, & Timmins,
2010; Pinborough-Zimmerman et al., 2007).
Figure 6.1: Comparison of SLI and SLD
The percentage of school students with SLI has remained
relatively constant since 1977. The percentage of students with
SLD rose dramatically until 2001 and has begun to decline with
new methods of identification of SLD, such as RTI.
6.2 How Has the SLI Field Evolved?
Speech and language difficulties have been reported almost

since the beginning of recorded history. Thousands of years
ago, young men in Greece and Rome were taught oratory skills
to improve public speaking, and tongue exercises were
developed to help those with speech difficulties. In medieval
times, physicians suggested treating the throat or removing
excess saliva from the mouth. In the 16th century, Hieronymus
Mercurialis noted that speech impediments could be influenced
by anxiety about speaking, and suggested methods for
overcoming the problem.
By the 18th century, physicians had learned more about how the
human body produces speech, which led to medical treatments
for those with speech and language difficulties. In the 19th
century, therapists like Alexander Graham Bell—the inventor of
the telephone and also a speech therapist—offered lessons to
help people with speech and language difficulties.
In the late 19th century, Samuel Potter, a stutterer, wrote about
and suggested treatments for different types of speech disorders.
Some of his treatments included repeating the alphabet, placing
vocal organs in proper positions, and regulating oxygen flow.
Edward Wheeler Scripture followed a few years later with a
book on stuttering and lisping.
To help students with speech difficulties, Margaret and Smiley
Blanton published a book on speech for parents and teachers in
1920. This book recommended speech training for all students
during the school day, regardless of whether they had a speech
difficulty. As more therapists began providing treatment in the
United States for people with SLI, Edward Lee Travis and his
colleagues formed the American Speech Society in 1925; this is
now the American Speech-Language-Hearing Association.
Throughout the 20th century, more research about speech and
language difficulties was carried out (Duchan, 2010). Therapists
began recognizing a larger number of specific types of speech
and language difficulties, and they suggested many different

therapies to help.
Over the last 50 years, standardized assessments and diagnostic
routines relating to speech and language have been developed to
assist with the diagnosis of SLI. Degree programs for certified
and professionally trained speech-language pathologists (SLPs)
have also become more prevalent.
The certification of more SLPs, along with the passing of
special education laws, has meant that more students can
receive the speech and language services they need (Katz,
Maag, Fallon, Blenkarn, & Smith, 2010). In fact, because so
many students require the services of SLPs and there are not
enough SLPs to provide the services, speech-language
pathology assistants (SLPAs) have become more prevalent in
schools. An SLPA implements interventions with students while
supervised by an SLP.
In the last few years, medical technologies have provided
greater insight into speech and language production, and
researchers have developed and tested therapies and
interventions for people with SLI (Baker & McLeod, 2011;
Cirrin et al., 2010). For example, a medical professional might
use different instruments (e.g., nasometry or electromyography)
to understand bodily functions related to speech. An SLP might
use evidence-based practices to improve the speech patterns or
language skills of a student with an SLI. The SLP might use
nonspeech movements, such as massage, cheek puffing, or icing
to improve the speech of students (Lass & Pannbacker, 2008).
6.3 What Are the Characteristics of Students With SLI?
The term SLI covers a wide range of disorders related to speech
and language; therefore, students with SLI may display many
different characteristics. In general terms, students with SLI
may experience difficulty following directions or understanding
and participating in a conversation. They may struggle with the
pronunciation of words and the production of language, and may

experience difficulty at school, where communication and
learning traditionally rely mainly on the expression of ideas
through speech and language.
The National Dissemination Center for Children with
Disabilities describes four major areas of difficulty for students
with SLI. The first three areas deal with speech difficulties:
Articulation difficulties, which involve problems with the
pronunciation of sounds. One type of articulation difficulty is a
lisp, which means /s/ and /z/ sounds are pronounced incorrectly.
Many toddlers and young children have difficulty with /l/ and
/r/ sounds as they are learning to speak. When the difficulty
persists past the age of 5, a student has an articulation
difficulty.
Fluency difficulties, which involve a student's flow of speech.
A struggle with fluency involves the disruption of the speech
pattern because specific sounds and words are difficult to say.
Students may repeat or slowly pronounce words, or they may
skip difficult sounds or words entirely. Stuttering is an example
of a disorder that affects speech fluency. When a student
stutters, they repeat or "get caught on" certain sounds (e.g., "I l-
l-l-like ice cream").
Voice difficulties, which involve pitches of sound when
speaking. Students may speak too loudly or too softly. They
may sound hoarse, breathy, or nasal.
The final area deals with language difficulties:
Language impairments, which involve difficulty with
communication. Students with language impairments have
trouble expressing their wants and ideas, understanding new
information, following directions, and understanding the written
or spoken word. Students may pause when speaking to find the
"right" word (Smith, Hall, Tan, & Farrell, 2011).
So, speech impairments affect how students make sounds and
words. Language impairments affect how students understand

language and communicate their thoughts and ideas.
Speech Impairments
Speech sound disorders involve the faulty production of sounds
and sound patterns. Motor speech disorders usually involve how
the face, mouth, and brain work together to create speech.
Speech sound and motor speech disorders can cause
articulation, fluency, or voice difficulties. Students with speech
impairments may have difficulty imitating the speech of others,
and their own speech may be difficult to understand or interpret.
They may be anxious when speaking because it is difficult for
them. Students with speech impairments often experience
language impairments because of disruptions with speech
(Finneran, Leonard, & Miller, 2009).
Speech sound disorders are more common than motor speech
disorders. Here are a few of the most prevalent types:
Articulation disorder. Students with articulation disorder have
difficulty making sounds. When saying syllables or words,
students may substitute one sound for another (easier-to-
produce) sound, add a sound, or take out a sound. For example,
a student may say "the rabbit ran" as "the wabbit wan." As
young children develop speech, almost all have difficulty with
articulation. When that difficulty continues past the time
students start kindergarten, they may require support to improve
their articulation. Teachers, however, need to ensure that the
student actually has an articulation disorder rather than
speaking a regional dialect or English as a second language.
English language learners are often over-identified as having an
SLI (Kapantzoglou, Restrepo, & Thompson, 2012). A trained
professional, such as an SLP, can help determine the difference
between an articulation disorder and a dialect or accent. Often,
as students improve their knowledge of English, it becomes
clear whether the student has a disorder.
Phonological process disorder. Students with a phonological

process disorder make patterns of errors when producing
sounds. This disorder is related to how the brain communicates.
Often, the student's tongue produces sounds incorrectly, but in a
way that other sounds are produced. For example, say the sound
/g/ as in the word "gut." Your tongue touches the inside of your
mouth, all the way in the back. Now, say the /d/ sound. Where
did your tongue touch the top of your mouth for /d/? Now, say
the /g/ sound again, but touch your tongue to the top of your
mouth a little further forward than you did for /g/ before. What
you said probably sounded more like /d/ than /g/. Students with
phonological process disorder may switch the sounds for /k/ and
/t/ as well. They may also have difficulty with blends of two
consonants. They often say the first of the two consonants and
drop the sound of the second consonant. "Trick" becomes "tick,"
and "drip" becomes "dip," for example.
Stuttering (also called dysfluency). When students stutter, they
get "stuck" on a syllable or word, and they repeat it several
times. Stuttering falls under speech sound disorders, but it also
may classify as a dysfluency disorder. Some stutterers say "um"
or "uh" frequently while they are preparing to say a word. For
some students, stuttering has little to no effect on speech. For
others it can be a major stumbling block for participation in
school and life activities. Some examples of stuttering include,
"P. . .p. . .p. . .please," "The. . .the. . .the dog," or "I want. . .uh.
. .uh. . .uh chocolate ice cream."
The following are a few of the most common motor speech
disorders:
Childhood apraxia of speech (CAS). Apraxia is the inability to
perform a movement (in this case, speech) even when the brain
and body understand what needs to be performed. Students with
CAS struggle with saying sounds, syllables, or words. Usually,
they want to say something, but their brain and their body parts
(e.g., mouth or tongue) have difficulty with the coordination of
the speech. Students with CAS typically understand language
(i.e., what is being said), but they have trouble speaking as they

respond to the language. CAS is different from stuttering in that
stuttering is a difficulty with creating speech and CAS is a
difficulty with the language that goes into speaking. In other
words, students with CAS can articulate words; they just have a
hard time finding the "right" words to say.
Dysarthria. Students with dysarthria typically have a
neurological impairment that causes difficulty moving the
muscles of the face and mouth. The muscles may be too weak or
slow to produce speech. These students may also have difficulty
breathing, which contributes to difficulty with speech. Students
may speak at a slow rate or appear to whisper or mumble. Voice
quality may be hoarse, nasal, or breathy. Some students may
have experienced a traumatic brain injury (TBI), while others
have a disease (such as Cerebral Palsy or Muscular Dystrophy)
that contributes to the dysarthria.
Orofacial myofunctional disorders (OMD). Students with an
OMD have difficulty with the control of their tongue, which
may cause difficulty with speaking. The tongue may move
forward in the mouth too much while the student is speaking,
which causes difficulty in the production of speech. For
example, try to say the word "sink" with your tongue sticking
out of your mouth. Did you say "think" instead?
When a student struggles with a speech impairment, whether it
is a speech sound disorder or motor speech disorder, the student
often demonstrates atypical classroom behavior. For example,
the student may not participate in classroom discussions or
volunteer to answer questions because they do not want to speak
aloud. If teachers are not aware of the speech impairment, they
may perceive the student's lack of classroom participation as
disinterest or a lack of knowledge.
Language Impairments
Unlike a speech impairment, which may affect just one part of
an individual's speech, a language impairment typically affects
all aspects of an individual's language (Archibald, Joanisse, &
Edmunds, 2011). Language impairments can be divided into two

categories: expressive and receptive.
Expressive language disorder. An expressive language disorder
affects how students produce verbal and written language.
Students typically have difficulty communicating thoughts and
feelings in a coherent manner. They may find it hard to put
words in the right order to form grammatical sentences, or they
may use words in inappropriate contexts. They may have
difficulty with verb agreement and using proper tenses
(Leonard, Miller, & Owen, 2000). For example, a student might
say "The cat lick his paw" or "Last week, Marta bring a frog to
class."
Receptive language disorder. A receptive language disorder
affects how students understand what other people are trying to
say. Students may struggle with understanding directions or
participating in conversations.
Mixed expressive-receptive language disorder. Often, students
struggle with both expressive and receptive language (Nickisch
& von Kries, 2009). Students have difficulty understanding
language and communicating with language.
In discussions of language impairment, you may hear or read
the term aphasia, which refers to difficulty remembering words
or remembering how to read and speak. Aphasia often occurs
after an older person has experienced a stroke or some other
type of brain or neurological injury, but young students can
experience it as well, especially after an accident. With aphasia,
a student may not be able to find the "right" word to say. For
example, she might say, "I want to play that game with the red
and black pieces—you know, that game. What's it called?"
Voice disorders affect the sound of a student's voice. Usually,
the unusual qualities in a student's voice indicate a condition
affecting the student's vocal chords (larynx) or trachea (wind
pipe).
6.4 What Are the Causes of SLI?
Different types of SLI have differing causes. One common

cause for an SLI is a hearing impairment, because of the role
hearing plays in understanding language and speech. Other
contributing factors include a variety of diseases, disorders, and
deficits within the brain. Sometimes, the causes remain
unknown.
The Role of Hearing Impairments
Hearing impairments are the most common causes of speech and
language difficulties (Keilmann, Kluesener, Freude, &
Schramm, 2011). When a student has a hearing impairment, he
or she has difficulty hearing and discriminating between sounds.
Students may have mild or moderate hearing loss, such that
sounds sound softer. They may have severe or profound hearing
loss, such that sounds can only be heard with technologies or
not at all.
Hearing impairments affect SLI because hearing others speak
influences much of our early speech development. Children
learn to speak by mimicking sounds their parents and others
make. If the child doesn't hear these sounds properly, it can
cause a delay in speech and language.
The Role of the Brain
In the 19th century, a French physician named Paul Broca
conducted an autopsy on a patient who could understand
language but had severely limited speech; he found damage to
the man's left frontal cortex (see Figure 6.2). After seeing
similar patterns of damage in other patients, Broca concluded
that this area of the brain helped produce language. This part of
the brain is now referred to as Broca's area. Several years later,
Carl Wernicke, a German physician, discovered another part of
the brain related to language understanding. Wernicke's area, as
it is now called, is located in the back of the left temporal lobe.
Figure 6.2: Broca's Area and Wernicke's Area
Information comes into the brain and travels to Wernicke's area,

one of the areas involved in how the brain makes sense of the
language. Information then travels to Broca's area, which is
involved in the process of responding. When students have
damage to either Wernicke's area or Broca's area, the student
may experience difficulties with speech or language.
Today's research reveals more about how specific areas of the
brain control the comprehension and output of language
(Badcock, Bishop, Hardiman, Barry, & Watkins, 2012). An
individual's brain may be involved in difficulties in the
production of speech and language or in the motor skills
required for speech. For example, parts of the brain may be
damaged or connections in the brain may not be working in a
typical manner. The brain may be misfiring and sending
incorrect signals to the student (Preston et al., 2012).
The Role of Genetics
Genetics may play a role in SLI (Pruitt, Garrity, & Oetting,
2010). Studies of twins have found that when one twin has a
speech or language impairment, there is a 40–75% chance that
the other twin will have an SLI (Viding et al., 2004). Students
with a parent with an SLI have an increased risk of also having
an SLI (Pruitt et al., 2010).
Research indicates that the development of language and
speech, as it is tied to the brain, is directly related to genetics.
That is, brain development and function tends to be similar from
parent to child. If a parent has a difficulty with speech and
language that is related to brain function, then his or her
children are more likely to, as well.
Other Factors
Some students experience SLI because of another disease or
disorder. For example, students with Muscular Dystrophy lose
muscle control, including control of the tongue, which
contributes to difficulty producing sounds and words. Students

born with a cleft palate, even if it has been repaired, may still
have a difficult time producing sounds and words.
Voice disorders may be caused by excessive or inappropriate
use of the vocal chords. For example, students who scream or
yell excessively can damage their vocal chords. The inhalation
of toxins, such as cigarette smoke, may contribute to vocal
difficulties as well.
Other environmental factors, such as allergies or ear infections,
can contribute to hearing difficulties, that can, in turn,
contribute to an SLI. Additional environmental factors linked to
SLI include abuse, neglect, or malnourishment. These factors
may contribute to abnormalities in brain development or
function, which may cause an SLI.
6.5 How Are Students Diagnosed With SLI?
If a teacher suspects that a student may have an SLI, the teacher
should refer the student for evaluation with a trained
professional, such as an SLP. The SLP and other medical
professionals can conduct appropriate assessments and provide
an appropriate diagnosis. Teachers do not diagnose SLI.
When Are Students Diagnosed?
Many teachers recognize SLI during preschool or elementary
school, but students can be diagnosed at any time during their
school career. Many delays in speech and language development
can be identified within the first few years of a child's life.
Other difficulties in understanding and expressing language do
not become evident until students begin to learn to read and
write.
Once students exhibit persistent difficulties with speech or
language, the evaluation process should be initiated. The longer
children go without services, the less likely they will be to
improve their abilities to understand and produce language.

Parents and teachers can sometimes have difficulty deciding
when a child's speech and language issues are something he or
she will "grow out of," and when the difficulty is something
that needs to be brought to the attention of an SLP. Parents may
attribute speech difficulties to "baby talk" long after the child
should have outgrown the speech patterns. The rule of thumb is
that most students should outgrow speech and language
difficulties before they enter kindergarten.
The Diagnostic Process
The official evaluation for, and diagnosis of, SLI comes from a
certified SLP or other certified therapist or professional,
typically early in a child's education. Family members or
teachers who notice difficulties indicative of an SLI may refer
the student to the school or district's SLP (Lindsay, Dockrell,
Desforges, Law, & Peacey, 2010). If a school or district does
not employ an SLP, the district must pay for an evaluation from
an outside center or SLP. Medical professionals, such as
doctors, may diagnose SLI as well.
The diagnostic process for SLI may be inconsistent from school
to school or clinic to clinic (Dollaghan, 2011). Each SLP may
employ their favorite diagnostic measures and processes.
However, there are some commonalities in the steps for
evaluation and diagnosis used with most students. For example,
three sources are typically used in an evaluation: a parent
report, a teacher report, and observation by a trained
professional (McLeod & Harrison, 2009).
Before an SLI assessment occurs however, an audiologist (i.e.,
hearing specialist) or an Ear-Nose-Throat physician or specialist
should conduct a hearing evaluation to help rule out or clarify
the role that hearing loss may have in the student's speech or
language difficulties.
Informal and Formal Observations
Once a hearing assessment has been conducted, the next step is

for an SLP to gather more detailed information from parents and
teachers about the speech or language difficulties of the student.
The SLP may also conduct informal and formal observations of
a student's speech and language skills. In a formal observation,
the SLP may conduct a set of activities with the student to elicit
specific responses related to speech and language. For example,
"This is a ball. Say ball. This is a rabbit. Say rabbit." The SLP
may ask students to follow specific directions; name colors,
numbers, letters, or common objects; or sing songs and rhymes.
In an informal observation, the SLP may observe the student
playing with a parent or peers to determine how the student
speaks and whether the student understands language. Informal
observations are often used with younger students, while formal
observations are often used with older students.
The information obtained helps the SLP determine which
diagnostic tests may be appropriate to administer to the student.
Assessment Activities
The SLP then administers a battery of assessments and has
students engage in activities to determine the source of
difficulty. The assessor first may administer an oral mechanism
examination to check for weakness of the lips, jaw, tongue, or
teeth. He or she may also evaluate how well the student's mouth
moves in different directions. To evaluate sound production, the
SLP may ask the student to say specific sounds or mimic sounds
and sound patterns.
The SLP may ask the student to speak and will then count the
number and types of dysfluency in the student's speech—that is,
how many breaks or pauses occur in a student's speech.
Additionally, the SLP may examine the student's rate of speech.
To determine difficulties with language, the SLP may
administer assessments of oral language comprehension and
production.

A medical professional may conduct an anatomical evaluation
of the mouth and face to determine whether the larynx or tongue
may be contributing to speech or language difficulties. Dentists
or orthodontists may notice or assist in the detection of
anatomical abnormalities in the student's mouth.
6.6 How Does SLI Differ Across Grade Levels?
Instructional support for students with SLI, like support for all
students with disabilities, varies depending on grade level.
Regardless of age or ability, however, instruction at every grade
level should promote stronger language skills and strengthen
specific areas of weakness, according to the individual child's
needs.
Early Childhood
SLI may first become evident as infants begin to respond to
adult communication. Early childhood language includes
babbling speech sounds (e.g., "ba" and "ga") and exhibiting
clear responses to direct communication from adults (e.g., a
baby turning to look at his mother when she calls his name). As
young children progress, they begin mimicking the speech
patterns of their parents and repeating basic words (e.g., "bye"
and "ball"). Children then begin to speak words to communicate
meaning, and eventually combine words to form simple
sentences (e.g., "I want cookie").
At any point during this speech and language development
process, delays can be observed. Some delay in speaking and
responding to communication may be within normal range, but
when significant difficulty is observed past recommended
developmental benchmarks, the child may have an SLI
Like all students with disabilities, students with SLI benefit
from early intervention. Interventions for SLI can either be
child-focused or environment-focused. Child-focused
intervention targets a specific behavior within the child, while
environment-focused intervention seeks to alter the setting or
behaviors of others who interact with the child on a regular

basis (Pickstone, Goldbart, Marshall, Rees, & Roulstone, 2009).
The earlier that parents or teachers can identify the need for
early intervention, the better the outcomes may be for the
student. Some students may be referred for early special
education services. For many students, speech and language
services may be provided by an SLP during pre-school or pre-
kindergarten. Some students may receive services in a clinic
setting even earlier, if necessary. The earlier that speech or
language services can be delivered to the student, the quicker
any impairments can be improved or remedied. Students can be
identified under IDEA 2004 with an SLI, or students may be
identified under the category of developmental delay and
receive appropriate services in this manner.
Interestingly, many young students with speech difficulties do
not believe they have a speech difficulty (McCormack, McLeod,
McAllister, & Harrison, 2010), so if these students can receive
speech services before they catch on to their difficulty, they
may avoid developing negative feelings about speaking.
Elementary School
Early intervention for SLI is particularly important as students
begin learning to read and write in early elementary school.
Students with SLI can benefit from small-group, explicit
instruction that focuses on recognizing and memorizing patterns
in speech sounds, word parts, and sentence structures. With
explicit instruction, the teacher or another trained therapist or
specialist provides focused instruction on specific topics
necessary for the student's speech or language development.
Students may need meaningful repetition and practice with the
elements of speech and language. Additional practice and
frequent feedback on language assignments may help students
with SLI improve their word recognition and processing speed.
Promoting social communication is key at this stage of a child's
education. In elementary school, students with SLI will become
aware of their impairment and the difficulties they face

understanding and communicating with others. Teachers can
plan positive interactions and opportunities for students to share
their ideas with others. Structuring activities for students to
demonstrate their strengths can build their confidence in their
ability to interact with peers and adults. Allowing, or even
requiring, multiple modes of communication, such as pictures or
storyboards, can increase student interactions.
For elementary students with speech impairments, work with an
SLP or other certified specialist is imperative. The general
teacher should collaborate with the SLP to coordinate
reinforcement and support in the general classroom that is
complementary to and builds off speech services. For example,
if the SLP is working on phonological awareness (PA) with a
student, it is important for the general education teacher to
reinforce PA skills in a similar manner.
Secondary School
Most progression of language ability occurs early in a student's
education, and by the time students enter late middle or high
school, many of their language habits and abilities are
solidified. In fact, the percentage of students receiving SLI
services in high school is often drastically lower than students
receiving services in elementary school. If adolescent students
with SLI do receive services, it is often in shorter increments
than elementary age students. However, significant academic
gains are still possible for secondary students. A focus on
building speech and language confidence and skills should
continue into secondary education for students with SLI.
An in-depth understanding of student strengths and weaknesses
can help teachers design specific interventions for targeted
skills. Secondary school students should have an understanding
of their progress to date and future goals for improving
expressive and receptive language ability. Continued emphasis
on building confidence is important to help students realize

their potential.
Adolescent students with SLI may perceive their academic and
social abilities to be lower than students without any language
impairment. Hughes, Turkstra, and Wulfeck (2009) studied
perceptions of executive function in students with SLI;
executive function is associated with goal-oriented behavior,
including memory, control, and self-monitoring, and it is
essential for language-based academic and social tasks for
secondary students. Hughes et al. (2009) found that both
adolescents with SLI and their parents tended to rate their
executive function (i.e., attention, planning, flexibility, etc.)
more negatively than students and parents of students without
SLI.
Transition
Secondary students with SLI will have a transition plan as a part
of their IEP. Post-secondary transition plans vary among
students with SLI and are created by the IEP team, including the
student, family members, special education teacher, SLP,
general education teachers, school counselor, and other service
providers, as appropriate. Students who plan to transition to
higher education and most careers must be able to effectively
read, comprehend, and express their ideas in oral and written
form. Post-secondary students with SLI need be able to
advocate for their individual needs so that their speech or
language impairment does not impede academic and social
performance. Additionally, students need to be well aware of
the accommodations and resources necessary for their continued
success.
For students with multiple or severe disabilities, IEP and
transition goals may include functional life skills. This will
likely include learning to communicate basic needs, such as
using the bathroom, through speech or assistive technology.
Such skills are critical to future quality of life, and should be

addressed in secondary IEP goals and transition plans.
Once they exit the K–12 school system, it is unlikely that adults
with SLI will receive targeted intervention in speech or
language. Adults with SLI may show poorer communication,
academic, educational attainment, and occupational outcomes
than adult peers without speech or language impairments
(Johnson, Beitchman, & Brownlie, 2010). However, adults with
SLI can be successful in college and career, especially with the
appropriate support systems in place.
6.7 How Do I Teach Students With SLI?
Students with SLI should receive speech and language services
from trained professionals. The role of the classroom teacher is
supportive and collaborative.
Collaboration With an SLP
An SLP often provides appropriate services for students with an
SLI, although other certified staff members (e.g., SLPAs,
audiologists, vocational specialists, occupational therapists, or
physical therapists) may contribute to providing speech and
language services (Richburg & Knickelbein, 2011). Depending
upon the student's IEP, the student may receive intensive
therapy (e.g., four or five times a week) or periodic therapy
(e.g., once a week; Bellon-Harn, 2012). SLPs may conduct a
wide range of therapies and activities tailored to the student's
disability. Most often, SLPs work individually with students
because each student requires an individualized speech or
language program.
Consultation between the SLP and the student's family is
important so that the family is aware of instructional methods
used with the student. The discussion should cover improving
and practicing speech or language in the home environment
(Roberts & Kaiser, 2011).
Special Education Perspectives: Working with Speech
Impairments
Students With Speech Disorders

SLPs may lead students with motor difficulties in exercises to
strengthen the tongue or mouth. Students may watch themselves
in the mirror or watch a videotape that the SLP has made of the
student speaking. Students with speech sound difficulties may
require different methods; SLPs may teach them how to
correctly pronounce letters or words by demonstrating and
explaining the actions. For example, the SLP may practice
helping a student say the /r/ sound in "rake" by discussing the
tongue's movement in the mouth.
SLPs may teach students who are working on speech or
language skills other ways to communicate in the interim. A
student may learn to use signs or gestures to indicate wants and
needs. In some cases, students may use picture boards or
augmentative and alternative communication (AAC) devices.
Chapter 9 discusses AAC and picture boards, as they are
commonly used for students with autism.
From My Perspective: Being an SLP
I'm Marta, and I've worked as an SLP for over 20 years. SLPs
work in a variety of settings and with a variety of
communication disorders. A child has to have an educational
deficit to be found eligible for the speech-language program
under IDEA 2004, regardless of the disorder. Most SLPs see a
caseload of 35 to 65 students, depending on the school system,
and each student's needs are identified on his IEP. Many SLPs
work directly in the classroom to integrate the speech-language
goals and successes into the daily routine, so that the teacher
can observe and carry over the techniques. Some students
require individual or group therapy, which can be conducted in
the SLP's room.
Articulation problems (difficulty pronouncing certain sounds)
require the SLP to determine the cause and then assist the
student with correct production—starting with single syllables
and building up to longer utterances. Visual modeling, auditory
discrimination training of the correct production, and tactile
cueing are all tools used to achieve success. Reinforcement and

repetition are key aspects of treatment.
Language reception and expression are a large part of the
caseload, often best treated in the natural environment of the
classroom. These areas are often seen in conjunction with other
learning challenges, so a collaborative approach provides the
best context for the child to improve her skills. Auditory
processing of information, syntax (sentence structure),
semantics (word meaning), and pragmatics (the non-verbal
aspects of expressing oneself) are all areas that are assessed
through standardized tests and language samples, and each can
be improved through targeted instruction.
Students With Language Impairments
Teachers can do a variety of activities with students with
language impairments. Vocabulary instruction should be
explicit and focused on vocabulary that is most important for
reading comprehension or communication (Taylor, Mraz,
Nichols, Rickelman, & Wood, 2009). Typically, a few
vocabulary words should be chosen and practiced to build
fluency (Bryant, Goodwin, Bryant, & Higgins, 2003). It is
helpful to provide pictorial representations, when possible, so
students can visualize the meaning of the vocabulary word
(Figure 6.3).
Figure 6.3: Teaching Vocabulary
Graphic illustrations may help a student who is learning the
word swoop. A square with four sections. The top left section
reads, "The eagle swoops down from the sky to catch a mouse."
The top right section reads, "Swoop means to fly down
quickly." The bottom left section shows an illustration of an
eagle swooping down to get a mouse. The bottom right section
reads, "Let's practice a swoop with our hand. Put your hand
high in the air. Now, quickly move your hand down and touch
the ground." This section shows and illustrations of an arm held
high in the air and an arrow moving from the palm of the hand
down.
Students can also learn strategies for "finding" the right word

(Bragard, Schelstraete, Snyers, & James, 2012). Students can
learn how to connect a vocabulary word to other known words
using definitions or pictures. For example, a student may not be
able to remember the word "carriage." But the student could
learn how to provide cues for the word: "It was used before
cars, it has four wheels, and a horse would lead it." The student
might even use the word "wagon" or a picture of a horse-drawn
cart to describe "carriage."
It may also be helpful to work on a student's listening skills.
Much of language involves listening and comprehending
information from other voices, so it is important that students
have opportunities to practice and improve their listening skills.
Teachers should connect listening to speaking, reading, and
writing. To help with listening, teachers can encourage a quieter
classroom with fewer noisy distractions (e.g., music from a
radio or chairs that scrape noisily on the floor).
Another helpful strategy to improve language is to expose
students to a variety of books or situations that involve reading.
Teachers read alongside students and encourage them to
synthesize what has been read and guess what they will read
next. Teachers should choose reading materials that are
appropriate for the student. This may mean choosing books with
a predictable structure or easy sentence patterns that enable the
student to focus on the ideas or the story.
General Strategies
Teachers may want to place the student with SLI in a seat that is
close to the focal point of the classroom (e.g., the whiteboard,
the teacher, or the activity). This allows the student easy access
to classroom instruction, and it allows the teacher to quickly
recognize when the student requires additional help. It might be
helpful for the teacher to speak in shorter sentences and
paraphrase or highlight main ideas. Teachers should ask
students to repeat directions or ask them questions to check for
comprehension. Speaking a little bit slower and taking audible
pauses may provide all students with time to digest and

understand directives.
Teachers need to provide ample "wait time" for students who
have difficulty creating speech or generating language. Even
though teachers may think it is reassuring, saying things like,
"It's okay, take your time," or "Relax and breathe" may be more
counterproductive than helpful. Phrases like these may draw
attention to the student and add to the student's anxiety about
speaking even more!
Strategies like an advance organizer (e.g., "Today we're
learning about plant life cycles") or graphic organizers (e.g.,
"Let's use pictures to show the life cycle of a plant") can also
help students with SLI. Students may especially benefit from
advance organizers that include a preview of important
vocabulary words.
Teachers may also employ response cards in a classroom with a
student with SLI. To use response cards, the teacher asks a
question, and each student responds by holding up an
appropriate card. Response cards may be general. For example,
students may have cards that say, "Yes" and "No." Students can
have cards with a happy face and a sad face. Students can hold
up a card to answer a teacher's question or show the teacher that
they answered a problem correctly or incorrectly. Response
cards may also be content-specific. For example, the students
may have pictures of an ear, a nose, and eyes. For a lesson on
the senses, the teacher may ask the student to hold up a
response card to designate the best way to investigate an item:
by listening, smelling, or seeing.
The teacher may need to educate the rest of the class on how to
interact or include a student with SLI into regular classroom
activities (McCormack et al., 2010). Young students may find it
hard to understand what a student with a lisp or a stutter wants
to say. The teacher should give other students guidelines—for
example, "Look directly at your classmates when they speak"—

to facilitate communication between peers. The entire class
should learn to not snicker or laugh when a student has a
speech, language, or vocal impairment. Negative peer reactions
may cause a student with an SLI to exercise their speech skills
less frequently, or it could exaggerate the student's difficulty.
It may also be helpful to work on a student's listening skills.
Much of language involves listening and comprehending
information from other voices, so it is important that students
have opportunities to practice and improve their listening skills.
Teachers should connect listening to speaking, reading, and
writing. To help with listening, teachers can encourage a quieter
classroom with fewer noisy distractions (e.g., music from a
radio or chairs that scrape noisily on the floor).
Another helpful strategy to improve language is to expose
students to a variety of books or situations that involve reading.
Teachers read alongside students and encourage them to
synthesize what has been read and guess what they will read
next. Teachers should choose reading materials that are
appropriate for the student. This may mean choosing books with
a predictable structure or easy sentence patterns that enable the
student to focus on the ideas or the story.
Tips for the General Classroom
The National Dissemination Center for Children with
Disabilities (NICHCY) provides tips for general classroom
teachers who work with students with SLI. Their suggestions
include the following:
Learn about the student's speech impairment or language
impairment. Do not assume that all students with an SLI have
the same difficulties.
Ask for a copy of the student's IEP and learn about the student's
accommodations for the classroom and during testing situations.
Meet with the SLP or the special education teacher. Discuss
how you can support the student in your classroom.

Talk with the student's parent or guardian. Discuss how they can
help support the student at home.
Be positive about including the student in your classroom!
General Strategies
Teachers may want to place the student with SLI in a seat that is
close to the focal point of the classroom (e.g., the whiteboard,
the teacher, or the activity). This allows the student easy access
to classroom instruction, and it allows the teacher to quickly
recognize when the student requires additional help. It might be
helpful for the teacher to speak in shorter sentences and
paraphrase or highlight main ideas. Teachers should ask
students to repeat directions or ask them questions to check for
comprehension. Speaking a little bit slower and taking audible
pauses may provide all students with time to digest and
understand directives.
Students use response cards or hand signals to participate in
answering questions and indicating understanding. A common
response is a thumbs-up or thumbs-down gesture. This teacher
may have requested, "Give a thumbs up if you can think of a
reason why cheating on a test is wrong."
Teachers need to provide ample "wait time" for students who
have difficulty creating speech or generating language. Even
though teachers may think it is reassuring, saying things like,
"It's okay, take your time," or "Relax and breathe" may be more
counterproductive than helpful. Phrases like these may draw
attention to the student and add to the student's anxiety about
speaking even more!
Strategies like an advance organizer (e.g., "Today we're
learning about plant life cycles") or graphic organizers (e.g.,
"Let's use pictures to show the life cycle of a plant") can also
help students with SLI. Students may especially benefit from
advance organizers that include a preview of important
vocabulary words.
Teachers may also employ response cards in a classroom with a
student with SLI. To use response cards, the teacher asks a

question, and each student responds by holding up an
appropriate card. Response cards may be general. For example,
students may have cards that say, "Yes" and "No." Students can
have cards with a happy face and a sad face. Students can hold
up a card to answer a teacher's question or show the teacher that
they answered a problem correctly or incorrectly. Response
cards may also be content-specific. For example, the students
may have pictures of an ear, a nose, and eyes. For a lesson on
the senses, the teacher may ask the student to hold up a
response card to designate the best way to investigate an item:
by listening, smelling, or seeing.
The teacher may need to educate the rest of the class on how to
interact or include a student with SLI into regular classroom
activities (McCormack et al., 2010). Young students may find it
hard to understand what a student with a lisp or a stutter wants
to say. The teacher should give other students guidelines—for
example, "Look directly at your classmates when they speak"—
to facilitate communication between peers. The entire class
should learn to not snicker or laugh when a student has a
speech, language, or vocal impairment. Negative peer reactions
may cause a student with an SLI to exercise their speech skills
less frequently, or it could exaggerate the student's difficulty.
References
Powell, S. R., & Driver, M. K. (2013). Working with
exceptional students: An introduction to special education
[Electronic version]. Retrieved from https://content.ashford.edu/
5.1 What Is ADHD?
This chapter discusses a disability that is not a separate
category under IDEA 2004: ADHD. It is one of the more
prevalent disabilities in schools today (Stolzer, 2007). This
section presents the formal definition of ADHD and discusses

the difference between the terms ADHD and ADD. It highlights
how IDEA 2004 defines ADHD and how prevalent it is in
students.
Defining ADHD
Students with Attention-Deficit/Hyperactivity Disorder (ADHD)
typically exhibit some combination of inattention,
hyperactivity, and impulsivity. A student displaying inattention
might have trouble focusing on a task for an extended period of
time, be easily distracted, or struggle with paying attention to
details. Hyperactivity might be seen in class as a tendency to
fidget and have difficulty staying seated for reasonable amounts
of time. A student who exhibits impulsivity may speak at
inappropriate times or have difficulty waiting for his or her
turn.
Displaying inattention, hyperactivity, or impulsivity does not
necessarily indicate that a student has ADHD. In fact, most
students occasionally show one or even all of these behaviors.
Any student may daydream or jump out of their seat and run to
the window to see something outside. Any student may grab a
marker from another student or talk fast and appear jittery.
However, when these difficulties are severe and persistent
enough to interfere with regular activities, the student who
exhibits them may be diagnosed with ADHD.
ADHD and IDEA 2004
ADHD falls under the IDEA 2004 category of Other Health
Impairment (OHI). For a student to qualify for special education
services under IDEA 2004 in the OHI category, the student must
exhibit an academic deficit related to ADHD and exhibit
characteristics of ADHD.
ADHD is one of the more commonly identified disabilities that
falls under OHI. Other disabilities that may fall under the OHI
umbrella include diabetes, epilepsy, and Tourette syndrome
(although some schools categorize Tourette syndrome under

EBD). Students with ADHD spend most, if not all, of their time
in general education classrooms. Thus, a typical general
education teacher will likely teach many of these students in his
or her classroom (Ambalavanan & Holten, 2005).
Students with ADHD may have either an IEP under IDEA 2004
or be covered by the Americans with Disabilities Act and have a
504 plan. Each school forms its own criteria and uses them to
decide whether a student with ADHD receives services under
IDEA 2004 or Section 504. Teachers use these plans as a
guideline to determine appropriate accommodations or
modifications. Most students with ADHD, however, do not have
many accommodations or modifications listed in their IEP.
Instead, accommodations or modifications are most often in the
form of a Functional Behavior Assessment (FBA) and Behavior
Intervention Plan (BIP).
DSM-IV and ADHD
Medical professionals often use the Diagnostic and Statistical
Manual of Mental Disorders (DSM-IV) to diagnose; it provides
another definition of ADHD (American Psychiatric Association,
2000). The DSM-IV outlines the three subtypes: ADHD
predominantly inattentive type, ADHD predominantly
hyperactive-impulsive type, and ADHD combined type
(Larsson, Dilshad, Lichtenstein, & Barker, 2011). Students with
the predominantly inattentive type struggle with inattention
without major difficulties with hyperactivity and impulsivity.
Students with the predominantly hyperactive-impulsive type
struggle with hyperactivity and impulsivity without major
difficulties with inattention. Students identified with ADHD
combined type exhibit both inattentive and hyperactive-
impulsive characteristics. See Table 5.1 for some examples of
each type of characteristic as described by the DSM-IV.
Prevalence of ADHD
ADHD affects approximately 3–10% of school-age students
(Ambalavanan & Holten, 2005). Because the criteria for

diagnosing and delivering services to students with ADHD vary
considerably by state, there is a wide variability in the
percentage of students diagnosed with ADHD in school
classrooms from state to state (anywhere from 3–15%).
Boys are more often identified with ADHD—in fact, up to three
times as often—than are girls (Bruchmüller, Margraf, &
Schneider, 2012; Barkley, 2006). However, boys generally
exhibit more hyperactive characteristics of ADHD, while girls
exhibit more inattentive characteristics (Abikoff et al., 2002).
This difference may be one reason why males are diagnosed
more often: Hyperactivity is usually more apparent and
distracting to adults, whereas inattention is not as obvious or
bothersome.
Interestingly, African-American students tend to be diagnosed
less with ADHD than Caucasian students (Mandell, David,
Bevans, & Guevara, 2008). However, African-American
students tend to be over-diagnosed with EBD, which probably
indicates that schools tend to categorize students (with the same
behavioral characteristics) differently based on racial category.
Researchers have also discovered that the younger students (by
age) in a classroom may be identified more often than older
students in the same classroom (Zoëga, Valdimarsdóttir, &
Hernández-Diaz, 2012). Perhaps younger students take longer to
learn behavior patterns in a typical classroom.
5.2 How Has the ADHD Field Evolved?
Behaviors that educators and medical professionals now
associate with ADHD have been highlighted in medical
literature for at least the last 200 years. While "bad parenting"
was sometimes blamed, some early physicians did believe that
the difficulties their patients had in performing certain tasks
stemmed from brain anomalies.
An early description of ADHD may be found in a children's
poem, "The Story of Fidgety Philip," published in 1845, by

German psychiatrist and author Heinrich Hoffman. The boy in
the poem cannot sit still at the dinner table, and fidgets despite
his parents' requests to stop. At the beginning of the 20th
century, an English doctor, George Frederic Still, described
young boys with behavioral difficulties that he believed were
due to differences in their biological makeup—specifically, in
the brain. Still's work, along with that of others, such as the
physician William James, was vital in explaining that the
behavior of some children was not a moral failing on the part of
parents.
In 1934, Eugene Kahn and Louis Cohen published a study in the
New England Journal of Medicine that described patients with
impaired attention, impulse control, and self-regulation. Soon
after, in 1937, Charles Bradley produced evidence that linked a
stimulant drug to the reduction of symptoms for children with
behavior difficulties. As more and more researchers worked
with these children and tried to find medications to assist with
their daily functioning, the term minimal brain dysfunction
began to be used to describe their condition. Another term,
hyperkinetic syndrome, emerged in the 1950s to describe brain
function that is overactive or overwhelmed.
As previous chapters have explained, the 1960s and 1970s were
a time of tremendous growth in understanding disabilities,
including ADHD. In 1968, the DSM-II recognized ADHD as an
actual disorder, hyperkinetic reaction of childhood. The terms
Attention Deficit Disorder and, later, ADHD were coined in the
1980s (Brown, 2006).
Attention Deficit Disorder (ADD) is an outdated term. When
people use the term ADD, they are usually referring to ADHD
predominantly inattentive type. Some adults prefer the term
ADD, since they do not experience hyperactivity as much as
children and adolescents do, but this chapter will refer to the
disorder as ADHD.

In the last few decades, much of the research on ADHD has
focused on learning more about the chemicals in the brain that
receive and transmit signals (neurotransmitters), understanding
the role of medication in helping to control ADHD, determining
how to better assess students with behavioral difficulties, and
learning how to best teach students with ADHD. These topics
will all be covered in the remainder of this chapter.
5.3 What Are the Characteristics of Students With ADHD?
The inattention, hyperactivity, and impulsivity of people with
ADHD can emerge in a variety of ways. Table 5.2 lists the
common characteristics of ADHD identified by the Centers for
Disease Control and Prevention (CDC).
Table 5.2: Common Characteristics of ADHD
Inattentive characteristics
Hyperactive characteristics
Impulsive characteristics
Has difficulty paying attention
Is in constant motion
Frequently loses necessary items
Makes careless mistakes
Is unable to stay seated
Is unable to play quietly
Daydreams
Squirms or fidgets
Acts and speaks without thinking
Doesn't seem to listen
Has difficulty following through
Has difficulty taking turns
Is easily distracted
Talks out of turn or too much
Interrupts others
Is forgetful

Has difficulty organizing information
Of course, not all children (or adults) who exhibit these
qualities have ADHD. In fact, for a diagnosis, students must
exhibit inattentive or hyperactive-impulsive characteristics
more frequently than is observed in other students of the same
age.
How do educators differentiate ADHD? There are three
governing principles outlined by the DSM-IV that all must be in
place for a student to receive a diagnosis of ADHD:
A student must exhibit characteristics (i.e., inattentive and/or
hyperactive-impulsive) for a sustained period of time (six
months or more) and in multiple settings (e.g., at home and in
school).
The behaviors must be disruptive to the classroom or home
environment.
Some of the inattentive, hyperactive, or impulsive behaviors
must have been manifested before the student was 7 years of
age.
When students exhibit the behaviors that are characteristic of
ADHD, it is important to rule out extenuating factors. For
example, a student who has recently experienced a sudden death
in the family or who is coming to terms with his parents'
divorce might act in atypical ways. It is also important to rule
out other medical reasons (such as seizures or depression) that
may cause students to appear to have ADHD.
Many students with ADHD are also diagnosed with other
disabilities, such as SLD (see Figure 5.1). In fact, the rate for
comorbidity (i.e., the likelihood that a student has two or more
disabilities rather than just one) with ADHD is as high as 50–
60% (Jensen et al., 2001). ADHD can occur alongside

behavioral disorders, such as Oppositional Defiant Disorder
(ODD), conduct disorder, bipolar disorder, anxiety disorder,
depression, or Tourette syndrome (Takeda, Ambrosini,
deBerardinis, & Elia, 2012). Some students with ADHD may
also have Autism Spectrum Disorder (Grzadzinski et al., 2011),
or be considered gifted (Foley-Nicpon, Rickels, Assouline, &
Richards, 2012).
Figure 5.1: Comparison of Students With ADHD and SLD
The number of students with ADHD, with SLD, and with both is
compared with the total number of school-age students. Note
that the number of boys diagnosed with ADHD, SLD, or both is
higher than the number of girls diagnosed with either disability.
5.4 What Are the Causes of ADHD?
Researchers have not identified a primary cause of ADHD. They
believe that it is probably related to a combination of biology,
genetics, and the student's environment (Larsson et al., 2011;
Thapar, Cooper, Eyre, & Langley, 2013). As technology
improves over the next few decades, researchers will be better
equipped to understand how these causes work and combine to
affect students with ADHD.
The Role of Biology
Many researchers hypothesize that students with ADHD are
either missing specific neurotransmitters or that the actions of
these neurotransmitters are faulty. When neurotransmitters are
not working as normal, the information processing system of a
student's brain has difficulty handling new information. In other
words, the "hardware" in the brain has trouble organizing new
information, so the brain becomes overloaded and shuts down.
Indeed, brain scans of students presented with a difficult or
distracting task show marked differences between students with
and without ADHD. Students with ADHD often show a decrease
in brain activity compared with students without ADHD. Before
the difficult or distracting task, all students demonstrated
similar patterns in brain activity.

It is well-established that the brain is involved in the intake and
processing of information; what may be less obvious is that the
rest of the body is also involved. Many students with ADHD
experience sensory overload (i.e., too many noises or too much
visual activity in the classroom). They may focus on the music
playing in the background or the busy collage on the wall
instead of focusing on the task at hand.
Genes also appear to play a role in the likelihood of a student
developing ADHD (Thapar et al., 2013). While no single gene
has been identified as responsible, approximately one-third of
students with ADHD have a sibling with ADHD, and
approximately half of students with ADHD have a parent with
ADHD (Freitag, Rohde, Lempp, & Romanos, 2010; Polderman
et al., 2007). The role of genetics in ADHD is further
complicated by the fact that about half of students diagnosed
with ADHD in school will outgrow their ADHD characteristics
by adulthood (Garnier-Dykstra, Pinchezsky, Caldeira, Vincent,
& Arria, 2010; Martel, von Eye, & Nigg, 2012).
The Role of the Environment
Quite a few environmental factors have been linked to ADHD
(Thapar et al., 2013). Several causal factors may occur during
gestation. For example, mothers who smoke or engage in
substance abuse may have babies with an elevated risk of
ADHD (Graham et al., 2013). Babies born premature or at a low
birth weight may also have a higher risk of ADHD. After birth,
malnutrition or other dietary factors—such as too much sugar or
fatty acids—could possibly be risk factors for ADHD. In
addition, researchers hypothesize that some students with
ADHD may have had exposure to pesticides or lead (Thapar et
al., 2013).
Some researchers believe that family dynamics may contribute
to students developing ADHD. For example, if parents and

students experience hostility or anger toward one another on a
constant basis, or if students are abandoned or feel unsafe in
their environment, this may put them at a higher risk for ADHD.
5.5 How Are Students Diagnosed With ADHD?
Like some other disabilities, ADHD is diagnosed by medical
professionals or clinicians using DSM-IV criteria or using
parent and teacher rating scales along with observations of the
student (Rushton, Fant, & Clark, 2004). No test exists for
diagnosing ADHD. The professionals may gather checklists,
rating scales, and observations from teachers and other school
staff members to aid in the diagnosis.
Teachers and school staff can talk with parents about the
possibility of their child needing to undergo an evaluation for
ADHD, but the official diagnosis must come from a medical
professional or clinician (i.e., medical doctor, psychiatrist, or
psychologist). Often, parents discuss their concerns with a
pediatrician or family physician, who then refers the family to a
clinic for professional screening for, and diagnosis of, ADHD.
Checklists
Medical professionals use a checklist of characteristics, along
with information in the form of anecdotal evidence and
behavioral observations from parents, caregivers, teachers, or
other school professionals, to thoroughly evaluate a student.
This evaluation usually takes weeks or months to complete
because data about the student's behaviors have to be gathered
over time and from a variety of sources. If the screening is
conducted properly, it is not possible for a student to walk into
a clinic or doctor's office for the first time and receive an
ADHD diagnosis.
As you learned, ADHD is divided into three categories: ADHD
predominantly inattentive type, ADHD predominantly
hyperactive-impulsive type, or ADHD combined type. Refer to
Table 5.2 for a checklist of characteristics divided into

inattentive, hyperactive, and impulsivity categories.
Rating Scales and Behavioral Observations
Rating scales, such as the widely-used Conners test or the
Barkley Scale, provide one of the more common ways to gather
information from teachers, parents, or even individual students
when they exhibit characteristics of ADHD.
There are three versions of the Conners test: one for parents or
guardians, one for teachers, and one for students who are old
enough to rate themselves (i.e., middle- or high-school
students). Parents, teachers, or students fill out the form and
rate the student's behavior by answering multiple-choice
questions. The Barkley Rating Scale also involves parents and
teachers filling out different versions of a questionnaire about
the frequency of difficult behaviors of the student. The
information from these tests and scales, if gathered properly,
can aid doctors or clinicians in a diagnosis of ADHD. They
should never depend on just one rating scale or source,
however, to determine whether a student has ADHD; a proper
diagnosis should have documentation from multiple sources.
Behavioral observation is also useful in information gathering
for a diagnosis of ADHD. Teachers, parents, or other trained
professionals may observe students in different settings (e.g., in
the classroom and at after-school workshops). In a behavioral
observation, the observer notes whether and how often certain
behaviors occur. This information can be used to aid medical
professionals in their diagnosis.
A boy at a desk looks off to the side, away from a teacher
writing on a blackboard.
Wolfgang Flamisch/Corbis
Diagnosing ADHD before school age can be difficult; it may be
hard to determine whether the student's inattention or

hyperactivity and impulsivity is due to ADHD or to being young
and inexperienced in social cues and norms. However, ADHD
students can be identified earlier than the age of 5 if they
exhibit very severe symptoms of ADHD.
When Are Students Diagnosed?
ADHD is often diagnosed near the end of the early childhood
period, during preschool or kindergarten. Around age 5, many
students begin to exhibit characteristics common to ADHD as
they start school and learn the new routines associated with the
structured setting of the classroom. Starting school involves
learning how to follow directions and how to act in group
settings, and if students are not used to school expectations,
they may display some of the inattentive, hyperactive, or
impulsive characteristics of ADHD (Anderson, Watt, Noble, &
Shanley, 2012).
However, this does not mean they have ADHD. If a student
comes from a home where lots of physical activity is
encouraged, it may take the student a while to learn how to not
run around the classroom all the time or jump out of her seat
when an adult enters the room. Once students become familiar
with the classroom rules and expectations, their classroom
attention and behavior should improve. Those students who do
not show improvement may have ADHD.
Most students with ADHD are diagnosed around second or third
grade, or between the ages of 8 and 10. At that time, they are
expected to work more independently and are held more
accountable for their schoolwork. When these expectations are
placed upon those students whose brains find it difficult to
process new information readily, they may begin exhibiting
characteristics of ADHD. Students may have displayed ADHD
characteristics for a few years, but they were not as noticeable
during their participation in the larger-group activities of
preschool or kindergarten as they are in a more "academic"
setting.

5.6 How Does ADHD Differ Across Grade Levels?
Teaching strategies for students with ADHD show some
similarities across grade levels, as well as some differences. For
example, all students may benefit from classroom management
and organization techniques, but these techniques may have to
be amended based on the student's grade level.
Early Childhood
ADHD is often diagnosed near the end of the early childhood
period, during preschool or kindergarten, when students are first
asked to participate in and finish tasks, follow directions and
rules, sit quietly, and control their movements. Students who
have a harder than average time sitting still or transitioning
from one activity to another may be showing symptoms of
ADHD. For instance, teachers may ask students to move from
an art center to the carpet area for story time, and students with
ADHD may act out or refuse to follow directions because they
find it difficult to leave one task to do another. Many of the
teaching strategies highlighted later in this chapter are
appropriate for very young students with ADHD.
Elementary School
Most students diagnosed with ADHD will be identified in the
elementary grades. Students in this age group may experience
difficulties related to spending hours in a classroom during the
school day. Students may struggle with inattention to classroom
material and hyperactive or impulsive behavior in groups.
When teaching elementary school students with ADHD, it is
helpful to present lessons in smaller groups. This allows the
classroom teacher to better differentiate instruction and monitor
on-task behavior. To differentiate, teachers tailor assignments
or materials to the individual student to ensure that the student
is getting the most out of the lesson. Peer tutoring, delivering
lessons in an explicit manner and at a brisk pace, and using a
variety of instructional tools for conceptual understanding are
all methods that are known to be helpful in teaching

elementary-aged ADHD students (Harlacher, Roberts, &
Merrell, 2006). When teaching in an explicit manner, teachers
provide direct and focused instruction on a topic area. The
teacher helps the student by guiding the student through
material and providing many opportunities for feedback and
discussion.
Keep in mind that many students with ADHD are hypersensitive
to sights and sounds. Think hard about whether to show a
presentation with many graphics or a movie with lots of music
and noise. Allowing students to have some choice of topics to
study (or how to study certain topics) can also be helpful, and
tends to help motivate a broad range of students. Activities that
are "hands-on" are also more compelling for these students.
These kinds of activities include conducting a science
experiment with bacteria samples in petri dishes and learning
fraction concepts through dividing pizzas.
Teachers need to remember that in-class and homework
assignments may take students with ADHD much longer to
complete accurately than the typical student. The practice of
sending home unfinished classroom activities or work to be
completed as homework is not usually effective for students
with ADHD. If these students demonstrated difficulty
completing an assignment in the classroom with teacher
monitoring and feedback, they will probably also struggle with
completing this assignment at home. This will only add to their
frustration—and that of their parents.
Secondary School
The transition from middle to high school can be difficult for
any student, and particularly so for someone with ADHD. First
and foremost, expectations from teachers at the secondary level
are different than those at the elementary level. Students are
expected to be much more responsible for themselves and their
learning. They must show up to the correct classroom at the

right time, keep track of their academic materials and
assignments, and take notes on class material in a way that will
help them score well on assessments. Second, secondary
students are experiencing numerous physical and emotional
changes that can lead to changes in the manifestation of their
ADHD. For example, students may become less hyperactive but
more impulsive.
Many of the teaching approaches highlighted in Chapter 2 are
helpful for secondary school students with ADHD—for
example, using explicit instruction, involving students in peer
tutoring, and using differentiation. It also may also be helpful to
collaborate with the students themselves to find solutions to
their educational problems. High school students frequently
complain that they are not treated or respected like adults are,
so teachers may want to involve them in decisions about what,
how, or when they study for a certain topic.
A teacher with high expectations for students, who does not
treat them like elementary students but instead provides
opportunities for them to take on new responsibilities and
exercise autonomy, will contribute to their self-confidence,
which in turn can improve behavior. Teachers should assume
students can handle certain tasks until they prove otherwise.
Transition
Secondary students with ADHD will also have transition plans
to ensure that high school courses and support services align to
postsecondary goals. In addition to specifying the effective
instructional practices listed in this chapter, transition planning
can help students, family members, and educators prepare for
ongoing success. These plans can help set up support that
continues after graduation from high school. Transition plans
should include appropriate service providers, including social
services and mental health counselors. Strategic planning
increases the likelihood that students with ADHD will complete

high school and successfully transition to college or career
opportunities.
Individuals with ADHD can absolutely be successful in colleges
and careers with the appropriate resources and support. Gaining
insight about ADHD, managing behaviors, and utilizing sources
of support can all help students achieve (Meaux, Green, &
Broussard, 2009). Meaux et al. (2009) outline the following
recommendations for postsecondary students with ADHD:
Gain insight about ADHD
Learn from experience
Seek information
Acknowledge difficulties
Open up for support
Manage life and behavior
Be accountable
Learn from consequences
Set alarms and reminders
Take prescribed medication
Engage in self-talk
Stay busy and schedule activities
Utilize sources of support
Parents
Friends
Teachers/Tutors
Academic support and disability services
5.7 How Do I Teach Students With ADHD?
Effective teachers at all grade levels make their classroom
environments and practices more conducive to students who
struggle with inattention, hyperactivity, or impulsivity.
As mentioned, many of the teaching techniques (such as explicit
instruction and peer tutoring) that are effective for students
with SLD and emotional and/or behavioral difficulties have also
been proven to be effective for students with ADHD. In
addition, the use of strategies related to classroom organization

and delivery of instruction can provide an optimal learning
environment for all the students in the general education
classroom.
Teachers should keep in mind that the biggest challenge that
students with ADHD face in the classroom is their tendency to
be easily overwhelmed or frustrated, either by their environment
or by the tasks they are being asked to perform. The
characteristics of students with ADHD may lead to classroom
behaviors like the following:
Making careless mistakes on assignments
Daydreaming during lectures
Keeping materials and desks unorganized
Only paying attention during "fun" activities
Not following directions and rules
Turning in assignments unfinished
Causing disruptions in class
Classroom Organization
Appropriate organization of the classroom is crucial in reducing
the stress an ADHD student feels in the typical, busy classroom
(Carbone, 2001). The teacher should make sure that all aspects
of instruction are well organized, from the way the classroom
functions to the arrangement of furniture and the materials
within it. Good classroom organization also extends to helping
students bring order to their assignments and providing
schedules to follow.
An organized classroom will help students focus on classroom
tasks (e.g., taking notes from a lecture, participating in group
instruction, completing a book report), minimizing distractions
that could lead students astray. An organized classroom also
enables the teacher to focus on quality academic instruction
without having to spend time on redirecting student attention or
correcting off-task behavior.
Functional Organization: Routines, Procedures, and Classroom

Rules
Effective functional organization of a classroom involves the
establishment of routines and procedures. These provide
structure to the classroom and the school day. They help
students understand expectations for behavior. A routine might
be as basic as one that involves students walking into the
classroom at the beginning of the school day and turning in
their homework:
Walk into the classroom quietly.
Walk to your locker.
Take your homework assignments out of your backpack.
Place your homework assignments in the green bucket.
Place your backpack into your locker.
Walk to your assigned desk.
Sit at your desk and begin your morning work.
This routine provides a framework for students in terms of
classroom behavior. Teachers could have a procedure for
getting materials from the art center for a painting project,
breaking into partners to proofread a narrative, or returning
library books to the school library.
Teachers should provide explicit instruction and modeling for
routines and procedures (Jacobson & Reid, 2010), and students
should have opportunities to practice them while the teacher
provides feedback. They are important ways to guide students
throughout the day. With established routines and procedures,
students know how things in the classroom operate and thus are
less likely to be distracted from the main focus of the academic
task by the logistical details of getting it done.
Functional classroom organization also includes the creation of
classroom rules that apply to all students. These rules should be
positive and brief, with clearly stated consequences for not
following them. Ideally, there is a set of rules for the entire
school, as this consistency helps ADHD students understand the

expectations in every classroom, not just their homeroom. Rules
for elementary and secondary students may differ slightly, but
the underlying concepts are the same (Figure 5.2). Rules are
stated positively, are applicable across various school
situations, and help students understand school expectations.
Figure 5.2: Classroom Rules
Rules for a second-grade classroom (left) and for a tenth-grade
classroom (right) reflect similar expectations for student
behavior. Both sets of rules are positive and age-appropriate.
Organization of Space
Appropriate organization of the classroom space is also
important for students with ADHD (Carbone, 2001). Cluttered
walls or bulletin boards, for example, can easily be distracting.
Classrooms should have meaningful posters and wall hangings,
but teachers should keep them to a minimum. Meaningful
posters and hangings include things that are important to current
classroom instruction or that outline classroom rules and
expectations. Content that has not yet been introduced in class,
on the other hand, is likely to pull students away from lessons
in progress.
Both elementary and secondary teachers should also pay
attention to the placement of student desks and work areas. All
students should be able to see the teacher at all times without
having to turn around in their seats. If there are tables in the
classroom, teachers will have to arrange them in such a way that
all students can focus on the teacher without strain.
Carbone (2001) suggests placing desks in rows because rows
help students avoid the distractions of being seated at a table. If
students can focus on the teacher (and the teacher can focus on
each student), there is less opportunity for distraction and off-
task behavior (see Figure 5.3 to consider seating options). Many
secondary classroom teachers do place student desks in rows,
and elementary teachers may also find it helpful.

Figure 5.3: Elementary Classroom Seating Options for a Student
with ADHD
In this floor plan for a kindergarten classroom, the star
indicates the seat for a student with ADHD. What do you think
about this choice of seat? What would you do to change this as
a classroom teacher?
Regardless of whether student desks or tables are in rows,
groups, or some other arrangement, teachers should always
assign all students, not just those with ADHD, to work spaces.
A student with ADHD will benefit from having an organized
work area. Teachers can suggest the use of different colored
folders for each class period for secondary students. They can
encourage elementary students to place plastic boxes or tubs in
their desk to hold small items like pens, pencils, and erasers.
To help elementary students who fidget with writing utensils or
scissors, the teacher should store these items in an accessible
area that is not within the student's immediate reach. Teachers
should also keep the student's workspace as clean and free of
distraction as possible, avoiding extraneous and overly
decorated items (as shown in Figure 5.4).
Figure 5.4: Overly Colorful Nameplate
This nameplate is less than ideal for a student with ADHD. It
begs for student distraction, with its U.S. map, colorful
patterns, and busy charts. A student may spend time tracing the
states when all she really needs to see is how to write the letter
J. Would this distract you if it were on your desk?
Organization of Assignments
Many strategies to help students organize their assignments may
help students with ADHD in writing, reading, or mathematics.
For example, students may have difficulty solving multi-digit
computation problems in mathematics (e.g., 5,462 x 23) because

they cannot keep their work organized on the page. Students
may have trouble keeping the numbers in columns or writing
their numbers small enough for their workspace. Teachers can
show them how to use graph paper to keep the place value of
numbers intact and organized (see Figure 5.5). Turning lined
notebooks sideways helps with organization, as well, because
the (now) vertical lines of the notebook paper can help students
organize their columns by place value (i.e., ones, tens,
hundreds, thousands, etc.).
Figure 5.5: Computation Examples
By using graph paper, students can keep each number in the
right place. This strategy enables students to organize their
work and make fewer mistakes.
Teachers can encourage students to use plain bookmarks as they
read to help them focus on the text line by line. For writing
assignments where handwriting is not the focus of the lesson,
students with ADHD may find it easier and less frustrating to
type their assignment.
In assigning work, teachers should consider whether it is
reasonable to ask students to complete 10, 20, or 50 problems.
Often, students with ADHD can demonstrate mastery of a skill
by completing just 10 problems of 30 on a worksheet. Students
with ADHD may need longer assignments to be broken into
smaller, manageable pieces. This may also be true for other
students, as well. For example, when middle school students in
an American government class are asked to write an essay on
interest groups that influence politics, a teacher could break the
assignment into the following parts:
Investigate different types of interest groups. List the types of
interest groups. Provide three examples of each group.
Investigate different ways in which these interest groups can
influence political policy. Use a graphic organizer to explain

five ways political policy is influenced by these interest groups.
Choose three specific interest groups for your research report.
Make sure they have enough in common that you can develop a
thesis statement about the methods they use to influence
American political policy.
Develop an outline or graphic organizer that includes a thesis
statement for the introduction, supporting details about how the
groups influence policy in each body paragraph, and a
concluding paragraph.
Write a five-paragraph essay as the first draft of your report.
Further details and examples can be provided in class
discussions about the assignment, as needed. The student turns
in each part of the assignment before proceeding to the
following step. The teacher provides timely feedback and
guidance to the student to ensure success on each part of the
assignment. By breaking an assignment into parts, the
individual tasks may not appear as daunting as an assignment
that states, "Write a five-paragraph essay on how interest
groups influence American politics." Students also feel a sense
of accomplishment with the completion of each step.
The Importance of a Schedule
Like other students with disabilities, students with ADHD may
function better in the classroom when they are aware of the
daily schedule. A visual or written schedule placed in a
prominent place in the classroom, in the student's daily planner,
or on the student's desk can be tremendously helpful (Figure
5.6). If the student works with a specialist at certain times
during the school day, these appointments should be listed on
the student's schedule.
Some elementary grade teachers use pictures of clock faces with
the hands pointing to the appropriate times for each different
activity during the school day. This strategy is especially
helpful for students who have difficulty reading the analog
classroom clock.

Figure 5.6: Sample Schedules
A schedule for a first-grade classroom hangs in the classroom
(left), and a smaller copy could be taped to a student's desk. A
schedule for an eighth-grade student (right) will be unique to
the student, so it is taped into the student's daily planner.
Delivery of Instruction
As discussed in Chapter 2, instruction for students with
disabilities should be explicit. In other words, the instruction
should be clear and concise, with many opportunities to check
for student progress and understanding (Gremillion & Martel,
2012). This is important for students with ADHD because
students may have fewer opportunities for inattention or
hyperactivity/impulsivity if they are actively engaged in the
academic lesson. Effective instructional delivery techniques
include prioritizing subjects, making sure students participate in
the lesson, modeling, providing adequate breaks, and
encouraging self-monitoring (Jacobson & Reid, 2010).
Prioritizing Subjects
Teachers of students with ADHD should prioritize the subjects
according to the best times to teach them. For example, reading
instruction is usually best in the morning, when students are
fresh and ready to learn, rather than, say, the last 45 minutes of
the school day after students have just returned from a physical
education activity. The end of the day might be better suited for
review activities or checking homework because these activities
require less concentration and focus than learning new academic
content.
Students at the middle or secondary school level who switch
classrooms multiple times per day usually have their longest
attention span at the beginning of any given period. Teachers,
then, should use the beginning of a period to deliver new and
important content. Tasks for which full attention is less crucial,

or that offer a social element that can refocus attention—such as
reviewing homework or completing a group assignment—are
better left until the end of the class period, when student
attention begins to wane. Teachers should be mindful that
students with ADHD may need to switch between tasks at
frequent intervals.
Ensuring Participation and Modeling
Teachers should provide frequent opportunities for students to
actively participate in a lesson to engage them and monitor
understanding and involvement. This participation may be in the
form of signaling a thumbs up, raising a hand to answer a
question, completing a problem on a white board, discussing an
idea with a partner, or echo reading. Echo reading involves a
teacher or student reading a sentence or passage and then
another person (or the class) repeating the same sentence or
passage. The more opportunities students have to interact with
and respond to the teacher, the less likely they are to lose focus.
Teachers should also model a concept or skill and practice it
multiple times with the student before asking the student to
complete an assignment independently. When modeling, the
teacher works through a problem or shows students how to
complete a task. This helps alleviate student frustration and
decrease behaviors that are reactions to frustration. For
example, if the teacher asks the students to use a graphic
organizer to write a persuasive essay, the teacher can model
how to fill in the graphic organizer—with the students—before
asking students to fill in their own graphic organizer with a
partner or on their own.
Providing Breaks and Releases
Even with organized and effective delivery of instruction,
students with ADHD may need brief breaks from the classroom
to release their hyperactive or inattentive tendencies (i.e., have
some "down time"). Some students may need a quick stretch

break at the completion of each academic task. This stretch
break may be established as a classroom routine so that it is not
distracting to other students, or teachers may find that all
students benefit from taking these breaks.
Students with ADHD may find it helpful to draw or doodle as an
outlet for their energy. If this drawing is not distracting to the
rest of the class, teachers should allow it to occur. Some
students may find it helpful to have a squeeze ball to squeeze
and release multiple times during tasks. This technique can help
eliminate hyperactive behavior and help the student focus.
Teachers and students should become aware of triggers that lead
to hyperactive or impulsive behavior and develop signals and
routines to use when the student needs a break from the current
activity or assignment. For example, if a student is feeling antsy
and needs to get out of his seat and stretch, he can raise his
hand. The teacher can then nod to signal that the student can
move to the back of the classroom to stand for a few minutes.
While this might be distracting to some teachers, developing a
routine for stretching or standing is better than having a student
jump out of his seat and disrupt the entire class.
Many students with ADHD, in fact, may find it difficult to sit
for long periods of time. Some elementary schools allow
students to sit on exercise balls, which require the student to
focus on balance rather than squirm around (Harlacher, Roberts,
& Merrell, 2006). This practice is less frequently used at the
secondary level, when students switch classrooms throughout
the day.
Encouraging Self-Monitoring
As discussed in Chapter 2, encouraging students with
disabilities to self-monitor their behavior is an important step in
fostering autonomy and ownership of their learning and success
(Johnson, Reid, & Mason, 2011). Having students use checklists

is one way teachers can help students monitor their own
progress in completing tasks or following classroom rules. In
addition, a student may stay more focused on an academic or
behavioral task if she has a written checklist or set of directions
that accompanies verbal directions. Students with ADHD may
have difficulty focusing on a long set of verbal prompts, and a
visual or written reminder will help them.
Checklists for academic tasks can help students with ADHD
break down assignments into manageable parts (Figure 5.7).
Checklists for behavior (Figure 5.8) can also be helpful. At the
secondary level, students may use more complex checklists.
Students with ADHD may also benefit from learning problem-
solving strategies as discussed in Chapter 4 (Jacobson & Reid,
2010). The strategy D.I.R.T. (Define the problem, Identify
choices, Reflect on choices, Try it out) helps students with EBD
and students with ADHD (Cook, 2005). Problem-solving
strategies can help students monitor their own behavior and
improve student attention to academic tasks (Iseman & Naglieri,
2011).
Figure 5.7: Sample Checklist in a Writing Classroom
A checklist can help keep students focused in a sixth-grade
writing classroom. The student answers questions that lead to
the completion of a written assignment with an introduction,
body, and conclusion. The color coding in the checklist
corresponds to the original instruction provided by the
classroom teacher on writing different types of paragraphs and
serves as a reminder to the student.
Figure 5.8: Behavior Checklist
A student-
generated checklist reminds the student to listen and raise his ha
nd. The student has indicated that he canearn stickers for sitting
at his desk, reading independently, raising his hand to use the b

athroom, participating in whole-
class instruction, and cleaning up after snack time. At the botto
m the student has shown the reward he will earn forfour stickers
—computer time.
Another way to help students monitor their behavior is through
the use of a timer that beeps at set, intermittent points. When
the timer beeps, students check their behavior and ask
themselves questions targeted to their own goals, such as "Am I
in my seat?" or "Am I paying attention?" The questions differ
based on the student and the situation.
References
Powell, S. R., & Driver, M. K. (2013). Working with
exceptional students: An introduction to special education
[Electronic version]. Retrieved from https://content.ashford.edu/

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