Sleep is a vital function for life. Without adequate sleep, children learn less, are more accident prone, and more irritable. Inadequate sleep is also linked with lower immune functioning and higher rates of illness. Many school problems are related to inadequate amounts of high-quality sleep. Sleep is when learning is consolidated into long-term memory, so without adequate sleep learning is compromised. Sleep also has restorative and repairing functions for your body. Some other ways children benefit from sleep include:

• Improved sports performance
• Improved academic performance
• Helping control body weight
• Reduced anxiety and depression
• Improved concentration
• Reduced chance of developing diabetes

School-age children often resist going to sleep, delaying bedtime as long as they can. Being consistent about bedtime is vital to help ensure your child is alert, happy, and ready to learn.

Sleep is divided into two types: rapid eye movement (REM) sleep and non-REM sleep (NREM). NREM sleep consists of several stages, from drowsiness through deep sleep. In the early stages (Stages 1 and 2) your child can wake easily and may not realize that you have been sleeping. However, during deeper sleep stages (3 and 4) it is very hard for your child to wake up. If you do wake your child they will be confused and disoriented. In NREM sleep your muscles are more relaxed than when you are awake.

REM sleep is much more active, and is essential for converting experiences into long-term memory. Breathing and heart rate change quickly, your child’s eyes move rapidly under their eyelids, and control of their body temperature is limited- they do not sweat or shiver if it is too hot or too cold. Nerve impulses from your brain are blocked at their neck, temporarily paralyzing their bodies. REM sleep is where they dream.

Individual sleep needs vary. Kindergarten age children need about 11 hours of sleep each night, decreasing to 9 hours by Middle and High School. The most important indicator of a child getting enough sleep is if they wake feeling refreshed. If a child is hard to wake in the morning, it’s a pretty good indication that they aren’t getting enough sleep.

Young Children

For kindergarten and lower elementary children, the bedtime routine should be short- about 30 minutes. This included bath, teeth, story, a goodnight kiss, then lights out. Any longer than this means that your child is delaying sleep, and likely won’t get an adequate amount.

Many children who are sleepy or tired act exactly the opposite. Some overtired children appear completely wired. Overtired children are often impulsive and moody. If you think your child is overtired, move the bedtime back by 15 minutes each week until they are waking refreshed. Chances are, your child will protest at this earlier bedtime. However, parents are the ones who set bedtimes, not children. Pick this battle. Be prepared to die on the hill of earlier bedtimes. The long-term benefits of adequate sleep far outweigh the short-term pain of a few nights of tears and tantrums.

Tips for young children:

• Establish a regular bed time and don’t vary from it
• Use a relaxing routine at bedtime , try a warm bath, and always read a story.
• No food/drinks with caffeine six hours before bedtime.
• Make after-dinner playtime a relaxing time as too much activity close to bedtime can keep children awake.
• No screens on,  or music playing while your child is going to sleep. White noise, like a fan might be helpful though.
• Make sure the temperature in the bedroom is comfortable and dark- tin foil on windows can help darken a room.
• Limit noise in the house.

Teens

Very few teenagers get 9 hours of sleep during the school year and are constantly in sleep debt. With the hormones of puberty comes a sleep phase delay that means teens fall asleep later and wake later. Compounding this, overtired teens often feel more alert in the evening, thus making it more difficult to go to bed at a reasonable hour. Teen sleep debt can cause a variety of problems, including irritability, impulse control, attention problems, and perhaps most immediately worrying, these problems are associated with a higher risk of car accidents. Sleep disturbances or deprivation shows up in school as excessive sleepiness, lateness, academic and behavior problems, inattention, irritability, hyperactivity, and impulse control problems.

Sleep Debt: refers to the effect of not getting enough sleep night after night. For each hour of sleep missed one night, the effects add up each night, increasing the harmful effects of lack of sleep. If your child stays up late one night, they need to make up at least most of the sleep debt the next night by going to bed earlier to “pay off” their sleep debt.

The correct amount of high-quality sleep is one of the single most important things you can do to ensure your child is ready for learning. Establish a healthy sleep routine that ensures your child wakes refreshed each day.

Tips for Teens:

• Exercise everyday, early in the day
• Establish a relaxing bedtime routine
• Create a good sleep environment
• Use your bed for sleeping only
• Avoid alcohol, drugs,and cigarettes
• Put your electronics to sleep an hour before bed
• Store and charge your electronics in your parent’s bedroom

Sleep tips for elementary age children

An excellent website for child sleep information

Sleep tips for teens

A short Mayo clinic video on teens and sleep

Psychology Today’s resources on sleep

Common sleep problems in Elementary and Middle School

Night terrors are very common in children. They normally occur as a child moves from a deep sleep into a lighter sleep phase (something that happens several times a night). Most children experience night terrors between 4-12 years old. Night Terrors can take on a variety of forms such as  when your sleeping child screams like they have just been bitten by a zombie. Some children will sit up in bed, and open their eyes as if looking right through you. After a little while they will lie back down and go from this light sleep state into a deep sleep state. Rarely, children will seem panicked, and will try and leave the house. Waking them doesn’t really help, guiding them back to bed works best, and chances are they won’t even remember it in the morning. In general, night terrors aren’t a big deal, although it can sure seem like it at the time.

Sleep Walking is also fairly typical in 8–12 year-olds. Generally, a child will sit up in bed with their eyes open, but still asleep- seeming to look right through you, or may walk around the house, even carrying out activities such as brushing their teeth. They may talk, but don’t normally respond intelligibly if you talk to them. Children normally outgrow sleepwalking by age 14. Safety and injury prevention is the most important thing with regards to a sleepwalking child. If you have a sleepwalker, keep doors and windows closed. Using the baby gate for across the stairs may help. The Canadian Sleep Society suggests a bell on your child’s door to so you can hear if they leave their room sleepwalking.

Bed Wetting: 1 in 20 ten year old children wet the bed. Bedwetting is thought to be due to developmental lag in neural systems that control feeling to the bladder. Bedwetting isn’t really physically harmful, although it can have pretty significant impact on self-esteem, and may limit social contact with friends- children often don’t want to go on sleepovers or overnight trips for example. Normally children grow out of bedwetting. There are also various methods of training children to become more aware of bladder sensations that may be effective. If a child who has been dry at night for a period of time starts to wet the bed, it may be due to a bladder infection.

Nightmares: Nearly all students have nightmares once in a while. Frequent nightmares are uncommon between ages seven and eleven. Frequent nightmares are usually due to emotional issues. If a child is having frequent nightmares, the best solution is to address the emotional issues during the day (not at bedtime). Crying and calling out happen after the nightmare when the child wakes. It is best to provide attention and support quickly. Children need reassurance- they are often very frightened. Show that you, not the nightmare are in control.

Sleep-Onset Anxiety is a difficulty falling asleep due to large worries or fears. It is often caused by worrying about normal things that happened during the day, or due to emotional trauma. Sleep-onset anxiety is mostly seen in older elementary students. Strategies include calming bedtime routines, reassurance, or in extreme cases cognitive behavioural therapy.

Delayed Sleep-Phase  is a problem with sleep rhythms that leads to problems falling asleep at an appropriate time. This leads to difficulty waking in the morning. Such delayed onset leads to trouble waking, sleeping through the day, excessive daytime sleepiness, truancy and lateness, and of course, poor performance in school. Treatment can include gradually moving the child’s sleep routine an hour or so each evening until a better routine is reached, and maintaining good sleep hygiene including a consistent sleep schedule.

If you have concerns about your child’s sleep, a discussion with your family doctor is the best place to start.

 Deliberately teaching metacognitive skills, or “thinking about thinking” can enhance a child’s ability to learn in all subject areas. Metacognition refers to a level of thinking that involves active control over the process of thinking that is used in learning situations. Planning the way to approach a learning task, monitoring comprehension, and evaluating the progress towards the completion of a task: these skills are metacognitive in nature. Similarly, maintaining motivation to see a task to completion is also a metacognitive skill.

The more students are aware of their thinking processes as they learn, the more they can control goals, dispositions, and attention. Self-awareness promotes self-regulation. If students are aware of how committed they are to reaching goals, of how strong their disposition to persist, and of how focused is their attention to a thinking or writing task, they can regulate their commitment, disposition, and attention.

How to Teach Metacognitive Skills

1. Preparation: Explain the importance of metacognitive learning strategies. Guide students to set specific goals for the task. Help students plan their time in order to accomplish the task.
2. Presentation: Model the learning strategy. Talk about the usefulness and applications of the strategy explicitly. Develop a menu of strategies for many possible tasks. Illustrate your strategy use through a reading task with “unknown” vocabulary words. Teach the strategies to use (one at a time). Give instruction on how to use these strategies. Remind that no single strategy will work in every case.
3.  Give students opportunities to practice the learning strategies with an authentic learning task. Ask the students to make a conscious effort using the metacognitive strategies while reading.
4.  Evaluation: Give students opportunities to evaluate their own success in using learning strategies. Activities used to develop students self-evaluation can include self questioning, debriefing discussions after strategies practice, and checklists of strategies used.

 Modelling Metacognitive Strategies

Teachers can raise the level of metacognitive thought in their classrooms by modeling the processes themselves. Such processes include:

• Thinking aloud when solving problems.
• Mirroring student ideas back to them.
• Rephrasing student ideas to include thinking words (planning, strategy, steps to be taken).
• Clarifying responses and questions.
• Having students include the “how they did it” as part of larger assignments.

 Think out Loud to Model Metacognitive Strategies

“Let’s see. I have five 1s in the ones column and one 10 in the tens column. I need to take away eight 1s from the ones column, but I don’t have enough. So now what do I do? I can’t do it with the ones, so now what? What do I know about the tens column? That one 10 is the same as ten 1s. So, if I take the one 10 and break it into its ten 1s and put them into the ones column, then I can take away eight. Now, is my answer reasonable? I will check it by adding the eight I took away and the seven that were left. 7 + 8 = 15!”

 General Metacognitive Strategies for Students

Teach students how to:

1. Plan the way to approach a learning task “What do I have to do and how will I do it?”
2. Identify: Students need to make conscious decisions about their knowledge. Guide students to list “What I already know about…” and “What I want to learn about….” As students learn, they will verify, and clarify, or replace with more accurate information, each of their initial statements.
3.  Monitor their own comprehension “Did I understand ALL of that?” “Do I need more information?”
4. Evaluate and debrief their progress “Have I done everything I need to…” Conduct closure activities that show how strategies can be applied to other situations. One such activity is guided self-evaluation, which can be introduced through individual conferences and checklists about thinking processes.
5. Maintain motivation to complete a task. The ability to become aware of distractions and sustain effort over time also involves metacognitive functions. Teach skills such as covering your ears while you read to screen distractions, finishing the math problem before looking up from the worksheet. Break work into chunks, etc.

 Teach text-noting tactics:

• Highlighting, underlining, circling, copying key words, phrases or sentences, outlining, diagramming.
• Listing ideas: causes, effects, characteristics, etc.
• Calling attention to confusion with a “?” in the margin.

 Teach mental learning tactics:

• Rote learning of specific information.
• Visualizing information.
• Self-questioning and self-testing.
• Mnemonics, chunking information, cognitive rehearsal.
• Use personal strengths to better understand the content. If I am a good reader, I focus on the text; if I am good at figures and diagrams, I focus on those.
• Inferring meaning: While learning, try to determine the meaning of unknown words that seem critical to the meaning of the content. (Ask for clarification, get a dictionary, use the context, or analyze the word).
• While learning, consider and revise background knowledge about the topic. Try to link it to prior knowledge.
• Distinguish between information that is already known and new information.
• Note how hard or easy a text is to read and use extra time or effort to learn harder material.

 Reading Comprehension Metacognitive Strategies for Students

 Successful comprehension depends on directed cognitive effort. Students must purposefully invoke strategies, and do so to regulate and enhance learning from text.

Teach children to:

1. Plan their reading: You may need to provide structure to start with.
2. Students should read the table of contents first to help understand what the text is about and set the scene.
3. Connect the current topic to prior knowledge. “An owl is a predator, like when we talked about lions being predators too.”
4. Use Previewing, Predicting, and Vocabulary Study.
5. Previewing text mentally prepares a student to receive information from written material. Discussion for fiction should center on whether the students think the story will be realistic fiction or fantasy and why, who the characters may be and how they will interact, what the problem in the story may be, etc. By focusing on story structure teachers give students a framework on which to place information from the text. Discussion of non-fiction should center on what students already know about a topic, what they would like to know; the structure of the book or article; and what information may be included.
1. Set Reading Goals Use the preview discussions to help students generate questions about what they want to find out from the text. For fiction, these questions will be centered on story structure, such as the characters and their goals and problems; for non-fiction, questions will focus on what students would like to learn about a topic. For both, chapter titles or subtitles may be rephrased as questions to help students set their goals for reading.
2. Study Essential Vocabulary Words. Choose vocabulary words that are not easily understood within the text, but are essential to its understanding. Discuss the words in terms of their meaning. Link these words to prior knowledge the students may have about them, and decoding and word structure.
3. Predict and Verify From the Text. Do this repeatedly before and during reading. Text is broken into chunks. For each section readers predict what will be in it, based on what has occurred before, and then read to verify their prediction, and then predict again.

 Teach general reading tactics

1. Skimming a text to get a general understanding or to look for words students don’t understand can be a useful first step.
2. Reading the text at normal speed.
3. Slower reading often enhances comprehension as does re-reading selected text.

Math Metacognitive Strategies for Students

Teach the Mnemonic DRAW

• Discover the sign.
• Read the problem.
• Answer the problem using lines and tallies or on scratch paper.
• Write the answer.
•  Add by counting on from the first addend or the larger addend.
•  Use mnemonics.
• Understand that two times any number will be even or that five times any number will always end in a zero or a 5.
•  Use a finger strategy for multiplying numbers less than 10 by 9.
•  Manipulatives are an excellent way for students to develop self-verbalizing learning strategies. Students should be encouraged to talk their way through each problem using manipulatives.
•  Construct relationships between the new process and what they already knew.

Ask questions about math problems.

• Comprehension questions (e.g., What is this problem all about?)
• Connection questions (e.g., How is this problem different from/ similar to problems that have already been solved?)
• Strategy questions (e.g., What strategies are appropriate for solving this problem and why?)
• Reflection questions (e.g., does this make sense? why am I stuck?)

Taking the time to deliberately teach metacognitive strategies can improve student learning. Giving students the ability to think about their thinking, and be aware of their learning goals promotes a more authentic learning environment. If you are new to deliberately teaching metacognitive skills, the lists above would be a great place to start.

Students, parents, and teachers benefit in multiple ways when parents are effectively engaged with their child’s schooling. However, some interactions between parents and educators can actually create more problems than they can solve. For example, a teacher seeking a parent’s help for a behaviour problem may not recognize the criticism implied when the teacher asks if there is anything wrong at home. Differing perspectives often create miscommunication and can hurt feelings. Developing a collaborative relationship to find and implement solutions to problems can help prevent miscommunication. A collaborative relationship means one that includes mutual trust and respect, bidirectional communication, sensitivity to the other’s needs, and demonstration of a commitment to the student.

Bringing Up Sensitive Topics With Parents

One of the most common sensitive topics for parents and teachers is regarding referrals for extra supports such as Family Support Liaison Workers, Psychologists, the Mental Health team etc. We don’t want referrals for extra services to be a surprise to parents. Therefore, it is important that, in partnership with the parents, teachers have had problem-solving conversations regarding the issues that have lead to the referral prior to the conversation about the referral.

If there are areas of concern, ensure that parents have been told about these immediately after they occur, so there are no surprises when you meet to discuss these concerns with them. Communicating frequently, honestly and openly develops trust and builds collaboration.

Here’s an example:

“Denise didn’t hand in those last two assignments. Do you have any insight as to why she wasn’t able to complete the work? This doesn’t seem like her.”

Followed by:

“As you know, Denise’s schoolwork has been slipping recently. She hasn’t handed in the last three assignments. She seems quite teary in class, and has been going to the bathroom a lot. One of her friends mentioned that she is worried about her. I am trying to figure out what I need to do differently. I’m wondering if we can problem-solve to figure out what is going on for Denise so we can get her back up to her normal standard of work.”

The next step might be:

“So I have implemented the strategies we discussed last time, but Denise continues to struggle. I’m worried that this is a sign of something bigger. One of her friends mentioned that she might be cutting herself. She seems REALLY sad. I feel like getting some expert advice would really help me out to get her back on track. What do you think about getting Denise some extra support by having her seen by our school Mental Health Therapist?  We both want Denise to be as successful as possible and I think that we would really benefit from the Mental Health Therapist’s input on strategies that will help get Denise back on track.”

If you feel that this would be a difficult conversation to have with the family, or you feel uncomfortable discussing mental health concerns, please call your school’s psychologist. They will be able to coach you on ways to make such a conversation as successful as possible.

Tips for Maximizing Parent Collaboration in Uncomfortable Conversations:

1. Use “I” statements to take responsibility for solving the problem. “I would like to seek expert help, because I am not sure what to do next. Using “I” statements like this limits possible misunderstandings that you are blaming the parent. Enlist the parents help with “We/Us” statements. “Can we work together to figure out a plan for Denise?”

2. The parent is the expert on their child. Ask for their advice. “You are the real expert on Timmy here, what do you think needs to happen to make him more successful?” Parent engagement is maximized when educators ask them for information.

3. Use empathic techniques to maximize engagement:
1. Paraphrase what the parent has said to you. “So just to make sure I got that, Timmy has said to you that he is being bullied on the playground, and you think that this has made him reluctant to come to school. OK, I will check that out”.
2. Acknowledge the feelings the parent has communicated to you. “I would guess that you are feeling concerned with Timmy’s lack of progress and angry that nothing has worked. Is that right?”
3. Agree with the parent where you can, we are trying to forge a collaborative relationship. “I agree that Timmy has been sadder at school recently.
4. Find points of common emotional understanding. “I’m worried about his reading too.”
5. Ask how the parent has been experiencing the issue. “Do you see this at home? Or is this just a school thing?”
6. Remind the parent that they are an important part of the collaboration. “What you said is really important.” “Thanks for taking the time to discuss this with me, I think I have more information about some next steps for Timmy now”.
4. Use a strength-based approach when discussing the student’s abilities and skills.
5. Use matter or fact language when describing behaviours. Describe what was observed. “On Wednesday morning Timmy threw a chair that hit Judy” rather than “Timmy is violent and dangerous”.
6. Prior to meeting with the parents, let them know what the agenda is going to be. Parents need to be prepared for discussions as well. Ask parents if they have any items or concerns they wish to discuss.
7. If you take notes during the meeting it can be helpful to inform the parent(s) that you would like to take notes and the purpose of these notes.  It is also important to offer to provide a copy of the notes to the parents afterwards to ensure that everybody has the same understanding of the meeting. If a parent is invited to a meeting and all professionals are taking notes on their laptops, it is important to think about how this maybe perceived by the parent and how it may impact the development of trust and engagement . It is helpful to ensure that the laptop is not positioned directly between ourselves and the parent(s) – positioning it off to the side allowing for no barriers between ourselves and the parents creates a more open and inviting exchange.

Communication Skills For Engaging Parents

  Further Reading on Engaging Parents

A great resource for learning more about parent collaboration from Alberta Education with video examples.

Communicating with Parents: Strategies for Teachers

Family School Collaboration

Attention Difficulties in the Classroom

Here’s a summary of Thomas and Grimes’ 1995 chapter on Attention Difficulties:

Students with attention disorders without hyperactivity often fail to finish tasks, they are easily distracted, they have difficulty listening, concentrating, and organizing their work, they require supervision to accomplish tasks, and they frequently shift activities. Students with attention disorders with hyperactivity display these same characteristics. They are also described as having difficulty remaining seated, exhibiting excessive fidgeting, frequently calling out in class, being always on the go, and often acting without thinking.

Although children with ADHD are commonly considered to have problems paying attention, for the purposes of developing effective interventions, it may be more useful to think of the disorder, as Barkley (1990) has suggested, as a biologically based “motivational deficit.” Children with attention disorders appear to be insensitive to normal behavioural consequences, either positive or negative. Thus, the typical responses to behaviour in school, such as praise, reprimands, or test grades, tend to be ineffective in shaping behaviours of children with attention disorders. Viewing attention disorders in this light helps resolve some of the seeming inconsistencies these children display. Parents and teachers often comment, “But he has no trouble paying attention to things he enjoys!” (E.g., video games). They also note that the quality of work these children produce in school can sometimes be exceptional, leading them to wonder why such children cannot produce work of high quality all the time. A motivational deficit hypothesis would suggest that many of the problems these students encounter in school (and at home) occur because they have an inordinate amount of difficulty making themselves do tasks that are not intrinsically interesting to them.

This also accounts for another characteristic of students with attention disorders: These students are susceptible to attention problems on tasks that they find difficult. While all people attend better to tasks that interest them, those with attention deficits show greater problems with tasks that are difficult, or uninteresting to them. It takes students with attention deficits a huge amount of effort and motivation for them to apply themselves to tasks that an ordinary student can accomplish with less effort and self-determination.

Another common characteristic of students with attention disorders is academic underachievement. Often these students have acquired basic academic skills but demonstrate difficulties with day-to-day classroom performance that stem from characteristics inherent in the attention disorder. Most often in written production, poor planning and organization, difficulty generating ideas, and problems sequencing thoughts. Some students with ADHD may also exhibit problems with reading comprehension—again, not because of skill deficits in either decoding or comprehension but because they have trouble concentrating on what they are reading sufficiently to grasp the meaning.

A significant number of children with attention deficits exhibit problems with a constellation of behaviours referred to as “executive functions.” Beside problems with sustained attention, executive function deficits may include problems with planning and organization, task initiation and follow-through, goal selection, anticipation of consequences of actions, and inhibition of impulsive responding.

It is important to recognize that all children with attention disorders (indeed, all children) bring a unique set of characteristics, both strengths and weaknesses, to any learning situation. While it is helpful to be aware of problems commonly associated with attention disorders, ultimately one must consider the specific needs of each child in order to develop interventions effectively tailored to those individual needs.

Suggested Strategies for Reducing Attention Problems

Written expression

1. Provide assistance with prewriting activities (brainstorming/concept mapping)
2. Allow use of computer or dictation for longer assignments
3. Provide assistance with proofing, preparing final draft

Long assignments

1. Break down long assignments into shorter ones
2. Help develop time lines for longer assignments
3. Reduce writing requirements by reducing length and allowing alternative methods of demonstrating learning

Following directions

1. Provide written as well as oral directions
2. Repeat group directions individually
3. Have student repeat directions to show understanding
4. Break down longer directions into smaller steps
5. Build in incentives for following directions and for asking for help

Distractibility

1. Preferential seating during whole class work
2. Nonverbal signal from teacher to attend
3. Quiet place to work during seatwork
4. Cue for transitions
5. Incentives for timely work completion

Incentive Systems. Children with attention disorders frequently do not respond to natural incentives, (positive or negative) that are effective with other students. Research has demonstrated that positive reinforcement is effective in addressing problem behaviours associated with attention disorders.

In its simplest form, a positive reinforcement procedure involves administering a reinforcer upon demonstration of an appropriate target behaviour. An example would be allowing a student to spend the last 15 minutes before lunch playing a computer game with a friend after completing all required morning seatwork. Simple reinforcement procedures, however, often are ineffective with children with attention disorders. Experts in ADHD (e.g., Barkley, 1993) offer suggestions:

1. Ensure that reinforcers are administered immediately and frequently. Continuous reinforcement systems are more effective than partial reinforcement systems. Systems need to be designed to ensure that the reinforcer can be administered consistently.
2. Build variety into the reinforcement system. Children with ADHD often crave novelty and satiate very quickly on specific reinforcers. This problem can be addressed by developing a reinforcement menu so that the student can choose from a variety of attractive rewards.
3. Assume that whatever system is designed will require adjustments. That the system will require some “fine tuning” to make it effective should be communicated to those who implement the system, lest they decide too quickly that the system has failed and should be abandoned.
4. Involve the student in helping to design the incentive system. Students often have good ideas about how the system can be administered, including how to keep records and how often and under what circumstances to give reinforcers. When the program needs to be revised, students often offer valuable insights into how it can be improved. When students are active participants in the process, they more likely to “buy into” the system. They also can learn valuable skills in task analysis, goal-setting, and self-monitoring.

Token economies. The use of token, reinforcers gives a teacher more flexibility in what rewards can be earned and when they will be given. By giving the student tokens (or points) for demonstrating appropriate target behaviours, the teacher gives immediate feedback regarding performance without having to give the reward right away. Such a system allows the child to earn a variety of reinforcers, since specific points values can be attached to each reward. This approach can be used with an individual student or with groups of students, with different target behaviours and reinforcers assigned to each student if desired. Reinforcers should include a variety of activity as well as tangible reinforcers. By building in group rewards, the aid of the whole class can be enlisted in helping the youngster achieve his or her goals, since all will benefit from the child’s earning rewards.

Response cost. With response cost, earned tokens are withdrawn when undesirable behaviours occur. This approach has been found particularly effective in increasing attention to task and work completion, and, as with many other interventions, it appears to be particularly effective when paired with medication.

Cognitive-behavioural interventions

Self-monitoring. These procedures involve training students to become aware of their own behaviour, with the eventual goal being for them to cue themselves to attend. The most common training procedure is to employ an audio track that sounds electronic tones at random intervals ranging from 15 to 90 seconds apart. When the tone sounds, students are instructed to ask themselves, “Was I paying attention?” Initially students are instructed to note their responses on a checklist. Eventually, they are weaned from both the checklist and the audio, but are instructed to note covertly whether they are attending. Visual reminders on student’s desks have also shown to be effective.

Self-evaluation. In this approach, students are taught to evaluate their progress on specific goals. For example: a teacher would have reading group members rate how well they attended or how much they participated during the reading group session.

With appropriate modifications, the educational needs of most students with attention disorders can be met primarily in a regular classroom environment. While behaviour modification strategies can be very effective in improving classroom performance and behaviour, altering the environment and making task modifications are also important. Research has found:

1. Stories presented at a faster-than-normal rate of speech resulted in improved listening comprehension and decreased activity level.
2. Using color to highlight important information increased accuracy and decreased activity level for students with ADHD.
3. Tasks with a high degree of structure decreased activity level, compared to low-structured, more open-ended tasks.
4. Requiring a motor response during activities resulted in improved performance, compared to more passive conditions.
5. Providing brief, global instructions, instead of lengthy, detailed instructions, produced shorter task completion time and fewer requests for cues.
6. Math and reading tasks presented in a low-noise environment created better performance and decreased activity levels than did a high-noise environment.
7. Other Effective classroom modifications included
   1. Seating students preferentially
   2. Calling on the student frequently during class discussions
   3. Writing start and stop times for written work completion
   4. Using a kitchen timer as a motivator

Children with attention disorders, particularly if they have concomitant executive skill deficits, may need help getting started on assignments. This can be done by walking them through the first few items or talking to them about the assignment to help them get oriented. They often do significantly better when tasks are modified to respond to their deficit areas, including presentation of briefer tasks, building in breaks, allowing the opportunity to stand up and move around, and, as noted above, providing high within-task stimulation.

Other modifications for children with ADHD address the fact that they do better when they have frequent opportunities to respond and receive immediate feedback. Peer tutoring and cooperative learning approaches both build in greater opportunities for individual response and immediate feedback than do more traditional classroom structures, such as lectures and individual seatwork activities. Computers also offer great promise for children with ADHD, because computer software can be novel, entertaining, and interactive.

Modifications that address difficulty in written production include reducing writing requirements, allowing students to dictate or tape record assignments, and allowing for alternative means of demonstrating knowledge, such as projects and oral reports. Providing access to computers to complete written assignments is an essential modification for many children with ADHD.

Still other modifications address the fact that children with ADHD do more poorly with tasks they find tedious, difficult, or uninteresting. These modifications include reducing repetitive seatwork and making tasks and assignments as appealing as possible. Children with ADHD respond very well to activities with a game format or to lessons that are presented as problems to be solved, particularly if they have real-life applications. Project-oriented learning is ideally suited to the learning style of many children. Others respond to the opportunity to design their own assignments.

Giving these students choices in terms of what assignments they will do, how they will do them, in what order, where, and with whom they will complete the work can have a dramatic impact on productivity and task completion. Pairing children with ADHD with other students allows them to use complementary strengths. A child with ADHD may have very creative ideas but have trouble putting them down on paper, while another student may be skilled at organizing work and writing but lack imagination; by pairing the two, both can benefit and learn from the strengths of the other.

While we generally think about classroom and task modifications in terms of the learning weaknesses of children with attention disorders, the strengths these students have must not be neglected. It is critically important to identify skills, and talents, to find ways to encourage their development, and to ensure that these students are recognized for their accomplishments. Children with attention disorders tend to receive negative feedback in greater quantities than their classmates. Special efforts must counteract these threats to self-esteem by finding areas where these students can shine.