Volume: 5, Issue: 4


Positive Behavior Support Interventions for Students with Specific Learning Disabilities and Attention Deficit Hyperactivity Disorder: A Review of the Literature
Хауэлл, Эрика [about] , Фок, Элиса [about]

KEY WORDS: positive behavior support, learning disabilities, specific learning disabilities, ADHD.
ABSTRACT: This article offers an abbreviated review of effective research-based behavioral strategies for student behaviors associated with Specific Learning Disabilities (SLD) and Attention Deficit Hyperactivity Disorder (ADHD) in general education classrooms.

Since the implementation of two major American educational laws: No Child Left Behind (NCLB, 2001) and The Individuals with Disabilities Education Act (IDEA, 2004), regulations in school academics have increased significantly.  These two educational laws have not only impacted instruction, but have placed higher accountability on teachers for their students’ educational performance and increased the emphasis on testing results. Furthermore, states encountering budget difficulties have increased class sizes, often leaving general educators feeling unprepared to handle the diverse educational needs of students with disabilities in their classrooms (Stormont, 2008).

Two disabilities that general education teachers commonly encounter in their classrooms are Specific Learning Disabilities (SLD) and Attention Deficit Hyperactivity Disorder (ADHD). From 1980-2000, the prevalence of Specific Learning Disabilities (SLD) in the American public school system increased by 15% (National Center for Education Statistics, 2012) and three to five percent of public school children are labeled with ADHD (Stormont, 2008). Identifying successful behavioral interventions for SLD and ADHD may assist general educators in successfully managing disability related characteristics. Furthermore, teachers versed in effective positive behavior supports may feel more empowered in meeting the needs of diverse learners.

Specific Learning Disabilities

            The National Institute of Health (2007) defined learning disabilities as “disorders that affect the ability to understand or use spoken or written language, do mathematical calculations, coordinate movements, or direct attention.  Although learning disabilities occur in very young children, the disorders are usually not recognized until the child reaches school age."  Listed below are some identifying characteristics of students with SLD that teachers should be informed on. According to Smith and Tyler (2010) and shown in Table 1, a child with a learning disability demonstrates deficits in the academic, behavioral and social domains that are displayed below.

Table 1

Characteristics of SLD in the Academic, Behavioral, and Social Domains

Academic Domain Behavioral Domain Social Domain
Unexpected Underachievement Inattentive Immature
Resistant to treatment Distractible Socially unacceptable
Difficult to teach Hyperactive Misinterpret social and nonverbal cues
Inability to solve problems Impulsive Makes poor decisions
Uneven academic abilities Poorly coordinated Victimized
Inactive learning style Disorganized Unable to predict social consequences
Poor basic language skills Unmotivated Unable to follow social conventions
Poor basic reading and decoding skills Dependent Rejected
Inefficient information processing abilities   Naive
Inability to generalize   Shy, withdrawn, insecure

Attention Deficit Hyperactivity Disorder

According to the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition, Text Revision (DSM-V), published by the American Psychiatric Association (2013), attention-deficit hyperactivity disorder, is a behavioral condition that makes focusing on everyday requests and routines challenging and is the most common childhood psychiatric condition. According to Smith and Tyler (2010) and shown in Table 2, a student with ADHD could demonstrate characteristics that impact their academic, behavioral, and social performance.

Table 2

Characteristics of ADHD in the Academic, Behavioral, and Social Domains

Academic Domain Behavioral Domain Social Domain
Difficulty with academic performance Inattention Positive social interactions tend to decrease
Score higher on tests of intelligence that other students with disabilities Hyperactivity Antisocial behaviors increase
Distractible Impulsivity Prone to self alienation
Spend less time on assignments   Could be rejected by peers for inappropriate social behaviors
Messy handwriting    
Work is frequently sloppy and careless    
Ideas and work can be illogical and disorganized    

Review of Best-Practice Behavioral Interventions for Students with SLD and ADHD

Behavioral Intervention/Strategy: School Wide Positive Behavior Intervention Supports (SWPBIS)

With IDEA (2004) being implemented across schools, a framework that involved research-based instruction was called upon to help teachers and students.  Response to Intervention (RtI) is a model that is being supported by state education agencies and is currently the structure that many schools are implementing (Sugai, 2007). The focus of RtI is to address learning difficulties with early intervention stages.  With the RtI model, teachers and administrators focus on making changes to the student’s environment by using research based methods and interventions, instead of looking for deficiency within the student (Ardoin, Witt, Connell, Koenig, 2005).  Research has been done on studies that demonstrate the benefits of integrating academic and behavior RtI systems.  Multiple investigations have examined the impact of School Wide Positive Behavior Intervention Supports (SWPBIS) and how integrating both the academic and behavioral supports can lead to improved student outcomes (Bohanon, Goodman, & McIntosh, 2013; Fleming, Harachi, Cortes, Abbott, & Catalano, 2004).   Students that demonstrate low academic skills often display problem behaviors that can follow them from the primary level to secondary level.

Benner, Nelson, Sanders, and Ralston (2012) researched primary-level, standard-protocol behavior intervention for students with externalizing behavior problems.  The study examined the behavior interventions used with students with externalizing behavior problems in primary elementary schools that were implementing the RtI process.   Schools that implemented SWPBIS within the RtI process showed an improvement in student behavior. Stewart et al., (2007) concluded that, “Academic interventions may be even more effective with the addition of behavior supports to provide organized and motivating classrooms. It has been shown that integrated academic and behavior RtI models produce larger gains in both outcomes than single models.”

SWPBIS is an operational framework and is not a curriculum, intervention, or practice.  The Positive Behavioral Interventions & Supports website (2009) states that SWPBIS, “ is a decision making framework that guides selection, integration, and implementation of the best evidence-based academic and behavioral practices for improving important academic and behavior outcomes for all students."  Like the RtI model, the SWPBIS structure analyzes the data for decision making, measures the outcomes of the data, practices researched based supports, and effectively implements these practices into the school system.  It starts with three levels, like the RtI framework; the first level is working at the universal level where everyone is receiving primary tier interventions such as school awards, positive reframing of behavior expectations, and teaching and praising appropriate behavior.  Next is the secondary tier of interventions where more intensive behavioral supports are provided if the student(s) are not responding to the primary tier.  The last tier is the tertiary tier where an individual will receive a highly individualized plan to support their behavior (www.pbis.org).

Behavioral Intervention/Strategy: Self-Monitoring

Self-Monitoring is a behavioral intervention/strategy that teachers can use to help with their classroom management.  It can be considered a secondary tier level of intervention when connected to SWPBIS (PBISWorld.com).  Rafferty (2010) wrote an article examining the validity of teaching students to self-monitor and investigated whether this strategy would be successful generalizing to urban schools. The aim of the research was to examine whether self-management techniques for teachers and students could be implemented during any time of the school day and across every age group in order to improve appropriate school-based behavior. 

Self-Management is about teaching the students how to monitor their own behavior using a variety of techniques and skills.  First, the teacher has to determine what target behavior they want to work with the student.  Next, the teacher can select the self-monitoring intervention they would like to use that can be implemented into the classroom structure such as using a variety of charts, graphs, and skills that the student already posses.  In addition, the teacher investigates the ‘reinforcers’ the student prefers and how they can be earned.  Finally, the teacher teaches the student how to use the system.  Eventually the role of the adult and the necessity of the reinforcing or preferred items will fade away and the student will monitor their own behaviors (Loftin, Gibb, & Skiba, 2005).

Behavioral Intervention/Strategy: Operant Conditioning (Fixed-Time Reinforcement)

When examining behavioral interventions and strategies one is ultimately looking to alter a certain behavior, whether it is in a positive or negative form.  When examining behaviors, B.F. Skinner, a psychologist and a leader of behaviorism, who contributed immensely to experimental psychology, developed a theory of operant conditioning (Nevin, 1992). Cherry (2013) explained the process of operant conditioning as a method of learning that creates an association between behavior and consequence for a specific type of behavior.  There are two types of reinforcement: positive and negative. There are also two types of punishments: positive and negative.  In operant conditioning, schedules of reinforcement are an important component of the learning process and an educator can either deliver positive or negative reinforcement.  A teacher can choose to do either continuous reinforcement, where a behavior is reinforced every single time it occurs, which is typically successful in the initial stages of training. As the student exhibits the required behavior more regularly, partial reinforcement is then used. Partial reinforcement is the response that is used only part of the time.  There are four schedule components of partial reinforcement as described by Cherry (2013):

  1. Fixed-ratio schedules – a response is reinforced only after a specified number of responses (ex. Student raises their hands five times in a row, then a teacher will give them a reward, such as a goldfish cracker or sticker).
  2. Variable-ratio schedules – a response is reinforced after an unpredictable number of responses (ex. Gambling).
  3. Fixed-interval schedules – the first response is rewarded only after a specified amount of time has elapsed (ex. A student remains on task for five minutes a teacher will come and praise their behavior either verbally or a predetermined reinforcer). 
  4. Variable-interval schedules – a response is rewarded after an unpredictable amount of time has passed (ex. A student finishes their given assignment independently with little to no prompting in an uncertain amount of time).

Austin and Soeda (2008) examined the Fixed-time (FT) reinforcer otherwise known as the Fixed-interval schedule, as created by Skinner. A teacher wanted to decrease off-task behaviors in typically developing third graders.  The study examined the validity of using FT reinforcement to reduce off-task behavior of two typically developing third graders with ADHD using a teacher-selected schedule.  The results of the study concluded that FT reinforcement was an effective strategy for reducing off-task behaviors, but the schedule of delivery needs to relatively dense.

Behavioral Intervention/Strategy: Peer-Assisted Learning Strategies (PALS) and Peer-Mediated Intervention

One intervention that educators have been using is peer-assisted learning strategies (PALS).  This strategy has students working together in small groups, usually in pairs, learning the same materials and using the peers as teachers.  This strategy is great for students with disabilities or ELLs as it does not encourage competition and respects the multicultural background of our students today.  Students will require guidance and structure from the teacher for this model to be successful. PALS is a supplemental resource as it provides classmates as tutors who exchange the roles of coaches and players after a teacher demonstrates and models what is expected from each person (Smith & Tyler, 2010).  PALS could be used as a tool to help with SWPBIS and be used for behavioral interventions in the tier one and tier two levels.

Peer-mediated intervention is another term for PALS.  Grauvogel-MacAleese and Wallace (2010) observed the use of peer-mediated intervention in children with attention deficit hyperactivity disorder.  The authors' purpose of the article was to examine the use of peer-mediated intervention to decrease the off-task behaviors of students with ADHD.  The study involved six participants ranging from ages six to ten years old in after school program.  Each participant was allowed to choose their peer they would like to work with during homework time. All sessions were done in five minute durations in the afterschool program.  The results of this study showed that peer-mediated intervention was effective in increasing on-task behavior.  Peers were also capable of differentiating the types of reinforcement needed to help get students back on task.  Although there were limitations to this study, this research investigation demonstrated that young children were able to be successful partners in a peer-mediated intervention.

Behavioral Intervention/Strategy: Self-Management and School-Home Notes Procedure

Parental involvement and cooperation in children’s educational experiences at school has shown a positive correlation with student performance (Semke & Sheridan, 2012).  Several factors are key to involving parents in educational practices. Family involvement is characterized by active and meaningful engagements with parents and children at home and at school (Fantuzzo, Tigne, & Childs, 2000).  School-Home Notes is a strategy that can possibly lower behavioral problems in school and help with the regulation of self-management.  It can also be a way for parents to become involved with the school and have accountability for their child's behaviors at home and at school.  McGoey, Prodan, and Condit (2007) researched the topic of managing disruptive behavior of young children in school and at home.  The study analyzed self-management and school-home notes procedure.  Notes were sent home daily establishing a line of communication with the teacher and parents at home about the student’s behaviors for the day.  The key results implied that school-notes home appeared to be a promising way of intervention for young students. This intervention examined the fostering relationships between home, school, and student.  Even though the sample size and population were small, the study showed that school-home connection notes were proven effective for the parent, teacher and students. 

Behavioral Intervention/Strategy: Transitional Kindergarten “Gift of Time”

A study was done by Morrow, Garland, Wright, Maclure, Taylor, et al. (2012) demonstrating that the younger a child is in their class, the probability of having an ADHD diagnosis and prescription increases.  Grade retention, also known as non-promotion, flunking, failing, being held back, or the “gift of time” refers to a student having to repeat the same grade level again next year.  With the high accountability rate that schools are being held accountable for, children are often dropping out of school, because they cannot pass the standardized tests and California exit exams.  The retention and dropout rates have been rising since the implementation of the NCLB Act of 2001 (Jimerson, Woehr, Kaufman, 2007).    

Morrow, Garland, Wright, Maclure, Taylor, et al. (2012) provided an informative article to administrators, teachers and parents discussing the entry date of a child in school in relation to a child's attention span.  The authors examined if school entry date impacted the diagnosis of ADHD in British Columbia, Canada across 937,943 children in British Columbia. The findings indicated that children who started at a younger age were more likely to receive an ADHD diagnosis, in effect, demonstrating that age can have an effect in the diagnosis and treatment of ADHD.  The investigators also discuss the implications of over diagnosing and overprescribing medications which can have an adverse impact on sleep, appetite and growth, in addition to increased risk of cardiovascular events.

With that being said, the state of California recently implemented the Kindergarten Readiness Act of 2010, which amended the California Education Code to change the required birthday admission to kindergarten and first grade.  A transitional kindergarten class would be implemented in the 2012-2013 school year.  The enrollment cutoff is currently November 1st for the 2012-2013 school year. October 1st for the 2013-2014 school year and every year subsequently is September 1st.  A transitional kindergarten classroom uses modified kindergarten curriculum that is age and developmentally appropriate (http://www.cde.ca.gov). 

Through the new Kindergarten Readiness Act as a pre-intervention it could possibly provide more support to our students and decrease retention and dropout rates and provide that early academic intervention needed for the RtI and SWPBIS process.  By initiating the transitional kindergarten classes and proposing for all birthday cutoffs is moving back to September there could be benefits in decreasing the amount of children who are being diagnosed with ADHD and, subsequently, given unnecessary pharmacological intervention.

Behavioral Intervention/Strategy: Functional Behavioral Assessment (FBA) Based Intervention

While SWPBIS may work for most students, it will not work for all students.  There are some students that require more intensive behavioral support such as behavior support plans created by special education teams.  Functional-based approach forms a continuum of support that includes the student, classroom, school, and district (Sugai & Lewis-Palmer, 2004).  The characteristics of a function-based approach to behavioral support as described by Sugai & Lewis-Palmer (2004) are (a) human behavior is purposeful, predictable, and changeable; (b) external factors can influence human behavior; (c) changes in the external factor can change an individual’s behavior.  The goal of functional behavioral assessment (FBA) is to identify the target behavior and the factors that trigger the behavior and the contexts and settings in which the behavior is most and least like to be observed (Horner, Sugai, Todd, & Lewis-Palmer, 1999-2000).  After the behaviors and external factors have been analyzed, data is collected, and a behavior intervention plan is put into place.  The FBA is developed to prompt a more desirable behavior to replace recurring unwanted behaviors.

One notable study examined the impact on functional behavioral assessments on reducing off-task and disruptive behaviors in a student with multiple disabilities, including ADHD (Stahr, Cushing, Lane and Fox, 06). Descriptive FBA procedures were used to identify the function of the off-task and disruptive behaviors. A self-monitoring system was used to facilitate appropriate communication and consequence-based strategies. The intervention showed a decrease in the target behaviors.

Summary of Behavioral Interventions

The research-based strategies discussed are effective in helping general educators manage problem behaviors in the classroom, especially those associated with SLD and ADHD. Most importantly, these positive behavior supports provide an alternative approach to using drugs such as Ritalin or Methylphenidate to reduce associated behaviors and characteristics of ADHD and SLD, especially in light of the need for information on the long-term effects of these drugs (Collingwood, 2010).  Most strategies are low-cost to implement, yet yield high gains in improving student behavior. General educators who are experiencing increasing teaching demands coupled with growing class sizes may find the implementation of these strategies key to managing a successful classroom.


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