.................................................................................................................................4 Chapter I: Introduction Statement of Problem .................................................................................................6 Research Question .....................................................................................................8 Definition of Terms....................................................................................................8 Chapter II: Review of Literature ............................................................................................10 Token Systems ...........................................................................................................11 Individual .......................................................................................................11 Group .............................................................................................................13 During Sports .................................................................................................15 Daily Behavior Report Cards .....................................................................................17 With or without Response Cost .....................................................................18 With or without Parent Delivered Consequences ..........................................20 Special Education Setting ..............................................................................22 Classwide Techniques ................................................................................................24 Peer Tutoring .................................................................................................24 Peer Tutoring with Peer Coaching .................................................................26 Individualized Training ..............................................................................................28 Social Skills Training .....................................................................................28 Cognitive Behavior Therapy ..........................................................................30 Self-Regulation ..............................................................................................32 TEACHING CHILDREN WITH UNDIAGNOSED ADHD 3 Alternative Ideas ....................................................................................................................33 Green Space ...................................................................................................33 Physical Activity ............................................................................................35 Chapter III: Results and Analysis Relative to the Problem ...................................................40 Token Systems ...........................................................................................................40 Daily Behavior Report Cards .....................................................................................40 Classwide Techniques ................................................................................................41 Individualized Training ..............................................................................................42 Alternative Ideas ........................................................................................................43 Chapter IV: Recommendations and Conclusion ....................................................................45 Recommendation .......................................................................................................45 Areas for Further Research ........................................................................................47 Summary and Conclusion ..........................................................................................48 References ........................................................................................................................49 Appendix ........................................................................................................................53 TEACHING CHILDREN WITH UNDIAGNOSED ADHD 4 Abstract The purpose of this review of literature was to describe effective and effacious methods for teaching children with undiagnosed ADHD in early elementary classrooms. This literature review includes studies on the topics of token systems, daily behavior report cards, peer tutoring, social skills training, cognitive behavior therapy, self-regulation, physical activity, and green space. The reviewed research typically used elementary students as the participants, with the majority being male. Results and conclusions from the studies indicated that many of the intervention techniques proved beneficial when working with ADHD children. Recommendations for improving effectiveness of teaching children with undiagnosed ADHD in early elementary classrooms include: class-wide techniques like peer tutoring, group token systems, incorporating physical activity, and utilizing green space, along with individualized approaches like using token systems and daily behavior report cards.The purpose of this review of literature was to describe effective and effacious methods for teaching children with undiagnosed ADHD in early elementary classrooms. This literature review includes studies on the topics of token systems, daily behavior report cards, peer tutoring, social skills training, cognitive behavior therapy, self-regulation, physical activity, and green space. The reviewed research typically used elementary students as the participants, with the majority being male. Results and conclusions from the studies indicated that many of the intervention techniques proved beneficial when working with ADHD children. Recommendations for improving effectiveness of teaching children with undiagnosed ADHD in early elementary classrooms include: class-wide techniques like peer tutoring, group token systems, incorporating physical activity, and utilizing green space, along with individualized approaches like using token systems and daily behavior report cards. TEACHING CHILDREN WITH UNDIAGNOSED ADHD 5 Chapter I-Introduction It is unknown what percentage of children have undiagnosed attentiondeficit/hyperactivity disorder (ADHD). Literature searches using ERIC, PsychINFO, and Google Scholar databases yielded few results on undiagnosed ADHD in children. One result regarded the undiagnosed and under researched African American population and the others related to teenager and adult ADHD. The lack of research on undiagnosed ADHD in children is understandable considering there are still topics in debate about the disorder itself. Literature on ADHD is wide-ranging and dates back at least three decades, yet several issues are still in debate because of the ever changing protocol for diagnosis of the disease (Center for Disease Control). In order to understand more about undiagnosed ADHD, it is imperative to first have knowledge on ADHD. In the United States the American Psychiatric Association (APA) states in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) that 3%-7% of school-aged children have been diagnosed with ADHD. ADHD is defined by the APA as developmentally inappropriate attention and/or hyperactivity and impulsivity so pervasive and persistent as to significantly interfere with a child’s daily life. Children with ADHD often struggle with academic achievement, social skills, following rules, and issues regarding self-esteem. There are no qualitative or quantitative tests in a medical laboratory or any x-ray, scan, or physical exam that can be done to diagnose children with ADHD; therefore, diagnosis is not an easy task. The DSM-IV provides recommended criteria for diagnosing ADHD. This criterion can be found located in the appendix. The criteria are presented in modified form in order to make them more accessible to the general public. They are listed for information purposes and should be used only by trained health care providers to diagnose or treat ADHD. TEACHING CHILDREN WITH UNDIAGNOSED ADHD 6 Statement of the Problem Having criteria to follow has helped with the diagnosing of ADHD in children. The key findings from the National Health Interview Survey found the percentage of children diagnosed with attention deficit hyperactivity disorder increased from 7% to 9% from 1998–2000 through 2007–2009. It appears that ADHD is being diagnosed more; however, this does not make it any easier to diagnosis. It is tricky for parents and educators to distinguish between what is normal behavior and what constitutes a disease or disorder. Parents may be the first to bring up their concerns about their child to a healthcare provider. In this case, a teacher often feels relief in the sense that the parent had their own concerns regarding their child’s behavior and is taking the lead. However, parents might not think “being hyper or not being able to focus was a reason to take a child to the doctor” and this type of thinking causes more problems for the teacher. This type of parental approach along with many children falling into a gray area between ADHD symptoms and non-ADHD symptoms is what can lead many children to be undiagnosed (Barkley, 2010). According to the American Academy of Pediatrics (AAP) “school settings can highlight a child’s problems relating to inattention, impulsivity, and hyperactivity because classroom activities demand an increased amount of focus, patience, and self-control from children. These types of demands are not as prevalent at home or in play groups” (Reiff, 2004, p. 21). Parents might not be as concerned about their child because they see the child in a different environment and do not see their child struggle as much. This is why in several situations it can be difficult for teachers to decide if they should approach the topic of ADHD or not. An ana