Journal Article Review

Van der Donk, Hiernstra-Beernink, Tjeenk-Kalff, van der Leij and Lindaur (2013) conducted a study to determine the effects of executive functioning and working memory interventions on academic achievement and classroom behavior in students diagnosed with Attention Deficit Hyperactivity Disorder (ADHD). This study consisted of two randomly selected groups of 175 students each between the ages of 8 and 12 that had a single, prior diagnosis of ADHD. The students were either assigned to a computer-based or a teacher instructed intervention. Students were selected from various elementary schools from two Dutch regions. The interventions were implemented by developmental psychologists that underwent a three-hour training course for their respective intervention. Group monitoring by a licensed clinical staff, recording observations of implementation, and reviewing student work samples were methods used to authenticate intervention fidelity. The computer-based intervention consisted of working memory tasks that adapted to the students’ skill level in a game format. The teacher instructed intervention consisted of several visual and verbal tasks that addressed five executive functions that are critical for success within a classroom setting. Both interventions were implemented 5 times a week for 45 minutes for a duration of 5 weeks. Various assessment methods including standardized tests and checklists were administered at baseline, at the conclusion of the intervention period, and six months after the intervention period to measure academic performance and classroom behavior. Results of the study showed a notable increase in academic performance and a statistically significant improvement in student behavior in the classroom.

Strengths and Weaknesses

This study had several strengths and limitations. One strength of the study was the randomization of the test groups. Randomly assigning subjects is the best practice to ensure efficacy. Each group was comprised of 175 students which is an adequate sample size to determine valid results. Measures were taken to verify the fidelity of intervention implementation. One limitation of this study was the content and applicability of the test groups differed greatly making it difficult to compare the efficacy of the interventions. Single tasks were used to assess the effects of working memory training which made results ambiguous as to whether academic and behavior improvement was due to the changes in ability or due to assessed tasks resembling practiced tasks.

Instructional Implications

The Centers for Disease Control and Prevention (CDC) reported that in 2016, 9.4% of children ages 4-17 were diagnosed with ADHD in the United States. 62% of children diagnosed with ADHD are taking some sort of medication. These medications help alleviate behavior symptoms of the disorder but are often associated with severe side effects (van der Donk et al., 2013). Results of this study show that classroom interventions can be just as effective as medications when controlling ADHD symptoms. This study shows promising results supporting the addition of working memory and executive functioning training in the classroom to promote academic performance and student behavior. Adding working memory and executive functioning training as an intervention accommodation for students with ADHD could positively impact the academic performance and behavior of these students.

Future Areas of Research

Future areas of research implicated by this study include comparing intervention settings and implementation styles. This study was performed in an isolated setting where students were removed from their general education classrooms. A future study should be done to compare the effects of working memory and executive function training within the classroom versus a pull-out method. The study included a computer-based intervention and a teacher instructed intervention that vastly differed making the comparison of data difficult. A future study should be performed to include similar interventions implemented using computer-based and teacher instructed methods to determine the most effective mode of implementation of the intervention.

Personal Reflection

With fifteen years of experience in the classroom, I have seen the effects of students on ADHD medications. The side effects that I have seen associated with these medications include extreme drowsiness, lack of motivation, and manic behaviors. This study includes promising data that working memory and executive function training can result in an increase in academic performance and alleviate symptom behaviors without the use of medication. As a mother of two sons diagnosed with ADHD I do not feel there are enough beneficial accommodations available to ensure the success of students with this disorder. I am compelled to speak with my administration about conducting my own action research study to determine the effects of implementing a pull-out intervention session for fifth-grade students diagnosed with ADHD on our campus. If the results show a positive correlation between intervention and academic performance and classroom behavior, I will request working memory and executive function training is offered as an intervention method for students.

Journal Summary

Schrandt, Townsend, and Poulson (2009) conducted a study to determine the effects of teaching empathic skills to children with autism. This study consisted of four children from one elementary school previously diagnosed as students with autism. These students were identified for participation in the study based on observations and reports from teachers. All students in this study were reported as having limited or lack of empathetic responses towards others. Each student received individual empathic skills instruction in a small room with limited distractions. The empathic skills lessons were implemented by instructors that underwent training prior to the study. Empathy instruction sessions were implemented 4-5 times a week for 20-30 minutes. Lessons began when an instructor presented a skit where a doll experienced pain or sadness. The student’s initial response to the stimulus was recorded as a baseline. A score of zero was given if the student did not respond with the correct empathetic response while a score of one was given if the student did respond empathetically. Students then received feedback and further empathy-related instruction. At the end of the study, students were again presented with skits where a doll experienced pain or sadness, and their responses were scored accordingly. Results of the study showed an increase in empathic responses across participants as compared to baseline data where infrequent or null response was recorded.

Strengths and Weaknesses

This study had several strengths and limitations. Procedural integrity and result validity are crucial aspects of this study. For each trial, an observer was assigned to monitor for procedural integrity by certifying fidelity of lesson delivery. To ensure result validity, 19 teachers unrelated to the study watched videotaped segments of each trial and recorded whether they observed the student demonstrating empathy. Data from the teachers and instructors were compared and a 99.9% validity score was reported. One limitation of this study was the use of dolls instead of actual people. Using dolls does not give an accurate conclusion as to how the students would respond in real settings and only depicts their response in a pretend setting. Another limitation of the study was the nature of the raters in the result validity evaluation. The teachers chosen were not involved in the study but were all instructors in a behavioral intervention facility and had extensive experience with individuals with autism. Their prior experience with individuals with autism could have resulted in biased ratings. Another limitation of this study was the small sample size. It is difficult to generalize the impact of empathic skills training on a large population when only four students were included in the study.

Instructional Implications

Empathy is a skill necessary for the social health of students. Individuals with autism often lack empathy and therefore do not show appropriate levels of concern or interest towards others (Rheingold & Hay, 1980). Results of this study show that isolated lessons that teach empathy can be an effective method to prompt appropriate social responses. Offering empathic skills training to students with autism would be beneficial to students transitioning from a special education setting to a general education setting or students in an inclusion classroom. A lot of energy is expended towards the academic performance of students. The results of this study imply that there is also a need to address the social aspect of students as these are also abilities that can be learned.

Future Areas of Research

Future areas of research implicated in this study include separate vocal and motor elements and utilizing actual people instead of dolls. This study included both vocal and motor elements within each trial. A future study should be done separating these two elements in order to determine whether an empathic response is triggered by one or both elements combined (Schrandt, Townsend, & Poulson, 2009). The study included trials where lessons and assessments were derived using dolls as the stimulus. A future study should be performed to include actual people in the empathic lesson and assessments to determine how students would respond in real-world situations versus pretend settings.

Personal Reflection

My son was diagnosed as a student with autism at the age of six-years-old. One of the first indications that he may have autism was his lack of empathy. When someone was hurt he responded by laughing because he could not feel the pain himself and therefore couldn’t understand the pain of the other person. I have seen the effects on my son year after year as a social outcast. Making and keeping friends is very difficult for him as he gives no affirmation to the interests of others. There are limited resources within the school system to address teaching social skills to students with autism. I have had to seek outside resources and even that has been met with inadequacy. This study includes promising results that social skills such as empathy can be learned by individuals with autism that may have previously lacked these abilities. I would like to share this study with the district my son attends and discuss the possible implementation of social skills training within their special education program.

References

Centers for Disease Control and Prevention. (2018). Attention deficit/hyperactivity disorder:

Data and statistics. Retrieved from https://www.cdc.gov/ncbddd/adhd/data.html

Rheingold, H.L. & Hay, M.J. (1980). Prosocial of the very young. Berkeley: University of

California Press.

Schrandt, J.A., Townsend, D., & Poulson, C. (2009). Teaching empathy skills to children with

autism. Journal of Applied Behavior Analysis. 42(1), 17-32. Retrieved from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2649842/

Van der Donk, M., Hiernstra-Beernink, A., Tjeenk-Kalff, A.C., van der Leij, A.V., & Lindaur, R.

(2013). Interventions to improve executive functioning and working memory in school-

aged children with ad(h)d: A randomized controlled trial and stepped-care approach. BMC Psychiatry. 13(23), 1-7. Retrieved from http://www.biomedcentral.com/1471-244x/13/23