Introduction to Special Education

Ms. Kau’s students are full of life and energy but many have trouble staying focused and are easily distracted. Several are diagnosed with attention deficit hyperactivity disorder (ADHD). She read an article suggesting that regu- lar movement could assist students with concentration as well as helping them control impulsivity. Intrigued with this idea, Ms. Kau started incorporating classroom transition exercises, lesson energizers, and structured movement games for recess. She even talked with the physical education teacher to explore using structured physical move- ment games in her students’ gym class. As a result of these changes, all of her

students, not just those with ADHD, are focusing better and paying closer atten- tion in class.

Teachers face many challenges in their daily effort to meet the needs of and ensure success for a diverse group of students, including students who are inattentive and have trouble staying focused and on task. All students, espe- cially those with ADHD, need exercise; it assists them with concentration and provides an outlet for healthy impulse discharge, helping to control impulsivi- ty. Establishing a classroom environ- ment that encourages beneficial move- ment throughout the school day—dur- ing content lessons, transitions, and via specialized games for recess and indoor rainy day activities—can improve results for students with ADHD, help reduce problematic classroom behavior, and better focus students’ attention on content instruction.

ADHD is defined as a “persistent pat- tern of inattention and/or hyperactivity- impulsivity that is more frequently dis- played and more severe than is typical- ly observed in individuals at a compara- ble level of development” (American Psychiatric Association, 2000, p. 85). Such inattention, hyperactivity and/or impulsivity make it difficult for students with ADHD to focus their attention long

enough or well enough to learn. Students with ADHD often exhibit defi- cient study skills and general disorgani- zation that cause significant academic, behavioral, and social problems stem- ming from the inability to pay attention (Slavin, 2003). More specifically, typical behaviors include inattentiveness dur- ing work or play, not completing assigned tasks, not listening to or fol- lowing directions, losing materials, inat- tention to details resulting in mistakes, and difficulty awaiting turns (Prater, 2007).

Students with ADHD are easily dis- tracted and teachers may find them- selves constantly redirecting the stu- dents’ attention. Students have difficul- ty staying on task and, as a result, may not complete assignments on time. Teachers often require students with ADHD to make up these assignments during nonacademic classes, recess, gym time, or after school. This, unfortu- nately, does not allow the students the opportunity to engage in physical activ- ities that provide them appropriate time for movement and give their minds a needed rest from academics. There is even evidence that indicates keeping students with ADHD from exercise may actually cause some classroom-related problems (Holtkamp et al., 2004). Ms. Kau, the teacher in our opening sce-

16 ■ COUNCIL FOR EXCEPTIONAL CHILDREN

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C r e a t i n g S u p p o r t i v e E n v i r o n m e n t s

The Active Classroom Supporting Students With

Attention Deficit Hyperactivity Disorder Through Exercise

Christopher F. Mulrine

Mary Anne Prater

Amelia Jenkins

nario, might be on the right track: Incorporating physical movement activ- ities into her classroom routine helps all of her students, including those with ADHD, to be better focused and to stay on task for longer periods of time.

Benefits of Exercise for All Students There is research evidence that imple- menting exercise activities throughout the day can help improve academic per- formance and reduce disruptive class- room and social problem behaviors (Barkley, 2004; Majorek, Tuchelmann, & Heusser, 2004). The physical education literature base is replete with studies stating the benefits of exercise and its effects on learning (see box, “Benefits of Exercise on Student Learning”). Exer- cise helps students to cope more effec- tively with stress, and promotes positive self-image, clearer thought, and improved memory (Akande, VanWyk, & Osagie, 2000). In addition, exercise can increase activity in the parts of the brain involved in memory, attention, spatial perception, language, and emotion (Olsen, 1994); there are indications that movement can strengthen learning and memory and boost learner motivation and morale (Jensen, 2005). Exercising just 30 min a day, 3 to 5 days a week has been shown to have advantages (Jambor, 1999).

Keeping students with ADHD from

exercise may actually cause some

classroom-related problems.

However, despite these findings, exercise for students in this country appears to be on the decline, correspon- ding to obesity rates for children unpar- alleled in any other time in history. A lack of physical exercise has resulted in American children becoming more obese since the 1960s (Hinkle, 1992). There also has been a dramatic increase in the number of children with Type 2 diabetes—a disease once limited to sedentary, overweight adults (Mayo Clinic, n.d.). Research further suggests that children’s cardiovascular health and fitness suffer when they are

deprived of physical activity, or play, for long periods of time (Pellegrini & Smith, 1998). How does this impact education? Teachers should not only be concerned with the physical health benefits derived from exercise, but also need to be aware of the positive impact of exer- cise and movement on classroom learn- ing for all students, especially for those with ADHD.

Benefits of Exercise for Students With ADHD

If, indeed, our bodies are designed to move and to learn while moving (Samaras, Straits, & Patrick, 1998), have these findings on exercise and learning been assimilated into the special educa- tion literature base as a viable strategy for teaching students, especially those with ADHD? Harvey and Reid (2003) reviewed 49 empirically based studies published between 1949 and 2002 on movement skill performance and physi- cal fitness of children with ADHD. Their review of the literature found that: (a) children with ADHD are at risk for movement skill difficulties, (b) children with ADHD are at risk for poor levels of

physical fitness, (c) there is comorbidity between ADHD and developmental coordination disorder, and (d) few inter- ventions have focused on movement performance and physical fitness of children with ADHD. In a related study, Barkley (2004) concluded that physical exercise, which has received limited attention for management of disruptive behavior for children and adolescents with ADHD, needs further and more rig- orous study as a relatively harmless, socially acceptable form of treatment.

Neuroscience, through the use of brain imaging studies, is providing addi- tional information on the topic of phys- ical activity and learning. Brain imag- ing—examining differences in blood flow to various brain regions—is being used to study the impact of exercise on learning performance in children with ADHD (Murray, 2000). Exercise impacts oxygen levels in the brain, with result- ing effects on brain chemistry, cerebral metabolism, and growth and develop- ment, establishing the link between exercise and learning (Coco & Sweigard, 2004; Dustman, Emmerson, & Shearer, 1990; Putnam, 2001). Oxygen is essen- tial for brain function, and enhanced blood flow increases the amount of oxy- gen transported to the brain. Physical activity and exercise increase blood flow and allow for more oxygen and nour- ishment to flow to the different parts of the brain through the blood vessels, arteries, capillaries, and veins (Han- naford, 1995; Jensen, 2005).

Related research on neurochemical reactions in the brain is investigating how exercise affects the behavioral and dopaminergic-like responses in children with ADHD. In preliminary findings, Tantillo, Kesick, Hynd, & Dishman (2002) cautiously stated that vigorous exercise might have the potential for treating the management of behavioral features of ADHD, but they suggested that further study is needed. Further, Wendt (2000) found that 40 min per day of exercise 5 days a week for 6 weeks significantly improved the behavior of ADHD students; students who run or jog may reduce the incidence of conduct and oppositional problems, in addition to helping them modify their disruptive classroom behaviors (Wendt, 2001).

TEACHING EXCEPTIONAL CHILDREN ■ MAY/JUNE 2008 ■ 17

Benefits of Exercise on Student Learning

An experimental group got four times more exercise per week than the con- trol group, but their “loss” in study time did not result in lower academic scores (Dwyer, Blizzard, & Dean, 1996).

In a Canadian study of more than 500 school children, those who spent an extra hour each day in a gym class far outperformed at exam time those who didn’t exercise (Hannaford, 1995).

Among three test groups, the one that had vigorous aerobic exercise im- proved short-term memory, reaction time, and creativity (Michaud & Wild, 1991).

Children engaged in daily physical education showed superior motor fit- ness, academic performance, and atti- tude towards school as compared to their counterparts who did not partic- ipate in daily physical education (Pollatschek & O’Hagan, 1989).

Neuroscience research clearly indi- cates a link between physical activity and brain function, and further indi- cates a relationship between physical activity and improved educational per- formance (Jensen, 2008; Labounty, 2007; Pierson, 2004). Additional studies have suggested a link between physical activity and behavior and academic per- formance of children with ADHD (Hall, 2007; Van Puymbroeck, 2006). These results have clear implications for class- room practice, and can be translated into everyday teaching activities to improve chances for success for stu- dents with ADHD.

Incorporating Exercise Activities Into the Daily Classroom Schedule

How can teachers translate these find- ings into effective classroom learning activities? It is especially appropriate to allow the student with ADHD opportu- nities for controlled movement and to develop a repertoire of physical activi- ties for the entire class (such as stretch breaks; LD Online, 1998). Sitting quiet-

ly in a chair and staying focused requires effort for all students, especial- ly those with ADHD. Conventional wis- dom tells us that students need breaks from learning and can focus better when provided breaks throughout the day; unstructured breaks from demand- ing cognitive tasks seem to facilitate both learning and social competence (Pellegrini & Bohn, 2005). Incorporating movement into classroom life can be accomplished by creating a classroom environment that encourages beneficial movement throughout the school day, during subject transition times and con- tent lessons, as well as structured movement games for recess and gym (see box, “Tips for Creating an Active Learning Environment”).

Incorporate Movement Activities During Transition Times

Transitions from one lesson or class to another are particularly difficult for stu- dents with ADHD; if prepared for these transitions, students are more likely to stay on task (U.S. Department of Education, 2004). Students, especially

those with disruptive classroom and social problem behaviors, are more like- ly to exhibit behavior problems during subject area transition times. Effective classroom transitions between learning activities need structure and boundaries to help students mentally prepare for task shifts and to be better positioned for learning. In many elementary class- rooms, transition time is spent sitting at one’s desk, and any physical activity is curtailed to bathroom breaks or a short walk to complete a classroom chore— then it is back to the seat for the next lesson. Remember: Students with ADHD may have difficulty sitting still, so teachers need to plan productive physical movement. Why not use more organized and structured movement activities during these times? Teachers can easily incorporate some simple movement activities during subject area transitions to get their students moving. Movement activities that become a part of the everyday classroom routine will soon become familiar to students and serve as a cue to transition from one subject area to the next, as well as pro- vide an opportunity for appropriate movement. It is critical, however, to establish a structure and boundaries for the movement activities (such as limita-

18 ■ COUNCIL FOR EXCEPTIONAL CHILDREN

Tips for Creating An Active Learning Environment

✓ Don’t sit at your desk. Move around as you teach.

✓ Discuss your own personal exercise routines with your students.

✓ Have students stand up and move around—give them the job of collecting and handing out papers.

✓ Don’t allow your students to sit for more than 30 minutes at a time.

✓ When giving instructions, have your students stand or sit on the carpet.

✓ Allow students to run errands within the school building (not just the well- behaved students).

✓ Limit student time on computer games and limit the use of videotapes. Go out- side instead!

✓ Have your students use music, movement, and dance when cleaning or tidying up the classroom.

✓ Allow students to pick some type of movement activity for the entire class after lunch. Some ideas might include walking, running in place, yoga exercises, or playing catch.

✓ Hold classroom parties outside.

✓ Have your class design a mini “field day” full of noncompetitive fun. Create sta- tions such as obstacle courses, games, dance activities, or tag. Make certain to include rest stations and water breaks! Enlist the help of your school’s physical education teachers.

✓ Don’t melt when it rains! Seek indoor opportunities for physical activity on days that the weather doesn’t permit outdoor play. Play indoor movement games like Duck, Duck, Goose, or have a dance party.

Classroom Transition Movement Activities

✓ Have students open the windows and door.

✓ Ask students to stand at their desk and take several deep breaths.

✓ Have students do simple stretching exercises such as pushing the palms of their hands together and bending over to stretch the calf and leg muscles, simple squat exercises or deep knee bends at their desks.

✓ Direct students to push down hard on the desktop, squeeze and relax fists, and then rotate the arms and trunk of their body.

✓ Have students march in place, sing, and dance to music.

✓ Walk with students down the hall, up and down stairs, or take a short walk around the school.

tions for range of movement, contact with others, and volume). Teachers can use age-appropriate signals indicating time to stop (“freeze” signals), nonver- bal signals (classroom lights on/off), and hand clapping (teacher claps three times, students repeat). See box, “Class- room Transition Movement Activities,” for additional possibilities.

Incorporate Lesson “Energizers”

Incorporating movement through role play and other curricular responses is an effective strategy for managing stu- dents with excessive activity (Carbone, 2001). “Energizers” are short (10-min) activities that integrate physical activity with academic subjects—another method by which teachers can help stu- dents become more physically active throughout the school day (see Table 1). Energizers can be targeted to lessons in math, science, language arts, and social studies; Table 2 provides an example of a social studies energizer (Mahar, Kenny, Shields, Scales, & Collins, 2006).

Specific Accommodations for Students With ADHD

Even though children with ADHD can vary considerably in their characteris- tics and skills, they all share the inabil- ity to regulate their attention and as a result may require lesson adaptations

and accommodations. Certain types of interventions have proven successful in working with students with ADHD, such as environmental supports, aca- demic interventions, behavioral inter- ventions, parent education, and med- ical interventions (Friend & Bursuck,

2006). When implementing movement activities during transitions and lessons utilizing energizers, teachers also may need to provide environmental, aca- demic and/or behavioral accommoda- tions for students with ADHD (see Table 3).

TEACHING EXCEPTIONAL CHILDREN ■ MAY/JUNE 2008 ■ 19

Table 1. Sample Daily Energizers (Grade 2)

Subject Classroom Energizer Lesson Objective

Math “Inches, Feet and Yards, Oh My!” Learning measurement systems; students take small, http://ncpe4me.com/pdf_files/energizers_K-2.pdf medium, and large steps to indicate distance in inches,

feet, and yards.

Science “Heart Smart” http://ncpe4me.com/pdf_files/energizers_K-2.pdf Understanding the human heart and learning about (page 18) activities that strengthen or weaken it; students either

jump (for strengthen) or squat (for weaken).

Language Arts “As If” Learning “action” words; students move (walk, jump) http://ncpe4me.com/pdf_files/energizers_K-2.pdf “as if” they were another animal or object, students act (page 12) out and then create the sentences, create a tree map of

other action words

Physical Education “Frogs in the Pond” Developing gross motor skills; similar to game of “tag” http://ncpe4me.com/pdf_files/energizers_K-2.pdf (page 29)

Language Arts “Jump to Spell” Spelling and learning the keyboard; students spell http://www.eduref.org/cgi-bin/printlessons.cgi/ words by jumping on a floor-size computer keyboard Virtual/Lessons/Physical_Education/Skill_Related/ SRF0003.html

Table 2. “California Dreamin’” Classroom Energizer (Grades 3–5)

Student formation Standing at desks

Equipment required None

Rules/directions Teacher leads the class on a “tour” of California (can use a wall map to point out specific landmarks or areas):

“March across the Golden Gate Bridge.”

“Surf the waves in the Pacific Ocean.”

“Climb a redwood tree.”

“Pretend you are an actor and wave to all your fans.”

“Flex your muscles like Governor Arnold Schwarzenegger.”

“Stomp grapes.”

“Pick oranges.”

“Rollerblade on the boardwalk.”

“Ski the Sierra Nevada Mountains.”

“Climb Mount Whitney, the highest peak in the continental United States.”

“Crawl through the sand in Death Valley.”

“Hit a homerun in Pac-Bell Park.”

“Shoot a foul shot at the Staples Center.”

Note. The same concept can be utilized with any state. From Energizers: Classroom- Based Physical Activities (3rd ed.) by M. T. Mahar, R. K. Kenny, A. T. Shields, D. P. Scales, and G. Collins, 2006, p. 32, Raleigh: North Carolina Department of Public Instruction. Copyright 2006 by the North Carolina Department of Public Instruction. Adapted with permission.

Incorporating Exercise Activities During Recess

Even when engaged in frequent move- ment activities in the daily classroom routine, recess is the time when stu- dents have the most opportunity to par- ticipate in physical exercise. Recess may be even more important for students with ADHD; the benefits of activity may

go beyond reducing the “fidget factor” (Silver, 2005). Tomporowski and Ellis (1986) suggested that vigorous play- ground behavior is related to attention to seat work after recess, and that exer- cise increases attention to various cog- nitive tasks and can help boost academ- ic performance. Children with ADHD, however, often experience difficulties during recess because they often lack the social skills needed to get along with their peers. They may have difficulty with peer relationships as a result of (a) inability to pick up on social cues, (b) acting impulsively, (c) having limited self-awareness of their effect on others, (d) overpersonalizing another’s actions

20 ■ COUNCIL FOR EXCEPTIONAL CHILDREN

Table 3. Movement Lessons/Activities Accommodations for Students With ADHD

Environmental Supports Academic Interventions Behavioral Interventions

Additional Resources

Energizers

East Carolina University’s “Be Active” Program For teachers: http://www.ncpe4me.com/energizers.html For parents: “Be Active Kids” http://www.beactivekids.org/parents.html#move)

Recess Activities

Games Kids Play http://www.gameskidsplay.net Basic instructions for traditional children’s games and directions for additional classroom ball games, rhymes used for jump-roping, and strength games

Education World http://www.education-world.com/a_special/physical_fitness.shtml Physical education stories, lessons, resources, and other activities that can be modified for the classroom

Educator’s Reference Desk http://www.eduref.org/cgi-bin/printlessons.cgi/Virtual/Lessons/Physical_ Education/Games/GAM0202.html Instructions for chasing, tagging, and ball games (e.g., “Sharks and Barracudas,” “Thunderball”)

Physical Education Lesson Plan Page http://members.tripod.com/~pazz/lesson.html Exercise games (e.g., “Sponge Bob, Gary, & Patrick,” “Shark Island,” “Hamburger Relay,” “Make Books Come Alive”)

A to Z Teacher Stuff http://www.atozteacherstuff.com/Lesson_Plans/Physical_Education/index.shtml Lesson plans for structured physical activity games and exercises

PE Central http://www.pecentral.org/adapted/adaptedactivities.html Adaptations for physical activities to use for students with disabilities

Keep student’s desk/area free from clutter and in an uncluttered area of the room.

Provide clear classroom rules and rou- tines; alert student when change in rou- tine is going to occur.

Seat student near well-behaved, attentive peers, and near front of room or teacher.

Allow student to disengage from activity or to move to a “free” desk/space if feel- ing overwhelmed.

Designate the student’s space; mark off with tape or carpet square.

Break activities into smaller parts and assign individually; give extended time, if needed.

Keep directions brief, don’t give too many directions at once, and don’t rely only on oral directions.

Provide visual supports such as hand- outs, outlines, and graphic organizers.

Directly model the activity and specify parameters for movement, volume, con- tact with others, etc.

Provide a peer partner to assist with activities.

Give frequent specific verbal praise and reinforcement for desired behavior.

Look for signs of stress, fatigue, and frus- tration, and intervene before behavior problems occur.

Provide visual reminders of expected behaviors (picture cue card, point chart, timer).

Repeat and model rules and expectations for behavior often; remind students in a calm, nonthreatening manner.

Engage the student in monitoring his or her own behavior (giving self points when on task).

Exercise increases attention to

various cognitive tasks and can help

boost academic performance.

as being criticism, and (e) not recogniz- ing positive feedback (Cowan, 2004).

Using structured games during recess (see box, “Additional Re- sources”) is a way to teach socially appropriate values and behaviors, including sharing, fairness, and respect. Games also teach listening and respond- ing skills and how to respect personal space, read social signals, cope with teasing, and manage anger. It is impor- tant to maximize the involvement of all the students. For example, with tag games, teachers can design strategies for children to reenter the game quickly to ensure continuous activity among all students. Examples of appropriate accommodations for students with ADHD for activities during recess include (a) assigning a peer partner, (b) giving simple, clear directions, (c) pro- viding frequent monitoring and rein- forcement of desired behavior, (d) mod- eling rules and expectations for behav- ior, and (e) reminding students of expectations in a calm nonthreatening manner.

Final Thoughts

Exercise activities incorporated through- out the day’s schedule are important for all students, especially those diagnosed with ADHD; research provides evidence that movement activities throughout the day can help all students with their con- centration and attention. The literature from physical education, special educa- tion, and neuroscience on the effects of exercise and learning suggests that physical activity is a viable teaching strategy worth implementing. Integra- ting the general strategy of active response into the curriculum and using varied and interesting movement tasks during classroom transitions, lessons, recess, and gym might have a positive effect on a child’s well-being and learn- ing. Engaging students with ADHD in planned frequent movement activities (while providing appropriate accommo- dations) increases the likelihood that students will experience success. Given the sedentary lifestyles of our youth and the learning problems associated with students with ADHD, these suggestions to get students more active surely will

not hurt, and chances are they just might help—so get moving!

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+ A D H D % 3 a + r e c r e a t i o n + c a n . . . -a0156651839

Wendt, M. (2000). The effect of an activity program designed with intense physical exercise on the behavior of attention deficit hyperactivity disorder (ADHD) children. Dissertation Abstracts Inter- national, 61, 500.

Wendt, M. (2001). How running and exercise can impact the behavior of children. KidsRunning.com. Retrieved August 8, 2006, from http://www.kidsrunning.com/ news/krnews0131adhd.html

Christopher F. Mulrine (CEC NJ Federation), Associate Professor, Special Education and Counseling, William Paterson University, Wayne, New Jersey. Mary Anne Prater (CEC UT Federation), Professor, Counseling Psy- chology and Special Education Brigham Young University, Provo, Utah. Amelia Jenkins (CEC HI Federation), Associate Professor and Chair, Special Education and Counseling, University of Hawaii, Honolulu.

Address correspondence to Christopher Mulrine, Department of Special Education and Counseling, William Paterson University, 300 Pompton Road, Wayne, NJ 07470 (e-mail: [email protected]).

TEACHING Exceptional Children, Vol. 40, No. 5, pp. 16–22.

Copyright 2008 CEC.

22 ■ COUNCIL FOR EXCEPTIONAL CHILDREN

he College of Teacher Education and Leadership (CTEL) at Arizona

State University congratulates Kathleen Puckett on her appointment as president-elect of the Council for Exceptional Children. We proudly support her leadership and service to the Council for Exceptional Children and applaud all members of this distinguished organization who, through teaching, leadership and service, are making a difference in the lives of individuals with exceptionalities.

T

ctel.asu.edu � 602-543-6300

Kathleen Puckett, Ph.D. Associate Professor, Special Education

CTEL at the West campus