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Foreword: Exploring the Comorbidity of Attention-Deficit/Hyperactivity Disorder

and Language, Speech, and Reading Disorders
Section Editor(s): Tomblin, J. Bruce PhD; Issue Co-Editors; Mueller, Kathryn PhD;
Issue Co-Editors

Free Access
Article Outline
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University of Iowa Iowa City, IA

The authors have no relevant financial or nonfinancial relationships to disclose.

This issue of Topics in Language Disorders (TLD) explores a common clinical

experience, whereby clients present with more than one condition. This happens
so frequently; we suspect it is often taken for granted that vulnerability in one
area opens up vulnerability in other areas.The term comorbidity was coined by
Feinstein (1970) to refer to additional, distinct health conditions occurring during
the development of an index disease. Within this conceptualization, the index
disease is considered as primary, and fully separate, from the co-occurring, or
comorbid, conditions that develop alongside it. In the area of medicine, where
the nature of disease is well understood, it is possible to draw this distinction.
However, it cannot be applied as clearly to areas of health and disease in which
disorders are not so well characterized and diagnostic systems are in flux. This is
exemplified in the fields of psychology and psychiatry by current debates over
the forthcoming Diagnostic and Statistical Manual of Mental Disorders, Fifth
Edition, diagnostic system. Because of this, it is quite common within these fields
to find the notion of comorbidity somewhat relaxed and it is simply used to refer
to two or conditions occurring within the same individual (Robins, 1994). Robins
(1994) has argued that the study of comorbidity, as defined by diagnostic
coexistence, is valuable to the understanding of comorbid conditions because it
gives insight into the nature of these conditions. A key point in this issue of TLD
is that comorbidity can be used to further researchers' and clinicians'
understanding of communication disorders, particularly developmental
communication disorders. In the first article (Tomblin & Mueller, 2012), we
introduce some of the principal candidate explanations for comorbidity that can
then serve as potential hypotheses for this research.Attentiondeficit/hyperactivity disorder (ADHD) is one of the most common co-occurring
conditions experienced by children with developmental communication disorders
(i.e., speech, language, or reading impairments). Indeed, it is arguable that

clinicians working with school-aged children see this so frequently that the
phenomenon is accepted as commonplace and uninteresting. A second point to
this issue, however, is to demonstrate how the co-occurrence, or comorbidity, of
ADHD with communication disorders is important for understanding the nature of
these developmental disorders, as well as their clinical management.The first
question we address is whether ADHD co-occurs with various forms of
developmental speech and language disorders (including reading) at rates
greater than expected by chance. If this is indeed the case, why does this
happen? All possible reasons need to be considered; however, a focus of this
issue involves the possibility that these disorders have at least partial genetic
overlap, which could then explain the overlap at the symptom, or phenotype,
level. If this is true, we might find these different developmental disorders are
not, in fact, so distinctly different but rather have fuzzy boundaries at the
symptom level, which continue on down through neurodevelopmental systems
and genetics. The clinical implications of such understanding are hard to predict;
however, we can be sure that understanding more about the clinical conditions
with which we work is better than knowing less. If we see that some of the
neuropsychological pathways in ADHD are in fact shared with developmental
communication disorders, it is important to incorporate this insight into clinical
management.Our approach to this issue has been to provide a short article
(Tomblin & Mueller, 2012) that lays the groundwork for discussing comorbidity,
along with some basic concepts in genetics that will be useful for understanding
the latter articles. The second article also serves as a backdrop with respect to
the current literature on ADHD. In the second article, Mueller and Tomblin
(2012a) review current conceptualizations of the disorder with respect to its
diagnosis and principal etiological bases. The literature and the research effort
directed toward ADHD are large, particularly in comparison with developmental
communication disorders. The result is that a number of studies, each involving
large numbers of children, have been conducted multiple times, thus allowing
researchers to perform interesting and informative meta-analyses. Much of this
overview article on ADHD provides a summary of this rich literature. In the
subsequent articles, we examine the issue of the comorbidity of ADHD with
spoken language impairment (LI; Mueller & Tomblin, 2012b), speech sound
disorder (SSD; Lewis et al., 2012), and reading disorder (Boada, Willicut, &
Pennington, 2012). Anyone who has spent much time with a caseload of schoolaged children should feel at home here, in that each of these conditions
frequently overlaps with others.In the article of Mueller and Tomblin (2012b), we
examine the existing literature on ADHD and spoken LI. With the exception of
two studies, most of this research has been carried out in clinical samples. That
is, these studies started with children identified clinically as having either ADHD
or LI and then determined the rate of the other condition. This research has
generally shown high rates of ADHD among children with LI, and vice versa. An
alternative way of examining comorbidity is to examine its overlap in the general
population. This method is advantageous in that it does not rely on a clinical
identification and diagnostic system for the identification of cases, which may
miss milder and less complex cases and can lead to an overestimation of
comorbidity if only severe cases are included. In this article, we provide an
analysis of the comorbidity of LI and ADHD in a population-based sample and
show that substantial rates of overlap are still found when using this method. We
also see that the risk for ADHD, given LI, is no greater than the risk for LI, given

ADHD, indicating the possibility that there is something common influencing this
overlap.Lewis et al. (2012) focus on the comorbidity of SSD and ADHD in children
with SSD identified via clinical referral. Likewise, they find elevated rates of
comorbidity. Their study is important on two counts. First, they saw that family
history of speechlanguage impairment is associated with greater rates of ADHD
in children with SSD, something also found in the article of Mueller and Tomblin
(2012b), indicating the possibility of a familial basis to comorbidity. Second,
Lewis et al. (2012) found that the comorbidity between SSD and ADHD was
partly driven by a third comorbid condition, in the form of LI. This does not mean
that we should not expect to see high levels of ADHD in children with SSD alone.
Rather, this finding is a reminder of the complexity with which we should
consider these disorders and their relationship.Boada et al. (2012) focus on a
form of reading impairment, dyslexia, which has been shown to be comorbid with
ADHD. Importantly, dyslexia, as it is currently defined, can be independent of LI
in that it is diagnosed on the basis of poor word decoding and recognition
abilities, as well as by poor spelling. Thus, dyslexia and LI are not diagnosed in
the same way. Dyslexia and LI, however, have been shown to be comorbid and
could therefore share a common etiology (Kamhi & Catts, 1986). An intriguing
finding from the article by Boada et al. (2012) is that there are probably multiple
factors that contribute to dyslexia and ADHD and that these overlap. One of
these factors, processing speed, is particularly interesting for those who are
interested in LI because slowed processing has been proposed as a prominent
feature of children with LI (Kail & Salthouse, 1994; Miller, Kail, Leonard, &
Tomblin, 2001). An interesting open question is whether such a slowing might
account for the comorbidity between LI and ADHD, as well as, perhaps,
dyslexia.This issue is aimed at encouraging further consideration of the
importance of comorbidity in research on developmental communication
disorders. The field of communication sciences and disorders straddles the
worlds of medicine and education. However, whereas notions of diagnosis and
comorbidity are central to the field of medicine, in the field of education, they are
not. The problem with diagnosis is that it is often viewed as being largely
concerned with labeling and classifying, rather than understanding. However, it
may be better to view diagnosis as an effort to understand the nature of clinical
interest. In this issue, we emphasize how comorbidity allows us to see beyond
the boundaries of a label or diagnosis and can be used to gain insight into what
are likely related, and perhaps very similar, conditions.J. Bruce Tomblin, PhD
Kathryn Mueller, PhDIssue Co-EditorsUniversity of IowaIowa City, IA
Back to Top | Article Outline
REFERENCES

Boada R., Willicut E. W., Pennington B. P. (2012). Understanding the comorbidity

between dyslexia and attention-deficit/hyperactivity disorder. Topics in Language
Disorders, 32(3), 264284.
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Feinstein A. R. (1970). The pre-therapeutic classification of co-morbidity in

chronic disease. Journal of Chronic Diseases, 23, 455468.
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Kail R., Salthouse T. A. (1994). Processing speed as a mental capacity. Acta

Psychologica, 86, 199225.
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Kamhi A., Catts H. (1986). Toward understanding of developmental language and

reading disorders. Journal of Speech and Hearing Research, 51, 337347.
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Lewis B. A., Short E. J., Iyengar S. K., Taylor H. G., Freebairn L., Tag J., et al. (2012)
Speech sound disorders and attention-deficit/hyperactivity disorder symptoms.
Topics in Language Disorders, 32(3), 247263.
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Miller C. A., Kail R., Leonard L. B., Tomblin J. B. (2001). Speed of processing in
children with specific language impairment. Journal of Speech Language and
Hearing Research, 44, 416433.
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Mueller K. L., Tomblin J. B. (2012a). Diagnosis of attention-deficit/hyperactivity

disorder and its behavioral, neurological, and genetic roots. Topics in Language
Disorders, 32(3), 207227.
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Mueller K. L., Tomblin J. B. (2012b). Examining the comorbidity of language

impairment and attention-deficit/hyperactivity disorder. Topics in Language
Disorders, 32(3), 228246.
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Robins D. L. (1994). How recognizing comorbidities in psychopathology may lead

to an improved research nosology. Clinical Psychology: Science and Practice,
1(1), 9395.
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Tomblin J. B., Mueller K. L. (2012). How can comorbidity with attentiondeficit/hyperactivity disorder aid understanding of language, speech, and reading
disorders? Topics in Language Disorders, 32(3), 198206.
Cited Here...

Cited By:

This article has been cited 2 time(s).

Topics in Language Disorders

From the Editor: Looking at Attention-Deficit/Hyperactivity Disorder and
Communication Disorders From Multiple Angles

Topics in Language Disorders, 32(3): 193-194.

10.1097/TLD.0b013e3182677c06
PDF (48) | CrossRef
Topics in Language Disorders
Diagnosis of Attention-Deficit/Hyperactivity Disorder and Its Behavioral,
Neurological, and Genetic Roots
Mueller, KL; Tomblin, JB
Topics in Language Disorders, 32(3): 207-227.
10.1097/TLD.0b013e318261ffdd
PDF (177) | CrossRef

http://education.jhu.edu/PD/newhorizons/Journals/Winter2011/Scott

Teaching Students with ADHD to F.O.C.U.S.: A Learning Strategy

Dr. Victoria Groves Scott, Ed.D.
Assistant Provost for Academic Innovation and Effectiveness and Professor of
Special Education, Southern Illinois University Edwardsville

Kendra Fark
Speech Language Pathologist completing her clinical fellowship year in Illinois

Students with attention deficit hyperactivity disorder (ADHD) make up a

significant portion of the students receiving intervention in schools. Bloom and
Cohen report that 4.5 million children in the United States between the ages of 3
and 17 had ADHD in 2006 (Bloom & Cohen, 2007). This disorder can have a
significant impact on students academic success due to difficulty with selective
attention, sustained attention, impulsivity, and high levels of activity. One
specific characteristic which inhibits academic success is reduced ability to
selectively attend in order to listen to and follow directions (Maag & Anderson,
2007; Zentall, 2005). Learning strategies are a frequently used intervention for
students with ADHD (Zentall, 2005). Furthermore, learning strategies to improve
listening effectiveness are supported for this population (Alberta Education,
2006).

This article focuses on teaching a learning strategy to develop improved listening

in students with ADHD. The goals of this article are to briefly define learning
strategies, discuss necessary aspects of listening, introduce the FOCUS strategy,
explain how to teach FOCUS, and explain how to evaluate students use of
FOCUS in class.

What is a Learning Strategy?

Learning strategies are actions taken by the student to make learning easier,
faster, more self-directed, more effective, and transferrable to new situations
(Oxford, 1990). Developed to help students succeed in a variety of academic
areas, learning strategies often employ the use of a first-letter mnemonic used to
cue students to follow strategy steps. Depending on the strategy, these steps
guide students as they work on academic tasks, such as reading comprehension,
paragraph writing, or test taking. Learning strategies do not teach students

content. They do, however, teach students how to approach the content.
Instead of teaching students multiplication facts, a learning strategy might teach
students the steps necessary to solve a multiplication problem (Scott &
Compton, 2007). Proven to be one of the most effective instructional techniques
for students with learning problems, strategy instruction is often crucial for
students success (Beckman, 2002; Reid & Lienemann, 2006).

What are the Elements of Listening?

The first step in developing a learning strategy for improved listening is to

identify the necessary elements in listening. First, listeners display several
behaviors to let their communication partners know that they are prepared to
focus their attention on the message; they will be quiet, watch the speaker, look
at the materials presented by the speaker, and avoid fidgeting (Owca, Pawlak, &
Pronobis, 2003). Secondly, individuals must be active listeners. Being an active
listener rather than a passive listener means an individual actively thinks about
the information being shared rather than just passively hearing it. Some ways in
which individuals can actively think about the information include identifying the
important parts, reminding themselves to focus on the message, summarizing
the message, making connections to what they already know, and visualizing the
message. In addition to being active listeners, individuals should be participants
in the communication. Listeners can make comments, ask questions, and
respond to questions (Brent & Anderson, 1993; Owca et al., 2003). These skills
were used to develop the learning strategy below to improve the listening of
students with ADHD.

Developing a Learning Strategy for Listening

Good learners are strategic, meaning that they possess a variety of ways to meet
cognitive challenges. Good listeners use strategies that improve their
performance when they are asked to listen. From the observations and literature
described above, a learning strategy was developed to cue students into critical
actions that they can take to attend to and process verbal information, commit it
to memory, and communicate to the speaker that they are interested. Each step
of the strategy corresponds with a specific task students should complete while
engaged in improved listening. FOCUS is the mnemonic developed to outline
this learning strategy. Each key word is an action verb that cues students on
what to do (Figure 1).

Figure 1. FOCUS cue card

Memory Device

Intended Associations

Focus on speaker

F1. Eyes and mind on the speaker.

F2. Resist talking to your neighbors.

F3. Keep your hands and feet quiet.

Open your mind

O1. Clear your mind of distracting thoughts. (Ignore distractions)

O2. Be ready to learn and remember.

O3. Set your mind on the subject.

O4. Your brain is like a parachute. It only works when its open.

O5. Think about what is being said.

Connect

C1. Try to relate what you are hearing to things that you already know and are
related to the lesson.

C2. Create a picture in your mind of the new information.

C3. Listen to other students related comments.

Use your eyes

U1. Pay attention to the book, chalk board, worksheets, overheads, or other
visual materials.

Select

S1. Select the important parts so you know what to remember.

S2. Say the important parts to yourself in your own words.

S3. Ask questions to make sure you understand.

Teaching FOCUS

There is considerable literature that outlines the most effective method to teach
learning strategies (Pressley & Woloshyn, 1995). Most experts agree that the
strategy should be described to the student. This should include information
about each step of the strategy and the benefits of using the strategy. If a
mnemonic is used, the mnemonic should be rehearsed until the student can
recite it easily from memory. The teacher should model strategy use and provide
opportunities for both guided and independent practice. The student should be
taught to apply the strategy in a variety of settings. Finally, the student and
teacher should evaluate and monitor strategy use (Pressley & Woloshyn, 1995).

To begin this process, the teacher should first use Figures 2 and 3 to collect preintervention or baseline information about the students listening skills. The
teacher might begin by teaching a short lesson on a topic related to the
curriculum. See Figure 4 for a sample mini lesson. During the lesson, a fellow
teacher or teachers aid might observe the students and note their listening
behaviors using the FOCUS observation chart (Figure 2). After the lesson the
teacher should check comprehension by asking the students questions related to
the lesson. Any students who exhibit difficulty with the listening behaviors or in
answering questions may significantly benefit from the FOCUS instruction.

Figure 4. Sample mini lesson

Today we are going to learn about penguins. Lets listen carefully because I will
be asking some questions about penguins after the lesson to see how much you
can remember.

Penguins are like people because they are warm blooded. But unlike people,
penguins have insulation that lets them live in extremely cold temperatures.
Insulation is something that keeps things warm. Houses have insulation to keep
them warm in the winter. The penguins insulation is several layers thick. A
layer of tightly packed feathers covers the penguins bodies. (Show picture of
penguin feathers from Internet.) Under the feather is a thick layer of fat called
blubber. Both the feathers and the blubber are insulation for the penguin.
Whales and dolphins also have blubber to keep them warm, or insulated from the
cold. A penguins insulation works so well that sometimes they get too hot.
What can you do when you get hot? How do you think a penguin will cool down
when it gets hot? When this happens, the penguin fluffs up their feathers to let
some of the heat out.

Comprehension check:

1.

What is this lesson about?

2.

How are penguins like people?

3.

What is insulation?

4.

What is the penguins thick layer of fat called?

5.

What can a penguin do if it gets too hot?

After baseline data has been collected, teachers should introduce the strategy to
students, teaching about the importance of the strategy and what each step of
FOCUS implies. Following the introduction, activities in which students verbally
rehearse the FOCUS steps can be used to help them master automatic recall of
the mnemonic (Beckman, 2002). The FOCUS Cue Card (Figure 1) can be used as
a visual cue at the beginning of verbal rehearsal and then removed as students
improve in their ability to recall the steps. Once students are able to recite the
FOCUS steps with 80% accuracy, without the cue card, the teacher can begin
teaching students how to use the strategy steps in listening activities.

Activities to Teach Use of FOCUS Steps

Teachers can use the following activities when teaching the steps to the FOCUS
strategy. Remember that each step should be described, modeled, practiced,
and evaluated.

Figure 5. Activities to teach FOCUS

FOCUS Step

Related Lesson

F: Focus on the Speaker

When teaching students to focus on the speaker, it is important to convey the

reciprocity in communication. Students can be good listeners and not look at the
speaker. However, that does not communicate to the speaker that the listener is
interested. This simple communication of listening may have a dramatic effect
on the quality of interaction. Anyone who has tried to talk to a disinterested
person can attest to this. Therefore, it is crucial for the student to demonstrate
behaviors consistent with good listening.

Video Feedback: Set up a video camera in the back of the classroom while
teaching. Plan for a small distraction to occur as a story is read, such as setting
a timer to tick. After the lesson, show the students the video and discuss how
they did or did not remain focused on the speaker. Have the students discuss
what the word focus means and describe the behaviors they exhibit when they
are focused on something.

O: Open Your Mind

Multi-tasking is a skill growing in importance and popularity. It requires

individuals to think about several topics at once. Unfortunately, this positive skill
can negatively impact a students ability to listen effectively. For this reason, it is
especially important to remind students that they must clear their heads and
concentrate on what is being said in order to gain information from listening.

Whats in Your Mind?: Begin by asking the students to take out a piece of paper
and write down or draw an image that displays what they are thinking about.
Next, lead a discussion about things that might interfere with listening. The term

distracted could be introduced here. The student may be distracted by

thoughts of lunch, friendships, after school activities, or the previous academic
topic, and all of these can cause students to run out of space in their head,
much like you can run out of space on your computer storage device. Explain
the importance of opening your mind to the current topic.

C: Connect

Making connections to the students prior knowledge (including interests and

experiences) is a fundamental part of scaffolding as well as the basic process of
learning. This part of the process helps the student to identify what he or she
already knows about the topic, compare it to what is being presented, and then
modify his or her concept of the topic to match. Making connections provides
hooks on which to hang the new information, making the new information
meaningful to the student and providing motivation to learn. Recognizing the
importance of making connections and being able to do so are key steps in
learning to use FOCUS.

Whos the Artist?: Separate students into pairs, and give each pair the name of
an unfamiliar animal (i.e. kangaroo rat, aye-aye, naked neck chicken, pygmy
marmoset, Andean condor, scorpion fish, sloth, anglerfish; See Your World,
2009). Student A will describe to Student B what he or she thinks the animal
looks like. Student B will draw exactly what Student A describes. Then the
partners will trade roles. After each student has had a turn to draw, ask them if
it was easy or difficult to follow their partners directions. Lead this discussion to
the idea that they used their prior knowledge to draw what they thought the
animal may look like. Students must take what they know about the topic and
combine it with or replace it by the new information (i.e., from their partners).

U: Use Your Eyes

Using your eyes is likely a straightforward step to most teachers and clinicians
reading this article. However, students may not recognize this as a valuable skill
that can improve their ability to listen. Therefore, it is necessary that their
attention is brought to the importance of looking at the visual aids that are
available. Visual aids can be a variety of items: a page in the book, writing on
the board, a poster, a worksheet, etc. Teaching students to recognize and use
visual aids is important for this step of FOCUS.

Math Magic (Hopkins, 2002): This is a quick lesson to demonstrate the

importance of using your eyes when you listen. Ask all the students to get into
pairs and take out a pencil, paper, and calculator (optional). Explain that they will

learn a trick for calculating peoples ages (students must be at least ten years
old for the math trick to work). Read the following steps to the class:

Ask your friend to think of the first number in his or her age.
Tell your friend to multiply that number by 5.
Then, tell your friend to add 3 to that number.
Next, ask your friend to double the latest number.
Finally, ask your friend to add the second number of his or her age to the total.
Ask your friend to tell you the number that resulted from the calculations.
Now, simply subtract 6 from that number.
Announce the answer as that person's age!
Once the steps have been read, have the students try to complete the trick from
memory. This would be difficult for any student to do without seeing the steps
written out or being given one step at a time. After a minute or so, put up a
Power Point slide or overhead of the steps listed in Figure 6. After students finish
the calculations, ask them what they thought about the math trick and what
might have made it easier. Discuss the importance of using visual aids that are
available.

S: Select

Selecting means that the student is eliminating extraneous information to focus

on what is important in the message. As stated above, students with ADHD have
noted deficits in selective attention, which negatively affects their ability to listen
to and follow directions. Instead of trying to remember each and every word
spoken by the speaker, the listener must learn how to identify and remember the
important parts of the message. Trying to remember information that is
unimportant can interfere with the students recall of the overall message.

Newspaper Ads (Jalongo, 1991): Place the students in pairs. One student will
be the product salesman, and the other will be the newspaper writer. The
salesman describes the product he wants to sell, including all the pertinent
information about the product. The writer will listen to the salesman and then
restate in his own words what the salesman told him. The pair will split up, with
the writer writing out an ad for the product. The two will trade roles. The ads
will be returned to the salespeople for them to review, and the salespeople will
judge whether or not they approve printing of the ad. Discuss the fact that not
all the information was included in the ads. Ask students how they decided what
was important enough to be included in the ad information. Explain that
identifying the important parts of a message helps them remember and focus on
it.

Strategy Practice

Students are now at the point where mini lessons can be given in a variety of
content areas as opportunities for them to practice applying FOCUS. See Figure 4
for a sample mini lesson. At first, lessons should be taken from content
materials one grade level lower than where students are currently performing.
This is done so that the focus of the challenge is on the use of the strategy, not
necessarily on the content of the lesson. As students achieve mastery of FOCUS
with the lower grade level content materials, mini lessons at the students
current grade level can be given to assist students in learning to apply the
FOCUS strategy to material that is more challenging.

Each mini lesson for FOCUS practice should follow a set of steps. First, the
teacher should review FOCUS with the students using the FOCUS Cue Card.
Next, students should be told that they will be practicing using FOCUS during a
lesson and that they will be asked questions afterward to see how well they
listened. The FOCUS Cue Card can be displayed in the room as a visual reminder
of the strategy. An advanced organizer can be given to each student as an
additional visual cue for use during the mini lesson. The teacher will present the
brief mini lesson while using the Observation Chart (Figure 2) to record the
behaviors that are representative of good listeners and take notes for individual
feedback after the lesson. Once the mini lesson has been taught, the teacher
will ask the students comprehension questions for information obtained through
the lesson. Each students accuracy on these questions will be recorded on his
or her Progress Chart (Figure 3) in the Controlled Practice section. Once the
mini lessons are taught at students current grade levels, the data is recorded in
the Advanced Practice section. These two forms of evaluation are explained in
greater detail in the following section. Finally, the teacher and students will
discuss how they applied the strategy during the lesson: how the steps were
helpful, what they noticed as they used the steps, what they did well, and where
they can improve.

As more mini lessons are taught, teachers should need to provide fewer and
fewer cues for students to use the strategy. Also, less explanation of the
strategy and less assistance with application will be needed as students progress
in their ability to effectively apply FOCUS.

Strategy Evaluation

As stated earlier, students behaviors that demonstrate listening and their

responses to listening comprehension questions should be evaluated before
FOCUS is introduced. Having this baseline data will allow the teacher to show

that students have experienced improvement in listening skills after learning to

apply the FOCUS strategy.

Once students have practiced using the FOCUS strategy in the mini lesson
format described above, their performance can be evaluated and recorded in the
Post-Test section of the Progress Chart for comparison to the baseline data.
Mini lessons like those above are used for the post-test evaluation sessions.
Evaluation is completed through two methods. First, the students are observed
and rated on behaviors related to the FOCUS strategy. During the lesson, each
student is evaluated for: (a) eye contact with the speaker, (b) demonstration of
listening by not talking to others, (c) use of correct sitting posture, (d) listening to
other students comments, (e) use of relevant comments or questions, and (f)
ability to follow directions (such as look at the board, take out your pencil, or turn
to your neighbor). These behaviors can be easily rated during the lesson using
the FOCUS Observation Chart (Figure 2)

Figure 2. FOCUS observation chart.

Secondly, comprehension questions related to the mini lesson are developed for
assessment after the lesson. These questions can be given orally or in written
form depending on the skills of the students. Each students score on the
comprehension questions can be tracked to document progress using the FOCUS
Progress Chart (Figure 3).

Figure 3. FOCUS progress chart

These two methods of evaluation should be employed for each mini lesson in
pre-test, controlled practice, advanced practice, post-test, and maintenance to
obtain data. The students should be able to gain 80% accuracy or above on the
comprehension questions following the mini lessons and on the FOCUS behavior
evaluation to demonstrate mastery at each level.

Conclusion

Students with ADHD face numerous challenges, with listening effectively being
one. Listening is used in every class and in every situation throughout each

school day. Students can apply the steps of the FOCUS strategy as they sit in
class, go through the lunch line, complete group work, and interact with peers on
the playground. Teaching students FOCUS and providing them with a variety of
opportunities in which to practice effective use of the strategy can give them a
tool to improve their functioning across the curriculum.

References

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Arlington, VA: ERIC Clearinghouse on Disabilities and Gifted Education, Council
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Additional Bibliography

Center for Research on Learning:

http://www.kucrl.org/sim/strategies.shtml

Cognitive Learning Strategies:

http://www.specialconnections.ku.edu/cgi-bin/cgiwrap/specconn/main.php?
cat=instruction&section=cs/main

Cognitive Strategies in Middle School:

http://www.ehow.com/way_5210506_counseling-students-using-cognitivestrategies.html

Neurofeedback and Metacognitive Strategies:

http://www.ncbi.nlm.nih.gov/pubmed/10457815

Peer-Assisted Learning Strategies:

http://ies.ed.gov/ncee/wwc/reports/english_lang/pals/index.asp

Rethinking ADHD from a Cognitive Perspective:

http://research.aboutkidshealth.ca/teachadhd/abc/chapter3

Suggested Classroom Interventions for Children with ADD & Learning Disabilities:
http://www.childdevelopmentinfo.com/learning/teacher.shtml

University of Nebraska-Lincoln/ Cognitive Strategy Instruction:

http://www.unl.edu/csi/index.shtml