Dealing with Acting-Out Students with Skill, Not Meds

In this thoughtful article in Education Week. Nancy Rappaport (Harvard Medical School) says that medications are sometimes the right intervention for students with ADHD. “But the use of stimulants to improve poor academic performance or enhance cognitive skills is a travesty that can lead to unintended consequences,” she says. “It takes experience and a nuanced eye to determine whether a child is suffering from ADHD, boredom, or something else entirely… Many students don’t need prescriptions. They simply need teachers trained in prevention strategies, which are key to providing them with a chance to learn and the skills they need to persevere.” 

This is what’s lacking in many schools, says Rappaport. “Too often, teachers enter the classroom ill-equipped to respond to students’ challenging behaviors: their refusal to do work, defiance of teacher authority, persistent arguing, or, in the words of one principal I know, their ability to go from ‘zero to 100 in a split second.’ Faced with challenging students, teachers often feel exhausted or incompetent.” 

The first step, says Rappaport, is a shift in mindset. “Teachers need to learn to see all behavior as a form of communication… Behavior happens for a reason, and by determining the intent or the function of the behavior, teachers can better decide how to intervene… Even though students’ behavior can look bizarre or disruptive, their actions are purposeful attempts to solve a problem.” The cause might be transitions, unstructured time, lunch, recess, being asked to write something, or social demands. These students need to learn replacement behaviors, learn self-calming strategies, and improve underdeveloped skills. 

Analyzing behavior and crafting effective interventions takes time and energy, says Rappaport – but so does getting a class back on track after one student has a meltdown. “For the teacher who thinks that it’s not his or her job to work with such a student, and that the student just needs to go somewhere else, keep in mind that inevitably the teacher will face another child with similar challenges.” 

Rappaport tells the story of a fourth grader who had lived in two foster homes and exploded three times a day. Working with the school counselor, the teacher realized that the meltdowns occurred after lunch and recess when the boy was required to write something. He had learned that acting out would get him what he wanted – lots of attention and not having to write. The teacher taught the boy to take a deep breath when he felt this way and to say “I’m frustrated” instead of screaming. The counselor worked on social skills and the teacher emphasized positive talk, provided a “comfort box” with Theraputty, a “power card” with a motivational character, a picture of his family, and other soothing items. The teacher also broke down writing tasks to help with the boy’s anxiety and previewed all writing assignments with pictures to help him get started. Within three weeks, the explosions had stopped, the boy was able to complete many tasks, and he was getting along better with his classmates. 

“Why ADHD Medication Is Not Reform: Understanding Behavior Is Critical” by Nancy Rappaport in Education Week, Feb. 27, 2013 (Vol. 32, #22, p. 23, 25), www.edweek.org

From the Marshall Memo #475