Our third Special Agents of Change webinar “The New Science of Learning: Effective Approaches for Older Students with Autism and Attention Disorders” with ASHA Fellow and neuroscientist Dr. Marty Burns concluded with an informative Q&A portion centered around the current research and tools available for building cognitive function in those individuals with attention disorders or autism.
To watch Dr. Burns’ entire 90-minute webinar, click here. Also, stay tuned for another Q&A installment coming to our blog soon, when Dr. Burns will answer more audience questions from the webinar.
Are we setting children up for failure by pushing them to take medications while they are young? Should we be teaching them strategies to cope with attention that will carry over into adulthood?
There is quite a bit of research on effectiveness of medication right now. We know from several studies done through the American Psychiatric Association and American Pediatric Association that medication by itself is not enough for ensuring attention. We also know from a study conducted six to seven years ago that medication is most effective for about 14 months because the brain then adapts. Additionally, earlier multi-setting trials conducted 10 to 15 years ago showed that medications are most effective when students also receive behavioral strategies.
There is a lot of cognitive technology out there now to help teach these behavioral or cognitive strategies. For example, AvMed has been very effective with ADHD and an independent research study out of the research labs in Oregon found that the intervention technology called Fast ForWard is also effective with attention. It is important that we deploy these cognitive interventions to help students develop coping strategies. That is what is going to carry them through in the long run.
Is there any current research on the effectiveness of lecture styles – those with visual presentation materials versus those without – for students with attention issues?
There is not much good research on presentation modes and their effectiveness to date. Educators have all sorts of devices that they can use in the classroom. Although this technology is becoming more popular, we do not have controlled research helping us understand how visuals help. The research right now is more on methodology, not on visuals.
In general, neural science research shows that teachers who use cognitive interventions are most effective. These methods include: how the teacher gets the child’s attention and keep the child’s attention, how the teacher reinforces students individually and how the teacher uses novelty. Sometimes, visuals can be novel, but it is it’s the combination with cognitive interventions that is most effective for students in terms of them changing their brain.
Does listening to music or physical activity during independent work help students regulate their behavior?
Again, we do not have much good, current research on the value of listening to music while working to regulate behavior. An old study on the Mozart effect found that older students who listened to Mozart saw some improvement on performance. Out of Northwestern, my colleague Nina Kraus conducted some outstanding research on the value of musical training for improving students’ cognitive skills. However, my general advice would be to not listen to music while working because it is probably more distracting than it is helpful. I do not recommend it, but again, we need some controlled research to really help us determine its effectiveness.
We are in the same situation regarding the effectiveness of physical activity. We need more research to show its value, how often it should occur, how frequently students should take breaks and more. We do know that physically fit students perform better on high-stakes academic testing and on achievement testing. We also know that physical activity increases something called “brain-derived neurotrophic factor,” which is the chemicals in the brain that drive the brain to change and promote neuroplasticity. Activity is important, but activity while learning has not been demonstrated to be more effective or less effective at this point in time.
What standardized tools or informal checklists have you found to be most useful for older students with suspected, but not yet diagnosed, Autism Spectrum Disorder (ASD)?
I would like to recommend two tools. Most of you in attendance probably know about the Autism-Spectrum Quotient (AQ). It is my favorite because it is a checklist. If you are not familiar with AQ, students read statements on the checklist and then choose if they agree or disagree with the statement based on the Likert Scale (“definitely agree” to “definitely disagree”). Some of these statements are:
- I prefer to do things with others rather than on my own.
- I prefer to do things the same way over and over again.
- If I try to imagine something, I find it very easy to create a picture in my mind.
Psychology-tools.com has an example of AQ here. AQ was developed by Simon Baron-Cohen almost 15 years ago and is used quite often with older individuals.
Baron-Cohen also developed the “Reading the Mind in the Eyes” test. Individuals taking the test examine a picture of someone’s eyes and have to choose one of four possible emotions the pictured person is feeling. Research from the Departments of Experimental Psychology and Psychiatry at the Autism Research Center in Cambridge shows it correlates with the AQ.
Are the intervention approaches you suggested applicable to telepractice?
I do a significant amount of telepractice with adolescents and adults. Currently, I work with four adolescents and young adults using telepractice and almost all of the methods that I have shared with you today work via telepractice. For example, keeping a planner helps students organize their homework and prioritize their time, as well as help them remember to complete tasks. A teacher working with students in person would quickly review students’ planners before leaving for the day. With telepractice, I have my students just scan and email me their planners so I can look at them.
Other techniques – like backwards goal setting, triggers and daily morning routines – require additional planning and family training when conducted via telepractice. I teach the families how to help guide their children through these techniques because I am unable to be there in person.
I actually love telepractice because I get to work with both the student and their families.
Are there any approaches that are more effective or different for treating girls with ASD or an attention deficit versus boys with the same needs?
Not that I know of. This is a really good question because girls do present slightly differently than boys, but evidence shows that intervention is most effective when each program is individualized for the student, regardless of their gender.
Someone else asked how to get students to make realistic goals. This is where individualization becomes important. If a student on the autism spectrum says his goal is to be a news reporter, I try to backtrack him a bit to decide on a more realistic goal because the original goal is probably too lofty for him based on his current skills. During interventions, I do not come into the meeting with a fixed idea of what goals the students should have or how that should translate into tactics. Instead, we work on that together and create a plan based on their needs and where they want to go in life.
Almost all students have the capacity for making some realistic goals with some guidance, even if it is something like “I want to be able to build computer games.” Many students will be capable of doing something like that or working for a technology company. That might be a very good, realistic goal for them with which to start.
One attendee noted that older students are often seeking independence and self-determination, so they may sometimes push back against some intervention strategies. What are your suggestions for getting high-functioning students to buy into the strategy being implemented?
This is tough because a big part of what the brain is doing during adolescence is pulling away from rules and structures and adult control and guidance. Because of that, we have to make the process very student-centered by using goals. It cannot be centered in our expectations of the student necessarily. Ultimately, we want our expectations of the student to be met, but we have to have the student see that they are an individual who can accomplish their goals.
Another strategy is finding what is important to the student and incorporating that into the goal. For example, maybe the student’s goal is to have more friends. A perfect first step is to go to the movies with a friend on Friday night. We then start talking about how the student can accomplish this short-term goal, including how to pick the friend, how to pick the movie, what to do if the friend wants to pick the movie and how to compromise. We always bring it back to what is important to them.
We all live such distracted lives these days. How do the strategies you suggest for maintaining attention translate to post school work life, if at all?
Actually I’m working with a couple of adults right now in work-related settings. I have one young man who has a history of drug abuse. He just finished a drug rehabilitation program and we are doing the same kind of attention and organizational activities that I do with high school students. We used backwards goal setting to set realistic goals for him. This includes discussion of how he is going to find a job, what kind of job search he is going to do, how he is going to strategize for interviews, how he is developing his resume and more. The only difference between working with adults and high school students is the content.
Is it true that watching too much television at an early age contributes to attention disorders?
There is some preliminary research from a few years ago suggesting that students who have increased screen time are at more risk for attention deficit disorder (ADD). However, this was not a controlled study, so we do not know if the students were diagnosed with ADD because they had more screen time or if they had more screen time because their ADD was emerging.
The American Pediatric Association (APA) provides information and recommendations for screen time. Go to their website www.aap.org and search for “managing media.” Here you will find commentary about excessive media exposure. This includes not only television exposure, but exposure to technology like smartphones and tablets. Excessive media exposure has been associated with obesity, lack of sleep, school problems, aggression and behavioral issues. APA cites some of this research on their website and also recommends that parents and teachers not only monitor the amount of time children spend with these media devices, but also content. There is good content on television, but there is also bad content.
Generally, APA recommends no more than two hours of screen/media time a day. I like to tell parents that the best way to use media is as a reward. TV or computer time should be a reward after homework is done or after meal time. APA also recommends that children should not have televisions or other technology in their bedrooms so students do not stay up at night.
One listener has a child who has a history of failing grades and thinks that no amount of effort will make an impact. How do you motivate children that seem not to care anymore?
This is actually more common than you might think. The vast majority of adolescents I work with have given up. They have repeatedly failed in school or received poor grades. Students know who teachers think are smart and not smart. They figure this out at a young age and they start to get discouraged very easily.
The neuroscience field has conducted extensive research on the effectiveness of rewards. One of the reasons rewards work for unmotivated children is they are rewarded for an effort that goes into doing work as opposed to only looking at the outcome of what they do. For example, students should be rewarded for handing in their paper on time, as opposed to getting a good grade on the paper. Incorporating these incentives, rather than punishments, is helpful for unmotivated students.
Another thing that can be very helpful, again, is technology programs, particularly programs created by neuroscientists as they are designed to reward the student. These games keep the student engaged and encouraged because they allow the student to be correct about 80 percent of the time, which makes them feel successful. I have had many students who used these programs who then suddenly have a boost in their self-confidence and in their belief that they can learn.
You showed some great tools for helping students become more organized, but how do I help very intelligent high school students with ASD and ADHD want to become more organized? Is that possible without intrinsic motivation?
Generally speaking, adolescents are not motivated to be organized. They are motivated to have friends, take risks, and otherwise do things we would rather they not do. I also know many adults who are not particularly motivated to be organized. What we have to do in both situations is provide them with organizational structure. I often say to parents and teachers, “You are your students’ frontal lobe. You are their organization.” If you are organized and if they have a structure, you can very slowly and incrementally incorporate organizational structure that is not overwhelming. Additionally, rewards are what the frontal lobe uses to build itself. It is a reward-centered system that overrides your limbic system. Therefore, incorporating rewards is important when trying to motivate unmotivated students.
Keeping a planner is a great start as it is a simple task that is easily monitored. If you reward the student for simply keeping a planner or something more difficult like keeping an accurate planner, the reward might be something like ordering a pizza or being able to watch an extra half-hour of TV over the weekend. Providing the organizational methods and then rewarding them for sticking to the structure is the key to success. Start small and do not expect them to have everything organized right away.
As the author of over 100 articles and multiple books, neuroscientist Martha S. Burns, Ph.D., is a leading expert on language, brain development and how children learn. She speaks frequently on the importance of applying the science of learning in early childhood education and the K-12 classroom. Dr. Burns is Adjunct Associate Professor at Northwestern University and a Fellow of the American Speech-Language-Hearing Association, and has served on the medical staff of Evanston-Northwestern Hospital for 35 years. She has consulted with school districts worldwide on ways to apply neuroscience to best practices in special education.