Beruflich Dokumente
Kultur Dokumente
ATTENTION INTERVENTIONS
Thank you for reading this manual on interventions and related resources for students
experiencing difficulties with maintaining attention in the classroom. We hope you will find this
to be a useful tool when exploring options to increase attention by students in your classroom.
This booklet has been divided into the following sections: classroom strategies for teachers,
mindfulness in education, websites for educator use, simple interventions, and suggested apps to
aid in the improvement of attention. References for each section are listed immediately
following the discussed information. If you have any additional questions, please contact:
ATTENTION INTERVENTIONS
Table of Contents
Part I: Classroom Strategies for Teachers
4-8
9-18
19-30
20
21-23
24-25
26-28
29-30
31-45
32-34
35-37
38-39
Intervention Coach Card: The Good Behavior Game (A Cooperative Approach) 40-42
Intervention Coach Card: Guided Note Taking
43-45
46-50
51-59
52
53
54
55
56-57
58-59
60-63
ATTENTION INTERVENTIONS
ATTENTION INTERVENTIONS
According to NASP, there are two primary approaches to attention behavior management
in the classroom: Environmental/instructional and contingency management.
Environmental strategies focus on providing opportunities for success for students with attention
issues, whereas contingency management is more focused on the reinforcement of desired
behaviors. Depending on the student, one or both of the approaches can be used to manage the
students attention deficits.
General Approaches to Behavior Intervention:
Attention issues and ADHD can be expressed in many different ways, and it is important
that the students set of problem behaviors is identified before implementing a specific
strategy.
o Attention issues can be expressed as Inattention, Hyperactivity, Impulsivity, or
combination.
Once the students specific set of problem behaviors is identified, alternative behaviors
that are appropriate should be acknowledged.
Interventions/strategies should not only teach a child more desirable behaviors, but also
provide them with methods of achieving the desired behavioral goals.
Directions should be given to students in a clear manner, broken down into steps. A
visual aid may also be helpful.
Praise for good behavior and work performance should be frequent and consistent.
ATTENTION INTERVENTIONS
Environmental/Instructional Strategies
1. Task Duration: Teachers can shorten the amount of time a student works on an assignment,
as well as provide performance feedback on the task. Longer projects can be broken down
into smaller steps, with breaks in-between each part. During long periods of class work,
students with attention difficulties should be given a break.
2. Task Difficulty: Students with attention deficits may become easily bored or frustrated. The
task at hand should match the students skill level; this helps them to avoid frustration, but
also keeps them engaged and prevents boredom.
3. Direct Instruction: Students are more likely to participate in teacher-directed activities, as
opposed to independent work. Explicit instruction on attention and how to take notes may be
beneficial. These skills should be practiced regularly.
4. Class-Wide Peer Tutoring/Peer Tutoring: Peer tutoring has been found to increase on-task
behavior for all students. Students with ADHD who have participated in class-wide peer
tutoring have been found to show increased academic performance and improved on-task
behavior. Feedback in any peer tutoring process should be explicitly taught and delivered
immediately.
5. Scheduling: Teachers should schedule the more difficult subjects in the morning. More
active, less academically-inclined activities should be scheduled for the afternoon.
6. Novelty: Novelty helps to keep students with attention issues engaged. Teachers can use
tricks such as bolding of text, using bright paper, or changing their tone of voice to keep
childrens attention focused.
7. Choice: Giving students a choice of activities can help them to feel empowered, as well as
increase on-task behaviors, while decreasing any disruptive behaviors.
ATTENTION INTERVENTIONS
8. Distractions/Classroom Setup: Placing the student near the teacher, and away from high
traffic areas such as windows or doors, can help to increase attention and focus by reducing
the number of distractions they face.
Contingency Management Strategies:
1. External Reinforcement: Rewards for appropriate behavior should be attainable for
students with attention deficits. Therefore, when students with attention difficulties display
appropriate behavior, their rewards should be delivered frequently and shortly after the
desired behavior is displayedimmediately, if possible.
a. Both negative and positive reinforcements should be used. For example, if a student
does not stop a particular behavior even after redirection, a reward can be taken away.
b. Reward-to-punishment ratio should be 2:1, so that the reinforcement remains
reinforcing, not punitive.
2. Self-Monitoring: Self-monitoring of behavior has been demonstrated to be effective for
students with attention issues and ADHD. It has also been found to increase on-task
behavior. Students should be directly taught how to monitor their behavior, and given a userfriendly method of tracking and recording their own behavior.
a. When students have become accustomed to self-monitoring, external reinforcements
from the teacher should be reduced, so that the self-monitoring becomes intrinsic.
b. A timer can be used to cue the student when to record behavior.
3. Token Economy Systems: Token economies can be effective for improving academic and
behavioral performance in students with ADHD and attention difficulties. A token economy
system helps to keep the child engaged, provides opportunities for immediate feedback, and
provides a reward that the student is willing to work towards.
ATTENTION INTERVENTIONS
References
Barkley, R.A. (2008, n.d.). Classroom accommodations for children with ADHD. Retrieved
April 24th, 2014, from
http://www.russellbarkley.org/factsheets/ADHD_School_Accommodations.pdf
Brock, S., Grove, B., & Searls, S. (2010, n.d.). ADHD: Classroom interventions. Retrieved
April 14, 2015, from http://www.nasponline.org/resources/handouts/05-1_S805_ADHD_Classroom_Interventions.pdf
Interventions for ADHD: Elementary School. (n.d.). Retrieved April 16, 2015, from
http://addinschool.com/interventions-adhd-elementary-school/
Additional Resources:
NASP: ADHD: Classroom Interventions:
www.nasponline.org/resources/handouts/05-1_S8-05_ADHD_Classroom_Interventions.pdf
This PDF is available for free download. It also provides further references in the form
of print, video, and online.
US Department of Education: Identifying and Treating ADHD: A resource for school and home:
http://www2.ed.gov/rschstat/research/pubs/adhd/adhd-identifying-2008.pdf
This PDF is available for free download. This resource provides extensive information
for families and mental health professionals.
ATTENTION INTERVENTIONS
ATTENTION INTERVENTIONS
10
Mindfulness in Education
Introduction
Mindfulness has recently become a cultural trend, frequently being included in popular books,
websites, and magazines. Mindfulness training is a type of intervention based on eastern meditation
techniques, which aids in increasing awareness of the present moment, enhancing non-judgmental
observation, and reducing automatic responding. With its increase in popularity, the application of
mindfulness-based interventions for youth have been
growing exponentially within clinical and educational
settings. Components of these types of interventions
emphasize benefits in the reduction of a wide range of
psychopathology including internalizing and externalizing
disorders. Mindfulness also serves to enhance functioning
and skills involved in attentional focus and concentration,
emotion regulation, social and academic performance,
adaptive coping, frustration tolerance, self-control, and self-esteem.
Mindfulness Definitions
Due to its many variations, there is no singular definition for mindfulness; however the most
frequently cited definition is that of Jon Kabat-Zinn, the father of the mindfulness integration movement
within psychotherapy. He defines mindfulness as paying attention in a particular way: on purpose, in the
present moment, and non-judgmentally. This core definition is utilized within a variety of mindfulnessbased therapies including mindfulness-based stress reduction (MBSR), mindfulness-based cognitive
therapy for children (MBCT-C), and acceptance and commitment therapy (ACT). On the other hand,
mindfulness within dialectical behavior therapy for adolescents (DBT-A) is defined as the intentional
process of observing, describing, and participating in reality nonjudgmentally, in the moment, and with
effectiveness.
ATTENTION INTERVENTIONS
11
There are three primary elements that define mindfulness: attitude, attention, and intention. A
mindful attitude is defined as one that is nonjudgmental, accepting, trusting, curious, and patient while
attention is directing focus, sustaining attention, and being able to switch attention between stimuli.
Therefore, mindful intention emphasizes the conscious effort to be mindful in attitude and attention.
Mindfulness is also described as a construct that has both state and trait qualities. Trait qualities refer to
qualities that are relatively stable across time; an example might by eye color. Whereas state qualities
refer to differences that can be induced through practice or training that do not remain over time; an
example might by colored contact lenses used to alter eye color. Some individuals may naturally possess
a mindful attitude due to having high
trait mindfulness, whereas others may
need to consistently practice
mindfulness in order to benefit from its
effects.
Mindfulness and Attention
Mindfulness, by its nature,
involves the practice of working with
ones attention and awareness.
Research suggests that mindfulness may be associated with the three primary attention networks: alerting
attention, orienting attention, and executing attention. Alerting attention is characterized by a steady
uninterrupted attention to ones experience; sustained, orienting attention is the ability to effectively scan
and select situational appropriate information; and executing attention pertains to a conscious examination
of ones reactions and responses to environmental events.
Mindfulness practice involves concentrated attention but is explicitly described by an open
monitoring of attention. With mindfulness, there is an initial focus on breath that builds concentrated
attention toward a steady monitoring of whatever arises from sensory, mental, or emotional states.
Studies of attentional changes with mindfulness training support that the technique can quickly lead to
ATTENTION INTERVENTIONS
12
changes in conflict attention. Conflict attention is a type of attention important in self-regulation. It
involves the inhibition of conflictual automatic responses to focus on less automatic stimuli, as
measured by tasks such as the Stroop test or the Attentional Network Task (ANT). The ANT task is a
computerized measure of attention that detects alerting, orienting, and conflict attention and has been used
in studies of both Attention Deficit Hyperactivity Disorder (ADHD) and mindfulness. This research
suggests a deficit in conflict attention in those with ADHD and an increase in conflict attention with
mindfulness training.
The literature suggests that on a dimensional continuum, ordinary attention lies somewhere
between mindlessness and mindful attention. At one extreme, mindlessness may be broadly characterized
by inconsistent awareness, unstable focus, distractibility, emotional reactivity, and attention to past or
future experiences. Absent-mindedness, the concept of looking without actually seeing what one is
looking at, is one example of mindlessness. At the other extreme, mindful attention is present-focused,
voluntarily directed, stable, and utilizes optimal arousal necessary for each situation. Therefore, mindful
attention means seeing with clarity, stability, minimal distraction, and little emotional reactivity. Some
qualities of mindful attention may include:
Decentered focus on present-moment events. Memories and anticipatory thoughts are identified
as events in the mind, the contents of which relate to past or future events.
ATTENTION INTERVENTIONS
13
ATTENTION INTERVENTIONS
14
that the practice of mindfulness may potentially lead to a shift in ones relationship with the external
environment, from where one can clearly observe, recognize, and disengage from habitual patterns or
mind states, and begin to respond more reflectively, rather than reactively.
Mindfulness for Parents
Mindfulness training may be beneficial for parents due to the fact that parents of children with
ADHD may show less consistent parenting, and inconsistent parenting increases the susceptibility to
ADHD in children who are genetically predisposed to the disorder. That is, parents of children with
ADHD are more likely to experience stress, which may lead to becoming less patient, paying more
attention to disruptive behaviors, and
responding more reactively. These
parents may also have similar problems as
their child, as research has shown ADHD
to be highly heritable. Parents of children
with ADHD tend to respond in an
automatic way to their childs
misbehavior. Also, parenting stress has
been shown to be elevated in parents of
children with ADHD and under stress, parents may become more rejecting and controlling with their
child. Overall, parents ADHD behavior, their own upbringing and judgments, and parenting stress all
contribute to parenting problems, which in turn influences the ADHD behavior of the child. Therefore, a
treatment focusing on both the child and the parent is likely to be more successful in decreasing
inattentive behaviors. In addition, generalization of the learned skills outside the treatment setting may be
enhanced by including parents.
In Mindful Parenting (MP) training, parents learn to pay attention to their children and their
parenting in a non-judgmental way, to increase their awareness of the present moment with their child,
and to reduce automatic negative reactions to their child. Also, by participating in daily meditation
ATTENTION INTERVENTIONS
15
practice, parents learn to take care of themselves and bring calm into their family. Most behavioral parent
training programs also include some form of parent-teacher communication, an integrated reward system
for home and school, and sometimes a teacher-training module. The research on MP for families of
children and/or adolescents with behavior disorders has found strong improvement on externalizing
problems and sustained attention. Research has also shown that maintenance of mindfulness training with
children and parents increases the beneficial effects of the treatment. Supporting families with ADHD to
continue and deepen mindfulness practice appears to be good clinical practice, as children will be
confronted with new and different challenges throughout development for which mindfulness practice
may be helpful.
The Breath: Instruct students to either sit in a chair or lie on the floor in a comfortable position
and say, Start by taking your mind inwards for a moment by focusing on your breath. Take a few
gentle deep breaths, from your belly. In and Out. Relax and let go. Continue to breathe slowly. Now
take your mind outwards. See your thoughts, feelings, moods, and sensations as objects floating
down a stream, coming into view and vanishing from sight. Simply watch without judgment or
analysis. Just watch them pass. Now pluck an object from the stream and focus on it. Let the other
sensations and thoughts go by in the background. Note any new thoughts or feelings that arise from
observing this object. Sit with these thoughts and feelings for a moment. Whenever youre ready to
leave this object behind, simply deposit it on a leaf and let it float downstream. Have students
continue for about 5 minutes until bringing them back to breath concentration.
Body Scan: Instruct students to sit or lie down in a comfortable position, making sure that they
do not have any constriction. Say, Starting with your feet, pay attention to the physical feelings in
them: any pain, discomfort, coolness, warmth, tension, tightness, whatever. Simply pay attention to
ATTENTION INTERVENTIONS
16
the physical feelings and sensations. Dont judge them as good or bad, dont try to change them, just
be aware of them. Slowly allow your awareness to drift up from your feet to your lower legs, again
simply paying attention to any physical sensations in that part of your body, including any tightness,
pain or discomfort. Then slowly let your awareness drift further up your body, doing the same gentle
noticing for all of the parts of your body your upper legs, hips, buttocks, pelvic region, stomach,
chest, your lower back, upper back, fingers and hands, lower arms, upper arms, shoulders, neck, your
head, forehead, temples, face eyes, cheeks, nose, mouth, jaw line. Then let your awareness drift
gently and slowly back down your body, noticing any other places where there is pain, discomfort or
tension and simply noticing this, until your awareness settles back at your feet. Have students
engage in the activity for about 5 minutes.
Tuning In: This is a good exercise to get participants to relax and focus at the beginning or end
of a classroom lesson. Ask the participants to get comfortable sitting on a chair or the floor. Have
them close their eyes and imagine their sense of hearing is a radio that can tune in to different
stations. First, ask them to listen to the sounds farthest away for a moment. Then, change the station
and listen to the sounds in the room. Change the station again and listen to the sounds of their body
their breathing, their heartbeat, etc. Bring their attention to each part of their body, starting with the
tips of their toes and up through their legs, hips, back, arms, shoulders, neck, and head. Change the
station again and ask them to listen to only their breathing. Then, listen to the sounds in the room.
Finally, listen to the sounds furthest away. When they are ready, ask them to open their eyes. Have
students engage in the activity for 5 to 10 minutes.
Awareness Exercises
Simply Watching: This is a particularly useful activity for inattentive students whose minds tend
to be very busy and who find it difficult to focus. Instruct students to sit in a chair or lie on the
floor in a comfortable position and close their eyes. Tell them to concentrate on their breathing
and then to begin letting their thoughts flow through their minds. Say, Watch the passing
ATTENTION INTERVENTIONS
17
thoughts without judging them as good or bad. Notice, pay attention to, and accept these
thoughts. Just watch them come and leave your mind like the clouds passing by or leaves floating
on a stream, noticing each passing thought and then the one that comes after it, and then the one
that comes after that. Identify and whisper each mood, thought, feeling, and sensation that comes
up. You may notice that just at the moment you become aware of a thought, it passes and is
replaced by another thought. That is what happens thoughts come and they go. Bring
students back to concentrating on their breath and tell them to open their eyes. Have students
engage in this activity for about 5 minutes.
Four Senses: This activity builds awareness by helping students to notice what they are
experiencing at the present moment through four senses sound, sight, touch, and smell. Instruct
students to begin by closing their eyes and concentrating on their breath, and then begin to ask
themselves:
-
Tell students to think of these answers to themselves slowly, one sense at a time. Give them
about 5 minutes and then instruct them to bring their concentration back to their breath.
Mindful Games for Children:
Jenga
Operation
Perfection
Simon Says
ATTENTION INTERVENTIONS
18
References
Felver, J. C., Tipsord, J. M., Morris, M. J., Racer, K. H., & Dishion, T. J. (2014). The effects of
mindfulness-based intervention on childrens attention regulation. Journal of Attention Disorders,
1-10. DOI: 10.1177/108705471458032.
Semple, R. J. (2010). Does mindfulness meditation enhance attention? A randomized controlled trial.
Mindfulness, 1, 121-130. DOI: 10.1007/s12671-010-0017-2
Singh, S. & Singh, S. (2014). Effect of mindfulness therapy on attention deficit among adolescents with
symptoms of attention deficit disorder. Indian Journal of Health and Wellbeing, 5(10), 11651172.
Smalley, S. L., Loo, S. K., Hale, T. S., Shrestha, A., & McGough, J. (2009). Mindfulness and attention
deficit hyperactivity disorder. Journal of Clinical Psychology, 65(10), 1087-1098. DOI:
10.1002/jclp.20618
The Mindful Word. (2012). MBSR: Mindfulness-based stress reduction exercises. Retrieved on April 28,
2015 from http://www.themindfulword.org
Van der Oord, S., Bogels, S. M., & Peijnenburg, D. (2012). The effectiveness of mindfulness training for
children with ADHD and mindful parenting for their parents. Journal of Child and Family
Studies, 21(1), 139-147. DOI: 10.1007/s10826-011-9457-0
Van de Weijer-Bergsma, E., Formsma, A. R., de Bruin, E., & Bogels, S. M. (2012). The effectiveness of
mindfulness training on behavioral problems and attentional functioning in adolescents with
ADHD. Journal of Child and Family Studies, 21, 775-787. DOI:
Zack, S., Saekow, J., Kelly, M., & Radke, S. (2014). Mindfulness based interventions for youth. Journal
of Rational-Emotive and Cognitive Behavioral Therapy, 32, 44-56. DOI: 10.1007/s10942-0140179-2
ATTENTION INTERVENTIONS
19
ATTENTION INTERVENTIONS
20
There are several different categories for ADHD interventions including: setting up the
classroom, presenting lessons, worksheets and tests, improving time on task, improving
social skills, increasing performance, and increasing compliance. Under each category
there are resources and strategies available pertinent to the title name.
The secondary level categories are identical to the categories found on the elementary
page, but with resources and strategies more developmentally appropriate for middle and
high school aged children. There is also a category dedicated to decreasing impulsive
behaviors.
Limitations: It was noted that on some computers, some of the links might not work. Also, it is
unclear if all of the strategies on the website are evidence-based. Furthermore, the website is
more geared towards strategies than actual interventions. If an educator is seeking out a more
intensive intervention, they would have to utilize another resource.
ATTENTION INTERVENTIONS
21
Within this section are categories that further explore what ADHD is (what it looks like
in boys versus girls), what it is not (facts versus myths), possible causes, symptoms (what
symptoms look like in childhood, the teen years, and in adulthood), and how ADHD is
diagnosed. Information provided is in an organized format and includes videos and
diagrams. This section also offers tips for caregivers of girls with ADHD (since girls
with ADHD are more likely than boys to report mostly inattentive symptoms), and
includes links to other websites in order to find additional information and support.
This section includes overall strategies for parents and caregivers of teenagers with
ADHD, and offers information regarding how the disorder is managed and how to stay
on track with a childs management plan.
ATTENTION INTERVENTIONS
22
Offers information on how to support students with ADHD at home, outlines available
school support teams, and lists step-by-step directions on how to get additional support
for your child in school.
Offers tips for parents and caregivers in the form of videos and resource guides, and
provides links to helpful websites and includes a glossary of important terms.
Outlines school support team roles and responsibilities, explains how to build
partnerships with parents and caregivers, provides tips for communicating with parents,
and highlights important topics school personnel may want to discuss with parents.
Provides strategies to be used in the classroom to help students with ADHD, as well as
helpful homework tips.
Offers tips for helping students transition from the classroom environment to less
structured school locations such as the playground, cafeteria, or hallway.
Provides educational videos and brochures with information on ADHD and offers tips
that may help with hyperactive, impulsive, and inattentive symptoms. This section
includes helpful resources for students such as essay organization tips, weekday planner
and class schedule templates, homework hints and logs, a project planner, note-taking
templates, and graphic organizers.
ATTENTION INTERVENTIONS
23
Also available are elementary, middle school, and high school daily/weekly report cards
for teachers to use to document student goals and track progress. This section also
provides a weekly contract to be used between a student and parent where measurable
and observable goals and home-based rewards are documented and agreed upon.
Strengths:
The website is accommodating to the Spanish speaking population, as the entire site can
be viewed in Spanish.
The website is visually pleasing, organized, and concise which allows parents, caregivers,
and school personnel to easily navigate the site and locate specific information pertaining
to ADHD. The website provides educational videos, brochures, charts, and diagrams that
enhance the learning experience of those researching online.
Limitations: Although there is an abundance of strategies and tools available for helping
students with ADHD, the website does not provide specific examples of evidence-based
interventions for school professionals to implement within the schools.
ATTENTION INTERVENTIONS
24
The LDA Resources section carries a variety of links and literature that are beneficial to
school psychologists and teachers alike. The LDA published Learning Disabilities: A
Multidisciplinary Journal, which is geared toward professionals in the mental health
field. Also accessible are resources specifically aimed at teaching and learning, and
literature available for download to handout. There are resources exclusively aimed at
ADHD, including resources that are appropriate for teachers to utilize in their classroom,
ATTENTION INTERVENTIONS
25
as well as several websites that may be useful to find more information on ADHD and
how it is related to learning disabilities.
Also under the Resources tab are links to numerous professional organizations, such as
the National Association of School Psychologists (NASP) and National Association of
Special Education Teachers (NASET), where educators can go to obtain more
information.
The Guides and Booklets section offers informational literaturemany of which are free
and available for download.
Under the Government Agencies and Resources tab, there is a listing of resources which
are accessible to parents, educators, and professionals.
Support
The support tab offers general information on various learning disabilities, including
ADHD. It also has access to state and local affiliates of the LDA, which includes, but is
not limited to, support meetings, collaborations with educators, conferences, and
advocacy assistance.
Ask the Expert is akin to a Frequent Asked Questions (FAQ) section. Website users can
click the Ask the Expert button and send in a question. Even though that exact
question may not be answered, a question similar to it may be posted. The qualifications
of the expert who answers the questions are listed after the answer.
Limitations: Even though LDA America online is a great resource on learning disabilities, it is
not specifically focused on ADHD and/or attention. Consequently, educators who are looking
for more detailed information on attention interventions may not find what they are looking for.
ATTENTION INTERVENTIONS
26
An Overview of ADHD- Offers insight into ADHD including causes, treatments, signs
and symptoms, as well as the strengths associated with these difficulties to help parents
understand their childs unique learning patterns.
Evaluating Your Child- Identifies all the components involved in a complete and
thorough assessment of ADHD including a sensory evaluation, psycho-educational
evaluation and an auditory processing evaluation. Includes information such as what to
do after the evaluation and how to process what was learned.
Tech Tools- Helps parents to evaluate the latest and best technologies designed to make
learning easier in the classroom and at home.
ATTENTION INTERVENTIONS
27
Terms and Definitions- Includes a glossary of commonly used words and phrases that
might be unfamiliar to those new to LD and ADHD.
Getting Help
This section of the website focuses on the social and emotional issues that children with LD or
ADHD may encompass. This section identifies how these issues can impact families, and
provides the knowledge and skills to help manage them in school, on the playground, and at
home.
ADHD- Provides and in-depth guide to treatments and interventions for managing
ADHD.
Making Friends- Provides expert advice and practical strategies to help a child overcome
the social challenges that often accompany LD or ADHD.
Emotions and Behaviors- Brings together the latest information to help deal with the
anxiety, stress, and behavior issues that often accompany LD or ADHD.
Know Your Childs Rights- Arms parents with information to navigate the educational
system and become the advocate their child deserves.
The ABCs of IEPs- Is a guide to effective educational planning, with an emphasis on how
you can become a key member of your childs education team.
Community
Parent to Parent- Offers wisdom, insights, and practical advice from experienced
parents.
ATTENTION INTERVENTIONS
28
Through My Eyes- Includes a series of first-person accounts detailing the trials and
tribulations of living with learning differences-experiences a child with LD or ADHD
face every day- and the triumphs in succeeding in spite of those challenges.
Success Profiles- Includes stories of people in business, sciences, sports and arts who
have overcome significant learning challenges to excel in their field.
Ask the Experts- Allows people to pose a question to a member of the panel of experts
whose response will be published on the website.
Strengths:
There a section to sign up for the free e-newsletter and it is possible to make a donation to
Smart Kids with Learning Disabilities right on the website.
Limitations: This website is geared toward parents and how they can be advocates for their
children, but does not include a section designated for school personnel.
ATTENTION INTERVENTIONS
29
ATTENTION INTERVENTIONS
30
Types of Issues
At a Glance: Therapies That Can Help Kids With Learning and Attention Issues
Top 9 Things Not to Say to Your Child About Learning and Attention Issues
Limitations: There was not a section designed specifically for educators and/or other school
personnel, however much of the information would be helpful for these professionals in addition
to parents and other caregivers.
ATTENTION INTERVENTIONS
31
ATTENTION INTERVENTIONS
32
A script of prompts
Selection of rewards
Explain the importance of positive verbal feedback and provide students with a list of
standard statements that are positively reinforcing. Teach tutors to give praise after every
third or fourth correct response and after particularly difficult problems.
Teach tutors how to respond when an incorrect answer is given. When an incorrect
answer is given, the tutor should promptly give and explain the correct answer without
being critical, and then give the tutee an opportunity to repeat the correct answer.
Model these behaviors for the tutors-in-training. Give correct and incorrect examples of
how to provide positive and corrective feedback.
ATTENTION INTERVENTIONS
33
Step 2: Put students together in pairs. Pair student who are close in skill level.
Step 3: Provide each student with a script of prompts, an answer sheet, and activity materials.
Step 4: Have students work together on the activity provided. One student acts as the tutor while
the other student acts as the tutee. The tutor provides the math problem, spelling word, or other
content-based question.
Step 5: The student acting as the tutee answers the questions both orally and in written format.
Step 6: The tutor monitors and assesses the correctness of the responses and provides positive,
reinforcing feedback when appropriate.
Step 7: As soon as the tutee responds incorrectly, the tutor provides immediate feedback with the
correct answer and the tutee repeats the correct answer three times orally.
Step 8: The tutee is rewarded points on the basis of the correctness of their answers. Tutors
should record these points in the log provided.
1 point for every assisted answer which the student practices three times orally
Step 9: After 10-15 minutes, the students switch roles and repeat the activity.
Step 10: Tally the final points for each individual and pair of students.
Use individual scores and/or pair scores to determine whether a goal has been reached.
If a competition is established, use pair scores to determine which group is the winning
team for that day.
Variations/Modifications:
Game format and group format with competition among teams encourages participation
and motivates, as well as provides more opportunities to respond.
ATTENTION INTERVENTIONS
34
Built-in reinforcement:
o The tutor provides verbal reinforcement and the teacher can acknowledge positive
tutoring behaviors with bonus points and praise.
o Winning teams receive extrinsic motivation.
o Additional motivators such as classroom goals or team goals can help students to
feel good about themselves and their learning.
Progress Monitoring:
Baseline: Administer at least three (3) iterations of the selected progress monitoring
measure prior to implementing the intervention.
Intervention: Continue administering the selected measure at least weekly. Data should
be recorded and analyzed to evaluate progress.
Citations:
Brown-Chidsey, R., Bronaugh, L., & McGraw, K. (2009). RTI in the classroom: Guidelines and
recipes for success. New York: The Guilford Press.
Elementary & Middle Schools Technical Assistance Center (EMSTAC). (2015). Programs and
strategies for positive behavior: Peer tutoring. Retrieved April 20, 2015, from
emstac.org.
DuPaul, G. J., Ervin, R. A., Hook, C. L., & McGoey, K. E. (1998). Peer tutoring for children
with attention deficit hyperactivity disorder: Effects on classroom behavior and academic
performance. Journal of Applied Behavior Analysis, 31, 579-592.
ATTENTION INTERVENTIONS
35
Contract
Computer
Printer
Select Rewards
Frequency: Daily for 6 weeks; Continuous monitoring of the contract to ensure it is being
followed correctly.
Directions:
Step 1: The students problem behavior should be identified and operationally defined.
Step 2: The teacher meets with the student, parents, and other school professionals as
appropriate.
Step 3: A contract is developed including the following sections, using language the student can
understand:
ATTENTION INTERVENTIONS
36
The minimum conditions in which a child can earn their reward (i.e.: a sticker is earned
whenever student raises their hand)
The conditions in which the student will earn the reward (i.e. 5 stickers for 5 minutes of
extra recess)
Contracts can have both short and long term goals for students.
Progress Monitoring:
As stated within the contract, the teacher and the student decide on dates when the
contract will be reviewed. When the contract is reviewed, the students behavior can be
compared to their behavior at the previous review date, monitoring the students progress.
In the meantime, behavior is monitored using whatever reward system the teacher and/or
child choose.
Baseline: Administer at least three (3) iterations of the selected progress monitoring
measure prior to implementing the intervention.
Intervention: Continue administering the selected measure once weekly. Data should be
recorded and analyzed to evaluate progress.
ATTENTION INTERVENTIONS
37
Citations:
Behavior Contracts. (n.d.). Retrieved April 16, 2015, from
http://www.interventioncentral.org/behavioral-interventions/challengingstudents/behavior-contracts
Smith, K. (n.d.). Contingency contracting: A proactive intervention for the classroom. Retrieved
April 10, 2015, from
http://www.cehd.umn.edu/ceed/publications/tipsheets/preschoolbehavior/contcon. pdf
ATTENTION INTERVENTIONS
38
Computer
Printer
After the DBRC has been implemented for some time, the teacher can have the student
rate their own behavior, if possible.
ATTENTION INTERVENTIONS
39
Progress Monitoring:
The data collected from the DBRC can be reviewed on a weekly basis so as to monitor
the students progress. Educators can customize the progress monitoring measure
utilizing the DBRC.
Baseline: Administer at least three (3) iterations of the selected progress monitoring
measure prior to implementing the intervention.
Intervention: Continue administering the selected measure once weekly. Data should be
recorded and analyzed to evaluate progress.
Citations:
Aldrich, S. (n.d.). Daily behavior report cards (DBRC). Retrieved April 16, 2015, from
http://www.jimwrightonline.com/mixed_files/ELL/Daily_Behavior_Report_Card _Full_
Set.pdf
Schaefer, Kristina, "Using Daily Behavior Report Cards as Intervention for Primary School
Students with ADHD" (2010). Senior Honors Theses. Paper 216.
Wright, J. (n.d.). Classroom behavior report card resource book. Retrieved April 12, 2015,
from http://www.jimwrightonline.com/pdfdocs/tbrc/tbrcmanual.pdf
Additional Resources:
DBRC Resource Guide:
http://www.jimwrightonline.com/mixed_files/ELL/Daily_Behavior_Report_Card_Full_Set.pdf
PBIS World:
http://www.pbisworld.com/tier-2/daily-behavior-form/
Intervention Central DBRC Maker:
http://www.interventioncentral.org/teacher-resources/behavior-rating-scales-report-card-maker
ATTENTION INTERVENTIONS
40
On the board create two categories; one category has a smiley face (J) at the top and one
category has an unhappy face (L) at the top (can be referred to as Mr. Happy and Mr.
Sad). They should be named in a way that communicates the emotion and make sense
within the specific classroom culture.
ATTENTION INTERVENTIONS
41
Directions:
1. Let your students know about the new game that will help the classroom run more
smoothly and also give them information about how it will work. Make sure to cover
what the rewards will be, such as extra recess, extra computer time, choice of a game, a
15-minute video or a special class project (drawing), or extra read-aloud story time.
2. Be specific about when the game is being played and when it will be over.
3. Explain that if you see a student doing a good job of following one or more of your
classroom rules (hands being raised, eyes on you, etc.) then you will put a tally mark
under the J column. However, if a student is breaking one of the classroom rules, you
will make a tally mark under the L column.
4. At the end of the designated game time, add up each column. If J has the most points,
then the students have earned their reward. If L has the most points, then explain that
they didnt make it today, but they can try again tomorrow.
Progress Monitoring:
Progress monitoring measures will vary according to the types of problem behaviors
being targeted.
o For inattentive behaviors, an off-task behavior observation form may be
appropriate.
Baseline: Monitor and record students classroom behavior for one week prior to
implementing the intervention.
Intervention: Continue administering the intervention weekly and make note of progress
being made in regards to students following the posted classroom rules. Data should be
recorded and analyzed to evaluate progress.
ATTENTION INTERVENTIONS
42
Citation:
Brown-Chidsey, R., Bronaugh, L., & McGraw, K. (2009). RTI in the classroom: Guidelines and
recipes for success. New York: The Guilford Press.
ATTENTION INTERVENTIONS
43
Presentation/overheads
Training activity
Pencils/pens
ATTENTION INTERVENTIONS
44
Step 4: Hold a practice session with feedback so that the student(s) may experience the correct
way of using the guided notes during a lecture.
Step 5: Teach the planned lesson utilizing the presentation/overheads that go along with the
students guided notes. Include prompts and/or questions while teaching the lesson if it seems
necessary or it will aid in student learning.
Step 6: Review the students notes in order to provide positive reinforcement. This can be done
by collecting, grading, and returning the notes to the student or, more preferably, by checking the
notes in front of the student so that you can provide positive praise and specific feedback.
Variations/Modifications:
Combine guided note taking with unison responding, a lottery incentive, or response
cards.
Progress Monitoring:
ATTENTION INTERVENTIONS
45
Baseline: Administer at least three (3) iterations of the selected progress monitoring
measure prior to implementing the intervention.
Intervention: Continue administering the selected measure at least weekly. Data should
be recorded and analyzed to evaluate progress.
Citations:
Burns, M. K., Riley-Tillman, T. C., & VanDerHeyden, A. M. (2012). RTI applications:
Academic and behavioral interventions (Vol. 1). New York: The Guilford Press.
Intervention Central. (2015). Guided notes: Increasing student engagement during lecture and
assigned readings. Retrieved April 20, 2015, from http://www.interventioncentral.org
ATTENTION INTERVENTIONS
46
ATTENTION INTERVENTIONS
47
ATTENTION INTERVENTIONS
48
Evernote (Free-iTunes)
Problem: Difficulty keeping track of paper clutter/ Poor organizational skills.
How to Use: Allows you to store text, photos, and audio notes on your device of choice. User
can create "notebooks" and categorize notes for recipes, an upcoming vacation, product research,
to-do lists, and so on. Notes are tagged with geo-location for mapping or search.
Benefits: Information is in one location, organized, and available through a simple search.
ATTENTION INTERVENTIONS
49
Audiobooks (Free-iTunes)
Problem: Lacking motivation to read/ Difficulty reading.
How to Use: Offer a unique way to synthesize written information, allowing kids who struggle to
maintain attention while reading a viable alternative. Audiobooks can be a great way to get a
child interested in reading, and can serve as a supplemental tool for kids to use while reading
along with a written text.
Benefits: Offers a wide variety of free content to browse and download, along with premium
books, which can be purchased through the app.
30/30 (Free-iTunes)
Problem: Difficulty completing tasks/staying on task.
How to Use: All you do is set up a list of tasks, and a length of time for each of them. When you
start the timer, it will tell you when to move on to the next task or when to take a break. The task
list is controlled entirely with gestures. The display is minimal but attractive and it still shows
you everything you need to know such as, 1. What am I supposed to be doing right now? 2.
How much time do I have left to do it?
Benefits: Users can gauge their overall productivity when the timer goes off, allowing a child to
make the appropriate adjustments in order to complete their assignment.
ATTENTION INTERVENTIONS
50
References
Attitudemag.com (2015). Strategies and Support for ADHD & LD. To-Do List Apps for ADHD
Kids and Adults. Retrieved from http://www.additudemag.com/adhd/article/8698.html
Falcetta, E. (2015). National Center for Learning Disabilities. Routines Reflections and
Rewards-Using apps for Kids with LD and ADHD. Retrieved from
http://www.ncld.org/blog/routines-reflections-and-rewards-using-apps-for-kids-with-ldand-adhd/
ATTENTION INTERVENTIONS
51
ATTENTION INTERVENTIONS
52
Appendix A
Daily Progress Log for Class-Wide Peer Tutoring
Name of Tutee: ___________________________
Date: ___________
Grade: ___________
Directions: The tutee is rewarded points based on whether or not they provide the correct answer. Tutors
should record these points in the log below. Reward the tutee with 2 points for every correct answer
provided on their own. Reward the tutee with 1 point for every assisted answer (wrong answer that is
corrected by tutor and practiced by tutee). Circle the number of points rewarded for each item. Write the
total points at the bottom.
Problem Number
Points Rewarded
Comments
Problem 1.
Circle:
Problem 2.
Circle:
Problem 3.
Circle:
Problem 4.
Circle:
Problem 5.
Circle:
Problem 6.
Circle:
Problem 7.
Circle:
Problem 8.
Circle:
Problem 9.
Circle:
ATTENTION INTERVENTIONS
53
Appendix B
Sample Off-Task Behavior Observation Form
Observation
Time
Date:
Challenging Behavior - Off task
behavior
From:
To:
From:
To:
From:
To:
From:
To:
From:
To:
Off-Task Behavior a. Off-Task Motor (OTM) - Instead of working on assigned task, the student is out of seat, constant and
noticeable fidgeting, playing with objects (e.g. pencil, toys, etc.) and/or other children, making
inappropriate gestures, acting silly, hitting, biting, or throwing things, fighting with others, etc.
b. Off-task verbal (OTV) - Instead of working on assigned task, the student is calling out, talking to
someone when prohibited, making noises, etc. and
c. Off-task passive (OTP) - Instead of working on assigned task, the student is looking around,
daydreaming, looking out window, skipping school, coming to class late, delaying starting assigned task,
etc.
On-Task Behavior a. Looking at teacher when giving lesson, directions and/or instructions
b. Participating in class discussion
c. Working on seat work
d. Working cooperatively on cooperative project
ATTENTION INTERVENTIONS
54
Appendix C
Curriculum-Based Measurement: Behavior Rating Scales Report Card Maker
Daily Behavior Report Card
Student Name: ______________________
Date: _____________________________
Rater: _____________________________
Classroom: ________________________
Directions: Review each of the Behavior Report Card items below. For each item, rate the degree
to which the student showed the behavior or met the behavior goal.
Student focused his attention on teacher instructions, classroom lessons and assigned work.
The behavior goal was:
Accomplished
Not Accomplished
Student remembered academic instructions and directions without needing extra reminders.
The behavior goal was:
Accomplished
Not Accomplished
Not Accomplished
Date: _____________
ATTENTION INTERVENTIONS
55
Appendix D
Student Behavior Contract
By signing this contract, it is agreed that ______________________________ will adhere to the
following rules, consequences, and rewards of this Student Behavior Contract as listed below.
1. (List Rule/Behavior Goal)____________________________________________________________
Consequence:
_________________________________________________________________________________
_________________________________________________________________________________
Reward:
_________________________________________________________________________________
_________________________________________________________________________________
2. (List Rule/Behavior Goal)____________________________________________________________
Consequence:
_________________________________________________________________________________
_________________________________________________________________________________
Reward:
_________________________________________________________________________________
_________________________________________________________________________________
3. (List Rule/Behavior Goal)____________________________________________________________
Consequence:
_________________________________________________________________________________
_________________________________________________________________________________
Reward:
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________
Students Signature
______________________________
Date
_________________________________
Teachers Signature
______________________________
Date
_________________________________
Parent Signature
_____________________________
Date
ATTENTION INTERVENTIONS
56
Appendix E
Sample Guided Notes Lesson (Student Copy)
Name: _________________
Date: ____________
Class: _________________
Grade: ____________
Respiration and Fermentation
Respiration ___________________________________________________________
During _______________, cells break down simple food molecules such as ________ and release the
energy they contain
During ______________________, plants capture energy from sunlight and save it in the form of
carbohydrates (sugars & starches)
When your cells need energy, they breakdown the _________________ (sugars & starches) in the
process of respiration
The Two Stages of Respiration:
1st Stage
takes place in the __________________ of the organelles cells
molecules of glucose are broken down into smaller molecules
**Oxygen is NOT involved!!!**
2nd Stage
takes place in the ____________________
the molecules are broken down into even smaller molecules these chemical reactions require
_______________
**___________________ are sometimes called the powerhouse of the cell because they release a great
deal of energy in stage 2!!**
When you breathe in, you take in oxygen (a material for respiration) and when you breathe out, you
release __________ _________ and ________ (products of respiration)
6 O2
- - - - - - - ->
Oxygen
6 CO2
+ 6 H 2O
Carbon Dioxide
Water
+ energy
ATTENTION INTERVENTIONS
57
Raw materials for respiration are __________ and ___________.
Plants and other organisms that undergo photosynthesis make their own sugar
Meanwhile, _____________ in the cells of animals and other organisms comes from the food they
consume
Together, __________________ and ___________________ form a cycle that keeps the levels of
oxygen and carbon dioxide fairly constant in Earths atmosphere living things use both gases over
and over again!
The amount of energy released from each sugar molecule during _______________ is much
____________ than the amount released during respiration
Alcohol Fermentation this occurs when ___________ and other single-celled organisms break down
_____________ its called alcohol fermentation because alcohol is one of the products; the other
products are CO2 and a small amount of energy
____________ ____________________ is important for bakers and brewers the CO2 produced by
yeast creates air pockets in bread dough, causing it to rise!
Ever run as fast as you could, in a race? What occurs?
__________ __________ __________________ this takes place in your body! It occurs when your
muscle cells use up the oxygen faster than it can be replaced, and since your cells lack oxygen,
fermentation occurs one product of this fermentation is acid and when it builds up, you feel a painful
sensation in your muscles your muscles feel weak and sore.
Note:
The sample lesson was obtained from a 7th grade science web resource:
http://www.ltps.org/webpages/mcandeletti/index.cfm?subpage=727033
Guided notes can be created online at interventioncentral.org via the Guided Notes Maker:
https://www.interventioncentral.org/rti2/guided_notes
ATTENTION INTERVENTIONS
58
Appendix F
Sample Guided Notes Lesson (Teacher Copy)
Respiration and Fermentation
During respiration, cells break down simple food molecules such as sugar and release the energy
they contain
During photosynthesis, plants capture energy from sunlight and save it in the form of carbohydrates
(sugars & starches)
When your cells need energy, they breakdown the carbohydrates (sugars & starches) in the process of
respiration
2nd Stage
**Mitochondria are sometimes called the powerhouse of the cell because they release a great deal of
energy in stage 2!!**
When you breathe in, you take in oxygen (a material for respiration) and when you breathe out, you
release carbon dioxide and water (products of respiration)
6 O2
Oxygen
- - - - - - - ->
6 CO2
Carbon Dioxide
6 H 2O
+ energy
Water
Raw materials for respiration are sugar and oxygen. Plants and other organisms that undergo
photosynthesis make their own sugar
ATTENTION INTERVENTIONS
59
Meanwhile, glucose in the cells of animals and other organisms comes from the food they consume
Together, photosynthesis and respiration form a cycle that keeps the levels of oxygen and carbon
dioxide fairly constant in Earths atmosphere living things use both gases over and over again!
Fermentation an energy-releasing process that does NOT require oxygen!! - single-celled organisms
that live where there is no oxygen, such as in the ocean or in the mud of lakes swaps, obtain energy
without using oxygen!
The amount of energy released from each sugar molecule during fermentation is much lower than
the amount released during respiration
Alcohol Fermentation this occurs when yeast and other single-celled organisms break down sugars
its called alcohol fermentation because alcohol is one of the products; the other products are CO2 and a
small amount of energy
Alcohol fermentation is important for bakers and brewers the CO2 produced by yeast creates air pockets
in bread dough, causing it to rise!
Lactic Acid Fermentation this takes place in your body! It occurs when your muscle cells use up the
oxygen faster than it can be replaced, and since your cells lack oxygen, fermentation occurs one product
of this fermentation is acid and when it builds up, you feel a painful sensation in your muscles your
muscles feel weak and sore!
Note:
The sample lesson was obtained from a 7th grade science web resource:
http://www.ltps.org/webpages/mcandeletti/index.cfm?subpage=727033
Guided notes can be created online at interventioncentral.org via the Guided Notes Maker:
https://www.interventioncentral.org/rti2/guided_notes
ATTENTION INTERVENTIONS
60
ATTENTION INTERVENTIONS
61
References
Aldrich, S. (n.d.). Daily behavior report cards (DBRC). Retrieved April 16, 2015, from
http://www.jimwrightonline.com/mixed_files/ELL/Daily_Behavior_Report_Card _Full_
Set.pdf
Attitudemag.com (2015). Strategies and Support for ADHD & LD. To-Do List Apps for ADHD
Kids and Adults. Retrieved from http://www.additudemag.com/adhd/article/8698.html
Barkley, R.A. (2008, n.d.). Classroom accommodations for children with ADHD. Retrieved
April 24th, 2014, from
http://www.russellbarkley.org/factsheets/ADHD_School_Accommodations.pdf
Behavior Contracts. (n.d.). Retrieved April 16, 2015, from
http://www.interventioncentral.org/behavioral-interventions/challengingstudents/behavior-contracts
Brock, S., Grove, B., & Searls, S. (2010, n.d.). ADHD: Classroom interventions. Retrieved
April 14, 2015, from http://www.nasponline.org/resources/handouts/05-1_S805_ADHD_Classroom_Interventions.pdf
Brown-Chidsey, R., Bronaugh, L., & McGraw, K. (2009). RTI in the classroom: Guidelines and
recipes for success. New York: The Guilford Press.
Burns, M. K., Riley-Tillman, T. C., & VanDerHeyden, A. M. (2012). RTI applications:
Academic and behavioral interventions (Vol. 1). New York: The Guilford Press.
DuPaul, G. J., Ervin, R. A., Hook, C. L., & McGoey, K. E. (1998). Peer tutoring for children
with attention deficit hyperactivity disorder: Effects on classroom behavior and academic
performance. Journal of Applied Behavior Analysis, 31, 579-592.
ATTENTION INTERVENTIONS
62
Elementary & Middle Schools Technical Assistance Center (EMSTAC). (2015). Programs and
strategies for positive behavior: Peer tutoring. Retrieved April 20, 2015, from emstac.org
Falcetta, E. (2015). National Center for Learning Disabilities. Routines Reflections and
Rewards-Using apps for Kids with LD and ADHD. Retrieved from
http://www.ncld.org/blog/routines-reflections-and-rewards-using-apps-for-kids-with-ldand-adhd/
Felver, J. C., Tipsord, J. M., Morris, M. J., Racer, K. H., & Dishion, T. J. (2014). The effects of
mindfulness-based intervention on childrens attention regulation. Journal of Attention Disorders,
1-10. DOI: 10.1177/108705471458032.
Intervention Central. (2015). Guided notes: Increasing student engagement during lecture and
assigned readings. Retrieved April 20, 2015, from http://www.interventioncentral.org
Interventions for ADHD: Elementary School. (n.d.). Retrieved April 16, 2015, from
http://addinschool.com/interventions-adhd-elementary-school/
Schaefer, Kristina, "Using Daily Behavior Report Cards as Intervention for Primary School
Students with ADHD" (2010). Senior Honors Theses. Paper 216.
Semple, R. J. (2010). Does mindfulness meditation enhance attention? A randomized controlled trial.
Mindfulness, 1, 121-130. DOI: 10.1007/s12671-010-0017-2
Singh, S. & Singh, S. (2014). Effect of mindfulness therapy on attention deficit among adolescents with
symptoms of attention deficit disorder. Indian Journal of Health and Wellbeing, 5(10), 11651172.
Smalley, S. L., Loo, S. K., Hale, T. S., Shrestha, A., & McGough, J. (2009). Mindfulness and attention
deficit hyperactivity disorder. Journal of Clinical Psychology, 65(10), 1087-1098. DOI:
10.1002/jclp.20618
ATTENTION INTERVENTIONS
63
Smith, K. (n.d.). Contingency contracting: A proactive intervention for the classroom. Retrieved
April 10, 2015, from
http://www.cehd.umn.edu/ceed/publications/tipsheets/preschoolbehavior/contcon. Pdf
The Mindful Word. (2012). MBSR: Mindfulness-based stress reduction exercises. Retrieved on April 28,
2015 from http://www.themindfulword.org
Van de Weijer-Bergsma, E., Formsma, A. R., de Bruin, E., & Bogels, S. M. (2012). The effectiveness of
mindfulness training on behavioral problems and attentional functioning in adolescents with
ADHD. Journal of Child and Family Studies, 21, 775-787.
Van der Oord, S., Bogels, S. M., & Peijnenburg, D. (2012). The effectiveness of mindfulness training for
children with ADHD and mindful parenting for their parents. Journal of Child and Family
Studies, 21(1), 139-147. DOI: 10.1007/s10826-011-9457-0
Wright, J. (n.d.). Classroom behavior report card resource book. Retrieved April 12, 2015,
from http://www.jimwrightonline.com/pdfdocs/tbrc/tbrcmanual.pdf
Zack, S., Saekow, J., Kelly, M., & Radke, S. (2014). Mindfulness based interventions for youth. Journal
of Rational-Emotive and Cognitive Behavioral Therapy, 32, 44-56. DOI: 10.1007/s10942-0140179-2