Emily: Part 3

Recommendations:

I strongly recommend that Emily be provided services through an Individualized Education Plan on the basis of her diagnosis of ADHD, and a learning disability characterized by weak executive functioning and poor written expression, which are undermining her academic skill development and functioning. The accommodations she is currently receiving on her 504 plan are not sufficient, as they do not address her significant difficulties in the area of cognitive organization and written expression.

With regard to her organizational weaknesses, Emily needs help breaking down long term projects in to manageable pieces. She also needs support in the areas of time management and remaining on task. In addition, Emily should be taught how to create a check list and encouraged to use it consistently. I recommend that she receive pull-out support (2-3 times per week, 45 minutes each session) with a special education teacher to provide her with support in the areas of time management and the organization of her materials.

Further, Emily's written expression vulnerabilities warrant the provision of individual or small group tutoring, in the area of written expression. This tutoring should involve direct teaching organizational skills through the use of graphic organizers that are applied to Emily's existing written assignments. It should employ a systematic, curriculum-based approach and be implemented by a qualified individual( special education instructor, speech/language pathologist) who is trained in such an approach. This pull-out service should be provided 3 times a week, for 45 minutes per session.

Based on Emily's attentional variability, due to her diagnosis of ADHD and executive functioning vulnerabilities, she should be provided with additional time (i.e. time and a half) to complete quizzes, tests, and standardized exams. To be clear, Emily may not use all of the time allowed; however, she needs to be instructed to check through her work more carefully due to her tendency to rush and make careless errors.

Due to Emily's level of distractibility, she should be provided with preferential seating (e.g., away from window views or busy hallways) to allow her to attend to what is being taught in class. In addition, her teachers should cue her for attention and refocusing. This cuing could be done with a subtle signal that does not single Emily out from the rest of the class.

Further, given Emily's weak organizational skills, she would be expected to have some difficulty discriminating the most salient aspects of new material presented in class. As such, she would benefit from the provision of an outline of information to be covered in class. Similarly, she would benefit from the provision of study guides for upcoming tests and quizzes.

Additionally, at the end of each school day, Emily should check in with a pre-designated faculty member familiar with her classes, to make sure she has the correct assignments and and all material needed to complete her homework.

Due to Emily's difficulty keeping track of her belongings, a vulnerability common among students with a diagnosis of ADHD, she should be provided with an extra set of books to keep at home to be sure she has access to the texts needed to complete homework.

Emily would also benefit from visual cuing strategies. For example, she could be provided with supports such as lists that offer individual cues to help her structure ans manage tasks more independently (e.g., morning routine, rechecking schoolwork for name, date, completeness).

Emily's relatively weak ability to learn de-contextualized information likely interferes with her ability to recall specific facts, dates, names etc. She would benefit from using memory strategies such as mnemonics (e.g., ROY G BIV to remember the order of colors in the prism), over-learning information through frequent rehearsal, as well as tape recording information herself and them replaying it.

I recommend that Mr. and Mrs. E (aka Ryun and I) continue to work with Emily's neurologist to address Emily's complicated profile and suggest that they share this neuropsychological report. Clearly Emily's neurological (i.e. seizure) issues need to be considered when determining appropriate medications to help address ADHD symptoms.

Individuals with ADHD have more difficulty than others regulating mood and behavior. Research indicates that exercise can regulate mood, while sufficient sleep and a consistent sleep schedule have been connected to improved attention. Thus, Emily should be encouraged to maintain a healthy diet including breakfast, a regular exercise regimen, and a consistent sleep schedule.

Finally, I recommend that Emily undergo neuropsychological re-evaluation in two years' time, in order to monitor her progress with the interventions listed above and to obtain updated information to facilitate further academic planning.