An abundance of research about autism and ADHD alone is available, but what does it mean if a child has a dual diagnosis? There are many effective strategies to teach students with autism or with ADHD, but what are some strategies that are effective for students who have a dual diagnosis? With the rise in cases of an ADHD and autism diagnosis, it is valuable to know effective strategies that really work within the general education setting.
Necessity of a Dual Diagnosis of Autism and ADHD:
Students with autism show many characteristics that could also classified as signs of ADHD. Although autism and ADHD share many characteristics, it is vital that doctors, teachers, and parents understand that autism and ADHD can be present at the same time. Doctors must diagnose those particular cases in a way that will best meet the needs of the child. According to Goldstein and Schwebach (2004), many people have questioned the need for a dual diagnosis of autism and ADHD over the past several years. Goldstein and Schwebach (2004) conducted a study consisting of 57 students. Some had only autism, some had ADHD only, and some children had both autism and ADHD. Data showed that students with concurrent ADHD and ASD had more trouble with everyday skills and showed difficulties in attention and excitability shown by students with only ADHD. This study did not take into account the social and emotional difficulties exhibited by the different groups of children.
A second study conducted by Grzadzinski et al. (2011) evaluated 70 children with an ADHD who also displayed autistic traits based on social and emotional skills. This study found that not diagnosing children with both ADHD and autism when necessary could prevent the correct treatment and management of those children.
According to Ghaziuddin et al. (1992), a dual diagnosis would help determine proper treatment options and promote more research studies in the area of autism and ADHD (as cited in Corbett and Constantine, 2006). Because of the finding of these studies, it is vital that doctors recognize children who display characteristics of ADHD and autism and give them a dual diagnosis if the diagnosis is warranted.
Characteristics of Concurrent Autism and ADHD:
Based on the studies mentioned above, there is a need to make teachers and parents more aware of the traits of children with both ADHD and autism. It is a tough disability to characterize. According to Ames and White (2010) for a student with autism to be identified with ADHD as well, common traits (such as hyperactivity, inattention, and impulsivity) must be seen in more than one place, for example both at school and at home. This study also reported that students who show autism and ADHD have a difficulty with interactions with peers and adults as well as difficulty with life skills.
Based on a study by Sinzig, Bruning, Morsch, and Lehmkuhl (2008), there was no evidence that children with autism and ADHD were much different than children with an autism-only diagnosis. However, the differences between the two cases are subtle. Children with a dual diagnosis of autism and ADHD have more trouble with activities involving attention and awareness than students with just autism or just ADHD. Also, children with concurrent autism and ADHD also showed an increased difficulty with organization (Sinzig et al., 2008). Ghaziuddin, Welch, Mohiuddin, Lagrou, and Ghasiuddin (2010), expressed that both autism and ADHD include deficits in social interactions, hyperactivity, and impulsivity. Students with concurrent autism and ADHD also showed more severe symptoms of the aforementioned traits and also did not know how to correctly respond to social situations. Students with only an autism or only an ADHD diagnosis did not have as much trouble deciding an appropriate reaction (Hartman, Luteijn, Serra, and Minderaa, 2010). Although the difference between a diagnosis of autism and concurrent autism and ADHD is faint, it is vital that teachers and parents be aware of the differences and apply necessary intervention strategies to promote the success of the children.
Effective Classroom Strategies for Students with autism and ADHD:
With a push on inclusion, regular education teachers and special education teachers alike need to know and understand strategies that will promote a safe and encouraging learning environment for those students with co-morbid autism and ADHD. Some effective strategies that can be used with students with autism and ADHD include: shadow teaching, behavior contracts, the â€œprevent-teach-reinforce model,â€Â the use of games within the classroom.
Shadow Teaching: According to Manansala and Dizon (2008), shadow teaching can be defined as collaborative teaching between the special education and regular education teacher. Although this scenario is not possible in all school districts, it is very effective in mainstreaming students with concurrent autism and ADHD. The shadow teacher could be a behavior therapist or special education teacher and is responsible for planning alongside the regular education teacher and supervising behavior and social skills instruction of the student with autism and ADHD (Manasala and Dizon, 2008). The role of the shadow teacher is to build academic, behavior, and social skills within the general education setting. Some benefits of shadow teaching include: prompts and cues to finish work, help with class work, improving and modifying social and emotional behaviors immediately upon occurrence, providing lesson modifications if necessary, and helping with peer to peer relationships (Manasala and Dizon, 2008).
Behavior Contracts: Downing (2002), explains that behavior contracts are written agreements between a student and teacher that deal with situations displayed within the classroom. In a study conducted by Mruzek, Cohen, and Smith (2007), students with autism and ADHD who displayed difficult behavior problems within the classroom setting created a behavior contract that included self-assessments, skills to handle different social situations, and classroom supports. The study showed a decrease in negative behaviors and an increase in positive behaviors through the interventions outlined in the contract. The students became more aware of their target behaviors and were taught intervention strategies to self-correct those behaviors.
Through the use of contracts, students can learn new behaviors, decrease harmful behaviors, generalize skills into other walks of life, and build problem-solving skills (Downing, 2002). By making students with autism and ADHD aware of problem behaviors and providing them with strategies to correct them in a written contract, students and teachers can work together to create a successful classroom.
Prevent-Teach-Reinforce: According the Strain, Wilson, and Dunlap (2011), students with autism and ADHD who are placed into the general education setting can be difficult for the teacher instruct. By assessing the behaviors of the student within the classroom setting, making changes to the structure of the classroom to decrease problem behaviors, teaching the student how to respond to certain situations, and creating consequences and reinforcements, teachers can help students with special needs to become more successful in the classroom. The aforementioned process is known as â€œPrevent-Teach-Reinforceâ€Â (Strain, Wilson, and Dunlap, 2011). Strain, Wilson, and Dunlap (2011) discovered that this model was very effective in quickly changing conduct and performance of the three children. Participation in classroom behavior was also noticed by following this model.
The Use of Games: Students with autism and ADHD typically have deficits in attention, hyperactivity, and impulsivity. By implementing games within the classroom that promote social interaction, competition, and movement, students with autism and ADHD are more likely to take part and be active in the learning process. Geurta, Luman, and van Meel (2008) suggest that when students with autism and ADHD are excited about learning, there is an increase in performance. Games can provide that motivation. In their study, Guerta, Luman, and van Meel (2008) found that students with autism and ADHD who believed that they were playing a game answered questions more accurately. They also discovered that when a prize was given in the game, they were even more motivated to succeed and performance increased more. Because of these findings, teachers should work to implement games that incorporate movement and competition between others.
Based on the literature, there is a need for society, educators, and parents to understand the prevalence and characteristics of students with concurrent ADHD and autism. Since many children with autism exhibit characteristics of ADHD, students with dual symptoms often go undiagnosed. It is vital that more quantitative research is conducted and data are reported to doctors in order for students to receive the treatment needed. If parents, doctors, and teachers are aware of the necessity of a diagnosis and the characteristics of a dual diagnosis, the needs of these children can be addressed and proper treatment options can be implemented. As more research is completed based on the characteristics of autism and ADHD, more quantitative and qualitative studies need to be conducted to find effective teaching strategies to implement in the inclusive classroom. Although the four strategies mentioned are helpful, it is important that teachers analyze their specific students and determine which strategy works best for them. This study will conduct further research on the different classroom strategies and their impact on students with concurrent autism and ADHD.