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How do you teach students with AD/HD?

Have you ever had a student who just couldn't sit still and listen? Have you ever had a student who couldn't focus on what you were saying for more than a few seconds? Have you ever had a student who got frustrated easily? Are these rhetorical questions? Of course they are! Anyone who has taught for several years has perhaps dreaded the sight of these students entering the studio. What's wrong with these students? Are they just being ornery, or not trying hard enough? Although that might describe some of them, many of them may have Attention Deficit/Hyperactivity Disorder. In this article, Margaret Young shares her research and experiences in teaching students with AD/HD. In addition to her fine article, Margaret has also listed some useful online resources. 

Creating successful learning environments

by Margaret Young 

Inside Jason's mind

On the first day of class a few years ago, Jason, a freshman in college, said, "Mrs. Young, I think you should know that I have Attention Deficit/ Hyperactivity Disorder. Don't be offended if I don't seem to be paying attention in class. It's not that I'm uninterested, but I just can't keep myself focused in class for very long." We spent the next few minutes talking about his strengths and weaknesses as a student. I was stunned that he was able to explain what worked well for him, and that as a freshman in college he was able and willing to share this very personal information with me. Our jobs as teachers would be much easier if all of our students were as open and forthcoming as Jason, however, this is not always the case. For that reason, I spent the remainder of the semester researching this disorder so that I could provide Jason, and other students like him, with successful music experiences. Attention Deficit/ Hyperactivity Disorder (AD/HD) is a disease that affects between five and nine percent of the children in the

United States, and the number of children diagnosed with AD/ HD is steadily increasing.1 Given these percentages, it is very likely that most piano teachers have had or will encounter students with AD/HD.

Techniques of good teaching

Although teaching students with AD/ HD may seem at times to be an insurmountable task, it is important to focus on similarities between students with AD/ HD and their typical peers, and the well-established teaching principles that are effective with all students. While I first focused on developing new strategies to accommodate Jason's disability, I soon discovered that many of the techniques I routinely use with all students were also effective with him. These practices included: sequencing material, encouraging the transfer of previously introduced material to different circumstances, providing frequent feedback, and assessing the student's progress. For more information on effective teaching strategies, see Robert Duke's Intelligent Music Teaching.2

But what special considerations need to be addressed when a student with AD/ HD enters our studio? How does our teaching need to change so the student feels comfort- able at the piano and has a successful experience? First, we must clarify our teaching goals - the specific goals for this student. Our primary goal, for any student who enters our studio, is to provide him/her with successful, high quality musical experiences. This should not change for a student with AD/ HD. However, appropriate adaptations may be necessary for the content, methodology, or delivery of instructions to meet the AD/HD student.3 

Defining the disease

There are two primary types of AD/HD: inattentive and hyperactive/ impulsive. Predominantly inattentive type behaviors of AD/HD include: failing to give attention to detail, not listening to what is being said, difficulty with organizing work, and being easily distracted. T he hyperactive and impulsive type behaviors of AD/HD are: fidgeting, excessively leaving one's seat and running around, blurting out answers before questions are finished, and difficulty in waiting or taking turns. Students who exhibit both behaviors are referred to as having the combined type of AD/ HD. It is important, however, to keep in mind that "one size (label) does not fit all" and that you may find students who differ from these commonly reported characteristics.

Scientists have discovered structural differences in the brains of individuals diagnosed with AD/HD. These differences can be seen by examining the genetic link between parents and children. For example, if one of the two parents has AD/ HD, the likelihood of their child having it is somewhere around 50%. If both parents have AD/ HD the likelihood of their child being diagnosed with the disorder increases to 70%.4

AD/ HD has been connected to irregularities in the frontal lobe - the lobe of the brain responsible for higher-level thought processes and the last lobe of the brain to develop during childhood. The frontal lobe controls working memory, organizational tasks, and - most importantly - impulse control. Scientists have discovered that compared to a typical brain, the frontal lobe is significantly smaller in individuals with AD/HD5 It has been suggested, although not proven, that the structural abnormality results in what we would characterize as common AD/HD behaviors.6

What we see as impulsive and hyperactive behaviors represent only a fraction of the disorder. Zeigler Dendy7 presents a diagram that displays the many different dimensions involved in this disorder, such as difficulty sleeping, low frustration tolerance, impaired sense of time, and accompanying disorders (see page 53).

Two-thirds of the population diagnosed with AD/ HD are also affected by accompanying disorders or diseases. Disorders most commonly associated with AD/HD include:

  • Bipolar disorder
  • Conduct disorder
  • Obsessive-Compulsive disorder 
  • Anxiety or mood disorders
  • Tourrette's Disorder
  • Sleep deprivation
  • Substance abuse 

Sadly, there is no cure for AD/HD, but doctors are able to manage many of these symptoms through behavior modification and medication.

Some of the most commonly prescribed medications for AD/HD are Ritalin, Adderall, Concerta, and Focalin.8 These medications stimulate the production of chemical messengers, or neurotransmitters, in the fronta l lobe. The stimulation of these chemicals does not last indefinitely; to date there is not a medication that can control AD/HD symptoms for 24 hours. The time of day at which the medication is given can drastically affect the way that person focuses later in the day. Sensitivity to the behavioral characteristics and the accompanying med- ical problems of students with AD/HD is essential for creating a learning environ- ment that will be adaptive, productive, and result in the student's success.

Adapting for success

Creating such a learning environment may be challenging for teachers who lack experience in teaching students with AD/ HD. Though many commonly used teaching strategies are quite successful, here are some strategies that I have found particularly helpful:

Establish routines

It is important to develop and maintain routines in each lesson. My students know that many of the lesson components will occur in the same order each week. I begin each lesson by asking questions about their week, followed by a technical warm-up, and then an introduction of new material. Developing a schedule and displaying it on the keyboard rack provides a visual guideline for the student, and it helps transitions between lesson topics. 

Journal practice 

When your students leave the studio, ideally they will structure their practice ina way that will continuously improve their playing until they return the following week. Unlike their typical peers, students with AD/HD may be unable to carefully plan and organize activities. A practice journal provides students with a reference of what happened in the previous practice session and can also provide goals for the next session. Students with AD?HD do not have an innate ability to develop thorough practice jounrals; therefore, we must teach our students how to document their practicing. With my guidance, students fill out a practice form in the lesson before they ever try to complete a form on their own. This way, they understand my expectations and can imitate the model we created together. 

Allow fidgeting

For students with the hyperactive/ impulsive type of AD/HD, fidgeting is a part of their daily lives. Though fidgeting may be distracting to us, it is best to suppress the tendency to talk about this problem. If you ask a student to stop fidgeting, they will direct their focus away from the piano lesson, and instead focus on discontinuing these seemingly extraneous movements. Research has shown that fidgeting can aid in the recall of information in students with AD/HD9 Our lesson goals for these stu- dents should not contain the objective: student will sit still for 30 minutes. We should not ask them to divert their attention from the music to satisfy our desire for a peaceful piano studio. Instead, we should turn our attention to making the lesson a positive experience for the movement as needed.

Give breaks

If you've spent any time with a child with AD/ HD, one of the first characteristics you might notice is that they are unable to con- centrate on one subject for a long period of time. Yet, when they arrive at their piano lessons, they are required to sit in one posi- tion for 30 minutes - or sometimes longer. That is an unreasonable expectation for some students. We must schedule a break of some manner for our students with AD/HD. One of my students is particularly interested in dogs (especially my Cocker Spaniel-Poodle mix). He knows that if he performs his pieces well and focuses on piano for 15 minutes, he'll get to spend one minute playing with my dog. This break accomplishes two objectives. First, he knows that if he does not perform well, he won't be able to play with the dog, which provides him with an extrinsic motivation to complete his assignments. Also, if he completes his assignments, he can move away from the piano bench and play.

Mix it up

It is important that we incorporate as much variety into our teaching as possible. Fortunately, music can be enjoyed aurally, visually, and kinesthetically. I have found using audio-recordings and videotapes particularly helpful in illustrating a new sound or technique. Educational videotapes can showcase new ideas and models, and students will enjoy watching them. In my studio, I have posters of key terms that my students and I use every lesson. These posters provide a visual representation to which we can refer throughout the lesson. These tools can be very effective, but it is important to remember that an atmosphere with too much clutter can detract from the successful learning experience of a student with AD/ HD. Make sure to use everythi ng in your studio during the lesson and remove any extraneous distractions - if you don't use it, lose it. 

Find work for the computer

In piano lessons, computers can be used effectively or ineffectively. Many of our students spend an inordinate amount of time at the computer completing assignments, surfing the web, and playing games. There are a number of ways that you can incorporate the use of computers into your teaching. I have created a few PowerPoint tutorials for my students, which allow me to guide their practice on a new literature piece or review key terms that we've covered in the previous lesson. Another way to use com- puters in the lesson is through the wide array of music software that can help students practice theory, history, and composition.In piano lessons, computers can be used effectively or ineffectively. Many of our students spend an inordinate amount of time at the computer completing assignments, surfing the web, and playing games. There are a number of ways that you can incorpo- rate the use of computers into your teaching. I have created a few PowerPoint tutorials for my students, which allow me to guide their practice on a new literature piece or review key terms that we've covered in the previous lesson. Another way to use com- puters in the lesson is through the wide array of music software that can help stu- dents practice theory, history, and composition. 

Maintain high standards

We know that all students are capable of amazing accomplishments if they are guided in the correct manner. Students with AD/HD are predominately of moderate to high intelligence, but struggle with tasks that might prevent them from achieving their potential in school. When teaching is adapted to meet their needs, students can reach higher standards and the experience for the teacher can be surprisingly rewarding. 

Little changes, big rewards

Although these strategies may provide a starting platform, you are the one who must accept these students into your studio. Teaching students with AD/HD does not require that you dramatically change your teaching philosophy; only a few adaptations must be made to ensure the student's suc- cess. Through my familiarity with Jason, and other students with AD/HD, I have learned that the label of AD/HD has a broad scope, and that each student's experi- ences with music have enriched their lives as well as mine. 

National Institute of Mental Health. (n.d.). Attention Deficit Hyperactivity Disorder. Retrieved March, 2009, fro m http://www. nimho ni heaIth/ publications/adhd/ nimhadhdp ub.pdf

2 Duke, R. A. (2005). Intelligent music teach- ing: Essays on the core principles of effective instruction. Austin, TX: Learning and Behavior Resources.

3 Jellison, J. A. (2006). Including everyone. In G. MacPherson (Ed.), Thechild as musician: A handbook of musical development. New York: Oxford University Press. 

Attention Deficit Hyperactivity Disorder Help Center. (n.d.). FAQs. Retrieved March, 2009, from http://www.add-adhd-

National Resource Center on AD/HD. (n.d.). What We Know: AD/HD and Coexisting Conditions. Retrieved March, 2009, from

Neven, R. S., Anderson, V & Godber, T. (2002) . Rethinking ADHD: integrated approaches to helping children at home and at school. Crows Nest, N. S. W: Allen & Unwin.

7 Ziegler Dendy, C. (2000). Teaching teens with ADD and ADHD: a quick reference guide for teachers and parents. Bethesda, MD: Woodbine House, Inc. 

National Institute of Mental Health. Attention Deficit Hyperactivity Retrieved Ma rch, 2009, from (n.d.). Disorder. health/ publications/adhd/nimhadhdpub.pdf 

Greenbaum,J.&Markel,G.(2001).Help- ing students with ADHD & learning disabil- ities: ready -to -use tips, techniques, and checklists for school success. Paramus, NJ: The Center for Applied Research in Edu-cation. 

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