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Creating Supportive Environments

The Active Classroom

Supporting Students With Attention Deficit Hyperactivity Disorder Through Exercise
Christopher F. Mulrine Mary Anne Prater Amelia Jenkins

Ms. Kaus students are full of life and energy but many have trouble staying focused and are easily distracted. Several are diagnosed with attention deficit hyperactivity disorder (ADHD). She read an article suggesting that regular movement could assist students with concentration as well as helping them control impuisivity. Intrigued with this idea. Ms. Kau started incorporating classroom transition exercises, lesson energizers, and structured movement games for recess. She even talked with the physical education teacher to explore using structured physical movement games in her students' gym class. As a result of these changes, all of her

students, not just those with ADHD, are focusing better and paying closer attention in class. Teachers face many challenges in their daily effort to meet the needs of and ensure success for a diverse group of students, including students who are inattentive and have trouble staying focused and on task. All students, especially those with ADHD, need exercise; it assists them with concentration and provides an outlet for healthy impulse discharge, helping to control impuisivity. Establishing a classroom environment that encourages beneficial movement throughout the school dayduring content lessons, transitions, and via specialized games for recess and indoor rainy day activitiescan improve results for students with ADHD, help reduce problematic classroom behavior, and better focus students' attention on content instruction. ADHD is defined as a "persistent pattern of inattention and/or hyperactivityimpulsivity that is more frequently displayed and more severe than is typically observed in individuals at a comparable level of development" (American Psychiatric Association, 2000, p. 85). Such inattention, hyperactivity and/or impuisivity make it difficult for students with ADHD to focus their attention long

enough or well enough to learn. Students with ADHD often exhibit deficient study skills and general disorganization that cause significant academic, behavioral, and social problems stemming from the inability to pay attention (Slavin, 2003). More specifically, typical behaviors include inattentiveness during work or play, not completing assigned tasks, not listening to or following directions, losing materials, inattention to details resulting in mistakes, and difficulty awaiting turns (Prater, 2007). Students with ADHD are easily distracted and teachers may find themselves constantly redirecting the students' attention. Students have difficulty staying on task and, as a result, may not complete assignments on time. Teachers often require students with ADHD to make up tbese assignments during nonacademic classes, recess, gym time, or after school. This, unfortunately, does not allow tbe students the opportunity to engage in physical activities that provide tbem appropriate time for movement and give their minds a needed rest from academics. There is even evidence that indicates keeping students with ADHD from exercise may actually cause some classroom-related problems (Holtkamp et al.. 2004). Ms. Kau, tbe teacher in our opening sce-


nario, might be on the righl track: Incorporating physical movement activities into her classroom routine helps all of her students, including those with ADHD, to be better focused and to stay on task for longer periods of time.

Benefits of Exercise on Student Learning An experimental group got four times more exercise per week than the control group, but their "loss" in study time did not result in lower academic scores (Dwyer, Blizzard. & Dean, 1996). In a Canadian study of more than 500 school children, those who spent an extra hour each day in a gym class far outperformed at exam time those who didn't exercise (Hannaford, 1995). Among three test groups, the one that had vigorous aerobic exercise improved short-term memory, reaction time, and creativity (Michaud & Wild, 1991). Children engaged in daily physical education showed superior motor fitness, academic performance, and attitude towards school as compared to their counterparts who did not participate in daily physical education (Pollatschek & O'Hagan, 1989). deprived of physical activity, or play, for long periods of time (Pellegrini & Smith, 1998). How does this impact education? Teachers should not only be concerned with the physical health benefits derived from exercise, but also need to be aware of the positive impact of exercise and movement on classroom learning for all students, especially for those with ADHD.

of Exttrcistt for All Studanta

There is research evidence that implementing exercise activities throughout the clay can help improve academic performance and reduce disruptive classroom and social problem behaviors (Barkley. 2004; Majorek, T\ichelmann. & Heusser, 2004). The physical education literature base is replete with studies stating the benefits of exercise and its effects on learning (see box, "Benefits of Exercise on Student Learning"). Exercise helps students to cope more effectively with stress, and promotes positive self-image, clearer thought, and improved memory (Akande, VanWyk, & Osagie, 2000). In addition, exercise can increase activity in the parts of the brain involved in memory, attention, spatial perception, language, and emotion (Olsen. 1994); there are indications that movement can strengthen learning and memory and boost learner motivation and morale (Jensen, 2005). Exercising just 30 min a day, 3 to 5 days a week has been shown to have advantages Uambor. 1999).

physical fitness, (c) there is comorbidity between ADHD and developmental coordination disorder, and (d) few interventions have focused on movement performance and physical fitness of children with ADHD. In a related study. Barkley (2004) concluded that physical exercise, which has received limited attention for management of disruptive behavior for children and adolescents with ADHD, needs further and more rigorous study as a relatively harmless, socially acceptable form of treatment. Neuroscience. through the use of brain imaging studies, is providing additional information on the topic of physical activity and learning. Brain imagingexamining differences in blood flow to various brain regionsis being used to study the impact of exercise on learning performance in children with ADHD (Murray. 2000). Exercise impacts oxygen levels in the brain, with resulting effects on brain chemistry, cerebral metabolism, and growth and development, establishing the link between exercise and learning (Coco & Sweigard. 2004; Dustman, Emmerson, & Shearer, 1990; Putnam, 2001). Oxygen is essential for brain function, and enhanced blood flow increases the amount of oxygen transported to the brain. Physical activity and exercise increase blood flow and allow for more oxygen and nourishment to flow to the different parts of the brain through the blood vessels, arteries, capillaries, and veins (Hannaford. 1995;Jensen, 2005). Related research on neurochemical reactions in the brain is investigating how exercise affects the behavioral and dopaminergic-like responses in children with ADHD. In preliminary findings. Tantillo, Kesick, Hynd. & Dishman (2002) cautiously stated that vigorous exercise might have the potential for treating the management of behavioral features of ADHD, but they suggested that further study is needed. Further, Wendt (2000) found that 40 min per day of exercise 5 days a week for 6 weeks significantly improved the behavior of ADHD students; students who run or jog may reduce the incidence of conduct and oppositionai problems, in addition to helping them modify their disruptive classroom behaviors (Wendt, 2001).

Keeping students with ADHD from exercise may actually cause some classroom-related problems.
However, despite these findings, exercise for students in this country appears to be on the decline, corresponding to obesity rates for children unparalleled in any other time in history. A lack of physical exercise has resulted in American children becoming more obese since the 1960s [Hinkle, 1992). There also has been a dramatic increase in the number of children with Type 2 diabetesa disease once limited to sedentary, overweight adults (Mayo Clinic, n.d.). Research further suggests that children's cardiovascular health and fitness suffer when they are

Baneflts of Exercise for Studente WHh ADHD

If, indeed, our bodies are designed to move and to learn while moving (Samaras. Straits. & Patrick, 1998), have these findings on exercise and learning been assimilated into the special education literature base as a viable strategy for teaching students, especially those with ADHD? Harvey and Reid (2003) reviewed 49 empirically based studies published between 1949 and 2002 on movement skill performance and physical fitness of children with ADHD. Their review of the literature found that: (a) children with ADHD are at risk for movement skill difficulties, (b) children with ADHD are at risk for poor levels of


Neuroscience research clearly indicates a litik between physical activity and brain function, and further indicates a relationship between physical activity and improved educational performance (Jensen, 2008; Labounty, 2007; Pierson, 2004). Additional studies have suggested a link between physical activity and behavior and academic performance of children with ADHD (Hall, 2007; Van Puymbroeck, 2006). These results have clear implications for classroom practice, and can be translated into everyday teaching activities to improve chances for success for students with ADHD. liMef|KHring Exercisa AcfivHies Into Ifae Dally Cltusroom Schedul* How can teachers translate these findings into effective classroom learning activities? It is especially appropriate to allow the student with ADHD opportunities for controlled movement and to develop a repertoire of physical activities for the entire class (such as stretch breaks; LD Online. 1998). Sitting quiet-

ly in a chair and staying focused requires effort for all students, especially those with ADHD. Conventional wisdom tells us that students need breaks from learning and can focus better when provided breaks throughout the day; unstructured breaks from demanding cognitive tasks seem to facilitate both learning and social competence (Pellegrini & Bohn, 2005). Incorporating movement into classroom life can be accomplished by creating a classroom environment that encourages beneficial movement throughout the school day. during subject transition times and content lessons, as well as structured movement games for recess and gym (see box, "Tips for Creating an Active Learning Environment").
Incorporate Movement Activities During Transition Times

Classroom TransiHon Movement Activities

/ Have students open the windows and door. / Ask students to stand at their desk and take several deep breaths. / Have students do simple stretching exercises such as pushing the palms of their hands together and bending over to stretch the calf and leg muscles, simple squat exercises or deep knee bends at their desks. / Direct students to push down hard on the desktop, squeeze and relax fists, and then rotate the arms and trunk of their body. / Have students march in place, sing, and dance to music. / Walk with students down the hall, up and down stairs, or take a short walk around the school.

TVansitions from one lesson or class to another are particularly difficult for students with ADHD; if prepared for these transitions, students are more likely to stay on task (U.S. Department of Education, 2004). Students, especially

Tips for Creating An Active Learning Enviranment

/ Don't sit at your desk. Move around as you teach. / Discuss your own personal exercise routines with your students. / Have students stand up and move aroundgive them the job of collecting and handing out papers. / Don't allow your students to sit for more than 30 minutes at a time. / When giving instructions, have your students stand or sit on the carpet. / Allow students to run errands within the school building {not just the wellbehaved students). / Limit student time on computer games and limit the use of videotapes. Go out side instead! / Have your students use music, movement, and dance when cleaning or tidying up the classroom. / Allow students to pick some type of movement activity for the entire class after lunch. Some ideas might include walking, nmning in place, yoga exercises, or 1 playing catch. / Hold classroom parties outside. / Have your class design a mini "field day" full of noncompetitive fun. Create stations such as obstacle courses, games, dance activities, or tag. Make certain to include rest stations and water breaks! Enlist the help of your school's physical education teachers. y Don't meh when it rains! Seek indoor opportunities for physical activity on days that the weather doesn't permit outdoor play. Play indoor movement games like Duck, Duck, Goose, or have a dance party.

those with disruptive classroom and social problem behaviors, are more likely to exhibit behavior problems during subject area transition times. Effective classroom transitions between learning activities need structure and boundaries to help students mentally prepare for task shifts and to be better positioned for learning. In many elementary classrooms, transition time is spent sitting at one's desk, and any physical activity is curtailed to bathroom breaks or a short walk to complete a classroom chorethen it is back to the seat for the next lesson. Remember: Students with ADHD may have difficulty sitting still, so teachers need to plan productive physical movement. Why not use more organized and structured movement activities during these times? Teachers can easily incorporate some simple movement activities during subject area transitions to get their students moving. Movement activities that become a part of the everyday classroom routine will soon become familiar to students and serve as a cue to transition from one subject area to the next, as well as provide an opportunity for appropriate movement. It is critical, however, to establish a structure and boundaries for the movement activities (such as limita-

1 . SampI* Dally Energlxers (Grado 2)

Subject Math Classroom Energizer "Inches, Feet and Yards, Oh My!" hup ://ncpe4 me. com/pdf_files/en ergizers_K-2.pdf "Heart Smart" http;//ncpe4nie.com/pdf_files/energizers_K-2.pdf (page 18) "As If" http://ncpe4me.com/pdf_fiIes/energizers_K-2.pdf (page \1) "Frogs in the Pond" http://ncpe4me.com/pdf_fiIes/energizers_K-2.pdf (page 29) "Jump to Spell" http://www.eduref.org/cgi-bin/printlessons-Cgi/ Virtual/Lessons/PhysicaI_Education/Skill_Related/ SRF0003.hlmI Lesson Objective Learning measurement systems; students take small, medium, and large steps to indicate distance in inches, feet, and yards. Understanding the human heart and learning about activities that strengthen or weaken it; students either jump (for strengthen) or squat (for weaken). Learning "action" words; students move (walk, jump) "as if" they were another animal or object, students act out and then create the sentences, create a tree map o: other action words Developing gross motor skills; similar to game of "tag"


Language Arts

Physical Education

Language Arts

Spelling and learning the keyboard; students spell words by jumping on a floor-size computer keyboard

tions for range of movement, contact with others, and volimie). Teachers can use age-appropriate signals indicating time to stop ("freeze" signals), nonverbal signals (classroom lights on/off), and hand clapping (teacher claps three times, students repeat). See box, "Classroom TVansition Movement Activities," for additional possibilities. Incorporate Lesson "Energizers" Incorporating movement through role play and other curricular responses is an effective strategy for managing students with excessive activity (Carbone, 2001). "Energizers" are short (10-min) activities that integrate physical activity with academic subjectsanother method by which teachers can help students become more physically active throughout the school day (see Table 1). Energizers can be targeted to lessons in math, science, language arts, and social studies; Table 2 provides an example of a social studies energizer (Mahar, Kenny, Shields, Scales, & Collins, 2006). Specific Accommodkrtlens for Stvdenfe With ADHD Even though children with ADHD can vary considerably in their characteristics and skills, they all share the inability to regulate their attention and as a result may require lesson adaptations

and accommodations. Certain types of interventions have proven successful in working with students with ADHD, such as environmental supports, academic interventions, behavioral interventions, parent education, and medical interventions (Friend & Bursuck,

2006). When implementing movement activities during transitions and lessons utilizing energizers, teachers also may need to provide environmental, academic and/or behavioral accommodations for students with ADHD (see Table 3).

Table 2. "California Dreamln'" Classroom Inorglxer (Grades 3-5)

Student formation Equipment required Rules/directions Standing at desks None Teacher leads the class on a "tour" of California (can use a' wall map to point out specific landmarks or areas); "March across the Golden Gate Bridge." "Surf the waves in the Pacific Ocean." "Climb a redwood tree," "Pretend you are an actor and wave to all your fans." "Flex your muscles like Governor Arnold Schwarzenegger." "Stomp grapes." "Pick oranges." "Rollerblade on the boardwalk." "Ski the Sierra Nevada Mountains." "Climb Mount Whitney, the highest peak in the continenta United States." "Crawl through the sand in Death Valley." "Hit a homerun in Pac-Bell Park." "Shoot a foul shot at the Staples Center."

Note. The same concept can be utilized with any state. From Energizers: ClassroomBased Physical Activities (3rd ed.) by M. T Mahar, R. K. Kenny, A. T. Shields. D. P. Scales, and G. Collins, 2006, p. 32, Raleigh: Norih Carolina Department of Public Instruction. Copyright 2006 by the North Carolina Department of Public Instruction. Adapted with permission.


Stable 3 . Mevamnt Lessoni/Actlvltles AccemmDclatlens for Students With ADHD Environmental Supports Keep student's desk/area free from clutter and in an uncluttered area of the room. Provide dear classroom rules and routiries: alerl student when change in routine is going to occur. Seat student near well-behaved, attentive peers, and near front of mom or teacher. Allow student to disetigage from activity or to move to a "free" desk/space if feeling overwhelmed. Designate the student's space: mark off with tape or carpet square. Academic Interventions Break activities into smaller parts and assign individually; give extended time, if needed. Keep directions brief, don't give too many directions at once, and don't rely only on oral directions. Pmvide visual supports such as handouts, outlines, and graphic organizers. Direetly model the activity and specify parameters for movement, volume, contact with others, etc. Provide a peer partner to assist with activities. Behavioral Interventions Give frequent specific verbal praise and reinforcement for desired behavior. Look for signs of stress, fatigue, and frustration, and intervene before behavior problems occur. Provide visual reminders of expected behaviors (picture cue card, point chart, timer). Repeat and model rules and expectations for behavior often; remind students in a calm, non threatening manner. Engage the student in monitoring his or her own behavior (giving self points when on task).

AddiHonal Resources Energizers

East Carolina Utiiversity's "Be Acliue" Program

Incorporating Exercise Activities During Recess

For teachers: http://www.ncpe4me.com/energizers.html g For parents: "Be Active Kids" http://www.beactivekids.org/parents.htmlffmove) Recess Activities
Gatnes Kids Play

Even when engaged in frequent movement activities in the daily classroom routine, recess is the time wben students have the most opportunity to participate in physical exercise. Recess may be even more important for students with ADHD; the benefits of activity may

http://www. games kidsplay. net Basic instructions for traditional children's games and directions for additional classroom ball games, rhymes used for jump-roping, and strength games
Education World

http://www. education-world.com/a_special/physical_fitness.shtml Physical education stories, lessons, resources, and other activities that can be modified for the classroom
Educator's Reference Desk

Exercise increases attention to various cognitive tasks and can help boost academic performance.
go beyond reducing the "fidget factor" (Silver, 2OO5J. Tomporowski and Ellis (1986) suggested that vigorous playground behavior is related to attention to seat work after recess, and that exercise increases attention to various cognitive tasks and can help boost academic performance. Children with ADHD, however, often experience difficulties during recess because they often lack the social skills needed to get along with their peers. They may have difficulty with peer relationships as a result of (a) inability to pick up on social cues, (b) acting impulsively, (c) having limited self-awareness of their effect on others, (d) overpersonalizing another's actions

http: //www. eduref. o rg/cgi -bin/printl essons. cgi/VirtuaI/Lessons/Physical_ Education/Games/GAM0202 .htm! Instructions for chasing, tagging, and ball games [e.g., "Sharks and Barracudas," "Thunderball")
Physical Education Lesson Plan Page

http://members.tripod.com/ "^ pazz/Iesson.html Exercise games (e.g., "Sponge Bob, Gary, & Patrick," "Shark Island," "Hamburger Relay," "Make Books Come Alive")
AtoZ Teacher Stuff

htlp;//www.atozteacherstuff.com/Lesson_Plans/Physical_Education/index.shtml Lesson plans for structured physical activity games and exercises
PE Central

http ://ww w. pecentral.org/adapted/adaptedactivities .html Adaptations for physical activities to use for students with disabilities


as being criticism, and (e) not recognizing positive feedback {Cowan, 2004). Using structured games during recess [see box, "Additional Resources") is a way to teach socially appropriate values and behaviors, including sharing, fairness, and respect. Games also teach listening and responding skills and how to respect personal space, read social signals, cope with leasing, and manage anger. It is imporiani lo maximize the involvement of all the students. For example, with tag games, teachers can design strategies for children to reenter the game quickly to ensure continuous activity among all students. Examples of appropriate accommodations for students with ADHD for activities during recess include (a) assigning a peer partner, (b) giving simple, clear directions, (c) providing frequent monitoring and reinforcement of desired behavior, (d) modeling rules and expectations for behavior, and (e) reminding students of expectations in a calm nonthreatening manner.

not hurt, and chances are they just might helpso get moving! References
Akande. A., VanWyk, C, & Osagie, J, (2000). Importance of exercise and nutrition in the prevention of iliness and the enhancement of heaith. Education, 120. 758-772. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author. Barkley. R. (2004). Adolescents with atteniion-deficit/hyperactivity disorder; An overview of empirically based treatments. Journal of Psychiatric Practice, 70(1). 39-56Carbone, E. (2001). Arranging the classroom with and eye (and ear) to students with ADHD. TEACHING Exceptional Children. 34(2), 72-81. Coco, M., & Sweigard, T. (2004). Children: Exercise, sports and health. Orange Bulletin. Retrieved August 8, 2006. from http://www.zwire.com/site/index.cfm? newsid = 12712425&BRD = 1661&PAG = 461&dept_id = 9538&rfi = 8 Cowan. D, (2004). Teacher tips: Improving social skills in ADHD students. EzineArticles. Retrieved February 12. 2007, from http://ezinearticles.com/?Teacher-Tips:Improving-Social-SkiHs-in-ADHDStudents&id = 4039 Dustman, R.. Emmerson, R.. & Shearer, D. (1990). Aerobic fitness may contribute to CNS health: electrophysioiogical, visual and neurocognitive evidence. Journal of Neurorehahilitation, 4, 241-254.

Final Thoughh
Exercise activities incorporated throughout the day's schedule are important for all students, especially those diagnosed with ADHD; research provides evidence that movement activities throughout the day can help all students with their concentration and attention. The literature from physical education, special education, and neuroscience on the effects of exercise and learning suggests that physical activity is a viable teaching strategy worth implementing. Integrating the general strategy of active response into the curriculum and using varied and interesting movement tasks during classroom transitions, lessons, recess, and gym might have a positive effect on a child's well-being and learning. Engaging students with ADHD in planned frequent movement activities (while providing appropriate accommodations} increases the likelihood that students will experience success. Given the sedentary lifestyles of our youth and the learning problems associated with students with ADHD, these suggestions to get students more active surely will

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MAV/JuNt: 2008 21

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Samaras, A.. Straits, S., & Patrick, S. (1998). Collaborating tbrough movement across disciplines and scbools- Teaching Education. 9(2). 11-20. Silver, L. (2005). How recess promotes focus for ADHD cbildren. AdditudeMag.eom. Retrieved February 27. 2008, from bttp:// www.additudemag.com/adhd/ articie/807.html Slavin, R. [2003). Educational psychology: Theory and practice (7tb ed.), Boston: Allyn & Bacon. Tantillo, M.. Kesick, C, Hynd, G.. & Disbman, R. (2002). Tbe effects of exercise on cbildren witb attention-deficit hyperactivity disorder. Medicine S Science in Sports & Exercise. 34, 203-212. Tomporowski, P., & Ellis, N. (1986). Effects of exercise on cognitive processes: A review. Psychological Bulletin, 99, 338-346. U.S. Department of Education, [2004). Teaching children with attention defieit hyperactivity disorder: Instructional strategies and praetices. Washington, DC: Autbor. Van Puymbroeck, M. (2006). Researeh update: Sports for children with ADHD: Recreation can enhance the Hues of children with ADHD. Ashburn, VA: National Recreation and Park Association. Retrieved February 26. 2008, from bttp:// www.thefreeIibrary.com/Research + update%3a + sports + for + children + with

+ ADHD% 3a + recreation + c a n . . . aOl56651839 Wendt, M. [2000). Tbe effect of an activity program designed with intense pbysical exercise on the bebavior of attention deficit hyperactivity disorder (ADHD) children. Dissertation Abstracts International. 61, 500. Wendt, M. (2001). How running and exercise can impact tbe behavior of children, KidsRunning.com. Retrieved August 8, 2006, from bttp://www.kidsrunning.com/ iiews/krnewsO131adhd.btml Christopher F. Mulrine (CEC NJ Federation). Associate Professor, Speeial Education and Counseling. William Paterson University. Wayne, New Jersey. Mary Anne Prater (CEC UT Federation], Professor, Counseling Psychology and Special Education Brigham Young University, Provo. Utah. Amelia Jenkins CCEC HI Federation), Associate Professor and Chair. Speeial Education and Counseling. University of Hawaii, Honolulu. Address correspondence to Christopher Mulrine, Department of Special Edueation and Counseling. William Paterson University. 300 Pompton Road, Wayne, NJ 07470 (e-mail: nmlrinec@wpunj.edu). TEACHING Exceptional Children, Vol. 40, No. 5. pp. 16-22. Copyright 2008 CEC.

Kathleen Puckett, Ph.D. Associate Professor, Special Education CTEL at the West campus

' he College of Teacher Education State University congratulates

and Leadership (CTEL) at Arizona

Kathleen Puckett on her appointment

as president-elect of the Coutidl for Exceptional Children. We proudly support her leadership and service to the Council for Exceptional Children and applaud all members of this distinguished organization through teaching, leadership atid .service, are making a difference in the lives of individuals with exceptionalities.

r College of Teacher Education & Leadership


ctel.asu.edu : 602-543-6300