Decreasing the inattentive behavior of Jordanian children: a group experiment.

Decreasing the inattentive behavior of Jordanian children: a group experiment. Abstract The present study investigated the efficacy of using response costpaired with Differential Reinforcement reinforcement/re��in��force��ment/ (-in-fors��ment) in behavioral science, the presentation of a stimulus following a response that increases the frequency of subsequent responses, whether positive to desirable events, or of Incompatible Behavior (DRI See Digital Research. ) tomanage the inattentive in��at��ten��tive?adj.Exhibiting a lack of attention; not attentive.inat��ten behavior of 30 students attending third andfourth grade in Jordan. A pretest- posttest post��test?n.A test given after a lesson or a period of instruction to determine what the students have learned. control group design wasemployed to evaluate the efficacy of response cost and DRI. Resultsshowed that students who were instructed using response cost and DRIstrategies reduced their inattentive behavior significantly comparedwith students in the control group. In addition, there was a significantdifference between experimental group means on the posttest andfollow-up, which occurred two weeks following the completion of theintervention. Issues regarding future research and implications forpractice are discussed. ********** Jordan is located at the heart of the Middle East with a populationof approximately 5.9 million and a surface area that is relativelysimilar in size to Pennysylvania. The percentage of youth in Jordaniansociety is relatively high. Using the definition of youth adopted byUNESCO UNESCO:see United Nations Educational, Scientific, and Cultural Organization. UNESCOin full United Nations Educational, Scientific and Cultural Organization (15-24 years), the percentage of youth in the Jordanianpopulation is 23%, while the figure for those below the age of 15 is39.6% (Imaddin, 2004). Taking into consideration the internationalprevalence of disability estimated by the United Nations is 10 %; thismeans that Jordan is expected to have approximately 590,000 individualswith disabilities. Although it has limited resources, Jordan has beenable to achieve notable progress in different areas related todisability. In 1993, Jordan passed the Welfare of Handicapped PersonsLaw, which shifted the responsibility of providing appropriateeducational services for individuals with disabilities from the Ministryof Social Affairs to the Ministry of Education. In addition, theNational Council for the Handicapped was formed to organize and proposepolicies and programs relevant to special education and rehabilitation rehabilitation:see physical therapy. (Hadidi, 1998). Consequently, Jordan has witnessed an increase in terms of publicawareness about disability, an increase in the number of facilities andforms of service delivery, positive changes in supporting partial andfull inclusion efforts in schools and in communities, and improvement inearly intervention ear��ly interventionn. Abbr. EIA process of assessment and therapy provided to children, especially those younger than age 6, to facilitate normal cognitive and emotional development and to prevent developmental disability or delay. programs targeting young children and their families.Currently, universities in Jordan AjlunAmmanAl-Ahliyya Amman University http://www.amman.edu/ Amman Arab University for Higher Studies http://www.aau.edu.jo/ Applied Science Private University http://www.asu.edu.jo/ Arab Open University http://www.arabou-jo.edu. graduate a number of highly qualifiedspecial educators each year to teach children with disabilities indifferent settings (Yousef & Hadidi, 1992). Attention Deficit Hyperactivity Disorder attention deficit hyperactivity disorder(ADHD), formerly called hyperkinesis or minimal brain dysfunction, a chronic, neurologically based syndrome characterized by any or all of three types of behavior: hyperactivity, distractibility, and impulsivity. (ADHD Attention-Deficit/Hyperactivity Disorder (ADHD)DefinitionAttention-deficit/hyperactivity disorder (ADHD) is a developmental disorder characterized by distractibility, hyperactivity, impulsive behaviors, and the inability to remain focused on tasks or ) is one of thedisorders that has not received much attention from professionals andthe community in general in Jordan. One reason that might explain thisis the difficulty in distinguishing ADHD from learning disabilities.According to according toprep.1. As stated or indicated by; on the authority of: according to historians.2. In keeping with: according to instructions.3. Mercer mer��cer?n. Chiefly BritishA dealer in textiles, especially silks.[Middle English, from Old French mercier, trader, from merz, merchandise, from Latin merx (1992), 20% to 75% of children who are identified ashaving learning disabilities are eligible to be identified as havingADHD. Therefore, it is possible that a number of Jordanian children, whoare referred to special education due to learning disabilities, mightmanifest ADHD symptoms. Lack of knowledge, resources, and skills toidentify this population and provide them with appropriate servicesevoked e��voke?tr.v. e��voked, e��vok��ing, e��vokes1. To summon or call forth: actions that evoked our mistrust.2. the efforts to conduct this research study in Jordan. ADHD is a developmental disorder developmental disorderPsychiatry An impairment in normal development of language, motor, cognitive and/or motor skills, generally recognized before age 18 which is expected to continue indefinitely and constitutes a substantial impairment Etiology Mental characterized by inattentive,hyperactive hy��per��ac��tiveadj.1. Highly or excessively active, as a gland.2. Having behavior characterized by constant overactivity.3. Afflicted with attention deficit disorder. , and impulsive behaviors impulsive behavior,n action initiated without due consideration or thought as to the costs, results, or consequences. . It is estimated that theprevalence of this disorder is between 3%-5% of the preschool andelementary school elementary school:see school. population (Barkley, 1998). Children with ADHD oftenexhibit high rates of off-task behaviors, have trouble finishing theirassignments on time with an adequate level of accuracy, engage in highrates of disruptive behaviors, and often feel isolated (Purdie, Hattie,& Caroll, 2002). Given the numerous responsibilities assumed byteachers in regular education classrooms, having a student with ADHD cancause teachers anxiety as they attempt to meet the needs of all theirstudents. Therefore, designing effective, reliable, and empiricallybased classroom interventions is critically important to improve theacademic performance and social development of young children whomanifest ADHD characteristics. Behavioral Interventions behavioral interventionBehavior modification, behavior 'mod', behavioral therapy, behaviorism Psychiatry The use of operant conditioning models, ie positive and negative reinforcement, to modify undesired behaviors–eg, anxiety. To date, extensive research has been conducted on the efficacy ofvarious types of interventions to decrease the inattentive behavior ofchildren with ADHD. A primary treatment option is the behavioralapproach, which relies on using reinforcement and punishment strategiesto increase desirable behavior, and decrease the occurrence ofunacceptable behaviors (Purdie et al., 2002). A variety of behavioraltechniques behavioral techniquePsychiatry Any coping strategy in which Pts are taught to monitor and evaluate their behavior and to modify their reactions to pain have been used to improve children's attentive at��ten��tive?adj.1. Giving care or attention; watchful: attentive to detail.2. Marked by or offering devoted and assiduous attention to the pleasure or comfort of others. behaviors, advance academic performance, and support social behavior In biology, psychology and sociology social behavior is behavior directed towards, or taking place between, members of the same species. Behavior such as predation which involves members of different species is not social. .Across behavioral techniques, response cost appears to be one powerfulapproach for establishing behaviors that are conducive con��du��cive?adj.Tending to cause or bring about; contributive: working conditions not conducive to productivity.See Synonyms at favorable. to classroomlearning (DuPaul, Guevremont, & Barkley, 1992; Gordon, Thomason,Cooper, & Ivers, 1991; Sullivan & O'Leary, 1990). Responsecost involves losing privileges in response to inappropriate behaviors(Fiore, Becker, & Nero, 1993). Interventionists tend to pairpositive reinforcement positive reinforcement,n a technique used to encourage a desirable behavior. Also calledpositive feedback, in which the patient or subject receives encouraging and favorable communication from another person. for appropriate behaviors with those that includeloss of privileges for the occurrence of inappropriate behaviors. Forexample, Sullivan and O'Leary compared the effects of response costand rewards on maintaining high rates of on-task behavior after fadingan intervention. Results showed that all 10 children maintained theirrates of on-task behavior after fading the response cost, and half ofthe children continued to do so after the reward system was terminated.In another study, response cost was compared with token reinforcement(McGoey & DuPaul, 2000). Both strategies were effective in reducingdisruptive behavior, but teachers had more favorable fa��vor��a��ble?adj.1. Advantageous; helpful: favorable winds.2. Encouraging; propitious: a favorable diagnosis.3. comments aboutresponse cost. Kelly and McCain (1995) compared the utilization ofhome-school home��schoolor home-school ?v. home��schooled, home��school��ing, home��schoolsv.tr.To instruct (a pupil, for example) in an educational program outside of established schools, especially in the home. notes with and without response cost to increase academicproductivity and appropriate behavior. Findings indicated thathome-school notes with response cost were more efficacious ef��fi��ca��cious?adj.Producing or capable of producing a desired effect. See Synonyms at effective.[From Latin effic than noteswithout response cost. Researchers have contrasted the effectiveness of negative andpositive consequences on academic performance and on-task behavior. Forinstance, Pfiffner and O'Leary (1987) assessed the effectiveness offour behavioral conditions on the on-task behavior and academicproductivity of 8 elementary children with behavioral and academicproblems. The conditions included: regular positive reinforcement,enhanced reinforcement, enhanced reinforcement and reprimand REPRIMAND, punishment. The censure which in some cases a public office pronounces against an offender. 2. This species of punishment is used by legislative bodies to punish their members or others who have been guilty of some impropriety of conduct towards them. , andenhanced reinforcement after fading the reprimands. The researchersconcluded that by using a combination of positive and negativeconsequences the students' on-task behavior and academicperformance incrementally improved, and continued after gradually fadingthe negative consequences. While the researchers asserted the efficacyof using negative consequences to control inappropriate behaviors, theyemphasized the importance of positive consequences to maintainimprovement in the target behaviors. Following the same logic, Kazdin (2001) asserted that rewardingincompatible behaviors could lead to more rapid change in challengingbehaviors. Differential Reinforcement of Incompatible Behavior (DRI)involves decreasing the occurrence of undesirable behavior byreinforcing an opposing behavior (Kazdin, 2001). For instance, Lock-woodand Bourland (1982) used DRI to decrease finger biting bitingpertaining to the characteristic behavior of performing a bite.biting lousesee species of the insect suborder mallophaga.biting midgeinsects of the family ceratopogonidae. for an individualwith intellectual disabilities by differentially reinforcing sustainedtoy play. A series of studies has shown the positive effects of combiningresponse cost with positive techniques on decreasing children'sinattentive behavior (DuPaul et al., 1992; McGoey & DuPaul, 2000;Rapport The former name of device management software from Wyse Technology, San Jose, CA (www.wyse.com) that is designed to centrally control up to 100,000+ devices, including Wyse thin clients (see Winterm), Palm, PocketPC and other mobile devices. , Murphy, & Bailey, 1982; Sullivan & O'Leary, 1990).However, research findings are limited due to small sample sizes andminimal follow up. Given the research to date, it appears that DRI couldbe a powerful strategy to use concurrently with response cost. To ourknowledge, no study has investigated the use of DRI combined withresponse cost to increase the attentive behavior of elementary schoolstudents. Solanto (1990) conducted an intervention study with 20 preschoolerswith ADHD to investigate the effects of: a) rewards on students'abilities to wait before responding (delayed response) and b) responsecost on children's impulsiveness im��pul��sive?adj.1. Inclined to act on impulse rather than thought.2. Motivated by or resulting from impulse: such impulsive acts as hugging strangers; impulsive generosity. . Findings indicated that therewere no statistically significant differences in the effects of rewardsand response cost in decreasing children's impulsiveness albeit aslight positive change was observed under the response cost condition.In another study, Carlson, Mann, and Alexander (2000) examined theeffects of response cost and rewards on the ability of 40 middle schoolage students with ADHD to finish assignments and correctly completeproblems. Results revealed that response cost was more effective thanrewards in improving the students' academic performance.Additionally, "neither reward nor response cost negatively affectedself-reported performance perceptions or motivation, or a behavioralmeasure of intrinsic motivation" (Alexander, 2000, p. 95). Theresearchers did note that response cost had more of an impact on thestudents' intrinsic motivation than rewards. The modest results ofthese two studies suggest a need for additional group design studies toassess the efficacy of response cost and positive reinforcement onmotivation and on other problem areas characteristic of ADHD. Young children with ADHD start to manifest symptoms at an earlyage, yet they are rarely noticed until they reach elementary school whenacademic demands increase. Therefore, research is warranted toinvestigate the use of behavior management behavior managementPsychology Any nonpharmacologic maneuver–eg contingency reinforcement–that is intended to correct behavioral problems in a child with a mental disorder–eg, ADHD. See Attention-deficit-hyperactivity syndrome. strategies with large groupsof children in regular education settings. Specifically, response cost,which has proven to be effective in single subject design research,should be further studied. In addition, there is a need for researchersto investigate other behavioral strategies such as DRI, which mightcompliment response cost. The current study examined the effects of response cost and DRI onthe inattentive behavior of 30 elementary-age children with attentionproblems in Jordan. The rationale for this combination of procedures wasthat together the two interventions could help minimize inattentivebehavior and prolong pro��long?tr.v. pro��longed, pro��long��ing, pro��longs1. To lengthen in duration; protract.2. To lengthen in extent. students' attention span, and yet be utilizedefficiently by teachers. Each procedure was expected to decreaseinattentive behavior, but response cost was hypothesized to be moreeffective than DRI. A group design was used to investigate the efficacyof the procedures and to assess maintenance of gains. This studyattempted to answer the following research questions: (a) are theresignificant differences between the control and experimental groups interms of changes in inattentive behavior? and (b) if students in theexperimental group display positive changes in attentive behavior, willthis progress be maintained after fading the intervention? Method Experimental Design This study used a pretest-posttest control group design (Gay &Airasian, 2000). This design was selected because it provides acombination of random assignment with the presence of apretest-post-test and comparison group, which serves to control threatsto internal validity Internal validity is a form of experimental validity [1]. An experiment is said to possess internal validity if it properly demonstrates a causal relation between two variables [2] [3]. . Participants and Setting Participants were recruited from eight elementary schools withresource rooms that were located in three school districts in Amman, thecapital of Jordan. Using an ADHD checklist, the resource room teachersidentified 154 third and fourth graders who were at risk for havingADHD. The first author selected the first 60 students, who obtained thehighest scores on an ADHD checklist, to participate in this study. Noneof these children were taking medication. The 60 children were randomlyassigned to two cohorts that represented an experimental and a controlgroup. Each group included 30 children from diverse socioeconomic so��ci��o��ec��o��nom��ic?adj.Of or involving both social and economic factors.socioeconomicAdjectiveof or involving economic and social factorsAdj. 1. classes. Children in both the experimental and control groups attendedprivate and public schools. The children who attended private schoolscame from higher socioeconomic classes as tuition was much moreexpensive than in the public schools. The sample was comprised of 33boys and 27 girls, between the ages of 8 and 9 years (see Table 1).Parental consent Parental consent laws (also known as parental involvement or parental notification laws) in some countries require that one or more parents consent to or be notified before their minor child can legally engage in certain activities. was secured prior to the onset of the study. In sum,the two groups were very similar in terms of grade, gender, and scoreson the ADHD checklist. The intervention was implemented by the 12 special educators whoworked in these eight targeted resource rooms. Teachers varied in theireducational levels (from two years of college through master degrees inspecial education), and teaching experiences (range = 3-10 years). Allteachers were between 25-33 years of age. After identifying potentialschools to participate in the study, the first author secured a formalletter from the district administration urging the principals andteachers to facilitate the research mission in their schools. Next,principals and teachers were approached personally, and told about studygoals and procedures. The author pointed out potential gains thatteachers and students would attain from participating in this study. All12 special educators who worked in these eight schools agreed toparticipate. The study was conducted in the resource rooms within the eightelementary schools. Typical service delivery was provided to studentparticipants 3-5 times per week using a pull-out model by a specialeducator. Each resource room was furnished fur��nish?tr.v. fur��nished, fur��nish��ing, fur��nish��es1. To equip with what is needed, especially to provide furniture for.2. with tables and chairsappropriate to the students' age and physical size. These roomsalso contained a variety of instructional materials. Services weredelivered to students in two formats: one to one and within smallgroups. The format and duration of special education services were basedon a comprehensive evaluation, which had been conducted by the NationalCenter for Evaluation prior to the students receiving a specialeducation diagnosis. Dependent Variable Based on the DSM 1. DSM - Data Structure Manager.An object-oriented language by J.E. Rumbaugh and M.E. Loomis of GE, similar to C++. It is used in implementation of CAD/CAE software. DSM is written in DSM and C and produces C as output. IV's (American Psychiatric Association The American Psychiatric Association (APA) is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the most influential world-wide. Its some 148,000 members are mainly American but some are international. , 1994)description of common characteristics related to the inattentive type ofADHD, a checklist of 11 statements was developed in the teachers'home language (see Table 2). A three-point Likert scale Likert scaleA subjective scoring system that allows a person being surveyed to quantify likes and preferences on a 5-point scale, with 1 being the least important, relevant, interesting, most ho-hum, or other, and 5 being most excellent, yeehah important, etc was developed (0= behavior described in statement never occurs; 1 = behavior describedin statement rarely occurs; 2 = behavior described in statementfrequently occurs) to rate target children. Total scores ranged from 0to 22, with high scores indicating the presence of more inattentivebehavior. The checklist was administered twice by the teachers, one timebefore intervention and once following the completion of intervention. The checklist was validated by distributing it to 20 individualswho had experience with children with ADHD. These individuals includedprofessors from special education and counseling, and special educationteachers in Jordan. Feedback from these "experts" focused onthe language of the 11 statements, since it was a verbatim ver��ba��tim?adj.Using exactly the same words; corresponding word for word: a verbatim report of the conversation.adv. translationof the original material. Based on their feedback, the language wasmodified to reflect the exact meaning, which was conveyed through thestatements in their original language. The checklist was returned to thesame individuals to ensure that their comments were included assuggested, and to approve the final version of the checklist.Subsequently, 20 children were randomly chosen from resource rooms in 20schools not targeted for inclusion in this study. The checklist wasadministered by teachers to these 20 children twice, two weeks apart.Test-retest reliability test-retest reliabilityPsychology A measure of the ability of a psychologic testing instrument to yield the same result for a single Pt at 2 different test periods, which are closely spaced so that any variation detected reflects reliability of the instrument on the checklist was .84. Procedures Pre-intervention. Observational data were collected during theregular routines in the resource rooms. Teachers were asked to continuedoing what they usually did in their rooms. The control group remainedin this phase throughout the study while the experimental groupproceeded through the following phases (see Table 3). Teacher training. Teachers, who implemented the intervention,received 10 hours of training over two weeks prior to the start to thestudy. During the first week, teachers were provided with informationabout ADHD, response cost, DRI, environmental arrangement, and how toconduct the intervention. The following week, the first author conductedindividual training sessions to demonstrate the procedures. Strategiessuch as modeling, role play, feedback, and direct instruction were usedduring the training sessions. At the end of training, teachers wereprovided with a vignette VignetteA symbol or pictorial representation of the corporation on a stock certificate. Usually a complicated and artistic design, it is meant to make the counterfeiting of stock certificates as difficult as possible. that illustrated intervention procedures. Theyalso were provided with guidelines guidelines,n.pl a set of standards, criteria, or specifications to be used or followed in the performance of certain tasks. on how to conduct observations andutilize environmental arrangement inside their resource rooms. Teachersin the experimental group implemented the intervention for six weeks. Introducing the new strategies. The 12 resource room teachersexplained to their students that they would begin doing some new thingsin class to help strengthen their attention skills. Given individualdifferences in student behaviors, the first author and teachers selectedthe most severe inattentive behaviors that affected each student'slearning. These behaviors were selected using the ADHD checklistpreviously described. To determine which behaviors interfered with astudent's learning, teachers observed each student for fiveconsecutive sessions, 45 minutes for each session, using momentary mo��men��tar��y?adj.1. Lasting for only a moment.2. Occurring or present at every moment: in momentary fear of being exposed.3. Short-lived or ephemeral, as a life. timesampling. The teachers then created a poster, which contained a list ofincompatible behaviors for the chosen inattentive behaviors (e.g., payattention to the teacher, follow the teacher's instructions, beorganized in your assignments, try to finish your assignments on time,go through your answers after you finish, do not forget your materials,listen carefully to directions). These behaviors were stated in apositive way, listed in an attractive style on a poster using coloredmarkers. The poster was hung on the wall facing the student's seat.The goal of listing the incompatible behaviors on a poster was toprovide a visual prompt to keep the student focused during the sessions. The next step was to organize the classroom environment to supportstudents' attention to the task at hand. For example, teachers wereinstructed to close the blinds, put extraneous ex��tra��ne��ous?adj.1. Not constituting a vital element or part.2. Inessential or unrelated to the topic or matter at hand; irrelevant. See Synonyms at irrelevant.3. materials out of thestudent's sight prior to starting a new task (e.g., paper,markers), and cover the closets with curtains so that toys were notvisible. Each intervention session lasted 40 minutes; it was divided intoeight 5-minute intervals. The teachers told the students that they wouldbe provided with eight smiley See emoticon. smiley - emoticon faces per session, and the only way tokeep them was by paying attention Noun 1. paying attention - paying particular notice (as to children or helpless people); "his attentiveness to her wishes"; "he spends without heed to the consequences"attentiveness, heed, regard . Also, students were told that theycould earn an extra smiley face each time they sustained their attentionduring one of the 5-minute intervals (i.e., they could possibly earn 8extra smiley faces on the top of the 8 points they already earned). Thestudents also were informed that if they lost a smiley face during anyinterval, they would lose the opportunity to earn an extra smiley facewithin that same interval. Prior to intervention, the first author asked student participantsto list 15 highly desirable items or rewards. Rewards varied from foodreinforcers (e.g., lollipops, gum) to materials (e.g., Pokemon toys,stickers, books). These tangible rewards were not available during thetypical school day. At the end of each training session, studentscounted their smiley faces and exchanged them for reinforcers of theirchoice. A reward menu was developed listing the value of eachreinforcer reinforcer/re��in��forc��er/ (-in-for��ser) any stimulus that produces reinforcement, a positive r. being a desirable event strengthening responses preceding its occurrence and a negative r. . For instance, if a student earned 10 smiley faces, at theend of the session, the student would go to the "smiley facetable" and see what reinforcer he/she could select for 10 smileyfaces. The number of smiley faces that could be earned by a student in asession ranged from 0 to 16. Intervention package. An intervention package that included: (a)visual prompts (in the form of charts), (b) reduced environmentalstimulation, (c) DRI, and (d) response cost was implemented. At thebeginning of the intervention phase the teacher hung each student'sposter (that included the incompatible behaviors) and arranged theclassroom environment to decrease external stimuli. Each student wasgiven eight smiley faces at the beginning of each session. The teacherreminded the student of the desirable and undesirable behaviors. Theteacher taught each student as usual based on the student's goals,which were recorded on the individualized in��di��vid��u��al��ize?tr.v. in��di��vid��u��al��ized, in��di��vid��u��al��iz��ing, in��di��vid��u��al��iz��es1. To give individuality to.2. To consider or treat individually; particularize.3. educational plan. If a studentwas not paying attention, he/she would lose one smiley face, would beinformed of the reason for the deduction, and would lose the opportunityto earn an extra smiley face at the end of that interval. If the studentdid not lose any smiley faces during an interval, the teacher initiatedeye contact with the student, praised the student for his/her attentivebehaviors, and added an extra smiley face to the student'scollection. Losing smiley faces for manifesting inattentive behaviorrepresented the implementation of response cost, while rewardingattentive behavior with extra smiley faces was DRI. A recording sheet was developed to help the teachers keep track ofthe smiley faces. The teacher and the student were seated at a table andthe smiley face sheet was placed between the teacher and student orsmall group of students (less than three students). The sheet containeda grid showing the eight intervals with enough space to record the extrasmiley faces. At the top of the sheet, eight smiley faces were drawn;the loss of a smiley face was noted by drawing an "X" throughit. Fidelity. Observations to assess fidelity of implementation wereconducted throughout the study by two trained graduate students who wereblind to the purpose of the study. These observers were trained by thefirst author to 100% accuracy on written tests and 85% agreement onobservational coding. Observations, using a 6 point fidelity checklist(see Table 4), occurred once weekly throughout the six weeks of thestudy. Each observation lasted for 40 minutes, and data were collectedacross the entire observation period. Teachers were provided withfeedback on their implementation of the intervention on the days whenfidelity measures were taken. Agreement was assessed in 25% of allobservational sessions across participants, and the overall meanagreement was 98.5%, with a range from 88.5%-100%. Agreement wascalculated by dividing the number of agreements by the number ofagreements plus disagreements and then multiplying by 100. Post intervention. After ceasing intervention, teachers were askedto rate the inattentive behavior of the students using the ADHDchecklist. Follow-up. The teachers rated the students' attention aftertwo weeks of no intervention, using the same checklist. Given timeconstraints In law, time constraints are placed on certain actions and filings in the interest of speedy justice, and additionally to prevent the evasion of the ends of justice by waiting until a matter is moot. , the first author randomly chose one resource room classsession per student and asked the teacher to rate the student'sattention during that selected class. Results Examination of the adjusted means of the students' scores onthe inattention in��at��ten��tion?n.Lack of attention, notice, or regard.Noun 1. inattention - lack of attentionbasic cognitive process - cognitive processes involved in obtaining and storing knowledge section of the ADHD checklist, prior to intervention,showed no significant differences between the experimental and controlgroups. The mean score for the control group was 17.07, whereas theexperimental group mean was 16.63. After implementing the intervention,an ANOVA anovasee analysis of variance.ANOVAAnalysis of variance, see there for efficiency ratio yielded a significant main effect for theexperimental group F (1, 57) = 165.20, p < .0001, with an effect size3.1. This indicated that the behavioral intervention had a significanteffect in decreasing inattentive behavior (see Table 5). Furthermore,significant differences between the adjusted means of the students'scores on the checklist for the experimental group before and afterintervention, and during follow-up showed positive changes instudents' attentive behaviors. Means after intervention and forfollow-up were 4.6 and 5.3 respectively; the pretest pre��test?n.1. a. A preliminary test administered to determine a student's baseline knowledge or preparedness for an educational experience or course of study.b. A test taken for practice.2. mean was 16.63. Additionally, using a t test for dependent samples, posttest meanswere compared to follow-up means to see if participants in theexperimental group maintained decreased levels of inattentive behavior t(1,29) = -2.21, p < .035 (See Table 6). Results showed that theintervention effect was sustained once treatment was faded. A minimumincrease in inattentive behavior was noted. Discussion The findings from this study indicate the efficacy of response costpaired with DRI on the inattentive behavior for a group of 30 third andfourth grade students. The results indicate that the use of responsecost and DRI contingencies were associated with substantial improvementamong students in the experimental group. These findings supportprevious research using single subject designs, which have shown thatresponse cost is more effective in decreasing children'sinattentive behavior when it is paired with other strategies (Du-Paul etal., 1992; Gordon, Thomason, et al., 1991; Sullivan & O'Leary,1990) The current study was conducted in Jordan, where most of theteachers are not fully aware of the characteristics of and recommendedpractices for working with students with attention problems, such asstudents with ADHD. Additionally, researchers had not previouslyinvestigated the cultural appropriateness of response cost and DRI.These facts amplified the desire to implement this intervention withinthe cultural context of Jordanian schools. It became evident thatimplementing response cost and DRI strategies in resource rooms byJordanian special education teachers, who knew little about behavioralintervention and ADHD, demanded the development of a comprehensiveprogram to educate teachers about the characteristics of ADHD as well asbehavioral intervention programs. An underlying premise was that response cost would be effective indecreasing the inattentive behavior of third and fourth graders.Nevertheless, it was not clear how response cost would operate incombination with DRI, or if DRI would maximize the efficacy of responsecost. To obtain successful and systematic implementation of thestrategies, and to assess their effects, teachers were exposed totheoretical and practical training. Teachers also were coached onenvironmental arrangement strategies to assure that the intervention wasimplemented within a supportive classroom environment. Due to thelimited resources and scarcity ScarcityThe basic economic problem which arises from people having unlimited wants while there are and always will be limited resources. Because of scarcity, various economic decisions must be made to allocate resources efficiently. of in-service training for Jordanianteachers, this research project created an opportunity to train teachersto be coaches for other professionals and parents within their settings.Providing immediate and constructive feedback to teachers about theirperformance was crucial to secure the proper implementation of theintervention. Anecdotal anecdotal/an��ec��do��tal/ (an?ek-do��t'l) based on case histories rather than on controlled clinical trials. anecdotaladjective Unsubstantiated; occurring as single or isolated event. information suggested that teachers became more confidentand comfortable in implementing the procedures. Teachers also expressedsatisfaction with the intervention, because it provided them withpractical methods to improve the attentiveness at��ten��tive?adj.1. Giving care or attention; watchful: attentive to detail.2. Marked by or offering devoted and assiduous attention to the pleasure or comfort of others. of their students.Teachers reported that DRI/response cost interventions could be easilyimplemented with little effort and time. Additionally, the interventionprovided the teachers with several skills that would help them in theirwork inside the classroom (e.g., conducting clinical observations,designing task analyses, and preparing homework in attractive formats). Drawing attention to the characteristics of ADHD in Jordan mighthelp increase public awareness, evoke e��voke?tr.v. e��voked, e��vok��ing, e��vokes1. To summon or call forth: actions that evoked our mistrust.2. problem solving problem solvingProcess involved in finding a solution to a problem. Many animals routinely solve problems of locomotion, food finding, and shelter through trial and error. , highlight effortsto work cooperatively toward serving children with ADHD, and stress theimportance of intervening early to lessen less��en?v. less��ened, less��en��ing, less��ensv.tr.1. To make less; reduce.2. Archaic To make little of; belittle.v.intr.To become less; decrease. the potential effects of ADHDon children's social and academic development. Research on ADHD canhelp focus the attention of professionals, parents, researchers, andothers on the negative consequences that this disability can have onchildren in schools and within the community. The teachers in thecurrent study became more aware of the prevalence and characteristics ofADHD, but there are still many Jordanian professionals who need to beeducated about ADHD. Therefore, more intervention research is warrantedto improve public awareness as well as provide educators, parents, andother professionals with strategies to use with students who displayADHD characteristics. Although this study was the first of its kind inJordan, it extends the previous research by investigating the efficacyof combining other strategies (i.e., DRI) with response cost and byusing group methodology. The stability of positive behavior change Behavior change refers to any transformation or modification of human behavior. Such changes can occur intentionally, through behavior modification, without intention, or change rapidly in situations of mental illness. after fading anintervention is critically important. Follow up results revealed thatstudents in the experimental group retained gains two weeks after fadingthe intervention. These follow-up results could be explained in twoways. First, the students might have sensed the positive outcomes of theintervention and begun to self-monitor their own behavior moreeffectively. Teachers reported that students made considerable progresson their academic tasks and social behaviors as a result of theintervention. One teacher noted that the students were reminding eachother of the incompatible behaviors, or prompting each other to be moreattentive. These comments imply that the students started to becomeself-driven to prolong their attention span, because the results weretangible and met their interests. On the other hand, it is possible thatDRI succeeded in establishing new behaviors that were beneficial forstudent learning and social interaction. This pairing of positive andnegative strategies is similar to the principle applied in Pfiffner andO'Leary's (1997) research. There are several limitations to this research such as the lack ofsocial validation data to ensure that gains were significantly apparentto teachers and parents. The results were derived using only onemeasurement tool, the inattentive section of the ADHD checklist.Therefore, behavioral change was limited to symptoms listed on thatchecklist, which focused on attention. It should be noted that theresearchers did not intend to diagnose diagnose/di��ag��nose/ (di��ag-nos) to identify or recognize a disease. di��ag��nosev.1. To distinguish or identify a disease by diagnosis.2. participating children or tolabel them. The lack of culturally appropriate assessment tools inArabic motivated the first author to utilize available resources todesign a checklist for use with children with inattentive behavior.Nevertheless, more work should be done related to the validity andreliability of this checklist before it can be utilized to assess ADHD. Additionally, the dual role for the teachers was a limitation.Implementing the intervention as well as rating target children'sbehavior might have encouraged teachers to rate those who participatedin the intervention more highly. Also, participating teachers hadchildren from both the control and experimental group on their caseload case��load?n.The number of cases handled in a given period, as by an attorney or by a clinic or social services agency.caseloadNoun .This might have interfered with their objectivity in implementation. Itshould be noted that Jordan is not a diverse country; in general Jordanis a fairly homogenous homogenous - homogeneous population although there are socioeconomicdifferences. Due to reasons related to parents' consent and schoolregulations, the first author was not able to gather enough informationon students' socioeconomic status socioeconomic status,n the position of an individual on a socio-economic scale that measures such factors as education, income, type of occupation, place of residence, and in some populations, ethnicity and religion. to conduct further analyses ondemographic characteristics. Although the intervention package reduced the inattentive behaviorsof students with ADHD, identifying which facets of the package were mostefficacious must still be investigated. Future research also iswarranted to study the efficacy of response cost and DRI on other typesof behaviors that are characteristic of ADHD. In addition, there is aneed to continue using group methodology to study large groups ofdiverse participants. Researchers should pay attention to the short andlong term effects of intervention techniques in school as well as inhome and community settings. In the current study, special educationteachers were the sole implementers of the intervention. Future researchshould target parents and general educators as interventionists.Moreover, future research should focus on generalization gen��er��al��i��za��tionn.1. The act or an instance of generalizing.2. A principle, a statement, or an idea having general application. from school tohome or to other settings, and the efficacy of building partnershipsbetween home and school in the provision of services to students withattention problems. Acknowledgments The preparation of this manuscript was supported by the Center forEvidence-based Practice: Young Children with Challenging Behaviors(Office of Special Education Programs, U.S. Department of Education(H324Z010001) and the Center on the Social and Emotional Foundations forEarly Learning, US Department of Health and Human Services Noun 1. Department of Health and Human Services - the United States federal department that administers all federal programs dealing with health and welfare; created in 1979Health and Human Services, HHS (PHS (Personal Handyphone System) A TDMA-based cellular phone system introduced in Japan in mid-1995. Operating in the 1880-1930 MHz band, PHS uses microcells that cover an area only 100 to 500 meters in diameter, resulting in lower equipment costs but requiring more base 90YD0119). The authors wish to express their appreciation for theteachers and students who participated in this study. 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(1992). Families of childrenwith disabilities in Jordan. International Journal of Disability,Development, and Education. 39, 127-133. Hasan Y. Zaghlawan Michaelene M. Ostrosky University of Illinois at Urbana-Champaign Early years: 1867-1880The Morrill Act of 1862 granted each state in the United States a portion of land on which to establish a major public state university, one which could teach agriculture, mechanic arts, and military training, "without excluding other scientific Jamal M. Al-Khateeb University of Jordan The University of Jordan (Arabic الجامعة الأردنية), founded in 1962, is the first university established in Jordan. It is located in the Jubeiha Area, District of University, Amman. Correspondence to Hasan Y. Zaghlawan, Department of SpecialEducation, University of Illinois at Urbana-Champaign, 288 Education,1310 S. Sixth Street, Champaign, Illinois “Champaign” redirects here. For topics with similar names, see Champagne.Champaign is a city in Champaign County, Illinois, in the United States. As reported in the 2000 U.S. Census, the city was home to 67,518 people. 61820; e-mail:zaghlawa@uiuc.edu.Table 1 Participant Characteristics Boys Girls 3rd grade 4th grade 3rd grade 4th gradeExperimental 9 9 5 7Control 9 6 6 9Table 2 Inattentive Symptoms of Children with ADHDChildren with ADHD: 1. Fail to pay close attention to details 2. Have difficulty sustaining attention to tasks or play activities 3. Do not seem to listen when spoken to directly 4. Do not follow through on instructions 5. Fail to finish schoolwork, chores, or duties 6. Have difficulty organizing tasks and activities 7. Lose things necessary for tasks or activities (e.g., toys, school assignments, pencils, books) 8. Are easily distracted by extraneous stimuli 9. Are forgetful during daily activities10. Make careless mistakes in schoolwork or other activities11. Avoid, dislike, or are reluctant to engage in tasks that require sustained cognitive effort such as schoolwork or homeworkTable 3 Study Procedures for the Experimental GroupPre- intervention Intervention Post- intervention Follow upPretest (inattentive six weeks of Posttest Two weeks section of ADHD intervention (inattentive after ceasing checklist) section of ADHD intervention checklist)Observations to Fidelity determine the observation most problematic behaviors (5 sessions at 45 min each)Table 4 Fidelity Checklist1. Teacher reminds the student of the desirable behaviors2. Teacher specifies behaviors that are incompatible with inattentive behaviors3. Teacher informs the student the reason behind the deduction4. Teacher awards or deducts smiley faces based on student attention5. Teacher exchanges the smiley faces based on the reward menu6. Teacher arranges the classroom environment to support student's on- task behaviorTable 5 ANOVA Between the Experimental and Control Group Means on thePosttestSource df SS MSS F Cohen's d pSource 1 142.62 142.06 11.54 .0001Groups 1 2033.46 2033.046 165.20 3.1 .0001Error 57 701.61 12.31Total 59 2955.93Table 6 t test for Dependent Samples Between Posttest and Follow-up forthe ExperimentalGroup df M SD t pPosttest--follow-up 29 -.833 2.069 -2.21 .035