Teaching English to students with Attention Deficit Hyperactivity Disorder (ADHD)

Education in the Knowledge Society 25 (2024) Education in the Knowledge Society journal homepage http://revistas.usal.es/index.php/eks/ 25 - 1 Recibido, 03/01/2023. Revisado, 17/04/2023. Aceptado, 24/05/2023. Publicado, 13/05/2024 e-ISSN: 2444-8729 Teaching English to Students with Attention Deficit Hyperactivity Disorder (ADHD) La enseñanza del inglés al alumnado con TDAH Ana Ma Pérez-Cabelloa(*), Margarita Gil-Pérezb, Francisco Jesús Oliva-Pérezc a Departamento de Didáctica de la Lengua y de la Literatura y Filologías Integradas, Facultad de Ciencias de la Educación, Universidad de Sevilla, Sevilla, España. https://orcid.org/0000-0001-9650-9730 [email protected] b Departamento de Didáctica de la Lengua y de la Literatura y Filologías Integradas, Facultad de Ciencias de la Educación, Universidad de Sevilla, Sevilla, España. https://orcid.org/0009-0002-6069-8562 [email protected] c Universidad de Sevilla, Sevilla, España https://orcid.org/0009-0005-6097-6560 olivaperezfr[email protected] ABSTRACT This research aims to study how teaching English to students with Attention Deficit Hyperactivity Disorder (ADHD) is developed and adapted. This study will allow us to discover the most effective strategies and methods to improve the teaching of L2 for ADHD students. To this end, a survey is delivered to English teachers in 8 schools in Condado de Huelva (Andalusia, Spain). Results show how teachers adapt their teaching favourably to these children. They employ various measures, strategies, and methods to provide ADHD students with skills to acquire English. Results are consistent with other researchers´ studies on teaching English to ADHD students. They show that these methods and strategies best suit students’ attention and movement needs. RESUMEN Este trabajo persigue estudiar el desarrollo y adaptación de la enseñanza de inglés al alumnado con Trastorno por Déficit de Atención e Hiperactividad (TDAH). Dicho estudio nos permitirá descubrir las estrategias y métodos más efectivos para mejorar la enseñanza de inglés a estos estudiantes. Para ello, se realiza una encuesta destinada a docentes de inglés de 8 centros educativos de la zona de Condado de Huelva (Andalucía, España). Los resultados muestran que el profesorado adapta favorablemente la enseñanza del inglés a estos escolares. Emplean una serie de medidas, estrategias y métodos que resultan útiles para dotar a estas personas de las destrezas necesarias para la adquisición del inglés como L2. Estos resultados concuerdan con otras investigaciones sobre el tema. Muestran que estos métodos y estrategias son los que mejor se ajustan a las necesidades de atención y movimiento que requieren estos estudiantes. (*) Autor de correspondencia / Corresponding author ARTICLE INFO Keywords ADHD, English, methodology, strategies, methods, teaching Palabras clave TDAH, inglés, metodología, estrategias, métodos, enseñanza Ediciones Universidad de Salamanca | https://doi.org/10.14201/eks.31235 | e31235 Ana M Pérez-Cabello, Margarita Gil-Pérez, Francisco Jesús Oliva-Pérez Ediciones Universidad de Salamanca | https://doi.org/10.14201/eks.31235 | e31235 25 - 2 1. Introduction The approach to teaching L2 is very complex. This complexity is accentuated in students with difficulties. Specifically, this research addresses ADHD students. Pelaz and Autet (2015) indicate ADHD “is the most frequent neuropsychiatric disorder in childhood” (p. 57)1. It is estimated that about 10% of child population suffers from ADHD (Konicarova, 2014). This neurodevelopmental disorder directly influences the teaching-learning process of ADHD students. The lack of medical and specialised attention required by ADHD students and their families and the school environment is a part of their reality. If we evaluate and compare what is established by law with the educational results obtained by ADHD students, we must improve work directed towards ADHD people. We must meet their individual difficulties so that they have the same success and opportunities as the rest of the students (Cline, 2003; Moro-Ramos, 2021). Addressing students with attention and concentration problems and impulse and movement control increases the difficulty in education (Tressoldi et al., 2012). Currently, numerous investigations are related to teaching core subjects aimed at ADHD students. However, there are few studies about strategies to work with these students and the teaching-learning of L2 (Moro-Ramos, 2021). In this sense, Liontou (2019) states, “limited research is available regarding the most beneficial teaching practices and materials for students with specific learning differences… in an EFL context” (p. 221). The need for methodological research is supported by Konicarova (2014), who figures that the ADHD child population “represents almost epidemic occurrence which needs to focus on research of special forms of education that are specifically different for various learning disciplines” (p. 62). This research aims to grant all students the opportunity to learn English as L2 equally. This work begins by targeting ADHD students’ characteristics and types. Next, the learning difficulties and obstacles in learning L2 are exposed. Subsequently, educational adaptations are indicated, and different methods and strategies are explained. 2. ADHD According to the American Psychiatric Association (2014), ADHD is “a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development” (p. 61). This pattern occurs in two or more settings (at school, home…). In addition, they negatively affect social, academic and/or work activities. Symptoms manifest before 12 years. Attention deficit is manifested “by the lack of constancy in activities that require the participation of intellectual functions and by a tendency to change from one activity to another, without completing any, together with a disorganised, poorly regulated and excessive activity” (World Health Organization, 2009, p. 356). Hyperactivity is due to excessive restlessness, which is reflected especially in situations that require calm. Mena Pujol (2011) defines ADHD as a neurobiological disorder “characterized by the presence of three typical symptoms: attention deficit, impulsivity and motor and/or vocal hyperactivity” (p. 1). Vaidya and Klein (2022) add, “with the last two symptom groups often clustered together” (p. 161). The lower number of neurotransmitters distinguishes an ADHD person’s brain, and differences in the frontal lobe and basal ganglia (Aguilar Millastre, 2014; Germano et al., 2010). This leads to a low ability to maintain attention and concentration and less control of behaviour (Aguilar Millastre, 2014; Hudson, 2017). On the other hand, genetics, education, and stimuli influence its appearance and development (Aguilar Millastre, 2014). 2.1. Characteristics of ADHD and intervention According to Aguilar Milastre (2014), ADHD children have these symptoms: decreased attention compared to the attention of other children of the same age, overexertion or hyperactivity, and impulsivity or propensity to respond or act unexpectedly and/or without thinking. It is easier to recognise ADHD students who have hyperactivity and impulsivity than those who show attention deficit (Hudson, 2017). ADHD students with combined subtypes are usually children with problems in writing and organising. They often have disputes with their peers due to teasing or provocation. In these individuals, depression becomes a repeated problem in personal and academic terms (Hudson, 2017). 1 See Germano et al. (2010). Ediciones Universidad de Salamanca | https://doi.org/10.14201/eks.31235 | e31235 Teaching English to Students with Attention Deficit Hyperactivity Disorder (ADHD) 25 - 3 The American Psychiatric Association (2014) describes the diagnostic criteria defining the pattern of inattention and/or hyperactivity/impulsivity (see Table 1). Table 1. DSM-5® Diagnostic Criteria INATTENTION HYPERACTIVITY/IMPULSIVITY 1. No attention to details or makes mistakes due to carelessness in schoolwork… 1. Excessive body movements 2. Difficulty maintaining attention on tasks or games 2. Seat absence 3. Not listening when spoken to directly 3. Frequent runs or jumps 4. Not following instructions and not finishing tasks 4. Difficulty playing quietly 5. Difficulty organizing tasks 5. Being busy 6. Refusal or avoidance of requiring sharp mental effort 6. Excessive talk 7. Loss of items needed necessary for tasks 7. Impulsive answers even when the question is not completed 8. Distractions due to external stimuli 8. No turn-taking 9. Carelessness of daily activities 9. Frequent disruptions Source: American Psychiatric Association (2014, pp.59-60) To confirm attention deficit and hyperactivity, and impulsivity, the child must manifest six or more of these symptoms, as well as maintain them for at least 6 months (American Psychiatric Association, 2014.). On the other hand, Millichap (2009) adds four more typologies: oppositional defiant disorder, conduct disorder, mood disorder and anxiety disorder (see Table 2). Table 2. Types of ADHD No. Number Detection criteria 1 Inattention without hyperactivity 1. Careless mistakes 2. No attention keeping or listening 3. No task-finishing 4. Disorganization 5. Distraction 2 Impulsive hyperactivity 1. Nervousness 2. Seat absence 3. Continuous movement 4. Too much talk 3 Inattention and impulsive hyperactivity It usually applies to children and adolescents whose symptoms have decreased with age or treatment 4 Oppositional defiant disorder 1. Temper loss 2. Discussion with adults 3. Refusal to do housework 4. Annoyance at other people 5. Frequent swearing 5 Conduct disorder 1. Lies 2. Absent play 3. Others´ property damage 6 Mood disorder 1. Increased self-esteem 2. Insomnia 3. Too much talk 7 Anxiety disorder Shortness of breath, dizziness, heart rate fast, shaking, sweating, and choking Source: Millichap (2009) Ana M Pérez-Cabello, Margarita Gil-Pérez, Francisco Jesús Oliva-Pérez Ediciones Universidad de Salamanca | https://doi.org/10.14201/eks.31235 | e31235 25 - 4 Barkley (2011) asserts ADHD children may present other disorders such as dissocial, emotional, defiant negativism, and learning ones. These difficulties are more frequent in attention-deficit students. Combrinck and Preez (2021) conclude “Both sex and the language of learning and teaching are associated with ADHD and lower reading and numeracy achievement” (p. 67). Other important aspects are low self-esteem and self-concept problems. ADHD children often change their mood and attitude, being unable to control emotions and frustration. Besides, because of the negative stimuli, these children often experience rejection feelings from people around. Similarly, the perception of being unable to do tasks adequately causes a negative self-concept. Once ADHD is diagnosed, it is necessary to make a correct intervention as soon as possible to avoid antisocial personality disorders and criminal behaviour (Aguilar Millastre, 2014). Besides, Teixeira Leffa et al. (2022) underline teachers’ role in the process because the demand at school “might reveal symptoms that are not present at home and because of their experience with children of similar age and development” (p. 7). 2.2. ADHD and Learning Issues According to the National Joint Committee of Learning Disabilities (1994), the term Learning Difficulty refers to: A heterogeneous group of disorders that are manifested by a significant difficulty in acquiring the rudiments of oral or written language, reasoning, or arithmetic, probably due to a dysfunction of the central nervous system that therefore occurs throughout the life cycle. (p. 65) Most ADHD children have learning difficulties (Guzmán Rosquete & Hernández Valle, 2005). Academic performance is often lower than expected because of attention deficit, hyperactivity, and impulsivity (Mena Pujol, 2011; Kroese et al., 2000; Re & Cornoldi, 2013). Learning in a formal context requires attention and self-regulation of mental processes. In repetitive tasks as school ones, ADHD students are impulsive, disorganized, and unable to maintain mental effort, so they end up failing (Barkley, 1998; Weiss et al., 1971). These children constantly stand and change from one activity to another without finishing any (Guzmán Rosquete & Hernández Valle, 2005). Not mastering literacy negatively influences the rest of learning, especially reading, writing and Maths (Guzmán Rosquete & Hernández Valle, 2005). Teixeira Leffa et al. (2022) explain the situation in this way, Attention problems are usually more prominent when individuals with ADHD are assigned boring, tedious, or repetitive tasks… Moreover, inattention symptoms can increase while the patient is working on demanding tasks that challenge their cognitive processing abilities. Motivation, relevance, and attractiveness of the task for the child can influence the manifestation of symptoms. (p. 4) Concerning reading, ADHD children perform omissions, additions and substitutions of words, syllables, and letters (/tr/ /bl/ /pr/ and /bl/), poor reading comprehension, and lack of motivation for both individual and group reading (inability to maintain attention on long tasks) (Mena Pujol, 2011). When writing, ADHD children join and fragment words and add and omit letters; they repeat and replace syllables or words and tend to have more spelling mistakes. In addition, their calligraphy is poor and disorganised. As for mathematics, ADHD students have a poor understanding of statements, confuse signs, fail in calculations, and show difficulty abstracting high mathematical concepts far from reality (Mena Pujol, 2011). On the other hand, ADHD is also associated with the cognitive area, mainly memory (limited capacity to assimilate information, difficulty remembering events...) (Aguilar Millastre, 2014; Guzmán Rosquete & Hernández Valle, 2005) and the perception of time (inability to organise and autonomous planning) (Aguilar Millastre, 2014). 3. Methodologies and techniques in the classroom These must be short, concrete, and expressed positively to ensure students comply with instructions. A physical proximity between teacher and child is also needed. Equally, explanations must be motivating, dynamic Ediciones Universidad de Salamanca | https://doi.org/10.14201/eks.31235 | e31235 Teaching English to Students with Attention Deficit Hyperactivity Disorder (ADHD) 25 - 5 and close to students’ reality. Tasks and duties should be brief, clear, and simple (Mena Pujol, 2011). Guzmán Rosquete y Hernández Valle (2005) propose the following indications when working with ADHD students (see Figure 1). Figure 1. Guidelines to work with ADHD students Source: Adapted from (Guzmán Rosquete &Hernández Valle, 2005, p.13) Hudson (2017) states that to help ADHD students, a teacher’s attitude (close, optimistic, and cheerful) and organised planning are essential. Classes should be structured (i.e., start with the same routine), be flexible in timing, provide time indications, use a multisensory approach to maintain students’ interest, use computers to improve their written work, and allow them to enjoy assignments. Hudson (2017) keeps students in rows facing the front, away from distractions, with space allowing movement. Finally, since ADHD students often manifest behavioural difficulties causing complex situations to handle, we must know the techniques to face them. Mena Pujol (2011) proposes: • Constant supervision: to foresee problematic situations (keep students’ self-control and security in tasks). • Individualised tutorials of about ten minutes: used to indicate rules and limits. • Positive reinforcement: when we want good behaviours to be repeated, we must use this technique to praise them (economy of the chips). • Extinction: if we intend to reduce a negative behaviour we must stop attending to it (economy of the chips). • Time out: when inappropriate behaviour occurs, students are isolated. • Turtle technique: used to promote self-control and relaxation. The teacher tells a story so that ADHD students identify themselves with the protagonist. In stressful situations, the teacher pronounces the word turtle, and the child adopts a position imitating a turtle inside its shell (see Figure 2), which counts to ten (Mena Pujol, 2011). • The traffic light: it allows students to self-register and self-evaluate. At the of the session, students self-evaluate using three colours. Each of them is associated with a behaviour: red indicates that the student is dissatisfied with his behaviour and that he will not repeat it; yellow reflects that the student is happy, but his behaviour can be improved; and green means the student is satisfied. This technique is also useful for working impulsivity (Pérez Cabello & Marzo Pavón, 2021). Ana M Pérez-Cabello, Margarita Gil-Pérez, Francisco Jesús Oliva-Pérez Ediciones Universidad de Salamanca | https://doi.org/10.14201/eks.31235 | e31235 25 - 6 Figure 2. Turtle techniques Source: https://d66z.short.gy/Wu6vNl Besides, Fundación CADAH (2012) offers strategies and methodological guidelines: • The stopwatch of shame: different themes are used. Students roll some dice to advance on a board. According to the box, they speak on the subject for a minute without pauses. • Cooperative or collaborative communication: its effectiveness depends on promoting group work, collaboration, reflective thinking, and action. • Active listening: The basic guidelines are to look into the interlocutors’ eyes, maintain an open posture during the conversation, make gestures and sounds that indicate listening, and ask questions if we have not understood something. Students carry out an oral activity in which they evaluate themselves. The teacher may pose questions at the end of the activity to motivate attention. • Non-verbal communication: the aim is to learn to recognise emotions in others, acquire knowledge about non-verbal communication, relate empathy with non-verbal communication, and extract information from others’ gestures. • Motivation: tell them work is simple, offer them different activities and their purpose, establish a work schedule, and work the Pygmalion effect... 3.1. Obstacles in the process of learning a second language in ADHD students Clares-Almagro (2013) states that to teach ADHD people, we must consider connections among pieces of information. In this way, it is essential to provide them with all the necessary information that allows their brain to establish connections (De la Cruz et al., 2020). Navarro Romero (2010) distinguishes the understanding of language process acquisition in L1 and L2. He affirms there are common elements between both learnings. The process of teaching L1 is applied to the process of L2, although L1 acquisition is conducted unconsciously and influenced by biological factors (Klein, 1996). ADHD students’ language difficulties appear when they acquire L1 (Tressoldi et al., 2012). In general, both speech inputs and outputs are altered. Many of them show difficulties in L1 linguistic competencies, problems that often creep into learning L2 (Sparks et al., 1992). Robinson (2003) states that attention plays an important role in acquiring L2. Attention is related to short-term memory and working memory. In the classroom, ADHD students receive a large amount of information, which can create chaos in their brains. Their sensory receptors are continuously working. They also have difficulty processing and distinguishing important information. Likewise, its language acquisition mechanism (Chomsky, 2000) is also altered due to the limitations of its ability to discriminate phonemes (Turketi, 2010). Listening comprehension problems are noticeable among ADHD students. Although interested, they only focus on some attractive details without grasping the main ideas (Mapou, 2009; Turketi, 2010). We must attractively present input, reinforce it several times, and use different channels (audio, visual…) (Kuczula & Lengel, 2010; Turketi, 2010). Stokman (2009) notes, “the acquisition of complex human skills, including language, is undoubtedly a multisensory task, involving the collaboration of all the senses” (p. 12). The more connections made and stimuli received, the more ADHD students learn. To become familiar with a new word, children must listen to it, see its spelling and picture, see, and touch the object denoted, and understand its function in a sentence or a close actual situation (Turketi, 2010). Turketi (2010) provides these suggestions (see Figure 3). Ediciones Universidad de Salamanca | https://doi.org/10.14201/eks.31235 | e31235 Teaching English to Students with Attention Deficit Hyperactivity Disorder (ADHD) 25 - 7 Figure 3. Suggestions to work with ADHD students Source: (Turketi, 2010, p.7) L2 writing skills are less automatic, so they affect working memory more. ADHD students usually make more spelling mistakes than in L1 since it is challenging to organise, plan and correct their writing (Kałdonek-Crnjaković, 2020). Turketi (2010) details that writing is one of the biggest challenges in learning L2. Many students end up writing in the same way they listen or read. When it comes to reading in L2, as in L1, ADHD students have problems skipping letters, words and even lines. In addition, they often confuse similar characters or their order. They often misunderstand content and have difficulty understanding polysemic words. ADHD children are usually slow readers due to poor decoding capacity, specifically with some English characters (b, d, p, q). Regarding outputs, Turketi (2010) declares that they encounter difficulties in speaking and writing both in L1 and L2. The main problems are experienced at the syntactic, semantic, and pragmatic level (see Figure 4). Figure 4. Language output problems of ADHD students Source: (Turketi, 2010, p.11) ADHD children’s output problems are due to difficulties generated by poor inputs (Turketi, 2010). In turn, the problems derived from hyperactivity and impulsivity impact oral interaction and production. As ADHD individuals are unable to control their behaviour voluntarily, they may present problems in developing sociopragmatic aspects of oral skills required effectively. Evaluation in ADHD students requires both time and format adaptations (providing more time, granting breaks during the exam, or allowing them to use technologies) (Hudson, 2017). 3.2. Methods and intervention strategies for the teaching of English as L2 to ADHD students ESL methodology diversity let us apply different techniques in teaching ADHD children. The challenge lies in choosing efficient means (Turketi, 2010). Teaching SEN students and AICLE students share some characteristics: task-based oriented, communicative purpose, interaction and evaluation techniques, activities difficulty gradation, and dynamic groupings (Pérez-Cabello & Marzo-Pavón, 2021). Ana M Pérez-Cabello, Margarita Gil-Pérez, Francisco Jesús Oliva-Pérez Ediciones Universidad de Salamanca | https://doi.org/10.14201/eks.31235 | e31235 25 - 8 Considering the difficulties of ADHD students, Turketi (2010) highlights the following methods: TPR (Total Physical Response), The Silent Way (TSW) and Task-Based Language Teaching (TBLT). A flexible combination of the different methods would fulfil these children’s needs. 3.2.1. TPR TPR is developed by Asher (1977). He believes the fastest and least stressful way to understand L2 is to follow the teacher’s instructions without using L1 (Larsen-Freeman & Anderson, 2011). To reduce stressors, the learning of L2 is based on how children learn L1. In L1, communication between parents and children consists predominantly of commands to which the child responds physically before beginning to respond verbally (Richards & Rodgers, 2014). Konicarova (2014) describes TPR central processes so: The first is based on developing listening competence… In the second period the ability of listening comprehension is linked to physical response to spoken language which enables to create cognitive maps. In the third period, the learning is focused on spontaneous speech production (p. 65). TPR brings many advantages in teaching L2 to ADHD students. Physical activities address these children´s need for movement and reduce stressors and affective filters. It helps ADHD students experience success in learning L2. At the same time, they focus on action. They focus on learning objectives (Turketi, 2010, p. 24). Turketi (2010) states that it has great benefits for ADHD students. It allows them to remember linguistic material in the long term since associating a word with some physical movement provides additional connections in their brain. ADHD students find it easier to perceive grammatical structures and internalise them intuitively. The TPR method contributes to enjoyable and satisfying learning. However, abusing it can cause tiredness. Thus, combining it with other language teaching methods encourages ADHD students’ progress in their acquisition of L2. 3.2.2. TSW It was developed by Gattegno (1972) as an educational theory based on the cognitive principles of the learning process. Silence and gestures are used as teaching tools to focus students’ attention, elicit responses, and encourage them to correct their own mistakes (Larsen-Freeman & Anderson, 2011). It is based on visual and experiential learning. Students begin studying phonemes with a colour chart. Based on L1 phonemes, the teacher leads students to associate L2 phonemes with certain colours. Subsequently, these colours help children learn the corresponding spelling and read and pronounce words correctly (LarsenFreeman & Anderson, 2011). To learn grammar and vocabulary tangibly, students manipulate coloured sticks. This is essential for ADHD students since they can see and touch language. However, care must be taken not to give students too many coloured sticks at once. This can provoke inattention. TSW allows grammar to be learnt inductively. Students must figure out grammar by producing grammatically similar structures. This method stimulates self-correction and self-awareness, essential skills in the learning process that most ADHD students lack (Turketi, 2010). It should be combined with other approaches to avoid overuse. Abuse of concentration and attention can be exhausting and frustrating for ADHD students. TSW usually works well when teaching grammar, vocabulary, and pronunciation in artificial linguistic situations. However, to develop and promote a more natural communication in L2 we can use TBLT. 3.2.3. TBLT TBLT is based on the acquisition of L2 because of an intentional non-linguistic activity (a task). In this way, acquired language knowledge is the product of real and meaningful communication. Tasks are the main elements of this method. Learning by doing or experiential learning of this approach allows students to commit to objective achievements (Turketi, 2010; Yousefzadeh, 2016). Ediciones Universidad de Salamanca | https://doi.org/10.14201/eks.31235 | e31235 Teaching English to Students with Attention Deficit Hyperactivity Disorder (ADHD) 25 - 9 For ADHD students, TBLT is more useful and beneficial than traditional language instruction. It allows them to stay focused and involved in the task. The teacher strategically places students in a situation of need in which they must learn words, sentences, or grammar to execute the proposed task. This generates ADHD students’ brains focus on an objective that is not linguistic (Turketi, 2010). It involves students’ active participation. Meanwhile, the teacher supervises students’ performance and intervenes when necessary. The task must have precise results so that both students and teachers can know if it has been completed successfully. After that, a reflection phase is fulfilled to reinforce students’ learning problems (Larsen-Freeman & Anderson, 2011). Questions such as: What was difficult for you in this task? What was the easiest? What did you learn from it? help children to analyse their learning strategies and reflect on how they can improve them (Turketi, 2010). Space organisation in this method is important. Groups should be placed apart to decrease interference from each other’s activities. ADHD students should sit in front of the classroom and close to the teacher to avoid possible distractions (Turketi, 2010). TBLT characteristics and the other methods presented allow teaching L2 to ADHD students in a motivating and innovative way. Konicarova (2014) adds the Communicative Language Teaching (CLT). It focuses on functional structures and social interaction activities (Richards & Rodgers, 2014). 3.3. Intervention strategies for English lessons Moro-Ramos (2021) ponders learning difficulties ADHS students may present when developing the four basic language skills (reading, writing, listening and oral production) (see Table 3). Table 3. Intervention strategies in the area of English aimed at students with ADHD. Reading problems - Make reading comprehension cards appropriate to the level - Get students used to looking up the dictionary - Search for motivational texts - Follow reading with a pencil or pointer so they don’t get lost - Practice skimming and scanning activities - Ask questions to ensure they understand the texts - Make games with acronyms, metaphors, and oxymorons Writing problems - Propose crossword puzzles, stairs (acronym game) unscramble and other word games - Play hangman - Name pictograms - Use computer to write - Respect ADHD students’ learning pace - Practice the self-instruction scheme for written activities. (read > think > answer > ask for help if needed > review > check) Problems in listening comprehension - Repeat oral productions until children understand them - Use visual aids and gestures - Give simple short instructions - Create gestures of complicity with ADHD students to ensure they understand the message - Vary the tone of voice - Use Sandwich Technique (L2-L1-L2) when necessary - Tell anecdotes or use a sense of humour to keep students’ attention - Create mental images of the messages - Practice the self-instruction scheme for oral activities. (Listen > Nod if you understand > ask if you don’t) Problems in oral production - Encourage students to express themselves in English - Allow them to insert L1 words when they are not able to deliver the full message in English and provide them with the words of that language they lack - Give them time to respond and elaborate the message, transmitting calm - Reward correct behaviour (for example, not respecting speaking turns or not interrupting). - Provide Feedback (praise progress and correct mistakes positively) Source: Based on (Moro-Ramos, 2021, pp. 11-15) De la Cruz et al. (2020) detail teaching-learning strategies to work with ADHD students in English lessons (see Table 4).