Running

head: ADHD & PLAY INTERVENTIONS 1

Play Counseling Interventions and Skill Building with Elementary Students

Exhibiting ADHD Behaviors

Lauren Brand

University of North Carolina at Chapel Hill

ADHD & PLAY INTERVENTIONS 2

Abstract

This experiment will be conducted to study the affects of child-centered play therapy (CCPT)

and expressive art interventions on students who display ADHD symptoms. From Carrboro

Elementary School, four to six students in Kindergarten, first grade, or second grade will

participate in the study. Teacher recommendations will decide who participates and parent

permission will be obtained. The studys design will be multiple single-case research design.

Students will be observed over a three-month period to track their ADHD behaviors exhibited in

the classroom. During that period, each student will participate in a six session play counseling

intervention and/or Skillstreaming provided by Carrboros school counseling intern.

ADHD & PLAY INTERVENTIONS 3

Play Counseling Interventions with Elementary Students Exhibiting ADHD Behaviors

Attention-deficit Hyperactivity Disorder (ADHD) is a brain disorder characterized with

problems with inattention, hyperactivity, and impulsivity and is one of the most common

diagnosed disorders in children (Conway, 2013). Nine percent of children from the ages of 13 to

18 are diagnosed with ADHD and 1.8 percent of those children are categorized as having severe

ADHD (Merikangas, et al., 2010). Many symptoms of ADHD are inability to refrain from

talking, squirming in seats, easily distractible, and an inability to follow through with tasks.

Other behaviors exhibited by children with ADHD include poor listening skills, failure to follow

instructions, decrease in attention over time, and struggle with multi-step instruction and tasks

(Barkley, 1990; as cited in Kaduson & Finnerty, 1995). Kronenberger and Meyer (2001)

suggested that ADHD is coupled with many other problems such as conduct disorder, learning

disabilities, anxiety disorders, and sleep disorders (as cited in Ray, Schottelkorb, & Tsai, 2007).

Males have higher rates of ADHD than females in the population. Centers for Disease Control

and Prevention (CDC) recommend behavior therapy for children with ADHD as the most

effective intervention before the children are prescribed medicine (Centers for Disease Control

and Prevention).

Impact on School Systems

One of the most common disorders in children present in our school systems is ADHD

(Grilo, Henriques, Correia, & Grilo, 2015). Plenty of research has been conducted to explore the

negative impact of ADHD symptoms on people and their futures. Compared to their non-ADHD

peers, students with ADHD are found to be more talkative, two times more likely to be off-task,

and three times more likely to show oppositional behaviors (Ray, Schottelkorb, & Tsai, 2007).

This has serious implications for the school system as it disrupts classroom environments and
ADHD & PLAY INTERVENTIONS 4

learning. Student attention and behavioral control are some of the most common reasons for

children to be referred to school and clinical psychologists (DuPaul & Stoner, 2003; cited in Ray,

Schottelkorb, & Tsai, 2007). However, many of the children diagnosed with ADHD do not

receive any special services in schools and are considered part of the mainstream study

population (Schnoes, Reid, Wagner, & Marder, 2006). With many of those students in the

regular classroom without services, behaviors exhibited by students who present ADHD

symptoms are disruptive to the classroom, their learning ability, and their social skills (DuPaul &

Jimerson, 2014).

Students diagnosed with ADHD are not the only ones impacted by their behaviors.

Greene, Beszterczey, Katxenstein, Park, & Goring (2002) found that students with ADHD cause

significantly more stress for teachers than their non-ADHD counterparts (as cited in Ray,

Schottelkorb, & Tsai, 2007). Further, Cornett-Ruiz and Hendricks (1993) discovered that

whether an ADHD behavior is labeled or not, teachers and peers negatively judged the child

significantly more than a child who does not exhibit ADHD behaviors. Therefore, teachers and

peers may inaccurately judge children who display ADHD symptoms, which could disrupt a

classroom environment.

In summary, research has shown that children with ADHD drastically change the

environment at schools. Schools in the United States spend about five thousand dollars more per

child with ADHD than their peer without ADHD annually due to special education services,

disciplinary referrals, and poor academic success and retention (Robb, Sibley, Pelham, Foster,

Molina, Gnagy, & Kuriyan, 2011); therefore, it is imperative that prevention and interventions

are placed in schools to lower this annual cost. Due to the academic and behavior effects of
ADHD & PLAY INTERVENTIONS 5

ADHD, schools are suffering to provide enough interventions, time, and financial support to

these students.

There are many long term effects if ADHD is untreated that stem far beyond the school

environment. Okie (2006) conducts a case study about adult ADHD. In her findings, the

researcher states that about fifty percent of childhood ADHD diagnoses continue into adulthood.

Further, Okie (2006) remarks that people who do not treat their ADHD are at risk for impairment

in school, work, and home performance, low self-esteem, relationship problems, less life success

and satisfaction, increase risk of tobacco use, substance abuse, and other mental illnesses. With

all the research suggesting the negative effects of ADHD on school systems and life success, it is

imperative that early intervention is considered with students who experience ADHD symptoms.

Play Therapy (PT)

Over the past couple of decades, the use of Play Therapy as an appropriate developmental

approach to helping children express themselves has prospered (Bratton, Ray, Rhine, & Jones,

2005). For children, play is their way of understanding the environment and developing internal

control and intrinsic motivation while escaping the binds of objective reality (Skard & Bundy,

2008). In play therapy, the counselor has the unique ability to enter into a childs world in which

the toys are the childs words and the play is a language (Landreth, Ray, & Bratton, 2009). Play

therapy never focuses on the problem. Instead, the child is the center of play therapy, and

therefore, the child is empowered to lead the counseling sessions. When a child participates in

play therapy with a trusted adult, the children will learn the following six attributes as outlined

by Landreth (2002): to accept themselves, to respect themselves, to assume responsibility for

actions and behaviors, to be creative and confront problems, the ability to have self-control and

direction, and the ability to make choices.

ADHD & PLAY INTERVENTIONS 6

PT in Elementary Schools

Play therapy has been researched as an effective intervention for different students in the

school system. Research has shown that there can be benefits of play therapy in as little as two

sessions (Bratton, Ray, Rhine, & Jones, 2005). While it can be used as a remediation process for

children, it can also be utilized as a preventative part of a comprehensive school counseling

program as it serves as a counseling medium for elementary school counselors; school

counselors who understand the appropriate developmental levels of elementary students also

understand the benefits of using play therapy in schools (Ray, Muro, & Schumann, 2004). Ray,

Muro, and Schumann 2004 documents the use of play therapy in schools by reviewing details

from a one-year play therapy program implemented in an elementary school. The researchers

noted discomfort from the administration and other school personnel for the use of aggressive

toys in the playrooms and therefore in the school environment. It is important to stress the need

to include these toys in order to effectively allow a child to explore anger or develop self-control,

but could be a potential barrier in the school environment. As for the results, the children

involved in the pilot program saw a decrease in their behavioral referrals as time elapsed.

Teachers also reported positive changes in the students behaviors. Campbell (1993) further adds

that allowing younger students the opportunity to speak through play can help them resolve

problems that may hinder their academic success in school.

Green and Christensen (2006) gathered the perceptions of seven elementary students who

received CCPT techniques in their respective schools. By conducting interviews, observing

students, and reviewing documents, the researchers found that the children responded well to a

nonjudgmental, attentive adult and enjoyed the ability to independently decide what activities

they were going to play. The children did prefer a mix of the traditional verbal interactions and
ADHD & PLAY INTERVENTIONS 7

the play/creative interventions given by the counselor. The students indicated that the counseling

techniques used directly enabled them to solve their own problems both in school and home.

While there is evidence to support the use of play therapy for students with a range of

difficulties, the implementation of play therapy in schools is not always easy. Research done by

Ebrahim, Steen, and Paradise (2012) found that elementary school counselors find play therapy

to be a useful tool in working with children. However, elementary counselors have indicated

barriers preventing the use of play therapy interventions in schools. By surveying 359 elementary

school counselors who are all members of the American School Counselor Association (ASCA),

the researchers determined that the top barriers to implementation of play techniques included

lack of training, administration support, time, resources, and space. Ray, Armstrong, Warren, and

Balkin (2005) also cited lack of time and training as barriers to the integration of play therapy in

school counseling programs. In order to overcome these barriers, Ebrahim, Steen, and Paradise

(2012) suggest more formal training and raised awareness of the benefits of play therapy use in

schools in order to combat these barriers. Elementary School Counselors must put effort and be

motivated to overcome systemic barriers in order to serve children using play therapy techniques.

PT with Hispanic students

Research has shown that school counselors report play therapy allows more of a response

from students across many cultures and diverse populations (Shen, 2016). However, little

research has been conducted on the effectiveness of play therapy with Hispanic children when

the counselor is a native English speaker. A dissertation study investigated the use of CCPT with

Hispanic children and compared CCPT with curriculum-based group counseling in the

elementary school setting (Garza, 2005). Garza (2005) recruited 29 Hispanic children to be

randomly assigned to either CCPT or group counseling for one session a week for 15 weeks.
ADHD & PLAY INTERVENTIONS 8

According to teacher report and feedback, Garza found that CCPT was an effective school-based

intervention to significantly reduce problem behaviors and anxiety within the students who

participated.

More dissertation research completed by McGee (2011) aimed to study the effects of

CCPT with students and counselors who do not speak the same language. Thirty-four children of

Hispanic descent who spoke Spanish participated in the study. They were identified and referred

for showing behavior problems and adjustment difficulties. The participants ages ranged from

four to eight. The children were randomly assigned to either the control group, which received

CCPT after the research was conducted or the experimental group who received eight sessions of

CCPT. The principal investigator found that teachers reported a significant reduction in the

behavior problems throughout the study.

PT with ADHD

Ray, Schottelkorb, and Tsai (2007) investigated the use of child-centered play therapy

(CCPT) and reading mentoring (RM) as interventions with 60 elementary students who exhibit

ADHD behaviors and were identified by their teachers. All of the students who participated in

this study were from Title One schools. Half of the students were randomly assigned to

participate in 16 sessions of CCPT and the other half received 16 sessions of RM. The play

therapy sessions were facilitated by trained play therapists with faculty mentors and followed

Play Therapy Guidelines set by Landreth. Trained by the researchers, four undergraduate

students facilitated the RM group and provided individual reading help to the students. By

comparing pre and post-test scores determining teacher-child relationship stress and the changes

observed over the time of interventions, both CCPT and RM had a significant effect in reducing

ADHD behaviors, such as hyperactivity, impulsivity, and inattention in the two experimental
ADHD & PLAY INTERVENTIONS 9

groups. However, students who participated in the CCPT group placed significantly less stress

on their teachers than the children who participated in the RM group.

Along the same lines, Schottelkorb and Ray (2009) utilized a single-case design and

studied the effectiveness CCPT and person-centered teacher consultation (PCTC) as

interventions for four elementary students from the southwest region of the United States. The

researchers used the Direct Observation Form (DOF; Achenbach & Rescorla, 2001), the

Conners Teacher Rating Scale-Revised, and the Teacher Report Form (Achenbach & Rescorla,

2010) as their research methods to collect the data on the students. Researchers concluded that as

a result in participating in CCPT, two of the students showed a significant decrease in the ADHD

behaviors and the other two students show questionable decreases in behaviors. Therefore, CCPT

was an effective intervention to reduce certain behaviors exhibited by children with ADHD

symptoms. In their discussion, the researchers outlined many implications for elementary school

counselors working with students with ADHD symptoms. One of the limitations cited for

elementary school counselors were the need for more than 12 sessions of CCPT for effective

intervention in this study. In addition, Schottelkorb and Ray urge elementary counselors to

gather different sources of data on students to rule out learning disabilities and life situations

from impacting the objective of the study; it might be needed to refer a child for testing due to

various other comorbid disorders affecting a childs ADHD symptoms. The study supports the

use of single-case design research as it aligns with the ASCA National Model expectation of data

collection from school counselors. When collecting such data, the researchers suggest a strong

baseline and many observations.

The research in this literature review has shown the effectiveness of play therapy

techniques as an intervention for children with ADHD. Therefore, a school counselor who
ADHD & PLAY INTERVENTIONS 10

implements CCPT interventions in the school should see a reduction in ADHD behaviors in the

children that are receiving the interventions.

Skill building in schools with ADHD students

ADHD in students can also affect their social interactions with peers and therefore,

impedes their school functioning and the school climate (Shillingford-Butler & Theodore, 2013).

Likewise, children with ADHD can struggle to fit into a traditional school setting; they tend to

show a deficit in interpersonal skills and prosocial behaviors (Sheridan, Dee, & Morgan, 1996).

Therefore, it is important to teach children with ADHD symptoms skills to aid in their social

development and contribute to a more positive learning environment.

Cognitive behavioral therapy (CBT) is seen to have a positive effect for interventions

with children who exhibit ADHD behaviors, as it allows children to modify and change their

behaviors through modeling, role-playing and self-instruction (Thyagarajan, 2016). Literature

supports the use of role playing to teach children with ADHD symptoms appropriate behaviors.

The use of a specific skill building program that relies on role-playing and modeling called

Skillstreaming has seen success in schools. Miller, Midgett, and Wicks (1992) used the

Skillstreaming program as an intervention in a large, urban school district in Florida. Seventy

students labeled as emotionally distributed, but with the same academic potential as peers

participated in the study. They found that teachers perceived a large gain in students social

behaviors in class after the studys completion and it aided in creating a more positive learning

environment. With the literature support of CBT interventions, school counselors could

implement programs such as Skillstreaming in an effective manner to help improve childrens

social skills.

Demographics
ADHD & PLAY INTERVENTIONS 11

The following study will be conducted in a public, suburban, Title One, dual-language

school in North Carolina. As a Title One school, 32.11 percent of the 497 students qualify for

free or reduced lunch. About 60 percent of the students participate in the dual language program.

Over 15 percent of the students are considered limited English proficient. The ethnic breakdown

of the school is around 56 percent Caucasian, 31 percent Hispanic, five percent African

American, four percent two or more identified races, three percent Asian, and less than one

percent American Indian/Alaskan Native.

The exact prevalence of ADHD at this particular school in unknown, but teacher report

shows that all seven of the Kindergarten through second grade teachers who responded believe

ADHD symptoms in the school seriously or severely impact student learning (see Appendix A;

see tables and figures). Other teacher data shows that 85.7 percent of the surveyed teachers feel

they are always (more than six times a day) redirecting children who exhibit ADHD symptoms,

such as inattentiveness, calling out, and increased distractibility. Out of the seven teachers also

surveyed, all of the teachers feel it is important or very important to have specific interventions

implemented for the students who exhibit ADHD behaviors.

Purpose

The elementary school counselor is responsible for delivering school appropriate

interventions and resources for students exhibiting or diagnosed with ADHD. Due to the

negative implications of untreated ADHD in schools and teachers request to make interventions

a priority, this study aims to investigate the effect of play counseling techniques and skill

building in the interventions of children exhibiting ADHD symptoms. There is considerable need

for a better understanding of students who exhibit ADHD behaviors and the effect of these

behaviors on the students ability to learn. While play is a suggested intervention to help children
ADHD & PLAY INTERVENTIONS 12

with ADHD explore behavioral and social problems (Barkley, 2006), there is limited research

done on play interventions with ADHD elementary students; therefore, the purpose of this study

is to continue the support of evidence-based play therapy as an effective intervention for students

with ADHD symptoms. There is even less research available on the efficacy of CCPT with

Hispanic children or ESL students. Further, there is little evidence on the success of

Skillstreaming program with children with ADHD symptoms, although the program aligns with

the literature on most successful programs for children with ADHD. Because many children who

exhibit ADHD behaviors without a diagnosis do not receive special services at school, minimal

literature is available on school based interventions (DuPaul & Jimerson, 2014). It is important to

asses the effectiveness of multiple interventions together, such as skill building in combination

with CCPT, to find the most effective intervention for school counselors that is time efficient and

within their role. Therefore, further research can help school counselors better understand how to

work with children with ADHD symptoms. The goal of this study is by the end of six to eight

sessions the students in the study will exhibit a reduction in ADHD behaviors as measured by

teacher report and direct observations regardless of ethnicity or language proficiency.

Research Hypothesis

Research has concluded the benefits of children with ADHD participating in CCPT and

skill building interventions. The hypothesis is by participating in CCPT and/or Skillstreaming,

the students at Carrboro Elementary will see a significant reduction in the ADHD behaviors

based on the DOF and Connors Teacher Scale. It is further hypothesized that the students

randomly assigned to the condition of half the session of CCPT and half the session of

Skillstreaming will see a more drastic decrease in ADHD behaviors than the children receiving

CCPT only or Skillstreaming only. The null hypothesis states that there will be no statistical
ADHD & PLAY INTERVENTIONS 13

difference in ADHD symptoms before and after the interventions are administered; further, there

will be no statistical difference between the students ADHD symptom reduction and the

intervention they are randomly assigned.

Method

Participants

The principal investigator (PI) will recruit four to six students from Kindergarten through

second grade at Carrboro Elementary through teacher recommendation. The PI will send out an

email to all Kindergarten through second grade teachers and ask for recommendations of

children with exhibit the most common ADHD symptoms of impulsiveness, inattention, and

hyperactivity. The PI will then screen the participants to see if their schedules align with

intervention time, if they are receiving outside therapy, parental permission, and fit with the

interventions. Students who currently receive outside therapy for ADHD symptoms will be

eliminated from the study. Out of the remaining students, the PI will randomly select four to six

students to participate in the study.

The participants will be between the ages of five and ten. They must be a current student

at Carrboro Elementary School and parent permission will be obtained (see Appendix A). For

research purposes, students who have had previous interventions with the principal investigator

will not be included in the study. For their participation, all of the students will receive the CCPT

and expressive arts interventions. The teachers will receive a candy bar and thank you note of

appreciation from the principal investigator.

Design

The study will test the effectiveness of play counseling techniques on the reduction of

ADHD behaviors in kindergarten to second grade students. The experiment will be a multiple
ADHD & PLAY INTERVENTIONS 14

single-case research, or time series, design. Single subject research design is conducive to the

time school counselors have to accurately evaluate intervention tools used (Sherperis, Young, &

Daniels, 2010). The independent variable is the conditions the students are randomly assigned.

The dependent variable is the score of the assessment. Each student will be randomly assigned

to one of three conditions. The first condition is all six sessions will be CCPT. The second

condition is that the first fifteen minutes will be CCPT and the second fifteen minutes will be

Skillsteaming. The third condition will be full sessions of Skillsteaming.

Materials

To identify students with exhibit ADHD behaviors and to gauge the intervention progress

according to teachers, the PI will distribute the Conners Teacher Rating Scale-Revised: Short

Form at the beginning and end of the research study (CTRS-R:S; Conners, 2001). The CTRS-

R:S is a 28 question assessment that appropriately used with children between the ages of three

and seventeen (Schottelkorb & Ray, 2009). The CTRS-R:S has been suggested for screening

and monitoring purposes for children who exhibit ADHD behaviors (Angello, Volpe, DiPerna,

Gureasko-Moore, Nebrig, Ota, 2003; as cited in Schottelkorb & Ray, 2009). The 28 questions

are rated using a four-point frequency scale ranging from zero, which means never to three,

which means very often. There are four subscales: oppositional, cognitive problems/inattention,

hyperactivity, and an ADHD index score (Conners, 2001). Test-retest reliability coefficients

ranged from .60 to .90 and internal consistency coefficients ranged from .85 to .95 (Schottelkorb

& Ray, 2009).

Throughout the study, students will be observed multiple time to monitor the ADHD

behaviors in the classroom using the Direct Observation Form (DOF; Achenbach & Rescorla,

2001). Each observation is ten minutes and completed by trained observers who track the childs
ADHD & PLAY INTERVENTIONS 15

on- and off-task behaviors; the observer further completes a 96-item checklist to rate the

behaviors observed versus not observed and the intensity of the behaviors on a scale of zero (not

observed) to three (intensely observed and lasting more than three minutes) (Schottelkorb & Ray,

2009). Multiple observations a week will be conducted and averaged for a weekly rating for each

student. The mean reliability score for the DOF (Achenbach & Rescorla, 2001) is .84 for the on-

and off-task scale. The consistency relies heavily on the agreement between two observers scores

and has been expected at eighty percent (Kennedy, 2005; as cited in Schottelkorb & Ray, 2009)

An evidence-based program called Skillstreaming the Elementary School Child will be

used for students who are receiving half or full sessions of social skills. Skillsteaming

deliberately teaches wanted behaviors to replace the unwanted or ineffective behaviors and relies

on structured learning theory and modified CBT approaches as the background for its

development (McGinnis, 2012). The seven social skills that will be taught and practiced are

listening, bringing materials to class, following instructions, completing assignments, ignoring

distractions, using self-control, and relaxing. The PI selected these skills as they align with the

literature on skills that students with ADHD symptoms typically lag behind in when compared to

their peers. The core teaching procedures of Skillstreaming are modeling, role-playing,

performance feedback, and generalization (McGinnis, 2012). The literature cites modeling and

role-playing as effective means of teaching children desired behaviors and increase school

climates (Thyagarajan, 2016).

Procedure

The PI will email the kindergarten through second grade teachers that responded about

the frequency and intensity of ADHD behaviors in their classroom and request specific student

recommendations based on the criteria presented in the CTRS-R:S (Conners, 2001) and
ADHD & PLAY INTERVENTIONS 16

judgment of the students impulsivity, hyperactivity, and inattention (see Appendix B). The PI

will screen the students for schedule conflicts, outside therapy, parental permission, and fit for

the interventions. Of the students will qualify for the research study, the PI will randomly select

six students. Then, the PI will contact the parents of the selected students and obtain parental

permission for their childs participation in the research study (see Appendix C). The respective

teacher will be asked to complete the CTRS-R:S (Conners, 2001) for each student in research

study. The students will be randomly assigned to one of three conditions: CCPT only sessions,

half CCPT and half skill building, or skill building only sessions. After the CTRS-R:S (Conners,

2001) is collected and the students are randomly assigned to the different conditions, baseline

observations using the DOF (Achenbach & Rescorla, 2001) will be conducted over two weeks

by the PI. Each student will be observed two times within the two-week period.

Once the baseline data is collected, the PI will conduct six intervention sessions with

each student dependent on the condition to which the students were randomly assigned. The PI

will pick up the students from their classrooms and bring them to the counseling office once a

week during their respective intervention time. Each class has a designated thirty-minute time

period for intervention each week. Twice every week, DOF (Achenbach & Rescorla, 2001)

observations will be conducted for each student while they are participating in the research

study. Each week, an email will be sent to the parents of the student with various research

information and updates on what the child is doing during intervention. Majority of the

intervention sessions will be video taped and the PIs university supervisor will review a random

number of the tapes.

When the intervention is completed, teachers, who will be blind to the treatment

conditions, will fill the CTRS-R:S (Conners, 2001) for each student again and the children will
ADHD & PLAY INTERVENTIONS 17

be exited from interventions. Any students who need additional support will be referred to

appropriate resources within the school or community. The observations will be observe twice

more in one week following the completion of the counseling sessions. For their participation,

students will receive interventions based on their behavior concerns.

Protection of Human Rights

American School Counselor Association (ASCA) Ethical Standards encourages school

counselors to be mindful of confidentiality when implementing interventions and keeping data

on the assessments, results, and interpretations (American School Counselor Association, 2016).

The principal investigator will ensure utmost respect of confidentiality with the data obtained

from the study. Only student initials will be used to identify students on observation forms,

lesson plans, and other papers needed to record data. Demographic information and permission

slips will be kept separate from the data. All of the data collected will be kept in a locked cabinet

for the entirety of the study and appropriate measures will be taken to preserve or destroy certain

data once the study is completed.

ASCA Ethical Standards will also be upheld when involving parental participation in the

study. It is important to acknowledge the parents and guardians when working with the students

(American School Counselor Association, 2016). Therefore, parent permission with the study

will be obtained before intervention is started (see Appendix C). Further, the PI will update

parents/guardians periodically throughout the research study on the progress of their child.

Parents can voluntarily withdraw their child from the research study at any moment without

penalty.

When working with children from diverse backgrounds, it is imperative to be aware of

bias and cultural sensitivity that may arise throughout the research study. All interventions and
ADHD & PLAY INTERVENTIONS 18

assessments will be reviewed to make sure that it is appropriate for the culture of the children, as

well as the developmental age of the student. Communication to parents will be provided in their

preferred language of Spanish or English and the PI will be aware of any potential language

barriers in communication with the parents or children and attempt to minimize the affects of

language on the outcome of the study.

As a school counselor, there is an ethical binding to provide intervention in a timely,

effective manner to all students; therefore, to follow best practice, all students will receive the

interventions and they will be compared to their own progress throughout the study. They may

be compared to other students who exhibit ADHD behaviors who could potentially receive the

intervention at a different time. Upon completion of the study, best practice will guide the PI in

the next steps. Any child who still needs additional support or other services will be

recommended for referral to appropriate resources within the school or in the community. The

aim of the study is to provide counseling within six to eight sessions. Support will be given to the

families to help ensure the right steps are taken to benefit the child.
ADHD & PLAY INTERVENTIONS 19

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Appendix A
ADHD & PLAY INTERVENTIONS 25

Appendix B

Teacher Recommendation Recruitment Email

Hello K-2nd Teachers,

I hope you all had a wonderful weekend.

You may have remembered back in October, I sent out an ADHD Symptom Survey to gauge the
occurrence of ADHD symptoms and the severity of impact ADHD symptoms in the classroom.
Of the respondents, it can be concluded that reducing ADHD symptoms in the classroom could
be beneficial for many students and should be a priority.

My study aims to reduce ADHD symptoms in students using skill coaching and play counseling
techniques.

Please send me recommendations of students you feel would benefit from participating in my
research study. For the integrity of these students, please only recommend students that exhibit
ADHD behaviors such as problems with listening, bringing materials to class, following
instructions, completing assignments, ignoring distractions, using self-control, and relaxing.
Also, please nominate students who have not had intervention with me during this school year.

I am accepting 6 students to participate in the study, but need more than 6 student
recommendations, so I can screen for ADHD symptoms, background, and parent consent.

There will be a short pre and post teacher survey to fill out for each student (meaning that the
survey will be administered once pretty soon, and then not again until the end of April).

If you have any questions or would like to meet to discuss potential students, please let me know
and I am happy to give more information and help with the recommendations.

Best,

Lauren Brand
Carrboro School Counseling Intern
ADHD & PLAY INTERVENTIONS 26

Appendix C

Informed Consent Form

Principal Investigator: Lauren Brand

(919) 414-5864
lbrand@chccs.k12.nc.us
Faculty Sponsor: Dr. Meghan Walter

Department of Education
University of North Carolina at Chapel Hill
walterm@email.unc.edu

Description: Your child is invited to participate in a study to assess to effect of play counseling
techniques and skill building programs on students exhibiting ADHD behaviors. Your child will
receive 6-8 sessions of play counseling intervention or skill building during the scheduled
intervention time from Carrboros school counseling intern, Lauren Brand. You will be
periodically updated throughout the individual counseling.

Procedures: If you and your child agree to participate in this study, your child will be observed
in their regular classroom setting at multiple times over a three month period and will participate
in 6-8 sessions of play counseling interventions with the school counseling intern, Lauren Brand.

Risks and Benefits: There are minimal to no risks associated with your childs participation, and
by participating, your child could benefit and see a reduction in certain classroom behavior
concerns. If you have any questions and/or concerns about your participation, please contact
Lauren Brand at lbrand@chccs.k12.nc.us. You can withdraw your child from the study at any
time without penalty.

Research Data and Records: Your childs participation in this study will be kept confidential to
the extent allowed by law. Your childs demographic information will be kept separate from the
observations and surveys. The results will not contain any information that could identify your
child. Once the study has been completed, you are welcome to a copy of the research paper.

Voluntary Participation: Your childs participation in this study is completely voluntary. You
may remove your child from the study at any time without consequence. Should you have any
questions or comments, you may contact Lauren Brand at the information provided above.

By signing below, you agree that you have been informed of the purpose and any risks of this
study. Please sign both copies and keep one for your records.

PRINT NAME: ___________________________________________

SIGN NAME:_____________________________________________ Date: _____________
ADHD & PLAY INTERVENTIONS 27

Questions for Dr. Walter:

1. Does it matter whether I have the null or research hypothesis first? How do my

hypotheses look?

2. I was thinking about an alpha level of .05but in class, we talked about typically for

education studies the alpha level is .10 because it is more low risk. Which do you think

would be best?

Things to do: add Appendix A, add the tables/figures, is this directional or non-directional?, add

the Connors and DOF, add social history (how will you get information about students), parent

email to secure okay, send home the consent forms in the Friday folder