Dr. Kamal SeSalem
The Effect of Fine Motor Training Program on the Academic Achievement for Students with Attention Deficit and Hyperactivity Disorder
Introduction
Fine motor skills involves the ability to control the small muscles of the body and is usually defined as the ability to coordinate the action of the eyes and hands together in performing precise manipulative movements. Manipulative movement such as handwriting is controlled by the central nervous system (Barkley, 1998). Many areas of the brain are involved in the act of manipulating. The act simultaneously controlling the nerves and muscles in the arm, wrist, hand, and fingers to move in four different directions, focusing the eyes on the writing; as well as controlling the amount of pressure exerted. Brain research has identified the critical need to supply a variety of multi-sensory stimulation to the young brain for motor development (Farmer, 2005). Multi-sensory fine motor g training answers that need in a non- traditional but innovative way. Joseph (1992) indicates that the entire right brain is dominant in regard to attention and arousal, factors strongly influenced by the fine motor process. Manipulating the fingers through handwriting not only calms the right brain, but also stimulates the left-brain, the 'brain that goes to school.' where the specialized reading/ writing capacities are located.
The link between children with attention deficit and hyperactivity disorder (ADHD) and fine motor coordination problems has been recognized for decades (Piek, Pitcher, & Hay, 1999). In a study of both fine and gross motor ability of males with ADHD compared with a group of control children, Pitcher, Piek, and Hay, (2003) found poorer fine motor ability in children with ADHD. Poor fine motor problems have been associated with ADHD in addition to the main symptom groups of inattention, impulsiveness, and hyperactivity (Meyer & Sagvolden, 2006).
The literature seems to suggest that fine motor training will improve the brain function of students with ADHD. This improvement has been attributed to better eye-hand co-ordination, improved fine motor control, and improved concentration. All these behaviors are impaired in students with ADHD. Research to investigate this relationship could spark more interest in using fine motor training programs to enhance the brain function of students with ADHD.
Schooling is a challenge for children with ADHD, as far as their academic failure and challenging behavior. Students with ADHD are more likely to achieve lower grades at school than their peers (Merrell & Tymms, 2001). The course of ADHD tends to be chronic and progressive, and without treatment may even increase students\' academic problems as well as their challenging behavior. Fine motor training is a simple way of stimulating the brain and improving the ADHD students\' academic achievement. Teachers who deal with students suffering from ADHD are aware of the problems their students encounter in the classroom. Perhaps the most serious concern for teachers of students with ADHD is how to enable the students to achieve academic success.
The purpose of this research study was to determine if students who participated in the Fine Motor Training (FMT) program make more progress in the WRAT-III thanthose who did not participate. The following research questions are addressed:
- Do ADHD students who have participated in the FMT program make more progress in the WRAT-III than students who have not participated?
- Do ADHD students who have participated in the FMT program make more progress in reading skills than students who have not participated?
- Do ADHD students who have participated in the FMT program make more progress in spelling skills than students who have not participated?
- Do ADHD students who have participated in the FMT program make more progress in mathematical skills than students who have not participated?
Method
Participants
Twenty male students between the ages of 6 and 11years, all of whom had classified as having combined symptoms of ADHD participated in the study. All participants were on psycho stimulants medication at the time of the study. Participants were selected from ethnically mixed students with ADHD attending public schools in southwestern Louisiana. Theracial composition was 88white and 12black. Participants were randomly divided into two groups, the experimental group (n=10) and the control group (n=10). All participants are receiving Special Education services. These services are based on their Individualized Educational Programs (IEP). Public Law 105-17 (1997) amendment to Individual with Disabilities Education Act (IDEA), requires that each public school child who receives Special Education and related services must have an IEP.
Materials
Three instruments were used on the study. The first instrument was the Wide Range Achievement Test-III (WRAT-III). The WRAT-III includes 3 subtests that measure basic school codes. The reading subtest measures decoding skills in which the student recognizes and names letters and pronounces words in isolation. The spelling subtest measures written spelling in which the student writes letters and words from dictation. The math subtest measures mathematical calculation, in which the student counts, reads numbers, identifies number symbols, solves oral problems and performs written computation within a time limit. The test is an individually administered for population ages 5-0 to 11-11, 12-0 to 75. The second instrument was the FineMotor Training (FMT) program. The FMT program was designed to develop and apply the fine motor skills needed for academic achievement in students with ADHD. Fine motor activities such as handwriting and manipulating small objects are included in this program, see Appendix A. The third instrument was the Data Collection Sheet. It was developed to collect demographic data about each participant in the study as well as the results of the WRAT-III, see Appendix B.
Procedures
Participants were randomly divided into two groups, the control group (n=10) and the experimental group (n=10). The present level of academic achievement was determined for both groups prior to the beginning of the FMT program (pretest) using the WRAT-III for Reading, Spelling, and Arithmetic. The experimental group received FMT in addition to the usual Special Education services based on their IEP, see Appendix A, while the control group received only the usual Special Education services base on their IEP. Training was provided for 4 sessions a day, 5 days a week over 2 months period. The length of each session was 10 minutes. After two months, both groups were evaluated with the WRAT-III (Posttest).
Data Analysis
The data was analyzed by comparing the growth the students made on the WRAT-III using a group pre-test/post-test design. The statistical procedure of treatment Effect Size (ES) was used to allow the comparison between scores earned at the beginning and end of treatment. The ES is the difference in the means between two group divided by the standard deviation. This measure of 'effect size' is known as Cohen\'s d. Cohen (1988) suggested that d of '0.2 is indicative of a small effect, 0.5 a medium and 0.8 a large effect size. However, ES as small as 0.1 may be of important practical significance if the intervention that produced the improvement is relatively inexpensive compared to other competing options; the effect is achieved across all groups of students; and the effect accumulates over time (Glass, 1988).
Results
Pretest to posttest Effect Size statistical procedure revealed significant gains on the WRAT-III scores for the experimental group (d=0.61). Consistent gains were noted across all WRAT-III subtests. The ES reading subtest was (d=0.69), the ES spelling subtest was (d=0.44), and the ES mathematic subtest was (d=0.66). The Institute of Education\'s Joint Dissemination Review Panel stated that an ES above 0.33 can be regarded as indication that significant educational changes has occurred (Tallmadge, 1977). Table 1 summarizes results of achievement changes for the experimental group (n=10).
Insert Table 1 about Here
Although the control groups improved their WRAT-III scores over the time of intervention, that improvement was not significant (d=0.17) and it would be attributed to the students\' normal development and/or to the implication of the IEP. Consistent non-significant gains were noted across all control groups\' WRAT-III subtests. The ES reading subtest was (d=0.14), the ES spelling subtest was (d=0.18), and the ES mathematic subtest was (d=0.0.15). All ES scores were lower than the suggested d =0.2 as indicative of a small effect (Cohen, 1988). Table 2 summarizes results of achievement changes for the control group (n=10).
Insert Table 2 about Here
Furthermore, the results indicated that ADHD students who have participated in the FMT program made more progress in the WRAT-III than students who have not participated. The results also indicated that the FMT program has a significant efficacy on the improvement of academic achievement for students with ADHD.
Discussion
Statistical analysis indicates that FMT program appears to enable studentsdiagnosed with the Combined Type of ADHD to make statistically significant gains in measures of academic achievement in the areas of reading, spelling, and mathematics. Contrary, no significant academic achievement gains were indicated for the ADHD students who did not participate in the FMT program. This finding suggests that providing ADHD students with fine motor training would positively impacted their academic achievement. Quality intervention should make an impact on life-long learning in enabling the individual to become an independent learner. Although it cannot be confirmed by one test or one study alone, it appears that the FMT program improves specific levels of academic achievement skills for students with ADHD.
Currently, fine motor training programs for students with ADHD are not well defined in public schools. Further fine motor training research needs to include a follow-up phase of this particular study to determine if students who participated in FMTP demonstrate regression in the broad areas of achievement after being retested at least one month after completion of the program. Furthermore, future studies with larger subjects, longer training periods, and on subjects with the Predominantly Hyperactivity-Impulsive Type ADHD or/and the Predominantly Inattention Type of ADHDare needed to determine the quality and the effectiveness of the FMT program.
References
Barkley, R. A. (1998). Attention –deficit/hyperactivity disorder: A handbook for diagnosis and
treatment (2nd ed.). New York: Guilford.
Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd. ed.). Hillsdale, NJ:
Lawrence Earlbaum Associates.
Farmer, J. (2005). The Thompson Center for Autism and Neurodevelopmental Disorders at the
University of Missouri-Columbia promotes research. Http://www.retrainthebrain.com.
Glass,G.V., & Stanley, J.C. (1988). Statistical methods in educational psychology. Englewood
Cliffs, NJ: Prentice-Hall.
Joseph, R. (1992). The right brain and the unconsciousness, discovering the stranger within.
Plenum Press, New York, NY.
Merrell, C. and Tymms, P. (2001). Inattention, hyperactivity and impulsiveness: Their impact on
academic achievement and progress. British Journal of Educational Psychology, 71: 43 – 56.
Meyer, A., and Sagvolden, T. (2006). Fine motor skills in South African children with symptoms
of ADHD: influence of subtype, gender, age, and hand dominance.
http://www.behavioralandbrainfunctions.com/content/2/1/33
Piek, J.P., Pitcher, T.M., & Hay, D.A. (1999). Motor coordination and kinaesthesis in boys with
attention deficit hyperactivity disorder. Developmental Medicine and Child Neurology,
41 (3), 159-165.
Pitcher, T., Piek, J., and Hay, D. (2003). Fine and gross motor ability in males with ADHD.
Developmental Medicine & Child Neurology , 45: 525-535 Cambridge University Press
Tallmadge,G.K. (1977). Idea book: The joint dissemination review panel. Washington, DC: US
Department of Health, Education and Welfare.
Appendix A
Fine Motor Training Program for Students with ADHD
Fine Motor Training Program (FMTP) for Students with ADHD
Session I. (10 Minutes-Handwriting):
- Have student pick out an excerpt from a book he/she likes at his/her grade level.
- Give student the opportunity for using print or cursive handwriting.
- Have student write the same excerpt over and over for 10 minutes using a pen of pencil on a Double lines worksheet to promote neatness and correct letter placement.
Session II (10 Minutes- Fine Motor Activities):
• Use fine motor activities to help student develop the precision, balance, and hand-eye coordination that are needed to perform the fine-motor skills used in handwriting.
• Have student pick out one or more of the following fine motor activities:
- Modeling Clay,
- Craft Scissors for cutting shape,
- Finger Paints,
- Puzzles,
- Drawing in Different Media,
- Play with Lego, miniature cars, small blocks, action figures, and other small toys.
- Sorting collections of loose coins into stacks of pennies, nickels, dimes, and quarters
- Creative Art Projects that involve using crayons, and/or
- Play Games that involve the handling of cards and small game pieces.
- Sort collections of loose coins into stacks of pennies, nickels, dimes, and quarters.
- Have student work on a chosen fine motor activity for 10 minutes.
- Make sure student has lots of motivating opportunities for using his/her hands.
Session III (10 Minutes-Handwriting):
- Have student pick out an excerpt from a book he/she likes at his/her grade level.
- Give student the opportunity for using print or cursive handwriting.
- Have student write the same excerpt over and over for 10 minutes using a pen of pencil on a Double lines worksheet to promote neatness and correct letter placement.
Session IV (10 Minutes- Fine Motor Activities):
• Use fine motor activities to help student develop the precision, balance, and hand-eye coordination that are needed to perform the fine-motor skills used in handwriting.
• Have student pick out one or more of the following fine motor activities:
- Modeling Clay,
- Craft Scissors for cutting shape,
- Finger Paints,
- Puzzles,
- Drawing in Different Media,
- Play with Lego, miniature cars, small blocks, action figures, and other small toys.
- Sorting collections of loose coins into stacks of pennies, nickels, dimes, and quarters
- Creative Art Projects that involve using crayons, and/or
- Play Games that involve the handling of cards and small game pieces.
- Sort collections of loose coins into stacks of pennies, nickels, dimes, and quarters.
- Have student work on a chosen fine motor activity for 10 minutes.
- Make sure student has lots of motivating opportunities for using his/her hands.
General Instructions:
- The program should be run for 2-3 months, once a day, 30 minutes a day,5 days a week
- Provide a quiet, comfortable, and warm atmosphere for student to work.
- Make sure student understands the directions before beginning a handwriting lesson.
- Make the writing interesting by doing things not done before
- It may be helpful if you could generate a list of handwriting and fine motor activities ideas every morning with student so that he/she has lots of choices.
- Have student write it as fast as he/she can while you accurately time him/her.
- Give student consistent undivided attention, motivating opportunities, encouragement, support, reward while working on his/her assignment.
Appendix B
Data Collection Sheet
Data Collection Sheet
School Name ____________________________________ Parish ______________
Teacher Name __________________________________ Date ________________
Student Name __________________________________ Grade _______________
Date of Birth ________ Gender (M) ___ (F) ____ Race ___________
ADHD (check one):
- Combined Type _____
- Predominantly Hyperactivity-Impulsive Type _____
- Predominantly Inattention Type ______
MedicationUsed____________________________________________________
• Achievement Test Used: Wide Rang Achievement Test-III
• Pre-Intervention Test Score: ________Date:___________________ Raw Score Std. Score le Grade Score Absolute Score
READING ______ ______ ____ ______ _____
SPELLING ______ ______ ____ ______ _____
ARTHIMATIC ______ ______ ____ ______ _____
Date _____________________________________________________________
• Post-Intervention Test Score:_______Date: ________________________
Raw Score Std. Score le Grade Score Absolute Score
READING ______ ______ ____ ______ _____
SPELLING ______ ______ ____ ______ _____
ARTHIMATIC ______ ______ ____ ______ _____
Table1
Summary of WRAT-III Changes for the Experimental Group (n=10)
__________________________________________________________________________
Pretest Posttest
WRAT-III Mean S.D. Mean S.D. Mean difference Effect-size d
___________________________________________________________________________
Reading 25.5 4.53 28.6 4.48 3.1 0.69
Spelling 22.3 6.91 25.2 6.29 2.9 0.44
Math 22.5 5.23 25.7 4.50 3.2 0.66
Full Test 70.3 15.43 79.5 14.61 9.2 0.61
____________________________________________________________________________
1 Wide Range Achievement Test, Revised (WRAT-III). 2. Standard Deviation (SD)
Table 2
Summary of WRAT-III Changes for the Control Group (n=10)
__________________________________________________________________________
Pretest Posttest
WRAT-III Mean S.D. Mean S.D. Mean difference Effect size d
___________________________________________________________________________
Reading 27.7 7.90 28.8 8.09 1.1 0.14
Spelling 23.6 6.90 24.9 7.25 1.3 0.18
Math 21.1 9.01 22.4 8.22 1.3 0.15
Full Test 72.4 21.73 76.1 21.86 3.7 0.17
____________________________________________________________________________
1 Wide Range Achievement Test, Revised (WRAT-III). 2. Standard Deviation (SD)
About the AuthorDr. Kamal Sesalem
Professor of Special Education
Dept. of Teacher Education
McNeese State University
Lake Charles, LA 70609
