Strategies for Teaching Adolescents with ADHD E-Book

Silvia L. DeRuvo

• Herausgeber: John Wiley & Sons
• Kategorie: Bildung
• Sprache: Englisch

Seitenzahl: 272

Veröffentlichungsjahr: 2009

Beschreibung

ADHD expert offers help for teaching the content areas tostudents with attention problems Written by an expert in the field of ADHD, this importantresource offers strategies to teach adolescents with ADHD acrossall core content areas: English Language Arts, Math, Science, andSocial Studies. These strategies have been classroom-tested andproven to engage students during content instruction so that theywill gain a lasting understanding of the material taught. Asstudents interact with the content--talk, write, draw, andcreate a variety of media in relation to the content--allstudents, including those with ADHD, will learn the basicsnecessary for post-secondary education and employment. * Offers an important guide for teaching core content toadolescents with ADHD * Includes information for engaging ADHD students in a way thatmakes content memorable * Explains how to use the strategies to teach allclassroom students * Written by a nationally known authority on ADHD * Published in partnership with the acclaimed WestEdorganization

Leseprobe

Table of Contents

Jossey-Bass Teacher

Title Page

Copyright Page

About This Book

About The Author

Dedication

Acknowledgements

Chapter 1 - Why Another Book on ADHD?

Education in the Twenty-First Century: The No Child Left Behind Act and Federal Accountability

The Individuals with Disabilities Education Act of 2004

Students with ADHD and Special Education: Section 504 of the Rehabilitation Act ...

Teaching in the Twenty-First Century: Current Research and Instructional Practice

Response to Intervention: Behavioral and Academic Approaches

To Sum Up

Chapter 2 - Understanding ADHD in Adolescents

Willful Disobedience or Neurobiological Disorder?

Understanding the Nerve Cell

Types of ADHD

ADHD in Girls

The Impact of ADHD on Adolescents

Academic Indicators of ADHD

Why Do Adolescents with ADHD Struggle?

Other Disorders Associated with ADHD

To Sum Up

Chapter 3 - Research-Based Teaching Strategies

The Engaging Classroom

Focus on Student Learning

Research-Based Strategies That Support Students with ADHD

Meeting the Academic Challenges of Students with ADHD

Implementation of Instructional Strategies: Meeting the Needs of All Students ...

Instructional Design That Supports Students with ADHD

To Sum Up

Chapter 4 - Strategies to Support Students with ADHD in English Language Arts

The Learner-Centered Classroom

Teaching English Language Arts

The Research

The Practice

To Sum Up

Chapter 5 - Strategies to Support Students with ADHD in Math

Mathematical Knowledge

The Research

The Practice

Putting It All Together: Strategies for Accessing Algebraic Concepts

To Sum Up

Chapter 6 - Strategies to Support Students with ADHD in Science and Social Studies

The Research: Science

The Practice: Science

The Research: Social Studies

Active Learning in the Science or Social Studies Classroom

To Sum Up

Chapter 7 - Creating a Positive Learning Environment for Students with ADHD

The Research

Preventing Problem Behaviors

Analyzing Problem Behaviors

Research to Practice

To Sum Up

Chapter 8 - Working Together to Promote Postsecondary Success

Responsibilities of the School

Response to Intervention: Schoolwide Support for All Students

Responsibilities of the Family

Responsibilities of the Student

To Sum Up

Endnotes

References

Index

Other Books of Interest

Other Books Published in Partnership with WestEd

Jossey-Bass Teacher

Jossey-Bass Teacher provides educators with practical knowledge and tools to create a positive and lifelong impact on student learning. We offer classroom-tested and research-based teaching resources for a variety of grade levels and subject areas. Whether you are an aspiring, new, or veteran teacher, we want to help you make every teaching day your best.

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Library of Congress Cataloging-in-Publication Data

DeRuvo, Silvia L.

Strategies for teaching adolescents with ADHD : effective classroom techniques across the content areas, grades 6-12 / Silvia DeRuvo.

p. cm. Includes bibliographical references and index.

eISBN : 978-0-470-61559-1

1. Attention-deficit-disordered youth—Education. 2. Educational innovations. 3. Interdisciplinary approach in education. 4. Content area reading. I. Title.

LC4713.2.D47 2009 371.94—dc22

2009025577

About This Book

Strategies for Teaching Adolescents with ADHDtakes on the challenge you face as teachers in trying to provide meaningful, engaging content-based instruction to meet the needs of your students with ADHD. This book provides insight into the disability of ADHD and how this disability manifests differently in adolescents than in students of other ages. This book also offers extensive insight into the biological and neurological components of ADHD and how weaknesses in executive functions affect not only academic but social and behavioral outcomes for these students as well. Having a clear understanding of ADHD will allow you to better cope with students’ needs and proactively plan instruction that meets those needs.

In addition to an understanding of the neurobiological components of ADHD, you need specific research-based instructional strategies that are not formulaic but strategic, focusing on instruction that supports student engagement. The content strategies in Strategies for Teaching Adolescents with ADHDprovide you, the secondary school teacher, with content-specific ideas in English language arts, math, science, and social studies that allow students to interact with the content through talking, writing, moving, drawing, and creating in a variety of media, all in relation to the content. Further, this book provides you with the effective classroom management structures needed to support an engaging classroom. This book also provides practical strategies for teaching the self-determination skills necessary for those with ADHD and others with mild disabilities to learn the content required for postsecondary education and employment.

About The Author

Silvia L. DeRuvo is a special education resources development specialist with WestEd, a nonprofit agency that works with schools, districts, state agencies, and national policymakers in educational research, products, and programs. Her job focuses primarily on working with schools and teachers on effective research-based instructional practices that support the needs of students with disabilities within integrated classrooms. Prior to her work at WestEd, Silvia was a special educator in elementary schools for two decades and a teacher trainer at California State University, Sacramento. She is a national speaker for the Bureau of Education and Research on topics pertaining to Response to Intervention implementation practices and is a coauthor of Teaching Young Children with ADHD: Successful Strategies and Practical Interventions for PreK-3, and The School Counselor’s Guide to ADHD: What to Know and What to Do to Help Your Students,both published by Corwin Press.

Silvia received an M.A. in communicative disorders from California State University, Fresno, and holds credentials in Multiple Subjects; as a Special Education Specialist: Communications Handicapped; as well as Resource Specialist certification. Silvia lives in Northern California with her husband, two children, a dog, and five cats.

To the Creator who is completing His Work in me

To my family: my husband, Fred, my helpmate and best friend; and Rachel and David, my mature and supportive children. You are all a blessing to me

To the teachers who are not afraid to try these strategies so that their students with ADHD can recognize themselves as capable, effectual learners

Acknowledgments

My deepest thanks and appreciation go to the following people:

Rich Lougy, for first inviting me to coauthor Teaching Young Children with ADHD: Successful Strategies and Practical Interventions for PreK-3, and The School Counselor’s Guide to ADHD: What to Know and What to Do to Help Your Students: I have learned so much from you about individuals with ADHD, and without your expertise and support, I could never have put this book together.

In memory, Bill Harris, who agreed to hire me at California State University, Sacramento, allowing me incredible opportunities to learn from my students.

The students in the special education cohort, Sacramento City Unified School District: You had faith in me, and despite significant challenges, you persevered, listened to me, and implemented many of these strategies in your classrooms. I learned so very much from my time in your classrooms. Thank you.

My students in the general education credential cohort of Project Impact: You also believed what I had to say about effective strategies and inclusion, and you weren’t afraid to try. Thank you for your courage. Your students benefited more than you can imagine.

My students and student teachers at California State University, Sacramento: You were not afraid to think outside the box and were willing to implement inclusionary models of special education services because it was best for kids. I learned a great deal from your experiences.

My colleagues at WestEd: You have supported me and provided me opportunities to work with the best of the best from all over the country.

Marjorie McAneny, my editor at Jossey-Bass: I have appreciated your patience, and I know you have done a tremendous amount of behind-the-scenes work to make this book a reality.

My students in Sanger, Clovis, and San Juan Unified: You have been the inspiration for the words written on these pages.

Silvia L. DeRuvo

Chapter 1

Why Another Book on ADHD?

As a secondary teacher, you are a powerful catalyst in the lives of the students who enter your doors. Your extraordinary impact on their success has far-reaching consequences. This book was written to equip you for this weighty responsibility by providing you with a clear understanding of your students with ADHD and how to teach them.

“Succeeding in school is one of the most therapeutic things that can happen to a teenager. In fact, school successes may often be more helpful for students struggling with ADHD than an hour of counseling a week. . . . Teachers are often the critical factor determining the success or failure for students with this condition!” 1 This statement by ADHD expert Chris Zeigler Dendy makes it very clear that it is up to the teacher to make academic success a reality for adolescents with attention-deficit/hyperactivity disorder (ADHD). Secondary students who do not achieve academic success have limited postsecondary options. Teachers face a significant challenge in helping their students with ADHD find academic success at the secondary level. This book was written to give teachers the tools to meet this challenge.

Education in the Twenty-First Century: The No Child Left Behind Act and Federal Accountability

Our nation is in an unprecedented period of focus on education and educational accountability. The sweeping reform created by the No Child Left Behind Act (NCLB) has brought to light the inequalities of education that have persisted for years in this country.

The sweeping reform created by the No Child Left Behind Act has brought to light the inequalities of education that have persisted for years in this country.

It has been an ongoing unspoken practice to provide a below-average educational experience for students who live in poverty, for students who speak a second language, and for students with disabilities. Students with ADHD were often included in this group of students, those whom Rod Paige, former Secretary of Education, identified as the “most difficult to teach” and were regularly left behind.2 These students typically did not pass classes, came up credit-deficient due to remedial class attendance, or were unable to pass high-stakes tests—and therefore did not graduate with a diploma. Those who were identified for special education as learning disabled or having other disabilities were often provided a subpar education that did not teach grade-level standards or grade-level skills. Low expectations reigned, and the outcomes were abysmal; 70 percent of adults with learning disabilities were unemployed or underemployed,3 and the average income for working adults with learning disabilities in 1997 was $20,000 a year.4

NCLB has placed a laser-like focus on these inequities and has opened a Pandora’s box of previously hidden inequities in the current systems through accountability. Under NCLB, for the first time, all states are being held accountable for the quality of the education they provide to all students. Each state has had to develop or adopt a standardized assessment to measure the proficiency of all students on the state’s grade-level content standards. NCLB holds the lofty goal that all students in each state, in each district, and in each school reach proficiency. This goal includes all students in every classroom, even those “difficult-to-teach” students in your classroom who may have ADHD or other disabilities. Discussion of NCLB often results in the rolling of eyes and the gnashing of teeth, but as former Secretary of Education Margaret Spellings stated in 2006, “What gets measured gets done.”5 This truth cannot be denied. Without the accountability of NCLB, there would continue to be different expectations for different student groups. Realistically, attaining the goal of 100 percent proficiency by 2014 is impossible, but the climb to meet the goal in all states has brought about profound changes in the way that teachers teach and in instructional opportunities for all students.

The Individuals with Disabilities Education Act of 2004

It is possible that the most pronounced change caused by NCLB has been for students with disabilities. The spotlight on the performance of these students has revealed that the educational outcomes for students with disabilities have not been held to the same standard as those for their peers. “Special education classification has too frequently been used to diminish the expectations for the students designated as eligible for such services and to minimize the responsibility of general education teachers and administrators for their progress.”6 The pervasiveness of lowered expectations and below-average educational opportunities has been brought to light.

The fact that, in the past, special education has existed in its own separate silos has contributed to the marginalization of special education students. In the typical approach to special education, children are not seen as students first but rather as part of a separate system in which labels have determined both the access to grade-level content and the instruction itself.

In conjunction with NCLB, the Individuals with Disabilities Education Act of 2004 supports the notion that students with disabilities can be proficient at grade-level standards when provided instruction in the general education curriculum. This is a far cry from the traditional special education practices of self-contained classrooms with a separate curriculum or resource rooms with remedial instruction. The combined effect of these two acts has broken down the silo mentality of separate systems and has created educational scenarios in which all teachers are responsible for all students, providing an integrated schoolwide instructional program in which all students have access to standards-aligned instruction in the general education core classroom (see Figure 1.1).

Educational equity for students with disabilities has not been an option in the past.

Students with ADHD and Special Education: Section 504 of the Rehabilitation Act of 1973

Prior to the reauthorization of the Individuals with Disabilities Education Act (IDEA) in 1997, the only statutory option for obtaining educational support for students with ADHD was Section 504 of the Rehabilitation Act of 1973. IDEA 1997 allowed students with ADHD who were significantly impaired to qualify for special education services under the “Other Health Impaired” (OHI) federal handicapping condition category [34 CFR §300.8(c)(9)]. Most students with ADHD do not qualify as having an OHI handicapping condition because the impairment is often not deemed significant enough to warrant special education services; however, instructional accommodations and adaptations provided through a Section 504 plan are considered to be required for the student to be academically successful.

Figure 1.1: Nonintegrated and Integrated Approaches to Instruction

Source: Illustration created by Fred DeRuvo.

While most students with ADHD in a typical classroom function without the intensive, specially designed academic instruction or supplementary services provided by special education under IDEA, many students are affected to the extent that they require a Section 504 plan of some sort. Section 504 of the Rehabilitation Act of 1973 is a civil rights law that prohibits discrimination or harassment on the basis of a disability in any program receiving federal financial assistance. Therefore, public schools must comply with the nondiscrimination requirements of Section 504 to provide students with disabilities with a “free and appropriate public education” in a program designed to meet the students’ educational needs as adequately as they meet the educational needs of students without disabilities. This statute (Section 504, 34 CFR § 104) identifies an “individual with a disability,” as a person who “has a physical or mental impairment which substantially limits one or more major life activities.”

• “Major life activities” is defined as functions such as caring for one’s self, performing manual tasks, walking, seeing, hearing, speaking, breathing, learning, and working.

• “Substantially limits ” describes a disability that significantly affects the student at school.

• “Meeting the students’ educational needs as adequately as they meet the educational needs of students without disabilities” refers to educating students in a general education classroom with the use of supplementary or related aids and services. These accommodations are identified in the student’s Section 504 plan and might include a change in the educational setting or materials or strategies that do not significantly alter the content of the curriculum or the level of expectation of a student’s performance but that allow the student to access the general e ducation curriculum.

Because learning is one of the major life activities identified in this law, students diagnosed with ADHD whose ability to be in school and do their schoolwork is substantially limited by their disability are found to be eligible for academic accommodations under Section 504.

Not every student with ADHD will have a 504 plan, but those who find that their disability substantially limits their ability to be successful in school will. There continues to be some confusion in the field about whether providing the accommodations to the student are a district’s, school’s, or individual instructor’s choice. Under the law, it is clear that the provisions are not optional. If the student has been assessed by a qualified professional and is found to qualify as a person with a disability under Section 504, then that student’s district, school, and individual instructors must provide the accommodations identified by the school’s 504 team and included in the 504 plan.

The 504 team, including the site administrator or that person’s designee, general education teachers, school psychologist or other specialists, parents, and the student determine which accommodations would allow the student to be free from discrimination and have the same instructional opportunities as his peers without the disability. An example of a reasonable accommodation for a student with ADHD who struggles with the organizational skill of lining math problems up correctly on a blank piece of paper would be to provide the student with a sheet that has the problems already written on it or with graph paper that would help the student with the organization needed to write the problems correctly. For note taking, the student might be provided with a graphic organizer or a note-taking guide. These simple examples show that the accommodations in a 504 plan are often easily implemented and do not require an inordinate amount of work or planning on the part of the school or the instructor, but nonetheless can have a significant impact for a student who might get the math answers wrong due to poor alignment on the page or have poor study notes due to difficulties in keeping up with note taking.

All teachers and staff working with the student should be informed of the 504 accommodations, and the student should be able to advocate for these herself. Once a district, school, or instructor is informed of the accommodations in the plan, it is a breach of the student’s civil rights to disallow the use of them. Compliance with the law requires that teachers, students, and staff recognize that accommodations are not optional because the disability puts the student at a disadvantage; the accommodations in the 504 plan simply level the playing field, creating a more equitable educational opportunity for young people with ADHD.

It is a breach of a student’s civil rights to disallow the use of accommodations.

Students identified as having ADHD whose disability significantly affects their academic progress to the extent of requiring specially designed academic instruction or supplementary services under IDEA will also have accommodations written into their Individualized Education Plan (IEP). In the same vein as 504 plans, these accommodations are deemed by the IEP team as necessary in order for the student to make progress in the general education curriculum. It would be a breach of IDEA to deny these accommodations that are provided to the student by law.

Teaching in the Twenty-First Century: Current Research and Instructional Practice

To a secondary school teacher, meeting the mandates of NCLB, IDEA 2004, and Section 504 of the Rehabilitation Act may seem overwhelming. Making sure that no student in your class is left behind and that all students, including your students with ADHD, meet grade -level standards is quite a challenge. This book has been written to support you, the secondary school teacher, in reaching these lofty, yet attainable goals.

First, as a teacher of young adults with ADHD, it is important that you be able to recognize how the disability may look in your classroom. Although you may have friends or relatives who have a child with ADHD, the symptoms of this disability may look very different in your secondary school classroom. It is also essential that you realize that the single label ADHD actually includes behaviors that differ from student to student and from gender to gender. Having a clear understanding of the neurobiological and neurological components of the disability may give you more clarity on the puzzling behaviors of some of your students. The next chapter will focus on what ADHD means for adolescents with this disability and what it may look like in your classroom.

Abundant research supports the proposition that engaged students learn more, and there is a direct correlation between the amount of time that students are actively engaged in learning and their achievement levels.7 Instruction that is engaging will produce better outcomes for students with ADHD as well as reduce many of their common behavior problems. Chapter Three will focus on instructional engagement strategies that allow students to be continually involved in their learning, thus improving their academic level and their psychological investment in meeting grade-level standards.

Differentiated Instruction

Differentiated instruction is focused to meet the specific learning needs and learning styles of all students. Our highly technological society has changed the way that students learn and take in information. Students are technologically connected in ways that most parents and teachers cannot comprehend. Is it any wonder that the traditional form of classroom instruction has become obsolete? The time has come to break the paradigms of our old instructional models and methods and embrace student-centered, active learning and engaging instructional methods. Chapter Three will also examine specific research-based instructional strategies that will support the instructional needs of your YouTube-generation students and the students with ADHD in your classroom.

The Student-Centered Classroom

Teaching in the twenty-first century requires a culture in which the focus has changed from what is taught to what is learned. Chapter Four defines the student-centered classroom, which is a major shift from the teaching of content to the teaching of students. In a student-centered classroom, the teacher facilitates the learning, but the students do the critical thinking work, solving problems through discussion and joint efforts. Students with ADHD flourish in a student-centered environment because the activities of the class have meaning and allow them to take greater ownership of their learning.

Within the context of a learning-centered classroom, research-based instructional strategies for English language arts will be examined in Chapter Four. This chapter investigates specific vocabulary instruction strategies, reading comprehension strategies, and classroom practices that motivate students with ADHD to become actively involved in literacy. Reading intervention structures and processes are also discussed, as well as specific scaffolds for developing independent writing skills in students who struggle with working memory.

High-level math skills are a gateway skill to higher education. Because a large number of students with ADHD have difficulty in learning math due to issues with working memory that affect their ability to memorize and recall information, it is essential for the twenty-first-century teacher to use instructional strategies that address these weaknesses. In Chapter Five, we will look at the different levels of math knowledge required to be successful in math and how ADHD affects these processes. The chapter also takes an in-depth look at seven instructional strategies for students who are at risk for math failure that were identified by the Center on Instruction. Strategies for accessing algebraic concepts will also be covered, including the use of the concrete-representational-abstract (CRA) instructional strategy to help students learn how to translate word problems into mathematical symbols and link the concrete to a representation and then to an abstract or symbolic level. Effective strategies to help with memory and recall, such as graphic organizers, mnemonics, and process steps, will also be discussed.

Standards-Aligned Instruction

The application of standards-aligned instruction in science and social studies is the focus of Chapter Six. When focusing on standards instead of textbooks and defining the curriculum as a structured set of learning outcomes, teaching these two content areas can be a very creative endeavor. This chapter will look at the latest research on effective science and social studies instruction within the context of a learner-centered classroom in which active learning and intentional student engagement are employed. This chapter will look at the motivational factors that affect students with ADHD when learning the content in these two areas as well as ideal processes for eliciting intellectual engagement. Examples from teachers who have made science instruction intellectually engaging and who have brought history alive are provided in this chapter as well as a few teacher tricks for helping students memorize basic science and history facts.

Response to Intervention: Behavioral and Academic Approaches

Students with ADHD often suffer from anxiety disorders8 and find the unpredictability of teachers’ behavioral expectations across a school campus too confusing to figure out, often leaving students lost, confused, or unresponsive. Students with ADHD need consistency and predictability as well as rituals and routines that support positive behavioral interactions with their teacher and other students. Developing schoolwide supports for positive behavior that include clear common expectations is covered in Chapter Seven. This chapter will cover the behavior management strategies that do not work as well as those that have proven to be successful. Chapter Seven also looks at proactive strategies for managing students’ behavior and at the principles of fairness and respect. Finally, this chapter covers the three tiers of behavior intervention that are often referred to as a multi-tiered intervention or a Response to Intervention model. Strategies that support students at all levels of behavioral needs will be investigated, as well as what can be done for students with ADHD who need the highest level of behavioral intervention.

Secondary school teachers have a tremendous responsibility for meeting the academic, social, and behavioral needs of their students with ADHD. Chapter Eight covers the schools’ responsibility for providing equitable educational opportunities for all students through a multi-tiered intervention or Response to Intervention (RtI) model. This chapter will explore the different purposes of RtI and how students with ADHD can benefit from each tier of intervention, depending on their particular academic needs. Finally, this chapter looks at the responsibility of the family and, ultimately, of the student. Students with ADHD at the secondary level need to be able to advocate for their own needs, but beyond that, they need to develop long-term strategies that will build self-determination and effective transition skills. This chapter investigates classroom activities that help students with ADHD develop these skills, which will serve them throughout life.

It is the school’s responsibility to provide equitable educational opportunities for all students through a multi -tiered intervention or Response to Intervention (RtI) model.

To Sum Up

Facing the changes created by NCLB and its subsequent accountability for all students is not easy. The shift in responsibility and instructional practice is uncomfortable for many teachers. Recognizing this discomfort is the first step in moving forward and taking the steps necessary to bring about necessary change. The information and strategies provided in this book provide an opportunity to empower teachers to take on the challenge of change. Recognizing the specific needs of students and having the tools, knowledge, and strategies to adjust instruction to meet those needs will create classrooms where productive learning will occur. This book aims to provide you, the secondary school teacher, with the tools, knowledge, and strategies you need to make productive learning a reality for your students.

Chapter 2

Understanding ADHD in Adolescents

Having ADHD puts kids at risk for problems at school, academically, socially, and behaviorally. Middle school and high school are often the most challenging years of these kids’ lives. These students often were supported by the structure of the elementary school classroom, but once they find themselves at middle school, the barrage of change and juggling of teachers, classes, homework, and assignments becomes overwhelming and grades often make a very quick downward spiral. A teacher can make a significant impact on changing the trajectory of this spiral. Teachers are very influential in the lives of teenagers, and when teachers believe in them and give them respect and esteem, they respond in kind. “When a teacher conveys a message that a teenager is capable and worthwhile, the teen believes the message.”1

Teachers want their students with ADHD to succeed but often feel ill equipped to do so. This book has been written to give those teachers not only the tools to teach but also a greater understanding of who their students with ADHD are and what the “hidden disability” of ADHD really means for them.

Willful Disobedience or Neurobiological Disorder?

Many students with ADHD have been accused of “willful disobedience,” “defiance,” “laziness,” or outright “rebellion.” Did these students choose to not follow directions or not complete their projects on time, or is their lack of ability to follow through due to a neurobiological disorder? Research has shown that for students with ADHD, there are some changes in the brain that are not present in nonaffected students. Positive emission tomography (PET) scans have shown some differences in the brains of students with ADHD, including reduced metabolic activity in the frontal areas of the brain that are involved in attention, impulsivity, motor activities, emotions, and memory.2

The variability of symptoms in individuals with ADHD can be explained in part by anomalies in these different parts of the brain’s circuitry. Students with ADHD who show decreased metabolic activity in the areas of the brain that are thought to be responsible for the regulation of inhibition and attention will exhibit ADHD symptoms due to abnormalities in neurotransmitter functioning. The abnormal functioning of these neurotransmitters affects the proper functioning of areas of the brain that regulate attention, impulse control, and so on.3 The two primary neurotransmitter systems most directly involved in ADHD are dopamine and norepinephrine systems. These two systems influence a variety of ADHD-like behaviors, including those involving attention, inhibition, motor activity, and motivation.

Understanding the Nerve Cell

In order to clearly understand how neurotransmitters affect the behavior of students with ADHD, it is essential to understand the function of the nerve cell (see