Interventions for Students with ADHD
Not every child who fidgets and fails to follow directions has attention deficit hyperactivity disorder (ADHD). To receive this diagnosis from a health care professional, a child must exhibit chronic, developmentally inappropriate levels of inattention, impulse hyperactivity, or both-and these behaviors must be manifested in more than one environment (e.g., home and school). Between 3 percent and 7 percent of children have ADHD, according to estimates from the American Psychiatric Association (2000), and these children often struggle socially and academically.
What can research tell us about how to help them succeed?
First, mainstream educators need opportunities to learn about ADHD. Most children with ADHD, including those receiving special education services, spend most of their time in general education classrooms (Schnoes et al., 2006). The National Institute of Mental Health estimates that each U.S. classroom includes at least one student with ADHD.
Here are some basic facts teachers need to know: (1) The causes of ADHD seem to be grounded in neurobiology and genetics. The National Institute of Mental Health reports, "There is little compelling evidence at this time that ADHD can arise purely from social factors or child-rearing methods." (2) Not all children with ADHD have the same types of challenges when it comes to attention and learning. The American Psychological Association has identified three different types of ADHD (see box). (3) ADHD behaviors may vary from day to day. (4) Children with ADHD sometimes have other conditions as well. About 33 percent to 50 percent, mostly boys, have oppositional defiant disorder; 20 percent to 40 percent develop a more serious antisocial behavior pattern called conduct disorder; 20 percent to 30 percent have a specific learning disability such as dyslexia; some have anxiety or depression; and a few have Tourette syndrome (NIMH, n.d.). (5) Stimulant medication is commonly used to treat the symptoms of ADHD, but medication alone is often not enough to produce the desired academic gains, and 20 percent to 30 percent of children do not react favorably to medication (Trout et al., 2007). (6) ADHD symptoms often lessen in adolescence but may persist into adulthood. Adolescents with ADHD are more likely than the general student population to be retained, get suspended, or quit school.
Teachers who know about effective interventions can help children with ADHD manage behaviors that interfere with their own learning. According to an analysis of the Special Education Elementary Longitudinal Study, strategies that show evidence of effectiveness include "strategic seating, modified assignments (e.g., shorter assignments, frequent breaks), individualized instruction, cooperative learning (e.g., peer tutoring), behavioral modification interventions, and specialized consultation for teachers and parents." Of these techniques, strategic seating was the only one that general educators in the study used as much or more than special educators (Schnoes et al., 2006).
"Because of the significant overlap between ADHD and academic underachievement, one might expect that there has been considerable research into nonmedical interventions to enhance academic functioning. However, this is not the case," concluded Alexandra Trout and colleagues in 2007. Her team found 41 experimental studies that evaluated the impact of nonmedical interventions on the academic functioning of students with ADHD, but "significant limitations in the literature allow for few conclusions about intervention effects and generalization." Overall, consequence-based interventions, peer tutoring, and token reinforcement emerged as promising practices. Large positive effects were noted for parent tutoring and strategy instruction, but available research was very limited. Comparisons of groups of students on and off medication indicate that medication combined with academic interventions "produces the most significant effects on students' academic performance."
In 2007, Jitendra et al. published the results of a large-scale longitudinal study that compared the effects of two schoolbased models on the academic achievement of elementary school children with ADHD. In both models, consultants collaborated with teachers to design and monitor evidence-based academic interventionsfocused on math and/or reading skills and used teacher-mediated, peer-mediated, computer-assisted, and self-mediated interventions. Individualized academic interventions, however, were featured in only one of the models. The researchers expected that this model would yield greater academic growth, but the results were equally positive for both groups over a 15-month period. This, they say, suggests that intensive, individual support may be needed by only a select group of children with ADHD.
Jason Harlacher, Nicole Roberts and Kenneth Merrill have identified wholeclass behavioral and academic interventions that benefit children with ADHD. These include contingency management (using positive reinforcements and making consequences contingent on specific behaviors), using therapy balls or gym balls as an alternative to regular seating, selfmonitoring (teaching students to monitor and rate their own behaviors), peer monitoring (training students to monitor one another's behavior and reinforce positive behavior) and peer tutoring.
Carla Thomas McClure is a staff writer at Edvantia, a nonprofit education research and development organization (www.edvantia.org) For references used in this article, go to www.DistrictAdministration.com.