Attention-Deficit/Hyperactivity Disorder (ADHD)

Problems with attention, impulse control, and activity level exhibited by children are among the most frequent behavior difficulties in classroom settings. In fact, approximately 3% to 5% of elementary school–aged children in the United States are diagnosed with attention-deficit/hyperactivity disorder (ADHD), a diagnostic classification used to describe individuals who exhibit developmentally inappropriate levels of inattention or impulsivity and overactivity.

Children with ADHD are at higher than average risk for a variety of behavioral difficulties, including defiance toward authority figures; poor relationships with peers; and antisocial acts, such as lying, stealing, and fighting. Also, students with ADHD frequently struggle scholastically and experience significantly higher rates of grade retention, placement in special education classrooms, and school dropout relative to their peers, as well as significantly lower high school grade point average, enrollment in college degree programs, and socioeconomic status. Further, approximately 20% to 30% of children with ADHD are classified as learning disabled because of deficits in the acquisition of specific academic skills. The high level of risk for poor behavioral adjustment and academic outcomes associated with ADHD suggests a pressing need for effective intervention strategies to address the attention, behavioral, and academic problems experienced by these children.

Two interventions shown to be efficacious with students with ADHD are psychostimulant medication (e.g., methylphenidate) and contingency management procedures (e.g., token reinforcement and response cost). Research studies are replete with evidence that these two intervention strategies are capable of enhancing rates of academic productivity and accuracy and reducing behavioral difficulties for students with ADHD. However, in research and in practice, these interventions do not influence all children in either a similar or a positive manner. As a result, complementary and supplementary strategies are needed in many cases.

In this regard, promising and recently developed schooland home-based interventions include peer mediation strategies, such as classwide peer tutoring (CWPT), and computer assisted instruction (CAI). Both CWPT and CAI allow for the provision of instruction characterized by many opportunities to respond, immediate feedback, and high rates of reinforcement. These strategies have been shown to not only improve academic functioning but also increase task engagement and decrease task-irrelevant behavior in students with ADHD.

Recent research also suggests that self-management and parent-mediated strategies (e.g., homework monitoring, tutoring, and school-home notes) can effectively address some of the difficulties associated with ADHD. One form of self-management, for example, engages students in evaluating their own behavior and academic performance. These evaluations initially are compared to those of the classroom teacher, and tokens or points are awarded for student ratings that match or closely approximate those of the teacher. Over time, the teacher ratings are faded. Finally, recent research also has demonstrated the effectiveness of intervention strategies derived from functional behavior assessments for students with ADHD.

In summary, students with ADHD are at risk for a number of academic and behavioral difficulties in school. Evidence-based interventions include both contingency management procedures and psychostimulant medications, as well as strategies focused on highquality instruction, improved self-management, and function-based behavior management. Individualized combinations of these strategies are indicated for students with ADHD.

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