ADHD in the Classroom: Effective Intervention Strategies

Author(s): George J. DuPaul, Lisa L. Weyandt and Grace M. Janusis

Source: Theory Into Practice , Winter 2011, Vol. 50, No. 1, Current Perspectives on
Learning Disabilities and ADHD (Winter 2011), pp. 35-42
Published by: Taylor & Francis, Ltd.

Stable URL: https://www.jstor.org/stable/23020735

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Theory Into Practice, 50:35-42, 2011
Copyright © The College of Education and Human Ecology, The Ohio State University
Routledge
? Taylor & Francis Croup
ISSN: 0040-5841 print/1543-0421 online
DOi: 10.1080/00405841.2011.534935

George J. DuPaul
Lisa L. Weyandt
Grace M. Janusis

ADHD in the Classroom:

Effective Intervention Strategies

School-related difficulties are commonly associ

ogists are presented. Multiple treatment strate
ated with attention deficit hyperactivity disorder
gies implemented in a consistent fashion across
(ADHD). This article describes effective school
school years can optimize the school success of
students with ADHD.
based intervention strategies including behav
ioral interventions, modifications to academic
instruction, and home-school communication
programs. One overlooked aspect of treatment of
children with ADHD is the need to form partner
ships among school professionals who can work
collaboratively on interventions for children with
Attention deficit
disorder (ADHD) hyperactivity
is characterized by
ADHD. Approaches to developing effective col
pervasive and developmentally inappropriate
laboration between teachers and school psychol
difficulties with attention, impulsivity, and
hyperactivity (American Psychiatric Association,
George J. DuPaul is a professor in the College of 2000). ADHD symptoms cause significant
Education at Lehigh University; Lisa L. Weyandt is impairments at home and in school and are
a professor in the Department of Psychology at the associated with a number of behavior difficulties
University of Rhode Island; Grace M. Janusis is a
such as aggression and noncompliance (Barkley,
doctoral student in the School Psychology Program
2006). Research also suggests that children
at the University of Rhode Island.
Correspondence should be addressed to Professor
with ADHD are more likely than typically
George J. DuPaul, Department of Education and Hu developing classmates to be rejected socially
man Services, Lehigh University, 111 Research Drive, and to have greater difficulties with their peers
Bethlehem, PA 18015. E-mail: gjd3@lehigh.edu (Hinshaw, 2002). In addition, teachers are more

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Current Perspectives on Learning Disabilities and ADHD

likely to perceive a child with an ADHD label Behavioral Interventions

less favorably with respect to intelligence,

personality, and behavior (Batzle, Weyandt, Behavioral interventions for students
Janusis & Devietti, 2010). with ADHD include both antecedent- and
Academically, children with ADHD are more consequence-based strategies. Impaired delay
likely to have poorer grades, lower scores on responding to the environment is the putati
standardized tests, greater likelihood of identi core deficit underlying ADHD (Barkley, 20
fication for special education, and an increased Behavioral interventions involve modifications
use of school-based services, compared to peers to the environment that directly address
without the disorder (Loe & Feldman, 2007). this impairment. A variety of antecedent
Students with ADHD are also more likely to based interventions have been used to try to
have a higher absenteeism rate, are three times prevent inattentive and disruptive behaviors
more likely to be retained during elementary from occurring. Antecedents are events that
school, and are at a higher risk for dropping precede and may trigger the occurrence of a
out of high school than their peers without specific behavior. First, teachers can post and
ADHD (Barbaresi, Katusic, Colligan, Weaver, strategically review classroom rules (DuPaul &
& Jacobsen, 2007). Students with ADHD who Weyandt, 2006). Rules should be few in number,
graduate from high school are less likely than phrased in a positive manner (i.e., tell students
their peers to pursue a post-secondary educa what to do, not just the behaviors to avoid),
tion (DuPaul & Weyandt, 2009). Interestingly, and posted in full view of all students. Rules
less research is available concerning methods should be clearly explained at the beginning
to remediate academic problems associated with and periodically throughout the year. Further,
ADHD, compared to studies regarding ways to teachers should frequently praise students who
treat behavioral and social difficulties associated are following the classroom rules. Children with
with the disorder (Jitendra, DuPaul, Someki, ADHD may need to have rules posted in closer
& Tresco, 2008). Given the less-than-favorable
proximity (e.g., printed on an index card affixed
prognosis for children with ADHD, it is im to their desk) and should be provided with more
perative that empirically supported interventions
frequent praise when following rules (Pfiffner,
Barkley, & DuPaul, 2006).
are implemented early, particularly during the
elementary school years. Another antecedent-based strategy frequently
The most common interventions for students recommended for students with ADHD is to

with ADHD include psychotropic medication reduce task demands by modifying the length
and behavioral strategies implemented in home
and/or content of assignments (DuPaul & Stone
and school settings (Barkley, 2006). Although
2003). Reducing the length of an assignmen
stimulant medication frequently is used to to
re match students' attention spans, may reduc
duce ADHD symptoms, pharmacological treat off-task, disruptive behavior. This strategy o
ment rarely is sufficient in addressing the multen is paired with teacher praise contingent o
tiple, chronic difficulties faced by students with
task completion. As students demonstrate succe
ADHD (DuPaul & Stoner, 2003). The purpose
with shorter assignments, the length of assig
of this article is to describe effective school
ments can be gradually increased thereby shapi
task-related behavior to match classroom norms.
based intervention strategies for children with
ADHD including behavioral interventions, mod A final example of an antecedent-based stra
ifications to academic instruction, and home egy is to provide students with task choices wh
school communication programs. Also discussed given classwork assignments. Choice-making i
are approaches to developing partnerships among
terventions allow students to choose among tw
school professionals including methods to facili
or more concurrently presented options (e.g.,
tate collaborative relationships between teachers
signments to complete, sequence of steps withi
and school psychologist consultants. an assignment, or partners for assigned act

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DuPaul, Weyandt, Janusis ADHD in the Classroom: Effective Intervention Strategies

ities). The various options should all lead to close as possible in time to the occurrence of
similar outcomes; for example, students could a target behavior (i.e., provided as immediately
choose an assignment from a menu of possible as possible following a desired behavior).
assignments all of which involve practice of Response cost is an example of a
the same specific academic skill. Dunlap et al. consequence-based intervention in which token
(1994) examined the effects of choice-making for reinforcers are removed contingent on disruptive
several students with disruptive behavior disor off-task behavior. Response cost should be used
ders and ADHD. When students were provided in situations where positive reinforcement
with assignment choices, they showed higher alone has not sufficiently ameliorated problem
rates of task engagement and lower frequency behavior. For example, a token reinforcemen
of disruptive behavior relative to class sessions program may lead to increases in on-task
when teachers chose the specific assignments. behavior but there may still be situations when
Consequence-based strategies involve manip off-task, disruptive behavior is evident or the
ulating environmental events following a specific increases in on-task behavior may not be
behavior to alter the frequency of that behavior. consistent across time. In most cases, response
Several consequence-based strategies have been cost is implemented in conjunction with a token
examined for students with ADHD including reinforcement program such that students are
contingent positive reinforcement, response cost, eligible to receive or lose tokens based on
and self-management interventions (DuPaul & their behavior or work performance. Several
Weyandt, 2006). The most common behavioral studies (e.g., DuPaul, Guevremont, & Barkley,
intervention for ADHD, at least in the research 1992) have demonstrated clinically significant
literature, is the use of contingent positive rein improvements in task-related attention, as well
forcement in the form of teacher praise or token as productivity and accuracy of classwork, when
reinforcement (DuPaul & Stoner, 2003). In such the combination of token reinforcement and

programs, students gain access to praise or token response cost is used.

reinforcement when they exhibit specific target Time-out from positive reinforcement is an
behaviors (e.g., completion of assigned work). other strategy sometimes used to reduce problem
Token reinforcers (e.g., poker chips, stickers, behaviors (Pfiffner et al., 2006). This procedure
points) are exchanged later in the day or week involves briefly removing the student to a sepa
for access to preferred activities (e.g., computer rate part of the classroom or outside the class
game, running errand for teacher) or other re room following disruptive behavior. Of course,
wards. the efficacy of time-out is solely dependent on
Several guidelines should be followed in using whether the classroom is viewed as a positive
reinforcement-based interventions with students
environment by the student; otherwise time-out
with ADHD (DuPaul & Stoner, 2003; Pfiffnercan actually reinforce (or increase the probability
et al., 2006). First, reinforcement should beof) problematic behaviors. In addition, time-out
should be used judiciously and only in combi
provided as frequently as possible, given that
children with this disorder may experience difnation with a mostly positive behavior support
ficulties demonstrating consistent behavior under
program.
conditions of partial reward or intermittent rein
forcement schedules. Second, rather than assum
ing that a specific reward will be motivating for Self-Regulation Interventions
a specific child, rewards should be individual
ized based on student preferences and interests. Self-management (or self-regulation) inter
Further, specific rewards should be rotated orventions encourage students with ADHD to mon
varied over time so that children do not become itor, evaluate, and/or reinforce their own be
haviors, often in conjunction with or following
bored or complacent with the same reinforcers.
the successful application of teacher-mediated
Finally, reinforcement should be provided as

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Current Perspectives on Learning Disabilities and ADHD

behavioral approaches. As is the case for be that directly address academic skills are needed
havioral interventions, self-regulation strategies for many students with this disorder. One effec
directly address the impaired delayed responding tive academic intervention is to provide teacher
that theory has posited to be the core deficit mediated direct instruction in relevant skills that

underlying the disorder. As an example of selfrequire remediation. For example, Evans, Pel
regulation, students with ADHD may be taught ham, and Grudberg (1995) showed that middle
to evaluate their classroom behavior and work school students with ADHD showed improved
performance at regular intervals using a Likert
note-taking and test performance following direct
scale (ranging from poor to excellent). Teachers
instruction in taking notes during teacher instruc
tion. Academic interventions can also be deliv
use the same Likert scale to evaluate student per
formance. Students then receive reinforcement ered through computer technology and classroom
depending on their self-evaluated performance peers. Several studies have shown that computer
assisted instruction in math (Mautone, DuPaul, &
and the degree to which self-evaluation ratings
match teacher ratings. As students demonstrateJitendra, 2005) and reading (Clarfield & Stoner,
success in matching teacher ratings and improv2005) leads to significant improvements in on
task behavior and academic performance for
ing classroom behavior, the frequency of required
students with ADHD relative to written seatwork
matches to teacher ratings is gradually reduced,
and eventually only self-ratings are used. A
conditions. Similarly, classwide peer tutoring in
recent meta-analysis showed that self-evaluation
math, reading, or spelling can be used to enhance
and other self-regulation interventions lead task
to engagement and test performance for all stu
dents, not just those with ADHD (e.g., DuPaul,
relatively large, positive effects on the on-task
behavior and academic performance of students Ervin, Hook, & McGoey, 1998). The combina
with ADHD (Reid, Trout, & Schartz, 2005). tion of academic intervention and self-regulation
A particularly effective and feasible strategy
strategies may actually promote maintenance and
is to teach students with ADHD to monitor their generalization of academic skills gains beyond
teacher-, computer-, or peer-mediated interven
own behaviors. Sometimes the act of consistently
tions, although this premise has yet to be demon
monitoring behavior results in improvements. For
example, Gureasko-Moore, DuPaul, and White strated empirically.
(2007) found that training several middle school
students with ADHD to monitor their homework

and classroom preparedness led to quick and Home-School Communication

durable improvements in organizational skills. Programs

Self-monitoring has been used successfully to
promote other behaviors (e.g., on-task, classworkGiven that children with ADHD experience
completion) and with a variety of age groups; significant difficulties across settings, home
school communication programs are important
this is a particularly effective strategy for students
with milder levels of ADHD (for review, see Reid
components of a comprehensive treatment plan.
et al„ 2005). A daily report card system is an example of
an effective home-school communication pro
gram. Daily report cards (DRCs) are one of
Academic Interventions the most frequently implemented interventions
for children with ADHD, and several studies
Although stimulant medication and behav
have documented their effectiveness when used
ioral interventions typically lead to significant
as a component in a multimethod intervention
reductions in ADHD symptoms and improve
(e.g., Owens et al., 2005). DRCs incorporate
ments in classroom behavior, these treatmentsongoing feedback to students and parents re
have minimal effect on academic achievement garding classroom performance and can target
(DuPaul & Stoner, 2003). Thus, interventions a variety of important behaviors (e.g., work

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DuPaul, Weyandt, Janusis ADHD in the Classroom: Effective Intervention Strategies

completion, academic performance, participation prior investigations of social skills training have
in class, getting along with classmates). Typi been conducted in outpatient clinic settings with
cally, a DRC contains a list of 3 to 5 goals minimal school outcome data beyond teacher
(e.g., complete assigned classwork, get along ratings. Results of these clinic-based studies are
with classmates) on which teachers indicate a equivocal with respect to efficacy (e.g., Pfiffner &
student's performance on a Likert scale (e.g., 1 McBurnett, 1997). Outcomes of these interven
represents superior performance and 5 represents tions are enhanced when specific strategies are
unacceptable performance). Teacher ratings are included to program for maintenance and gener
provided throughout the day (e.g., by academic alization of effects. For example, peers without
class period) and parents then provide home ADHD could be involved in all phases of a social
based reinforcement based on these ratings. As relationship intervention to encourage generality
students make progress, goals are increased in of outcomes.

complexity. DRC programs have been successful

in enhancing classroom behavior and academic
performance of students with ADHD, particularly Collaborative Consultation
those with milder levels of symptom severity
(Murray, Rabiner, Schulte, & Newitt, 2008). Developing positive partnerships among
school professionals through collaboration
can also increase the likelihood of treatment
Interventions Addressing Social success (DuPaul & Stoner, 2003). Collaborative
Relationship Difficulties consultation can improve school functioning
outcomes and academic achievement (e.g.,
Children with ADHD often experience diffi DuPaul et al., 2006). Collaborative consultation
culties with peer relationships, including mak involves an equal partnership between two
ing and keeping friends (DuPaul & Weyandt, partners (e.g., school psychologist and classroom
2006; Weyandt, 2007). Further, children with this teacher) to define a problem and develop
disorder are more likely than their classmates interventions. This model is in contrast to the

to respond to interpersonal problems in an ag traditional, expert model of consultation where

gressive manner. Given the frequent association a school psychologist prescribes interventions
of ADHD with social relationship difficulties, based on teacher input (Erchul & Martens, 2002).
interventions designed to address peer relations An example of an effective partnership model is
must be implemented for a sufficient duration to Project PASS (Promoting Academic Success in
counteract the high risk for problematic outcome. Students) that uses a collaborative consultation
Unfortunately, interventions that target social model between teachers and school psychologist
knowledge and the acquisition of prosocial be consultants to design academic interventions for
haviors in group therapy formats (i.e., traditional children with ADHD. DuPaul and colleagues
social skills training) have not been found to lead (2006) found that consultation-based academic
to durable changes in interpersonal functioning in interventions may enhance reading and math
real-world environments (Gresham, 2002). The skills for children with ADHD. Academic

lack of maintenance and generalization of tradi improvements were noted for students
tional social skills training has led to proposals teachers received two different intensity
for a more comprehensive approach to social of consultation.
relationship intervention for children with dis Collaborative consultation can vary in inten
ruptive behavior disorders (for a review of social sity with respect to the amount of data collected
skills strategies, see Gresham, 2002). to design and evaluate interventions, as well as
Relatively few studies of social relationship the degree to which consultants monitor teachers
interventions for children with ADHD have been with respect to accuracy of treatment imple
conducted, especially in school settings. Most mentation. All models include four core steps

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Current Perspectives on Learning Disabilities and ADHD

that involve school psychologists and teachers is unlikely that a singular focus on antecedent or
jointly defining the academic problem(s), dis consequent events will be sufficient in addressing
cussing possible interventions (all of which are the behavioral difficulties exhibited by students
empirically supported), choosing an intervention with this disorder. Further, many antecedent
plan that teachers believe to be feasible and based strategies have the additional advantage
effective, and evaluating the success of the plan of directly addressing academic functioning. Sec
so that modifications can be made, if necessary. ond, assessment data should be used to design,
Several studies have demonstrated that regardless evaluate, and modify interventions within and
of intensity, collaborative consultation leads to across school years. Assessment-based interven
effective academic interventions for the majority tions presumably will be more effective and
of students with ADHD (e.g., DuPaul et al., time-efficient than using strategies on a trial
2006). The most effective outcomes are found and-error basis. Finally, multiple mediators (e.g.,
when teachers take the lead during the problem peers, computer technology, and students with
identification stage of the collaborative relation ADHD) should be used to deliver treatment so
ship and when consultants lead when possible that classroom teachers are not asked to shoulder

strategies to address problems are discussed and all of the responsibility for intervention. The
designed (Erchul et al., 2007; Erchul et al., 2009). use of collaborative consultation in choosing and
Stated differently, in most collaborative con developing classroom interventions can optimize
sultation relationships, teachers are the experts the implementation of interventions across mul
regarding their classroom, curriculum, and the tiple mediators. Although many effective school
target student's difficulties, while the consultant based interventions are available to address the

typically is the expert regarding empirically needs of students with ADHD, it is clear that
supported interventions to address student dif more research is needed particularly with respect
ficulties. The most successful outcomes occur to the functioning of secondary school students
with this
when there is reciprocal recognition of these disorder.

complementary areas of expertise.

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Tip

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