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Abstract. Attention deficit hyperactivity disorder is a relatively common childhood behavior disorder that typically is treated with psychotropic medication
(e.g., methylphenidate), behavioral strategies, or their combination. This article
provides an overview of the school-related difficulties associated with attention
deficit hyperactivity disorder. School-based intervention strategies including behavioral interventions, modifications to academic instruction, and home-school
communication programs are described briefly. Several important gaps in the
school-based intervention literature are identified with particular attention to the
need for feasible, effective strategies that can be used in general education settings
with a variety of age groups. An overview of the purpose and content of the
special series is provided.
The preparation of this article was supported by the National Institute of Mental Health, Grants ROlMH62941 and R01-MH061563.
Correspondence regarding this article should be addressed to George J. DuPaul, School Psychology
Program, Lehigh University, 111 Research Drive, Bethlehem, PA 18015; E-mail: gjd3@lehigh.edu
Copyright 2007 by the National Association of School Psychologists, ISSN 0279-6015
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Psychotropic Medication
The most common and widely studied
treatment for children and adolescents with
ADHD is psychotropic medication, specifically the use of central nervous system stimulants (Barkley, 2006). In fact, methylphenidate and other central nervous system stimulants are the single most effective treatment
for reducing ADHD symptoms in children
(MTA [Multimodal Treatment of ADHD] Cooperative Group, 1999,2004). Further, numerous studies have shown methylpbenidate and
amphetamine compounds to improve classroom attention, behavior control, and peer interactions as well as to enhance productivity
and accuracy on academic tasks and curricu185
Academic Interventions
Students with ADHD often experience
difficulties witb academic acbievement and
development of core reading and matb skills
(DuPaul & Stoner, 2003; Hinshaw, 1992).
187
Thus, interventions directly addressing academic deficits are necessary. Althougb academic interventions for students with ADHD
have not been as widely studied as bebavioral
treatments for tbis population, recent studies
bave provided initial support for academic remediation strategies. The results of single-subject researcb design studies indicate tbe efficacy of computer-assisted instruction (Clarfield & Stoner, 2005; Mautone, DuPaul, &
Jitendra, 2005; Ota & DuPaul, 2002), classwide peer tutoring (DuPaul, Ervin, Hook, &
McGoey, 1998), bome-based parent tutoring
(Hook & DuPaul, 1999) or homework support
(Power, Karustis, & Habbousbe, 2001), selfregulated strategy for written expression (Reid
& Lienemann, 2006), and directed note taking
(Evans, Pelbam, & Grudberg, 1995) in enhancing specific areas of academic performance.
Beyond their positive effect on scholastic skills, academic interventions also bave
severed advantages as a treatment for students
with ADHD. First, most academic strategies
empbasize tbe modification of antecedent
events (e.g., instruction and task presentation)
tbat may precede problematic inattentive or
impulsive bebavior. Tbus, in terms of bebavior
management, academic interventions may be
considered proactive or preventive. As a result, a second advantage of academic remediation strategies is tbat these may lead to
changes in problematic behavior. Stated differently, improvements in academic performance may lead to or be associated witb enbancement of bebavior control. In fact, effect
sizes for behavior cbange associated witb academic interventions are very similar to effect
sizes obtained for contingency management
strategies (DuPaul & Eckert, 1997). Tbus, in
some cases, academic interventions may serve
tbe dual purpose of improving academic skills
and attentive, refiective bebavior. Finally,
many of tbe academic strategies studied tbus
far involve the use of mediators (e.g., peers,
parents, and computers) beyond an exclusive
reliance on classroom teacbers. Tbe use of
multiple mediators may enhance tbe acceptability and feasibility of classroom-based
treatment by reducing tbe burden on teachers.
188
Home-School Communication
Anotber viable treatment approach for
enbancing tbe school functioning of students
witb ADHD is tbe use of home-scbool communication programs (e.g., daily report card).
Tbis strategy involves teacbers, parents, and in
tbe case of older students, students tbemselves, collaborating to (a) identify appropriate classroom-based target bebaviors, (b) delineate home-based reinforcers that can be delivered on a daily and/or weekly basis, and (c)
agree upon a process for regular communication, preferably on a daily basis (Barkley,
2006; DuPaul & Stoner, 2003). Tbe assumption underlying this intervention strategy is
tbat appropriate bebavior at scbool can be
reinforced by contingencies delivered at
bome, an environment tbat presumably bas a
wider variety of bigbly salient reinforcers
available for tbis purpose. The efficacy of tbe
daily report card strategy bas been supported
tbrougb several single-subject and group design studies, most notably in tbe researcb of
Pelham and colleagues (e.g., Pelbam et al.,
1993). In particular, bome-scbool communication programs appear viable for students
witb mild to moderately severe ADHD symptoms (Barkley, 2006; DuPaul & Stoner, 2003).
Tbere are several factors tbat may enbance
tbe utility and efficacy of a daily report card
system (DuPaul & Stoner, 2003). First, a reasonable number (i.e., tbree or four) of bebavioral
goals should be targeted for cbange. Goals
sbould be stated in a positive manner (i.e., wbat
tbe student should do ratber than wbat tbe student sbould not do) and sbould be set at an
attainable level. Second, home-based reinforcement sbould be delivered on a consistent basis
dependent on teacber ratings of goal attainment.
Given tbat cbildren witb ADHD exbibit impaired delayed response to tbe environment
(Barkley, 1997), tbe more frequent and immediate tbe reinforcement (i.e., daily), tbe better tbe
possible outcome. Tbird, teacber ratings of goed
attainment should be completed following eacb
academic period or a segment of the scbool day
ratber than a summary judgment at the end of the
day. In this fasbion, students wiU bave a clearer
Conclusions
Students with ADHD experience sigtiificant academic, social, and bebavioral difficulties in scbool settings. Empirical studies indicate tbat stimulant medication and atomoxetine as well as scbool-based intervention
strategies, sucb as bebavioral interventions,
modifications to academic instruction, and
bome-scbool communication programs, are
effective in reducing ADHD symptoms and
enbancing scbool functioning. Nevertbeless,
tbere are many important gaps in tbe extant
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