# Evidence-based assessment/Attention deficit hyperactivity disorder (assessment portfolio)/extended version

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Evidence-based assessment/Attention deficit hyperactivity disorder (assessment portfolio)/Sidebar

## What is a "portfolio"?

For background information on what assessment portfolios are, click the link in the heading above.
Does all of this feel like TMI? Click here to go to a condensed version.

## Preparation phase
### Diagnostic Criteria of ADHD in youth

   ICD-11 Diagnostic Criteria
   * General Definition:
   ** Attention deficit hyperactivity disorder is characterized by a persistent pattern (at least 6 months) of inattention and/or hyperactivity-impulsivity, with onset during the developmental period, typically early to mid-childhood. The degree of inattention and hyperactivity-impulsivity is outside the limits of normal variation expected for age and level of intellectual functioning and significantly interferes with academic, occupational, or social functioning. Inattention refers to significant difficulty in sustaining attention to tasks that do not provide a high level of stimulation or frequent rewards, distractibility and problems with organization. Hyperactivity refers to excessive motor activity and difficulties with remaining still, most evident in structured situations that require behavioural self-control. Impulsivity is a tendency to act in response to immediate stimuli, without deliberation or consideration of the risks and consequences. The relative balance and the specific manifestations of inattentive and hyperactive-impulsive characteristics varies across individuals, and may change over the course of development. In order for a diagnosis of disorder the behaviour pattern must be clearly observable in more than one setting.
   * Predominantly Inattentive Presentation:
   ** All definitional requirements for attention deficit hyperactivity disorder are met and inattentive symptoms are predominant in the clinical presentation. Inattention refers to significant difficulty in sustaining attention to tasks that do not provide a high level of stimulation or frequent rewards, distractibility and problems with organization. Some hyperactive-impulsive symptoms may also be present, but these are not clinically significant in relation to the inattentive symptoms.
   * Predominantly Hyperactive-Impulsive:
   ** All definitional requirements for attention deficit hyperactivity disorder are met and hyperactive-impulsive symptoms are predominant in the clinical presentation. Hyperactivity refers to excessive motor activity and difficulties with remaining still, most evident in structured situations that require behavioural self-control. Impulsivity is a tendency to act in response to immediate stimuli, without deliberation or consideration of the risks and consequences. Some inattentive symptoms may also be present, but these are not clinically significant in relation to the hyperactive-impulsive symptoms.

### Base rates of youth ADHD in different populations and clinical settings

This section describes the demographic setting of the population(s) sampled, base rates of diagnosis, country/region sampled, and the diagnostic method that was used. Using this information, clinicians will be able to anchor the rates of adolescent depression that they are likely to see in their clinical practices.
* To find prevalence rates across multiple disorders, click here.
| Demography | Setting | Base Rate(s) | Diagnostic Method |
| Worldwide, Ages 3-18 | Meta-Analysis of worldwide prevalence of Child/Adolescent ADHD | 6.1% (parent rating) 7.1% (teacher rating) 10.5% (ages 3-5) 11.4% (ages 6-12) 8.0% (ages 13-18) | Multiple, but each focused on DSM-IV criteria |
| USA Nationally Representative, Ages 3-17 | Epidemiological NHIS (US CDC, 2011) | 8.4% (Overall) 12.0% (Male) 4.7% (Female) 2.1% (ages 3-5) 8.4% (ages 6-11) 11.9% (ages 12-17) 10.3% (southern region of US) | Parent-report of whether child had ever been diagnosed |
| USA Nationally Representative, Ages 4-17 | Child and Adolescent Epidemiological National Survey of Children's Health (US CDC, 2007) | 9.5% (overall) 12.3% (male) 5.3% (female) 1.5% (ages 3-5) 9.1% (ages 6-11) 12.4% (ages 12-17) 15.6% (North Carolina) | Parent-report of whether child had ever been diagnosed |
| USA Nationally Representative, Ages 5-14 | Teacher-Reported Prevalence of ADHD | 5.25% (overall) 5.58% (elementary schoolers) 3.53% (middle schoolers) 7.1% (one county in rural NC) | Teacher report of number of children who have been identified with ADHD in their class |
| USA Nationally Representative, Ages 13-18 | Adolescent Epidemiological National Comorbidity Survey-Adolescent Supplement | 8.7% | CIDI 3.0 structured diagnostic interview |
| Ages 6-90 | Meta-Analysis of Clinical Samples | 38% | Structured Diagnostic Interviews |
| Ages 6-90 | Meta-Analysis of Clinical Samples | 23% | Clinical Evaluations |
| Representative Sample of Johnston County School Children, North Carolina, Ages 6-12 | Johnston County, North Carolina Sample | 15.5% | Combined parent and teacher report (NTRS and DISC) with DSM-IV criteria |
| Sample drawn from 11 counties in Western NC, Ages 9-16 | North Carolina Community Sample | 0.9% (3-month prevalence) 4.1% (estimated by age 16) | CAPA structured diagnostic interview |
| Sample recruited at Durham, NC, Seattle, Nashville, and Central Pennsylvania sites. Sample was followed longitudinally and identified as at high risk for externalizing disorders in kindergarten. 50% African American, Ages 12-15 | High-Risk Community Sample | 14.3% | Diagnostic Interview Schedule for Children (DISC) |

## Prediction phase
### Psychometric properties of screening instruments for youth ADHD

The following section contains a list of screening and diagnostic instruments for ADHD. The section includes administration information, psychometric data, and PDFs or links to the screenings.
* Screenings are used as part of the prediction phase of assessment; for more information on interpretation of this data, or how screenings fit in to the assessment process, click here.
* For a list of more broadly-reaching screening instruments, click here.

### Screening and diagnostic instruments for attention deficit hyperactivity disorder

| Measure | Format (Reporter) | Age Range | Administration/ Completion Time | Inter-rater reliability | Test-retest reliability | Construct validity | Content validity | Cost | Highly recommended |
| ADHD Rating Scale (ADHD-RS) V | Teacher, Parent | 5-17 y/o (Child 5-10, adolescent 11-17) | 5 minutes | | | A | G | | |
| Conners Rating Scale-Revised (CRS-R) ADHD | Teacher, Parent | | | | A | G | G | | Y |
| Attention Deficit Disorder Evaluation Scales (ADDES-3) | Teacher, Parent | | | | | A | A | | |
| Diagnostic Interview Schedule for Children-IV (DISC-IV) | Parent | | | | Unavailable | A | G | | |
| Behavior Assessment System for Children | Self-report, Teacher-report, Parent-report | 2:0 - 21:11 (TRS and PRS); 6:0 through college age (SRP) | 10-20 minutes (TRS and PRS), 30 minutes (SRP) | A | G | A | A | Purchase on website: BASC | |
| Strengths & Difficulties Questionare | Self-report, Teacher-report, Parent report | 4-17 y/o | 5 minutes | A | A | G | G | Free PDF: SDQ -Strengths and Difficulties Questionnaire for parents or educators of 2-4 year olds Assessment Center Link -Strengths and Difficulties Questionnaire for parents or teachers of 4-10 year olds Assessment Center Link -Strengths and Difficulties Questionnaire for parents or teachers of 11-17 year olds Assessment Center Link -Strengths and Difficulties Questionnaire (Child Self-Report) [age 11-17] Assessment Center Link -Strengths and Difficulties Questionnaire for self-report by those aged 18+ Assessment Center Link -Strengths and Difficulties Questionnaire for informant report on those aged 18+ Assessment Center Link | |
| Swanson, Nolan, & Pelham Rating Scale (SNAP) | Parent-report | | | | | | | Free: PDF:, Assessment Center Online Link | |
| Child and Adolescent Functional Assessment Scale | Parent-report, Self-report | | | | | | | | |
| Impairment Rating Scale | Parent-report, Teacher-report | 4-12 y/o | | | | | | Free: | |
| Weiss Functional Impairment Rating Scale | Parent-report, Self-report | 5-19 y/o | | A | | A | A | Free: | Y |
Note: L = Less than adequate; A = Adequate; G = Good; E = Excellent

### Likelihood ratios and AUCs of screening measures for (insert portfolio name)

* For a list of the likelihood ratios for more broadly reaching screening instruments, click here.
| Screening Measure (Primary Reference) | AUC (sample size) | DiLR+ (score) Score | DiLR- (score) Score | Clinical generalizeability | Study description |
| Child Behavior Checklist (CBCL) - Attention Problems T-Score | .84 (N=187) | 6.92 (>55) | 0.19 (<55) | Somewhat High | Utilized sample ages 6-18 recruited from local pediatricians, psychiatrists, and community advertisements. Included 95 children who met criteria for ADHD. 70 of these children also met criteria for ODD/CD. |
| Child Behavior Checklist (CBCL) - Attention Problems T-Score | .84 (N=187) | 12.2 (>60) | 0.41 (<60) | Somewhat High | Utilized sample ages 6-18 recruited from local pediatricians, psychiatrists, and community advertisements. Included 95 children who met criteria for ADHD. 70 of these children also met criteria for ODD/CD. |
| Child Behavior Checklist (CBCL) - Attention Problems T-Score | .84 (N=187) | 47 (>65) | 0.53 (<65) | Somewhat High | Utilized sample ages 6-18 recruited from local pediatricians, psychiatrists, and community advertisements. Included 95 children who met criteria for ADHD. 70 of these children also met criteria for ODD/CD. |
| Child Behavior Checklist (CBCL) - Attention Problems T-Score | .84 (N=187) | 34 (>70) | 0.66 (<70) | Somewhat High | Utilized sample ages 6-18 recruited from local pediatricians, psychiatrists, and community advertisements. Included 95 children who met criteria for ADHD. 70 of these children also met criteria for ODD/CD. |
| Child Behavior Checklist (CBCL) - Attention and Aggression Problems T-Score | Boys: .86 (N=111) | 10.2 (>55) | 0.41 (<55) | Somewhat High | Utilized sample ages 6-18 which consisted of 219 brothers and sisters of children who were referred to a hospital pediatric unit for ADHD or other symptoms. Half of these siblings had brothers and sisters who had ADHD, half did not. |
| Child Behavior Checklist (CBCL) - Attention and Aggression Problems T-Score | Girls: 0.90 (N=108) | 11.2 (>55) | 0.35 (<55) | Somewhat High | Utilized sample ages 6-18 which consisted of 219 brothers and sisters of children who were referred to a hospital pediatric unit for ADHD or other symptoms. Half of these siblings had brothers and sisters who had ADHD, half did not. |
| Teacher Response Form (TRF) - Attention Problems T-Score | Not reported (N=184) | 3.66 (>70) | 0.73 (<70) | Somewhat High | Utilized sample ages 5-12 years referred to a research clinic for assessment of ADHD. 108 children were ultimately diagnosed with ADHD, while 76 were not. LR's are calculated for discriminating between those two groups. |
| Teacher Response Form (TRF) - Attention and Aggression Problems T-Score | Not reported (N=184) | 4.33 (>70) | 0.89 (<70) | Somewhat High | Utilized sample ages 5-12 years referred to a research clinic for assessment of ADHD. 108 children were ultimately diagnosed with ADHD, while 76 were not. LR's are calculated for discriminating between those two groups. |
| Disruptive Behavior Disorder Rating Scale (DBDRS) - Parent Report (Pelham et. al, 1992) | 0.78 (N=232) | 5.06 (Endorsed ≥ 6 symptoms of inattention or hyperactivity) | 0.20 (<9) (Endorsed < 6 symptoms of inattention or hyperactivity) | Somewhat High | Sample consisted of 232 ethnically diverse children ages 5-10 with (n = 121) and without (n=111) ADHD recruited through advertisements at school and through self-help groups. |
| Disruptive Behavior Disorder Rating Scale (DBDRS) - Teacher Report (Pelham et. al, 1992) | 0.63 (N=232) | 1.97 (Endorsed ≥ 6 symptoms of inattention or hyperactivity) | 0.24 (Endorsed < 6 symptoms of inattention or hyperactivity) | Somewhat High | Sample consisted of 232 ethnically diverse children ages 5-10 with (n = 121) and without (n=111) ADHD recruited through advertisements at school and through self-help groups. |
| Vanderbilt ADHD Diagnostic Parent Rating Scale (VADPRS) | Not reported | 4.79 (Endorsed ≥ 6 symptoms of inattention or hyperactivity) | 0.38 (Endorsed < 6 symptoms of inattention or hyperactivity) | Moderate | Sample consists of 582 children ages 5-15 recruited through schools in Oklahoma. Sample includes children screened as "high risk" for ADHD and "low risk" for ADHD. |
| Vanderbilt ADHD Diagnostic Teacher Rating Scale (VADTRS) | Not reported | 2.91 (Positive risk score) | 0.657 (Negative risk score) | Moderate | Sample consisted of 370 children ages 5-15 recruited though schools in Oklahoma. Sample was representative community sample. |
| Conners Rating Scale (Revised) - Long Form Parent Report (Conners, 1997) | Not reported | 15.33 (>93rd percentile) | 0.09 (<93rd percentile) | Moderate | Data come from normative sample of 2482 children ages 3 to 17 across the United States and Canada. Diagnostic likelihood ratios here discriminate ADHD from Non-Clinical. |
| Conners Parent Rating Scale-48 (CPRS-48) Impulsive-Hyperactive Subscale T-Score (Conners, 1990) | Not reported | 1.26 (>70) | 0.79 (>70) | Somewhat High | Utilized sample ages 5-12 years referred to a research clinic for assessment of ADHD. 108 children were ultimately diagnosed with ADHD, while 76 were not. LR's are calculated for discriminating between those two groups. |
| Conners Teacher Rating Scale-39 Hyperactivity Subscale T-Score (Conners, 1990) | Not reported | 5.2 (>70) | 0.53 (<70) | Somewhat High | Utilized sample ages 5-12 years referred to a research clinic for assessment of ADHD. 108 children were ultimately diagnosed with ADHD, while 76 were not. LR's are calculated for discriminating between those two groups. |
| Conners Teacher Rating Scale (Revised) - Long Form (Conners, 1997) | Not reported | 8.66 (>93rd percentile) | 0.24 (<93rd percentile) | Moderate | Data come from normative sample of 1973 children ages 5 to 17 across the United States and Canada. Likelihood ratios discriminate ADHD from non-clinical. |
| ADHD Symptom Checklist-4 (ADHD-SC4) - Parent Report | Not reported | 1.45 (Endorsed ≥ 6 symptoms of inattention or hyperactivity) | 0.70 (Endorsed < 6 symptoms of inattention or hyperactivity) | Somewhat High | Data come from sample of 207 children ages 5-17 years old who were referred to psychiatric outpatient service with variety of emotional and behavioral disorders. |
| ADHD Symptom Checklist-4 (ADHD-SC4) - Teacher Report | Not reported | 1.53 (Endorsed ≥ 6 symptoms of inattention or hyperactivity) | 0.60 (Endorsed < 6 symptoms of inattention or hyperactivity) | Somewhat High | Data come from sample of 207 children ages 5-17 years old who were referred to psychiatric outpatient service with variety of emotional and behavioral disorders. |
| ADHD RS-IV - Home (DuPaul et. al, 1998b) | Not reported | 1.63 (>80th percentile) | 0.35 (<80th percentile) | Moderate | Sample of 2000 children ages 5 to 18 years old from geographically representative normative base. |
| ADHD RS-IV - School (DuPaul et. al, 1998b) | Not reported | 4.5 (>80th percentile) | 0.42 (<80th percentile) | Moderate | Sample of 2000 children ages 5 to 18 years old from geographically representative normative base. |
Note: All studies with one exception used structured or semi-structured clinical interviews to establish diagnosis of ADHD. The exception, the Sprafkin & Gadow study (2007), used a combination of CBCL rating scales, clinician review, and clinician consensus to confirm ADHD diagnosis. “LR+” refers to the change in likelihood ratio associated with a positive test score, and “LR-” is the likelihood ratio for a low score. Likelihood ratios of 1 indicate that the test result did not change impressions at all. LRs larger than 10 or smaller than .10 are frequently clinically decisive; 5 or .20 are helpful, and between 2.0 and .5 are small enough that they rarely result in clinically meaningful changes of formulation (Sackett et al., 2000).

### Interpreting ADHD screening measure scores

* For information on interpreting screening measure scores, click here.
* Also see the page on likelihood ratios in diagnostic testing for more information

## Prescription phase
### Gold standard diagnostic interviews

* For a list of broad reaching diagnostic interviews sortable by disorder with PDFs (if applicable), click here.

### Recommended diagnostic interviews for ADHD

****Depression instruments are placeholders
Diagnostic instruments for (insert portfolio name) :
| Measure | Format (Reporter) | Age Range | Administration/ Completion Time | Interrater Reliability | Test-Retest Reliability | Construct Validity | Content Validity | Highly Recommended | Free and Accessible Measures |
| Barkley Functional Impairment Scale—Children and Adolescents (BFIS-CA) | Parent Report | 6-17 | 5-7 minutes | E (.81) | G | G | G | | Link to purchase |
| Weiss Functional Impairment Rating Scale | Parent/Caregiver Report | 5-19 | | A | A | A | A | | PDF |
Note: L = Less than adequate; A = Adequate; G = Good; E = Excellent; U = Unavailable; NA = Not applicable

### Severity interviews for ADHD

| Measure | Format (Reporter) | Age Range | Administration/ Completion Time | Interrater Reliability | Test-Retest Reliability | Construct Validity | Content Validity | Highly Recommended | Free and Accessible Measures |
| Children's Depression Rating Scale - Revised (CDRS-R) | Structured Interview | 6-12 | 15-20 minutes | G | A | G | G | X | Link to purchase CDRS-R PDF (excerpt) |
Note: L = Less than adequate; A = Adequate; G = Good; E = Excellent; U = Unavailable; NA = Not applicable

## Process phase

The following section contains a brief overview of treatment options for ADHD and list of process and outcome measures for ADHD. The section includes benchmarks based on published norms for several outcome and severity measures, as well as information about commonly used process measures. Process and outcome measures are used as part of the process phase of assessment. For more information of differences between process and outcome measures, see the page on the process phase of assessment.

### Process measures
   #### CBCL Attention Problems Subscale

       Could be used on a weekly basis to track changes in ADHD symptomotology. T-scores from this measure could also be recorded on a weekly basis to determine if reliable and clinically significant changes in ADHD symptoms are occuring. The CBCL Attention Problems Subscale has repeatedly demonstrated good-to-excellent convergence with diagnostic interviews for diagnosing ADHD. The CBCL Attention Problems Subscale is a scale on the CBCL, which is readily available at the Finley Clinic.

   #### Daily Report Card

       Several scholars have pointed out that it is equally important to track changes in the functional behaviors that a child with ADHD engages in, in addition to their ADHD symptoms, to capture the full range of adaptive changes that are made by children with ADHD throughout the course of treatment. The daily report card is a mechanism by which such adaptive behavioral changes can be tracked. When implementing the daily report card, problematic child behaviors at home and at school are targeted for change. Rewards are offered to the child for reaching daily and weekly goals for reducing maladaptive behaviors and increasing adaptive behaviors. Parents and Teachers track child behaviors on a daily basis and provide feedback to one another and the child with behavior frequency counts and/or daily "grades" on how well the child behaved. Daily report cards are a mainstay of cognitive-behavioral and behavioral modification evidence-based intervention strategies for ADHD, and they are highly recommended for tracking child treatment outcomes. Instructions for creating a daily report card are attached in Appendix 1.

### Outcome and severity measures

This table includes clinically significant benchmarks for ADHD specific outcome measures
* Information on how to interpret this table can be found here.
* Additionally, these vignettes might be helpful resources for understanding appropriate adaptation of outcome measures in practice.
* For clinically significant change benchmarks for the CBCL, YSR, and TRF total, externalizing, internalizing, and attention benchmarks, see here.
Clinically significant change benchmarks with common instruments and ADHD rating scales :
| Measure | Diagnostic category | Cut Scores* | Cut Scores* | Cut Scores* | Critical Change (Unstandardized Scores) | Critical Change (Unstandardized Scores) | Critical Change (Unstandardized Scores) |
| Measure | Diagnostic category | A | B | C | 95% | 90% | SE$_{difference}$ |
| Benchmarks Based on Published Norms ||||||||
| CBCL T-scores (2001 Norms) | Total | 49 | 70 | 58 | 5 | 4 | 2.4 |
| CBCL T-scores (2001 Norms) | Externalizing | 49 | 70 | 58 | 7 | 6 | 3.4 |
| CBCL T-scores (2001 Norms) | Internalizing | N/A | 70 | 56 | 9 | 7 | 4.5 |
| CBCL T-scores (2001 Norms) | Attention Problems | N/A | 66 | 58 | 8 | 7 | 4.2 |
| TRF T-Scores (2001 Norms) | Total | N/A | 70 | 57 | 5 | 4 | 2.3 |
| TRF T-Scores (2001 Norms) | Externalizing | N/A | 70 | 56 | 6 | 5 | 3.0 |
| TRF T-Scores (2001 Norms) | Internalizing | N/A | 70 | 55 | 9 | 7 | 4.4 |
| TRF T-Scores (2001 Norms) | Attention Problems | N/A | 66 | 57 | 5 | 4 | 2.3 |
| Conners 3-Teacher Rating Scale T-Scores | ADHD Inattentive | 36 | 74 | 57 | 11 | 10 | 5.6 |
| Conners 3-Teacher Rating Scale T-Scores | ADHD Hyperactive-Impulsive | 36 | 74 | 57 | 11 | 9 | 5.5 |
| Conners 3-Parent Rating Scale T-Scores | ADHD Inattentive | 37 | 72 | 58 | 10 | 10 | 5.6 |
| Conners 3-Parent Rating Scale T-Scores | ADHD Hyperactive-Impulsive | 37 | 72 | 58 | 10 | 8 | 4.7 |
| Benchmarks Based on ADHD Samples ||||||||
| Disruptive Behavior Disorders Rating Scale | Disruptive Behavior Disorders Rating Scale | 1.4 | 8.6 | 5.7 | 12 | 10 | 0.9 |
Note: “A” = Away from the clinical range, “B” = Back into the nonclinical range, “C” = Closer to the nonclinical than clinical mean.
Search terms: [ADHD or CONNERS or DBD] AND [clinical significance OR group means] in PsycINFO

### Treatment

* Please refer to the Wikipedia page on Attention Deficit Hyperactivity Disorder for more information on available treatment for ADHD or go to Effective Child Therapy for a curated resource on effective treatments for ADHD.
Click here for ADHD Treatment Information :
Executive summary
1. If intervening with children ages 4-5, behavior therapy should be the first line of treatment.
2. If intervening with children ages 6-11, behavior therapy should be the first line of treatment, in conjunction with medication.
3. If intervening with children ages 12-18, medication should probably be the first line of treatment, though behavior therapy could be used in combination.
4. Three types of therapeutic interventions have well established evidence-bases:
a. Behavioral Parent Training Interventions
b. Behavioral Classroom Management Interventions
c. Behavioral Peer interventions involving recreational peer groups (e.g. summer camps)
5. If considering a classroom management intervention:
a. Academic and Cognitive-Behavioral Interventions are most effective in changing academic outcomes
b. Cognitive Behavioral and Contingency Management Interventions are most effective in changing behavioral outcomes
Clinical practice guidelines
Published by the American Academy of Pediatrics in 2011.
Preschool-aged children (ages 4–5)
Primary care clinicians should prescribe evidence-based parent and/or teacher-administered behavior therapy as the first line of treatment, and may prescribe methylphenidate if behavioral interventions are not effective.
Elementary-aged children (ages 6–11)
Primary care clinicians should prescribe FDA-approved medications for ADHD and/or evidence based parent and teacher administered behavior therapy. Preferably, both medication and behavior therapy will be prescribed.
Adolescents (ages 12–18)
Primary care clinicians should prescribe FDA approved medications for ADHD with the assent of the adolescent and may prescribe behavior therapy as a treatment for ADHD, preferably both.
Behavioral therapies
These meet the American Academy of Pediatrics and American Psychological Association Task Force criteria for well-established evidence-based treatments. Descriptions and effect sizes are taken from the American Academy of Pediatrics' guidelines and Pelham & Fabiano's review article.
Behavioral Parent Training
Behavior modification principles provided to parents for implementation in home settings. Typical outcomes include improved compliance with parental commands, improved parental understanding of behavioral principles, high levels of parental satisfaction with treatment.
Median effect size: 0.55
Behavioral Classroom Management
Behavior-modification principles provided to teachers for implementation in classroom settings. Typical outcomes include improved attention to instruction, improved compliance with classroom rules, decreased disruptive behavior, improved work productivity, and improved academic achievement.
Median effect size: 0.61
Behavioral Peer Interventions
Interventions focused on peer interactions/relationships. These could include group-based interventions provided weekly and include clinic-based social skills training used either alone or concurrently with behavioral parent training and/or medication. Typical outcomes are more mixed with these interventions. Some clinical-office based interventions have produced minimal effects, while some studies of behavioral peer intervention coupled with behavioral parent training found positive effects on parental ratings of ADHD symptoms. No studies of this type of intervention reveal differences on social functioning or parental ratings of social behavior. Behavioral Peer Interventions implemented in peer group/recreational settings (e.g. summer camps) have the most evidence of being effective.
Median effect size: None reported, effect sizes found are considered moderate.
School based interventions
Single Subject Design Effect Sizes
Intervention type
Effect size
Academic outcomes
Behavioral outcomes
Academic
4.73
1.53
Cognitive behavioral
3.77
3.31
Contingency management
2.29
2.40
Combined
2.29
1.31
Findings from a review by DuPaul and colleagues.
Associated with greater effects on academic outcomes
Academic — interventions focus primarily on manipulating antecedent conditions via things like peer tutoring, computer-aided instruction, and organizational skills.
Combined academic and contingency management interventions.
Associated with greater effects for behavior outcomes
Contingency management — interventions use reinforcement and punishment.
Cognitive behavioral — interventions focus on development of self-control skills and reflective problem-solving strategies. :

## External Links

* Society of Clinical Child and Adolescent Psychology
* EffectiveChildTherapy.Org information on ADHD
* Establishing a School-Home Daily Report Card
* What Parents and Teachers Should Know About ADHD (Fact Sheet)
* Psychosocial Interventions for ADHD
* ADHD Medication Information Sheet for Parents and Teachers