School-Based Interventions for Children and Adolescents with Attention-Deficit/Hyperactivity Disorder: Enhancing Academic and Behavioral Outcomes

Abstract The most common and widely studied treatments for Attention-Deficit/Hyperactivity Disorder (AD/HD) are psychostimulant medications and behavioral interventions. The purpose of this article is to review empirically-supported, behavioral school-based interventions that are designed to enhance classroom behavior and academic achievement of students with this disorder. Two major types of interventions are described including (a) proactive or antecedent-based interventions that primarily target academic and organizational skills and (b) reactive or consequent-based interventions that target social behavior and classroom deportment. The use of teachers, peers, parents, computers, and the students themselves as treatment mediators is reviewed. Implications of findings for delivery of school-based services for this population as well as directions for future research are discussed. ********** Students with Attention-deficit/Hyperactivity Disorder (AD/HD) display developmentally inappropriate levels of inattention, impulsivity, and/or motor activity that are associated with functional impairment (American Psychiatric Association, 2000). Symptoms of AD/HD typically appear in early childhood and are manifested throughout the lifespan (Barkley, 2006; Weyandt, 2001). Approximately 3 to 5% of school-aged children and adolescents are diagnosable with this disorder (American Psychiatric Association, 2000), with boys outnumbering girls 2:1 to 6:1 (Biederman et al., 2002). AD/HD typically emerges early in life and is a chronic disorder that places children at higher than average risk for academic, behavioral, and social difficulties in school settings (DuPaul & Stoner, 2003). In fact, poor school outcomes (e.g., grade retention, failing grades, and dropout) are among the most ubiquitous long-term difficulties associated with AD/HD (Barkley, 2006). Thus, it is critical for educators and other school personnel to be aware of effective interventions for this disorder and to advocate for their use across home and school settings. The purpose of this article is to provide an overview of empirically-supported, school-based interventions for students with AD/HD. (1) First, school-based strategies are discussed in the context of a multimodal treatment protocol for this disorder. Next, important principles underlying school-based intervention are delineated. Third, specific interventions are described under the general categories of antecedent-based (proactive) and consequent-based (reactive) strategies. Possible adaptations of these interventions for use with secondary school students are summarized. Finally, directions for future research on school-based interventions for students with AD/HD are recommended. Multimodal Treatment of AD/HD The most effective treatments for AD/HD include psychostimulant medications (e.g., methylphenidate or Ritalin[TM]) and behavioral strategies (e.g., contingency management) implemented in home and school settings (Barkley, 2006). Non-stimulant medications such as atomoxetine (Strattera[TM]), bupropion (Wellbutrin[TM]), and clonidine (Catapres[TM]) also have received empirical support as viable treatments for AD/HD (Spencer, Biederman, & Wilens, 2006). Research also indicates that a multimodal treatment protocol is more effective than unimodal treatment in addressing the myriad of difficulties associated with this disorder. Multimodal treatment typically is defined as the combination of medication, behavioral strategies, and educational accommodations. Investigations systematically comparing the combination of stimulant medication, behavioral interventions and their combination (i.e., multimodal treatment) have found medication to be superior to behavioral treatments in reducing AD/HD symptoms (Abikoff et al., 2004; MTA Cooperative Group, 1999). The largest scale and most comprehensive investigation of these two treatments was the Multimodal Treatment of AD/HD (MTA) study completed at multiple sites in North America (MTA Cooperative Group, 1999). …