Strategies for Implementing Evidence-Based Psychosocial Interventions for Children with Attention-Deficit/Hyperactivity Disorder

Attention deficit hyperactivity disorder (ADHD) is a highly prevalent, chronic disorder affecting millions of children. Current prevalence estimates range between 5% and 10% of the child and adolescent population in the United States.2,4,59 The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV, TR)2 defines three subtypes of ADHD: ADHD, Combined Type (i.e., elevated symptoms of inattention and hyperactivity/impulsivity), ADHD, Predominantly Inattentive Type (i.e., symptoms of inattention in the absence of clinically significant symptoms of hyperactivity/impulsivity), and ADHD, Predominantly Hyperactive/Impulsive Type (i.e., symptoms of hyperactivity/impulsivity in the absence of symptoms of inattention). Children with ADHD frequently experience impairment related to academic performance (e.g., lower achievement test scores, higher rates of grade retention)6,47 and social interactions, including strained relationships with parents, siblings, teachers, and peers.25,34 Because of challenging classroom behavior (e.g., significant time off-task, frequent rule violations, failure to comply with teacher instructions),3 teachers often spend a significant amount of time providing supports to children with ADHD, which may result in conflict in the student-teacher relationship.25 Also, due to behavioral difficulty at home, children with ADHD frequently have stressful and conflicting interactions with their parents, which negatively impact parent-child relationships and parents’ ability to support their children’s education.4 In addition, conflict between families and schools is common among children with ADHD, which further contributes to school problems. This conflict may result from parental dissatisfaction with the teacher’s attempts to meet the educational needs of the child, as well as teacher concerns about the child’s disruptive behavior in the classroom and strained communications with parents.25 Additionally, parents of children with ADHD often feel less effective in their efforts to support their children’s education and feel less welcome in schools compared with the parents of children without ADHD.67 Thus, because students with ADHD experience considerable educational impairment and challenges relating to parents and teachers, there is a need for a comprehensive intervention plan that targets the child’s behavior at home and school, academic performance, and parent-child and family-school relationships. Treatments to support children with ADHD include pharmacotherapy, most commonly stimulant medication, and psychosocial interventions that are implemented at home and school, including strategies to support family-school collaboration. Psychosocial interventions include strategies to address performance deficits (i.e., situations in which the child knows how to perform a particular skill but does not do so consistently) and skills deficits (i.e., situations in which the child does not yet posses a skill or performs the skill suboptimally). Interventions aimed at performance deficits include environmental adaptations and accommodations to intervene at the point of performance, such as techniques to modify the antecedents and consequences in the environment to change child behavior.56 Interventions aimed at skills deficits include direct instruction and increasing opportunities for repeated practice of new skills. The purpose of this paper is to describe evidence-based psychosocial interventions (EBIs) targeting both performance and skills deficits that can be applied to address the educational needs of children and adolescents with ADHD. (Key references for school practitioners are identified with an asterisk. Resources are provided in Box 1.) Box 1 Key Resources School wide Interventions OSEP Center on Positive Behavioral Interventions and Supports: Effective School-wide Interventions: www.PBIS.org Special Accommodations National Resource Center on AD/HD, Children and Adults with ADHD (CHADD): http://www.chadd.org/ Token Economy/Point Systems Center for Children and Families: http://ccf.buffalo.edu/pdf/school_daily_report_card.pdf National Initiative for Healthcare Quality (NIHCQ) – ADHD Toolkit: http://www.nichq.org/resources/adhd_toolkit.html Social Skills Children and Adults with ADHD (CHADD): http://www.chadd.org/Content/CHADD/EFParents/SocialSkillsforChildren/default.htm Behavioral Parent Training Parent-child interaction therapy (Bell & Eyberg 2002); http://pcit.phhp.ufl.edu The Incredible Years (Webster-Stratton, 2005); www.incredibleyears.com Family School Partnerships Conjoint Behavioral Consultation: Promoting Family-School Connections and Interventions 68