School interventions for children with ADHD
Do some instructional methods benefit kids with ADHD?
George DuPaul and colleagues reported the results of their examination of treatments to address symptoms of attention-deficit hyperactivity disorder. In this follow-up study of an earlier report (DuPaul et al, 2014), DuPaul et al. (2022) reviewed research about five types of classroom interventions that have been evaluated to learn whether they improve outcomes for children with ADHD.
DuPaul et al. (both 2014 and 2022) indicated that although medical interventions (e.g., drugs like methylphenidate or “Ritalin”) can alleviate some symptoms of ADHD, those biological interventions do not teach children with ADHD how to behave or read, write, compute, and so forth. The authors, instead, promote environmental interventions.
They recommend that “classroom behavioral strategies, organizational skills training, and self-regulation strategies” should be employed. Those approaches have the strongest evidence, according to DuPaul et al.
So, let’s just take a little dive into these recommended practices.
Five broad types of intervention have been used to address symptoms and impairment exhibited by elementary school students with ADHD, including behavioral, academic, behavioral peer, organizational skills, and self-regulation strategies.
DuPaul et al. (2022) recommend three of those interventions. They are (in the order DuPaul et al. presented them):
Behavioral strategies “replace a socially undesirable behavior” with an appropriate behavior. The authors contend that “The empirical support for classroom behavioral interventions for elementary-students with ADHD has been well documented...Results of these studies have indicated that behavioral classroom management techniques meet the requirements for consideration as a well-established treatment.”
Explicit academic instruction
DuPaul et al. refer to explicit instruction as a preferred approach for addressing academic deficits. By “explicit instruction,” they mean (a) clearly explaining what is to be learned, (b) providing instruction in small steps with copious examples, (c) frequently assessing student performance, and (d) promoting active participation. Some readers of SET may quibble with these characterization of beneficial teaching, but clearly DuPaul and colleagues are in the right church.
Although “the effects of explicit instruction on academic achievement have not been specifically studied with students with ADHD,” they argue that “there is ample controlled evidence for this approach for children with emotional and behavioral disorders.”
Self-regulation, which DuPaul et al. (2022) define as “the core set of skills that enable individuals to control their behaviors, thoughts, and emotions,” is a winner, they say. They mention the usual host of self-* practices (e.g., self-monitoring) and conclude that these are beneficial interventions. But they mix those extensively documented methods in with methods (e.g., mindfullness) that have relatively limited documentation.
DuPaul and colleagues are providing a good service. They are communicating to their audience (mostly school psychologists) that there are some effective interventions for kids with ADHD. Although their analysis lacks rigor, at least they are mostly promoting practices that have evidentiary support.
To me (editorial comment here!), this is a good illustration of how important it is for us to read academic literature carefully. Sometimes we may find an article (or two) that fit with our bias, but that aren’t quite “dead on.”
We need to examine those differences. Maybe—and this is important to me—we can learn stuff that improves our biases!
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DuPaul, G. J., Gormley, M. J., & Daffner-Deming, M. (2022). School-based interventions for elementary school students with Attention-Deficit/Hyperactivity Disorder. Child and Adolescent Psychiatric Clinics, 31(1), 149-166.
DuPaul, G. J., Gormley, M. J., & Laracy, S. D. (2014). School-based interventions for elementary school students with ADHD. Child and Adolescent Psychiatric Clinics, 23(4), 687-697.