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ObjectiveEvaluate whether stimulant medication improves acquisition of academic material in children with attention deficit hyperactivity disorder (ADHD) receiving small-group, content-area instruction in a classroom setting.MethodParticipants were 173 children between the ages of 7 and 12 years old (77% male, 86% Hispanic) who met Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for ADHD and were participating in a therapeutic summer camp. The design was a triple-masked, within-subject, AB/BA crossover trial. Children completed two consecutive phases of daily, 25-min instruction in both (a) subject-area content (science, social studies) and (b) vocabulary. Each phase was a standard instructional unit lasting for 3 weeks. Teachers and aides taught the material to small groups in a summer classroom setting. Each child was randomized to be medicated with daily osmotic-release oral system methylphenidate (OROS-MPH) during either the first or second of the instructional phases, receiving placebo during the other.ResultsMedication had large, salutary, statistically significant effects on children's academic seatwork productivity and classroom behavior on every single day of the instructional period. However, there was no detectable effect of medication on learning the material taught during instruction: Children learned the same amount of subject-area and vocabulary content whether they were taking OROS-MPH or placebo during the instructional period.ConclusionsAcute effects of OROS-MPH on daily academic seatwork productivity and classroom behavior did not translate into improved learning of new academic material taught via small-group, evidence-based instruction. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Children with attention-deficit/hyperactivity disorder (ADHD) receive supports and services in general and special education classrooms in schools. The present study aimed to report the contents of individualized education programs (IEPs) for children with ADHD and to compare the behavior of children with ADHD who had IEPs versus those with ADHD who did not have IEPs. Two-hundred one children with ADHD participating in a summer treatment program (STP) were grouped by whether they had an IEP (N = 50 children) or not (N = 151). The content of the IEPs was descriptively reviewed. Further, children with and without IEPs were compared on measures of ADHD symptoms, aggressive behaviors, academic achievement, and psychosocial impairment. Groups were also compared on functioning in the STP setting on behavioral measures of rule-following, negative behaviors, and academic productivity in situations where intensive behavior modification procedures were and were not employed. The results indicated no significant differences between the two groups on any ratings or behavioral measures, with the exception of academic achievement scores (children in special education scored lower, on average). All children improved within the context of intensive behavioral intervention. The results are discussed in light of current approaches to supporting children with ADHD in schools.

In this study, we (a) describe patterns of challenging student behaviors (classwide and for a target student with attention deficit hyperactivity disorder [ADHD]) and teacher behaviors (i.e., praise, commands, and responses to challenging behavior) in kindergarten through Grade 5 classrooms, (b) examine the relations between these behaviors, and (c) describe a threshold of teacher behaviors most associated with low levels of challenging student behavior. Participants were 55 teachers observed using a modified version of the Student Behavior Teacher Response (SBTR) system. Across grades, there was variability in rates of classwide challenging behavior per hour (M = 35.81 to 102.62) and rates of praise per hour (M = 10.90 to 37.70). The percentage of challenging behaviors to which teachers responded appropriately was generally low (M = 27% to 47%) and stable across grades. For classwide challenging behavior, higher percentages of appropriate teacher response were significantly associated with lower rates of challenging behavior (b = -0.43; p < 0.01), but effective commands and labeled praise were not. Classwide challenging behaviors dropped to 30 per hour once teachers reach a threshold of 51% appropriate response, with little incremental benefit at higher levels. Implications for professional development and future study of behavior management practices are discussed.

Teachers can implement a high quality Daily Report Card (DRC) intervention when they receive face-to-face consultation or interactive online supports. Yet, it is unclear which method is most cost-effective. Using an ingredients-based approach and societal perspective, we examined costs and cost-effectiveness (compared to typical practice) of three implementation strategies (face-to-face standard consultation, face-to-face enhanced consultation, interactive online supports) with 112 elementary school teachers. Teachers received consultation for DRC implementation with one student with or at risk for ADHD. Over 2 months, we collected data on teachers' implementation and changes in student behaviors. Regarding cost per student, enhanced consultation was the most costly ($864), followed by standard consultation ($634) and interactive online supports ($307). Regarding cost-effectiveness (costs required to achieve the desired effect beyond typical practice), interactive online supports were the most cost-effective followed by enhanced consultation and standard consultation. We discuss implications for research and maximizing outcomes given dollars spent. [For the corresponding grantee submission, see ED610850.]

One study has examined the month-to-month effectiveness of the daily report card (DRC) intervention for students with disruptive behavior, yet these findings have not been replicated. With a sample of 37 student-teacher dyads (Kindergarten-5th grade), we sought to replicate previous findings with an independent sample and advance the literature by using a nonparametric effect size (ES) that accounts for baseline trends, examining academic and behavioral DRC target behaviors separately, and examining differences between optimal and suboptimal intervention responders. Replicating findings from the previous study, large improvement in behavioral and academic DRC target behaviors was demonstrated in the first month of intervention, with small incremental gains and/or maintenance of effects observed in months 2, 3, and 4. Differences assessed between optimal and suboptimal responders were not statistically significant. However, trends, particularly those for optimal and suboptimal responders to behavioral targets on the DRC, suggest that teacher consistency in responding to classroom rule violations is an important variable for future study. The results replicate previous findings and suggest important directions for future research on classroom intervention implementation and intervention decision making.

In the context of best practices consultation with high needs teachers, we examined (a) relations between teachers' appropriate response to student rule violations and rates of rule violations, and (b) rates of student misbehavior among teachers who do and do not achieve various benchmarks of integrity and/or growth in skills. Participants were 48 teachers, 48 target students with or at risk for attention deficit hyperactivity disorder (ADHD; one per teacher), and remaining students in each classroom. Teachers received up to eight consultation sessions on classroom management and implementation of a daily report card (DRC) with the target student. We observed classwide rule violations, target student rule violations, and DRC violations, as well as the percentage of rule violations to which the teacher provided an appropriate response. Teachers who responded to a higher percentage of rule violations had fewer classwide rule violations (rs = -0.32 to -0.53) and target student rule violations (rs = -0.22 to -0.51) at baseline, Months 1 to 2, and Months 3 to 4 of consultation. Teachers who reached the minimum benchmark of 51% appropriate response and who demonstrated greater growth in appropriate responding witnessed fewer rule violations than teachers who did not achieve these benchmarks. Implications for preservice training, professional development, and consultation are discussed. [For the corresponding grantee submission, see ED598694.]

Objective: The current study examined the impact of the gender of children with ADHD on teachers' perceptions toward inattentive, hyperactive, or oppositional behaviors, and how these perceptions relate to teachers' ratings of children's impairment and referral recommendations. Method: Teachers read eight vignettes depicting boys and girls with different subtypes of ADHD, as well as one depicting comorbidity (ADHD + ODD). Teachers then completed measures of impairment, and responded to questions about what services they would likely refer for the child and why. Results: Teachers rated girls as being significantly more impaired and more in need of services than boys. Regardless of gender, teachers overwhelmingly reported preferring the use of behavior modification for the described child. Also, children who were described with symptoms of ADHD-predominately inattentive subtype were rated as being the least impaired, while girls described as hyperactive and impulsive were rated by teachers as being the most impaired. Conclusion: The current study adds to previous literature on gender bias in ADHD referrals by providing evidence for the differential referral of ADHD boys and girls to treatment based on presentation of symptoms. (Contains 4 tables.)

Objective: To test the efficacy and tolerability of the methylphenidate transdermal formulation (MTS) against immediate-release methylphenidate (IR MPH) and placebo in a 12-hr analog classroom setting. Method: A total of nine boys ages 6 to 9 years, medicated with MPH for ADHD, complete a within-subject, double-blind study. For the purpose of the study, the boys are administered a dose of 20 cm[superscript 2] MTS, a matched dose of IR MPH 10 mg TID, and placebo. ADHD symptoms and frequency counts of classroom rule violations and the number of math problems completed are assessed hourly, during three consecutive analog classroom sessions. Results: Findings show that, across measures and throughout the day, both treatments significantly differentiated from placebo (p less than 0.05) but not from each other. It is also observed that the MTS produced more consistent results across the day but had a delayed onset versus IR MPH. Both medications are well tolerated with only mild reductions in sleep onset. Conclusion: The MTS demonstrates comparable efficacy and tolerability to TID IR MPH. (Contains 2 tables and 1 figure.)

Objective: The current study evaluated the effects of differing intensities of behavior modification and medication on parents' self-reported success in managing their child's misbehavior and the attributions parents gave for success or failure. Method: Children were randomized to receive in counterbalanced orders different levels of behavior modification, each for 3-week cycles. In addition, medication was manipulated using a medication assessment procedure. Parents reported daily how successful they were in managing their child's misbehavior and the attributions for either their success or failure. Results: Parents of children with ADHD generally felt successful in managing their child's behavior, regardless of treatment condition. In the high behavior modification condition, they were more likely to endorse items that attributed their success to their own effort. Conclusion: In conditions in which parents were given more intensive tools to manage misbehavior they were more likely to attribute their success to their own effort. (Contains 5 tables.)

Individual treatment response to behavior modification was examined in the context of a summer treatment program. Four children ages 11 to 12 and diagnosed with attention-deficit/hyperactivity disorder were examined in a BABAB design in which a comprehensive behavioral program was utilized and withdrawn across an 8-week period. Dependent measures included frequency counts of negative behaviors, rule violations in recreational and classroom settings, and academic seatwork completion and accuracy. Results documented the effectiveness of the behavioral intervention with all 4 children. Some children showed consistent responses regardless of setting, while others showed differential responses in classroom and recreational settings. In general, behavior worsened progressively over days during the withdrawal weeks. The second withdrawal of treatment produced deleterious effects for several children that persisted for a time even when behavior modification was reinstated. The individual response patterns of each of the 4 children are discussed.

The summer treatment program (STP) is a comprehensive intervention for attention-deficit/hyperactivity disorder (ADHD) that combines several empirically validated, behavioral treatment components in order to address multiple areas of impairment. The current study utilized a BAB treatment withdrawal design to evaluate the effectiveness of the STP. Participants included 44 children diagnosed with ADHD and comorbid disruptive behavior disorders who were enrolled in the STP. During the 6th week of the STP, behavior was measured during a planned period where all behavioral treatment components were withdrawn. Treatment was then reinstated in its entirety. Across measures of behavior, academic functioning, and teacher, counselor, and child ratings, substantial behavioral deterioration occurred during the withdrawal period, and behavior returned to previous levels upon the reinstatement of the STP treatment components. Results support the efficacy of the STP as an intervention for ADHD across multiple domains of impairment, including classroom and peer functioning.

Behavior modification is an evidence-based treatment for children with attention-deficit/hyperactivity disorder (ADHD). Time-out from positive reinforcement is one behavior-modification procedure commonly recommended to manage disruptive or noncompliant behavior. This investigation examined the effects of time-out on children's behavior within the context of an intensive summer treatment program at two sites. Short (5-minute), long (15-minute), and escalating/de-escalating time-out conditions were compared to no time-out for 71 children. Results indicated that the time-out conditions were superior to no time-out in reducing the occurrence of intentional aggression, intentional destruction of property, and repeated noncompliance in the recreational and classroom settings regardless of child age or parent reported oppositional or conduct problems. There were no effects of time-out on staff member ratings of time-out effectiveness or the pleasantness of staff-child interactions. All three time-out conditions were equally effective in the group analyses, though analyses of normalization of functioning indicated there were individual differences in response to the time-out conditions. The results indicated that time-out is an effective means of reducing negative behavior in children with ADHD.

Interest in symptoms of sluggish cognitive tempo (SCT) has led to a number of studies evaluating how these symptoms respond to treatment commonly utilized in youths with symptoms of ADHD. No study to date, however, has examined the extent to which symptoms of SCT predict behavioral treatment response in youths across multiple domains of functioning. The current preliminary investigation integrates a number of methodological (e.g., direct observations) and analytic (e.g., Poisson regression) refinements to evaluate the extent to which symptoms of SCT predict treatment responses across multiple domains including behavioral (e.g., interruptions, rule violations), social (e.g., social skills, negative verbalizations), and severe behavioral difficulties (e.g., intentional aggression) above and beyond other demographic characteristics (e.g., symptom severity, Full Scale Intelligence Quotient [FSIQ]). A relatively small sample of 37 children, aged six to 12 years (M = 8.03, SD = 1.83, 35 males: 2 females) attending an eight week multi-component intensive behavioral treatment program for youths with behavioral difficulties participated in the current study. Baseline parental perceptions of SCT were collected prior to the initiation of treatment. Results from this preliminary investigation revealed that pre-treatment SCT symptoms only predicted a less robust treatment response to time out which was associated also with parent's perceptions of underlying working memory problems. Results revealed also that pre-treatment SCT symptoms failed to predict paraprofessional counselor's and teacher's improvement ratings of both rule following and social skills following treatment. Notably, other potential predictors (e.g., symptom severity, FSIQ) also largely failed to predict behavioral treatment response. [ABSTRACT FROM AUTHOR]