There has little to no research conducted that addresses school-based interventions to give teachers some tools to handle children in their classroom with ADHD. This lack of information is partly due to the fact that ADHD is conceptualized as a psychiatric construct, and thus it is most often approached from a medical perspective.

Most of the responsibility for meeting educational needs of children with ADHD lies with their general education teachers, while this particular group in several researches expressed that they need assistance and more information about managing children with ADHD. Currently, most schools do not have a general approach to handle classroom problems caused by children with ADHD systematically. Also, teachers mostly rely on punishing approaches only and tend to deny the problems of children with ADHD.

A solution for these problems could be the multimodal model, which involves coordinated treatment planning by all involved parties (parents, teachers, psychologists etc.). The model incorporates different kinds of treatments such as medical approaches, behavior modification, educational accommodations and psychological support. There is a considerable amount of research that has shown the effectiveness of the multimodal model.

Functional assessment is an approach to the multimodal treatment of ADHD which focuses on manipulating the environment variables to determine the best conditions under which children may perform appropriate classroom behaviors. Thereby it empowers teachers to fulfill the following three goals:

1. Prevent inappropriate classroom behavior from occurring by analyzing and modifying environmental events.

2. Determine what children try to achieve with their inappropriate behavior and seek for replacements of appropriate behavior with a similar function.

3. Develop interventions which enables children with ADHD to perform socially desirable classroom behavior.

Overview of the traditional approach and its critique

The goal of traditional assessment is quite the same as that of functional assessment, but the traditional assessment has had little implication for changing the behavior of ADHD children. Traditional assessment is based on Cronbach’s ideas about correlation. He hypothesized that the aptitude by treatment interaction approach (ATI) was the most effective way for assessment. This approach is based on the two principles that (1) inappropriate behaviors are due to underlying characteristics of the individual and (2) it is necessary to identify the underlying trait that is causing the behavior in order to remediate the behavior. Unfortunately, correlation was erroneously equated with causation. When there is relation between two variables, it doesn’t necessary mean that the one variable caused the other to occur. Therefore it is very uncertain to select an intervention based on a prediction from a variable. The effectiveness s ATI has never been proven and consequently is not a functional approach. The same thing can be said for a lot of current treatments for ADHD; token strategies, classroom interventions and even Ritalin cannot be differentiated between children with and without ADHD.

When Cronbach realized that ATI didn’t work, he replaced it with a context-specific approach. The main difference between those two approaches was the shift from aptitudes to context. Seen from the ecological perspective, which considers environment and behavior as a ongoing interaction, context provides meaning to behavior. The best way to change a child’s behavior is to take the context under which these behaviors occur into account. The context-specific approach focuses on the outcomes of interventions. The child gets the best possible treatment, the desired progress gets observed and if the treatment doesn’t work it gets modified.

Overview of the functional perspective

The functional perspective is a logical extension of the context-specific approach. It addresses the interaction between specific behaviors of a child and the environmental factors. These specific behaviors are cued by antecedents and decreased, increased or maintained by followed consequences. Therefore the purpose of functional assessment is to find the relation between behavior and the environment, and hereby identifying the most effective method to modify behavior.

Stages of functional assessment

An approach that has shown to be effective for classroom use in several studies is the framework developed by Dunlap and Kern. Their approach consists of three levels: hypothesis development, hypothesis testing and intervention development.

Hypothesis development is a process that should embody three activities and thus consists of three stages:

1. Developing a precise definition of the behavior in question.

2. Collecting information during the conditions under which the specific behavior occurs.

3. Analyzing whether the information obtained shows any patterns that might indicate a functional relation.

There are a few conditions which a definition of behavior should meet to qualify as well-defined. First, it should pass the ‘stranger test’. This means that a stranger should be able to determine when a behavior occurs does or doesn’t occur on basis of the definition, in reasonable agreement with those observations of the teacher. Second, a behavior should pass the ‘so what test’. This implies that behavior that doesn’t interfere with the learning targets of the child with ADHD or its peers should be ignored. Because a child with ADHD shows many behaviors that could be a target for intervention but time and resources are limited, this is very important. Also, this minimizes the effect of the teacher’s own standards of what is normal. Third, a good target behavior is one that is also a ‘fair pair’. This concept states that for every inappropriate behavior that should be decreased, there’s an incompatible behavior that should be targeted to increase. Finally, the description should pass the dead man’s test. This test shows whether a fair pair is targeted. If a dead man can perform the target behavior, then you do not have a fair pair. If he cannot, you do.

Information can be collected through multiple techniques such as interviews, observation, archival records and rating scales. Any functional assessment should include direct observation and interviews because these are the most reliable sources of information. However, most of the time it’s very useful to start an investigation with examining archival records and completing behavior rating scales. The latter two can be used to get a fix on the problem and thereby help select behaviors and settings most salient for observation. Furthermore, it’s advisable to interview multiple people to determine in which settings certain behavior does and doesn’t occur. This information gives a contextual starting point to formulate hypothesis which can be tested using direct observation methods. The most ecologically valid assessment technique is to define the target behaviors, observe and record their occurrence or nonoccurrence in their natural environment and analyze this data. This not only confirms or denies expectations about relationships between environments and certain behavior, it also provides baseline information about the behavior before treatment. The most commonly used method to do a functional assessment behavioral observation is an antecedent-behavior-consequence analysis (ABC).

Next, it’s important to collect information on behavioral intent. Why does a child perform certain behavior and what does it want to achieve with its acts? In order to determine these intentions, the Outcome Analysis Worksheet was developed. This is quite similar to the ABC-analysis with the added component of hypothesizing on the possible outcome. As from now, replacement behaviors – appropriate behaviors to replace the inappropriate – can be conducted for hypotheses testing.

Hypotheses testing aims to identify the conditions where the variables thought to be related to the behavior can be controlled and manipulated directly. This can be done using in vivo (naturalistic) or analogue (role play) assessment.

In vivo assessments observe students performing the target behavior in their natural habitat while the practitioner systematically controls and manipulates situational and contextual events. In order to determine the validity of the hypothesized functional relation, multiple observations would be required. Disadvantages of this approach are that it’s difficult to control all situational variables, and that target behavior must occur during the observations while not all naturalistic situations encourage children to perform the target behavior.

The analogue assessment involves a role play in which a child’s behavior during staged situations gets observed. The advantage of this approach is that target behavior can be elicited and observed while situational and contextual events are controlled or manipulated. Analogue assessment also has a therapeutic value, for students with ADHD might learn appropriate behavior from their peers. When they receive reinforcement from children their own age, they are more likely to perform this appropriate behavior more often. The limitation of this approach is that because of the artificial nature of the method, the information obtained often doesn’t correspond with naturalistic observations. It is therefore recommended to use the analogue assessment combined with in vivo assessment.

It takes a lot of time to test hypotheses, and consequently, teachers often tend to skip this step. However, it takes even more time to implement ineffective accommodations and interventions which have to be changed afterwards. Determining which environmental variables have the greatest impact on a child’s behavior can help to avoid this.

Accommodations and interventions

Information obtained from testing hypotheses can be translated into accommodations and interventions by using the most important variables that have come forward from the testing and operationalizing them into specific, practical interventions. The process of testing hypotheses should be seen as part of the intervention process, because the environmental variables are constantly being manipulated while observing their effect on behavior.

Manipulating antecedents is a form of prevention. Most classroom accommodations focus on antecedents to prevent inappropriate behavior from occurring, a proactive strategy. Changing antecedents can result in a major change of behavior and usually arise from logically thinking, therefore they are practical, simple to implement and require minimal time.

of the categories of accommodation is the physical location of a child in the classroom. This may have to do with where the student is seated, group composition, activity grouping (group vs. independently working) and the type of work station a child gets assigned to (lots of materials on it?). There’s a new approach for children with high motor activity, which provides them with multiple desks: one in the front of the classroom and one on each side of the back of the room. That way, when a child feels restless it can pick up its stuff and move to another part of the classroom. Most important when implementing accommodations is to be flexible, creative and broad-minded.

The manipulation of task material can also be very useful. The amount and type of feedback provided during task performance, degree of stimulation, the response mode, the degree of task structure and the amount of interest students show in a task are all variables worth manipulating to enhance appropriate behavior.

Letting students with ADHD complete assignments independently can lead to a few problems. They might not have the skills to work independently. It is very important to ensure that a child with ADHD fully understands the assignment before moving to independent practice activities. Teacher-led small-group question and answer sessions is a method to clarify the degree of accuracy in which the student has mastered the concept. Furthermore, students with ADHD can experience some difficulty in obtaining help during seatwork activities, or the teacher is unable to provide assistance at that very moment. To asses this problem, teachers can construct assistance cards. On one side of the card, the teacher writes ‘Please help me’, and on the other side ‘Please keep working’. When a child is in need of assistance, it can flip the card to ‘Please help me’ and but it on his table. If the teacher isn’t able to provide help at that moment, he can flip the card to ‘Please keep working’. He thereby acknowledges the child’s request, and the child knows the teacher will assist him as soon as possible. Finally, children with ADHD often misbehave when too much work is required during independent seatwork. Short assignments and frequent breaks can be helpful. It’s very important that breaks or transitions are highly structured.

Curricular instructions can also be manipulated and thereby prevent certain behavior from occurring. The curriculum is a structured set of learning outcomes. To accommodate students with ADHD, the sequence of the curriculum may be shuffled, its tasks may divided into smaller pieces or combined into larger ones, organizational structure can be altered and different instructors may help to teach the program. The most important factor to make children feel involved with the curriculum, is to make them see the learning material as meaningful. The otherwise short attention-span of children with ADHD is much longer when they are engaged in high-interest activities: also called the Nintendo-effect. When de study material gets linked with topics that interest the child, they will try a lot harder to engage.

The length, format and difficulty of lessons can me modified to better fit the needs of a child with ADHD. Giving students the opportunity to answer questions they’ve been asked instead of letting them wait for a long time before they can respond is crucial for their engagement.

Instructional strategies are meant to enhance a student’s acquisition. Cognitive strategy instruction teaches students to use self-instructions and mental imagery to accomplish academic tasks independently. Mnemonic instruction is a related strategy and designed to improve memory. By reconstructing study material and connecting it to existing knowledge of the student, they remember the content better. By using the students frame of reference, they add a personal meaning to the task. Peer tutoring also seems to be a relative technique.

Moving from one group, classroom, activity or subject to another is called a transition. By setting aside certain times on which the transitions are performed, establish the expectation that the students move quickly from one place to another and tell them that any lost time is made up during free time, transitions become more efficient and instructions more effective.

We call events that follow behavior consequences: they can increase, decrease or maintain certain behavior by ignoring, punishing or reinforcing. When a certain behavior is ignored, an appropriate behavior should be reinforced. In order to effectively ignore undesired behavior, the child performing the behavior should also be excluded from positive or negative attention from its peers. Punishment is not very effective when it’s not combined with positive reinforcement, which focuses on increasing desired behavior.