Although the most common and most effective treatment for Attention Deficit Hyperactivity Disorder (ADHD) has been psychostimulant medication, it has significant drawbacks. Stimulants have been found to enhance attention, impulse control, interpersonal behavior, and academic productivity in 70 to 80 percent of children with ADHD – but only as long as the children continue to take the medication. And 20 to 30 percent of children do not respond to such medication, while others experience serious side effects including insomnia and appetite reduction.
When researchers George J. DuPaul, Lehigh University, and Tanya L. Eckert, Syracuse University, carried out a meta-analysis of all published and unpublished studies relating to school-based interventions for ADHD, their goal was to determine which interventions were most effective in reducing disruptive, off-task behavior and improving academic performance. Although DuPaul and Eckert found that teachers can intervene successfully to improve the behavior of children with ADHD, they were disappointed with the overall quality of the research studies.
In analyzing the quality of hundreds of research studies, DuPaul and Eckert found them limited in a variety of important ways. Very few studies included a control group, random assignment to treatment groups or follow-up phases to determine if the effects of the treatment were long lasting. DuPaul and Eckert excluded studies that did not meet minimum methodological standards. They also excluded studies involving students who exhibited behavioral problems other than hyperactivity and inattention. In the end, only 63 studies were included in this analysis.
The results of this meta-analysis indicate that school-based interventions for children with ADHD can lead to significant behavioral improvement. The effects of intervention on academic performance were less powerful and extremely variable. Effects for behavior were 1.5 to 2 times greater than effects for academic performance. In these studies, behavior modification, along with academic interventions such as peer tutoring, worked better than cognitive strategies (teaching children self-instruction and self-regulation) in improving classroom behavior. But these studies suggest that cognitive strategies may be more effective for enhancing academic performance. Further study in this area is needed.
Interventions in special education classes produced significantly greater positive effects on behavior than those found in general education classes. This may have been due to the smaller class size or differences in teachers’ training and experience. There was no difference in academic performance between special and general education classes.
Although stimulant medication continues to bring about the greatest improvement in the behavior of ADHD children, academic and behavioral interventions also appear to help significantly. These researchers conclude, however, that interventions are less effective in improving academic performance. This is a concern since one of the greatest risks for children with ADHD is poor academic performance. It is premature to suggest that any one treatment is more effective than another in improving the academic performance of children with ADHD.
Children with ADHD are a diverse population and this contributes to the variability in their response to treatment. DuPaul and Eckert express concern that relatively few of all the studies conducted, examine the effects of academic interventions, include adolescents and/or girls, or evaluate treatment over time. Further high-quality research is needed.
“The Effects of School-Based Interventions for Attention Deficit Hyperactivity Disorder: A Meta-Analysis”, School Psychology Review, Volume 26, Number 1, April 1997,pp. 5-27.
Published in ERN May/June 1997 Volume 10 Number 3.