ADHD Symptom Reduction in Elementary Students: A Single-Case Effectiveness Design

Article excerpt

The authors used a single-case design to examine the effectiveness of child-centered play therapy (CCPT) and person-centered teacher consultation (PCTC) for four elementary students identified with attention deficit hyperactivity disorder (ADHD) symptoms. Two students participated in CCPT and their teachers participated in PCTC. Two students participated in reading mentoring and CCPT. Behavioral observations of all students occurred three times per week. Results indicated that two students demonstrated a substantial reduction and two students demonstrated questionable reduction in ADHD symptoms due to participation in CCPT Implications for elementary school counselors are discussed.


Students exhibiting behavioral problems associated with attention deficit hyperactivity disorder (ADHD)--inattention, hyperactivity, and impulsivity--are a common concern of teachers, parents, and elementary school counselors (DuPaul & Stoner, 2003). In the classroom, students with ADHD exhibit significantly different behaviors than students without ADHD (Carroll et al., 2006). Students with ADHD are more talkative, two times more likely to display off-task behaviors, and three times more likely to be oppositional than students without ADHD (Carroll et al.). These off-task behaviors are disruptive in the classroom and can interfere with student learning (Mulrine, Prater, & Jenkins, 2008). Without early intervention, children with ADHD can experience negative long-term effects as adults, such as lower levels of education and more arrests (Barkley, Fischer, Smallish, & Fletcher, 2002). Because ADHD is the most common diagnosis of childhood (as cited in Woodard, 2006), it is imperative that elementary school counselors be aware of specific interventions they may use to help decrease the ADHD symptoms that negatively impact student learning. In this article, the authors review the results of a single-case design study examining the effectiveness of play therapy for elementary students with ADHD symptoms.


Play therapy developed out of the realization that traditional talk forms of counseling did not seem to be effective with young children due to their developmental levels and capabilities (LaBauve, Watts, & Kottman, 2001). Children under the age of 10 have not developed the cognitive and verbal abilities to participate fully in talk forms of counseling and instead their natural form of communication occurs through play (Landreth, 2002). Child-centered play therapy has its roots in adult person-centered counseling. A student of Carl Rogers, Virginia Axline, adapted the person-centered theoretical approach to her work with children. Axline (1947) believed that people of all ages have an innate drive toward maturity, independence, and self-direction; thus directing children in counseling would interfere with their natural tendency to grow. Like Rogers, Axline believed that development of the relationship provided the conditions for change. Garry Landreth expanded Axline's nondirective play therapy approach to formalize child-centered play therapy (CCPT).

For young students struggling with personal/ social issues, elementary school counselors can use CCPT. Although a comprehensive developmental guidance program prefers the referral of students with individual counseling issues to a counselor outside of school, many students cannot or will not access counseling outside of school. Therefore, elementary school counselors can utilize CCPT, which falls within the responsive services component of the ASCA National Model[R] (American School Counselor Association, 2005). Gysbers and Henderson (2006) recommended that elementary school counselors devote approximately 30-40% of their time providing responsive services, such as CCPT.

In their exploration of the effectiveness of CCPT in the school setting, researchers have demonstrated student improvement in self-efficacy, self-esteem, teacher relationships, and internalizing and externalizing behavioral problems (Fall, Balvanz, Johnson, & Nelson, 1999; Garza & Bratton, 2005; Packman & Bratton, 2003; Post, 1999; Ray, 2007). …