In this article, we review and organize the current research-based knowledge on nonpharmacological interventions relevant to educating students with attention deficit disorder (ADD).
We conducted a search of the literature through an iterative process designed to identify work of historical significance, as well as ongoing projects. Our search methods included (a) computer searches of databases in education, psychology, and medicine; (b) requests to ADD organizations for intervention materials and reference lists; (c) letters to leading researchers who have published work related to educational interventions; and (d) pursuit of reference trails from research articles, review articles, and book chapters. Because the criteria for defining and identifying attention deficits have changed over time, we included studies with subjects whom researchers identified as having characteristics or behaviors associated with ADD, whether or not formally diagnosed. Though our focus was on nonpharmacological interventions (Swanson and his colleagues review pharmacological interventions elsewhere in this issue), we included studies that compared drug therapy with other interventions.
After screening for subject characteristics, applicability in education settings, recency (or historical importance), and methodological soundness, we identified 137 empirically based articles for inclusion in an electronic database. The articles we cite here are either representative of that body of work, particularly noteworthy for their clarity on various topics, or unique in their findings. In the following sections, we review the empirical evidence according to four topic areas of interest to educators: behavior management, academic instruction, home-school collaboration, and comprehensive programming.
Before describing the empirical evidence related to each of these topics, we must note two important limitations that affect the validity of the work we describe. First, investigators have collected relatively few data on interventions in public school classrooms. Clinical psychologists, neuropsychologists, and physicians conducted most of the reported research in laboratory or clinic settings (including clinic-based classrooms); only 21 of the 137 studies reported on interventions in actual classroom settings. If we had limited our review to those studies set in actual schools, we would have had little to report.
Second, the subjects for the studies we reviewed are far from a homogeneous group. A great range of characteristics guided the investigators as they identified the children with attention deficits who served as subjects, partly because the definition of ADD has changed over time (see McBurnett et al., this issue). In addition, for many studies, the investigators determined that subjects had attention deficits based on screening instruments rather than through formal diagnostic protocols. For other studies, the investigators were interested in a single ADD characteristic (such as hyperactivity) and thus chose subjects on measures of that characteristic alone. These subject-selection issues raise concerns about the generalization of the findings to other children or youth with ADD and signal a need for caution in making comparisons across studies.
Research in behavior management with children with ADD has focused on increasing on-task behavior, task completion, compliance, impulse control, and social skills while reducing hyperactivity, off-task behavior, disruptive behavior, and aggression. The following overview examines studies that employed behavioral or cognitive-behavioral strategies--the two nonpharmacological treatments for managing children with ADD that have been most extensively investigated.
Behavior therapy, behavior modification, and contingency management all refer to strategies that use reinforcement and punishment to establish or reduce target behaviors. …