Running head: ADHD IN THE CLASSROOM

ADD/ADHD in the Classroom: Challenging Behavior, Student Learning,

and Classroom Management

Kelly Aceves
University of La Verne

A Paper Prepared for EDUC 596

In Partial Fulfillment of
The Requirements for the Degree
Master of Education

March 2015

ADHD IN THE CLASSROOM

Abstract
Attention Deficit Hyperactivity Disorder (ADHD) is a common challenge faced by many
students. Statistically, every classroom will include an ADHD student. The symptoms of ADHD
commonly present in off-task behavior and poor academic achievement. Research suggests that
many of these challenges are due to lack of executive function skills. There are several strategies
for addressing these challenges such as self-monitoring, reinforcers, consequences, and physical
activity. Classroom managements is also key to successfully addressing the needs of ADHD
students. Students routinely show improvement when teachers use empirically tested methods of
intervention.

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ADHD in the Classroom:

Challenging Behavior, Student Learning and Classroom Management
Literature Review
Introduction
At any given moment in the classroom, there are a number of challenges that may be
present, ranging from academics to behavior to classroom management in general. Now, more
than ever, with the movement toward inclusion, general education teachers are faced with the
difficult task of meeting the individual needs of the diverse classroom population. For this
undertaking to be successful, it is imperative that teachers equip themselves with effective
strategies and interventions than can be interwoven into lesson plans and classroom procedures.
One challenge that all educators should expect is meeting the needs of a student with Attention
deficit hyperactivity disorder (ADHD). Likely affecting up to 5% of the school children in our
country (APA, 1994), statistically, every classroom in the United States will contain an ADHD
student (Fabiano & Pelham, 2003).
The purpose of this literature review is to investigate interventions for ADHD students
and to ascertain which methods are proven to be most successful in the classroom. I will first
identify the challenges specific to this disorder and how they affect behavior and student
learning. I will then explore strategies used to address these challenges at both the individual
and whole class levels. Finally I will assess the external and internal validity of the studies that I
am reviewing.
ADHD Defined
According to the American Psychiatric Association (APA), ADHD is a developmental,
neurological disorder that is characterized by severe and chronic inattentiveness, hyperactive

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behavior and impulsive actions (as cited in Daley & Birchwood, 2009). However, APA further
states There are no laboratory tests that have been established as diagnostic in the clinical
assessment of Attention-Deficit/Hyperactivity Disorder ( as cited in Armstrong, 1999 pp. 1112). The diagnosis of this disorder is pronounced after reviewing the individuals medical
history, psychological assessments, and documentation of observations in various settings
(Armstrong, 1999). According to DSM-IV criteria published by the APA, over the course of six
months and before the age of seven, a child needs to demonstrate several inattentive,
hyperactive, and impulsive behaviors which significantly impair daily functioning at home and
school (as cited in Armstrong, 1999). While some researchers believe that the cause of ADHD is
biologically grounded, others question its origin. According to a 2002 study by Hill et al., there
is evidence that neuro-imaging examinations of children with ADHD have yielded a smaller
prefrontal-cortex (As cited in Armstrong, 1999). However Armstrong states ADD/ADHD
looks much more like a complex interaction between brain and world than any kind of intrinsic
medical problem located solely inside the genes or brain chemicals of a child (1999, p. 8).
Regardless the cause of ADHD, the symptoms of inattention, impulsivity, and
hyperactivity present themselves in a very real way in the classroom. Actually, these symptoms
seem to flourish even more in an academic setting than in other situations. Prescription
stimulants such as Ritalin are often the first place that parents turn for treatment of their childs
ADHD symptoms. While the use of psychotropic drugs can produce a more focused, compliant,
and less aggressive student, these results quickly wear off. Therefore, medication can provide
symptomatic relief but should in no way be considered a cure for the disorder (Armstrong, 1999,
p. 15) Furthermore, DuPaul and Stoner discovered that it is abnormal for pharmaceutical drugs
alone to be an effective intervention for the multiple, chronic challenges that students with

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ADHD face (As cited in DuPaul, Weyandt & Janusis, 2011). Due to their popularity, it is
reasonable to acknowledge the frequent use of psychotropic drugs for ADHD treatment, but this
review will focus primarily on the teachers role in lessening the effects of ADHD in the
classroom.
ADHD in the Classroom
Being presented with the symptoms of ADHD, alone, are enough to interfere with daily
functioning at school. However, the challenges do not typically end with the tell-tale signs of
inattention, hyperactivity and impulsivity. It is common for those with ADHD to suffer from comorbid complications as well. According to Biederman et al., up to half of individuals with
ADHD suffer from conduct disorder (CD) and/or oppositional defiant disorder (ODD) (As cited
in Daley & Birchwood, 2009). Hinshaw found that children with ADHD are also susceptible to
social rejection and difficulties in general with their peers (As cited in DuPaul et al., 2011). And
the list continues, these students are frequently absent from school, are three times more likely to
be held back in elementary school, and have a greater chance of dropping out of high school than
their peers without ADHD (Barbaresi, Katusic, Colligan, Weaver & Jacobsen, 2007). With an
abundance of complications to consider, it is helpful to break down the challenges of ADHD into
categories of behavior and academics.
The most readily observable symptoms of ADHD are typically those that relate to the
childs behavior. In a case study by Fabiano and Pelham (2003), teachers listed some of the
negative behavior of one of the ADHD participants: interrupting teachers, getting out of his
seat without permission, talking back to teachers when corrected, teasing peers, and being noncompliant(p. 123). This unfavorable conduct is common among ADHD students and often
leaves teachers feeling frustrated and peers hesitant to interact. While a teacher may be more

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aware of the disruptive nature of externalizing behaviours, it is not these problems that should be
targeted when considering improvements in academic performance (Daley & Birchwood,
2010). Understanding this challenging misbehavior is only a small piece in the puzzle of ADHD.
It appears that ADHD students also have an academic disadvantage. Twenty to thirty
percent of children with ADHD will present a related learning challenge in spelling, writing,
reading, and arithmetic (Daley & Birchwood, 2009). In a recent ex post facto study, a group of
researchers in Germany used data from two ongoing population-based birth cohort studies to
determine the relationship between ADHD and students with dyslexia and dyscalculia. The two
longitudinal studies that they relied on were The LISAplus (The Influence of Life-style factors
on the development of the Immune System and Allergies in East and West Germany plus the
influence of environment and genetics) and GINIplus (German Infant Study on the influence of
Nutrition Intervention plus environmental and genetic influences on allergy development. They
began circa 1997 and are ongoing. Both studies originated with healthy full-term infants
(combined N=9088) and followed-up with participants at regular intervals during development.
In both studies, questionnaires assessing reading and learning disorders as well as ADHD were
administered at the 10-year follow-up. Parents were also asked if their children had problems in
mathematics. Data from both studies was pooled and analyzed to determine comorbidity of
dyslexia or dyscalculia. The results of the study indicate that there is significantly higher risk for
difficulties in reading/spelling as well as in math for students with ADHD symptoms (Czamara
et al., 2013). Furthermore, when compared to a controlled group of students, ADHD students are
more prone to being placed in a special education classroom or eliciting help from remedial
academic services (Daley & Birchwood, 2010).

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Although ADHD students often struggle to perform well on day to day classroom
assignments and homework, they usually rank average on achievement tests (Harris, et al.,
2005). Additionally, Kauffmann and Nuerk (as cited in Daley & Birchwood, 2010) observed a
control group of typically developing (TD) students compared to a group of ADHD students and
found that there was no difference in the complex calculating skills, but when it came to basic
number processing, such as comparing the magnitude of single digit numbers, the ADHD group
displayed significantly lower performance. Countless research points to a number of academic
challenges for the population of ADHD children, but as previously mentioned, this is a highly
co-morbid disorder. Daley and Birchwood (2010) pose the question, Are these academic
problems the result of factors directly related to ADHD (symptoms, underlying processes) or are
they the result of factors that are indirectly related to ADHD? The results of their research
suggest that the root of academic underperformance associated with ADHD-diagnosed students
may very well be a product of deficits in executive functioning. Whether these academic
struggles are a direct result of ADHD or a co-morbid disorder, there is no question that the
ADHD student is more likely to struggle in the classroom, and that warrants investigation of a
solution.
Interventions
Since the origin of ADHD and its many co-morbid factors are highly debated, it would be
beneficial to have a broad source of effective strategies to promote learning amongst the ADHD
population. As Armstrong mentions, We must see the whole child against the backdrop of his
physiology, personality, gender, developmental level, learning styles, educational and cultural
background, and social milieu, if we are to understand the nature of his behavior and to
determine which tools, approaches, and methods may be most effective in helping him (1999, p.

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48). With great variation between ADHD students, it is inconceivable that there would be a onesize-fits-all strategy that consistently produced successful results. This is evident in the
abounding number of accommodations and approaches used by teachers to assist their ADHD
students (Armstrong, 1999). In their case study, Fabiano and Pelham (2003) examined the effects
of modifying an existing, ineffective behavior plan in such a way that it would result in improved
behavior. They followed a third grade boy in a general education classroom who also had access
to a special education teacher during small group activities. The participant had an existing
behavior modification plan which consisted of a daily report card that provided opportunity to
earn rewards. Even with this modification in place, the disruptive behavior continued. It was
hypothesized that the proposed rewards were substantial, but not easily attainable. At the time of
the study, the subject had yet to reach a goal that warranted a reward. During the case study,
three major changes were made to the current system: 1) The participant had the opportunity to
earn smaller, daily rewards based on his classroom behavior, 2) Teachers were asked to provide
immediate feedback when the participant was breaking the rules of the classroom, 3) A goal
listed on his daily report card could be met by fewer than three violations of each target behavior.
At the conclusion of the study, it was determined that the percentage of intervals in which John
displayed disruptive behavior before the intervention was 29.8% (SD=12.91). After the changes
to his behavior plan were implemented, disruptive behavior intervals decreased to 10.33%
(SD=4.18). Building on the findings of this study, some additional interventions that are likely
to improve behavior, whether or not a current plan exists, are self-monitoring, reward systems,
consequences, physical activity, and modified classroom management.

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Self-Monitoring and Goal Setting

It is widely accepted that training a student in self-monitoring (also termed selfregulation, self-awareness or self-management) can be a valuable tool. This is especially true of
students with ADHD or other learning disabilities (Harris et al., 2005; DuPaul et al., 2011 &
Barkley, 2008). Self-monitoring is a multiple component strategy. First, the teacher evaluates
the students academic performance or on-task behavior and then discusses the results with the
student. Next the teacher mediates the student to self-monitor at regular, frequent intervals. In
some cases a tone or other cue is produced at the moment that the student should complete his
evaluation. A Likert rating scale is often used to record evaluations (Harris et al., 2005 & DuPaul
et al., 2011). The students evaluations are closely compared with the teachers in an effort to
train the student in accurate self-assessment. Students receive reinforcers for their performance
as well as their accuracy in self-monitoring based on the extent to which their assessment was
analogous with the teachers evaluation. Barkley (2008) suggests that a student has a Daily
School Behavior Report Card, on which he is rated by his teacher in a number of areas at the end
of each subject, or class period (for upper grades). The ratings can be converted to points and
privileges. To modify this strategy as a self-monitoring tool, one copy of the Daily School
Behavior Report Card would be assigned to the student and another to the teacher. With any
self-monitoring intervention, the goal is to mediate the student to a point where she is
consistently accurate at evaluating her own behavior or performance, and thus the need for
teacher comparison is reduced and eventually removed (DuPaul et al., 2011). In meta-analysis, it
has been shown that self-monitoring interventions produce considerable gains on the academic
performance and on-task behavior of the ADHD students (Harris et al., 2005).

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A quasi-experimental study was conducted to determine the effect that Self-Monitoring

of Performance (SMP) and Self-Monitoring of Attention (SMA) had on on-task behavior and
academic performance (Harris et al., 2005). The study took place at an elementary school located
in the suburbs of a large city in the Middle Atlantic states. The school was situated in a mostly
low-to-middle class neighborhood and encompassed a student body of approximately 420
students. The participants were six third-, fourth-, and fifth-grade students with ADHD. They
were observed for four consecutive days during their language arts period. The participating
students were taught SMA and SMP. They were instructed to self-monitor for attention and as
they were doing so, they were observed at frequent intervals and coded as on-task or off-task.
The participants had also been using SMP in regards to practice of spelling words. The results
indicate that both SMA and SMP had a positive effect on students on-task behavior. During
baseline, the group of participants averaged 55% for on-task behavior. During the SMP phase the
group averaged 92% and during the SMA phase the students averaged 94%. Self-monitoring
also had a positive effect on the academic performance of the six participants. Prior to any selfmonitoring, the group correctly practiced their spelling words 38 times. During the SMP phase of
the study, the mean number of correct practices was 83. During the SMA phase, the average of
correct practices was 114. Overall the results of SMA and SMP are promising and seem to
reflect the holistic approach of Armstrong (1999): We essentially want our students not to
change their behavior like robots, but to do so with understanding, reflection, and learning, so
that they can begin to regulate their own lives (p. 97). Similarly, the use of personal best goals
are achieving positive results with ADHD students (Martin, 2013).
Goal-setting fits well with a system that includes self-monitoring. Both strategies
promote the use of executive functioning. A somewhat novel goal-setting strategy involves

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personal best (PB) goals. PB goals are defined as specific, challenging, competitively selfreferenced targets towards which students strive (Martin 2013). Rather than a comparison with
other students, PB goals focus on ones own progress. A recent study involving more than 3,400
Australian high school students demonstrated that PB goals positively affected progress in
ADHD students achievement, planning, persistence, and homework completion as well as a
higher level of student engagement in academics (Martin 2013). The act of setting PB goals
provides specific details about what a student needs to aim for in order to outperform his
previous best. This includes specific tasks that are a necessary to achieve the desired academic
outcome. The two forms of PB goals are process PB goals and outcome PB goals. Process PB
goals focus on the steps that lead to performance on a distinct task (i.e. studying for a test over
the weekend when in the past no weekend studying has occurred). Outcome PB goals refer to the
results of the process (i.e. answering more problems correctly on ones math quiz). By nature of
the strategies, PB goals and self-monitoring seem to fit well together. The ADHD-diagnosed
student could first work on goal-setting, and then self-monitor his progress toward that goal.
Reinforcers
Another strategy frequently used in conjunction with self-monitoring is a positive
reinforcement system. This type of intervention is most often implemented with the purpose of
rewarding on-task or appropriate behavior rather than academic performance. Reinforcers can
include tokens to later be exchanged for a prize, or simple verbal praise from the teacher
showing recognition of the desired behavior (As cited in Harris et al., 2005). Several studies are
in agreement, that reinforcers should be provided immediately following the targeted behavior
whenever possible (DuPaul et al., 2011; Barkley, 2008; Marina et al., 2002; Anhalt et al., 1998).
Research also suggests that these rewards should be given as frequently as possible to promote

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effectiveness (DuPaul et al., 2011). Furthermore, studies propose that rewards should be changed
or rotated. Barkley (2008) recommends that reward options are changed every two or three
weeks to maintain the effectiveness of motivating the child to demonstrate the targeted behavior.
Additionally, the reward options should be presented in the form of a menu. The menu is
developed collaboratively with the students. The students generate a list of suggested prizes and
come to an agreement on the specific point value to be assigned to each reward (Barkley, 2008 &
Miranda et al., 2002). Involving the students in the process heightens their interest in the reward
system. DuPaul et al., (2011) are in agreement that rewards should be individualized based on
student preferences and interests(p. 37). Even with a consistently implemented, high-interest,
menu of rewards, selected by the students, some students may still exhibit off-task behavior. In
such a scenario, a consequence-based intervention may need to be introduced.
Consequences
For a disruptive student who is continually engaged in off-task behavior, intervening with
response cost may be necessary (DuPaul et al., 2011). Response cost involves removing
reinforcers or tokens for negative behavior, and is therefore always used in conjunction with a
positive reward system. In contradiction, the research of Douglas and Parry advises that ADHDdiagnosed students tend to experience frustration with the removal of rewards and thus have a
more difficult time maintaining targeted behavior (as cited in Armstrong, 1999). Barkley (2008)
adds that consequences need to be delivered immediately and more frequently with ADHD
students than with typically developing children-Swift, not harsh justice is the essence of
effective punishment (p. 7). An additional strategy to reduce off-task behavior is giving the
student time-out by removing them to an isolated area of the classroom or outside of the
classroom following disruptive behavior (DuPaul et al., 2011). However, as with response cost,

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this intervention may backfire and increase the undesired actions of the student. Although
DuPaul et al. (2011) and Barkley (2008) differ slightly in their opinion of the response-cost
strategy; they are in agreement that if negative consequences need to be used with ADHDdiagnosed students, the overall behavior support program needs to be primarily positive.
Physical Activity
Although it often occurs on the playground, physical exercise may greatly affect the
learning that happens in the classroom. Exercise has been shown to have a positive effect on
stress levels, memory, self-image, and clarity of thought (Mulrine et al., 2008). In 1995
Hannaford studied more than 500 Canadian school children and determined that students who
participated in an hour of gym class each day performed far better on exams than students who
did not exercise (As cited in Mulrine et al., 2008). Additionally, Wendt found that forty minutes
of exercise per day for five days a week, over a six-week period, had an immense effect on the
behavior of ADHD students (As cited in Mulrine et al. 2008). Ridgway et al. (2003) conducted
an action research study involving three eight-year old boys diagnosed with ADHD, compared to
a small group of typically developing students. All assessments were conducted at the private
elementary school where the participants attended. The school did not have a scheduled morning
recess break. The purpose of the study was to analyze the effects of recess on classroom
behavior for both the ADHD student and the non-ADHD student in order to determine if a
regular recess break should be instituted. Initial observations of the classroom were conducted
for three days at periodic intervals, from the beginning of the day until the students lunch break,
to determine the level of inappropriate behavior and assess the best time to introduce a recess
break. As the study progressed, all students were introduced to a ten-minute outside recess at
9:45AM on alternating days. All three participants showed increasing intervals of inappropriate

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behavior as the morning advanced, with a mean percentage of the intervals being 48.3%.
Furthermore, the study demonstrated that the longer a student spent in class, the less attentive he
became. After 10AM (post recess time) the mean percentage of intervals of off-task behavior
rose to 70% among the participants. In contrast, post-recess, the mean percentage of intervals of
inappropriate behavior for the participants, decreased to 35%. This study is in synch with
additional research which indicates that children are more focused and less likely to fidget
following recess (Pellegrini, Huberty & Jones, 1995). The sum of the results reveals a strong
positive correlation between recess and attention in the classroom. In some school districts,
however, recess time has been cut, and teachers are forced to find other ways to incorporate
physical activity into the school day.
With or without access to recess, students need additional breaks from sitting still in a
classroom. This is especially true for ADHD-diagnosed students. Several strategies are
recommended for providing movement during and in between classroom instruction. Some
teachers will intervene solely for the ADHD students and provide them with a means of physical
activity while the rest of the class remains static and focused. Such interventions would include
providing the ADHD student with fidgets to use at their desk, or assigning them individual tasks
that require movement throughout the room (i.e. watering a plant or distributing papers). Some
educators even suggest seating the ADHD-diagnosed student in the back of the room. This is
counter-intuitive to the typical front of the room, near the teacher, seating arrangement. The
reasoning behind this strategy is that the student will have more freedom to stand up and stretch
if he is in the back of the room rather than front-and-center for all to see.
In addition to these types of intervention, Armstrong (1999, p.75) argues that far more
powerful strategies for allowing appropriate movement in the classroom tie the activities directly

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into the teaching/learning process itself and involve all students, not just those with the
ADD/ADHD label. Mulrine et al. (2008) echo this thought and suggest that students should
not be required to sit more than thirty minutes at a time. To avoid sitting for lengthy periods of
time, they advocate having students stand up or move to the carpet during delivery of
instructions. Another example of incorporating physical activity into lesson content is to have the
students move while learning spelling words: they can jump out of their seats on vowels and sit
down on the consonants (Armstrong, 1999, p.75). Classroom energizers, short activities that
integrate movement with academic content, are helpful for getting all of the students in motion
(Mulrine et al., 2008). An example of an energizer is a teacher taking the students on an
imaginary tour of a region and having them role play their experience. For example, while
touring California, the students will march across the Golden Gate Bridge and surf the waves
in the Pacific Ocean (California Department of Public Health 2009).
Although the results are debatable, there is some research that suggests that having
students perform a series of specific movements referred to as Brain Gym may be helpful in
improving some common symptoms associated with ADHD. Brain Gym is based is on the idea
that learning is connected to movement, and therefore learning difficulties or disabilities can be
overcome by certain postures and exercises which are believed to create new pathways in the
brain (Khanam, para. 1). There are twenty-six original Brain Gym movements that help children
activate both the right and the left hemispheres of their brains. These movements, along with
other elements of the Brain Gym program, frequently produce significant improvements in the
following areas: concentration and focus, memory, academics, physical coordination,
relationships, self-responsibility, organization skills, and attitude (Brain Gym International,
2011). Pederson (2012) conducted a case study of a first grade boy diagnosed with ADHD

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which included an eight-week Brain Gym program. The results of the study were consistent with
the above-mentioned improvements, and were confirmed by both parents and teachers of the
participant.
Classroom Management
There are abundant strategies for helping the ADHD student to make progress in the
classroom, and they are usually most rewarding when used concurrently. In addition to the
previously mentioned strategies, there are some basic classroom management considerations that
can help strengthen the chosen strategies and create a unified system for controlling off-task
behavior and poor academic performance for the ADHD students. Barkley (2008) often hosts
workshops for educators in which he shares many research-based strategies to help manage
classrooms inclusive of ADHD students. His primary recommendation for classroom
management is to dedicate the first few weeks of school to laying the foundation of behavior
expectations, and then gradually make the shift to focus on curriculum. When instructions are
given they should be clear and brief, and the ADHD students in particular should be asked to
orally repeat them. Assignments should be chunked into smaller portions with short breaks
between each section. Barkley continues his recommendations with advising that a traditional,
all desks face forward, seating arrangement be used. Participatory teaching, which gives students
a meaningful physical task to accomplish during the lesson, is encouraged too. Alternating low
appeal with high appeal tasks will also help to maintain student interest level. And to keep
students focused, continuous note-taking should be required during lectures and while reading.
Implementing these strategies as a regular part of classroom procedure should prove effective.
Student grouping can also play a role in minimizing off-task behavior. A recent
correlational study, involving thirty-one ADHD-diagnosed children and thirty-one age and sex

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matched control participants, was conducted in Belgium. All students were between the ages of
six and twelve and attended regular Flemish elementary schools. The students were observed in
their classroom for two consecutive school days to determine the impact of instructional context
on classroom on-task behavior (Imeraj et al., 2013). The study assessed three types of class
structure and four categories of academic content. In both groups, small group structure, in
contrast with individual work, positively influenced on-task levels. This was especially true for
the ADHD participants. Based on the results of this study it would be beneficial for teachers to
increase the amount of small group work activities. Additionally, the study found that there is a
small improvement in on-task behavior when transition times are structured and when teacher
supervision is increased during high demanding tasks. Mulrine et al., are in agreement that
transitions need arrangement: Effective classroom transitions between learning activities need
structure and boundaries to help students mentally prepare for task shifts and to be better
positioned for learning (2008, p. 18). Consistent with the previous discussion of implementing
physical activity into the classroom, it has been suggested that students do some simple
stretching or exercises during transitions, of course the challenge is to keep the movement
structured. Research shows that these are practical interventions that will benefit the whole class,
while aiming to promote academic and behavioral progress with ADHD students in particular.
Summary
This literature review examined some of the special needs of ADHD students in the
classroom and surveyed a number of interventions to address them. Although individual needs
greatly vary, they can typically be categorized as behavioral or academic. Behavioral issues such
as off-task or disruptive behavior are often the most obvious symptom of an ADHD student, but
just as prevalent are the learning difficulties, especially in the content areas of reading, spelling,

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and math. Based on the studies reviewed, teachers who implemented the discussed strategies
saw favorable results in both academic and behavioral progress of their ADHD students.
Although the results were promising, the studies included in this literature review were
not without their limitations. I referenced many studies, but closely examined the methodology
of five in particular (Czamara et al., 2013; Imeraj et al., 2013; Harris et al., 2005; Fabiano et al.,
2003 & Ridgway et al., 2003). In all five of these studies I discovered several threats, both
internal and external. Some of the specific threats, such as selection, were present throughout the
studies.
In regards to internal validity, two of the five studies (Imeraj et al., 2013 & Ridgway et
al., 2003) demonstrated selection threats. In the study conducted by Imeraj et al., which looked
at the role of instructional context in on-task behavior, only thirty-one ADHD-diagnosed
children were observed. These students were recruited from a psychiatric clinic rather than
selected at random, and only six of them were girls. The thirty-one age and sex matched control
participants were randomly chosen from a pool of sixty-five students that were selected by the
teachers involved in the study (Imeraj et al., 2013). Likewise, the control group in the Ridgway
study (Ridgway et al., 2013) was also teacher-nominated, and the sample size was a mere three
students, all of which were boys. In the case study by Fabiano and Pelham (2003), history
seemed to play a role in the sense that the school year ended before any follow-up data could be
collected to determine the effectiveness of their approach. Also, the authors of this case study
would have been able to come to a stronger conclusion, had they used more than two baselines.
Instrumentation is another internal validity threat that was present in two of the five focus
studies. In the German study that looked at relationships among ADHD, dyslexia and
dyscalculia, much of the data was collected via parent surveys. Some of the results were

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processed based on a single question relating to the perception of their childs difficulties in math
or reading (Czamara et al., 2013). The authors of this study also admit that they did not have
enough data to determine whether or not the participants ADHD symptoms preceded their
reading and mathematical difficulties. Therefore they were unable to infer causality or
chronology of symptoms. In reviewing the study relating to recess and classroom behavior
(Ridgway et al., 2003), I noted weak instrumentation as well. Since the observation periods were
only three days, it is questionable how reliable the data can be. In addition to internal validity
threats of selection and instrumentation, one study was found to pose a threat in the way of
maturation. In the study by Harris et al. (2005), the students were asked to self-monitor their
attention and performance while practicing spelling words. Effectiveness of the strategy was
measured by number of correct practices, however the number of correct practices may have
occurred, at least in part, due to passage of time and increased familiarity with the words and the
practice routine.
Of the five focus studies that I reviewed, all presented threats to external validity.
Selection was an issue with all five. Imeraj et al. (2013) conducted their research at a Flemish
elementary school and all of the participants were Caucasian students of the same socioeconomic class. One of the studies was carried out in Germany (Czamara et al., 2013). It is
uncertain how the results of these studies would generalize to the ADHD population in the
United States. However, even the American studies posed a threat in the way of selection.
Fabiano and Pelhams case study was set at a low-income public school (2003). The study by
Harris et al. (2005) was carried out a in low to middle-class suburban region and Ridgway et al.
(2003) studied the effects of recess at a private school. Each study presents a unique group of

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participants and therefore the findings may not necessarily be similar if the study was conducted
using contrasting subjects.
Another common threat to external validity is the Hawthorne effect. The Hawthorne
Effect states that people behave differently when they are being observed or when they are in a
different environment. This threat was present in four of the studies being reviewed. Due to the
nature of observations, all of the children in the studies were aware that they were being
observed, whether by a video camera or a researcher. In two other studies (Imera et al., 2013 &
Ridgway et al., 2003) the teachers knew the purpose of the study and which students were being
included. This may have caused them to interact differently with those students while they were
being observed. Although un-blinded studies yield such limitations, there is still value in the
results.
Continuing to critique external validity, I also found multiple treatment interference in
three studies (Imeraj et al., 2013; Harris et al., 2005 & Ridgway et al., 2003). Multiple treatment
interference occurs when there are two different treatments with the potential of mixing together
to produce results that would otherwise not typically be demonstrated. In the study relating to
instructional context and behavior, all of the participants were previously taking methylphenidate
(Ritalin). For the purposes of the study they were free from this medication at least twenty-four
hours prior to participation (Imeraj et al., 2013). It is unclear if removing the participants from
their regular dose of prescription medication impacted the results of the study. On the other hand,
in the study by Harris et al., all of the participants were on various medications and continued to
take them during the course of the study which could have led to a confounding variable effect
(2005). In the study that looked at the role of recess in classroom behavior, there were a couple
ways that multiple-treatment interference could have occurred. First of all, the students were not

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21

accustomed to having a morning recess so the affect that recess had on their behavior may have
been greater than the affect of recess on a student who routinely has a recess break. Additionally,
all of the ADHD students were taking Ritalin. The increase in off-task behavior as the morning
progressed is consistent with the dissipation rate of the drug, and could have been a source of
causality.
A final factor influencing external validity was the Halo Effect which was present in the
study of self-monitoring (Harris et al., 2005). The Halo Effect results when participants attempt
to make themselves look good by giving the answer they think the researcher wants to hear. In
the study mentioned, the participants were asked to self-report how many times they had
correctly practiced their spelling words. There was no verification for accuracy of these reports,
and it is reasonable that the students may have inflated the number of practices that they
reported. Even with the presence of several threats to validity, the methodology of these studies
is still sound, and therefore the results should not be discarded.
For the purposes of this Literature Review, I dove into the broad topic of ADHD in the
classroom. It is easy to become overwhelmed by the amount of information that is available on
this topic. Yet, with so many resources, teachers are still challenged to find a solution for off-task
behavior and poor academic progress among students with ADHD symptoms. At the conclusion
of the study, I find myself more aware that the academic and behavioral difficulties of the
ADHD student should not be treated as separate challenges.
Prior to this study, I was skeptical about the extent to which physical activity could affect
learning. I also falsely interpreted poor academic achievement as a lack of effort and attributed
disruptive behavior to disrespect for rules. It was exciting to learn about strategies, such as selfmonitoring, that help refine students executive functioning abilities and in turn produce better

ADHD IN THE CLASSROOM

22

academic results and a higher rate of on-task behavior. Instead of reacting to challenging
students with frustration, I look forward to implementing some of these empirically tested
strategies. I truly believe that there is opportunity for growth in all students, even those who
appear beyond help. Although, he did not initiate his own research study, I appreciate
Armstrongs (1999) holistic approach to viewing the ADHD student and was inspired by his
recommendation that we need to make sure that we approach the child with awe and reverence,
respecting the miracle of life and vitality that each child represents (p. 51). I now eagerly await
the challenge of ADHD students in my classroom and fully anticipate being a part of their
solution.

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Armstrong, T. (1999). ADD/ADHD alternatives in the classroom. Alexandria, VA: Association
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Biederman, J., Newcorn, J. & Sprich, S. (1991) Comorbidity of attention deficit hyperactivity
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DuPaul, G., Volpe, R., Jitendra, A., Lutz, J., Lorah, K. & Gruber, R. (2004) Elementary school
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