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The Effectiveness of Behavioral Interventions at School
An article in a recent edition of School Psychology Review provides a comprehensive summary of studies testing different types of behavioral interventions in the classroom for students with ADHD.
Results from 137 studies conducted over the past decade were examined. Three types of behavioral interventions were considered. Contingency Management Interventions (CMI) are those where rewards or punishments are used to try and alter the child’s behavior. Academic Interventions (AI) are those where modifications in the teaching process (e.g. using peers as teachers; providing choice of assignments) are employed. Thus, rather than providing consequences contingent on the child’s behavior, the interventions alter the way material is presented and taught. Finally, Cognitive Behavioral Interventions (CBI) are those that attempt to teach the child specific thinking skills. For example, children may be taught how to self-monitor their behavior to reduce impulsivity or how to solve social problems without becoming aggressive.
Overall, the studies reviewed provide clear evidence that behavioral interventions can be quite effective. The authors note, however, that the effects typically achieved were less than what is generally provided by medication.
Results also indicated that certain interventions are more likely to be effective than others. Contingency Management Interventions and Academic Interventions tended to produce greater benefits than Cognitive Behavioral Interventions. In other words, trying to teach children with ADHD new cognitive skills to help them manage their behavior differently on their own, was less effective than the other approaches. This finding is consistent with Dr. Russell Barkley’s contention that trying to teach new cognitive skills to children with ADHD is not likely to be effective (see the prior issue of ADHD RESEARCH UPDATE.)
It also appeared that behavioral interventions were more effective in improving children’s classroom behavior than in enhancing their academic performance. Although statistically significant improvements in academic functioning were obtained, the actual magnitude of the improvements were disappointingly small.
This nice review paper has several important implications. First, it is clear that well designed behavioral interventions work and can be an important part of many children’s treatment. For a child with a relatively mild case of ADHD, behavioral interventions alone may be sufficient to enable that child to succeed. For other children who do not respond to medication, or who experience adverse side effects, behavioral interventions can be an effective alternative. Even for children who respond positively to medication, there are often problems which remain that can be addressed using behavioral strategies.
This paper also underscores the importance of not confusing behavioral improvement with academic improvement. Sometimes, when treatment results in a child’s being less disruptive, their can be the unwarranted assumption that everything is going better. The quality of a child’s work can still be problematic, however, although parents often don't learn about this until report card time. Carefully monitoring academic performance - even when their classroom behavior is okay - is thus absolutely essential for promoting the long term success of students with ADHD.
Finally, it is important to stress that an effective behavioral intervention has to be designed on a child by child basis. There is no "programmed intervention" that can be applied to all children with ADHD. Consulting with an experienced child psychologist to help in developing a good behavioral plan is strongly recommended.
Note: This article originally appeared in Attention Research Update, an online newsletter written by Dr. David Rabiner, a Duke University psychologist and former member of CHADD's Professional Advisory Board. You can learn more about Attention Research Update and sign up for a free subscription at www.helpforadd.com.