The Effects of Classroom Interventions on Off-Task and Disruptive Classroom Behavior in Children with Symptoms of Attention-Deficit/Hyperactivity Disorder: A Meta-Analytic Review

Abstract

Children with attention-deficit/hyperactivity disorder (ADHD) often exhibit problem behavior in class, which teachers often struggle to manage due to a lack of knowledge and skills to use classroom management strategies. The aim of this meta-analytic review was to determine the effectiveness of several types of classroom interventions (antecedent-based, consequence-based, self-regulation, combined) that can be applied by teachers in order to decrease off-task and disruptive classroom behavior in children with symptoms of ADHD. A second aim was to identify potential moderators (classroom setting, type of measure, students’ age, gender, intelligence, and medication use). Finally, it was qualitatively explored whether the identified classroom interventions also directly or indirectly affected behavioral and academic outcomes of classmates. Separate meta-analyses were performed on standardized mean differences (SMDs) for 24 within-subjects design (WSD) and 76 single-subject design (SSD) studies. Results showed that classroom interventions reduce off-task and disruptive classroom behavior in children with symptoms of ADHD (WSDs: MSMD = 0.92; SSDs: MSMD = 3.08), with largest effects for consequence-based (WSDs: MSMD = 1.82) and self-regulation interventions (SSDs: MSMD = 3.61). Larger effects were obtained in general education classrooms than in other classroom settings. No reliable conclusions could be formulated about moderating effects of type of measure and students’ age, gender, intelligence, and medication use, mainly because of power problems. Finally, classroom interventions appeared to also benefit classmates’ behavioral and academic outcomes.

Exploring neuropsychological effects of a self-monitoring intervention for ADHD-symptoms in school

“…The nonsignificant improvement in "peer interaction" may be explained by the fact that peer behaviors are more dependent on external stimuli than the other observed behaviors. The significant improvements in on-task behavior/ reduced off-task behavior show a positive effect of the intervention in line with findings of recent meta-analyses by Bruhn, McDaniel, and Kreigh (2015) and Gaastra, Groen, Tucha, and Tucha (2016) and confirm that classroom behavior can be improved by means of a self-monitoring intervention. Classroom interventions appear to be one of the most effective interventions for improving classroom behavior (Gaastra, Groen, Tucha, & Tucha, 2016).…”

“…Self-monitoring interventions are easily accessible and can be used for children with and without an ADHD diagnosis, as long as they experience difficulties with self-regulatory strategies and self-monitoring (Hoff & Ervin, 2013). Most classroom interventions for ADHD focus on classroom management strategies that teachers apply including consequence-based and antecedent-based strategies (DuPaul, Eckert, & Vilardo, 2012;Gaastra, Groen, Tucha, & Tucha, 2016). The advantage of selfmonitoring interventions is that children themselves are taught new self-regulatory skills.…”

“…Bruhn, McDaniel, and Kreigh (2015) analyzed 41 studies in their meta-analysis and reported consistent evidence that classroom behavior of children with ADHD could be substantially improved by a self-monitoring intervention. A recent comprehensive meta-analysis compared effectiveness of different types of classroom interventions for ADHD, and concluded that both self-regulation interventions (including self-monitoring interventions) and consequent-based management strategies (i.e., making use of reward and response cost schedules) are most effective for managing ADHD (Gaastra, Groen, Tucha, & Tucha, 2016). The majority of effect studies (over 80%) use single-subject designs with fewer than 10 participants, which is due to practical restrictions of this type of research; such as time-consuming daily observations and low numbers of children with ADHD in the classroom.…”

Interrogating the Effectiveness of Educational Practices: A Critique of Evidence-Based Psychosocial Treatments for Children Diagnosed with Attention-Deficit/Hyperactivity Disorder

“…Systematic literature reviews of the EBPTs reveal the usefulness, effectiveness, and preference for psychosocial interventions, which mainly promote behavior management and organizational and/or social skills training (Eiraldi et al, 2012;Evans et al, 2014;Watson et al, 2015;Gaastra et al, 2016). The "advantage" of these interventions is that they meet two criteria that are absolutely necessary for evidence-based research to be carried out: first, they can be completely standardized (i.e., manualized by developing a protocol-like approach) in order to exclude the impact of individual teachers or trainers on the effectiveness outcomes and, second, they are brief so as to avoid other influences to occur due to the length of time.…”

The advantages of an ADHD classification from the perspective of teachers

“…Critique aimed at classifying children is further strengthened as more is discovered about the greater effectiveness of group approaches that work for whole classrooms, compared with treating individual children (Pfiffner, Barkley, and DuPaul 2006;Gaastra et al 2016;Moore et al 2016). Affirming a general consensus in the pedagogical disciplines: classroomwide approaches are typically to be preferred over child-centred approaches that single out individuals.…”