Incremental Benefits of a Daily Report Card Over Time for Youth with Disruptive Behavior: Replication and Extension

Reconceptualizing the approach to supporting students with attention-deficit/hyperactivity disorder in school settings

The long-term academic outcomes for many students with attention-deficit/hyperactivity disorder (ADHD) are strikingly poor. It has been decades since students with ADHD were specifically recognized as eligible for special education through the Other Health Impaired category under the Education for all Handicapped Children Act of 1975, and similarly, eligible for academic accommodations through Section 504 of the 1973 Rehabilitation Act. It is time to acknowledge that these school-policies have been insufficient for supporting the academic, social, and behavioral outcomes for students with ADHD. Numerous reasons for the unsuccessful outcomes include a lack of evidence-based interventions embedded into school approaches, minimizing the importance of the general education setting for promoting effective behavioral supports, and an over-reliance on assessment and classification at the expense of intervention. Contemporary behavioral support approaches in schools are situated in multi-tiered systems of support (MTSS); within this article we argue that forward-looking school policies should situate ADHD screening, intervention, and maintenance of interventions within MTSS in general education settings and reserve special education eligibility solely for students who require more intensive intervention. An initial model of intervention is presented for addressing ADHD within schools in a manner that should provide stronger interventions, more quickly, and therefore more effectively.

Implementation resources to support teachers' use of behavioral classroom interventions: protocol of a randomized pilot trial

BACKGROUND

Teacher-delivered behavioral classroom management interventions are effective for students with or at-risk for attention-deficit/hyperactivity disorder (ADHD) or other disruptive behavior challenges, but they can be difficult for teachers to use in the classroom. In this study, we will pilot test a package of implementation strategies to support teachers in using behavioral classroom interventions for students with ADHD symptoms.

METHODS

We will use a 2-group, randomized controlled trial to compare outcomes for teachers who receive Positive Behavior Management Implementation Resources (PBMIR), a theory and data-driven implementation resource package designed to increase teacher implementation of behavioral classroom management interventions, with those who do not receive this additional implementation support. We will measure teacher implementation outcomes (e.g., observed fidelity to behavioral classroom interventions) and student clinical outcomes (e.g., ADHD-related impairment, ADHD symptoms, student-teacher relationship, academic performance) before and after an 8-week intervention period for both groups; we will also measure teacher-reported acceptability, appropriateness, and feasibility for the PBMIR group following the intervention period.

DISCUSSION

If there is preliminary evidence of feasibility and effectiveness, this pilot study will provide the foundation for evaluation the PBMIR at a larger scale and the potential to improve outcomes for students with or at risk for ADHD.

TRIAL REGISTRATION

This clinical trial was registered at ClinicalTrials.gov. ( https://clinicaltrials.gov/ ) on 8/5/2022 which was prior to the time of first participant enrollment. The registration number is: NCT05489081.

Exploring Teachers' Intentions to Use Behavioral Classroom Interventions

Multi-tiered systems of behavioral supports offer teachers tools to implement positive, antecedent- or consequence-based interventions for all students (i.e., Tier 1), and for those who need additional support (i.e., Tier 2), such as students with ADHD. Because these interventions may be challenging to use, targeted, theory-driven implementation strategies may assist teachers in implementing them with fidelity. This exploratory study examined teachers' intended and self-reported use of specific Tier 1 and Tier 2 behavioral classroom interventions. Sixty-five K-8 teachers from five urban public schools completed an online survey about their intentions to use and self-reported use of four Tier 1 and Tier 2 behavioral classroom interventions. Teachers' intentions varied by intervention, with the weakest intentions for using a daily behavior report (Tier 2), and weaker intentions for using high rates of specific praise than for other Tier 1 interventions. Teacher's self-reported use was significantly lower than intended use for Tier 1 interventions, but not Tier 2 interventions. Results were generally similar whether the referent group was students with ADHD symptoms or the entire class. These results suggest specific factors to target to support teachers' use of behavioral classroom interventions.

Examining Benchmarks for the Daily Report Card Intervention in a Therapeutic Recreational Setting

OBJECTIVE

This study aimed to (1) examine benchmarks for the benefits of the Daily Report Card (DRC) within a therapeutic recreation setting, that is, the Summer Treatment Program (STP) and (2) explore differences in baseline characteristics and treatment outcomes among optimal and suboptimal responders. Benchmarks were examined for children's DRC target behaviors using standardized mean difference (SMD) effect sizes (ES) across 2-week periods of the STP.

METHOD

Participants were 38 children attending an STP.

RESULTS

Aside from teasing, all DRC targets showed improvement by the second 2-week period that was sustained through the third 2-week period. Optimal responders demonstrated greater improvement in parent-rated impairment and camp behaviors than suboptimal responders. Some baseline differences between responder groups were found.

CONCLUSION

This study provides the first benchmarks for change in DRC targets within a therapeutic recreational setting, offering guidelines for treatment expectations. Implications for clinical decision-making, treatment planning, and future research are discussed.