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Educational interventions for students with attention deficit disorder.

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 therapy, behavior modification, and contingency management all refer to strategies that use reinforcement and punishment to establish or reduce target behaviors. Behavior therapy techniques have the advantages of being cost effective, relatively easy and quick to implement, and adaptable to multiple settings. To special educators familiar with contingency management, the research on children and youth with ADD offers few surprises. The ADD literature does suggest, however, a special emphasis on three common behavioral interventions: positive reinforcement, punishment, and response cost.

Positive Reinforcement. Research provides evidence that positive reinforcement procedures (most often using secondary reinforcers) can be effective in reducing activity level, increasing time on task, and improving academic performance of students with ADD. O'Leary and her colleagues reported on a series of studies (Friedling & O'leary, 1979; O'Leary, Pelham, Rosenbaum, & Price, 1976; Rosenbaum, O'Leary, & Jacob, 1975) indicating the effectiveness of carefully implemented token economies. Their work provides examples of successful behavioral treatments that included group reward contingencies and parent rewards for progress toward goals set in a clinic school. Using social praise as a reward, Douglas and Parry (1983) found that reward improved reaction time for subjects with hyperactivity but only continuous reward reduced response variability. They concluded that children with hyperactivity are unusually sensitive to rewards and that partial rewards are less effective than continuous rewards. When Pelham, Milich, and Walker (I 986) examined different schedules of reinforcement using a token economy, however, they found no difference on spelling tasks between continuous and partial reinforcement conditions.

Ayllon, Layman, and Kandel (1975) studied three children with learning disabilities and hyperactivity using a token reinforcement condition focused on reading and mathematics performance. Under the reinforcement condition, the students' hyperactivity was reduced to levels comparable to the levels achieved with methylphenidate; and, in contrast to the students' performance while taking methylphenidate, the establishment of the token economy led to dramatic improvements in academic performance. Other investigators have questioned the relative effectiveness of behavior therapy compared to stimulant medication. For example, Gittelman-Klein et al. (1976) found methylphenidate to be more effective in improving conduct, attention, hyperactivity, and disruptive behavior than a positive reinforcement program that included home and school use of token reinforcers; and combining the behavior therapy with methylphenidate did not produce results beyond those obtained with methylphenidate alone.

Punishment. A number of behavior therapy studies have examined the effects of negative feedback or reprimands, which are specific forms of punishment, on the performance of students with ADD. (We use the term "punishment" in the behaviorist sense--a contingency that reduces the frequency of a behavior. Research on subjects with ADD has employed only mildly aversive contingencies.) Specifically, these mild corrections have proven effective in decreasing off-task behavior and, to some extent, in increasing academic productivity. Worland (1976) compared positive feedback, negative feedback, and no feedback and found that hyperactive children were on task significantly more under negative feedback than the other two conditions; but negative feedback significantly increased their errors on a spelling correction task. In a pair of similar experiments, Abramowitz, O'Leary, and Rosen (1987) compared the effects of teacher encouragement, teacher reprimands, and no feedback on off-task behavior. They found significantly lower off-task rates with reprimands.

Abramowitz's work on reprimands (or redirection) is noteworthy because it demonstrates how empirical evidence can contribute to the refinement of a simple and common classroom technique. Abramowitz, O'Leary, and Futtersak (1988) demonstrated that short reprimands resulted in significantly lower rates of off-task behavior, compared with long reprimands; and they found a similar, though nonsignificant, trend in improvement of academic performance. The authors conjectured that long reprimands, because they involve more adult attention, may serve as positive reinforcers. Abramowitz and O'Leary I 990) found that immediate reprimands yielded much lower rates of interactive (involving another student) off-task behavior than did delayed reprimands; regardless of timing, however, reprimands did not affect noninteractive off-task rates. Futtersak (1988) compared the effectiveness of consistently strong verbal reprimands to reprimands that gradually increased in strength. He found that the sudden introduction and maintenance of strong reprimands resulted in more overall suppression of unwanted behavior and reduced the overall level of negative consequences needed in the classroom, while exposure to a gradually strengthening series of reprimands led to increased persistence of unwanted behavior that continued even after the reprimands became strong.

Response Cost. Research also indicates that response cost programs--a combination of positive reinforcement and punishment--can be effective in improving attention, on-task behavior, and completion of academic tasks. Sullivan and O'Leary (1990) compared reward-only and response cost and found that both programs were effective in producing immediate gains in students' on-task behavior; after the programs were faded out, however, students who were more hyperactive and aggressive maintained on-task behavior better under the response cost condition. In two single-subject design experiments, Rapport, Murphy, and Bailey (1980) also found that response cost was more effective than positive reinforcement in improving on-task behavior and completion of academic assignments.

Pelham et al. (1986) investigated the interaction effects between psychostimulant medication and a response cost program and reported that the combination of methylphenidate and response cost yielded significant improvements over a noreinforcement/placebo condition. Rapport et al. (1980) found that methylphenidate combined with response cost slightly increased on-task behavior but did not increase assignment completion. Rapport, Murphy, and Bailey (1982) compared the effectiveness of differing dosages of methylphenidate versus a response cost system. Analyses of on-task behavior and phonics and math performance indicated that methylphenidate and response cost were effective, but the greatest improvement occurred during response cost.

Researchers have also obtained promising results with commercially available electronic devices, placed on children's desks, that automatically credit children with points and allow teachers using remote control devices to deduct points. Using such a device, DuPaul, Guevremont, and Barkley (1992) investigated the effects of a response cost program on two boys with ADD enrolled in a self-contained public school classroom for children with behavior disorders. The response cost program resulted in improvements for both boys in on-task behavior, attention, product completion, and overall level of ADD behavior (such as fidgeting and vocalizing). In a clinical setting, Gordon, Thomason, Cooper, and Ivers (1991)obtained similar results with an electronic device. Five out of six children improved in attention to academic tasks during attention training. The training effect dissipated quickly, however, once they discontinued use of the device. Though commercially available electronic apparatuses make implementation of a response cost program practical in a regular classroom setting, acceptance by target students and classmates has not been adequately examined.

Cognitive-Behavioral Therapy

Although behavior therapy offers a limited but time-tested and practical course for educators, cognitive-behavioral therapy is the most intuitively appealing intervention because it combines behavioral techniques with cognitive strategies designed to directly address core problems of impulse control, higher order problem solving, and self-regulation. Some evidence, though virtually none without contradiction, suggests that cognitive-behavioral therapy may produce positive changes in sustained attention, impulse control, hyperactivity, and self-concept.

In a series of studies, Brown and his colleagues (Brown, Borden, Wynne, Schleser, & Clingerman, 1986; Brown, Wynne, & Medenis, 1985; Brown, Wynne et al., 1986) examined the effectiveness of cognitive therapies in combination with or in contrast to drug therapy. Comparing the effects of methylphenidate therapy, cognitive training, and a combination of the two, they found that only the medication conditions (with medication continuing through posttesting) produced significant improvements in sustained attention, cognitive impulsivity, academic achievement, and teacher and parent behavioral ratings. When they discontinued medication before posttesting, the medication effects dissipated rapidly; and posttest measures showed no significant main treatment effects or interactions. In none of the studies did the combination of medication and cognitive therapy produce results beyond medication alone.

Inconsistent findings on cognitive-behavioral interventions persist throughout the research literature. When Hall and Kataria (1992) investigated the relative effectiveness of behavior modification and cognitive training implemented with and without medication, none of the treatments significantly improved sustained attention; the combination of cognitive training and medication was the only intervention that significantly improved subjects' abilities to delay impulsive responding. Douglas, Parry, Marton, and Garson (I 976) trained boys with hyperactivity to use self-verbalizations and self-reinforcement during cognitive tasks, academic problems, and social situations. The trained group showed significantly greater improvement on several posttest and follow-up measures, but not on a teacher rating scale. Hinshaw and Melnick (1992) reported improved behavior for two cases in which they used cognitive-behavioral interventions, in combination with behavior strategies and methylphenidate, to enhance self-monitoring and self-evaluation skills and to train anger management.

Kendall and Braswell (1982) compared the effects of cognitive-behavioral treatment and behavioral interventions for elementary school students with ADD. The cognitive-behavioral group improved significantly on teacher ratings of self-control and hyperactivity, child self-concept reports, academic performance measures, and on-task behaviors; but parent ratings indicated no significant improvements in self-control or in hyperactivity. After 1 year, no significant differences could be found across treatment conditions. In an elementary school-based study, Bloomquist, August, and Ostrander (1991) compared the short-term efficacy of multicomponent cognitive-behavioral therapy, teacher-only cognitive-behavioral therapy, and no treatment. The multicomponent cognitive-behavioral therapy included child training, teacher training and consultation, and parent training. On classroom observations, teacher ratings, and student self-reports, the researchers found posttreatment benefits to the multicomponent group only in reduction of off-task/disruptive behavior.

Citing research that shows the importance of considering the match between children's cognitive capacities and the requirements of training tasks, Borden, Brown, Wynne, and Schleser (1987) examined the influence of cognitive development level (derived from basic Piagetian conservation tasks) on the ability of children to benefit from cognitive therapy. Contrary to the hypothesis, measures of sustained attention, distractibility, academic achievement, academic aptitude, and behavioral ratings of teachers and parents, produced no statistically significant differences across developmental groups. Only on cognitive impulsivity did the researchers find significant group differences, but these favored the nonconserving group.

In preliminary investigations, Paniagua (1992) and Paniagua, Morrison, and Black (1990) demonstrated the potential of a strategy with features similar to cognitive-behavioral therapy. They tested the effectiveness of correspondence training, which trains a relationship between verbal and nonverbal behavior. In the two studies, the researchers used training activities designed to decrease inappropriate behaviors of hospitalized children with ADD by evoking promises to inhibit problem behaviors. They rewarded the children for making promises, fulfilling them, and accurately reporting what they had done. On measures that included observations of inattention, overactivity, and conduct problems, correspondence training resulted in the consistent reduction of inappropriate behaviors. Less elaborate in implementation than traditional cognitive-behavioral therapy, correspondence training may prove to offer educators a practical school-based technique.

As reviewers (most notably Abikoff 1987, 1991) have demonstrated, the weight of the empirical evidence is against the efficacy of cognitive-behavioral therapy. As implemented and tested to date, cognitive-behavioral therapy has not consistently demonstrated positive effects on a magnitude that would recommend its widespread use, especially considering the relatively high staff investment required for implementation. Nevertheless, experienced clinicians (e.g., Barkley, 1990; Goldstein & Goldstein, 1990; Hinshaw & Erhardt, 1991) advocate additional study of cognitive-behavioral therapies, especially as components of comprehensive intervention programs.


Though researchers have focused a relatively large amount of effort on testing strategies to increase behaviors, such as sustained attention, that may indirectly increase academic productivity of students with ADD, much less work has directly addressed instruction and learning. A limited, but promising, body of work focuses on characteristics of academic instruction or materials for students with ADD. Zentall's exploration of optimal stimulation theory is particularly intriguing and offers promise for finding an academic treatment (based on optimally stimulating instruction and instructional materials) that may be uniquely effective with students with ADD. (See Zentall, this issue, for a more complete presentation.

Conte, Kinsbourne, Swanson, Zirk, and Samuels (1987) studied varying presentation rates with children with ADD with and without hyperactivity by presenting paired-associate learning tasks at slow, fast, and mixed rates. Results indicated that children with ADD failed to benefit from consistently slow presentation compared with fast presentation, but did benefit from slow-rate items within a mixed-rate task. The authors concluded that the children with ADD were affected by the slow rate over an extended time period and suggested that, because average event rate rather than individual item duration was the relevant variable, situational context plays an important role in regulating the behavior of children with ADD.

On communication tasks, Zentall and Gohs (1984) found that subjects with hyperactivity took significantly longer to complete tasks when initial information was detailed rather than global; and subjects with hyperactivity requested significantly more cues when their initial cues were detailed, suggesting that the difficulties children with hyperactivity experience as receivers of verbally communicated information occur in response to detailed rather than global information. Shroyer and Zentall (I 986) varied rate of auditory presentation and level of content stimulation of stories to examine the effects of those variables on listening comprehension, activity level, and off-task behavior and found that the subjects with hyperactivity were least active and most on task when the story was read fast without added nonrelevant detail. But the subjects performed best on comprehension when the story was read slowly without added detail, suggesting that high activity level and poor performance are independent problems for children with hyperactivity.

In a series of studies, Zentall and her colleagues explored the effects of color added to instructional materials. Comparing children's performances on colored and noncolored versions of a search task, Zentall (1985) found that color added to search-attentional tasks improves the performance of children with hyperactivity; but after children have adapted to task and color novelty, performance gains diminish more rapidly for children with hyperactivity than for those without. On repetitive-copying tasks with adolescent boys, Zentall, Falkenberg, and Smith (1985) compared copying performances across multiple conditions of stimulation and information and found that, on most of the copying tasks, the boys with attention problems performed significantly better with high than with low stimulation; but the information-added conditions had no effect. On spelling-recognition tasks (Zentall, 1989), subjects with hyperactivity outperformed those without hyperactivity when black-letter trials preceded color-letter trials.

In an attempt to channel excessive activity into constructive active responses, Zentall and Meyer (1987) investigated whether motor responses added to rote tasks would reduce sensation-seeking activity and impulsive errors of children with hyperactivity. They tested children on two experimental tasks requiring sustained auditory attention and simple word recognition. Under the active-response condition, children had opportunities for simple motor responses. On a variety of behavior and performance variables, the children with hyperactivity performed significantly better under the active-response condition.


The issue of collaboration between home and school to improve outcomes for children with ADD has not been studied directly. The literature contains no empirical studies of strategies or programs designed specifically to implement or promote home-school collaboration. From the literature, however, we can identify strategies in two areas, tested with children with ADD in clinical settings. These strategies have implications for ways educators and parents can work together. Both approaches involve parents in enhancing or extending professional treatment.

The first of these two areas is quite limited. Some behavior therapy studies have included a component of parent collaboration, usually with parents providing rewards for positive behavior at school or in a treatment program. For example, O'Leary et al. (1976) evaluated the effectiveness of a combined home-school behavioral treatment for elementary school children and found that the behavioral treatment program, which included parent reward of the child for progress toward daily goals, led to significant improvements in hyperactive behaviors. Hoza, Pelham, Sams, and Carlson (1992) reported similar success with an intervention program that included parent reward for positive school behaviors.

The second area of strategies with implications for home-school collaboration involves parent training and the direct use of parents to provide treatment. The literature contains many examples of parent-training programs (typically instructing parents in behavioral strategies) that have demonstrated some effectiveness in reducing activity level, conflict, and anger intensity and in increasing on-task behavior and compliance. Significantly, none of the studies we identified involved school personnel. Instead, these studies reported on the efforts of clinic-based psychologists and physicians, and thus tested a component of clinic-home collaboration. Nevertheless, these studies are suggestive of the potential of similar home-school collaborations, and we describe some of this work in the following paragraphs.

Many studies have compared the effects of parent training (in behavioral strategies) and medication on child outcomes. Thurston (1979) found that both methylphenidate and parent training resulted in significant reductions in activity levels, while parent ratings of overall improvement showed parent training to be superior to both drug therapy and no treatment. Firestone, Kelly, Goodman, and Davey (1981) found that subjects receiving each treatment alone, or the two treatments in combination, made academic, behavioral, and emotional adjustment gains; but parent training with methylphenidate did not produce benefits over methylphenidate alone. Pelham, Schnedler, Bologna, and Contreras (1980) reported that parent and teacher behavioral training improved on-task behavior, but the training was not maximally effective until combined with methylphenidate. Interestingly, the investigators also reported a drug-therapy-by-parent-training interaction whereby children required smaller doses of medication following parent training. Pollard, Ward, and Barkley (I 983) found that both methylphenidate and parent training decreased the number of parental commands and improved parents' ratings of deviant child behavior in the home, whereas only parent training increased parents' use of praise and attention following child compliance; the combination of treatments did not prove more effective than either treatment alone.

Other studies have compared parent training with child cognitive-behavioral therapy. With children of elementary school age, Horn, Ialongo, Popovich, and Peradotto (1987) reported that behavioral parent training, child self-control instruction, or a combination of the two treatments all significantly improved behaviors in the home at posttest and follow-up; but differential improvements across treatments occurred in only 1 of 32 possible comparisons. Using a single-subject design, Guevremont, Tishelman, and Hull (1985) examined a child self-instructional training program that used the subjects' mothers as adjunct therapists and reported improvements in classroom work completed, self-control, and hyperactivity. Barkley, Guevremont, Anastopoulos, and Fletcher (1992) found that three different family treatment approaches with adolescents all produced improvements in communication, conflicts, anger intensity, and school adjustment, according to mother and child reports; but clinical measures of the same variables showed only slight improvements with no significant differences among the treatment groups. Horn, lalongo, Greenberg, Packard, and SmithWinberry (1990) reported that a combined program of behavioral parent training and child self-control instruction did not produce effects that endured longer or generalized better than either treatment alone, though, as reported by parents, the combined treatment did produce a significantly greater proportion of improvements in some behavior, none of the groups made significant gains on measures of academic achievement or cognitive style.

Studies of parent training with preschoolers with ADD have also produced mixed results. Erhardt and Baker (1990) described two case studies of family-based behavioral interventions with preschool boys and reported modest gains attributable to parent training. Pisterman et al. (1989) evaluated the effectiveness of a parent information and training program to improve compliance of preschoolers. On every measure of compliance, the experimental group showed significant improvements that were maintained at a 3-month follow-up; but the researchers found no generalization across settings. As a follow-up to this and another study with similar positive results, Pisterman et al. (1992) found that parents who participated in training groups reported significantly decreased parenting stress and an increased sense of competence following treatment and at follow-up. In a study of low-income parents of preschoolers with behavior problems (over half of whom had attention deficits), Strayhom and Weidman (I 989) used research assistants, with cultural roots in the communities, to train parents to have fun with and to instruct their children. The experimental intervention exceeded the control treatment on 7 out of 15 outcome measures, but failed to show a significant effect on the children's classroom behavior at initial follow-up. Teacher ratings at a 1-year follow-up (Strayhorn and Weidman, 1991), however, indicated that the behavior of children in the experimental group evidenced much greater improvement than that of children in the control group.


Comprehensive programming encompasses efforts to develop effective general and special education programs that will ensure appropriate educational opportunities for students with ADD. As with home-school collaboration, researchers have not directly addressed the development of comprehensive educational programs for these students. Findings in two areas, however, have implications for program development. First, some studies have demonstrated the potential benefits of multimodal interventions (e.g., Barkley et al., 1992; Hall & Kataria, 1992; Hinshaw, Henker, & Whalen, 1984; Hinshaw & Melnick, 1992; Pelham et al., 1980). Though not without contradiction (e.g., Bloomquist et al., 1991; Firestone et al., 1981; Horn et al., 1987, 1990), the findings from these multimodal studies suggest that treatments may have additive or interactive effects. Effective comprehensive programming for students who are difficult to serve may well require the exploration of multiple interventions, using resources within and outside the school community.

The second area of findings with implications for educational programs is the between-subject variation that many investigators have reported. This variation suggests that results based on groups or averages may not be as relevant as individual case findings. For example, in investigating the effects of low, moderate, and placebo methylphenidate doses in combination with two intensities of teacher reprimands, Abramowitz, Eckstrand, O'Leary, and Dulcan (1992) found that optimal intervention combinations varied across subjects, suggesting that a simple behavioral intervention can be as effective as medication for some, but not all, children with ADD. When Hoza et al. (1992) administered varied doses of methylphenidate and different potencies of behavior therapy to two boys, both responded well to behavior therapy. For one boy, however, the behavior therapy combined with a low dose of methylphenidate proved to be the most effective intervention, whereas the other boy responded most favorably to a high dose of methylphenidate combined with the most potent behavioral contingency.


Intervention research on children with attention deficits has moved well beyond the concept, associated with the era of "minimal brain dysfunction," of serving students with attention deficits in barren cubicles (e.g., Cruickshank, Bentzen, Ratzeburg, & Tannhauser, 1961). Instead, researchers have focused on training or shaping specific desirable target behaviors, reducing the frequency of undesirable behaviors, creating optimally stimulating learning tasks, and refining multimodal intervention programs. Overall, however, the empirical evidence in favor of nonpharmacological interventions to promote the education of students with ADD is weak. Although some evidence supports behavior therapy, cognitive-behavioral therapy, parent training, and task stimulation, the findings are invariably inconsistent.

The teacher or school administrator seeking guidance from the literature must also keep in mind other significant limitations of the research. First, generalization is problematic because the samples for the reported studies are far from homogeneous and represent children with a great diversity of behavior or learning difficulties. Second, researchers drew subjects almost exclusively from elementary school-age children, making application of findings to older students questionable. Third, though for the convenience of this review we have grouped treatments in categories, the actual interventions within these categories varied considerably across studies. Fourth, the dependent measures also varied greatly and were often too broad to capture subtle distinctions between treatments. Fifth, and perhaps most important, because the research comes almost exclusively from the fields of medicine and clinical psychology, researchers tested few interventions in school settings, and even fewer in regular classrooms.

From an educational perspective, researchers have devoted too much effort to peripheral questions. Perhaps because the population is inadequately defined, investigators have often labored to identify performance differences between children with attention deficits and those without, rather than comparing treatments with randomly assigned groups of children with ADD. Similarly, investigators have frequently compared nonpharmacological interventions to drug therapy. Although this provides one valid standard against which treatments can be measured, the merit of an intervention relative to medication is a moot point for educators who must use nonpharmacological interventions to improve the performance of students who may or may not be on medication.

Most important, many key questions have not been addressed:

* What specific curricula or instructional materials do students with ADD need?

* What role can computers and other technologies play in the education of students with attention deficits?

* What interventions can be applied by teachers in general education classrooms?

* What implications for interventions does the presence of multiple disorders have?

* Do interventions that are effective with students with learning disabilities or emotional and behavioral disorders, such as time-out, need to be modified to be effective with students with ADD?

* What strategies are most effective in teaching social skills to students with ADD?

* At school, what related services do students with ADD need?

* How should responsibility be shared among schools, social agencies, and medical professionals?

In describing the current state of practice, Hinshaw and Erhardt (1991) effectively summed up the challenge educators face:

It is stressed that no intervention strategies to date, whether employed singly or in combination, have proved clinically sufficient and durable for the troubling and troublesome problems of these youngsters, thus necessitating the continuing search for integrated components--cognitive, behavioral, and pharmacologic--that will constitute an adequate treatment package. (p. 99)

Overall, the literature on educationally relevant interventions for children and youth with ADD is exploratory, not prescriptive. Though the problem of attention deficits is pervasive, investigators have tested relatively few interventions that speak to the day-to-day issues teachers face or to the larger issues related to developing comprehensive programs for these students. From the research, we have some sense of what might work in the classroom--redirection, response cost, correspondence training, color added to repetitive tasks--but not enough information to make definitive, categorical decisions about educational programming for students with ADD.


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THOMAS A. FIORE (CEC NC Federation), Senior Research Scientist, and ELIZABETH A. BECKER and REBECCA C. NERO (CEC NC Federation), Education Analysts, Center for Research in Education, Research Triangle Institute, Research Triangle Park, North Carolina.

Preparation of this article was supported by the Office of Special Education Programs in the U.S. Department of Education (Contract No. H023S10005). The article does not necessarily reflect the position or policy of the funding agency.
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Author:Fiore, Thomas A.; Becker, Elizabeth A.; Nero, Rebecca C.
Publication:Exceptional Children
Date:Oct 1, 1993
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