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Promising school-based practices for students with attention deficit disorder.

As noted in the Introduction to this issue, the Office of Special Education Programs (OSEP) of the U.S. Department of Education recently funded four research centers to "synthesize the existing research knowledge in assessment and interventions for meeting the needs of children with attention deficit disorders" (Schiller Hauser, 1992, p. 31). Although a great deal of research has been done in this area, little is available that is school based. The overwhelming majority of studies were conducted in controlled settings, such as hospitals or university clinics (Repoil on Education Research, 1992). Only a handful of school-based research projects have contributed to more effective educational practice in either general or special education (Fuchs & Fuchs, 1990). Kaufman, Kameenui, Binnan, and Danielson (1990) indicated that more research should be moved from the laboratory into the schools to find solutions to the problems that face education today. Tharp and Gallimore (1988) echoed this concern, suggesting that many researchers focus on matters far removed from the classroom.

In an effort to gain information about how U.S. schools are addressing the issue of educating students with ADD, OSEP charged the Federal Resource Center for Special Education (FRC) at the University of Kentucky to identify successful practices for serving students with ADD at the local and district school levels. In contrast to the four research centers, the FRC looked for practices within the nation's schools that showed promise in appropriately serving these children and their families.


To identify promising field-based practices, we used a multiple-level model for stakeholder involvement,

as suggested by Pfieffer, Goodstein, and Nolan (1989) and Pascarelia and Frohman (1989). The stakeholders represented five groups that are essential to the educational identification and intervention of children with ADD: school personnel, parents, health care professionals, family support professionals, and researchers. This model has been adapted to a three-tier plan to include a core work team, a review team, andthe constituency at large represented by those groups. Participating members of the teams were identified by nominations from national organizations, such as the National Education Association, National Association of School Psychologists, Children with Attention Deficit Disorders, Attention Deficit Disorder Association, National Association of School Nurses, American Academy of Child and Adolescent Psychiatry, Council for Administrators for Special Education, and the Professional Group for ADD and Related Disorders.

The core work team consisted of 11 national leaders in their fields; it represented school personnel, parents, family support professionals, researchers, and health professionals. This team guided the FRC's efforts in locating, evaluating, and selecting promising school-based practices for children. The review team, also representing the five stakeholders, included 14 members who reviewed the work of the core team and provided consultation and feedback regarding the project.


A set of criteria was established to define promising practices in both educational identification and intervention. The criteria provided a standard that reviewers used in selecting practices. After engaging in a nominal group process, the core team recommended 12 criteria (Figure 1).

Locating the Practices

We designed a two-step procedure to collect information regarding assessment and intervention practices in use by school systems serving children with ADD. First, we designed and implemented a method for obtaining nominations of individuals doing promising work with students with ADD. We mailed a nomination form to a random sample of 1% of all the schools in the United States, and we solicited nominations through national and state organizations.

Second, we developed a method to obtain written descriptions of actual practices, and we provided this document to each individual nominated as doing promising work with students with ADD.

As a result of this effort, 504 individuals or groups were identified who were undertaking potentially promising practices. These nominees were widely distributed geographically, representing 43 states. An application packet, along with a cover letter, was sent to all nominees, asking them to describe their practice in detail.

This process resulted in 146 written descriptions of practices submitted to the FRC for review. Sixty-nine percent of the submitted practices were broadly described as intervention practices for the student with ADD, and 31% were submitted as assessment practices. Written descriptions of practices that were reviewed by the FRC came from 36 states.

Selecting the Practices

Every consultant on the FRC project--on both core and review teams--reviewed

the 146 practices submitted, using the established criteria. Each practice was randomly assigned to three independent reviewers, representing three separate stakeholder perspectives. Scores were assigned to the practices, and a qualitative rating was given indicating whether the practice showed strong promise, some promise, or no promise. Each individual reviewer rated from 18 to 21 practices.

The scores from each group of three raters were correlated to determine interrater reliability. The correlation of each rater with each of the other two raters was calculated. For each group of three reviewers, at least two raters had statistically significant interrater reliability, suggesting that there was general agreement on the overall merits of the rated practices. The average correlation across the eight groups of three raters was .40 (p < .05). Although we originally hoped that the raters would show greater agreement, it must be remembered that each group of three raters reflected three dramatically different perspectives (e.g., researchers, parents, and school personnel); so the fact that statistically significant agreement was obtained was encouraging. The ratings on each practice were then summarized and used to assist the core work team in making decisions regarding which practices showed promise for working with students with ADD.

The core team met and reviewed the data on the practices to select practices considered to be promising. The consultants recommended that the practices be selected based on a double-gating procedure. To pass the first gate, a practice had to be rated as having strong promise by at least two of the three raters who reviewed the practice. In this process, 30% of the identification and intervention practices passed the first gate. The practices were then rescreened according to additional criteria established by the core team. These criteria included geographical diversity; collaborative involvement; empirically validated as well as unique strategies; positive outcomes; potential for public school replication; academic, social, and behavioral practices; and representation of all school levels.

Eight assessment practices (17%) and 18 intervention practices (17%) passed the second gate of the review process. These 26 practices were considered to hold strong promise for successfully educating students with ADD. To gain more information about these practices, we visited sites where 10 of these 26 promising practices were in use. The 10 sites were selected because they served different age ranges; included a variety of practices, such as assessment, intervention, and training; served children from nondominant cultural backgrounds; and were located in diverse geographic and demographic settings. We obtained details on the other 16 practices by reviewing original submissions and conducting telephone interviews.


Through this search for promising practices, two main outcomes emerged. First, there were demonstrable differences between selected and nonselected practices. Second, eight themes emerged in the selected practices that should be considered when developing educational plans for students with ADD.

The first analyses were undertaken to determine if the promising practices were different from the practices submitted that showed little or no promise, based on the relevant criteria. The written descriptions, as submitted by the developers of the 26 promising practices, were compared with a randomly selected group of 26 practices that did not pass gate 1 or 2 of the selection process. These 52 practices were blindly rated by graduate-level students of school psychology on seven key features noted as essential by the core stakeholder consultants. The graduate students read the practice and simply noted whether the practice had this feature.

Table 1 shows that the practices the consultants rated as showing strong promise consistently included essential key features, compared with those practices that did not show promise. The percentages reported in this table indicate the percentage of practices that were rated as meeting the stated criterion. For example, 96% of the promising practices discussed how the practice resulted in positive outcomes for students and/or families while only 52% of the practices that showed limited promise addressed this topic. This same pattern was true for the other key features, except for the issue of cultural diversity, which was inadequately addressed by both groups.


No single plan submitted to the FRC could meet every need of every youngster because students vary in their needs, and schools systems have access to different resources. However, the following themes can serve as a guide to determine if a practice has merit for use with students with ADD.

1. Before implementing a program or practice, one should determine whether implementing a change in the educational design is likely to have a positive effect. Further, one should begin to evaluate how one knows that change has occurred and account for maintenance and generalization.

For example, an elementary school in California created a practice that resulted in positive student outcomes by using highly trained paraprofessional aides in the regular classroom. Elementary students with ADD were provided structured feedback by the paraprofessionals every 15 min on target behaviors. In addition, the students participated in social skill training twice a week in small groups. These two strategies resulted in dramatic reductions in school discipline referrals and increases in prosocial behavior at school.

2. It is important to note if the strategy has practical value in school or home situations. Experimental interventions that are conducted in controlled laboratory settings may effect positive change; however, the reality of school life may prohibit the use of such practice. Issues such as enhanced academic and/or behavioral performance, as well as acquisition, maintenance, and generalization of skills, should be considered when determining if an intervention has practical meaning.

A preschool teacher in Des Moines, Iowa, developed a technique that enhances the student's ability to comply with classroom rules. This strategy involved taking a photograph of the children with ADD as they acted out the rules. The picture was then displayed along with the written rule; the class practiced the rules together and a variable interval schedule of monitoring rule compliance was used. As a result, these preschool children's compliance with the displayed rules improved.

3. At least one of the three major components of ADD (inattention, impulsivity, and overactivity) must be addressed. These factors influence children's academic performance as well as their behavior. Ideally, there should be an attempt to address these issues early in a child's educational career.

To evaluate inattentive behavior, a school psychologist in Raleigh, North Carolina, recommended using an assessment strategy that requires systematic observation of off-task behavior. The referred child is observed for 5 min and off-task behavior is recorded. Then a same-gender peer is observed for 5 min. This process is repeated five times. These observations provide comparisons of the referred child's behavior with a nonreferred child and allow the observer to determine if the off-task behavior of the referred student is significantly different from that of peers.

4. Many practices concentrate on the child's, the parent's, the school's, or the community's weaknesses, without appropriate consideration of assets. Practices that show promise focus also on the strengths of the individuals or groups involved.

A middle school teacher in Drexel Hill, Pennsylvania, focused on students' strengths by using visual cues in the classroom to help students organize their work. When projects required multiple steps, the teacher placed a model on the bulletin board. Students were then encouraged to check the board with the display before turning in the assignment. Through the use of this technique, students' organization skills improved.

5. The work of identifying and intervening with students with ADD should be a team accomplishment. To achieve positive educational outcomes for children with ADD, school personnel, families, and community service providers must work together.

Through the leadership of a parent group in North Canton, Ohio, a local district was able to assess and meet the training needs relevant to ADD. This practice resulted in increased collaboration between parents and school personnel and improved services for children.

6. Better outcomes for students with ADD can be achieved from practices that proactively plan for continuous, positive parental involvement in the assessment and intervention process.

An elementary school in Omaha, Nebraska, facilitated parental involvement through a behavior management strategy that was designed to get the home and school working together to improve the students' behavior. During a joint meeting, parents and educators agreed to target behaviors, set goals, and establish consequences. A case manager trained the teacher and family and provided follow-up consultation to ensure appropriate implementation. As a result, parents became involved in the children's school progress on a daily basis.

7. Evaluations and interventions used with students with ADD from diverse cultures should address potential bias in assessment procedures, tease out language issues that may be contributing to inattention, and develop interventions that are sensitive to the child's background.

A psychologist in Minneapolis, Minnesota, developed an early identification and treatment protocol. It was designed to reduce the risk of children from diverse cultures with ADD being inappropriately identified as having conduct disorders or learning disabilities and placed in special education programs. These children were assessed using a series of interviews, standardized behavior rating scales, and systematic behavioral observations relevant to the child's culture. The utility of this protocol was illustrated by the several cases of young elementary school-age children who were being considered for special education services by the school district until they were accurately diagnosed and an appropriate treatment program was established. They were now functioning in their regular classrooms.

8. Pharmacological intervention is the most common form of treatment for children with ADD, and schools play a critical role in the monitoring of its use. Often physicians need behavioral data to assist in determining the need for the medication, as well as school-based data to adjust the dose. As well, schools are often in the best situation to report the side effects of the medication.

In Sturgeon Bay, Wisconsin, a group of educators developed a method to monitor children with ADD on medication. Two weeks after a student starts medication or 2 weeks after any change in medication or dosage, a follow-up report is completed. This report monitors the existence of typical side effects of stimulant medicine, as well as behavioral and, academic problems. This follow-up is completed quarterly on all medicated students. Copies of the report are shared with the child's physician and parents, as well as maintained in the school file.


Experts in the field of ADD, including school professionals, parents, physicians, and researchers, reviewed a broad range of school-based practices submitted to the FRC. Twenty-six practices were identified as showing promise for serving students with ADD. These practices are consistent with research and demonstrate practical applications in school settings. No single practice can meet the needs of every student with ADD because these youngsters exhibit varying educational needs. In addition, different school systems have access to different resources, which may affect service delivery. Schools clearly do have an obligation to serve students with ADD, and this project was able to identify many sites where school professionals were meeting that challenge successfully.

This project found that schools engaged in promising work with students with ADD consistently exhibited the following characteristics:

* A systematic and comprehensive training program specific to ADD was initiated district-wide. This training typically included an overview of the disorder, school-based assessment, and intervention strategies.

* Full support and understanding of the district's administration undergirded the development and implementation of practices for students with ADD. Districts that were effective secured support of the superintendent, the school board, and building principals so that resources could be made available. This included a range of support services, such as allowing time off for training, allocating adequate space, purchasing appropriate materials, and hiring an ADD specialist.

* Effective school practice resulted from the use of teams in all aspects of decision making. This was evidenced in decisions that affected district policies, as well as in individualized educational planning for students. Parents were legitimately included in this process.

* Districts used an array of classroom interventions in the regular classroom before initiating formal assessment procedures. The interventions were typically behaviorally based; and when formal assessment was necessary, results of the interventions were used as part of the assessment strategy.

* Schools doing promising work with students with ADD recognized that ADD is a discernable disorder.

There were clear gaps in the school service delivery system. First, practices specific to meeting the needs of adolescents with ADD were glaringly absent from our search for promising practices; practices specific to identification and intervention with preschool children were similarly sparse; practices that focused on the use of instructional curricula to serve students with ADD were rare; and finally, practices that specifically addressed issues relevant to children with ADD from diverse cultural backgrounds were limited.

There is much work to be done in serving students with ADD in the public schools. However, as Samuel Smiles once said, "Human knowledge is but an accumulation of small facts ... the little bits of knowledge and experience carefully treasured up and growing at length into a mighty pyramid" (Barkley, 1990, p. 169). This search for promising practices may provide some bit of knowledge that will one day complement the larger service delivery system for students with ADD.


Criteria for Selecting Promising Practices

* Show a positive effect for the child with attention deficit disorder (ADD) and/or

the family.

* Have practical value or meaning in educationally intervening with the child with

ADD and/or the family.

* Be able to be replicated at other sites with the expectations of similar results.

* Acknowledge the benefits of early detection.

* Address the three major components of the disorder (inattention, impulsivity,

and overactivity).

* Focus on strengths as well as needs.

* Show evidence of collaborative involvement by families and the community.

* Be sensitive to issues relevant to cultural diversity.

* Be designed to consider skill acquisition of desired behavior or academic material,

as well as maintenance and generalization.

* Incorporate the behavior and/oracademic performance needs of the child prior

to medication.

* Be sensitive to the effects of medication on the child's academic performance

and/or behavior.

* Be sensitive to the side effects of medication.


Barkley, R. A. (1990). Attention deficit hyperactivity disorder: A handbook for diagnosis and treatment. New York: Guilford Press. Fuchs, D., & Fuchs, L. S. (1990). Making educational research more important. Exceptional Children, 27, 102-107. Kaufman, J. F., Kameenui, E. J., Birman, B., & Danielson, L. (1990). Special education and the process of change: Victim or master of educational reform? Exceptional Children, 27, 109-115. Pascarella, P., & Frohman, M. (1989). The purpose-driven organization: Unleashing the power of direction and commitment. San Francisco: Jossey-Bass. Pfieffer, J. W., Goodstein, L. D., & Nolan, T. (1989). Shaping strategic planning: Frogs, dragons, bees and turkey tails. Glenview, IL: Scott Foresman. Report on Educational Research. (1992). Researchers compiling ADD information for classroom teachers. Alexandria, VA: Capitol Publications. Schiller, E., & Hauser, E. (1992). OSEP's initiatives for meeting the needs of children with attention deficit disorders. OSERS News in Print, 4(3), 30-31. Tharp, R. G., & Gallimore, R. (1988). Rousing minds to life. Cambridge: University Press.


BARBARA BURCHAM, School Psychologist and the ADD Program Consultant, Federal Resource Center, University of Kentucky. LAURANCE CARLSON, Director of the Federal Resource Center, University of Kentucky. RICHARD MILICH, Consultant for the ADD project, Federal Resource Center, and Professor and Associate Chair, Department of Psychology, University of Kentucky, Lexington.

Preparation of this article was supported in part by Contract No. HS91004001 between the Office of Special Programs, U.S. Department of Education, and the University of Kentucky as part of Task 6. The contents of this article do not necessarily represent the opinions of the Department of Education of the University of Kentucky and the reader should not assume endorsement by the federal government of any products or organization mentioned herein.
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Author:Burcham, Barbara; Carlson, Laurance; Milich, Richard
Publication:Exceptional Children
Date:Oct 1, 1993
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