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The document discusses the prevalence and academic challenges faced by children with Attention Deficit Hyperactivity Disorder (ADHD), highlighting that 9.5% of children aged 4 to 17 are affected. It emphasizes the need for effective classroom interventions and monitoring due to the negative impact of ADHD on engagement and academic performance, particularly in early grades. The study compares the classroom behaviors of children with ADHD to their peers, using systematic observations to assess engagement and off-task behaviors across different teaching formats.
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0% found this document useful (0 votes)
16 views13 pagesResearchAssignmentStudy2_F21
The document discusses the prevalence and academic challenges faced by children with Attention Deficit Hyperactivity Disorder (ADHD), highlighting that 9.5% of children aged 4 to 17 are affected. It emphasizes the need for effective classroom interventions and monitoring due to the negative impact of ADHD on engagement and academic performance, particularly in early grades. The study compares the classroom behaviors of children with ADHD to their peers, using systematic observations to assess engagement and off-task behaviors across different teaching formats.
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/ 13
Reserrch Thal A
According to the Centers for Disease Control and Prevention, 9.5% of chil-
dren between 4 and 17 years old have attention deficit hyperactivity disorder
(Blumberg et a, 2012; Visser, Bitsko, Danielson, Perou, & Blumberg, 2010).
Children with ADHD are at risk for associated deficits in working memory,
processing information, developing strategies, and organizing and executing
tasks (Barkley, 1997; Clatk, Prior, & Kinsella, 2000). Adaptation to the school
setting is often challenging for children with ADHD because of behavioral
issues, such as physical and verbal aggression, seeking attention from the
teacher, out-of-chair time, and noncompliance (Vile Junod, DuPaul, Jitendra,
Volpe, & Cleary, 2006). Detrimental academic effects of ADHD are evident
early in elementary school, Although 44% of children with ADHD also
present with a learning disability (Pastor & Reuben, 2008), it is not necessary
for a child with ADHD to present with a learning disability to lose academic
ground. Children with ADHD fail to achieve the academic level predicted
by their age or IQ even after controlling for comorbid leaming disabilities
(Bany, Lyman, & Klinger, 2002; Marshall, Hynd, Handwerk, & Hall,
1997).
Previous studies using classroom observations suggest that children with
ADHD from ages 6 10 12 years are significantly less engaged in class than
are their comparison peers (Imeraj et al., 2013; Kofler, Rapport, & Alderson,
2006; Vile Junod et al., 2006) and are at tisk for dropping behind in reading
skills in as early as first grade (Rabiner & Coie, 2000).
The effect of age of students with ADHD on classroom engagement
is important, as negative effects of ADHD on academic functioning can be
found in early grades. This leads to accumulated effects of ADHD throughout
the course of the student’s schoo! career. As academic gaps accumulate each
school year, there is an increased risk for school dropout as grades progress
(Currie & Stabile, 2006). In ater grades, adolescents with ADHD are at higher
tisk for teen pregnancy, criminal behavior, academic failure, and dropout
GHarpin, 2005).
‘The complex intertwining of ADHD symptoms, executive function-
ing, and academic skills has led multiple experts in the field to recom
mend continued close academic and behavioral monitoring at school, along
with proactive classroom interventions (DuPaul et al., 2004; Ferguson, 2000;
Rapport, Scanlan, & Denney, 1999). Individualized behavioral classroom in-
terventions to support students with ADHD have been consistently used
‘over time, Common accommodations and modifications include preferential
seating, repeating instructions for the student in short chunks, giving both vi-
sual and auditory cues, and incorporating physical movement time if needed
into the daily schedule (Brock, 2002). However, even with these classroom
supports, children with ADHD are still considerably less engaged and more
offtask than are their peers, ultimately leading to negative academic out-
comes.
The literature supports several categories of instructional strategies that
aim to support all student learning including students with ADHD. These in-
clude identifying similarities and differences, summarizing and note taking,
reinforcing effort and providing recognition, homework and practice, non.
linguistic representations, cooperative leaming, setting objectives and pro-
viding feedback, generating and testing hy s, and questions, cue and advance organizers (Marzano, Pickering, & Pollock, 2001), Little research,
however, analyzes the effects of changing general classroom environment
(eg., decreasing distracters such as placing computers at the back of the
classroom, scheduling academic subjects at the beginning of the day) and
teaching style (e.g., visual and auditory instruction simultaneously) on the
‘engagement and achievement of the classrooms as a whole. Furthermore,
there isa lack of information on how different teaching formats (e.g, teacher-
led instruction versus small groups) might affect classroom engagement
(Greenwood, Horton, & Utley, 2002; Vile Junod et al., 2006).
Evaluating students with ADHD in the classroom setting through di-
rect observation can be challenging. In the literature, direct observations
are dichotomized into naturalistic observations with anecdotal descriptions
and systematic observations with interval coding, Standardization and psy-
chometric testing of the observation tool cannot be done with naturalistic
‘observations (Hintze & Matthews, 2004; Hintze, Volpe, & Shapiro, 2002). Sys-
tematic classroom observations, however, use an interval recording system,
provide quantitative data, and have reliability standards. Research studies
using systematic classroom observations have been helpful in supporting
our understanding of how students with ADHD behave in the classroom
setting. However, frequently practitioners might conduct one observation in
order to interpret a student’s behavioral profile and overlook the amount of
observation time needed to assess the behavior of one child. Hintze (2005)
stated that the total observation time to reliably estimate a child's behavior
can range from two to three 15-min observations to 5 hr of observation.
‘A meta-analysis reviewing studies using systematic classroom observations
found that children with ADHD were consistently less visually on task than
were their classroom peers (Kofler, Rapport, and Alderson 2008). Imeraj
and colleagues (2013) found that despite higher levels of supervision by the
teacher, children with ADHD were more off-task during individual school-
‘work and whole-class group teaching but not during small group work.
‘They also showed significantly lower on-task time spans than did their fel-
low classroom peers.
In the present study, we compared the behavior of elementary school
children with ADHD to their classroom peers using rigorous systematic class-
room observations. We hypothesized that participants with ADHD would
be less engaged and more offtask than would their classroom peers. In
addition, we hypothesized that teaching format would have an effect on
the classroom behavior of children with ADHD, but not on their com-
parison peers. Last, we hypothesized that engagement and off-task be-
haviors of children with ADHD would be more severe in grade 4 com-
pared with grade 2, while grade would have no effect on comparison
peers. METHOD
Participants
‘This study was conducted in 19 public elementary schools in two school
districts in the Greater Boston area. Participants were eligible if they met the
following criteria: (a) clinical diagnosis of ADHD made by the child's clin-
fcian and (b) a child in second or fourth grade, Exclusion criteria included
(@) a coexisting diagnosis of conduct disorder, autism spectrum disorder,
or other serious mental illness; and (b) an IQ of less than 80. Participants’
ADHD diagnosis was submitted in written format by the child's clinician and
‘was confirmed by the Conners 3-Parent Report, where 95% of participants
scored in the clinical range with ¢ scores of 65 or greater on the DSM-IV
ADHD Inattentive and/or DSM-IV ADHD Hyperactive/Impulsive subscales.
Five participants’ ADHD diagnosis was not confirmed using this method.
Peers were randomly selected for observation in the same classroom as
study participants. In each participant observation, 12 classroom peers were
also observed (see the “Study Design” section). Because the classroom peers
Were not active participants of the study, no background information was
collected on them. They do, however, represent 2 community sample of
students who may or may not have ADHD. ‘These data were collected as
‘@ component of a larger trial investigating the efficacy of two computer at-
tention training systems for children with ADHD (Steiner, Frenette, Rene,
Brennan, & Perrin, 2014), which was supported and approved by the au-
thors’ institutional review board as well as the respective participating school
districts before data collection.
study Design
Observations were conducted using the Behavioral Observation of Students
in Schools (BOSS), which is a systematic observation system for coding
classroom behavior that has been found to be reliable between observers
(hapiro, 2004; Volpe, DiPerna, Hintze, & Shapiro, 2005). The BOSS has
shown to both differentiate between children with ADHD and their typically
developing peers and to be sensitive to treatment effects (Clark et al., 2000;
‘Shapiro, 2004). Observed behaviors are coded over sixty 15-s intervals in the
following classroom behavior categories: both passive and active on-task
behaviors Chereafter, engagement), motor or verbal off-task behaviors Chere-
after, off-task-MV), or passive off-task behaviors (hereafter, inattention).
‘At every fifth observation interval, the behavior of a randomly selected
classroom peer is coded following the identical coding criteria as for the
target participants, For example, after coding the participant's behavior for
four consecutive intervals, a peer is coded for one interval, after which the
pattern repeats with a different peer, rotating around the classroom in a systematic way. The order of classroom peers to be observed every fifth
interval was determined at random before beginning each observation, Over
the course of the full 15-min observation, 48 intervals are of the participant
and 12 intervals are of classroom peers.
Examples of engagement are looking at the teacher during presentation
of material or actively engaged on the assigned worksheet at their desk
during independent seatwork. Examples of off-task-MV are speaking to a
classmate when they should be listening to the teacher or getting out of
chair. An example of how inattention is coded for is staring off for more than
3 8 as opposed to attending to the task at hand like filling in a worksheet.
Engagement is scored at the beginning of each 15-s interval; this is called
‘momentary time sampling. During the remainder of each 15-9 interval, off-
task-MV and inattention are recorded if the event occurs within that interval;
this is called partial-interval method. All of these examples pertain to both
participants and their randomly selected peers.
Four different teaching formats are also coded for, namely, teacher-led
classroom instruction, small group work, supervised independent seatwork,
and unsupervised independent seatwork when the teacher is in a sepa-
rate small group. For the present study, teacher format was dichotomized
into teacher-led classroom instruction, where the teacher was instructing the
classroom as 2 whole, and other instruction, where the teacher was not
instructing the classroom as a whole. This systematic observation system en-
ables the comparison of the study participant with ADHD to classroom peers
and the effect of teaching format on classroom behavior categories.
In the present study, three 15-min observations of each study participant
were conducted. Research assistants (RAs) were trained using a systematic
detailed protocol including use of a practice video and practice classroom.
observations before conducting the actual study observations in the schools
in order to reach a high interrater reliability (x > .80; Steiner et al., 2013),
Interrater reliability is measured by two statistics, percent agreement and the
more robust kappa statistic (which takes into account percent agreement).
‘The formula for the kappa statistic is as follows:
Po —Pe/1—Pe,
where Po represents the proportion of agreements between observers on oc-
‘currences and nonoccurrences, and Pe represents the proportion of expected
agreements based on chance (Hintze, 2005).
Actual study observations occurred over 2 days during different aca-
demic subjects, either English language arts/social studies or math/science
and during different teaching formats. Participants and peers did not know
that they were being observed. Throughout the observation period, one third.
of the observations were conducted by two RAs simultaneously to both mea-
sure and assure continued high interrater reliability, Baseline questionnaires TABLE 1 Participant Demographics
Variable (n= 100) 1 (4) or M (SD)
Male 70 (673%)
Child's race*
White 76 (74.5%)
Black or Aftican American 765%)
Asian 1908.60
‘Age at baseline 93.1)
‘Age at ADHD diagnosis 744.)
Fourth grade 7168.39)
Suburban schoo! 76.(73.198)
Families speaking English only 87 3.790,
TQ composite nod (227)
‘Achievement composite 1060 (043)
Note. ADHD = stention defick hyperactivity daorder,
‘Not all parents of patilpants answered each demographic question.
for study participants were filled out by parents and included information
about past or current ADHD support treatments including ADHD medica-
tion, counseling (one-on-one/group therapy), and/or Individualized Educa-
tion Program (IEP) services.
Statistical Analyses
Analyses were conducted using Stata 12.0. Descriptive statistics for partici-
pant demographic variables and treatment status were calculated. Separate
linear mixed regression models were used to test for differences in engage-
ment, offtask-MV, and inattentive behaviors with respect to the following
independent variables: ADHD status, teaching format (teacher-led classroom
instruction vs. other instruction), grade level, and treatment status. Inde-
pendent variables that displayed significant bivariate relations were then
included in further multivariate models that included main effects and inter-
actions. One multivariate model was analyzed for each classroom behavior
category. Mixed models (also known as multilevel or hierarchical models)
were chosen to account for the fact that there were multiple observations
for each child,
RESULTS,
Research assistants maintained high interrater reliability on observations
throughout the study (& = .86). The study sample consisted of 312 ob-
servations of 104 participants (see Table 1 for participant demographics) and
their randomly selected peers. Each observation consists of 15 min with 48
intervals of the participant and 12 intervals of classroom peers, This amounts TABLE 2 Panicipant ADHD Treatments
‘Treatment type (m1 = 104) noo
(On Individualized Education Program 52.600)
Counseling (eg., one-on-one, group therapy) 243)
Medication,
‘ADED medication? 49671)
‘Stimulant medication 5
‘Atomoxetine 3@9)
‘Antihypenensive 468)
Other psychotropic medications” 209)
‘Nate, ADHD = atention defick hyperscivty disorder
“Some sudenis were on polypsychouoalc eatments so subtypes do not sum to the
wal
the only non- ADHD peychotroplc medications listed by parents ofthese children were
selective serotonin resprake inhibitor, and the children Were act aking any additional
‘medication in conjunction.
to a total of 14,976 intervals coded for participants and 3,744 intervals coded
for peers. Forty-nine of the study participants were receiving medication for
ADHD (see Table 2 for participant ADHD treatments).
Teacher-led classroom instruction was the most frequently observed
teaching format (45% of the time). Other classroom instruction represented
small group work 11% of the time, supervised independent seatwork 37%
of the time, and unsupervised independent seatwork when the teacher is,
in a separate small group 7% of the time. Participants were engaged with
classroom activities 74.6% of the time, while classroom peers were engaged
with classroom activities 83.9% of the time. Furthermore, participants were
motor or verbally off-task 25.8% of the time and inattentive 7.5% of the
time, while classroom peers were motor or verbally off-task only 14.79% of
the time and inattentive 4.6% of the time (see Table 3 for percentages and
standard errors of study variables). Relative risks reflect that offtask and
inattentive behavior was observed 114%-196% more often for participants
than for peers, while engagement with classroom activities was observed
£85%-94% less for participants than for peers (see Table 3 for more details).
Initial linear regression models revealed significant associations between
classroom behavior categories and three independent variables: ADHD sta-
tus, grade level, and teaching format. No effect of treatment status on the
three classroom behavior categories was found. Multivariate models for each
classroom behavior category therefore included ADHD status, grade level,
and teaching format. Figure 1 presents adjusted means from the engage-
ment classroom behavior regression model. No three-way interactions were
significant.
‘When comparing participants with ADHD to their peers across behav-
ioral categories, participants displayed lower levels of engagement, #(103) = "TABLE 3 Percentage of Time Engaged, Off-Task-MV, or Inattentive Behavior by ADHD Sta-
tus, Grade Level, and Teaching Format
Engagement Offask MV Inattentive
Grade level Teaching format___af (SE) MGA MGB
Panicipant Second,
Teacherled 75.94.50) 23.8587) 7.90(1.30)
Other BLO) §— 2424281) 4.08.27)
Fourth
‘Teacher led 69.00(1.63) 30.26.88) 10.10(0.84)
‘Other TANG — A901) 6.00.92)
Total
Teacherled 72.47.07) 77.06.37) 7.92(1.07)
Other 9372.10) B2GA) 6511.10)
Peer Second
Teacherled 95.79.50) 11,572.87) 4391.30)
Other 3472.44) 1640281) 4700.27)
Fourth
Teacher led 82.28(1.63) 16.3201.88) 4.26008)
Other 85.21.76 1327.0 5'57(0.92)
Total
Teacherled —84.04(2.07) 1395.37) 4331.07)
Other B41) 1483041) 5.11.10)
Relative Second
risk
Teacherled 0.91 175 157
Other 094 in 14
Fourth
Teacherled 085 1.62 1.96
Other 089) 174 1.50
Total
Teacherled 0.88, wr
Other 092 12
‘Nowe. ADHD = atenton defick hypenscvty dorder
* Other is a mean of small group work, supervised independent searwock, and unsupervised independent
‘seatwork when the teacher isin & separate sal group weaching format.
Relative risk = 9 of pancipant/¥ of peers.
8.60, p< .001, and higher levels of off-task-MV behavior, (103) = 7.89, p
< .001, regardless of grade or teaching format.
Significant interactions between ADHD status and teaching format were
identified for engagement (p < .01) and inattention (p < .001) but not for
off-task-MV (p = .08). In teacher-led classroom instruction, participants with
ADHD displayed lower levels of engagement (p < .001) and higher levels of,
inattention (p < .001). However, no differences in engagement or inattention
‘were identified in other classroom instruction formats. ‘OPanicipanss wih, ADD.
3
8
i
3
Tine gaged
as
3
7 Fourth
‘Second mie
FIGURE 1 Engaged classroom behavior, by ADHD statu, teaching format, and grade. ADHD
‘= attention deficit hyperactivity disorder. tp < 0.05, “sp < 001, **p < 0.001
Last, a significant interaction between ADHD status and grade level
‘was identified for engagement (p < .05). Participants displayed lower levels
of engagement in fourth grade than in second grade (p < .05), whereas
no differences in engagement with respect to grade were identified for
peers.
DISCUSSION
For participants with ADHD, risks for academic delays are evident early
in elementary school. Our results are consistent with previous studies (Vile Junod et al., 2006) that have found students with ADHD have significant
difficulty fulfilling behavior expectations in the classroom, as motor or ver-
bal offtask behaviors were observed approximately twice as much as their
peers, Regardless of treatment type (ADHD medication, counseling, or IEP)
classroom behavior means were similar between participants with ADHD,
showing no clear benefit of any specific approach, Furthermore, classroom
engagement was lower during teacher-led classroom instruction and lower
in fourth grade compared with second grade. In contrast, the behavior of
classroom peers was not found to vary by teaching format or grade. These
observational findings suggest that students with ADHD are more sensitive
to the type of teaching format. Because this is a cross-sectional observed
effect of students in their natural classroom environment and there is no
experimental shift in teaching conditions, other variables not accounted for
‘might also influence outcomes such as classroom environment. Neverthe-
less, differences between second- and fourth-grade students were observed
and might represent an increase of difficulties over time. Modifications to
teaching format may benefit the substantial proportion of students with
ADHD who are having a hard time engaging and staying on-task in the
classroom.
Strengths of this study include use of a highly reliable, systematic obser-
vational system for assessing classroom behavior. The BOSS was an appro-
priate choice for the direct behavioral observations for this investigation as
it utilizes a systematic observation method as opposed to a naturalistic ob-
servation method; therefore, it requires quantitative data and that can help
reduce biases. Furthermore, this approach allowed for researchers to achieve
high reliability between observers. Classroom peers were not selected based
on background information, making them a true community sample. It is
very likely that some of the peer children observed also had ADHD or other
mental disorders that could affect their classroom behavior, yet our results
still showed that participants with ADHD were significantly more off task
than were their peers.
Limitations of this study include that RAs were aware that participants
had ADHD, which could lead to expectancy effects, such that RAs would
‘expect the participants to be more off-task than their peers. However, the RAS
‘were unaware whether the peers had ADHD or other mental health disorders
that might affect classroom behavior. Also, the 45 min of total observation
time may not be considered sufficient time to capture a full representation
of the behaviors of every student, however observations were conducted
over multiple days, and in both English language arts/social studies and
math/science subjects with the goal of collecting a comprehensive picture
of each student. Furthermore, participants were observed for more intervals
than were their classroom peers because this is how the BOSS is conducted.
However, this imbalance was accounted for in the analysis. Implications for Practice
‘We found that children with ADHD are more offtask and less engaged in
teacher-led large group classroom settings, in which they have less opportu-
nity to actively engage, as opposed to group work or independent seatwork
settings, where they can be actively engaged in work either with peers or
on their own. Research shows that an increased opportunity for students
to respond to classroom activities highly correlates with increased academic
achievement (DiPerna, Volpe, & Elliott, 2002). Therefore, decreasing teacher-
led classroom instruction time, while increasing small group work time and
other research-based strategies, such as Classwide Peer Tutoring, could be
considered to support students with ADHD. Classwide Peer Tutoring is a
collaborative teaching approach where peers in the classroom support the
learning of their other peers (Kamps et al., 2008). Furthermore, the Depart-
‘ment of Education suggests the following strategies to support students with
ADHD: reviewing previous lessons, setting learning expectations, stating ma-
terials needed, simplifying instructions, being predictable, using audiovisual
materials, performing ongoing student evaluations, using oral and written di-
rections, dividing work into smaller units, highlighting key points, and using
assistive technology (Jackson, 2004),
Based on our results that show a progression of off-task behavior from
second to fourth grade in students with ADHD, and the literature that as-
sociates weaker academic outcomes with students with ADHD, we sug-
gest proactive academic surveillance and support for students with ADHD
early on, before academic concems develop. If future research continues to
consolidate findings of academic discrepancies between children with and
without ADHD, it will be important to investigate this type of preventative
approach, along with experimental shifis in teaching conditions to support
students with ADHD.
Last, we recommend that school psychologists train (Steiner et al., 2013)
and carry out systematic classroom observations, coding for classroom set-
ting/format, as we have found children with ADHD to be sensitive to dif-
ferent settings. Given that increased engagement is associated with higher
academic achievement (Marks, 2000), this information could inform teachers
how their students are engaged and which classroom format results in the
highest level of engagement in their classroom. This may benefit not only
the children with ADHD, but other students in the classroom as well.
Implications for Research
This study included a greater amount of observation time over more than
1 day compared with previous studies (Vile Junod et al., 2006), enabling the
research team to collect a more complete data set representing participants and classroom peers. This allowed for a more accurate analysis and a greater
ability to generalize to the larger population of students with ADHD. Future
research should address the possible effect time of day has on the engage-
ment of students with ADHD in the classroom and should perhaps examine
specific activities within the different teaching formats to gain a more precise
picture of the activities teachers could plan in their classrooms to increase
the engagement of children with ADHD. Furthermore, because the effect
of medication treatment on academic success in students with ADHD is far
from clear (Bamard-Brak & Brak, 2011), these studies will continue to assess
alternative approaches to psychotropic medications that influence academic
‘outcomes.
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