Dealing with ADHD at school: Further insight into the assessment and treatment of ADHD behavior in the classroom

In the Netherlands, schools are required to support all children with additional needs regarding psychiatric difficulties or learning disabilities within regular primary education. Inattentive, hyperactive and impulsive behaviors are common among school-aged children, that are related to their school functioning. These children often experience difficulties at school, such as conflicts with teachers and peers and lower academic performance. Although schools are required to support these children, teachers and schools report to have a lack of handles to support these children. There is also still much unknown about how to optimally assess and treat ADHD behavior within the school setting, which was the aim of the current dissertation. The first part of this dissertation focusses on optimal assessment of ADHD behavior in the classroom. Teacher rating scales, that are already frequently used in school-based and clinical practices, appear to be valid and useful to assess ADHD behavior and may be featured more prominently in the assessment of ADHD. Further, objective classroom observational measures seem of added value for the assessment of inattentive behavior. Regarding the treatment of ADHD behavior in the classroom, the second part of this dissertation provides insight into ‘what works and for whom’ in behavioral teacher training for ADHD. Techniques aimed at eliciting desired behavior (i.e., stimulus-control) and techniques aimed at changing consequences of behavior (i.e., contingency management) are equally and highly effective in reducing classroom ADHD behavior and related problems. It seems that certain children benefit more from certain techniques than others, depending on their age and neurocognitive functioning. Also class size affects technique effectiveness. Moreover, the short and individually tailored interventions developed for this study appear highly effective and more effective than existing, usually longer, interventions. This format thus may be a promising step in developing and improving teacher interventions for ADHD behavior. The final, third, part of this dissertation focusses on teacher-, context- and child factors that may elicit or maintain classroom ADHD behavior. The findings indicate that children with ADHD behavior receive much more reprimands than compliments from teachers, while this pattern was reversed for children without ADHD behavior. The number of reprimands towards children with ADHD behavior further increases when teachers experience a less warm and affectionate relationship with this child, which often is the case for children with ADHD behavior. Regarding contextual factors, it was found that behavior of children with and without ADHD is related in a similar way to three common teaching methods. All children show more hyperactive behavior during classroom transitions than during individual seatwork or group lessons. Finally, we show that children with ADHD experience difficulties recognizing (subtle) emotional expressions in peers, which is in turn related to their social problems. In order to support children with ADHD behavior in the classroom, their teachers can therefore benefit from training in their use of feedback in children with ADHD behavior and the role of the student-teacher relationship in this, the role of classroom transitions in hyperactive behavior, and the difficulties children with ADHD behavior experience in recognizing (subtle) emotional expressions.