Teacher Acceptability of Evidence-Based and Promising Treatments for Children with Attention-Deficit/Hyperactivity Disorder

Abstract

This study examined teachers’ acceptability of evidence-based and promising treatments for children with attention-deficit/hyperactivity disorder (ADHD). Teachers (N = 156) from 11 elementary schools read a vignette describing a boy with symptoms typical of combined type ADHD. Using the Intervention Rating Profile-10, teachers rated the acceptability of three promising treatments (peer tutoring, self-reinforcement, and social skills) and three evidence-based treatments, both psychosocial (daily report card and time-out) and pharmacological (stimulant medication). Teacher factors, including teacher self-efficacy, were evaluated as predictors of treatment acceptability. The daily report card (DRC) received the highest mean acceptability rating among the treatments, and was rated significantly higher than 4 of 5 other treatments; the DRC was not rated significantly higher than the self-reinforcement strategy. Years of experience was predictive of acceptability in that more experienced teachers rated time-out as more acceptable than peer tutoring. Results replicate previous findings and uniquely indicate that promising treatments are considered as acceptable, and in some cases, more acceptable than evidence-based treatments for children with ADHD.

Appendix: Treatment Descriptions for Evidence-Based and Promising Treatments

The Daily Report Card (DRC)

The teacher identifies 2–4 specific behaviors that John needs to improve (e.g., work completion, raises hand to speak), clearly defines these behaviors for him, and decides what criteria he must meet in order to have a “successful DRC” and earn a reward (e.g., 70% complete, 3 interruptions). The teacher monitors and tracks his behaviors, provides verbal feedback on a daily basis, fills out the DRC indicating whether John has met his goals, gives John the report card to take home to his parents, and makes sure that DRC success is met with a reward for him either at home or at school. The teacher gradually changes the DRC to make it more challenging as John’s behavior improves

Time-Out (TO)

Time-out involves removing John from an enjoyable activity or one that includes the rest of the class because he has displayed an inappropriate or negative behavior (e.g., aggression, disrespect to the teacher). Upon the violation, the teacher tells John that he has earned a time-out. The teacher informs him of the time-out location and length of time that must be served. The teacher keeps an eye on John’s behavior from a distance and then instructs him to return to the prior activity after he has served his time-out appropriately.

Stimulant Medication (SM)

This medication (Ritalin) is used to improve John’s attention span and work completion as well as reduce his impulsivity and classroom disruptiveness. The medicine is given before school by John’s parents and at lunch by the school nurse. During a trial of medication which lasts 20 days, the teacher completes a 5-item rating scale at the end of each day in order to determine the effectiveness of the medication. Also, the teacher is asked to inform parents if they notice any changes in health status (e.g., complains of stomachaches) or mood while John is on medication. Once the correct dose is decided, the teacher completes a brief questionnaire once a month to determine whether the medication is having the intended effect.

Peer Tutoring (PT)

PT allows John to receive one-on-one instruction on an academic activity with another student (who is typically a higher achieving student). The higher achieving student provides assistance, instruction, and/or feedback to John as they work together. In the context of PT, the teacher divides the class into pairs, taking into consideration the academic strength of the students being paired. The teacher should monitor the tutoring, provide reinforcement for pairs of students who are following directions, and working appropriately. PT sessions typically last 20–30 min.

Self-Reinforcement (SR)

SR can be used to gradually fade out a behavior program in which the teacher has initially been providing John with points, tokens, or rewards for good behavior or removing these items when he displays inappropriate behavior. SR requires teaching John to observe and monitor this own behavior and to evaluate and reinforce his own performance. Both the teacher and John track his behavior and he is rewarded for good behavior with bonus points if his ratings match the teacher’s ratings exactly. Over time, the teacher ratings are faded except for periodic “matching challenges” which encourages John to rate his behavior accurately. The teacher continues to reward John for good behavior and accurate ratings throughout the remainder of the treatment.

Social Skills (SS)

In Social skills instruction in the classroom setting, the teacher designates approximately 20 min to the social skill lesson. First, the teacher introduces the skill to the entire class in a brief manner. The topics teachers may choose from include skills such as giving and accepting a compliment, learning appropriate ways of making complaints, apologizing, learning how to say no, asking favors appropriately, beginning, listening, and ending a conversation, working cooperatively, helping, or sharing. The teacher models the skill for the class. Then students, including John, role-play the social skill. Teachers may also incorporate a short group game to allow students to practice the technique. Throughout the day, the teacher praises and reinforces students for using social skills outside of the 20-min social skills lesson.