Enhancing Quality in
School Mental Health

Providing guidance for teachers

When establishing a school-based intervention for ADHD, teachers need support and guidance to assure the successful implementation of the treatment plan.
This article discusses relevant issues for a behavioral intervention in the classroom.
Youth with ADHD require more immediate and obvious feedback than their classmates in order to achieve positive outcomes. Clinicians should emphasize to teachers the importance of providing reinforcement “in the now” for students with ADHD.
While contingent positive reinforcement should serve as the primary component of a behavioral intervention, teachers may also use mildly negative consequences or redirection to address inappropriate task behavior. Reprimands should be delivered in a specific, immediate, calm, and private manner; following these principles clarifies contingencies and maintains respect for the child.
Teachers can prevent confusion by gradually increasing the level of difficulty of assigned tasks; teachers can avoid boredom by avoiding the assignment of repetitive tasks.
Teachers should measure positive outcomes in terms of improved academic performance, rather than appropriate task behavior. This approach encourages independent learning and reduces inappropriate behavior (i.e., by not attending to it) for students with ADHD.
Clinicians should encourage teachers to vary and evaluate a student’s list of preferred activities. Teachers can create a list of possible privileges to be reviewed with the student prior to the start of each week, which helps assure that reinforcers remain reinforcing.
Clinicians should provide a checklist for teachers to assure the fidelity of the intervention. This information will help the clinician determine if the teacher needs additional support.
Dupaul, G.J., & Stoner, G. (2003). ADHD in the schools: Assessment and intervention strategies. New York: Guilford Press.

Resources for clinicians and teachers:
Selecting reinforcers for students with ADHD: http://ici2.umn.edu/preschoolbehavior/tip_sheets/posrein.htm.
ADHD medication information: http://128.205.76.10/Medication.pdf

Practical strategies for school clinicians

Drawing on the work of Dawson and Guare (1998), briefly described below is one approach to working with adolescents with ADHD (i.e., coaching model).
This article continues in the same vein by focusing on the extensive developmental demands placed on adolescents. The following are some practical strategies for working with adolescents with ADHD:
Provide specific instruction on note-taking and test preparation. Don’t assume that adolescents with ADHD already acquired these skills.
Require students to keep homework assignment books. Have them record all assignment and be sure to have parents review each evening.
Ask teachers if students can tape-record lectures. This will provide a resource for future instruction on note-taking and test prep.
Dupaul, G.J., & Stoner, G. (2003). ADHD in the schools: Assessment and intervention strategies. New York: Guilford Press.

Medical treatments for ADHD

Discussing pharmacological treatments with parents

Because they daily observe student functioning, school mental health clinicians can accurately advocate for appropriate services. Deciding to recommend medication for a student with ADHD requires a heightened sensitivity to both clinical and familial issues.
In keeping with the focus on family engagement, this article provides an overview of topics to discuss with families before pursing pharmacological treatments for ADHD:
Determine the severity of the student’s presenting behavior. The more severe, the more likely medication should be considered.
Review prior treatment history for ADHD. If other approaches have not been used (i.e. parent praise, tangible rewards), delay full consideration of medication until assessing other means for improvement. If other approaches have been correctly implemented with little improvement, consider medication as adjunctive treatment.
Recommend medication that has strong empirical support. Stimulants that affect the Central Nervous System have been shown to successfully treat ADHD.
Assess parental and child attitude toward medication. Explain to families the advantages and disadvantages of different medications. Families should not be coerced into using medication for their child, as it will likely decrease the likelihood of treatment compliance.
Determine the adequacy of adult supervision. In order for medication to be successfully incorporated into treatment, parents must have the time and resources to supervise the administration of the medication.
Dupaul, G.J., & Stoner, G. (2003). ADHD in the schools: Assessment and intervention strategies. New York: Guilford Press.