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dissertation entitled

PERCEPTIONS OF "REASONABLE" ACCOMMODATIONS IN

GENERAL EDUCATION FOR SECONDARY SCHOOL STUDENTSLIWI'UH/WDHD:

TREATMENT ACCEPTABILITY RATINGS OF TEACHERS

presented by
Marilyn Mae Higgins

has been accepted towards fulfillment
of the requirements for

Ph.D. School Psychology

 

 

degree in

fluwj$€gaé5w

(Major professor

Date August 26, 1999

 

MSU is an Affirmative Action/Equal Opportunity Institution 0-12771

 

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PERCEPTIONS OF “REASONABLE” ACCOMMODATIONS IN
GENERAL EDUCATION FOR SECONDARY SCHOOL STUDENTS
WITH ADHD: TREATMENT ACCEPTABILITY RATINGS OF TEACHERS
By

Marilyn Mae Higgins

A DISSERTATION

Submitted to
Michigan State University
in partial fulfillment Of the requirements
for the degree of

DOCTOR OF PHILOSOPHY
Department of Counseling and Educational Psychology

1999

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ABSTRACT

PERCEPTIONS OF “REASONABLE” ACCOMMODATIONS IN
GENERAL EDUCATION FOR SECONDARY SCHOOL STUDENTS
WITH ADHD: TREATMENT ACCEPTABILITY RATINGS OF TEACHERS

By

Marilyn Mae Higgins

The implementation and success of classroom intervention plans
for students with ADHD may be dependent on teachers’ acceptance of a plan as
reasonable, fair and appropriate to the situation. This study assesses
acceptability to teachers Of three school-based intervention plans: School-home
Notes, student Self-monitoring, and Contingency Contracting. Participants were
high school and middle school teachers (grades six through twelve). Teachers
reviewed two clinical vignettes Of students with ADHD, one with mild behavior
problems and one severe. Each vignette was followed by descriptions of three
intervention plans. Each intervention plan was followed by a modification of the
TEI-SF rating scale (Treatment Evaluation Inventory-Short Form), an instrument
designed to rate the acceptability of the intervention plan as a way of dealing
with the student’s classroom learning and behavior problems. Teachers rated
the three intervention plans acceptable and gave significantly higher ratings for

School-home Notes than for Self-monitoring. School-home Notes were rated

inte

 

 

 

higher than Contingency Contracting but this difference was not significant.
Teachers recognized the difference in severity Of problem behaviors described in
the student vignettes. The interaction between severity and order of students
was significant. Type Of teacher, i.e., general education versus special
education, had a significant affect on acceptability ratings. Special education
teachers report using Contingency Contracting more than others and they
evaluate it higher. The order in which teachers received student vignettes had an
effect on acceptability ratings. It is clear that general education and special
education teachers agreed that assistance would be needed to develop and
implement some interventions for students with ADHD in general education. The
acceptability Of an intervention was affected by the context in which the

intervention was presented.

Copyright by
MARILYN MAE HIGGINS
1999

DEDICATION

This work is dedicated tO my friends and family who never quit believing
that I could accomplish my goals
and never once asked me, “Why?”
To Mike, Laura, and Tim
with Love from Morn.

ACKNOWLEDGMENTS

I would like to thank the many people who have supported my
efforts to return to graduate school and to obtain a doctorate. Their time,
energy, resources, and encouragement were the constant support that
allowed me to accomplish this task.

I would like to express appreciation to the members of my
committee: Dr. Harvey Clarizio, teacher and advisor, who was a part of my
graduate training and career development from the beginning; Dr. Walter
Hapkewicz, whose calm and friendly manner reminded me that the “storm
and stress” I may have been feeling was all a part of the process; Dr.
Thomas Koepke who continually helped me refocus my attention on the
basic demands of an experimental design; and Dr. Judith Brady whose
guidance and patience through numerous weekly meetings brought me
from the chaos of my own thinking and attention deficit to help me with the
organization and focus for the completion Of this work.

Special thanks goes to Dave Buck whose combined knowledge of
psychology and statistical analysis and communication skills made him an
invaluable resource. Additionally, I want to thank the people whose
technical skills kept me on track. I feel blessed to have such highly
competent friends and family who served as research assistants, helping

me with keyboarding, graphic design, data entry and other shared

vi

computer skills necessary to complete this project. I list them here in
alphabetical order as they are all Of great importance to me and there is
no way to value one above the other. Thank you to Ruth Barton, Rosie
Bickert, Laura Higgins, Michael Higgins, Timothy Higgins, Matthew Kolar,
Amy Pobst and Mark Reeves.

There is a kind of support that is difficult to name. It came to me
through many professional women who went before, paved the path, and
helped me to see what was possible for me. To Dr. Rebecca Tift-Barcy,
Dr. Judith Brady, Dr. Evelyn Oka, Darlene Robel, and Dr. Martha Whipple.
I thank you for your mentoring. It helped sustain me through the difficult
times when l was ready to give up. A similar kind of support was there for
me in what may seem a very unusual form. I want to thank Master
Instructor D. S. Shinn and the students Of the TaeKwonDO Academy with
whom I found a source of strength, discipline, commitment and nurturing
as well as an escape from the mental stress of a doctoral program.

Most Of all, I want to thank my parents who helped me believe in
myself form an early age and who continued to express their pride in a
daughter’s accomplishments even when those accomplishments took me

down a path not expected Of a women of my generation.

vii

TABLE OF CONTENTS

LIST OF TABLES ....................................................................... xiii

LIST OF

FIGURES .................................................................................. xiv

CHAPTER 1

INTRODUCTION ........................................................................ 1
Purpose of the Study .......................................................... 3
Preview of Chapters to Follow .............................................. 4

CHAPTER 2

REVIEW OF THE LITERATURE .................................................... 6

Which Treatment, For Which Student, Under What Conditions,

Is Most Likely To Be Accepted By Teachers ........................ 6
Acceptability ............................................................. 8
Clinical and medical studies ............................... 10
Educational studies .......................................... 11

Attention Deficit Hyperactivity Disorder ........................... 12
Prevalence of ADHD ........................................... 12

Severity Of ADHD ............................................... 13

The long-term side affects of ADHD ....................... 14

Justification for Providing Treatment in the School Setting. 15

viii

School-based Interventions Used to Assist students with ADHD .......... 19

Theory and Practice ............................................................ 19
University of California-Irvine Child Development Center ............ 22
Self-management ................................................................ 24
Three Intervention strategies presented in this study .................. 25
Self-monitoring .......................................................... 25
Contingency Contracting ...................................................... 28
School-Home Notes .................................................... 31
Conditions That Might Influence Treatment Acceptability ..................... 33
Characteristics of the Person Receiving the Treatment .................. 33
Age Of the client or student ............................................. 33
Severity of the problem behavior ..................................... 36

The Type, Description, and Design of the Intervention .................. 37
Intervention types .................................................................. .37

Data on effectiveness .................................................... 38

The language used in describing the treatment .................. 38

The person in charge of
implementing the intervention ......................................... 39

Characteristics of the Raters ................................................... 39

Parents ...................................................................... 40
Children ..................................................................... 41
Teachers .................................................................... 42
Interaction of Variables ........................................................... 43

Prior Research on Acceptability Of School-Based
Interventions for Students with ADHD 44

Variables to be Assessed in This Study ................................................. 46
CHAPTER 3
METHODOLOGY ..................................................................................... . 48
Participants .............................................................................. 49
Procedures ............................................................................... 51
Instrument ................................................................................. 52
Research Hypotheses ................................................................. 55
Statistical Analysis ..................................................................... 58
CHAPTER 4
RESULTS ..................................................................................... 60
Participant Response Rate and Demographics ................................. 6O
Reliability of the Modified TEI-SF ................................................... 63
Perceived Severity of Behavior ..................................................... 65
Hypothesis 1: Effects of Intervention Type ....................................... 65

HypothesisZ: Treatment Acceptability and Severity ........................... 68

Hypothesis 3: Teacher Characteristics and TEI-SF Ratings ................ 70
Frequency Of Use .................................................................. 71
General Education vs. Special Education Teachers ...................... 72

Hypothesis 4: Effects of Order Of Vignettes ..................................... 75

TEl-SF Item 8: Need for Support in Development and

Use of a Treatment ..................................................................... 76
CHAPTER 5
DISCUSSION ................................................................................ 84
Synopsis of Results .................................................................... 84

Extent to Which Results are Congruent to or

Discrepant with Past Data ............................................................ 87
Limitations ................................................................................ 91
Subject Selection Variables ..................................................... 91

Lack Of Usable Information as to the
Gender of the Participants ...................................................... 92

Representativeness Of Students
Described in Student Vignettes ................................................ 92

Questioning the Use of a “Neutral” (3)

Rating to Conclude Acceptability .............................................. 93
Questioning the Definition of Severity ........................................ 93
Acceptability is Not a Measure of Effectiveness ........................... 94

xi

 

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Contributions for Practice ............................................................ 95
Classroom Performance Based Focus ....................................... 95
Focus on Adolescents ............................................................ 96

Developing a Database Permitting Treatment Acceptability
to be Incorporated Into the Decision-making Process Of

Consultation and Service Delivery .............................................. 97
Prescribed Research Procedures ............................................. 97
Future Directions for Research ..................................................... 98
Summary ................................................................................. 100
APPENDIX A
Diagnostic Criteria for Attention-Deficit/Hyperactivity
Disorder ...................................................................................... 103
APPENDIX B
Diagnostic Criteria for Oppositional Defiant Disorder ............................ 106
APPENDIX C
Survey Instrument .......................................................................... 108
Reference List .............................................................................. 128

xii

LIST OF TABLES

Table 1.
Responses by Demographics of
Participants in This Study ....................................................... 50

Table 2.
Cronbach’ s Alphas Across All 6 Treatment Combinations for the
Modified TEI-SF Items With and Without Item 8 .......................... 64

Table 3.
Means and Standard Deviations (SD) for All 6 Treatment Combinations
Using the First 7 Items on the Modified TEI-SF Scale ..................... 67

Table 4.
Mean and Standard Deviation (SD) of the Modified TEI-SF Rating
Across Interventions ............................................................... 68

Table 5.
Mean Ratings and Standard Deviation (SD) Of Use by Intervention... 71

Table 6.

Mean Scores on the Modified TEl-SF Using General Education

Versus Special Education Teachers for Each Of the 6 Treatment
Combinations ........................................................................ 73

Table 7
Need For Help to Implement a Specific Intervention ...................... 78

Table 8
Need for Assistance Developing Type of Intervention by
Order Of Intervention ............................................................... 79

Table 9

General and Special Education Teachers’ Report Of Need for
Assistance Developing School-based Interventions ..................... 81

xiii

LIST OF FIGURES

Figure 1
Teacher Acceptability Ratings for All 6 Treatment Combinations ‘
by School District .................................................................. 62

xiv

CHAPTER 1

INTRODUCTION

Educators continuously seek better ways to meet the educational
needs Of students. Teachers in both general and special education,
school psychologists and other support personnel frequently work
together to intervene in students’ lives. They treat problems encountered
in the school setting and plan for the individual educational needs of
students at risk Of school failure (Flugum 8. Reschly, 1994).

To intervene means to impose a change or introduce something
new, a new strategy, approach, or activity, in an already ongoing
relationship such as that of teacher and student. The intent of the
intervention is to change a relationship, behavior, or internal state Of the
client or student to achieve a positive outcome (Sandoval, 1993). A
common hurdle in the planning and implementation of classroom
intervention techniques is a difference Of opinion as to what constitutes a
reasonable accommodation for an individual student in the general
education classroom.

The term reasonable can be defined as answering one or more of
the following questions: (a) Can the proposed accommodation be done

by the people involved? (b) Does the teacher like the idea? (c) Does it

meet the need of the student? and (d) Does the teacher expect the
student to have a positive response to the proposed intervention?
Teacher opinion is very important as the implementation of an intervention
plan is almost invariably the responsibility of the classroom teacher (Bahr,
1994)

Kazdin (1980) studied the concept Of “reasonable” within the larger
context of treatment acceptability. He defined treatment acceptability as
an overall evaluation of the treatment procedures using judgements by lay
persons of whether treatment procedures were viewed as appropriate, fair
and reasonable for the problem or client. Kazdin (1980) stated several
reasons for evaluating the acceptability of treatment including the fact that
for any client, there may be several treatment techniques or combination
of techniques that could effectively treat the presenting problem. He
developed the Treatment Evaluation Inventory as an instrument that could
be administered before the selection and initiation of treatment. The basic
assumption being that “treatments viewed by the public as more
acceptable than others are more likely to be sought by potential
consumers, initiated, and adhered to once they are initiated.” (p. 260)

Elliott, Witt, Galvin & Peterson (1984) extended Kazdin’s research
to apply to teachers’ ratings Of acceptability of behavioral interventions in

schools and varying the type of intervention proposed. Witt & Elliott

(1985) found that consultants such as school psychologists frequently
give recommendations for procedures that teachers find unacceptable or
at least not very practical due to lack of resources, time demands, or basic
philosophical differences with the assumptions and theoretical orientation
Of the intervention plan. Recent literature continues to support the
practice of assessing treatment acceptability during the consultation and
treatment design process (Bahr, 1994; DuPaul & Stoner, 1994). Gajria &
Salend (1996) refer to treatment acceptability as “a critical dimension for
overcoming teacher resistance to implementing adaptations for

mainstreamed students.” (p. 91).

Purpose of the Study

The study presented here extends previous research by examining
secondary school teachers perceptions of the reasonableness of several
classroom-based interventions for a select subgroup of adolescents with
learning difficulties namely, those with Attention-Deficit/Hyperactive
Disorder (ADHD). Teachers read two student vignettes, one describing
an adolescent with mild symptoms of ADHD and one who presents as
more severe. Three intervention plans and a modified Treatment
Evaluation lnventory- Short Form (TEI-SF) for each intervention plan

followed each student vignette. The order of presentation of the student

vignettes and the descriptions of interventions was counterbalanced as
each had an equal chance of being presented first or second within the
larger survey instrument. The goal is to determine which of three school-
based interventions Is most likely to be accepted by teachers and if

teachers’ choices change given differing conditions.

Preview of Chapters to Follow

The second Chapter addresses the relevance of the concept of
treatment acceptability and social validity in recent research. TO develop
the topic Of treatment acceptability, a specific problem in need of
treatment, ADHD, is identified and discussed. Research on treatments
found effective in ameliorating the effects of ADHD is reviewed with a
focus on a specific population effected by the problem, i.e., students in
grades 6 — 12. The chapter concludes with a review of research findings
on factors that influence treatment acceptability in general and more
specifically teacher acceptance of school-based interventions to address
the needs Of students with ADHD in the middle school and high school
years.

The third chapter presents the research methodology. It includes a
general description of participant demographics and response rates.

There is a discussion Of participant selection procedures and safeguards

for confidentiality. The procedures and data collection materials are
described and hypotheses stated. An overview of the data analysis plan
leads into the fourth chapter and a presentation Of the details of the
results of the study.

The fifth chapter concludes the work with a discussion Of the
practical contributions this study makes to the field as well as limitations of

the study and suggestions for future research.

 

 

 

 

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Review of the Literature

Which Treatment, For Which girdent. Under What ConIfltions, Is Most Likely TO

Be Accepted Bv Teachers?

There is a growing need for interventions in the school setting that
address both the educational and mental health needs Of students (Pfiffner &
O’Leary, 1993; DuPaul & Stoner, 1994; Hoff & DuPaul, 1998; Nastasi, B., Varjas,
K., Bernstein, R., & Pluymert D, 1998). However, similar or nearly equal
treatments might not be perceived as equally acceptable to the consumer, i.e.,
teacher, parent and/or student. School psychologists are often asked to assess
students’ learning and social behaviors and to recommend intervention plans to
address the students’ needs. The success of an intervention plan is in a large
part dependent on implementation of that plan by the teacher and/or parents.
The plan might fail not because it is ineffective but because it is not carried out.
The link between assessment of student needs and the intervention planned to
meet those needs must be viewed as effective and acceptable by the practitioner
who is to implement the intervention if that practitioner usage and adherence to
procedures are to be achieved (Mehrens & Clarizio, 1993). Researchers have
consistently pointed out that it is not enough for procedures to be effective.

Treatment procedures also need to be accepted by the individuals necessary to

implement them (Wolf, 1978; Kazdin, 1977; Witt & Elliott, 1985; Miltenberger,
1990; Power, Hess & Bennett, 1995; and Ervin, DuPaul, Kern & Friman, 1998).

The first section of this Chapter focuses on the question: “Which
treatment is most likely to be accepted by teachers?” The concept of treatment
acceptability is reviewed in general along with the analog methodology that is
most Often used to assess treatment acceptability. TO develop the topic of
treatment acceptability, a specific problem in need Of treatment (ADHD) is
identified and discussed in terms of the negative impact ADHD has on academic
performance, social-skills, and intrapersonal functioning. The prevalence of the
disorder is presented followed by information on the long-term side effects of
ADHD and a justification for providing treatment in the school setting. This first
section concludes with a review Of the research on treatments found effective in
ameliorating the effects Of ADHD. Three specific treatment types Of school —
based interventions are reviewed in depth. These three treatments are
Contingency Contracting, School-Home Notes and Self-monitoring.

The second section of this chapter focuses on student characteristics and
the question: “Which treatment for which student?” The majority of previous
research deals with treatment for ADHD in early and middle childhood. Far
fewer studies have focused on treatment for adolescents with ADHD. The
present study focuses on adolescence. It addresses normal adolescent
developmental issues of middle school and high school students. Predicted
learning and mental health outcomes of youth who successfully negotiate issues

of adolescence is presented along with the identification Of support students

typically need and factors that might interfere with a student successfully
negotiating this developmental stage. The topic of ADHD is revisited as a
disorder that might interfere with successfully negotiating developmental issues
of adolescence with emphasis on functioning in the school setting.

The final section emphasizes the topic of specific conditions that have
been found to influence ratings of acceptability. This includes the severity of
student behaviors and/or learning problems and characteristics of the one rating
the plan as acceptable or not acceptable. The chapter ends with a justification of

the variables selected for this study.

Acceptabilig

Treatment does not exist in a vacuum. Choice or acceptability of a
treatment, personal meaningfulness and social significance/validity are important
factors in applied research as they connect research results to a social context in
which decisions can be made regarding the expected effects, the importance or
treatment procedures (Kazdin, 1977; Wolf, 1978; Kazdin, 1980; Robin & Foster,
practical value Of the expected treatment effects, and the appropriateness of the
1989; Kelley, 1990; Storey & Horner, 1991; Waas & Anderson, 1991; and
DuPaul & Stoner, 1994). In 1978, Wolf wrote, “If the participants don’t like the
treatment then they may avoid it, or run away, or complain loudly. And thus,
society will be less likely to use our technology, no matter how potentially
effective and efficient it might be.” (p. 206). Calvert and Johnston (1990)

reviewed the rationale for treatment acceptability research and concluded that it

 

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is a construct in need of further evaluation. They suggested that researchers
need to expand the scope of treatment acceptability application to take into
consideration nontreatment factors such as the presentation of the treatment
Information, the type of problem presented that is in need of treatment, the
characteristics of the environment and characteristics Of the person
implementing the treatment.

Kazdin (1980) defined treatment acceptability as, “Judgements about
treatment procedures by ...potential consumers of treatment. Judgements Of
acceptability are likely to embrace evaluation of whether treatment is fair,
reasonable, and intrusive, and whether treatment meets with conventional
notions about what treatment Should be.” (p. 259). He developed the Treatment
Evaluation Inventory as an instrument for assessing treatment acceptability using
an analog methodology which assigns a numeric value to participant responses
so that thesurvey data can be transformed into numeric values for data analysis.
The typical treatment acceptability research design requires participants to read
a written case description of a client or student who is described as
demonstrating a particular set of behavior problems (case vignette).

Participants then read a written description of one or more intervention plans that
could be applied to the problem described in the vignette. Participants rate the
treatment as applied to the problem using a treatment acceptability rating scale.
By varying the participants selected, the case vignettes and intervention plans;
researchers can evaluate various factors that may influence treatment

acceptability. Use of analog methodology to study treatment acceptability

continues to be a viable source Of information in recent clinical (Bennett, Power,
Rostain, & Carr, 1996; Bihm, Sigelman, & Westbrook, 1997; and Miltenberger &
Lumley, 1997), medical (Miller, Manne & Palevsky, 1998; Sinnott et al. 1998),
and educational studies (Gajria & Salend, 1996; Nastasi, 1998; Sheridan, 1995).
Clinical and medical stiflies. Bennett et al. (1996) assessed parents’
acceptability of medical treatment for children (ages 5 to 13) with ADHD in
connection to counseling feasibility and counseling acceptability. Ratings of
treatment acceptability failed to predict client adherence to counseling and
medication at follow-up. The researchers suggested a need to assess treatment
acceptability at multiple points during the assessment and treatment processes
of clinical treatment. Bihm et al. (1997) asked university students to assess
treatment acceptability in their study Of perceptions of behavioral programs to
treat self-injurious behavior in a hypothetical 17-year-old boy with mental
retardation. They found a preference for positive reinforcement strategies over
all other programs described despite the fact that the treatment outcome
information given the raters was identical for all treatments described.
Miltenberger and Lumley (1997) also studied acceptability of possible treatments
described asking 132 direct care staff (aged 18 — 57) from community agencies
to rate acceptability of a time-out procedure and a guided compliance treatment
for the aggressive behavior of a 23-year-old man with severe mental retardation.
Time-out was significantly more acceptable even though it is a general treatment
for many possible problems rather than one designed to functionally address the

patient’s aggressive behaviors.

10

Miller et al. (1998) studied treatment acceptability Of behavioral
interventions recommended for children with cancer. Participants were parents
of children on active medical treatment for cancer, pediatric oncology nurses,
and parents of healthy children. Participants read a vignette describing a
hypothetical child’s compliance/noncompliance to medical treatment and five
behavioral interventions recommended. They then rated the acceptability of
each intervention. Parents of Children with cancer rated the punitive strategies
as significantly lower in acceptability.

Educational studies. Sheridan (1995) studied school psychologists’
acceptance of a consultation style involving student, parents and teachers called
conjoint behavioral consultation using treatment acceptability ratings. Gajria and
Salend (1996) reviewed the literature on treatment acceptability and found
acceptability a critical aspect of overcoming teacher resistance to implementing
classroom adaptations in general education. The Power, Hess, and Bennett
(1995) study asked elementary and middle school teachers tO read vignettes
describing five possible school-based interventions for treatment of ADHD.
Teachers then rated the acceptability of each treatment type. The researchers
found that the daily report was more acceptable than response cost. Behavioral
treatments were viewed as more acceptable than the medication treatment alone
by elementary teachers although a fairly high number of middle school teachers
rated the response cost procedure as least acceptable.

Each Of these studies, whether in the medical, clinical or educational

setting, assists professionals working with children to make better judgements

11

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when planning interventions. They help in guiding treatment selection given the
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school.

Attention Deficit Hyperactive Disorder: A Problem in Neejd of Treatment

The focus Of this study is on the behaviors of the students described to fit
the criteria for ADHD according to the DSM-IV (American Psychiatric
Association, 1994). Some of the behaviors described may be similar to
presenting behaviors of other mental health diagnoses such as Impulse-Control
Disorder: Not Elsewhere Classified, Depression, or Dementia due to General
Medical Condition. It is beyond the scope of this study to discuss differential
diagnosis. The presenting behaviors describing the two hypothetical students in
the study are taken directly from the DSM-IV criteria for ADHD. The intent Of the
study is to assess teacher acceptability Of school-based interventions designed

to ameliorate the problems associated with the behaviors described.

Prevalence Of AED. The estimated prevalence Of ADHD is 3 to 5
percent of school-aged children (Rief, 1993) with at least 2 million children in the
United States diagnosed with Hyperactivity. Each Child may have a different
cluster of characteristics that combine to fit the diagnosis of ADHD (American
Psychiatric Association, 1994), from the more mild problem behaviors of ADHD:
Predominantly Inattentive Type with 6 or more symptoms of inattention such as

careless mistakes, easily distracted, Often forgetful, loses things and avoiding

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tasks that require sustained mental effort. The more severe behavior problems
of ADHD include Hyperactivity and Impulsivity and Often include a combination of
other factors including Learning Disabilities, Depression, and/or Oppositional
Defiant Disorder (American Psychiatric Association, 1994; Richters, Arnold,
Jensen, & Abikoff 1996). Not all symptoms apply to each child. Behaviors
characteristic of ADHD such as jumping from one activity to another, losing
things, not listening to directions, being very active, or somewhat shy and
withdrawn may be accepted as normal in early childhood, but as the student
grows Older these behaviors become much more problematic. Barkley (1995)
reports that approximately 35% of the ADHD children have repeated at least one
grade in school before reaching high school and more than 40% receive special
education programming for learning or behavior problems. Special education
eligibility or labeling is not the focus Of this study. The focus here is on the
learning and social behaviors of ADHD that may interfere with academic success
and teacher’s acceptance Of three specific interventions that have been used to

assist students in overcoming the negative effects of ADHD.

Severity of AM; Severity is defined as the relationship of the subtype
of ADHD to predicted outcomes. The two subtypes presented in the student
vignettes in this study are ADHD: Primarily Inattentive Type which has far fewer
comorbid psychiatric conditions and ADHD: Combined Type (Barkley, 1997).
Students with ADHD that includes impulsivity and hyperactivity combined with

inattention are more likely to have anxiety disorders and other mood disorders

13

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and Often are more likely to present aggressive, defiant and oppositional
characteristics. Barkley (1997) stated, ”Findings from follow-up studies have
shown that early hyperactive-impulsive behavior is associated with a greater risk
for adolescent delinquency, early substance use and abuse, and school
suspensions and expulsions....” (p. 27). It is hypothesized that teachers will
give higher acceptability ratings to all treatments when the student described
presents the more severe problems of ADHD including hyperactivity and

impulsivity in addition to inattention.

The log; term side effects of ADHD. If left untreated, the effects of ADHD
include a progressive decline in academic achievement, higher incidence of
school drop-out, disturbances in peer relationships, low self-esteem, and lower
expectations or confidence Of success in the future (DuPaul & Stoner, 1994).
Hansen, Weiss, and Last (1999) published a 10-year prospective study of 18
young adult men (18 — 26 years of age) who had been diagnosed with ADHD in
childhood. They compared these young men with 18 males of similar age who
had never been diagnosed with psychiatric difficulties. The young adults with
ADHD were significantly more likely than the control group to report additional
psychological problems and to have dropped out of high school. The ADHD
males also tended to have a greater history of trouble with the law. Babinski,
Hartsough, and Lambert (1999) reported similar findings in their 15-year study of
230 males and 75 females. The results Show that both hyperactivity-impulsivity

and early conduct problems predict a greater likelihood of having an arrest

14

record for if
not at great-
document tl
more studie
that will be I

academic a

Justification

ADH
Psychiatric .
significant iI
The sympto
attention to
task to anot
times! more
al the table I
and/0r mace
1994)- This
DenomanCe
IOUline Clem;
SUQQesl that
adolescent C.

inteWentions

record for males but not for females. Children with attention problems only were
not at greater risk for criminal involvement. As the body of research grows to
document the long term effects Of ADHD in adolescence and young adulthood,
more studies are needed to find interventions that can be implemented early on
that will be effective in helping the students’ social/emotional development and

academic achievement.

Justification for ProvidingTreatment in the School Setting

ADHD is a mental health diagnosis that by definition ((American
Psychiatric Association, 1994) must present clear evidence of Clinically
significant impairment in social, academic, or occupational functioning.

The symptoms of ADHD are frequently Observed as lack of consistency in
attention to instruction, limited attention for multi-step tasks, moving from one
task tO another without completion of any one project, talking at inappropriate
times, more than average movement about the room such as leaving their seat
at the table or their desk at school, not working independently, and carelessness
and/or inaccuracy in the work that is done (Barkley, 1995; DuPaul & Stoner,
1994). This disorder negatively impacts a student’s ability to meet the
performance demands they encounter daily in the school setting as well as
routine demands of the real-world for goal directed behavior. DuPaul and Stoner
suggest that the lower confidence and expectations for success of the ADHD
adolescent compound the general academic decline. It makes sense that

interventions for treatment of the negative effects of ADHD would be classroom

15

based to be
made and d!
classroom n
the necessa
early stages
must occur a
the identifier
recommend
lngersoll, 19
states that
settings at tt
338).

Grest
Important for
ISSRSl of 0
among the It
classroom a:
instructions!
Work, StUder
studemS it th
the moist DO;
they Would Ia

lmewelllions

based to be near in place and time to where so many performance demands are
made and desired behaviors are expected. Possible treatments include
classroom modification and behavior interventions to help the student develop
the necessary organization skills, self-regulation, and response inhibition. In the
early stages of learning a new skill or stopping an old habit, the consequences
must occur as quickly and frequently as possible following the response. Thus, if
the identified problem behaviors occur during the school day, it is highly
recommend interventions take place within the school setting (Goldstein &
Ingersoll, 1993). Barkley (1997) refers to this as the “point Of performance” and
states that “...the most useful treatments will be those that are in place in natural
settings at the point of performance where the desired behavior is to occur.” (p.
338).

Gresham, Elliott and Black (1987) surveyed teacher rating of social skills
Important for success in the classroom using the Social Skills Rating Scale
(SSRS) of Clark, Gresham, and Elliott (1985). The teachers rated the following
among the top ten most important social skills for students (a) completes
classroom assignments in required time, (b) asks for help, (c) follows
instructions, (d) uses time productively, and (e) produces correct academic
work. Students also valued improved academics. When the researchers asked
students if they would rather be (a) a star athlete, (b) a straight-A student, or (c)
the most popular student, both boys and girls in sixth through eighth grades said
they would rather be a “straight-A student”. Thus it would seem that

interventions that target Improving student time-on task and academic

16

functioning. i.e..
by most classro

Homewo
children and yo
than just a sour
has been show
levels (Keith, it
deIleIIdenI vari
SChOOl-Home j
instruction trair
lhe above (Har
1994; Ollendici
Miller and KEIIE
through sixth g
reversal dESIgr
home‘IOIk; ob<

included use d

 

homewmk b er

before treatmel

the tour studej

treatment Was

Olymp;

 

 

functioning, i.e., assignments completed, on time and accurate, would be valued
by most classroom teachers.

Homework completion in general is Often a major problem for families of
children and youth with ADHD. Homework completion and accuracy are more
than just a source Of irritation for students, teachers, and parents. Homework
has been shown to contribute to improved student achievement across ability
levels (Keith, 1982; Keith & Page, 1985). Recent studies using homework as the
dependent variable have looked at the effects of specific interventions such as
School-Home Notes, response cost and/or Contingency Contracting, self-
instruction training, parent training programs, goal-setting, and combinations of
the above (Harris, 1986; Maag, Reid, & DiGangi, 1993; Miller & Kelley, 1992,
1994; Ollendick, 1982; Olympia, Sheridan, Jenson, & Andrews, 1994). The
Miller and Kelley (1994) study involved four parent-child dyads with fourth
through sixth grade students using a combination of multiple baseline and
reversal designs. Parents rated the quality and accuracy of their students’
homework; Observers rated “on-task” behavior. A parent-training component
included use of goal-setting and performance feedback for the students’
homework behavior. Total time spent on homework did not change but time on
task increased by 11 to 28% and work improved from between 64-71% correct
before treatment to 90 - 92% accuracy during treatment. However, in three of
the four students, accuracy rates returned to the lower baseline level when
treatment was withdrawn.

Olympia et al. (1994) studied homework completion and accuracy with a

17

group of sixt
acombinatit
selected 902
giving the st
and Kelley (
components
reinforceme
accuracy rat
performance
goals. SIUCII
behavior dec
homework or
the 16 show.
treatment ph

A COrr
Involved in tr
allects. Thu:
classroom pe

group of sixth grade students having difficulty with mathematics. This study used
a combination of self-management, two treatment conditions Of either self-
selected goals or teacher-selected performance goals, and group contingencies
giving the students more control over their homework behavior than in the Miller
and Kelley (1994) study. The self-management program consisted of four
components: Self-monitoring, self-instruction, self-evaluation, and self-
reinforcement. All students showed improved homework completion and
accuracy rates during the treatment phase. Students who self-selected
performance goals performed better than the students using teacher—selected
goals. Student performance in math improved and, concurrently, disruptive
behavior decreased. Once the treatment ended, 12 of the 16 students had
homework completion rates that dropped to pre-treatment levels but only four of
the 16 showed decreased accuracy according to data collected in the post-
treatment phase.

A comparison of these studies suggests that the more a student is
involved in the treatment plan, the greater the likelihood Of positive treatment
effects. Thus, it seems that students with ADHD might demonstrate improved
classroom performance if they were included in problem identification, goal

setting, and self-evaluation.

18

W

The thre
acceptability sc
Home Notes. E
of the individua
“normal” proces
principles of be
and social-lea."
intervention tee
f0”the the ba.

Sando,
belonging to O.
modifications 3
attemills to im
lcl modifying t
Studenl must i
a” have the QC
ClaSSIQOm l0 lI
avatying deg,

Wlllle enhanc.

 

School-Based Interventions Used to Assist Students with ADHD

Theory and Practice

The three intervention strategies presented in this study’s treatment
acceptability survey are Self-monitoring, Contingency Contracting and School-
Home Notes. Each Of these intervention techniques requires an understanding
of the individual student with ADHD in addition to an understanding of the
“normal” processes of cognitive, affective, and social development. The
principles of behaviorism, cognitive development, cognitive-behavior modification
and social-learning theory combine to contribute to the understanding of the
intervention techniques as something more than a single theoretical orientation
forming the basis Of each of the three intervention strategies.

Sandoval (1993) described school-based interventions as basically
belonging to one of three types: (a) changing instructional techniques, curriculum
modifications and attempts to modify the students classroom behavior; (b)
attempts to improve a student’s self-perception and self-understanding; and/or
(0) modifying the environment of the school and/or family system in which the
student must function. The three intervention plans included in the present study
all have the goal or desired outcome of changing the student’s behavior in the
classroom to improve learning behaviors. Across the three interventions, there is
a varying degree of emphasis on changing the student’s self-understanding.

While enhanced self-understanding might be achieved during implementation of

19

any of the t
emphasis C
Home Note
as to achie'
designed tc
that “reacth
will occur a
behaviors (
directed at
function. H
or parent in
in some We

All tr
aversive) tn
learning bet
Contingenc
aVeISlVe y
leClUired. E.
or in CONSuIt
take less the

and/0r 0tIler

any of the three interventions, Contingency Contracting places the least
emphasis on self-understanding. Both Contingency Contracting and School-
Home Notes do help identify expected behaviors and give the student comments
as to achievement of desired goals. The Self-monitoring plan is specifically
designed to enhance student self-understanding and is built on the assumption
that “reactivity”, a change in behavior as a result of improved self-understanding,
will occur and that the student will choose to improve classroom and learning
behaviors (Mace & Kratochwill, 1986). None of the interventions described is
directed at changing the environment or system In which the student must
function. However, it could be argued that any direct involvement Of the teacher
or parent in Changing the student’s behavior could affect relationships and thus
in some way affect the environment in which the student functions.

All three interventions described are presented as primarily positive (non-
aversive) treatments that focus on solving a problem related to the student
learning behaviors although the possible response cost procedure of
Contingency Contracting and School-Home Notes could be seen as somewhat
aversive. NO change in instruction, curriculum, basic materials or course work is
required. Each could be implemented independently by the classroom teacher
or in consultation with school support staff. Each intervention described should
take less then two hours of teacher time to (a) consult with students, parents,

and/or other staff, (b) develop the plan, and (c) create the individualized forms.

20

Students (at
increased in
critena. The
focus of res;
student's prI
teacher mai
ln School-HI
In Self-mom
the effects f
to obtain mc

Eafly
ADHD withir
Ming COUIC
grade male 5
response rat
BUIdlng on tl
among high 5
penorman Ce
have IOCUse-d
behaVior. Do

therapIES to a

Students (and parents in the case Of School-Home Notes) are provided with
increased information on teacher expectations, student goals, and performance
criteria. The essential difference between the three intervention types is the
locus Of responsibility for delivering the consequences or responding to the
student’s problem behaviors. In the Contingency Contracting model, the
teacher maintains control Of delivering the consequences for student behaviors.
In School-Home Notes, the parents are responsible for providing consequences.
In Self-monitoring it is the student who is expected to develop an awareness of
the effects his/her behavior has on others and to react by changing the behavior
to Obtain more positive results.

Early studies reporting on implementing interventions for students with
ADHD within the school setting focused on determining if treatment in the school
setting could be effective. Kirby and Shields (1972) found when one seventh
grade male student was provided with an academic program that improved his
response rate in mathematics, the student’s disruptive behaviors decreased.
Building on that idea, Keith and Page (1985) found that homework completion
among high school students contributed significantly to improvement in school
performance in general and across ability levels. Studies that are more recent
have focused on treatment goals of improving student self-control and on-task
behavior. Dobson (1988) presented a review Of cognitive problem-solving

therapies to address maladaptive behaviors and dysfunctional ways Of thinking.

21

Philner and '
address hyp
Henker (199
middle schor
decreasing r
to improving

included ass

Prior 1
Disabilities E
children diag
be education
services (Sw
fOuncl that th
ContinuoUSyy
throughout th
at the Univ 6r
sch°°l~base
with Altentio

Parallel Tear;

Pfiffner and O’Leary (1993) reviewed both home and school based strategies to
address hyperactivity levels in elementary school age children. Whalen and
Henker (1998) reviewed therapies for hyperactive children at the elementary and
middle school level Often directed at the goal of increasing compliance,
decreasing restlessness, aggressive behaviors and social withdrawal in addition
to improving academic achievement. However, none of the studies cited above

included assessment of treatment acceptability.

University of California-Irvine Child Development Center

Prior to the most recent Federal reauthorization bill, the Individuals with
Disabilities Education Act of 1997, about 45 to 50% of elementary school aged
children diagnosed with Attention-Deficit/Hyperactivity Disorder were not found to
be educationally impaired to the degree that would require special education
services (Swanson, 1992). However, many adults working with ADHD students
found that the students’ learning and behavior problems were manifested
continuously throughout the day and required Classroom interventions in place
throughout the school day. A group Of educators, psychologists, and physicians
at the University of California-Irvine Child DeveIOpment Center developed three
school-based intervention models for working with elementary school students
with Attention Deficit Disorder (Swanson, 1992). The three models are the

Parallel Teaching model, the Paraprofessional model, and the Multicomponent

22

model. The d
educational in
of appropriate
student's nee

The P2
University of I
model Involve
provide regul.
to monitor the
Teaching mot
and IGSponSE
teacher-studs

About.

SIQnifrcaht lea

the reouiar ed

of California-”
District Work e

supplementar

 

palalle] teaCh l

model. The differing models were designed for students with differing degrees of
educational impairment based on school evaluation and professional judgement
of appropriate educational placement and programming to meet the individual
student’s needs.

The Parallel Teaching model was developed by the group at the
University of California -lrvine lead by Linda Pfiffner (Swanson, 1992). This
model involves training teachers to do two things in parallel. They first have to
provide regular academic instruction to the entire class while scanning the room
to monitor the behaviors Of the identified students. Additionally, in the Parallel
Teaching model, teachers are trained to implement appropriate reinforcement
and response cost strategies toward the goal of increasing the frequency of
teacher-student interactions and avoiding the escalation Of disruptive behaviors.

About 35% to 40% Of students diagnosed ADHD are found to have
significant learning and behavior problems requiring special education support in
the regular education classroom (Swanson, 1992). The staffs of the University
of California-Irvine Child Development Center and the Irvine Unified School
District worked together to develop the Paraprofessional Model for delivery of
supplementary services to ADHD students in the general education classroom.
This model recommends the addition Of teachers’ aides (i.e., paraprofessionals)
to the general education Classroom. Teachers’ aides are trained to facilitate the

parallel teaching model described above and to expand on that to include a daily

23

report card corr
training and cor
services could I
classroom settt
classes meet Vt
instruction sorr
Aboutl

placement in s
multicompone
b6havioral Spe
Dhannacologh
The behavior

COntingency ‘
be Used to te

the COHIInUOL

%

Shaph
Used in the 9

Student in ch

report card component and a skill remediation component to provide social skills
training and cognitive behavior modification programs. The paraprofessional
services could be provided individually or in small groups either within the
classroom setting or in a “pull-out” program where children from one or more
classes meet with the paraprofessional outside the classroom for short term
instruction sometime during the school day.

About 10% to 15% Of students diagnosed ADHD were found to require
placement in special education classroom and received a more intensive
multicomponent program of 10 to 15 students team taught by a teacher and a
behavioral specialist. This third level model included assessment of
pharmacological treatments, parent involvement groups and individual meetings.
The behavior modification programs are extended to the home setting.
Contingency Contracting, skills training, Self-monitoring and self-evaluation may
be used to teach for generalization across settings and to help maintain
behaviors and teach the concepts of responsibility and privilege while fading out

the continuous use of tokens for Contingency Contracting.

Self-mamement
Shapiro and Cole (1994) developed a multicomponent program to be
used in the general education setting. The goal of this program is to put the

student in charge using self-management interventions in the classroom to teach

24

responsibility
settings. This
focus on their
appropriate b
locus of inter
external cues
to record on:
individual per
and ifso to s
reinforcemer

learned in on

W
Self-IT

Identify goals

goals. and (c
take” (OI not
Siialegies ls l
psiChO'Oov (l
pamClDants ir

social learnin

responsibility for managing academic skill and social behaviors across multiple
settings. This cognitive-behavior modification approach teaches students to
focus on their own behavior and antecedent events or environmental triggers for
appropriate behaviors as well as the inappropriate. This strategy moves the
locus Of intervention toward student self-management. The program begins with
external cues for the student to stop, pay attention to what he or she is doing and
to record on-task and Off-task behavior. The student is taught to evaluate
individual performance against set criteria, to determine if the criteria are met
and if so to select from a menu of possible reinforcers. The external cueing and
reinforcement is faded out over time as the student is taught to transfer skills

learned in one specific time period to other times and other classes.

Three Intervention Strategies Presented in This Study

Self-monitoring The Self-monitoring strategy teaches students to (a)
Identify goals or “target” behaviors, (b) identify steps required to achieve those
goals, and (0) state awareness of natural reinforcers or consequences for actions
taken (or not taken). The need for some individualization of the intervention
strategies is in line with the basic assumptions of cognitive-behavioral
psychology (Hughes & Hall, 1989). Individuals are expected to be active
participants in their own learning. This perspective builds on Bandura’s (1977)

social learning theory, research on observational learning, and the potential for

25

an individual to
Ileichenbaum':
on the cognitiv:
The Set
level of most rr
recipients of ft
the environme
to understand
their own situe
0n the individi
understanding
SUPDOII Furl
situation, invc
generate Way
Gardnt
be Used with
claserOm Se
Willi children
as Students Il
rellon On Set

OI mental IQI.‘

an individual to be an Observer Of their own behavior. This thinking merges with
Meichenbaum’s (1977) work in self-instruction training which was based, in part,
on the cognitive and developmental psychology Of Vygotsky (1962).

The Self-monitoring strategy can be a good match for the developmental
level of most middle school and high school students who are the potential
recipients Of the treatments discussed in this study. Adolescents tend to view
the environment from the perspective of the individual. Teaching students how
to understand, recognize and change environmental contingencies by analyzing
their own situation and systematically making a change for their benefit focuses
on the individual in the here and now. This gives the adolescent a basis for
understanding his/her own behavior while providing instruction, practice and
support. Furthermore, it allows students to look at their own behavior and
situation, involves them in determining what is problematic and allows them to
generate ways to change their own behavior.

Gardner and Cole (1988) reported that Self-monitoring procedures could
be used with one or more individuals within a group and with whole groups or
classroom settings. They suggest that Self-monitoring procedures can be used
with children and adolescents presenting a variety Of individual differences such
as students in general education, special education, or residential settings. They
report on Self-monitoring procedures being used with students having diagnoses

of mental retardation, learning disabilities, behavior disorders, hyperactivity,

26

psychiatric im
high school w
concluded the
could be self-
characteristic
that the proce
school setting

Shapu
demonstratec
task behavior
study, three 1
behaviors, T
”0'" 2080%
(1987) IBDIIC;
glade SlUden
did the 1991 ,
adoleSCents (
the Seth—“om

GIOmb
WATCH to i”

as having beh

psychiatric impairment, and general education students from preschool through
high school with no identified impairment at all. Gardner and Cole (1988)
concluded that, “Although the type, number, and complexity of behaviors that
could be self-monitored vary among children and adolescents differing in
characteristics such as age, cognitive level, and emotional status, it is evident
that the procedure may have utility with the entire range of children served within
school settings.” (p. 209)

Shapiro and Cole (1994) reported on numerous studies that have
demonstrated effectiveness of Self-monitoring on increasing attention and on-
task behaviors. In the Hallahan, D. R, Marshall, K. J., & Lloyd, J. W., (1981)
study, three 10-year-Old students were taught to self-monitor their on-task
behaviors. The result showed increase in on-task behavior for all three students
from 20-30% time-on-task to 50-80% time-on-task. Hughes and Hendrickson
(1987) replicated the Hallahan et al. (1981) study with 12 fourth, fifth, and sixth
grade students in a regular education classroom and achieved similar results as
did the 1991 study by Prater, Joy, Chilman, Temple, and Miller who taught five
adolescents (twelve to seventeen years of age) with learning disabilities to use
the Self-monitoring technique in math, social studies and in study hall.

Glomb and West (1990) used a Self-monitoring technique they called
WATCH to improve creative writing skills for two high school students identified

as having behavior disorders. The results of the study showed significant

27

improveme
mMaHeveE
correct on I
In a
nmnhonng
meta-analy
monhonng
of techniqu
other SBIf-Tt
Sehrnonhc
mognnn.
(loot
henegoha:
describes ti
and/or a de
tol‘eIIS) if it

 

IncreaSe Ill
reported th
Contractin.

improvement in the percentage of words completed on writing assignments from
initial levels Of near zero words written to between 70% and 100% of the words
correct on weekly writing assignments.

In a recent study of the effectiveness of interventions using Self-
monitoring and other self-regulatory techniques, FebbarO and Clum (1998) used
meta-analysis to assess the effect size Of Self-monitoring alone and Self-
monitoring in combination with other self-regulatory techniques. All combinations
of techniques were more effective than no treatment. Self-monitoring plus any
other self-regulatory techniques was more effective than Self-monitoring alone.
Self-monitoring is a component Of Shapiro and Cole’s (1994) self-management
program.

Contingency Contracting. This behavior management technique involves
the negotiation Of a contract between student and teacher. The contract
describes the reinforcement for desired levels of academic and social behaviors
and/or a description of the response cost (i.e., loss of privileges, points, or
tokens) if the student engages in behaviors that are not acceptable. This blend
of reward and response cost in Contingency Contracting has been shown to
increase the levels of on-task behavior, 1994). Rapport, Murphy & Bailey (1982)
reported the amount of classroom improvement found with Contingency
Contracting as the only form of treatment equaled the amount of improvement

obtained by students receiving stimulant medication for ADHD.

28

An imr
of the time dt
delivering the
This interver
behavior anc

The c
contract are
With older 5‘
there is mutt
regardless o
reinforcers,
has trouble i
I‘éacher coul
engages in y
lo a Classm~

Stude
relilllorcer. T
Intended to
that caUSes
p0SIIIVe C0,.

on mOSt da‘

 

 

An important variable to consider when developing a contract is the length
of the time delay between the behavior and the consequence. Optimal timing for
delivering the consequence is at the end of the Class period or that school day.
This intervention loses effectiveness as the time increases between the student’s
behavior and the delivery Of the consequence.

The choice of behaviors targeted for change and the development of the
contract are both important variables that can affect the success of the contract.
With Older students it is advisable to negotiate directly with the student to be sure
there is mutual understanding of behaviors that need to change. All students,
regardless of age, should be involved in developing a menu of possible
reinforcers. Reinforcers are very individual and situation specific. If the student
has trouble identifying preferred activities that could be used as reinforcers, the
teacher could suggest some of the “Off-task” behaviors that the student typically
engages in when they are expected to be attentive in class (for example, talking
to a classmate, drawing, wanting to get something from their locker, etc).

Students can loose points they have been working for to acquire a desired
reinforcer. This is a response cost procedure similar to punishment in that it is
intended to decrease the likelihood of the students continuing to do whatever it is
that causes them to lose points The teacher needs to be sure that the number Of
positive consequences outweigh the number Of negative consequences and that

on most days the child acquires more points than they can loose. A student’s

29

point tot:
power at
consequ

Rt
parents c
point sys
procedurt
clinical e)

Hc
disruptive
treatment
settings 0'
Phase Ont
Classroon
and a rail
5=excerret
tithe; and

the tl'IIEe

 

the ll'lfee

uSlIOngly

 

point total should never fall below zero or the response cost procedure loses its
power and the student could continue to be disruptive or Off-task and the
consequences would be non-existent as one can not lose what they do not have.

Robin (1998) recommended behavioral contracts and point systems for
parents Of adolescents with ADHD using allowance and household chores or a
point system for younger adolescents (age 11 — 13). He outlined a multistep
procedure for designing a point system basing the suggestions on years Of
clinical experience of his own and others (Barkley 1996).

Hoff and DuPaul (1998) designed a three-phase treatment study of
disruptive behaviors such as hitting, kicking, and being verbally aggressive. The
treatment included a token system and took place across three classroom
settings Of reading, math and recess for three 9-year-old students with ADHD.
Phase one of the treatment was a baseline count of disruptive behaviors.
Classroom rules and appropriate reinforcers were discussed with the students
and a rating scale was developed to rate compliance with classroom rules setting
5=excellent, followed all the rules; 3=average, followed rules about 80% Of the
time; and 0=totally unacceptable. The researchers recorded individual data on
the three students in each of three classroom settings. Disruptive behaviors for
the three students decreased from 30-32-33% to 9-10 and 12% respectively.
Treatment acceptability ratings were Obtained. Teachers rated the treatment as

“strongly agree” that the treatment was beneficial. The children rated the

30

treatments

would help

Sch

 

daily repor
staff to wo
help devel
success.
School-Ho
specific re
Progress, :
reinforcing
Mar
Classroom
Ial focusin
they work l
to Change,
Implement
that IOCUSE
inCIEaseS l
Self‘estee
t6acher ti

treatments as “strongly agree” that they liked the intervention and thought it

would help them do better in school.

School-Home Notes. The School-Home Note strategy is similar to using a
daily report card. It is a form of communication that allows parents and school
staff to work together to clarify expectations both at home and at school that will
help develop a students learning and/or social behaviors and promote school
success. When both parents and teachers are willing to work together, the
School-Home Note can be an effective tool that focuses teacher attention on
specific relevant behaviors. This keeps the parents informed of the students’
progress, and provides a structure for delivering consequences at home thus
reinforcing the home-school connection.

Mary Lou Kelley’s (1990) book, School-Home Notes: Promoting Children ’8
Classroom Success, presents the primary advantages of School-Home Notes:
(a) focusing on collaborative problem solving between parents and teachers as
they work together to define the problem behaviors, decide what behaviors need
to change, set goals, decide on treatment methods, and work together to
implement the plan; (b) provides parents and students with frequent feedback
that focuses on how the student is improving and what the student does well,
increases the likelihood of parental praise and enhances the student’s sense of
self-esteem and control over their situation; (0) requires a minimal amount of
teacher time as it is not necessary to significantly alter the daily classroom

routine; and (d) does not produce a perception Of inequity of giving special

31

rewards It
based at I
options th
the use of
students
oooperatir
notes bac
fax or e-m
conseque
Ear
effective ir
disruption
children pl
(i990) ela
title. Kelle
i"Illlemert
Seventh g
homewor
aVErage r .
SChoolH
daily 338,1,
for Class,

Within tw,

 

rewards to only a few students in the Classroom as the reinforcement system is
based at home where parents usually have a wide range of reinforcement
Options that are more meaningful to the student. Three important variables in
the use of the School-Home Note include (a) the teachers emphasis on the

student’s positive rather than negative behaviors (for example, _behaved
cooperatively before and during class”), (b) reliance on the student to get the
notes back and forth between school and home (although this could be done by
fax or e-mail), and (c) the parents following through with appropriate
consequences at home.

Early studies of effectiveness found the School-Home Note strategy to be
effective in increasing academic performance and decreasing classroom
disruption with adolescents (Wolf et al., 1976). Ginsburg (1990) found that
children prefer reinforcers available at home to those available at school. Kelley
(1990) elaborated on the School-Home Note procedure in her book by the same
title. Kelley presents case illustrations Of students for whom this treatment was
implemented and found effective. One student, Jim, a 13-year-old student in the
seventh grade was described as disorganized, inattentive, frequently losing
homework papers and talking during class. He was assessed as having an
average range of cognitive functioning but not working up to his potential. A
School-Home Note system was selected to keep Jim and his parents informed of
daily assignments. The behaviors recorded on the home note were “prepared

for class, used class time well, participated in class, and handed in homework.

Within two months Jim’s classroom behaviors improved to a satisfactory level

32

and by four

 

Characteris
Ag;
each child.
to another
somewhat
as the stu
hstwhet
self-com,
experien
BSIEem,
Conflict .
F
iii a rel;
Whicha
InternE
meao

deveh

and by four months his academic performance gradually Improved as well.

Conflons That Mav Influflce Treatment Acceptability

_Laracteristics Of the Person Receivigq the Treatment

Age of the client or student. As stated earlier, not all symptoms apply to
each child. Behaviors characteristic Of ADHD such as jumping from one activity
to another, losing things, not listening to directions, being very active or
somewhat shy and withdrawn may be accepted as normal in early childhood, but
as the student grows older these behaviors become much more problematic.
Just when there is an increase in the demands for good problem-solving ability,
self-control, study habits, and organizational skills, the ADHD adolescent often
experiences academic performance deficits, social-skills deficits, low self-
esteem, and an increase in conduct problems, depressive symptoms, and family
conflict (Brown 8 Borden, 1986; Robin & Foster, 1989).

From a stage theory model of development, there is a basic assumption
Of a relatively standard progression of identifiable patterns Of changes through
which all people progress as they move toward independence. Children
internalize the behaviors they have practiced by reconstructing and transforming
the activities and experiences as they move through the stages Of earlier

development (Vygotsky, 1962). Between the ages of 9 and 15 children begin to

33

develop I
and meet
competer
possibiliti
systemat
those of l
(Hoffman
style is m

Tr.
growth to
Opportun
type of re
need to t
Presenter
bener def
“IISkilled.
DIOblemS
DIOCeSS! '
1993). Pt
develop 8

able to bu

develop the skills necessary for working with another person to solve conflicts
and meet mutual goals, the building blocks of collaboration and social
competence (Yates & Selman, 1989). Most adolescents are able to think about
possibilities. They can think about abstract concepts and ideas, they can
systematically test hypotheses, they can think about their own thoughts and
those of others, and they can consider the psychological viewpoints of others
(Hoffman, Paris, & Hall, 1994). This developing cognitive, social and behavioral
style is not always possible for the adolescent with ADHD (Barkley, 1997).

The primary task of adolescence, according to Robin 8 Foster (1989), is
growth towards independence. In order to achieve that growth, youth need an
opportunity to interact with someone with whom there is a trusting or intimate
type Of relationship to develop a sense Of belongingness and self-esteem. They
need to be engaged in the constructive solution of the problems they are
presented with and the problems they present. Most middle school students are
better decision-makers than younger children are but they are relatively
unskilled. With the help Of adults and more competent peers, children solve
problems they could not solve by themselves. At each step in the developmental
process, children gain more and more control over their behavior (Takanishi,
1993). Providing a supportive social structure that allows the adolescent _tO
develop self-control helps build a sense of control and competence. Students

able to build a sense of control, competence, commitment and caring in one

34

setting
belongi
made
over ch
control)
called s
associa
rates of
T
develop!
gratificat
Compete
al- (1994‘
generate
comprom
kn0Wledgi
SOmetime

Zi

low or ste

depressio

 

setting usually generalizes to other settings and supports a general sense of
belongingness and self-esteem. Adolescents must be willing to make a decision,
to act on the decision, and need to believe that he or she has a degree of control
over choices, behavior, and the potential outcomes (i.e., an internal locus of
control). Zimmerman, Copeland, Shope, and Dielman (1997) found what they
called self-esteem trajectories for adolescents. A high level of self-esteem was
associated with better grades in school, lower rates of delinquency and lower
rates of illegal substance use.

The ability to delay gratification is an essential element in the
development Of self-control and social maturity. Children who are able to delay
gratification are more competent later in life at handling daily problems, making
competent decisions, setting goals and making plans for the future. Hoffman et
al. (1994) refer to this as “practical intelligence” which involves the ability to
generate options, consider consequences, anticipate obstacles, and make
compromises. This is also a sign of the development of metacognitive
knowledge, as students begin to regulate and control their own learning activities
sometimes referred to as self-regulated learning (Zimmerman, 1990).

Zimmerman et al. (1997) found that adolescence is frequently a time of
low or steadily decreasing self-esteem, which is Often associated with
depression, suicide, delinquency, substance use, and poor academic outcomes.

Decreased parent involvement typical during the secondary school years may

35

also n69at
adolescen
parents SL
trajectory.
availability
for adolest
ADHD. Tr
achieveme
Trautlein, '

@
continues I
treatment;
the probler
setting Whe
lnterventio
behaviors y

Miltenberg.

Mpg

Tre

Variables z

 

also negatively influence Optimal developmental outcomes. Although
adolescents typically want greater autonomy, they still need to know that their
parents support their goals. TO have a positive impact on the developmental
trajectory, there needs to be an intentional organizational effort to alter the
availability of supportive relationships and resources for adolescents particularly
for adolescents with health or learning problems such as those associated with
ADHD. To neglect the individual needs Of the student leads to poor school
achievement and increased rates of school dropout (Price, Gioci, Penner, &
Trautlein, 1993).

Sgeritv Of the goblem behavior. Problem severity has been and
continues to be among the most common variable included In studies of
treatment acceptability. Many of the studies reviewed reported the more severe
the problem behavior, the higher the acceptability rating except in the school
setting where there is often an interaction effect of time involvement.
Interventions requiring less time are less acceptable for the severe problem
behaviors (Calvert & Johnston, 1990; Gajria & Salend, 1996; Kutsick, 1991;

Miltenberger, 1990; Reimers et al. 1992b).

TheType, Description. and Design of the Intervention
Treatment acceptability research in the past 10 years has investigated

variables associated with treatment acceptability such as: positive/reward

36

treatmt
probler
amoun‘
instruct
Reimer;
wmmm
been (a
descfibe
for imple
problem
fl
frequentl-
lb) reinfo
behavior;
ad'clhtatio
DIEterred
Bekeny‘ 1
rated low
Schumm ,
I€Inforoen

mOSl BC“

 

 

treatment vs. negative/time-out or punishment procedures, severity of the
problem to be treated, and perceived effectiveness Of the treatment and the
amount of time, resources needed tO implement the treatment and need for
instructional modifications (Elliott, 1988a, 1988b; Johnson 8 Pugach 1990;
Reimers et al. 1992a, 1992b; Whinnery, Fuchs, 8 Fuchs, 1991). The most
common variables studied for effects on treatment acceptability ratings have
been (a) intervention type, (b) treatment effectiveness, (C) how the treatment was
described, (d) the complexity and time involved, (e) who was to be responsible
for implementation of the intervention, and (f) the severity of the behavior
problem to be treated.

Intervention types. According to Calvert and Johnston (1990) the most
frequently assessed types of interventions include (a) some variation of time-out,
(b) reinforcement, (c) response cost, (d) pharmacological intervention, (e)
behavioral contracts, (f) self-monitoring, and (g) instructional modifications or
adaptations to curriculum. The pharmacological intervention was rated as least
preferred by parents (Brown 8 Sawyer, 1998; Tarnowski, Simonian, Part, 8
Bekeny, 1992). Instructional modifications or adaptations to the curriculum were
rated low in acceptability by teachers (Johnson 8 Pugach, 1990; Munson, 1987;
Schumm 8 Vaughn, 1991; Whinnery et al. 1991). Positive treatment or
reinforcement-based treatments designed to increase behaviors were rated as

most acceptable (Calvert 8 Johnston, 1990; Gajria 8 Salend, 1996; King et al.

37

1998; Mill
interactior
acceptabl
training (v
resources
level (Hart
have rece
Sdend,1l

@
given trea‘
treatment
behaviors,
(Calvert 3,

@
Effect the t
treatments
d‘v‘SCribed
“plasmahc

ROIIdEr| A)

 

haVll‘lg all

Com’EISa:

 

1998; Miltenberger, 1990; Rasnake, 1993; Tarnowski et al. 1992). Some
interaction effects have been noted. Social reinforcement was significantly more
acceptable but primarily for mild problem students. Self-instructional strategy
training (which was seen as more intensive and costly in time, effort and
resources) was rated as significantly more acceptable at the severe problem
level (Harris, 1990). Usually the more complex and time intensive treatments
have received lower acceptability ratings (Calvert 8 Johnston, 1990; Gajria 8
Salend, 1996; Miltenberger, 1990).

Data on effectiveness. Descriptions of the expected effectiveness Of a
given treatment at the initial or pre-treatment stage positively correlate with
treatment acceptability. The exception is that for more severe problem
behaviors, efficacy information does not influence treatment acceptability ratings
(Calvert 8 Johnston, 1990; S. Elliott, 1990).

The language used in describing the treatment. Professional jargon can
effect the treatment acceptability rating. Calvert and Johnston (1990) found that
treatments described as “behavioral” received the lowest ratings. Treatments
described as “humanistic” received higher ratings. The treatments described as
“pragmatic” received the highest acceptability ratings. Elliott (1988a) and
Rolider, Axelrod and Van-Houten (1998) also found communication style as
having an effect on acceptability ratings. The optimal style included the use of

conversational language followed by detailed descriptions Of the intended

38

outcome.

It;
and implen
questioned
collaboratit
reported pr
Sheridan, '

charge oft

1990; Ellio

Rec
at3I3t-2-ptabili
characteri
community
teachers v
groups ha:
rankings 0

Mo
Specific p,

19Sailing

 

outcome.

Thiperson in charge Of impfinentigg the intervention. The development
and implementation of the intervention is viewed differently by staff members
questioned. Teachers report that they prefer to develop the intervention plans in
collaboration with the school psychologist (Kutsick, 1991). School psychologists
reported preferring a 3-way collaboration with teachers and parents (Colton 8
Sheridan, 1998; Sheridan, 1995). Teachers generally prefer to be the one in
charge of the actual implementation of the intervention (Calvert 8 Johnston,

1990; Elliott, 1988b).

Characteristics of the Raters.

Recent studies include rater characteristics the evaluation treatment
acceptability. Earlier studies (Miltenberger, 1990) reported on rater
characteristics only in broad terms of role of the rater, i.e., institutional staff vs.
community based staff, or college students and their mothers, or students vs.
teachers vs. school psychologists. In general, differences between adult rater
groups have not been substantial, and most comparisons yielded similar relative
rankings of treatments (Calvert 8 Johnston, 1990).

Most recent studies have looked at acceptability of interventions for
specific populations such as children with cancer (Miller, Manne, 8 Palevsky,

1998), instructional interventions for mainstreamed students (Allinder 8 Oats,

39

1997: 5
student
Bennet
f
are the
race we
a later 5
vary as a
severity.
Behavior
interventi.
Th1
of treatme
The two In
The resear
IBIaled to j)
initial acce
The author.
adherenCe
Mill

that may 3!.

 

1997; Sheridan, 1995; Smith, Young, Nelson 8 West, 1992) and specifically at
students with ADHD (Bennett, Power, Rostain, 8 Carr, 1996; Power, Hess 8
Bennefl,1995)

Parents. Preliminary studies assessing interaction effects when parents
are the ones rating treatment acceptability indicated that parental income and
race were related to acceptability judgements (Heffer 8 Kelley, 1987). However,
a later study by Tarnowski et al. (1992) found that treatment acceptability did not
vary as a function Of maternal race, socioeconomic status or the child’s symptom
severity. The main effect found in the Tarnowski study was for type Of treatment.
Behavioral treatments were rated as acceptable and pharmacological
interventions rated as unacceptable.

The Bennett et al. (1996) study assessed parent acceptability Of two types
Of treatment for children with ADHD who were being seen in an outpatient clinic.
The two treatments described to the parents were counseling and medication.
The researchers reported that the parent’s knowledge of ADHD was positively
related to their initial acceptability ratings of stimulant medication. However,
initial acceptability of each treatment did not predict adherence to the treatment.
The authors conclude that more information is needed to predict client
adherence to treatment beyond initial acceptability ratings.

Miller and Kelley (1992) also studied treatment acceptability and variables

that may affect the acceptability ratings including parent characteristics. The

40

rank order c
gender or rr
following or
chair time c
for gender
actual scor
six treatme
the severity
distress ga
positive rei
room as a -
that distres
negative in
When man
increased
on the pan
With as re
SUIIOUndjn
Chi .

\

adults, Cr

plans. TIIE

 

rank order of treatment preference was similar for all parents regardless of
gender or marital distress. Treatment conditions were generally ranked in the
following order: 1) positive reinforcement, 2) response cost, 3) room time out, 4)
chair time out, 5) spanking, and 6) medication. While there was no main effect
for gender or marital adjustment, there were significant interaction effects as the
actual scores on the parent’s acceptability ratings differed significantly across the
six treatment conditions depending on parent gender, marital adjustment, and
the severity Of the child’s behavior. Parents with a higher degree of marital
distress gave Significantly lower acceptability ratings for treatment involving
positive reinforcement and higher acceptability ratings for time-out in the child’s
room as a treatment Option. The authors suggested a possible explanation in
that distressed parents may be accustomed to relating to their family in a
negative manner and thus be more inclined to use aversive control techniques
when managing problematic behavior as marital discord is associated with
increased maternal negativism towards children. Increased interpersonal stress
on the part Of the parents may result in the greater acceptance of procedures
such as room time-out that remove the child from the parent’s immediate
surroundings (Miller 8 Kelley, 1994).

Children . Children’s ratings of treatment types differ significantly from
adults. College students were the most negative in their ratings of all treatment

plans. The younger students preferred in-classroom behavior contingencies to

41

removal tron
(Waas 8 An

lega_c_
regular edur
rate the acc
Students re
percent of v
resulted in a

quantity of ,

 

However, tiL
general edt
setting, Je
teachers to
found Som.

the differer

 

ldentifrcatic

the reading

by S. L‘ DE
In tf
was USEG I

 

 

removal from the classroom for group counseling or special class placement
(Waas 8 Anderson, 1991)

Teachers. The Smith, Young, Nelson and West (1992) study asked
regular education teachers and students trained for inter-Observer agreement to
rate the acceptability of self-management procedures for 8 tenth grade boys.
Students recorded percent of work completed for English assignments, the
percent Of work correct, and time on task. The self-management procedure
resulted in a decrease in disruptive behaviors and an increase in both the
quantity of academic work completed and the quality Of the work done.
However, the benefit did not transfer from the special education setting to
general education until the treatment was initiated in the general education
setting. Jenkins and Leicester (1992) worked with 10 elementary school
teachers to design instruction for students with reading problems. They also
found some differences between general and special education. In this case,
the difference was in the general education teachers’ approach to problem
identification, selection and implementation Of instruction to meet the needs Of
the reading problem identified compared to the findings of a study done in 1985
by S. L. Deno with elementary level special education resource teachers.

In the Allinder and Oats (1997) study, Curriculum Based Measurement
was used to measure math achievement for 42 third through sixth grade

students in special education. A positive relationship was found between

42

acceptability
Neither teac

Funk
raters mom
that influenr
client chara
study is des
acceptabilitj

The |
at specific v

treatment at

parent and (

 

acceptability ratings and the implementation Of Curriculum Based Measurement.
Neither teacher nor student characteristics were related to the outcome.

Further research is needed to determine which characteristics Of the
raters account for differences in acceptability. Learning more about variables
that influence treatment acceptability will assist in enhancing a match between
client characteristics and choice Of treatment (Calvert 8 Johnston, 1990). This
study is designed to look for teacher characteristics that may influence treatment
acceptability.

Interaction Of Variables.

The past five or six years of treatment acceptability research has looked
at specific variables such as gender Of parent rating the acceptability of
treatment and the quality of the relationship between parents and between
parent and child (Kemp, Miltenberger 8 Lumley, 1996; Miller 8 Kelley, 1992).
Age and gender of the child (Phares, 1996), gender Of the student depicted in
the case vignette (Miller, Martens 8 Hurwitz, 1990; Phares, Ehrbar 8 Lum 1996),
race and socioeconomic status (Tarnowski, Simonian, Park 8 Bekeny, 1992)
have been included as possible confounding variables in the design of treatment
acceptability studies. In most studies, the child’s age, grade, gender and
location of the misbehavior have had no effect on ratings of treatment
acceptability (Calvert 8 Johnston, 1990; Miller et al.1990; Phares, Ehrbar 8 Lum,

1996). However, Calvert and Johnston found an interaction of age with type of

43

treatment. I

acceptable f

Prior Resez

At tht
assess teag
with ADHD.
strategies It
With either /
acceptaburt
was a multr
plaYQIOUnd
phase Was
resWises. ,

and leache

 

dining the t

whe” the It

 

treatment. In their study, reinforcement procedures were rated as more

acceptable for older children than for younger children.

Prior Research on Accepta_bilitv Of SchooLBagd Interventions for Students with

ADHD

At the time Of this writing, only two studies have been published that
assess teacher acceptability Of school-based treatment for students diagnosed
with ADHD. Hoff and DuPaul (1998) studied the use of self-management
strategies to decrease disruptive behavior of three 9-year Old students diagnosed
with either ADHD or Oppositional Defiant Disorder (ODD). Teacher and student
acceptability ratings were collected before the initiation Of the treatment. This
was a multiphase treatment across two general education settings and
playground time. After baseline measures were collected, a token reinforcement
phase was initiated to teach the students to rate their own behavior. Teacher
responses and reinforcers were used during this phase. Student self-evaluation
and teacher evaluations were compared to assist the students to accurately self-
evaluate their behavior. Eventually the teacher ratings were faded to an average
of once every six days. There was a general decrease in aggressive behaviors
during the treatment. A lower level of disruptive behavior was maintained even

when the teacher was not present. The teachers found this treatment initially

44

acceptable
consistently
treatment ir
The .
middle sch
five possibl
Teachers I
included (a
response c
medication
days, (d) a
and (e) a C
The resear
reshonse c
accelitable
high numb
Particularly
was ”OI cc

 

acceptable. However, one teacher reported that she did not have time to
consistently rate students during the teacher matching phase and found this
treatment intrusive and time-intensive.

The Power, Hess, and Bennett (1995) study asked elementary (n=76) and
middle school (n=71) teachers in regular education to read vignettes describing
five possible configurations Of school-based interventions for treatment Of ADHD.
Teachers then rated the acceptability of each treatment type. The interventions
included (a) use of a daily report card with school based consequences, (b) a
response cost procedure with school based consequences, (c) a stimulant
medication treatment requiring the teacher to cOmplete a checklist daily for 20
days, (d) a combination of the daily report card and the stimulant medication,
and (e) a combination of the response cost procedure and stimulant medication.
The researchers found that the daily report card was more acceptable than the
response cost procedure. Both behavioral treatments were viewed as more
acceptable than the medication alone by elementary teachers although a fairly
high number of teachers rated the response cost procedure as least acceptable
particularly among the middle school teachers. Teacher knowledge of ADHD
was not correlated with ratings Of acceptability. The number Of years of teaching

experience was also not related to acceptability ratings.

45

This
two clinical
problems a
Psychiatric
three simila
the effects
behaviors 2
treatments
the teacher
of teachingl
With the int
differential
intefaction

differences

 

counterbal
by the we
I

This

of masher

 

Variabis to be Assessed in This Study

This research project asks middle school and high school teachers to read
two clinical vignettes of students with ADHD, one with mild to moderate behavior
problems and one severe as described in the DSM-IV criteria (American
Psychiatric Association, 1994). Each vignette is followed by descriptions of
three similar intervention plans that have been shown effective in ameliorating
the effects of ADHD. All three treatments are designed to increase desired
behaviors and are similar in complexity and teacher time involved. The
treatments are described in conversational language and can be implemented by
the teacher. Teacher rater characteristics to be assessed include gender, years
of teaching experience grade level taught, type of class taught and familiarity
with the intervention plan. The primary goals of the study are to look for
differential acceptability rates for the three interventions, to look for possible
interaction effects, and to determine if rater characteristics account for
differences in acceptability. The information on students and treatment types is
counterbalanced in the survey format to determine if teacher opinion is affected
by the order in which the material is presented.

This study is unique in that it accessed the opinions of over 100 middle
and high school teachers in several school buildings in more than one school
district. The focus was on teacher opinion and included a measure of reliability

of teacher opinion with the counterbalanced design. Based on the Jenkins and

46

Leicester (i

of regular e

 

 

and implen‘
general ant
_ I
characteris
In 5.
based behe

and used 5

 

 

medication
(Cl assessr
Education

eXaminatir

accelitabi

Leicester (1992) suggestion that there may be a difference between the opinion
of regular education and special education elementary teachers in their choice
and implementation of intervention, this study separated the responses of
general and special education teachers in addition to a variety of other teacher
characteristics that may influence treatment acceptability.

In summary, this study is distinctive in terms of its (a) focus on school-
based behavioral treatments to be implemented at the secondary school level
and used separately rather than in combination with other treatments such as
medication, (b) sample size with secondary level teachers with ADHD students,
(0) assessment of the reliability of teacher opinion, (d) comparison of regular
education and special education teachers at the secondary level, and (e)
examination of selected teacher characteristics that might moderate treatment

acceptability

47

This

 

based inter
identify go
goals, and
actions or
adolescen
of a mutua
the rewarc
of the con
School-H
Parent th
ellpectati
behaving

Re

SDecific t
I

intewenn

 

CHAPTER 3

Methodology

This investigation obtains teacher ratings of acceptability of three school
based interventions. The Self-monitoring intervention teaches students to
identify goals or “target” behaviors, identify steps required to achieve those
goals, and to state awareness of natural reinforcers or consequences for their
actions or lack of action. Contingency Contracting, as described here in use with
adolescents, is a behavior management technique which involves the negotiation
of a mutually agreed upon contract between the student and teacher describing
the reward for desired levels of academic and social behaviors and a description
of the consequences if the student engages in behaviors that are not acceptable.
School-Home Notes are a form of written communication between teacher and
parent that allows parents and school staff to work together to clarify
expectations that will help the students develop desired learning and/or social
behaviors.

Relevant information about the teachers was obtained to determine
specific teacher characteristics such as gender, years of teaching experience,
and courses/grades taught. This is done to help determine if there are any
specific characteristics that may influence the acceptability rating of a given

intervention.

48

Print

 

districts we
school dist:
demograph

one high so

 

 

middle schr
school teac
in this one
allowed so
receiving 5
teachers r
district. C
hdudedi
99nder,:
Participa
reported
edullatic

Silldy.

Particigants

Principals in all of the middle and high schools in two public school
districts were contacted for permission to distribute surveys to teachers. The two
school districts are located in one North Central State and have similar student
demographics. Of the eight schools in one district, only one middle school and
one high school principal allowed distribution of the surveys. Thirteen of the 82
middle school teachers returned completed surveys. Eighteen of the 81 high
school teachers returned surveys. This is a 19% return rate for the two schools
in this one district. In the second district, principals in seven of the eight schools
allowed survey distribution. Thirty-nine of the 212 middle school teachers
receiving surveys returned completed surveys. Forty-five of the 294 high school
teachers returned surveys. This is a 16.6% return rate for the second school
district. Of the 115 total surveys returned, 14 were not complete and not
included in the data analysis. Of those who responded to the question of
gender, 31% were males and 69% were females. Seventy-two percent of the
participants indicated that they taught general education. Twenty-five percent
reported that they taught either special education or a combination of special
education and general education. Table 1 helps delineate the participants in this

study.

49

Resgonse‘.

Middleosct
High-scho
Male

Female
General e
Special ec

\

Years Of ill
experienc

years tear

Total of te
ContaCtec

 

Table 1.

Responses by Demographics of Participants in This Stpgy

Percent response rates

 

mpants fitrict 1 District 2 Overall
Middle-school 43 46 45
High-school 57 54 55
Male 25 33 31
Female 75 67 69
General education 64 80 72
Special education 36 20 25

 

Years of teaching
experience (range) 1-42 1-39 1-42

Mean number of
years teaching 16.6 16.3 16.6

Total of teachers
Contacted 1 15 31 84

50

Res

 

approval to
offices that
lopic of a s
teacher sti,
received a
district wer
Mmmhd

whereby p,

 

 

 

 

There was

In b
reclUired be
teacher mi
Within 10 s
in an easil
COVer iette
for the W”
teacherst
rEmain CO

each Sun,

Procedures

Research review committees in both school districts were contacted for
approval to implement the research plan. The two school district research
offices that gave permission to distribute surveys to teachers differed on the
topic of a stipend for participating teachers. One district insisted on a per-
teacher stipend. In this case, teachers who returned completed surveys
received a $5.00 check. Nineteen percent of the surveys distributed in this
district were returned. Twenty-nine percent of the total surveys returned came
from this district. The second school district recommended a lottery system
whereby participants had an equal change of receiving a check for $100.00.
There was a 16.6% survey return rate in this district.

In both school districts, approval of individual building principals was
required before distributing the surveys to the teaching staff. Surveys were put in
teacher mailboxes and teachers were asked to return the completed surveys
within 10 school days. A portable file box for collecting completed surveys was
in an easily accessible location near the teachers’ mailboxes. All returned survey
cover letters were put in one box and an independent third party drew one name
for the winner of the $100.00 stipend. The survey cover sheet informed the
teachers that their participation was voluntary and that all responses would
remain confidential. The data were coded by identification number assigned to
each survey. No individual, school, city, or district name can be connected to the

published data.

51

P
with mild
presentat
accomplis
packet in
mahenhvr
was press
that each
analog me
entered in
entry was

iEChniqueg

The
teacher ac
research ii

Student ac

 

Was explat
il’lSiflrmem
Were dESc
DSMIV Cr

DGfiant Di:

 

Participants read two student vignettes, one describing an adolescent
with mild symptoms of ADHD and one severe. There was a counterbalanced
presentation of both student vignettes and three intervention plans. This was
accomplished by teachers” having an equal chance of receiving a materials
packet in which the vignette for the student with ADHD: Predominantly
Inattentive Type was presented first or the student with more severe symptoms
was presented first. The order of presentation of the intervention types varied so
that each intervention had an equal chance of being first or second. Using the
analog methodology, all survey data were transformed into numeric values and
entered into spreadsheet format for data analysis. The accuracy of the data
entry was verified by a second person trained in the computer program

techniques.

Instrument

The survey instrument is a compilation of materials used to assess
teacher acceptability ratings of three school-based intervention plans that prior
research has shown to be effective in ameliorating the effects of ADHD on
student achievement (DuPaul & Stoner, 1994). The need for teacher opinion
was explained and informed consent obtained on the cover sheet of the survey
instrument. The learning and behavior problems of two hypothetical students
were described in some detail. The descriptors were taken directly from the
DSM-IV criteria for Attention-DeficitlHyper-activity Disorder and Oppositional

Defiant Disorder (American Psychiatric Association, 1994, p. 83-94) and are

52

reprinted i

Stu
would war
characteri:
makes cart
omenspo
mtntantt
schoohwor
(egrtoys.
mdmwac
wwhbe

Sh
ADHD:C
DcoMer
the degre
dESCnber

inattentiv

 

quality of

being fidi,

 

additiOn‘

argUlng \i

 

tEMedfC

higher r '

 

reprinted in Appendices A and B with copyright approval of the APA.

Student “S” was described as presenting six of the nine symptoms that
would warrant the diagnosis of ADHD: Primarily Inattentive Type with
characteristics a, c, d, f, g, and i of the description for “inattentive” such as (a)
makes careless mistakes in schoolwork, work; (0) often does not seem to listen
when spoken to directly; (d) fails to finish schoolwork; (f) often avoids or is
reluctant to engage in tasks that require sustained mental effort (such as
schoolwork or homework); (9) often loses things necessary for tasks or activities
(eg. toys, school assignments, pencils, books, or tools) and (i) is often forgetful
in daily activities. It was intended that in this case, the presenting problems
would be viewed as being in the mild to moderate range of severity.

Student “J” was described as presenting more severe symptoms of
ADHD: Combined Type with some characteristics of Oppositional Defiant
Disorder (O.D.D.) (American Psychiatric Association, 1994, p. 93-94) but not to
the degree that this student could also be diagnosed O.D.D. Student “J” is
described as a student with ADHD: Combined Type demonstrating
inattentiveness in addition to a pattern of hyperactivity and impulsivity, with poor
quality of work, failure to finish work, forgetting materials necessary for school,
being fidgety, often out of seat, talking excessively and disrupting the group. In
addition, student “J” ‘5 description included some defiant behaviors such as
arguing with adults and refusing to follow the rules. These vignettes were pilot
tested for rater perception of severity and raters confirmed that student “J” had a

higher rating of severity on a scale of 1-10. However, to improve confidence in

53

the validlh
severity of
10 point r:
behavior/l-
asked to r
was like a

De:
monitoring
copy of th.
descriptior
effectivenr
implement
requiring a
pleparatio
minutes pr

Ai

 

SF) (Kell
dESCliptic
original Tr

and Come

betWEen 2'

WOrked e>

(1989) de

 

the validity of the assumption of severity, participants’ rated their perception of
severity of the learning and/or behavior problems for both student vignettes. A
10 point rating scale for teachers to rate their perception of severity of the
behavior/learning problems followed each student vignette. Teachers were also
asked to rate on a 10 point rating scale how much the student description given
was like any student they may have known.

Descriptions of three intervention plans: School-Home Notes, Self-
monitoring and Contingency Contracting follow each of the student vignettes. A
copy of the survey instrument including student vignettes and intervention
descriptions is in Appendix C. Descriptions of these interventions include
effectiveness data and estimates of the amount of time required for
implementing the intervention. All three interventions could be classified as
requiring a ‘medium-low’ amount of teacher time needing 1 to 2 hours of
preparation and or consultation time to initiate the program and less than 15
minutes per day to maintain the intervention.

A modified form of the Treatment Evaluation Inventory - Short Form (TEI-
SF) (Kelley, Heffer, Gresham & Elliott, 1989) follows each intervention
description. The goal is to determine acceptability of treatment alternatives. The
original Treatment Evaluation Inventory (TEI) was developed by Kazdin (1980)
and contained 16 items with a seven-point Likert format. Miller and Kelley (1992)
worked extensively with the TEl and found it an instrument that does discriminate
between alternative treatment methods. Kelley, Heffer, Gresham and Elliott

(1989) developed a simplified version of the TEI called the Treatment Evaluation

54

inventory
assess a
Lmentyi
survey it
approva
bmdud
Satori
gemeri

F
manner
hequent
mgwmni
educaho
Mth)h
wnanw

i0l the Si;

Ti

 

deSCflbe

vmhwe

 

Inventory -Short Form (TEI-SF) which is a 9-item questionnaire designed to
assess adults’ acceptability of treatment used with children. This is a five-point
Likert-type scale (1 = Strongly Disagree; 3 = Neutral; 5 = Strongly Agree). The
survey instrument for this study used a modified version of the TEI-SF with the
approval of Dr. M. L. Kelley. A copy of the survey instrument used in this study
is included in Appendix 2. A treatment is deemed “Acceptable “ if the total score
is at or higher than the mid-point (Calvert & Johnston, 1990) or a score of 3 or
greater on each item of the treatment acceptability measure (Kelley et al. 1989).
Following the modified TEI-SF, teachers rated their familiarity with each of
the interventions described on a scale of 0-Not familiar with it, to 3-Use it
frequently. Teachers were also asked to provide demographic information
regarding years of teaching experience, gender, type of class taught (general
education or special education, science, math, English, etc.), grade levels (sixth -
twelfth) taught in the past, grade level taught the most, and grade level they are
currently teaching. The total time necessary to read and complete the TEI-SF

for the six scenarios was estimated to be less than 30 minutes.

Research Hypotheses

The main dependent variable is acceptability of the intervention types
described. Teachers’ perception of the severity of the learning and behavior
problems described was assessed to determine if severity was indeed a valid

variable. The independent variables include teacher familiarity with students

55

similar to
of the intl
the study
Self-mon
interest ir

acceptab

Hypothes
Te

students

Fo
the stude
A t
a major ir
ratings of
students

bEdiffere

 

fitmes
Ti

 

similar to the students described in the vignettes, familiarity and frequency of use
of the interventions described and characteristics of the teachers participating in
the study. The three intervention types presented are School- Home Notes (N),
Self-monitoring (M), and Contingency Contracting ( C). The question of greatest
interest in this study is to determine if teachers find these interventions

acceptable for use with students demonstrating symptoms of ADHD.

Hypothesis 1:

Teachers will rate all three intervention plans acceptable for use with

students demonstrating symptoms of ADHD.

Hypothesis 2:

For all treatment types, treatment acceptability ratings will be higher for
the student demonstrating the more severe problem behavior, i.e., student “J”.

A teacher’s perception of severity of students’ problem behaviors may be
a major influence on teacher willingness to implement intervention plans and on
ratings of treatment acceptability in general. If teachers differentiate between
students “S” and “J” on the ratings of severity, it is predicted that there will also

be differentiation on the acceptability ratings.
Hypothesis 3:

There will be an interaction between teacher characteristics and teacher

ratings of treatment acceptability as measured by the modified TEI-SF.

56

58‘.
acceptabil
assess p0
variance ll
degree to
by respon
familiarity
of interver
students i

versus sp

     

H othes

 

 

Several demographic variables might be related to how teachers evaluate
acceptability of an intervention. The following information was collected to
assess potential covariates that might account for significant amounts of
variance in TEI-SF scores: degree to which respondents knew a student like J,
degree to which respondents knew a student like S, most common grade taught
by respondent, current grade taught by respondent, total years spent teaching,
familiarity and frequency of use of intervention C, familiarity and frequency of use
of intervention M, familiarity and frequency of use of intervention N, number of
students in special education, number of students taught this year, and general

versus special education teachers.

Hypothesis 4:

There will be no effect of order of vignette.

The order of presentation of the intervention descriptions and the order of
student vignettes was counter balanced in the survey packets. This is a
standard technique in survey research of this type. It is predicted that the order
of the information presented will not effect the dependent measures.

In summary, this study builds on what is known through prior research
about three interventions that can be effective in ameliorating problems of social
and learning behaviors of children and youth with ADHD and blends that
information with a survey of general and special education teacher opinions to
answer four questions. The first question was asked to determine if classroom

teachers agree with the clinical/medical (DSM-IV) literature on the severity of the

57

problem t
asked of t

describe:

 

demogra:
the first it
character
with the it
interventb
possibility

presenter

 

TI’
WES Suffi
TEI-SF V
”9X1 Vari
SGVerity,
behavior
recoghiz
behaVior
mUitiVar-
ratings (

presentr

problem behaviors described in the student vignettes. The second question
asked of the classroom teachers was how acceptable are the three treatments
described for the two different hypothetical students. Thirdly, teacher
demographics were included in the analysis to determine if the answers found in
the first two questions are likely to be true for most teachers or are there specific
characteristics of the teacher that the school psychologist or clinician consulting
with the teacher needs to take into consideration when recommending a specific
intervention. The fourth major issue of this survey was included to analyze the
possibility that survey responses were an artifact of the order of information

presented in the survey instrument.

Statistical Analysis

The first order of analysis was to determine if the participant response rate
was sufficient to allow analysis of the data and then to determine if the modified
TEI-SF was actually a measure of one thing, i.e. treatment acceptability. The
next variable assessed was severity. There was an assumption of perception of
severity. Therefore, a paired-sample t-test on teacher ratings of severity of
behavior problems for students 8 and J was conducted to determine if teachers
recognized these two students descriptions as different in severity of presenting
behavior problems and to determine if severity was a valid variable. Several
multivariate analyses were conducted to analyze differences between teacher
ratings of acceptability on a modified version of the TEI-SF in the six conditions

presented in the survey instrument. Modifications to the TEI-SF included

58

dropping
the fact t
study (19
measure
interventi
adepend
A .
x interve
used to I
find thes
acceptab
over ano
Years of
Students
teaching
Severity, I
final anal
”3‘th wi

interactic

dropping two questions and changing the wording slightly to specifically address
the fact that teachers were the respondents, not parents as in the Kelley et al.
study (1989). Item number eight was new to the scale. Item 8 was intended to
measure the degree to which a teacher needs assistance to implement a specific
intervention. Including item 8 in the scale required further analysis of this item as
a dependent variable.

A four-way mixed factorial ANOVA (order of intervention x order of student
x intervention x severity of ADHD) was conducted. Analysis of variance was also
used to look for main effect of intervention. The goal was to determine if teachers
find these three treatments acceptable and if there was a difference between the
acceptability ratings of the interventions to support use of one intervention type
over another and to analyze possible interaction of continuous co-variables of
years of teaching experience, grade level taught, and familiarity with the types of
students described. Teacher gender, type of class taught, and school district
teaching in were included into the analysis to see if there is a difference in
severity, familiarity or acceptability ratings as a function of these variables. In the
final analysis, all non-significant co-variables were dropped and the analysis was
re-run with only the significant co-variables to look for main effects and

interactions.

59

Ac
influence
teachers
perceive:
presente
account
behavior
the cons

Which tre

 

Within 2
iricomp

responr

(72%") i
CheCke

talight

CHAPTER 4

Results

Acceptability ratings for the three interventions were found to be
influenced by several contextual conditions. General information about the
teachers responding to the survey, the reliability of the modified TEI-SF, and
perceived severity of the student behaviors described in the vignettes is
presented first. The effects of intervention type and a review of variables that
account for the variance in the acceptability ratings and perceived severity of
behavior follow this. As predicted, certain characteristics that a teacher brings to
the consultation and intervention planning setting play a role in determining

which treatment is most acceptable for which student.

Participant Remnse Rate aflemographics

Of the 669 surveys sent out, 115 teachers returned completed surveys
within 2 weeks (response rate = 17.2%). Of the 115 returned packets, 14 had
incomplete data for the six vignettes. The data from the remaining 101
respondents were used in the following analyses. Seventy-three respondents
(72%) checked that they taught general education while 18 teachers (18%)
checked that they taught special education. Seven (7%) checked that they

taught both special education and general education and three (3%) did not

60

respond to this item. Respondents who taught both were combined with special
education teachers (for a combined total of 25% of respondents) in subsequent
analyses. Of the 101 respondents, 23 reported being males and 51 reported
being females. Twenty-seven respondents did not identify their gender.
Because these missing data would greatly reduce sample size, gender was not
used as a variable in omnibus analyses. The school districts did not make
characteristics of teachers in general (age, gender, years of teaching experience,
percent of teachers in general and/or special education) available to allow
comparison of respondents to nonrespondents. Thus, no demographic
information was available to ascertain whether respondents differ from
nonrespondents. In addition, no attempt was made to do a follow-up interview
with nonrespondents to see if the two groups differed in major ways. However,
as shown in Figure 1, teachers from both school districts participating in the
study gave similar responses to questions of treatment acceptability.
Furthermore, the total N of 101 usable surveys was sufficient for the necessary

data analysis.

61

Figure 1.

.Tx-N. Mod. ADHD

.Tx-N. Sev. ADHD

.Tx-C, Mod. ADHD
.Tx—C, Sev. ADHD

.Tx—M, Mod. ADHD

Ejfx-M, Sev. ADHD

 

 

 

Mean TEI-SF Scores

 

1

School Districts

Teacher Acceptabiliy Ratings for all 6 Treatment Combinations by

School District

62

Reliability of the Modified TEI-SF

Reliability refers to the property of the measurement instrument that
causes it to give similar results. In this study, internal consistency reliability was
used to assess the homogeneity of the TEI-SF scale. To this end, Cronbach’s
alphas and bivariate correlations were conducted using the eight items of the
modified TEI-SF scales for each of the six vignettes. All items showed high
positive correlations with each other except for item 8: “Would you need support
to design and implement this plan?” Item 8 was either not correlated or
negatively correlated with all other items on the TEI-SF. The analysis was rerun
without item 8. All alphas were higher without item 8 (see Table 2). Thus, item 8
of the modified TEI-SF, which indicated teachers’ need for support to design and
implement the intervention, was excluded from the composite TEI-SF score and
analyzed as a separate variable. Modified TEI-SF scores were calculated by
summing items 1 through 7 making the possible range of scores to be 7 to 35.
All Cronbach’s Alphas were greater than .90, supporting the reliability of this

measure.

63

Table 2.

Cronbach’s flphas Across All 6 Treatment Combinations for the Mopifirfl

TEI-SF Items With and Without Item 8.

 

 

Vignette With item 8 Without item 8
Student 8

Contingency contracting .817 .924
Self-monitoring .864 .933
School-home notes .869 .933
Student J

Contingency contracting .804 .900
Self-monitoring .875 .936
School-home notes .874 .947

 

64

Perceived Severitv of _Behavior

One hundred respondents rated the severity of student 8 and student J’s
behaviors on a 10 point Likert scale. A paired-sample t-test was conducted on
respondents’ ratings of severity of behavior for student 8 (ADHD: Primarily
Inattentive Type) and student J (ADHD: Combined Type). Student J’s behavior
was rated significantly more severe (M = 8.51, SD = 1.37) than student S’s
behavior (M = 6.64, SD = 1.55), t(99) = -11.05, p < .05. This result suggests that
teachers do recognize the two student descriptions as different in severity of
presenting behavior problems. In addition, this supports the issue of severity as
a valid variable and allows it to be kept as a factor for further analysis. This was

of particular interest when accounting for variance in the acceptability ratings.

Hypothesis 1iffects of Intervention Tvg

Hypothesis 1 examined teachers’ ratings of all three intervention plans as
acceptable for use with students demonstrating symptoms of ADHD. A three-
way mixed-factorial ANCOVA (order of student, type of intervention, and severity
of ADHD) found a significant main effect of type of intervention, F2 (94)= 4.43,

p = .014. Follow-up t-tests showed the mean rating of acceptability for School-
Home Notes (N) was significantly higher than acceptability ratings for Self-

monitoring (M) T (100) = 2.91, f-.004. Contingency Contracting was ranked in

65

the middle and not significantly different from the other two interventions, p < .05.
Table 3 presents the means and standard deviations for all six treatments by
severity combinations using the first seven items on the modified TEI-SF. All

interventions were rated as acceptable thus providing support for Hypothesis 1.

66

Table 3.

Means and Standard Deviations (SD) for All 6 Treatment Combinations

_LJsing the First 7 Items on the Modified TEI-SF Scale.

 

 

Treatment N Mean 8 D
Student S

Contingency contracting 101 24.8020 5.5318
Self-monitoring 101 23.6634 6.0881
School-home notes 101 25.4752 5.7194
Student J

Contingency contracting 101 24.1584 5.3136
Self-monitoring 101 22.6634 6.5746
School-home notes 101 24.6337 6.1963

 

67

Hypothesis greatment Acceptability and Severitv

Hypothesis 2 stated the expectation that for all three treatments,
treatment acceptability ratings would be higher for the student demonstrating the
more severe problem behavior, i.e., student “J”. However, the effects of
intervention type were the same for student 8 and student J. Thus Hypotheses 2
cannot be supported. There was no interaction between severity and type of
intervention. Thus, it was feasible to collapse across severity levels and report

the overall means for each of the three treatments in Table 4 below.

Table 4.

Mean and Standard Deviations (SD) of the Modifietflgl-SF Ratings

Across Interventions

 

 

Intervention Mean (SD)
Contingency contracting (C) 24.48 (4.82)

Self-monitoring (M) 23.16 (5.76)
School-home notes (N) 25.05 (5.55)

 

Note: Means were collapsed across student S and student J. The difference

between M and N was significantly different, p < .05

68

There was, however, a significant main effect of severity of ADHD,

F (95) = 4.64, p = .034 as determined by a four-way mixed-factorial analysis of
variance (ANOVA) (order of intervention x order of student x intervention x
severity). The overall mean TEI-SF scores were significantly higher for the
student with the moderate symptoms of ADHD (student S: M = 24.64, SD = 3.90)
than for the students demonstrating the more severe symptoms of ADHD
(student J: M = 23.82, SD = 4.16). This is the opposite of what was predicted in
Hypothesis 2. Both the effect of severity and the effect of intervention were
relatively small. Severity of ADHD accounted for 4.7% of the overall variance
and type of intervention accounted for 4.3% of the variance. The small effects
sizes should be considered when the practical meaning of the results of this
study are addressed.

The results suggest that the differences found in the first ANOVA may
have been influenced by type of teacher (general versus special education) and
how often teachers have used intervention C (Contingency Contracting) or N
(School-Home Notes). In addition, these main effects may be due to differences
in other dependent variables not included in the design. Thus, variables that
potentially may have contributed to the variance in TEI-SF scores were

evaluated as possible covariates for the overall analysis.

69

Hypothesis 3: Teacher Characteristics and TEI-SF Ratings

Hypothesis 3 predicted an interaction between teacher characteristics and
teacher ratings of treatment acceptability as measured by the modified TEI-SF.
Bivariate correlation was calculated between scores on the modified TEI-SF
scale and several demographic variables that might theoretically be related to
how teachers evaluate interventions. These variables were: degree to which
respondents knew a student like J (ADHD: Combined Type), degree to which
respondents knew a student like S (ADHD: Primarily Inattentive Type), most
common grade taught by respondent, current grade taught by respondent, total
years spent teaching, familiarity and frequency of use of intervention C
(Contingency Contracting), familiarity and frequency of use of intervention M
(Self-monitoring), familiarity and frequency of use of intervention N (School-
Home Notes), number of students in special education, number of students
taught this year, and general versus special education teachers. These variables
were examined as potential covariates that might account for significant amounts
of variance in TEI-SF scores. Three of the variables were significantly correlated
(p < .05) with TEI-SF scores for at least one of the six vignettes. These variables
were familiarity and frequency of use of intervention C (Contingency
Contracting), familiarity and frequency of use of intervention N (School-Home

Notes), and general versus special education.

70

Freguency of Use

The intervention reportedly used the least is Self-monitoring. Thirty-five
percent of teachers report never using this intervention. Only 6% of teachers
reported they use it frequently. Contingency Contracting was used frequently by
7% of the teachers and never used by 10%. School-Home Notes were used
frequently by 32% of the teachers and never used by only 6%. Table 5 presents
the mean rating of use by intervention. Teachers rated each intervention twice,
once for student S and once for student J. Therefore, by combining the two, the

range of ratings is now from zero (not familiar with it) to six (use it frequently).

Table 5.

Mean Rating and Standard Deviation (SD) of Use by Intervention

 

 

Intervention Mean S D

Self-monitoring 1.95 SD = (1.71)
Contingency contracting 3.06 SD = (1.42)
School-home notes 4.16 SD = (1.58)

 

71

_General ggucation vs. Special Education Teachers

To compare the means of the TEI-SF scores for general education and
special education teachers, six t-tests were run on the modified TEI-SF scores
using general education versus special education as the independent variable.
General education teachers gave significantly higher TEI-SF scores for the
School-Home Notes intervention (M = 26.44, SD = 5.37) than teachers who
taught some or all special education courses (M = 23.20, SD = 5.09), t(96) =
2.63, p = .01. Table 6 looks at the mean acceptability rating given by general

education versus special education teachers.

72

Table 6.

Mean scores on the Modifieg TEI-SF Usigq General Edgcation VerStg

_§pecial Education Teachers for Each of the 6 Treatment Combinations.

 

 

Intervention General Ed. Teachers Special Ed. Teachers
Student S

Contingency contracting 24.79 25.08

Self-monitoring 24.33 21.08

School-home notes 26.44 23.2 t(96) = 2.63, p = .01
Student J

Contingency contracting 24.34 23.88

Self-monitoring 22.97 21.68

School-home notes 25.99 23.52

 

73

These results suggest there is a slight tendency for general education
teachers to rate interventions as more acceptable in comparison to the ratings by
special education teachers. The results also suggest that teachers who use
Contingency Contracting do not like the School-Home Note and Self-monitoring
interventions, and teachers who use School-Home Notes like the intervention but
do not like Contingency Contracting. These effects only hold true for ratings for
the student with moderate ADHD (student S). There was no significant
correlation between the measure of use of an intervention and the score given
on the TEI-SF for any intervention applied to student J (severe ADHD). The
three variables (intervention x severity x general education versus special
education teachers) were retained as covariates for the analysis of covariance.

General education and special education teachers were similar in
frequency of use Self-monitoring (2.87 for special education teachers and 1.63
for general education) and School-Home Notes (4.12 for special education and
4.19 for general education teachers). It was apparent that Self-monitoring is
used much less often than School-Home Notes for both area teachers. There
was a significant difference (t (94) = -4.34, p. < .001) between means of how
often general education and special education teachers use Contingency
Contracting (2.09 for general education teachers and 4.08 for special education).
Thus, type of teacher (general education versus special education) is a
significant covariate as it was already demonstrated that teacher acceptability of
Contingency Contracting depends on how much the intervention is used.

Special education teachers use it more, so they evaluate it higher. Teachers in

74

both general and special education use Self-monitoring less and rate it lowest in
acceptability. This provides partial support for Hypotheses 3 in that some
teacher characteristics play a role in the acceptability ratings of the three
interventions. These findings suggest the need to differentiate between special
education and general education teacher responses in the data analysis in

research of this nature.

Hypothesis 42Effects of Order of Vignettes

Merit \Licmettes. Intervention Type, and the MorflfiedLEl-SF: Items 1-7

Of the 101 respondents, 59 received descriptions of the student with
ADHD: Primarily Inattentive Type (student S) first and 42 received descriptions of
the student with ADHD: Combined (student J) first. In addition, 35, 34, and 32
respondents received the three possible orders (CMN: Contingency Contracting
first then Self-monitoring and School-Home Notes; NCM: School-Home Notes
first then Contingency Contracting and Self-monitoring; and MNC: Self-
monitoring first then School-Home Notes and Contingency Contracting)
respectively. The four-way mixed-factorial ANOVA was conducted to test
whether the order of intervention (CMN, NCM, or MNC) or order of student
(student S first versus student J first) had a significant effect on TEI-SF scores.
Assumptions of homogeneity of variance and covariance, normality, and
sphericity were tested. Levene’s test of homogeneity and Mauchly’s test of

sphericity showed these assumptions to be met. However, a Box’s M test found

75

significant heterogeneity of covariance, F (105, 10,034) = 1.70, p < .001. The
number of subjects was sufficiently equal across between subject groups so that
subsequent analyses would be robust against this violation of general linear
model assumptions (Tabachnick & Fidell, 1996).

No significant main effects of student order or intervention order were
found. However, the interaction of student order x severity was significant, F (1,
94) = 4.04, p = .047. Specifically, respondents who received student S vignettes
first had significantly higher TEI-SF ratings overall for student S (M = 24.81, SD =
3.88) compared to J (M = 23.36, SD = 4.79), t(58) = 3.21, p = .002. For those
who received student J’s vignettes first, the TEI-SF ratings were not significantly
different in general across student 8 (M = 24.42, SD = 3.96) and student J (M =
24.47, SD = 3.00), t(41) = -.116, p = .908. These results suggest that the order in
which respondents received vignettes (student S with ADHD: Primarily
Inattentive Type first versus student J, severe ADHD, first) had an effect on TEI-
SF scores. Thus, order of severity was used as a between subject factor for
analyses. Hypothesis 4, “There will be no effect of order of vignette”, must be
rejected. Though statistically significant, the effect of order was not large and

only accounted for 4.8% of the overall variance (eta-squared =. 048).

TEI-SF Item 8: Need for Support in Develgment and Use of a Treatment

Item 8 on the modified TEI-SF measured the degree to which teachers

believed help would be needed to develop and implement a specific intervention.

76

An interaction effect of order indicated teachers tended to rate the intervention
plan that appeared first in the survey packet as requiring more assistance. A
four-way mixed-factorial ANOVA (order of intervention x order of student x
intervention x severity of ADHD) was conducted using item 8 as the dependent
variable. There was a significant interaction between order of intervention and
type of intervention, F (196) = 3.06, p = .018. No effects or interactions involving
order of student were significant. Thus, the ANOVA was rerun without order of
student as an independent variable.

The three-way mixed factorial ANOVA (order of intervention x type of
intervention x severity of ADHD) showed a significant main effect of type of
intervention, F(97) = 17.94, p < .001. This effect accounted for 27% of the
variance in item 8. Respondents rated Contingency Contracting and School-
Home Notes as both being significantly easier to implement compared to Self-
monitoring (see Table 7). This effect was qualified by a significant order of

intervention by type of intervention interaction, F(196) = 3.06, p = .018.

77

Table 7.

Need For Help to Implement a Specific Intervention

Mean ratings for item 8 on the modified TEI-SF across three interventions

 

 

Intervention Mean (SD)
Contingency contracting(C) 3.27 (1.13)
Self-monitoring(M) 3.41 (1.17)
School-home notes(N) 2.78 (1.16)

 

Note: Means for both Contingency Contracting and Self-monitoring interventions

were significantly higher than School-Home Notes, p <.001.

78

Table 8.

Need for Assistance Developipq Type of Intervention x Order of Intervention

 

Order of presentation of intervention in survey packet

 

Intervention type CMN MNC NCM
Contingency contracting (C) 3.34 (1.19) 3.40 (1.03) 3.09 (1.18)
Self-monitoring (M) 3.27 (1.21) 3.95 (0.86) 3.06 (1.24)
School-home notes (N) 2.66 (1.13) 2.94 (1.04) 2.78 (1.32)

 

For CMN, C and M were significantly greater than N, p < .05.
For NCM, there were no significant differences between means.
For MNC, all three means differed significantly from each other, p < .05.

Note: When Self-monitoring was first, it was the highest mean, and when the
School-Home Note intervention was first, it was not significantly less than Self-
monitoring or Contingency Contracting. These results suggest that teachers

tended to rate first interventions higher.

79

Table 8 shows the mean of teacher ratings for item 8 of the modified TEI-
SF, think a teacher would need help to develop and use this plan from someone
such as a teacher consultant, school psychologist or social worker.” for each of
the interventions by order of treatment. These results suggest that there was an
effect of order (being the first intervention rated by the teacher) at least for
intervention M. More broadly, it was clear that the context in which the
interventions were presented affects the teachers’ acceptability rating of type of
intervention.

All teachers, both general education and special education, were basically
in agreement that they would not need additional assistance developing a
School-Home Note intervention. More teachers saw a possibility for the need for
assistance for the other two intervention types (see Table 9), particularly Self-

monitoring.

80

Table 9.

General and Special Education Teachers’ Report of Need for Assistance in

Developing School-based Interventions

 

 

 

 

 

 

 

 

some special ed or none ITEM8C ITEMBM ITEMBN
general ed Mean 3.2534 3.4452 2.7945
N 73 73 73
Std. Deviation 1.1935 1.2283 1 .2186
special ed or mixed Mean 3.3400 3.4200 2.9000
N 25 25 25
Std. Deviation .9852 .9755 .9465
Total Mean 3.2755 3.4388 2.8214
N 98 98 98
Std. Deviation 1.1355 1.1827 1.1515

 

Note: ITEMBC = need for assistance in developing Contingency Contract

ITEM8M = need for assistance in developing Self-monitoring

ITEM8N = need for assistance in developing School-Home Notes

81

 

In summary, Hypothesis 1 stated that teachers would rate all three
intervention plans acceptable for use with students demonstrating symptoms of
ADHD. As predicted, all interventions were rated as acceptable thus providing
support for Hypothesis 1. However, the three interventions were not all rated
equally. Ranked in order of acceptability based on mean TEI-SF scores, Sohool-
Home Notes received the highest rating, followed by Contingency Contracting,
then Self-monitoring.

Hypothesis 2 stated that for all treatment types, treatment acceptability
ratings would be higher for the student demonstrating the more severe problem
behavior, i.e., student “”.J However, the effects of intervention type were the
same for student S and student J. Thus Hypotheses 2 could not be supported.

Hypothesis 3 stated that there would be an interaction between teacher
characteristics and teacher ratings of treatment acceptability as measured by the
modified TEI-SF. The three variables significantly correlated with TEI-SF scores
were use of intervention C (Contingency Contracting), use of intervention N
(School-Home Notes), and the rater being a teacher in general education only
versus one who teaches special education students. This provides partial
support for Hypotheses 3 in that some teacher characteristics played a role in
the acceptability ratings of the three interventions;

Hypothesis 4 stated that there would be no effect of order of vignette.
This hypothesis was rejected. There was no effect of order of treatment
presentation but there was an effect of order of presentation of the student

vignettes. Teachers that read student S (moderate ADHD) first tended to give

82

higher TEI-SF ratings to all three interventions for student S (ADHD: Primarily
Inattentive Type) than to those for student J who was described as having the
more severe symptoms of inattention combined with hyperactivity and impulsivity
and some oppositional type behaviors. Teachers that got student J first in the
survey packet tended to rate the acceptability of the interventions the same for
student S and student J.

It appears that the modified TEI-SF for items 1-7 is a reliable instrument
as a measure of acceptability. It was teacher opinion in general that could be
swayed by contextual issues such as teacher experience with special education
and the order in which information was received.

One additional finding in this study was the information obtained from item
8 of the modified TEI-SF. While all three interventions described have been
recommended for use in the general education classroom, general education
and special education teachers agree that teachers would need help developing
and implementing these interventions, particularly Contingency Contracting and

Self-monitoring.

83

CHAPTER 5

Discussion

Synopsis of Results

As stated in the introduction to this study, a common hurdle in the
planning and implementation of classroom intervention techniques has been a
difference of opinion as to what constitutes a “reasonable” accommodation for an
individual student in the general education classroom. Teacher opinion of what
is “reasonable” was identified as a very important component of the intervention
as the implementation of an intervention plan is most often the responsibility of
the classroom teacher (Bahr, 1994). A "reasonable” intervention was defined as
one that (a) could be done by the people involved, (b) was liked by the teacher,
(0) meet the needs of the student, and (d) the teacher might expect the student
to have a positive response to the proposed intervention. Prior research found
Kazdin’s (1981) Treatment Evaluation Inventory to be an instrument that could
be administered before the selection and initiation of treatment. The basic
assumption being that treatments viewed as more acceptable were most likely to
be initiated.

The primary goal of this study was to determine if teachers found the
interventions presented as reasonable school-based interventions for secondary

school students with ADHD. The answer to that question was yes. The data

84

support Hypothesis 1, in that teachers’ ratings on the three treatment plans
found all plans acceptable for use with students with ADHD. The type of
treatment did affect teacher ratings of treatment acceptability on the modified
Treatment Evaluation Inventory-Short Form (TEI-SF). The rank order of
acceptability with the treatment receiving the highest acceptability rating listed
first was School-Home Notes, Contingency Contracting and Self-monitoring.
Hypothesis 2 predicted that treatment acceptability ratings would be
higher for the student demonstrating the more severe behavior problems. This
hypothesis was not supported by the results of this study. The mean TEI-SF
scores was significantly higher for student S (presenting the moderate behavior
problems) than for student J. This effect is in the opposite direction of that
hypothesized. Anecdotal data from notes several teachers wrote in the margins
of the surveys returned stated that those teachers thought that student J’s
behavior problems were too severe for a student like that to benefit from the
treatments described. Respondents were able to discriminate between the
moderate and severe behavior problems presented in the student descriptions.
Special education teachers gave student S (ADHD: Primarily Inattentive Type) a
severity rating, on a scale of 1-10, of 6.6 and gave student J (the more severe
ADHD: Combined Type) a severity rating of 8.3. General education teachers
responded similarly with severity ratings of 6.72 (student S) and 8.63 (student J).

Hypothesis 3 was partially supported by the results of this study, as there

85

was an interaction of certain teacher characteristics with teacher ratings of
acceptability. Type of education (general versus special) was a significant
covariate. Teacher familiarity and use of Contingency Contracting did correlate
with special education teacher evaluations of Contingency Contracting and they
rated it higher in acceptability. General education teachers reported highest use
of School-Home Notes and rated School-Home Notes as highest overall on the
modified TEI-SF. Teacher status as either regular education or special
education could not be included as an independent variable in this study as the
sample size of special education teachers was too small.

Hypothesis 4 predicted that there would be no effect on ratings of
acceptability by the order in which the information was presented in the survey.
However, this was not supported by the data. The interaction between severity
and order of student was significant. This means that the order in which
teachers received vignettes (moderate first versus severe first) had an effect on
ratings. Teacher acceptability ratings of the three interventions were effected by
the severity of student behavior but only when teachers received student S
(moderate problem behavior) first. Ratings did not differ as a function of severity
when they received student J first. This effect of order is problematic because it
calls into question the reliability of the modified version of the TEI-SF. If a
teacher’s evaluation of an intervention can vary as a function of whether they

read a vignette about a moderately ADHD student first or second, it may also

86

 

vary as a function of other context-related factors (e.g., types of students that
respondents interacted with that day).

In addition to the four hypotheses examined in the data analysis, the
responses to item 8 of the modified TEI-SF pointed to one additional finding of
probable interest to school psychologists and others who consult with teachers to
develop school-based interventions. That is, that both general and special
education teachers indicated they could develop and implement the School-
Home Note intervention without help. However, they indicated that for the Self-
monitoring and Contingency Contracting interventions they would probably need
help. This supports the need for support personnel such as school psychologists
working in the general education setting to assist with the development and

implementation of school-based interventions for students with ADHD.

Egent to Which Results are Congruent to or Discrepant with Papst Data

This study is similar to other studies in that it identifies a specific
population for which to rate the acceptability of a specific intervention. Miller et
al. (1998) studied treatment acceptability for children with cancer. Bihm et al.
(1997) and Miltenberger & Lumley (1997) studied treatment acceptability for
persons with mental retardation. Bennett et al. (1996); Power, Hess & Bennett

(1995) and Hoff & DuPaul (1998) all studied acceptability of intervention plans

87

for elementary and middle school students with ADHD.

This study is unique in that the participants include teachers of high
school students and discriminates between general and special education
teachers. This study is also unique in that it assesses teacher familiarity with
type of student described in the vignette. No correlation was found between
teacher report of familiarity with type of student and rating of treatment
acceptability. However, given the differences found between general and special
education teachers, one might question the lack of effect of familiarity with type
of student.

Previous studies of treatment acceptability suggested that the style of
presentation of the treatment information in conversational language followed by
detailed descriptions of the intended procedures increased the likelihood of the
treatment being rated as acceptable (Calvert & Johnson, 1990). Research also
indicated that teachers prefer interventions that do not require changes in the
basic curriculum, material or instructional style (Elliott, 1988a, 1988b; Johnson &
Pugach 1990; Reimers et al. 1992a, 1992b; Whinnery, Fuchs, & Fuchs, 1991).
The intervention techniques need to be primarily positive (increasing desired
behaviors such as doing homework on time) not aversive (such as use of time-
out for off-task behaviors) and appropriate for the age of the student (Calvert &
Johnston, 1990; Gajria & Salend, 1996; Rasnake, 1993). Complexity, time and

resources needed for the intervention all affect acceptability (Gajria & Salend,

88

1996; Reimers et al. 1992). All three of the intervention plans presented in this
study were described as requiring a similar amount of time and resources. All
three met the above criteria for acceptability and the teachers participating in the
study rated all three treatments as acceptable.

Age and gender of the child (Phares, 1996), gender of the student
depicted in the case vignette (Miller, Martens & Hurwitz, 1990; Phares, Ehrbar &
Lum 1996), race and socioeconomic status (Tarnowski, Simonian, Park &
Bekeny, 1992) have been included as possible confounding variables in the
design of other treatment acceptability studies. In most studies, the child’s age,
grade, gender and location of the misbehavior have had no effect on ratings of
treatment acceptability (Calvert & Johnston, 1990; Miller et al.1990; Phares,
Ehrbar & Lum, 1996). However, Calvert and Johnston found an interaction of
age with type of treatment. In their study, reinforcement procedures were rated
as more acceptable for older children than for younger children. Accepting the
findings of previous research, this study did not include the students’ age, grade
or gender in the student vignette. The students in the vignettes were presented
as adolescents, therefore somewhat older than the children described in
previous studies. It is interesting that the two intervention plans that included the
potential for reinforcement, Contingency Contracting and School-Home Notes,
were both rated as somewhat more acceptable than the Self-monitoring strategy.

Many studies of treatment acceptability include pharmacological

89

interventions and combinations of procedures for acceptability ratings (Calvert &
Johnston, 1990). This study present three discrete treatments all based on
behavioral procedures and a combination of social learning theory and cognitive
behavior modification.

The severity of behavior problems described has been included as a
variable in several studies. Generally, the more complex the intervention, the
lower the acceptability ratings (Calvert & Johnston, 1990; Gajria & Salend, 1996;
Miltenberger, 1990). Given that teachers indicated a greater need for assistance
in developing and implementing the Self-monitoring strategy (item 8 on the
modified TEI-SF) proposed in the present study, this may explain why Self-
monitoring received the lowest acceptability rating.

However, Harris (1990) found that the more effort required in terms of
time and resources the more acceptable the intervention for the more severe
problem. Calvert & Johnston (1990), Gajria & Salend (1996), Kutsick (1991),
Miltenberger (1990), and Reimers et al. (1992b) all found the more severe the
problem, the more acceptable the treatment. Some interaction effects have
been noted. Social reinforcement was significantly more acceptable but primarily
for mild problem students. Self-instructional strategy training was seen as more
intensive and costly in time, effort and resources in the study by Harris (1990)
and was rated as significantly more acceptable at the severe problem level. In

the present study, the self-instructional, i.e. Self-monitoring strategy was

90

designed to be similar in time and effort to the other two interventions. However,
teacher lack of familiarity with Self-monitoring may have influenced the
perception of need for assistance implementing the plan.

There was a significant main effect of severity. The overall mean TEI-SF
scores were significantly higher for the student with the moderate symptoms of
ADHD than for the students demonstrating the more severe symptoms of ADHD.
This is the opposite of what was predicted. It may be that Self-monitoring was
perceived as more complex but not complex or intensive enough to address the
needs of the more severe problem behavior.

The need for assistance implementing an intervention has been a
significant factor in teacher opinion. Calvert and Johnston (1990), Elliott (1988b),
Gajria and Salend (1996) and Kutsick (1991) all report teachers prefer to be the
ones in charge of the actual implementation of the treatment. The need for
assistance may have been a more significant factor in this study than

anticipated.

Limitations

 

_S_r_1biect Selection Variaples
Volunteer samples are a fact of life for applied researchers and one that

does limit the generalization of the research. The difference in response rates

91

between the two school districts, the question of representativeness of the
participants to teachers in general, and the use of different incentives ($5.00
stipend for each respondent versus the $100.00 lottery system) all limit the
generalizability of the results of this study. However, the sample size is sufficient
for analysis of variance and the assessment of teacher characteristics as

covariables adds to the confidence with which the data can be interpreted.

Lack of Usajle Information as to the Gender of the Participants

Of the 101 respondents, 23 reported being males and 51 reported being
females. Twenty-seven respondents did not identify their gender. Because
these missing data would greatly reduce sample size, gender was not used as a
variable in omnibus analyses. Previous research found gender of rater when the
raters were parents to have no substantial affect on acceptability ratings.
However, it is not known if gender of teacher might influence treatment
acceptability ratings, as it has not been used as a variable in previous research

and was not included in this study.

_R_epresentativeness of Students Described in sgdent Vignettes

The learning and behavior problems of two hypothetical students were
described in some detail. The descriptors were taken directly from the DSM-IV

criteria for Attention-Deficit/Hyperactivity Disorder and Oppositional Defiant

92

 

Disorder (American Psychiatric Association, 1994, p. 83-94) and are reprinted in
Appendices A and B with copyright approval of the APA. However, not all
students with ADHD will have this particular composite of characteristics. It may
be that an identical study using different descriptions of the two students with
ADHD may have different results. The specific student’s descriptions used in the

student vignettes limit the generalizability of this study.

Qdestioninfle Use of a “Neutral” (3) Rating to Conclude Accepta_biflty

The modified TEI-SF instrument used in this study incorporates a five-
point Likert-type scale (1 = Strongly Disagree; 3 = Neutral; 5 = Strongly Agree)
like that used by Kelly et al. (1989) and Kazdin (1981). Previous researchers
have used these instruments with the stated understanding that a treatment is
“Acceptable “ if the total score is at or higher than the mid-point (Calvert &
Johnston, 1990) or a score of 3 or greater on each item of the treatment
acceptability measure (Kelley et al. 1989). There may be a point of contention
using “neutral” to equal “acceptable”. However, this was the standard used in

previous research and replicated in this study.

Qge_stion_ing the Definition of Severitv

Severity was defined as the relationship of the subtype of ADHD to
predicted outcomes. The two subtypes presented in the student vignettes in this
study are ADHD: Primarily Inattentive Type which has far fewer comorbid

psychiatric conditions and ADHD: Combined Type (Barkley, 1997). Students

93

 

with ADHD that includes impulsivity and hyperactivity combined with inattention
are more likely to have anxiety disorders and other mood disorders and often are
more likely to present aggressive, defiant and oppositional characteristics.
Barkley (1997) stated, ”Findings from follow-up studies have shown that early
hyperactive-impulsive behavior is associated with a greater risk for adolescent
delinquency, early substance use and abuse, and school suspensions and
expulsions....” (p. 27). The study hypothesized that there would be a main
effect of severity on teachers’ ratings of acceptability. Teachers’ were not given
a definition of severity nor were they asked to give their definition of severity. It
is not clear that teachers understood the definition of severity the same way it
was defined by Barkley (1997). However, it is clear that whatever the teachers’
definition of severity, they rated the students with ADHD: Combined Type as

more severe that the students with ADHD: Primarily Inattentive Type

Acceptability is Not a Measure of Effectiveness

Kazdin (1980) defined treatment acceptability as, “Judgements about
treatment procedures by ...potential consumers of treatment. Judgements of
acceptability are likely to embrace evaluation of whether treatment is fair,
reasonable, and intrusive, and whether treatment meets with conventional
notions about what treatment should be.” (p. 259). There may be acceptable
interventions that are not effective for use with ADHD students in the school
setting. There may be interventions that are effective but not acceptable to

teachers for implementation in the school setting. Choice or acceptability of a

94

treatment, personal meaningfulness, social significance and social validity are
important factors in applied research as they help connect research results to a
social context in which decisions can be made. This was a study of
acceptability. Further research is needed to determine a correlation or lack
thereof between acceptability and effectiveness. Bearing in mind all of the above
limitations, this study makes some significant practical contributions to the study

of school-based interventions for adolescents with ADHD.

Contributions for Practig

Classroom Performance Based Focus

The majority of previous research studies of school-based interventions
for children and youth with ADHD have focused on elementary school age
children, and have targeted “on-task” behavior as the dependent variable. This
study adds to the information base three school-based treatment procedures for
adolescents with ADHD and includes skills teachers have rated as the most
important for success in the classroom (Gresham et al., 1987), i.e., completing
classroom assignments in the required time, following directions and producing
correct academic work. An increasing emphasis exists in the school psychology
literature on providing this assistance to students and teachers through
consultation and prereferral intervention. This study adds to the literature to
confirm the need for consultative services from someone such as the school

psychologist for both general and special education teachers to develop and

95

implement classroom based interventions to assist students with ADHD to

benefit from learning in the general education classroom.

Fow on Adolescents

This study is distinctive in that it focuses on adolescents with ADHD and
support for the social and academic needs of adolescence within the school
setting. According to Barkley (1994 and1997), ADHD students are often delayed
in development. Some students in early adolescence may still be in the
beginning of the ‘reciprocal’ stage of social development (Yates & Sleman, 1989
and Hoffman et al., 1994). Some students may be better than others at viewing
their actions from the psychological viewpoint of another, better able to delay
gratification and to make deals to get their needs met. Students still operating in
the earlier reciprocal stage of peer relations may need immediate and tangible
procedures implemented such as a combination of Contingency Contracting and
Self-monitoring training in addition to frequent contact between school and home
to keep the parents informed and involved in the process. Many adolescents
may not recognize the impact of their behavior on the classroom environment
and on their learning. When the adolescent begins to observe how their own
behavior effects other people’s reactions, the adolescent usually becomes much

more effective in negotiating mutual goals.

96

Developing a Database Permitting Treatment Acceptability to be Incorporated
Into the Decision-making Process of Comltation and Service Delivery

The primary goal of this study was to determine what intervention(s) would
be most acceptable to teachers, for which student, and under what conditions.
The teachers participating in the study rated all three interventions presented in
this study as acceptable using the modified TEI-SF. Contextual conditions such
as previous use of an intervention, previous work with special education
students, and the order in which the teacher is presented with information such
as severity of behavior problems influenced teacher opinion as to the
acceptability of a given treatment. It may be that an instrument sensitive to
contextual variables may be just what the clinician/consultant needs in dealing

with a variety of individual differences.

Prescribed Research Procedures

Specific teacher characteristics of having previously used an intervention
and previous experience or lack of experience teaching special education
students played a role in the teacher ratings of treatment acceptability. This
study is distinctive in that it identifies significant variables for applied research.
Given the findings of this study, future studies involving teacher opinion of
school-based interventions will need to include the two variables of teachers’

previous use of a specific treatment and the type of teacher, i.e. general

97

education versus special education.
In addition, as this study highlights the effect of order, future studies need
to continue the practice of presenting information in a counter-balanced format to

assess the possible effect of order on outcome variables.

Future Directions for Research

The order in which respondents received vignettes (student S with ADHD:

 

Primarily Inattentive Type first versus student J, severe ADHD, first) had an
effect on TEI-SF scores. Thus, order of severity was used as a between subject
factor for analyses. The order effect is problematic. To assess the reliability of
teacher opinion, further research is needed. Future studies should attempt to test
the reliability of the modified TEI-SF over time with the same teachers using a
test-retest methodology to assess stability of evaluation of interventions and of
teacher opinion.

Further research is needed to determine additional characteristics of the
raters that may account for differences in acceptability. This may also help in
identifying a good match between client characteristics and choice of treatment.

Teachers are primarily the ones to implement intervention strategies in the
school setting. However, the opinion of building administrators, professional

support staff, parents, and the students themselves should also be studied to

98

fully assess treatment acceptability.

Subgroups of students with ADHD have significantly different patterns of
behavior. Future studies could change the descriptions of student behaviors to
assess possible change in teacher ratings of acceptability for the three
intervention plans described as a function of different clusters of behaviors.

Future studies could assess other school-based intervention plans that
have been shown effective for students with ADHD, such as Shapiro and Cole’s
(1994) Self-Management program. A study might assess the total self-
management program and the individual aspects of the program, such as the
cueing techniques, to determine teacher acceptability of all aspects of an
intervention strategy.

Additional questions could be asked on the modified TEI-SF such as, “ for
student _, which of the treatments described would you be most likely to try in
your classroom.” This forced choice question would give the researcher and the
practitioner a better idea of which treatment teachers found most acceptable.

Additional treatment outcome studies are needed to determine if a
proposed intervention will work particularly for adolescents in the general
education secondary school setting. Of additional importance is knowing what
makes the treatment work. As stated previously, the value of assessing
treatment acceptability is based on the assumption that the more acceptable the

treatment, the more likely it is that the treatment will be implemented. Further

99

study Is needed to assess the reality of that assumption. Finally, follow-up
studies need to be done to determine a relationship between initial acceptance
of an intervention plan and the implementation of that plan, and the final

effectiveness of that intervention.

Summagy

The primary goal of this study was to determine what intervention for
which student would be most acceptable to which teacher. General education
teachers were found to prefer using School-Home Notes particularly In the case
of students with mild ADHD (ADHD: Predominantly Inattentive Type). Special
education teachers preferred Contingency Contracting and were more likely to
have used it in the past. Further study is needed to make an optimal match
between teacher, student and school-based intervention plans. The test-retest
reliability of the modified TEI-SF and the of teacher opinion need further study.
It seems that the modified TEI-SF is an instrument sensitive to contextual
factors, which may be just what the clinician needs in dealing with a variety of
individual differences.

Individual differences must be taken into account when making treatment
recommendations. Research often relies on standardized diagnostic labels and
rigid treatment regimes. Individual differences of teachers and students and the

life situations they bring to the planning table must be taken into account in the

100

 

 

actual goal setting and intervention planning process. The general acceptability
of a specific intervention does not presuppose that all teachers of students with
ADHD are identical just as the students are not identical. The presence of
individual differences does not mean researchers should give up on investigating
optimal treatments for different individuals with varying characteristics. Over time
as finer refinements are made as were made in this study, further distinctions
can be made to better match type of treatment with subtypes of presenting
problems with type of teacher, practitioner or therapist implementing the
treatment.

The bottom line is that teachers in both general education and special
education at the secondary school level have expressed a need for support in
the design and implementation of interventions that In the past have been found
to be effective in ameliorating the negative affects of ADHD. Trained consultants
need to be available to support teachers in both general education and special
education in order to provide services to students in the least restrictive setting.
Additionally, the consultants need to be sensitive to the contextual issues of
teacher and student characteristics when working with public school teachers in
the design and implementation of school-based interventions for adolescents

with ADHD.

101

APPENDICES

102

APPENDIX A

Diagnostic Criteria for
Attention-DeficitlHyperactivity Disorder

(American Psychiatric Association, 1994, p. 83—84)

103

Attention-DeficitlHyperactivity Disorder

A. Either (1) or (2);

(1) Six (or more) of the following symptoms of inattention have persisted for a
least 6 months to a degree that is maladaptive and inconsistent with

developmental level:
Inaflenfion

(a) often fails to give close attention to details or makes careless mistakes
in schoolwork, work, or other activities

(b) often has difficulty sustaining attention in tasks or play activities

(0) often does not seem to listen when spoken to directly

(d) often does not follow through on instructions and fails to finish
schoolwork, chores, or duties in the workplace (not due to oppositional
behavior or failure to understand instructions

(e) often has difficulty organizing tasks and activities

(f) often avoids, dislikes, or is reluctant to engage in tasks that require
sustained mental effort (such as schoolwork or homework)

(9) often loses things necessary for tasks or activities (eg. toys, school
assignments, pencils, books, or tools)

(h) is often distracted by extraneous stimuli

(i) is often forgetful in daily activities

(2) six (or more) of the following symptoms of hyperactivity-impulsivity have
persisted for at least 6 months to a degree that is maladaptive and
inconsistent with developmental level.

Hyperactivity

(a) often fidgets with hands or feet or squirms in seat

(b) often leaves seat in classroom or in other situations in which remaining
seated is expected

(c) often runs about or climbs excessively in situation 3 in which it is
inappropriate (in adolescents or adults, may be limited to subjective
feelings of restlessness)

(d) often has difficulty playing or engaging in leisure activities quietly

(e) (e) is often “on the go” or often acts as if “driven by a motor”

(f) often talks excessively

104

Impulsivity

(9) often blurts out answers before questions have been completed

(h) often has difficulty awaiting turn

(i) often interrupts or intrudes on others (e.g., butts into conversations or
games)

B. Some hyperactive-impulsive or inattentive symptoms that caused impairment
were present before age 7.

C. Some impairment from the symptoms is present in two or more settings.

D. There must be clear evidence of clinically significant impairment in social,
academic, or occupational functioning.

105

APPENDIX B

Diagnostic Criteria for
Oppositional Defiant Disorder

(American Psychiatric Association, 1994, p. 93-94)

106

Oppositional Defiant Disorder

A. A pattern of negativistic, hostile, and defiant behavior lasting at least six
months, during which four (or more) or the following are present:
(1) often loses temper
(2) often argues with adults
(3) often actively defies or refuses to comply with adults’ requests or rules
(4) often deliberately annoys people
(5) often blames others for his or her mistakes or misbehavior
(6) is often touchy or easily annoyed by others
(7) is often angry and resentful
(8) is often spiteful or vindictive

Note: consider a criterion met only if the behavior occurs more frfluently than is

apically observed in individuals of comparable age and devemmentjl level.

B. The disturbance in behavior causes clinically significant impairment in social,
academic, or occupational functioning.

C. The behaviors do not occur exclusively during the course of a Psychotic or
Mood Disorder.

D. Criteria are not met for Conduct Disorder, and, if the individual is age 18
years or older, criteria are not met for Antisocial Personality Disorder.

107

APPENDIX C

Survey Instrument

108

A Search of "Reasonable" Accommodations
in General Education
for Secondary Students with ADfHD

Dear Teacher,

It seems that teachers are often advised to make modifications and/or
accommodations to instruction and classroom procedures, but seldom are asked their
opinion of the proposed treatment. Yet, the implementation and success of the treat-
ment may, at least in part, depend on teachers’ acceptance of the plan as reasonable,
fair and appropriate to the situation. The following survey assesses teacher
acceptability of three classroom-based plans for students diagnosed with Attention
Deficit / Hyperactivity Disorder. The three plans all focus on solving a problem related
to the student’s learning behaviors. No change in instruction, curriculum, basic
materials or course work is required. The goal of the study is to collect information
about which treatment, for which student, under what conditions, is most likely to be
accepted by teachers.

The survey should take less than 30 minutes to complete.
Your participation is voluntary, and there is no penalty for
refiising to answer questions.

Teachers returning a completed survey by
will have their identification number put into a lottery
for a $190.09 cash prize.

 

 

(Print your name clearly here to be entered in the lottery.)

To protect your confidentiality, this sheet will be separated from the survey
form prior to the data being sent for analysis.

Your responses will not be identified and confidentiality will be maintained
in any report of the findings.

You indicate your voluntary agreement to participate by
completing and returning the questionnaire.
Thank you for your consideration.

Questions, concerns, or requests for copies of the results of this study
should be directed to Marilyn M. Higgins at
higgin16@pilot msu.edu or 517/333-4142.

109

A Search of "Reasonable" Accommodations
in General Education
for Secondary Students with AD/HD

Dear Teacher,

It seems that teachers are often advised to make modifications and/or
accommodations to instruction and classroom procedures, but seldom are asked their
opinion of the proposed treatment. Yet, the implementation and success of the treat-
ment may, at least in part, depend on teachers’ acceptance of the plan as reasonable,
fair and appropriate to the situation. The following survey assesses teacher
acceptability of three classroom-based plans for students diagnosed with Attention
Deficit / Hyperactivity Disorder. The three plans all focus on solving a problem
related to the student's learning behaviors. No change in instruction, curriculum, basic
materials or course work is required. The goal of the study is to collect information
about which treatment, for which student, under what conditions, is most likely to be
accepted by teachers.

The survey should take less than 30 minutes to complete.

Your participation is voluntary, and there is no penalty for
refusing to answer questions.

Teachers returning a completed survey by
will be compensated $5.00 for their participation.

 

 

(Print your name clearly here to receive payment.)

To protect your confidentiality, this sheet will be separated from the survey form
prior to the data being sent for analysis. It will be returned to you with payment.

Your responses will not be identified and confidentiality will be maintained
in any report of the findings.

You indicate your voluntary agreement to participate by
completing and returning the questionnaire.

Thank you for your consideration.
Questions, concerns, or requests for copies of the results of this study

should be directed to Marilyn M. Higgins at
higgin16@pilot msu.edu or 517/333-4142.

110

 

 

 

Below is a description of a hypothetical student. After reading the description,
please give your perception of the overall severity of this child's problems

and similarity to a student you might know.

 

 

 

 

Student "S"

"S" is often forgetful, doesn’t do chores requested to do at home, and has
trouble getting started and finishing work both at home and at school. When
assignments do get done, they are often incomplete, messy, hard to read, and contain
careless mistakes. "8" may even loose the work before it gets turned in.

Both the Art and Physical Education teachers report that "S" has a lot of
difficulty following directions, is often distracted by the activities of others,
sometimes just doesn’t listen and seems to be daydreaming or staring off into space.
"S" does not plan ahead, seems to lack awareness of time and requires a lot of
external guidelines to do the job required.

Socially, "S" is a little immature but gets along well with others at school,
home, and in extracurricular activities.

On a scale of 1 - 10, how severe do you think the behavior/learning problems are
for Student "S?" (Please circle your choice.)

Mild Moderate Severe

On a scale of l - 10, how much is Student "S" like a student you know?
(Please circle your choice.)

 

l 2 3 4 5 a 7 8 9 10
Not at all I know
like any student a student
I know just like this

 

 

Now consider that the above student actually exists and is a member of
your class. On the following pages are descriptions of three possible
interventions that you could use. After reading each of the three
interventions, please complete the corresponding evaluation form.

 

 

 

 

 

 

lll

 

Descriptipp pf Ingervegtipp: Contingency Contracting

This is a behavior management technique which involves the negotiation of a contract
between student and teacher. The contract describes the reinforcement for desired levels of
academic and social behaviors and a description of the response cost (i.e., loss of privileges,
points, or tokens) if the student engages in behaviors that are not acceptable.

An important variable to consider when developing a contract is the length of time
delay between the behavior and the consequence. Optimal tinting for delivering the
consequence is at the end of the class period or that school day. This intervention loses effec-
tiveness as the time increases between the student's behavior and the delivery of the conse-
quence.

Teachers negotiate directly with the student to be sure there is mutual understanding of
behaviors that need to change. All students should be involved in developing a menu of
possible reinforcers. Reinforcers are very individual and situation specific. If the student has
trouble identifying preferred activities that could be usedas reinforcers, the teacher could
suggest some of the "off-task" behaviors that the student typically engages in when they are
expected to be attentive in class (for example, talking to a classmate, drawing, getting
something from their locker, etc.).

The response cost procedure is an integral part of the plan. The student can lose points
they have been working for to acquire a desired reinforcer. The teacher needs to be sure that on
most days the child acquires more points than they lose. A student's point total should never
fall below zero or the response cost procedure loses its power and the student could continue
to be disruptive or off—task and the consequences would be nonexistent as one can not lose
what one does not have. A sample of a classroom-based contingency contract is printed
below.

Sample Contingency Contract

 

I. agree to do the following:
(insert student name)

1. Record all of my assignments in my daily planner.

2. Turn in at least 80% of my homework assignments on time.
3. Give the teacher my full attention when s/he is speaking.

4. Remain quiet while the teacher is speaking.

5. Follow all school rules.

I will earn one point for each of these things I do correctly, each class period. For every 5 points I
earn, I will be allowed to choose on of the following:
1. 2. 3.

If I choose to not do what is necessary to gain points, I understand that loss of points will lead to loss
of the above listed choices.
I agree to fulfill this contract to the best of my ability.

Signed Signed
(student signature) (teacher signature)

 

 

 

 

112

Modified Treatment Evaluation Inventory Short Form (TEI-SF)
Please complete the items below by placing a checkka on the line next to each
question that best indicates how you feel about the treatment. Please read the items very
carefully because the checkmark accidentally placed on one space rather than another may not

represent the meaning you intended

For Student "5" Strongly Disagree Neutral
Disagree
1. I find this treatment to be
an acceptable way of
dealing with the student’s

Agree Strongly
Agree

 

 

learning behavior.

2. I would be willing to use
this procedure if I had to
change the student's
learning behavior.

 

3. I believe that this treatment
could be done in the general

 

 

education setting.

4. I like the procedures used
in the treatment.

 

 

5. I believe this treatment is
likely to result in permanent
improvement.

 

 

6. I believe it would be
acceptable to use this treatment
with students who cannot choose
treatments for themselves.

 

 

7. Overall, I have a positive
reaction to this treatment.

 

 

 

8. I think a teacher would need help
to develop and use this plan from
someone such as a teacher
consultant, school psychologist or
social worker.

 

 

 

How familiar are you with this intervention?

Not familiar Am familiar, but Have used it
with It haven’t used it

 

113

Use it Frequently

 

Desedptionpflmmentipm Self-Monitoring

Self-monitoring is a form of self-assessment. It is a process by which one changes a
behavior due to knowledge of being observed; specifically, being observed by one's self. This
technique increases a student’s understanding of the relationship between classroom
expectations and his or her behavior, and develops the student’s awareness of the effects his/her
behaviors have on others.

Self-monitoring must be taught to the student and occasionally cross-checked by the
teacher to be sure the student assessment is accurate. The emphasis is on the student. Training
can be done either individually for a specific student or it can be used as a whole class
technique. There are three basic phases for this type of intervention technique: 1) Awareness
and 2) Skill Building and Feedback, and 3) Monitoring change over time. Self-monitoring
forms might look like the following examples:

W

The teacher provides the student with graphic information on the past few weeks’ work.
The student then takes over the job of recording the information. (See Figure A below.) The
goal of this phase is to increase the student’s awareness of course expectations and his/her own
performance.

Figure A.

 

Due Actual Date #Problems #Problems Percent
WWW—42mg

 

 

 

 

 

 

(Please see next page for Phase H and IH.)

114

El II'SI'IIB'II' SE II I

The goal of this phase is to help students identify academic goals and the steps required to
achieve those goals. As each class begins, teachers need only to remind students to get out their
self-monitoring charts. Students need to:

A. Continue charting work product and accuracy, as in example above
or
B. (1) Identify other goals or "target" behaviors for school success (See Figure B),
(2) Identify steps required to achieve those goals, and
(3) State awareness of natural reinforcers or consequences for actions taken (or not taken).

 

Figure B.
Effort and Its Payoff

1 2 3 4 5
I did not try to do my best. I tried to do my best.
I gave up. I stayed with it.
I hurried through the task. I took enough time.
I fooled around. I stayed on task.
Why?

 

 

What was the "Payoff?"

 

 

 

 

El III‘ I [0 . . :1 UV I.
Students are taught to convert data from daily charts (as in Figures A & B) into graphs that
provide a picture of progress toward their goal over an extended time, such as an entire

school semester (See Figure C).

 

 

 

 

 

Figure C.
100
90 : A / \v/
80 | f '
Percent of 70 /\ |
homework 60 jAv VA\ I
completed 50 I
accurately 40 l
30 Sept = 60% l Oct = 90%
20 l
10 l
0
Phase I Phase H
Baseline Implement Self-Monitoring

 

 

 

 

115

Modified Treatment Evaluation Inventory Short Form (TEI-SF)
Please complete the items below by placing a checkmark on the line next to each
question that best indicates how you feel about the treatment. Please read the items very
carefully because the checkmark accidentally placed on one space rather than another may not

represent the meaning you intended

For Student "5" Strongly Disagree Neutral
Disagree
1. I find this treatment to be
an acceptable way of
dealing with the student's
learning behavior.

Agree Strongly
Agree

 

2. I would be willing to use
this procedure if I had to
change the student's
learning behavior.

 

3. I believe that this treatment
could be done in the general
education setting.

 

4. I like the procedures used
in the treatment.

 

5. I believe this treatment is
likely to result in permanent

 

improvement.

6. I believe it would be
acceptable to use this treatment
with students who cannot choose
treatments for themselves.

 

7. Overall, I have a positive
reaction to this treatment.

 

8. I think a teacher would need help
to develop and use this plan from
someone such as a teacher
consultant, school psychologist or
social worker.

 

 

How familiar are you with this intervention?

Not familiar Am familiar, but Have used it
with It haven’t used it

 

116

Use it Frequently

 

Desgg'ptjpp pf Iptpflentiop; School - Home Note

School-home notes are like daily reports cards, i.e. a form of communication that
allows parents and school staff to work together to clarify expectations both at home and at
school that will help develop a student's learning and/or social behaviors. The procedure
requires parents and teachers to work together to define the problem and to determine mutual
goals. The goal is to emphasize desired behaviors and increase communication between
teachers and parents. Teachers evaluate students' behavior in a systematic manner and provide
frequent feedback to the parents. Several goals can be identified and worked on at one time.
The emphasis is on keeping parents informed.

Parents are to use this information to develop a, set of consequences at home in
response to the student‘s school performance. School staff do not need to be involved in family
choices for reinforcement. It is assumed that parents have access to and control over a wider
variety of consequences than do teachers.

Three important variables in the use of the school-home note include A) emphasis on
the student’s achieving individual goals (e.g. "S" behaved cooperatively before and during
class), B) reliance on the studentto get the notes back and forth between school and home
(although this could be done by fax or e-mail), and C) the parents following through with
appropriate consequences at home.

Sample School-Home Note (From M.L. Kelley, 1990, Pg. 120)

 

 

 

Date: Teacher Signature: ,
Class: Student Name: 4
Was prepared for class Yes No NA Homework Assignment:

Paid attention in class Yes No NA
Handed in homework Yes No NA
Worked appropriately Yes No NA
with others

Homework/Test Grade

 

Comments

 

 

 

Parent Comments (consequences provided)

 

 

 

 

 

 

117

 

Modified 'Ii-eatment Evaluation Inventory Short Form (TEI-SF)
Please complete the items below by placing a checkmark on the line next to each
question that best indicates how you feel about the treatment. Please read the items very
carefully because the checkmark accidentally placed on one space rather than another may not

represent the meaning you intended

For Stadel‘lt "3" Strongly Disagree Neutral Agree Strongly

Disagree
1. I find this treatment to be
an acceptable way of
dealing with the student’s
learning behavior.

Agree

 

2. I would be willing to use
this procedure if I had to
change the student’s
learning behavior.

 

3. I believe that this treatment
could be done in the general
education setting.

 

4. I like the procedures used
in the treatment.

 

5. I believe this treatment is
likely to result in permanent
improvement.

 

6. I believe it would be
acceptable to use this treatment
with students who cannot choose
treatments for themselves.

 

7. Overall, I have a positive
reaction to this treatment.

 

8. I think a teacher would need help
to develop and use this plan from
someone such as a teacher
consultant, school psychologist or
social worker.

 

 

How familiar are you with this intervention?

Not familiar Am familiar, but Have used it
with It haven’t used it

 

118

Use it Frequently

 

 

 

Below is a description of a hypothetical student. After reading the description,
please give your perception of the overall severity of this child’s problems

and similarity to a student you might know.

 

 

 

 

 

 

Student "J"

"J" has trouble getting up in the morning, often arrives late for school and
forgets materials necessary for school including lunch money. "J" seems really restless
and fidgety, often drops things, and finds reasons to get out of the seat in class. "J" is
not doing well academically although at times seems to be quite bright. "J" is often
confused and disorganized and has a lot of trouble following directions. "J” may start a
project but doesn’t finish the work or at least often doesn’t turn the work in. The quality
of the work is often poor and sloppy. "J" is difficult to discipline and difficult to help,
tends to argue or talk back, and doesn’t accept responsibility for mistakes.

".1" is often left out of group activities because of disrupting the group. People
can not depend on "J" to get the work done on time or do a fair share of the project.
Besides, "J" talks incessantly, gets lost in the details, and loses sight of the main idea.
Maybe the worst thing is that "J" does things without thinking, like setting off the fire
alarm.

On a scale of l - 10, how severe do you think the behavior/learning problems are
for Student "J?" (Please circle your choice.)

1 2 3 4 5 6 7 8 9 10
Mild Moderate Severe

On a scale of 1 - 10, how much is Student "J" like a student you know?
(Please circle your choice.)

 

1 Z 3 4 5 d 7 8 9 10
Not at all I know
like any student a student
I know just like this

 

 

Now consider that the above student actually exists and is a member of
your class. On the following pages are descriptions of three possible
interventions that you could use. After reading each of the three

interventions, please complete the corresponding evaluation form.

 

 

 

 

 

 

119

Descp'ptipn pf Iptempgtipg; Contingency Contracting

This is a behavior management technique which involves the negotiation of a contract
between student and teacher. The contract describes the reinforcement for desired levels of
academic and social behaviors and a description of the response cost (i.e., loss of privileges,
points, or tokens) if the student engages in behaviors that are not acceptable.

An important variable to consider when developing a contract is the length of time
delay between the behavior and the consequence. Optimal timing for delivering the
consequence is at the end of the class period or that school day. This intervention loses effec-
tiveness as the time increases between the student's behavior and the delivery of the conse-
quence.

Teachers negotiate directly with the student to be sure there is mutual understanding of
behaviors that need to change. All students should be involved in developing a menu of
possible reinforcers. Reinforcers are very individual and situation specific. If the student has
trouble identifying preferred activities that could be usedas reinforcers, the teacher could
suggest some of the "off-task" behaviors that the student typically engages in when they are
expected to be attentive in class (for example, talking to a classmate, drawing, getting
something from their locker, etc.).

The response cost procedure is an integral part of the plan. The student can lose points
they have been working for to acquire a desired reinforcer. The teacher needs to be sure that on
most days the child acquires more points than they lose. A student's point total should never
fall below zero or the response cost procedure loses its power and the student could continue
to be disruptive or off-task and the consequences would be nonexistent as one can not lose
what one does not have. A sample of a classroom-based contingency contract is printed
below.

Sample Contingency Contract

 

I, agree to do the following:
(insert student name)

1. Record all of my assignments in my daily planner.

2. Turn in at least 80% of my homework assignments on time.
3. Give the teacher my full attention when s/he is speaking.

4. Remain quiet while the teacher is speaking.

5. Follow all school rules.

I will earn one point for each of these things I do correctly, each class period. For every 5 points I
earn, I will be allowed to choose on of the following:
I. 2. 3.

HI choose to not do what is necessary to gain points, I understand that loss of points will lead to loss
of the above listed choices.
I agree to fulfill this contract to the best of my ability.

Signed Signed
(student signature) (teacher signature)

 

 

 

 

120

Modified Treatment Evaluation Inventory Short Form (TEI-SF)
Please complete the items below by placing a checkmark on the line next to each
question that best indicates how you feel about the treatment. Please read the items very
carefully because the checkmark accidentally placed on one space rather than another may not

represent the meaning you intended

For Student "J"

l. I find this treatment to be
an acceptable way of
dealing with the student's
learning behavior.

2. I would be willing. to use
this procedure if I had to
change the student's
Ieaming behavior.

3. I believe that this treatment
could be done in the general

education setting.

4. I like the procedures used
in the treatment.

5. I believe this treatment is

likely to result in permanent

improvement.

6. I believe it would be

acceptable to use this treatment
with students who cannot choose

treatments for themselves.

7. Overall, I have a positive
reaction to this treatment.

8. I think a teacher would need help
to develop and use this plan from

someone such as a teacher

consultant, school psychologist or

social worker.

Strongly Disagree Neutral Agree Strongly
Disagree Agree

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

How familiar are you with this intervention?

Not familiar Am familiar, but Have used it Use it Frequently

with It haven’t used it

 

 

 

121

Descriptiprmflntemenfipn; Self-Monitoring

Self-monitoring is a form of self-assessment. It is a process by which one changes a
behavior due to knowledge of being observed; specifically, being observed by one's self. This
technique increases a student's understanding of the relationship between classroom
expectations and his or her behavior, and develops the student's awareness of the effects his/her
behaviors have on others.

Self-monitoring must be taught to the student and occasionally cross-checked by the
teacher to be sure the student assessment is accurate. The emphasis is on the student. Training
can be done either individually for a specific student or it can be used as a whole class
technique. There are three basic phases for this type of intervention technique: 1) Awareness
and 2) Skill Building and Feedback, and 3) Monitoring change over time. Self-monitoring
forms might look like the following examples:

W

The teacher provides the student with graphic information on the past few weeks' work.
The student then takes over the job of recording the information. (See Figure A below.) The
goal of this phase is to increase the student’s awareness of course expectations and his/her own
performance.

Figure A.

 

Due Actual Date #Problems #Problems Percent
Math Assignment Date Turned 1n Attempted 99mm Cpmegt

 

 

 

 

 

 

(Please see next page for Phase II and III.)

122

The goal of this phase is to help students identify academic goals and the steps required to
achieve those goals. As each class begins, teachers need only to remind students to get out their

self-monitoring charts. Students need to:

A. Continue charting work product and accuracy, as in example above

or
B. (1) Identify other goals or "target" behaviors for school success (See Figure B),
(2) Identify steps required to achieve those goals, and
(3) State awareness of natural reinforcers or consequences for actions taken (or not taken).

 

Figure B.
Effort and Its Payoff

1 2 3 4 5
I did not try to do my best. I tried to do my best.
I gave up. I stayed with it.
I hurried through the task. I took enough time.
I fooled around. I stayed on task.
Why?

 

 

What was the "Payoff?”

 

 

 

 

Students are taught to convert data from daily charts (as in Figures A & B) into graphs that
provide a picture of progress toward their goal over an extended time, such as an entire

school semester (See Figure C).

 

 

 

 

 

Figure C.
100
90 : A m f
80 /\ | /
Percent of 70 |
homework 6O JAV VA\ I
completed 50 l
accurately 40 l
30 Sept = 60% l Oct = 90%
20 I
10 l
0
Phase 1 Phase 11
Baseline Implement Self-Monitoring

 

 

 

 

123

Modified 'II'eatment Evaluation Inventory Short Form (TEI-SF)
Please complete the items below by placing a checkmark on the line next to each
question that best indicates how you feel about the treatment. Please read the items very
carefully because the checkmark accidentally placed on one space rather than another may not

represent the meaning you intended

For Student "J' Strongly Disagree Neutral Agree Strongly

we

1. I find this treatment to be
an acceptable way of
dealing with the student's
Ieaming behavior.

Agree

 

2. 1 would be willing to use
this procedure if I had to
change the student's
learning behavior.

 

3. I believe that this treatment
could be done in the general
education setting.

 

4. I like the procedures used
in the treatment.

 

 

5. I believe this treatment is
likely to result in permanent
improvement.

 

6. I believe it would be
acceptable to use this treatment
with students who cannot choose
treatments for themselves.

 

7. Overall, I have a positive
reaction to this treatment.

 

 

8. I think a teacher would need help
to develop and use this plan from
someone such as a teacher
consultant, school psychologist or
social worker.

 

 

 

How familiar are you with this intervention?

Not familiar Am familiar, but Have used it
with It haven't used it

 

124

Use it Frequently

 

Description of Intervention: School - Home Note

School-home notes are like daily reports cards, i.e. a form of communication that
allows parents and school staff to work together to clarify expectations both at home and at
school that will help develop a student's learning and/or social behaviors. The procedure
requires parents and teachers to work together to define the problem and to determine mutual
goals. The goal is to emphasize desired behaviors and increase communication between
teachers and parents. Teachers evaluate students' behavior in a systematic manner and provide
frequent feedback to the parents. Several goals can be identified and worked on at one time.
The emphasis is on keeping parents informed.

Parents are to use this information to develop a set of consequences at home in
response to the student's school performance. School staff do not need to be involved in family
choices for reinforcement. It is assumed that parents have access to and control over a wider
variety of consequences than do teachers.

Three important variables in the use of the school-home note include A) emphasis on
the student's achieving individual goals (e.g. "S" behaved cooperatively before and during
class), B) reliance on the studentto get the notes back and forth between school and home
(although this could be done by fax or e-mail), and C) the parents following through with
appropriate consequences at home.

Sample School-Home Note (From M.L. Kelley, 1990, pg. 120)

 

 

 

gate: Teacher Signature: .
Class; Student Name;
Was prepared for class Yes No NA Homework Assignment:

Paid attention in class Yes No NA
Handed in homework Yes No NA
Worked appropriately Yes No NA
with others

Homework/Test Grade

 

Comments

 

 

 

Parent Comments (consequences provided)

 

 

 

 

 

 

 

125

Modified 'h‘eatment Evaluation Inventory Short Form (TEI-SF)
Please complete the items below by placing a checkmark on the line next to each
question that best indicates how you feel about the treatment. Please read the items very
carefully because the checkmark accidentally placed on one space rather than another may not

represent the meaning you intended

For Student "J" Strongly Disagree Neutral Agree Strongly

Disagree
1. I find this treatment to be
an acceptable way of
dealing with the student's
Ieaming behavior.

Agree

 

2. I would be willing to use
this procedure if I had to
change the student's
Ieaming behavior.

 

3. I believe that this treatment
could be done in the general
education setting.

 

 

4. I like the procedures used
in the treatment.

 

 

5. I believe this treatment is
likely to result in permanent
improvement.

 

 

6. I believe it would be
acceptable to use this treatment
with students who cannot choose
treatments for themselves.

 

 

7. Overall, I have a positive
reaction to this treatment.

 

 

8. I think a teacher would need help
to develop and use this plan from
someone such as a teacher
consultant, school psychologist or
social worker.

 

 

 

How familiar are you with this intervention?

Not familiar Am familiar, but Have used it
with It haven't used it

 

126

Use it Frequently

 

 

 

 

Please provide the following information about yourself.
(This information is essential to the study.)

 

 

 

 

 

1. Years of teaching experience:

2. Check the grade levels you have taught in all of your years of teaching.
(Check all that apply.)

6 7 8 9 10_ 11_ 12_

3. Check the grade level you have taught the most. (Check only one.)
6 7 8 9 10_ 11_ 12_

4. Check the grade level you teach the most this year. (Check only one.)

6 7 8 9 10_ 11_ 12_

5. Check the content areas you teach this year. (Check all that apply.)

Fine Arts _ Social Studies _ Physical Education _
Math _ Technology __ English _
Science_ Languages _ Other _ (Specify:

 

6. Are you currently teaching general education or special education?
General __ Special _

7. How many students from all of your classes are receiving special
education/504 services?

 

8. How many students in total do you teach in all of your classes?

 

9. Gender

Male _ Female __

127

REFERENCES

128

 

REFERENCE LIST

Allinder, R., & Oats, RG. (1997). Effects of acceptability on teachers’
implementation of curriculum-based measurement and student

achievement in mathematics computation. Remedial and Special
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