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Psychology in the Schools, Vol. 35(1), 1998

© 1998 John Wiley & Sons, Inc. CCC 0033-3085/98/010067-13

THE ADHD CLASSROOM KIT: A WHOLE-CLASSROOM APPROACH

FOR MANAGING DISRUPTIVE BEHAVIOR
karla anhalt, cheryl b. mcneil, and alisa b. bahl
West Virginia University

In this article, an inclusive treatment package for children with ADHD, The ADHD Classroom Kit
(Kit), is described. Components of the Kit are categorized in three areas: consequences for appro-
priate behavior, consequences for inappropriate behavior, and peer-mediated interventions. The
empirical rationale for each component of the Kit is discussed. Also, a case study of a 6-year-old
girl (Carol) with reported disruptive behavior problems is presented as preliminary data support-
ing the Kit’s effectiveness. An A-B-A reversal design was used in Carol’s classroom. Mean fre-
quencies of appropriate behavior were 61.3% (baseline), 78.5% (Kit), and 70.7% (reversal). In ad-
dition, mean frequencies of on-task behavior were 76.2% (baseline), 87.8% (Kit), and 82.5%
(reversal). Implications for future research and practice with the Kit are addressed. © 1998 John
Wiley & Sons, Inc.

Numerous studies have demonstrated that children with Attention Deficit Hyperactivity Disor-
der (ADHD) have deficits in sustained attention, impulse control, and the regulation of their activi-
ty levels (see Barkley, 1989). Classroom behavior problems that are commonly reported for children
with ADHD include difficulties in completing independent seat work, disorganized school materi-
als, talking with classmates at inappropriate times, and frequent out-of-seat behavior (DuPaul &
Stoner, 1994). As a result of these and other challenging behaviors, children with ADHD are at risk
for significant difficulties in a variety of functional areas. For example, during elementary school
years, they are likely to exhibit academic underachievement that may lead to diagnoses of learning
disabilities (Barkley, 1989). Further, low self-esteem, social rejection, and antisocial behavior, are
more common in children with ADHD than in typical children (Barkley, 1990).
Effective interventions in classroom settings are essential for the academic progress and emo-
tional well-being of children diagnosed with ADHD. Barkley (1994) recommended that treatments
take place in the natural classroom setting, target the behaviors that will facilitate academic progress,
respond to targeted behaviors quickly and frequently, and continue as long as maintenance of tar-
geted behaviors is desired. It also has been suggested that the combination of several empirically val-
idated techniques will be more likely to result in clinically significant improvements than the use of
only one technique (Pfiffner & Barkley, 1990).
Therapeutic strategies for children with ADHD in school environments often neglect the need
to improve peer relationships. Approximately 50% to 60% of children with ADHD experience some
form of social rejection from their peers (Guevremont, 1990). Thus, in planning a comprehensive
school treatment program for children with ADHD, techniques to enhance peer social status also
should be considered. Many attempts to improve the social functioning of children with ADHD are
clinic-based and focus on teaching social skills apart from the child’s peer group. Typically, ADHD
children become more knowledgeable about appropriate and inappropriate social behavior as a re-
sult of these programs; however, the learned skills are often not performed in the children’s home
and school environments (Guevremont, 1990). In order to facilitate the generalization of social skills,
Guevremont (1990) has recommended that natural therapy facilitators (e.g., peers, teachers) take part
in this aspect of treatment.
In this article, a comprehensive classroom intervention program for children with ADHD is de-
scribed. The program discussed is The ADHD Classroom Kit: An Inclusive Approach to Behavior

Correspondence concerning this article should be addressed to Cheryl B. McNeil, Ph.D., Department of Psychology,
P.O. Box 6040, West Virginia University, Morgantown, WV 26506-6040.

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68 Anhalt, McNeil, and Bahl

Management (Kit; McNeil, 1995). The Kit is a whole-classroom reinforcement program that incor-
porates the types of techniques which have demonstrated benefits in the behavior management of
children with ADHD. The Kit was designed for use in regular education classrooms, kindergarten
through sixth grade.
The Kit was developed as a whole-classroom approach for several reasons. First, children with
ADHD often are provided an individual behavioral treatment program, including some special at-
tention or rewards. Teachers and classmates may feel that it is not fair for ADHD children to receive
special rewards for complying with rules that everyone in the class has to follow. Second, teachers
may have two or three children with ADHD in their classroom and may find it difficult to meet their
needs while also meeting the needs of typical children. Third, a reinforcement system designed for
the entire classroom may prove practical and beneficial for all its students. The purpose of this arti-
cle is to describe the main components of the Kit, to explain the inclusion of Kit elements through
an empirically-based rationale, and to present preliminary data supporting the Kit’s effectiveness. To
begin, a summary of the Kit is presented.
The basis of the program is that groups of children try to follow the class rules and instructions
in exchange for the privilege to play the Rewards Target Game (RTG). Groups of children receive
happy faces for following classroom rules and teacher instructions. Teachers are encouraged to pro-
vide enthusiastic labeled praises to individual and groups of children as often as possible, particu-
larly when giving happy faces to a group.
For instances of noncompliant and disruptive behavior, groups receive sad faces. However, chil-
dren have the opportunity to modify their behavior before earning a sad face. This opportunity is giv-
en through a visual warning signal. Several times a day, groups of students that have more happy
faces than sad faces earn the privilege of playing the RTG, a novel and stimulating game. Every time
children play the RTG, they earn one of over 50 possible rewards. Rewards involve playing games,
acting silly, and obtaining tangible reinforcers (e.g., treats, stickers, hand stamps).
Techniques utilized in the Kit are categorized as consequences for appropriate behavior (e.g.,
on-task work), consequences for inappropriate behavior (e.g., noncompliance), and peer-mediated
interventions. The components in each of these areas are described separately. The first category de-
scribed is consequences for appropriate behavior.

Consequences for Appropriate Behavior

Children diagnosed with ADHD typically perform best when immediate and frequent positive
feedback is provided to them (Fiore, Becker, & Nero, 1993). Positive consequences are often effec-
tive in decreasing activity level, increasing amount of time spent on-task, and improving the acade-
mic performance of students with ADHD (Fiore et al., 1993). In addition, consequences such as
praise and token reinforcement programs have proven useful in managing the behavior of children
with a variety of challenging behaviors (O’Leary & O’Leary, 1977). The Kit incorporates positive
consequences that usually act as reinforcers for children with ADHD. These consequences include
labeled praises, happy faces, and the Rewards Target Game.

Labeled Praises
Component. Labeled praises are different from unlabeled praises in that they specify the be-
havior receiving attention (Hembree–Kigin & McNeil, 1995). Teachers are encouraged to provide
labeled praises as frequently as possible. Labeled praises are specifically “required” when children
receive happy faces (description of happy faces follows). For example, a labeled praise for sharing
is “Mike, nice job sharing your marker with Lisa,” whereas an unlabeled praise is “Good job, Mike.”
In the latter example, there is no mention of the specific prosocial behavior that the teacher intends
to praise, and the student may not be aware of the particular behavior that pleases the teacher.
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ADHD Classroom Kit 69

Rationale. The use of praise has been documented to increase on-task and appropriate be-
havior in typical children and children who exhibit disruptive behaviors in the classroom (e.g., Drab-
man & Lahey, 1974; Kirby & Shields, 1972). In order to increase the likelihood that praise will be
effective in modifying targeted behaviors, praise should specify the behavior and it should be pro-
vided immediately after the desired behavior has been exhibited (O’Leary & O’Leary, 1977). Teacher
provision of frequent and immediate labeled praises to individual and groups of children is the first
consequence for appropriate behavior.

Happy Faces
Component. Happy faces are given to groups of children for individual and group behaviors
that are compliant and prosocial. Examples of behaviors that merit happy faces are following class
rules, staying on-task during a work period, and helping another student when appropriate. Happy
faces are awarded to a group of children as many times as the teacher is able to observe targeted be-
haviors from the group or individual children.
Rationale. The use of labeled praises for appropriate behavior often is not sufficient to im-
prove the academic and social performance of children with ADHD (Pfiffner & Barkley, 1990). In-
stead, studies indicate that positive consequences are most powerful when they include a combina-
tion of labeled praises and other rewards (e.g., Pfiffner, Rosen, & O’Leary, 1985). The provision of
points or tokens to children with ADHD upon exhibiting target behaviors have proven valuable in
improving their challenging behaviors (DuPaul, 1991). Because of their immediacy and frequency,
happy faces (in conjunction with labeled praises) are likely to be powerful reinforcers for typical
children and children with ADHD. Issues regarding the use of group-based rewards are discussed in
the peer interventions section of this article.

Rewards Target Game (RTG)

Component. Children earn the privilege of playing the RTG if their group has more happy
faces than sad faces (the sad faces component of the Kit is described below). The RTG is played one
to three times in the morning and one to three times in the afternoon. The game is intended to pro-
vide short breaks from academic tasks and stimulating rewards for appropriate behavior. A target is
used when playing the game, such that children throw a ball at a number. Each number corresponds
to a card that specifies a reward. Over 50% of the game cards provide activity rewards that involve
movement (e.g., freeze dancing), playing games (e.g., charades), and acting silly (e.g., act like your
favorite zoo animal). Cards also include tangible reinforcers, such as animal crackers, stickers, and
hand stamps. Thus, children who play the RTG do not know the type of reward they will receive,
and the game remains novel and stimulating.
Rationale for novel and stimulating rewards. When children with ADHD are exposed to sit-
uations that have low levels of stimulation they are likely to exhibit increases in hyperactive behav-
ior and disruption of on-task performance (Zentall & Zentall, 1983). Many academic tasks may be-
come repetitive and tedious for children with ADHD. One method for increasing motivation to focus
on academic work is for rewards to be new and interesting. The RTG contains numerous novel and
stimulating rewards. Therefore, it is expected that typical children and children with ADHD will be
more prone to monitor their behavior during class work time, because appropriate behavior will re-
sult in the opportunity to play the RTG.
Rationale for frequent breaks. Pfiffner and Barkley (1990) have recommended that short
breaks be interspersed with classroom lecture and academic periods. The purpose of these breaks is
to provide an alternative to the monotonous nature of many academic tasks. Because on-task be-
havior for academic work may be aversive to some children with ADHD, the RTG was designed to
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70 Anhalt, McNeil, and Bahl

function as a negative reinforcer by allowing children to stop that activity briefly. The RTG is played
two to six times a day, and teachers are encouraged to allow time to play the game, especially after a
“work burst.” A work burst is defined here as a short interval (5 to 20 min) of intense concentration fol-
lowed immediately by a break or reward for those students who worked hard and remained quiet dur-
ing the burst. Because the RTG is delivered under a variable-interval reinforcement schedule, high rates
of appropriate behavior are expected to result from that contingency (Sulzer–Azaroff & Mayer, 1991).

Renewed Opportunity to Play the RTG

Component. As mentioned previously, students have the opportunity to play the RTG if the
number of their group’s happy faces are greater than the number of sad faces. Once children transi-
tion into playing the RTG, a new period of earning happy and sad faces begins. Hence, all children
have an equal opportunity to participate in the RTG the next time it is played.
Rationale. An intervention that allows a child many opportunities during the day to obtain re-
wards increases the likelihood that the child will exhibit compliant and appropriate behaviors in the
future (DuPaul, 1991). In contrast, a reward program that involves lengthy delays between the ex-
pected behavior and the reinforcer is likely to be a poor motivator for students with ADHD. Con-
sider the following example, the common “stoplight” program approach to classroom discipline. All
children begin the day with their name tags placed in the green light zone. Misbehavior leads to a
name being placed initially in the yellow zone and afterward in the red zone, with corresponding
negative consequences. All children who remain in the green zone receive a reward at the end of the
day. As children with ADHD often have difficulty settling into schoolwork, it is common for them
to be placed in the yellow or red zone before the morning is over, thereby eliminating any motiva-
tion they might have had to try harder during the afternoon. By starting with a “clean slate” while
the RTG is being played, students with ADHD can regain interest in following classroom rules be-
cause the opportunity to earn a stimulating reward is renewed.

Consequences for Inappropriate Behavior

Few interventions based solely on positive reinforcement are effective in reducing off-task, non-
compliant, and disruptive behavior in children with ADHD and other behavior disorders (DuPaul,
1991). Some mild aversive consequences appear to be important in order to establish and maintain
the compliant and prosocial behavior of children with ADHD (Abramowitz & O’Leary, 1991).
Therefore, consequences for disruptive and noncompliant behavior are part of the Kit and include
sad-face warning signals, sad faces, and loss of the privilege to play the RTG.
Sad-Face Warning Signal
Component. Individual or groups of children are given a warning signal if they behave in a
disruptive manner or do not follow the rules of the class. The warning signal, called the “sad-face
warning signal,” consists of the teacher calling the child’s name, holding up two fingers, and giving
a two-choices statement. The two-choices statement means: “You have two choices. You can either
improve your behavior or your group will receive a sad face.” The child’s name is called using a mat-
ter-of-fact, monotonous voice, and the warning signal is given with minimal attention. Before the
program is initiated, children are taught the meaning of the signal and the two-choices statement.
Rationale. The warning signal in the Kit was incorporated to reduce the likelihood that teacher
attempts to redirect noncompliant and disruptive behavior could become reinforcing through nega-
tive attention. Any intervention that involves the use of negative attention (e.g., scolding) may be
counterproductive for children with ADHD. Often, negative attention is a reinforcer for students with
ADHD, whose needs for stimulation are greater than those of typical peers (Zentall & Zentall, 1983).
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ADHD Classroom Kit 71

Thus, the warning signal serves the function of prompting children to modify their behavior without
providing unnecessary negative attention.

Sad Faces
Component. Following the administration of a warning signal, students who continue behav-
ing inappropriately will receive a sad face. Sad faces are given in a matter-of-fact voice to minimize
attention given to children for negative consequences. An appropriate way to provide a sad face, for
example, would be to say “the kangaroos just earned a sad face,” using a neutral tone of voice with
minimal negative expression.
Rationale. Mild punishment procedures (e.g., response-cost) in token economies have result-
ed in increases of on-task behavior and decreases in disruptive behaviors of children with ADHD
(Abramowitz & O’Leary, 1991). Sad faces in the Kit serve as conditioned aversive stimuli because
they are paired with decreased opportunities to play the RTG. Therefore, sad faces are expected to
decrease disruptive behavior.
An advantage of using the sad-face warning signal and the sad faces is that these consequences
can be provided numerous times throughout the day to manage the many disruptive behaviors of
ADHD children. In this manner, teachers can avoid the common trap of not providing consequences
for misbehavior. When consequences are not in place for inappropriate behavior, escalation is like-
ly to happen, and the outcome is often a major consequence given to a child, such as removal from
the room, loss of recess, or suspension. By managing behavior in the Kit with sad-face warning sig-
nals and sad faces, escalation of disruptive behavior may be avoided.

Losing the Privilege of Playing the RTG

Component. Groups that have earned the privilege of playing the RTG are moved to a special
area of the class (usually a floor area in front of the blackboard). Children who do not earn the priv-
ilege of playing the game are told to remain in their seats. These students can watch the game being
played, but are not permitted to participate. The ‘clean slate’ approach in which the teacher erases
all happy and sad faces prior to the next round of play helps to prevent and manage disruptive be-
havior by students who are not permitted to play the game. Nonparticipating students who are dis-
ruptive during the RTG will receive sad faces for the next round of play.
Rationale. The justification for this component is similar to the rationale for the sad faces tech-
nique. DuPaul and Stoner (1994) reported that loss of privileges is an effective method of increas-
ing target behaviors, especially when used in conjunction with reinforcement-based procedures. The
loss of the opportunity to play the RTG is expected to decrease the frequency of noncompliant and
disruptive behaviors.

Peer-Mediated Interventions
The group model of the Kit system has goals similar to cooperative learning, an educational
approach that has received considerable attention (e.g., Johnson, Maruyana, Johnson, Nelson, &
Skon, 1981; Slavin, 1983). Students involved in a cooperative learning program work in small groups
on academic material. Usually, the groups receive a group reward for good performance (Furman &
Gavin, 1989). Different investigators have found that children in a cooperative learning environment,
compared to children in individualistic learning conditions, show higher levels of self-esteem, im-
proved interpersonal cooperation, greater tolerance of others, and increased social acceptance (Fur-
man & Gavin, 1989). Also, in a meta-analysis of 122 studies, Johnson et al. (1981) concluded that
children in cooperative learning programs show greater improvements in achievement and produc-
tivity than children in either interpersonal competition or individualistic efforts.
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72 Anhalt, McNeil, and Bahl

With the Kit, children work together to try to follow the rules of the class. Although some of
the rules and activities involve working on academic material together, others do not. Still, it is ex-
pected that using the Kit will result in effects similar to cooperative learning strategies, that is, im-
proved academic performance and social functioning for all children. Other peer-mediated inter-
ventions in the Kit include group leaders and group-based rewards. Group-based rewards are set up
as dependent and interdependent group contingencies.

Group Leaders
Component. In the Kit, each group has a different leader every day. The leader is responsible
for motivating the group in following the rules. The leader also has the privilege of using the warn-
ing signal when a member of the group is behaving in a disruptive or noncompliant manner. Group
leaders are monitored by the teacher to ensure that redirecting is appropriate. Positive redirection is
reinforced with happy faces. Inappropriate redirection or criticism of another student on the part of
the group leader results in the group receiving a sad face.
Rationale. The empirical literature indicates that peer monitoring of student behaviors has re-
sulted in increases in prosocial behavior and decreases in disruptive behavior on the part of the tar-
geted student (e.g., Smith & Fowler, 1984). In addition, the leader’s opportunity to provide feedback
and redirection to another student could positively impact the leader’s social functioning and self-
esteem. Therefore, it is expected that the group leader component of the Kit will be beneficial to both
the facilitator and to the receiver in improving social and academic functioning.

Group-Based Rewards
Component. As mentioned earlier, the happy and sad faces are delivered to groups of chil-
dren. Provision of happy and sad faces can be the result of individual and group behavior. In order
for groups to have equal opportunities to earn happy and sad faces, a balance is recommended in the
formation of groups. That is, a group should contain a mix of students that misbehave often and chil-
dren that exhibit exemplary behavior at school. If a group has a member with ADHD, strong role
models of prosocial and on-task behaviors should be placed in the same group.
Rationale. The provision of happy faces and sad faces are based on both dependent and in-
terdependent group contingencies, while the RTG is based on an interdependent group contingency.
In dependent group contingencies, group rewards are provided based on the performance of one or
several group members (Sulzer–Azaroff & Mayer, 1991). Interdependent group contingencies are
characterized by group members being treated as a single behaving individual; that is, group per-
formance determines eligibility for a group or individual reward (Sulzer–Azaroff & Mayer, 1991).
Both dependent and interdependent group contingencies have proven helpful in the improve-
ment of academic performance and prosocial behavior of typical children and children with disrup-
tive behavior problems. For example, Barrish, Saunders, and Wolf (1969) found that group-based re-
wards were motivating to individual children in decreasing out-of-seat and talking-out behaviors. In
addition, students in the meta-analysis conducted by Slavin (1983) were found to exhibit their best
performance when their individual efforts counted toward a group reward.
With the use of the Kit, it is expected that children will exhibit their best academic and social
behavior because the provision of positive consequences (i.e., happy faces and playing the RTG) to
a group of children is contingent on each member’s behavior. Conversely, misbehavior is less like-
ly to occur with the Kit, as negative consequences for a group will be in effect for disruptive behav-
ior of individual children. Students will also benefit from the modeling provided by their group lead-
ers and other group members who exhibit high rates of prosocial behavior. An additional benefit of
the Kit system is that group-based token economies are also more practical in terms of time and ex-
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ADHD Classroom Kit 73

pense than individual ones when conducted with large numbers of students in regular education class-
rooms.
In the following paragraphs, a case study is presented that examines the effectiveness of the Kit
in decreasing ADHD behaviors (e.g., off-task behavior) in a 6-year-old Caucasian girl with report-
ed disruptive behavior problems.

Method

Participant.
Carol was a 6-year-old Caucasian girl attending first grade in a regular education classroom. Teacher
ratings of disruptive behavior were used to select Carol for screening. After the initial identification,
her teacher completed a Conners’ Teaching Rating Scales-28 (CTRS-28; Conners, 1989). Teacher
reports of Carol’s behavior on the CTRS-28 resulted in clinically significant scores on the hyperac-
tivity subscale. Thus, Carol was selected as the participant for this case study.
Measures
Classroom Coding System. Components of the Classroom Coding System (McNeil, Eyberg,
Eisenstadt, Newcomb, & Funderburk, 1991) were utilized to code Carol’s behavior during classroom
observation periods. Two categories of behavior were coded for Carol: appropriate vs. oppositional
and on-task vs. off-task. The operational definitions for these categories are based on those provid-
ed by McNeil et al. (1991; see Appendix).
Treatment integrity measure. A treatment integrity measure was used on 40% of the data col-
lection days to assess the accuracy with which Carol’s teacher was implementing each of the condi-
tions. Each checklist verified that the guidelines for each program (i.e., school-wide discipline and
ADHD Classroom Kit; described below) were implemented according to the training provided.
Conners’ Teaching Rating Scales-28 (CTRS-28). The CTRS-28 is a 28-item teacher report of
a particular child’s disruptive behavior problems. Responses on the CTRS-28 are factored into four
subscales: conduct problem, hyperactivity, inattentive-passive, and hyperactivity index (Conners,
1989). A description of scoring, interpretation, and reported adequate psychometric properties of the
CTRS-28 has been discussed elsewhere (see Conners, 1989). Carol’s teacher was asked to complete
the CTRS-28 (considering Carol’s behavior) prior to data collection and near the end of each exper-
imental condition.
Teacher satisfaction measure. This measure was designed to assess consumer satisfaction
with each of the behavior management programs. Ratings on this measure ranged from 1 5 poor to
5 5 excellent on a 5-point Likert scale. Areas identified included ease of program implementation
and usefulness of program. Carol’s teacher was asked to complete this measure near the final session
of each experimental condition.

Procedure

Classroom Observation
All observations of Carol’s behavior were coded in vivo using the components of the Classroom
Coding System (McNeil et al., 1991). Observations were made on a 10 s observe, 10 s record basis
for 10 min sessions each day. Classroom observations took place every day during the morning
throughout data collection. For reliability purposes, a second observer independently collected data
on 40% of the sessions. Observers used a prerecorded audiotape played on dual jack earphones to
cue the intervals. On reliability days, observers sat as separate from one another as possible to as-
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74 Anhalt, McNeil, and Bahl

sure independent data collection. Kappa was used to estimate percent agreement between observers.
Mean k coefficients for observed behaviors were as follows: total reliability equaled 0.81, appropri-
ate behavior equaled 0.83, and on-task behavior equaled 0.83.

Experimental Design
The experimental design in Carol’s classroom was an A-B-A reversal. The baseline and rever-
sal phases (i.e., A conditions) consisted of the school-wide discipline program already in place at
Carol’s elementary school. This program involved a green, yellow, and red light system in which
children could receive a total of three violations for disobeying rules of the classroom. If no misbe-
havior occurred throughout the day, children kept a green light. The first violation resulted in a ver-
bal warning; the second violation resulted in children receiving a yellow light and a note in the class
roster sheet; and the third violation resulted in children receiving a red light. Children who kept their
green light throughout the week (i.e., received no violations) earned one point for the class total.
When the class points equaled 100, a star was added to the star mobile and the class received a
reward.
The treatment phase (i.e., B condition) was the ADHD Classroom Kit (discussed in detail
throughout the introduction of this paper). Carol’s data were gathered in conjunction with data col-
lection for another study described elsewhere (Bahl & McNeil, 1997). Of interest, the research of
Bahl and McNeil (1997) involved data collection in two classrooms; one classroom functioned un-
der an A-B-A design (Carol’s classroom) and the other under a B-A-B design. Each condition was
in effect for a minimum of 10 observation days. Children in Carol’s classroom were visually and ver-
bally cued by their teacher regarding the classroom management strategy implemented that day.

Teacher Training
There were three phases of training for Carol’s teacher. First, she was asked to review handouts
explaining each of the previously described behavior management programs. Because the instruc-
tions for the Kit were more complex, a videotape was included with the written handout. Second,
Carol’s teacher was involved in two 1 hr didactic sessions; each 1 hr session was devoted to inter-
active explanation, discussion, and role-play of one of the programs. Finally, in vivo coaching took
place in Carol’s classroom until the integrity criteria were met.

Results

Results of Observational Data

Classroom Coding System. Carol’s frequencies of appropriate and on-task behavior are dis-
played in Figures 1, 2, 3, and 4. Each figure depicts results from the three conditions (i.e., baseline-
Kit-reversal). To facilitate the presentation of findings, each datum in Figure 1 represents the mean
frequency of on-task behavior for two consecutive days. (Data points 2, 15, and 17 are exceptions,
and only represent the frequency of on-task behavior for one day). There was a higher frequency of
on-task behavior during the Kit condition than during baseline. In addition, frequencies of on-task
behavior in the reversal condition were generally lower than in the Kit condition. The trends dis-
cussed for Figure 1 are supported by the analysis of mean frequencies of on-task behavior per con-
dition, as presented in Figure 2. To illustrate, mean frequencies of on-task behavior were 76.2% dur-
ing the baseline condition; 87.8% during the Kit condition; and 82.5% during the reversal condition
(see Figure 2).
Figure 3 shows the frequency of appropriate behavior across conditions. Each datum in this fig-
ure represents the mean frequency of appropriate behavior for two consecutive days. (Data points 3,
15, and 17 are exceptions, and only represent the frequency of appropriate behavior for one day).
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ADHD Classroom Kit 75

Figure 1. Carol’s frequency of on-task behavior during baseline, Kit, and reversal conditions; each datum depicts the mean
frequency of on-task behavior for observations on two consecutive days.

The trends in the data for appropriate behavior were very similar to the findings for on-task behav-
ior. Thus, there was a higher frequency of appropriate behavior during the Kit condition than during
baseline. In addition, frequencies of appropriate behavior in the reversal condition were generally
lower than in the Kit condition.

Figure 2. Carol’s mean frequency of on-task behavior during baseline, Kit, and reversal conditions.
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76 Anhalt, McNeil, and Bahl

Figure 3. Carol’s frequency of appropriate behavior during baseline, Kit, and reversal conditions; each datum represents
the mean frequency of appropriate behavior for observations on two consecutive days.

The trends discussed for Figure 3 are supported by the analysis of Figure 4, which presents the
mean frequencies of appropriate behavior per condition. To illustrate, the baseline mean frequency
of appropriate behavior was 61.3% of the intervals. During the Kit condition, the mean frequency of
appropriate behavior was 78.5%. This reversed to 70.7% in the return to baseline phase (see
Figure 4).
Treatment integrity measure. The mean treatment integrity percentages per condition were as
follows: 95% during baseline, 95% for the Kit condition, and 93% for the reversal condition. The
above percentages reflect a good overall adherence to the corresponding classroom management
strategy.

Figure 4. Carol’s mean frequency of appropriate behavior during baseline, Kit, and reversal conditions.
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ADHD Classroom Kit 77

Teacher-Report Measures
Conners’ Teacher Rating Scales-28 (CTRS-28). Carol obtained the following t scores on the
Hyperactivity subscale of the CTRS-28: 99 (initial screen), 84 (baseline), 54 (Kit), and 69 (rever-
sal). Thus, during baseline and the initial screen, Carol’s reported hyperactive behaviors reached
the clinical significance level when compared to normative data. Reported hyperactive behaviors
during the Kit condition decreased to normal levels. Finally, hyperactive behaviors during the re-
versal condition reached borderline clinical significance levels. Teacher-report on the CTRS-28 re-
vealed Conduct Problem t scores of 59 (initial screen), 1001 (baseline), 76 (Kit), and 83 (reversal).
Thus, there is some support for a relative decrease in conduct problem behaviors during the Kit con-
dition.
Treatment satisfaction measure. Carol’s teacher completed this measure at the end of each
condition in the study. She rated her satisfaction with the school-wide discipline program at the end
of baseline as a 20 out of 50. Also, at the end of the Kit condition, Carol’s teacher rated her satis-
faction with this program as a 47 out of 50. Finally, Carol’s teacher rated her satisfaction with the re-
versal condition (i.e., school-wide discipline program) as a 19 out of 50.

Discussion
This case study examined the effectiveness of the ADHD Classroom Kit in increasing on-task
and appropriate behaviors of a 6-year-old Caucasian girl with reported disruptive behavior prob-
lems. Results offer preliminary support for the Kit as a whole-classroom approach for managing
disruptive behavior. Particularly, frequencies of appropriate and on-task behaviors were higher dur-
ing the Kit condition than during baseline. Further, when the reversal condition was implemented,
frequencies of appropriate and on-task behaviors decreased in relation to rates during the Kit con-
dition.
Teacher-report measures also offer preliminary support for the effectiveness of the Kit as a
whole-classroom approach to behavior management. Specifically, Carol’s teacher ratings of hyper-
activity reached clinical and borderline clinical significance levels during the baseline and reversal
conditions, respectively. Interestingly, Carol’s reported hyperactive behaviors decreased to normal
levels during the Kit condition. Although Carol’s conduct problem behaviors remained in the clini-
cally significant range throughout the study, her teacher reported relatively fewer conduct problems
in the Kit condition. Further, Carol’s teacher reported greater levels of satisfaction with classroom
behavior management at the end of the Kit condition than at the end of baseline and reversal condi-
tions (i.e., while the school-wide discipline program was in effect).
In conclusion, the Kit was developed by carefully examining interventions that have proven ef-
fective for managing the behavior of children with ADHD. The Kit follows the recommendations of
leaders in the area of school interventions for children with ADHD. Specifically, it includes several
positive and negative consequences that have proven useful in changing the behavior of children with
ADHD. In addition, the Kit addresses two aspects that have not received much attention from the lit-
erature: inclusion and peer interventions. The field of education is moving toward inclusion of chil-
dren with special needs into regular education classrooms; however, teachers often do not have the
tools or skills to meet these special needs.
The preliminary findings of this study suggest that the Kit may be helpful in the behavior man-
agement of children with ADHD, while also providing an effective whole-classroom discipline pro-
gram. However, more controlled investigations are needed to support these initial results and to pro-
vide further information regarding such issues as changes in the social functioning of children with
ADHD, children’s satisfaction with the intervention, teacher acceptance of the procedures, and class-
room-wide behavior change.
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78 Anhalt, McNeil, and Bahl

References
Abramowitz, A. J., & O’Leary, S. G. (1991). Behavioral interventions for the classroom: Implications for students with
ADHD. School Psychology Review, 20, 220–234.
Bahl, A. B., & McNeil, C. B. (1997). Evaluation of a whole-classroom approach for the management of Attention Deficit
Hyperactivity Disorder. Unpublished manuscript, West Virginia University at Morgantown.
Barkley, R. A. (1989). Attention-Deficit Hyperactivity Disorder. In E. J. Mash and R. A. Barkley (Eds.), Treatment of child-
hood disorders (pp. 39–72). New York: Guilford Press.
Barkley, R. A. (1990). Developmental course and adult outcome. In R. A. Barkley (Ed.), Attention Deficit Hyperactivity
Disorder: A handbook for diagnosis and treatment. (pp. 106–129). New York: Guilford Press.
Barkley, R. A. (1994). Foreword. In G. J. DuPaul and G. Stoner (Eds.), ADHD in the schools: Assessment and interven-
tion strategies. New York: Guilford Press.
Barrish, H. H., Saunders, M., & Wolf, M. M. (1969). Good behavior game: Effects on individual contingencies for group
consequences on disruptive behavior in a classroom. Journal of Applied Behavior Analysis, 2, 119–124.
Conners, C. K. (1989). Conners’ rating scales manual: Conners’ teacher rating scales and Conners’ parent rating scales.
Toronto, Canada: Multi-Health Systems.
Drabman, R. S., & Lahey, B. B. (1974). Feedback in classroom behavior modification: Effects on the target and her class-
mates. Journal of Applied Behavior Analysis, 7, 591–598.
DuPaul, G. J. (1991). Attention Deficit-Hyperactivity Disorder: Classroom intervention strategies. School Psychology In-
ternational, 12, 85–94.
DuPaul, G. J., & Stoner, G. (1994). ADHD in the schools: Assessment and intervention strategies. New York: Guilford
Press.
Fiore, T. A., Becker, E. A., & Nero, R. C. (1993). Educational interventions for students with Attention Deficit Disorder.
Exceptional Children, 60, 163–173.
Furman, W., & Gavin, L. A. (1989). Peers’ influence on adjustment and development: A view from the intervention liter-
ature. In T. J . Berndt & G. W. Ladd (Eds.), Peer relationships in child development (pp. 319–340). New York: Wiley.
Guevremont, D. (1990). Social skills and peer relationship training. In R. A. Barkley (Ed.), Attention-Deficit Hyperactiv-
ity Disorder: A handbook for diagnosis and treatment (pp. 540–572). New York: Guilford Press.
Hembree–Kigin, T. L., & McNeil, C. B. (1995). Parent–child interaction therapy. New York: Plenum.
Johnson, D. W., Maruyana, G., Johnson, R., Nelson, D., & Skon, L. (1981). Effects of cooperative, competitive, and
individualistic goal structures on achievement: A meta-analysis. Psychological Bulletin, 89, 47–62.
Kirby, F. D., & Shields, F. (1972). Modification of arithmetic response rate and attending behavior in a seventh-grade stu-
dent. Journal of Applied Behavior Analysis, 5, 79–84.
McNeil, C. B. (1995). The ADHD Classroom Kit: An inclusive approach to behavior management. King of Prussia, PA:
Center for Applied Psychology (available by calling 1-800-962-1141).
McNeil, C. B., Eyberg, S., Eisenstadt, T. H., Newcomb, K., & Funderburk, B. (1991). Parent–child interaction ther-
apy with behavior problem children: Generalization of treatment effects to the school setting. Journal of Clinical Child
Psychology, 20, 140–151.
O’Leary, K. D., & O’Leary, S. G. (1977). Classroom management: The successful use of behavior modification. (2nd ed.).
New York: Pergamon Press.
Pfiffner, L. J., & Barkley, R. A. (1990). Educational placement and classroom management. In R. A. Barkley (Ed.), At-
tention-Deficit Hyperactivity Disorder: A handbook for diagnosis and treatment (pp. 498–539). New York: Guilford
Press.
Pfiffner, L. J., Rosen, L. A., & O’Leary, S. G. (1985). The efficacy of an all-positive approach to classroom manage-
ment. Journal of Applied Behavior Analysis, 18, 257–261.
Slavin, R. E. (1983). When does cooperative learning increase student achievement? Psychological Bulletin, 94, 429–445.
Smith, L. K., & Fowler, S. A. (1984). Positive peer pressure: The effects of peer monitoring on children’s disruptive be-
havior. Journal of Applied Behavior Analysis, 17, 213–227.
Sulzer–Azaroff, B., & Mayer, G. R. (1991). Behavior analysis for lasting change. Fort Worth, TX: Holt, Rinehart, and
Winston.
Zentall, S. S., & Zentall, T. R. (1983). Optimal stimulation: A model of disordered activity and performance in normal
and deviant children. Psychological Bulletin, 94, 446–471.

Appendix: Definitions of Behaviors Observed in the Classroom

1. Appropriate behavior. The absence of oppositional behaviors. Behavior must have been ap-
propriate for the entire 10 s interval. If coders were unsure whether behavior was appropriate or op-
positional, they were instructed to code appropriate behavior.
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ADHD Classroom Kit 79

2. Oppositional behavior. Behavior was coded as oppositional during an interval if the child en-
gaged in any of the following behaviors: whining, crying, yelling, temper tantrums, destructiveness,
negativism, pathological self-stimulation, demanding attention, high-rate behavior, talking out of or-
der, being out of area, or cheating.
3. On-task. Carol was considered to be on-task if she was attending to the material and the task,
making appropriate motor responses (e.g., writing, computing, pasting), and asking for assistance
(where appropriate) in an acceptable manner. Interacting with the teacher or classmates about aca-
demic matters or listening to teacher instructions and directions were considered to be on-task be-
haviors. To be coded as on-task, Carol must have remained on task for the full 10 s observation in-
terval.
4. Off-task. Carol’s behavior was coded as off-task if at any point during the 10 s interval she
engaged in behavior that did not meet the definition for on-task behavior. Examples of off-task be-
havior included failure to attend to or work on the assigned task, breaking classroom rules (e.g., out
of seat, talking out, disturbing others, etc.), laying head on desk passively when there was a task to
complete, and daydreaming. If Carol was in time-out during the observation interval, her behavior
was automatically coded as off-task.
5. Not applicable. Coded when there was no readily identifiable task that Carol was expected
to perform. Examples of this category included free-play and unstructured recess time.