(Please note that the study described below is a case control study involving only 3 children.  In the past when I have reviewed studies with so few subjects, many readers have written asking whether such research can be considered valid.  This is a legitimate concern, and it should be noted that studies such as the one described here are only the first step in evaluating whether a particular intervention approach is effective, and need to be followed by larger trials.  Because the results obtained here are promising, however, and the need for effective academic interventions for students with ADHD is great, I felt that this would be an interesting study for you to know about. )

Many students with ADHD have difficulty achieving to their ability level in a variety of academic areas, including mathematics.  Difficulties in math that are common among children with ADHD include conceptualizing problems, basic fact retrieval, timely completion of problems, and the use of effective problem solving strategies.  Mastering basic addition/subtraction facts and multiplication tables often takes substantially longer than for students without ADHD and this can have negative implications for the later learning of higher level mathematical and technical skills.

Research on promoting academic achievement for students with ADHD has shown that they tend to do better when tasks are structured to match their individual academic levels, when they are provided with frequent feedback about how they are doing, and when consequences are consistently linked to their work.  The manner in which tasks are presented to students with ADHD can also facilitate their academic performance.  Specifically, when academic material is experienced as novel and is presented in a stimulating way, the attention and performance of students with ADHD often improves.

Unfortunately, consistently providing these learning conditions in the general education classroom environment can be difficult for a variety of reasons, which may be one reason that students with ADHD are prone to struggle academically.  As a result, some researchers have explored whether non-traditional instructional methods where such learning conditions are more likely to be present may be of particular benefit for students with ADHD.  One such method is presenting academic material via computer and is known as Computer Assisted Instruction, or CAI.

CAI may be an especially promising instructional approach for students with ADHD because instructional material can be individualized to the child's skill level, something that a teacher of 20-30 students cannot consistently do.  Furthermore, computers can provide a stimulating method for presenting material that involves multiple senses and can be programmed to provide children with immediate and consistent feedback on their performance. Thus, the features of CAI are those that have been shown to enhance the academic productivity and skill mastery for students with ADHD, and several preliminary reports provide tentative support for the benefits of CAI for children with ADHD.

A recently published study extends on this preliminary work by examining the impact of CAI on the mathematics performance of students with ADHD within a general education classroom (Mautone, Dupaul, & Jitendra. 2005. The effects of computer-assisted instruction on the mathematics performance and classroom behavior of children with ADHD. Journal of Attention Disorders, 9, 301-312.).  This was a small sample controlled case study involving 3 8-9 year-old children who, in addition to being diagnosed with ADHD, were at least one grade below their expected level in mathematics. 

CAI was provided within children's classrooms during regularly scheduled math instruction times.  The software used to deliver CAI was the Math Blaster for children ages 6-9, a program that is commercially available from Knowledge Adventure.  The software allows students to develop skills in addition, subtraction, multiplication, division, percentages, fractions, and decimals.  Difficulty levels may be adjusted by the user at the start of each session so that teachers could tailor the sessions to each student's individual academic needs.

Each activity provided a structured mathematics task in a game-like format where students earned points and moved through levels by answering questions correctly.  After responding to each item, students received feedback about whether their response was correct, and earned points for correct responses.  If they missed a problem, the computer provided the correct answer before the next problem was presented.  Once a predetermined number of points were earned during each session, students were rewarded with the opportunity to play a video game for several minutes before the math task resumed.

During the intervention phase of the study, the students worked on the Math Blaster program for 3 times per week for 10-15 minutes each session.  The number of weeks that each child received the CAI intervention varied from 10-20. There were no additional behavioral or academic components to the intervention, and other than making sure that the program began each day at a level that matched the child's skill level, no extra time or activity required of the teacher.  In addition, none of the students were receiving medication during the study.

Prior to beginning work with the Math Blaster program, each child's computational skill level was assessed on multiple occasions.  In addition, students were observed multiple times while working on math problem sheets so that the time they were actively engaged vs. off-task during regular math work could be measured.  These same measures of computational skills and active engagement were collected on repeated instances during the CAI intervention so that change in computational skill level and active engagement during mathematics work could be measured.


RESULTS

Assessments of computational skill conducted during the last two weeks of CAI indicated that each student had made significant performance gains.  Although some gain in computational ability would be expected to result from regular classroom instruction, 2 of the students improved at a substantially faster pace than would be expected for children their age, and improvement for the third was at the age expected level.  This is important because students with ADHD typically fail to progress at a rate in computational skill that is equivalent to their peers.  Thus, it appears that the intervention enabled the students to progress in their computational skills at a rate that would have been unlikely to occur in the absence of CAI.

Not surprisingly, notable changes in each student's active-engaged time and off-task behavior during math instruction were also evident.  One student showed an increase in active-engaged time from 44% to 85%, a second student from 18% to 88%, and the third student from 46% to 93%.  Off-task behavior showed a corresponding decrease.  These are striking changes and clearly indicate the degree to which the characteristics provided by CAI - individualized instructional level, stimulating presentation of material, and the frequent and immediate provision of performance feedback - can enhance the appropriate, on-task behavior in students with ADHD.

In addition to examining the impact of CAI on the growth in students' computational skills and changes in their behavior during math instruction, the researchers also inquired about its' acceptability to the students and teachers. This is an important aspect of any intervention because regardless of how helpful a particular approach may be, it is unlikely to be consistently implemented in schools if it is not acceptable to teachers and/or students.  For example, behavior therapy approaches can also be effective in improving students' academic performance, but can be difficult for teachers to implement because of the time that can be required.  In the case of the CAI intervention tested in this study, however, both teachers and students gave it high ratings of acceptability.


SUMMARY and IMPLICATIONS

The results of this study suggest that CAI can be an effective and acceptable intervention for some elementary school students with ADHD who are having difficulty with math.  Although not explicitly tested in this study, it is likely that the effectiveness of CAI in improving students' calculation skills is related to the fact that it provides frequent and immediate reinforcement as the student works on the computer.  In addition, CAI provides students with "increased opportunities to practice the targeted skills in the stimulating and individualized learning environment provided by software with a game format."

Despite the positive findings reported in this study, there are several important limitations to keep in mind.  First, and most importantly, this was a controlled case study that involved only 3 elementary school students.  Thus, replicating these findings with a larger sample that includes an appropriate control group will be required to better understand the potential benefits of this approach for students with ADHD who are struggling in math.

Second, there was no follow-up component to this study, so it is not possible to know whether the gains accruing from the CAI intervention would be maintained over time.  Whether CAI would continue to be effective if it were continued for a longer period and the novelty began to wear off is unknown.

Third, because behavioral observations were only conducted when students were working on the computer, no information is provided about whether the increases in active engagement during instructional time were limited to CAI, or whether they may have generalized to other instructional times.

Finally, because this study was limited to younger children, it is not clear whether CAI could also be effective for older students.  This is an important question because in later grades the academic material to be mastered in math becomes more conceptually challenging, and the degree to which this can be effectively presented via computer is unclear.  In addition, teachers of older students "might be concerned about the potential stigma related to singling out those students who need to work on basic academic skills on the computer."

Despite these limitations, results from the present investigation are sufficiently encouraging to warrant careful follow-up research in which some of the limitations noted  above are addressed.  Currently, my colleagues and I are initiating a study in which CAI will be tested as a method for enhancing academic success in students with significant attention problems that includes a larger sample, an appropriate control group, and a longer-term follow-up period.  Results from this study will not be available, however, for several years.

In the interim, however, the use of computerized instructional programs is something that parents and educators may wish to consider implementing, especially since the required software is readily available, reasonably priced, and appears to have the potential to be helpful.