This document is a senior thesis submitted by Madison Monahan to the Global Health Studies Department at Allegheny College. It analyzes the similarities and differences between an ADHD treatment program and classroom dynamics. The document provides background information on ADHD, including common symptoms, diagnosis criteria from the DSM-5, and treatment options. It then discusses an ethnographic study conducted by the author to compare themes in an ADHD summer treatment program and classrooms in Meadville, Pennsylvania, such as recognition of mental health issues and maintaining attention. Differences identified include tolerance for disruptive behaviors and interactions between students and teachers. The author concludes more education is needed to help teachers understand ADHD and improve diagnosis and treatment plans.

1. SIMILARITIES AND DIFFERENCES BETWEEN AN ADHD TREATMENT PROGRAM
AND CLASSROOM DYNAMICS: RECOGNIZING THE PROBLEMATIC ISSUES
SURROUNDING ADHD BEHAVIORS
Madison Monahan
Submitted to the Global Health Studies Department, Allegheny College
in partial fulfillment of the requirements for the degree of
Bachelor of Science
March 30, 2015

2. Monahan 2
SIMILARITIES AND DIFFERENCES BETWEEN AN ADHD TREATMENT PROGRAM
AND CLASSROOM DYNAMICS: RECOGNIZING THE PROBLEMATIC ISSUES
SURROUNDING ADHD BEHAVIORS
A Senior Comprehensive Project
Presented by:
Madison Monahan
March 30, 2015
I hereby recognize and pledge to fulfill my responsibilities as defined in the Honor Code and
to maintain the integrity of both myself and the College community as a whole.

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Abstract
Attention-Deficit/Hyperactivity disorder (ADHD) is one of the most common
neurobehavioral disorders among youth populations. Treatment for managing the three major
symptoms of ADHD—inattention, hyperactivity and impulsivity—has become a popular area
of research. Pharmaceutical treatments as well as behavior modification treatment have all
yielded positive results in managing the symptoms of ADHD, but recent research reveals no
information on long-lasting results. Although several behavior modification treatment
programs have produced behavioral changes, the question of surveillance may reveal why
treatment outcomes are not permanent. Because ADHD is a chronic condition, temporary
treatment is not sufficient enough in producing life lasting results. Using an ethnographic
approach, the purpose of my study was to analyze and compare overlapping themes that may
be present in a summer treatment program and the classroom setting in Meadville,
Pennsylvania. Common themes observed were the recognition of mental health and effects on
progress, a low tolerance for disobedient behavior and similar strategies in maintaining
attention. Differences included the idea of threat versus action, tolerance for aggressive
behavior and interactive behavior between students and teachers. Because externalizing
behaviors are more commonly recognized than internalizing ADHD behaviors, it may be
beneficial to educate teachers and bridge the gap between medical, psychological and school
professionals to create a more specific diagnosis and appropriate treatment plan.

4. Monahan 4
Introduction
Interventions have been facilitated and studied in order to modify behavior in youth
populations specifically regarding mental health (Harrison, Thompson & Vannest, 2009).
Examples of children and adolescents who have been targeted for behavioral interventions
include those who suffer from mental impairments such as anxiety and/or attention-
deficit/hyperactivity disorder (Santucci, Ehrenreich, Trosper, Bennett & Pincus 2009; Legget
& Hotham, 2010). Not only are these populations particularly susceptible to stress, but they
experience equal amounts of pressure, creating a negative atmosphere in social settings that
can continue through adulthood (Santucci et al., 2009; National Institute of Mental Health,
[NIMH] 2012).
Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most common brain
disorders among both youth and adult populations (NIMH, 2012; Centers for Disease Control
and Prevention, [CDC] 2013d). ADHD is defined by three major symptoms: inattention,
hyperactivity and impulsivity (NIMH, 2012). An individual experiencing inattention may
become easily distracted, have difficulties processing thoughts and completing homework
assignments (NIMH, 2012). Children who are hyperactive may have trouble sitting still and
completing tasks quietly (NIMH, 2012). The last symptom, impulsivity, can be seen in
children who become impatient easily, act out without prior thought and interrupt
conversations and activities (NIMH, 2012). These symptoms have led to noticeably low
academic performance levels (Loe & Feldmen, 2007). Children and adolescents experiencing
inattention, hyperactivity and impulsivity have suffered in academics with low reading levels
and low scores in standardized math tests ultimately leading to declining rates of high school
graduation and postsecondary education (Loe & Feldmen, 2007). Additionally, children and
adolescents with ADHD who have also been diagnosed with a coexisting mental health
condition, such as anxiety, have been associated with greater rates of absentees in school

5. Monahan 5
(ADHD Institute, 2015). Also, adults with ADHD and comorbid disorders have been linked
to higher rates of unemployment (ADHD Institute, 2015).
In order to diagnosis ADHD, an assessment process is combined using the 5th
edition
of Diagnostic and Statistical Manual of Mental Disorders, (DSM-5) interviews and rating
scales (ADHD Institute, 2015). A clinical examination searching for hearing, vision and
neurological impairments related to motor skills are evaluated (ADHD Institute, 2015).
Clinical exams will also gauge the presence of other comorbid disorders since ADHD has
symptoms that relate to other common behavioral disorders (ADHD Institute, 2015). After a
clinical exam, clinicians will conduct interviews among the patient, parents and teachers
(ADHD Institute, 2015). Rating scales are also used to assess the patient and may also be
completed by the patient, parent and teacher (ADHD Institute, 2015). Rating scales help
evaluate the presence of inattention, hyperactivity and impulsivity as well as cognitive
functioning and quality of life (ADHD Institute, 2015). In some cases, a healthcare
professional may not use interviews or rating scales and simply use the DSM-5 to diagnosis
ADHD (ADHD Institute, 2015). If a clinician uses the supplemental tools, after a thorough
assessment, a child or adolescent may or may not be diagnosed with ADHD using the DSM-5
(ADHD Institute, 2015).
The DSM-5 has recently been updated to provide more information to healthcare
professionals on ADHD in adults to help improve the treatment process (CDC, 2015). Other
changes include the condition that a child/adolescent must exhibit several symptoms in more
than one setting (CDC, 2015). The age at which symptoms can occur was also changed and
now includes age twelve as a point where symptoms can occur versus the previous set age at
six (CDC, 2015). The DSM-5 for ADHD is divided into two subcategories: inattention and
hyperactivity-impulsivity (Table 1). To be diagnosed with ADHD, a child or adolescent must
present six behaviors in either the inattentive or impulsive-hyperactive categories consistently

6. Monahan 6
for at least six months during the assessment process (Table 1). After sixteen years of age, the
patient only needs to present five symptoms in each category in order to be diagnosed, but
symptoms must be present before the age of twelve (Table 1). All symptoms must be present
in at least two settings (i.e. home and school) with the recognition that the symptoms have
severely affected the child/adolescent’s functioning and quality of life (CDC, 2015). The last
condition that must be met for ADHD diagnosis is that the symptoms are not prevalent during
the development and progression of psychotic disorders such as schizophrenia and that the
symptoms are not better explained by another mental disorder (CDC, 2015).
Inattention Hyperactivity and Impulsivity
◦Often fails to give close attention to details or
makes careless mistakes in schoolwork, at work,
or with other activities.
◦Often has trouble holding attention on tasks or
play activities.
◦Often does not seem to listen when spoken to
directly.
◦Often does not follow through on instructions
and fails to finish schoolwork, chores, or duties in
the workplace (e.g., loses focus, side-tracked).
◦Often has trouble organizing tasks and activities.
◦Often avoids, dislikes, or is reluctant to do tasks
that require mental effort over a long period of
time (such as schoolwork or homework).
◦Often loses things necessary for tasks and
activities (e.g. school materials, pencils, books,
tools, wallets, keys, paperwork, eyeglasses,
mobile telephones).
◦Is often easily distracted
◦Is often forgetful in daily activities
◦Often fidgets with or taps hands or feet, or
squirms in seat.
◦Often leaves seat in situations when remaining
seated is expected.
◦Often runs about or climbs in situations where it
is not appropriate (adolescents or adults may be
limited to feeling restless).
◦Often unable to play or take part in leisure
activities quietly.
◦Is often "on the go" acting as if "driven by a
motor".
◦Often talks excessively.
◦Often blurts out an answer before a question
has been completed.
◦Often has trouble waiting his/her turn.
◦Often interrupts or intrudes on others (e.g.,
butts into conversations or games)
From the Centers for Disease Control and Prevention, 2015
Table 1. Inattentive and hyperactive-impulsive behaviors of ADHD classified by the
DSM-5. These behaviors must be prevalent for at least six months prior to diagnosis and
identified before the age of 12. Depending on which and how many behaviors are exhibited,
an individual may be diagnosed with one of the three subtypes of ADHD.
ADHD is categorized into three subtypes depending on the symptoms the individual
presents: combined presentation (presents six or more symptoms from both inattentive and
hyperactive-impulsive categories), predominately inattentive presentation (presents six or

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more symptoms of inattention and less than six hyperactive-impulsive symptoms) and
predominately hyperactive-impulsive presentation (presents six or more symptoms in the
hyperactive-impulsive category and less than six inattentive behaviors) (CDC, 2015; NIMH,
n.d.). Combined presentation is the most common diagnosis of ADHD while the
predominantly inattentive presentation often goes unnoticed (NIMH, n.d.). Though ADHD
can be diagnosed by recognizing one or all of the symptoms of ADHD (inattention,
impulsivity, and hyperactivity) in the assessment process, this condition is often confused
with other problems and can sometimes be overlooked (NIMH, 2012). Not all children and
adolescents with ADHD will show all symptoms, making it difficult to identify and diagnose
(NIMH, 2012). Some individuals will only experience problems with inattention and may
never be diagnosed with ADHD because they are often quieter and more introverted (NIMH,
2012). In addition, others who show signs of hyperactivity and impulsivity may be
recognized for simply having social and disciplinary problems (NIMH, 2012). ADHD is
commonly associated with other comorbid disorders such as conduct disorder, oppositional
defiance disorder, anxiety and depression which may reveal why the diagnostic process of
ADHD becomes difficult (ADHD Institute, 2015).
After years of misdiagnoses, epidemiological inconsistencies arose due to research
irregularity (CDC, 2013a). The ADHD institute states that, globally, the mean prevalence of
children and adolescents (under the ages of 18) is between 5.29 and 7.1% (ADHD Institute,
2014). The American Psychiatric Association (APA) states that as of 2013 nearly 5% of the
youth (ages 4-17) population is affected by ADHD (APA, 2013). Although a new set of
diagnostic guidelines for ADHD have been created, inconsistencies in classifications and
research still create major discrepancies in national data (CDC, 2013c; CDC, 2013d).
Furthermore, community-based studies have shown much greater numbers than the national
average revealing an average prevalence rate of 11% in 2011 (CDC, 2013a.) In fact, research

8. Monahan 8
has shown an annual increase of 5% according to parent reporting (CDC, 2013b). State-based
evidence reveals that the lowest prevalence of ADHD in children is 5.6% and the highest
prevalence is 18.7% (CDC, 2013a). For example, Pennsylvania had an average prevalence of
9.3% in 2011, which was greater than the national average of 8.8% (CDC, 2011). Methods,
cultural differences and identification of the disorder all contribute to a complicated view for
ADHD prevalence (ADHD Institute, 2014).
The underlying causes of under- or over-diagnosing ADHD may be due to a debate
among scientists about the causal factors of ADHD. Genetics, environmental factors such as
smoking, nutrition (including sugar and food additive intake) have all been researched and
examined as potential links to ADHD (NIMH, 2012). Disagreement about whether ADHD
has causal links to genetics, environmental factors, or a combination of both has led to
controversy among diagnosing and treatment options (Singh, 2008). While biologists look for
genetic explanations and social scientists focus on behavioral and environmental
justifications, the validity of ADHD has been questioned on the ethics of its diagnostic format
and treatment options (Singh, 2008). It is important to note that there are several factors that
may be influencing the under- or over-diagnosing of ADHD in specific populations (Singh,
2008). One factor, known as the masculinity stereotype, has been observed as a factor that
influences the diagnoses of ADHD that leaves specific populations unnoticed and under-
recognized (Singh, 2008).
ADHD has commonly been associated with Caucasian males, and have been the most
commonly studied population in the area of research (Gershon, 2002). Boys, with an overall
ADHD prevalence rate of 13.2%, were more likely than girls (5.6%) to have ever been
diagnosed with ADHD (CDC, 2013a). Because girls have not often been a targeted
population in clinical research, females with ADHD are often treated less than males
(Gershon, 2002). Because disruptive behavior is a major sign of ADHD, other symptoms are

9. Monahan 9
often ignored, which has larger implications for girls (Gershon, 2002). Girls with ADHD
have been noted to internalize their symptoms and are usually less disruptive (Gershon,
2002). Although ADHD prevalence rates are much higher among boys than girls, and boys
are often targeted for clinical research, a meta-analytic review of gender differences in
ADHD reveals that girls have lower ratings of the three major symptoms of ADHD:
hyperactivity, inattention, and impulsivity, which suggest that girls are often under-diagnosed
because their symptoms are not as prevalent (Gershon, 2002). It is crucial to incorporate girls
with ADHD in clinical research because not only are their symptoms harder to identify, but in
comparison to boys, they have lower levels of intellectual functioning (Gershon, 2002).
Epidemiologic inconsistencies in prevalence measurements have led to a growing
concern in ADHD research and its impact on health and society (CDC, 2013a). Two other
key areas of research regarding ADHD, social/economic and intervention efficacy, have
given science varying implications (CDC, 2013d). For example, one study using a prevalence
rate of 5% concluded that ADHD has an estimated cost of $14,576 per individual and has a
total annual societal impact of $42.5 billion per year (Pelham, Foster & Robb, 2007).
However, both this study and CDC research state that socioeconomic data is incomplete and
has not been thoroughly recorded (Pelham, Foster & Robb, 2007; CDC, 2013d).
Another major area of concern regarding ADHD and its health implications are
treatment interventions (CDC 2013d; Harrison, Thompson & Vannest, 2009). Managing the
symptoms of ADHD can be found in two forms of treatment: medication and psychotherapy
(NIMH, 2012). Medications, otherwise known as psychostimulants include methylphenidate
and amphetamines which can help reduce symptoms of hyperactivity by activating specific
brain functions that stimulate a more focused behavior (NIMH, 2012). A variety of non-
stimulant medications may also be recommended such as atomoxetine, guanfacine, and
clonidine (NIMH, 2012). Although these medications have helped reduce symptoms of

10. Monahan 10
ADHD, several stimulants and non-stimulants have led to a multitude of side effects (NIMH,
2012). The most common side effects include decreased appetite, sleep issues, anxiety and
irritability, but the Food and Drug Administration (FDA) has found much more serious side
effects (NIMH, 2012). Both stimulant and non-stimulant medication have been associated
with increased psychological problems noting that atomoxetine has been associated with
suicidal thoughts in teenagers (NIMH, 2012). This becomes an increasingly important health
concern for individuals with ADHD and comorbid disorders. Because ADHD is commonly
linked to other mental health problems like anxiety and depression, psychostimulants have
the potential to increase the severity of these issues (ADHD Institute, 2015).
Another form of treatment, psychotherapy, otherwise known as behavioral therapy or
behavioral modification treatment focuses on altering the individual’s behaviors to reduce
symptoms of hyperactivity, inattention, and impulsivity (NIMH, 2012). These options include
counseling, therapy and assistance programs (Legget & Hotham, 2010). The American
Academy of Children and Adolescent Psychiatry (2013) suggest three methods for an
effective behavior treatment program: 1) parent-based training, 2) child-focused treatment,
(such as a summer treatment program) and 3) school-based interventions. The National
Institute of Mental Health (2012) recommends parent-based training to keep kids organized
and focused. The framework includes schedule making, giving clear and consistent rules and
ultimately rewarding positive behaviors. And, although there have been inconsistencies in
research, studies have still shown that behavioral therapy not supplemented with medications
have yielded extremely positive results (Harrison, Thompson & Vannest, 2009).
The Centers for Disease Control and Prevention (2013c) recommends that children
and adolescents diagnosed with ADHD be prescribed an effective form of medication as well
as behavioral therapy. However, research reveals inconsistencies in treatment effectiveness.
Contradictions in studies have created a particular interest in the research of ADHD

11. Monahan 11
interventions (Harrison, Thompson & Vannest, 2009). Firstly, parents and teachers play a
major role in the diagnostic and treatment process of the child or adolescent. Specifically to
ADHD, research has focused on the key development of behavior modification by the use of
medication, behavioral treatment or a combination of both (Harrison, Thompson & Vannest,
2009; Legget & Hotham 2010; Moldavsky, Pass & Sayal, 2013). A combination of both
medical and behavioral treatment has proven to be an extremely successful form of
intervention (Harrison, Thompson & Vannest, 2009). Nevertheless, psychostimulants,
behavior modification or a combination of both have still resulted in positive outcomes for
the child (Harrison, Thompson & Vannest, 2009). However, the idea of combining both
medical and behavior therapy arose after inconsistent results in effectiveness were found and
the question of long-term efficacy still remains (Harrison, Thompson & Vannest, 2009).
Because ADHD is one of the most common disorders among school-age children, the
classroom becomes a key area of focus for the initial stages of diagnosis and treatment
(Moldavsky, Pass, & Sayal, 2013). First, recognition of ADHD in children/adolescents is the
first major step to outlining a treatment program. The process of assessing an individual for
ADHD usually begins with school teachers for they may be the first ones to notice consistent
abnormal behavior in the academic setting (Moldavsky, Pass & Sayal, 2013). Through an
interview process and rating scales, a clinician may take into account teacher reports in order
to supplement the diagnostic process (ADHD Institute, 2015). Also, in several cases, teachers
are usually the first professionals that parents may consult with in recognizing difficulties in
their child’s behavior (Moldavsky, Pass & Sayal, 2013). Because children spend most of their
day in school, it is important to have teachers’ perspectives on diagnosis and treatment
processes (Moldavsky, Pass & Sayal, 2013). It is possible that a teacher may be the primary
identifier of the symptoms of ADHD, but the parents are the overall decision makers and
evaluating the home setting important in constructing ADHD (Carpenter-Song, 2009). In an

12. Monahan 12
ethnographical study conducted by Carpenter-Song, (2009) her participant observations and
key informant interviews revealed that the view of the medicalization of ADHD differs
among family backgrounds. Evaluating family beliefs and perceptions may be the leading
factor in catalyzing the treatment process for children with ADHD. For example, some
families observed completely disregarded ADHD as a health issue and simply categorized it
as an individual or familial issue (Carpenter-Song, 2009).
If and/or once a child has been diagnosed, behavior interventions, (whether they are
pharmaceutical or natural) become controversial among both parents and teachers
(Moldavsky, Pass & Sayal, 2013; Harrison, Thompson & Vannest, 2009). Firstly, parents are
the initial decision makers when it comes to treating their child. As aforementioned, the most
commonly used drugs to treat the major symptoms (inattention, impulsivity and
hyperactivity) are psychostimulants (APA, 2013; Legget & Hotham, 2010). However,
research shows that parents usually search for several non-pharmaceutical options for their
children before resorting to medication (Legget & Hotham, 2010). Teachers’ perspectives
have also been consistent with parents’ in that they are more likely to prefer non-medical
treatment before endorsing pharmaceuticals (Groenewald, Emond & Sayal, 2009). Both
teachers and parents are willing to accept in-home as well as classroom interventions that
build a stronger rapport with the children as a form of treatment and believe medication
should be the last option considered (Coles et al., 2005; Legget & Hotham, 2010; Moldavsky,
Pass & Sayal, 2013).
Examples of natural assistant programs that have been provided to help reduce the
symptoms of ADHD in children are physical programs. In a program using moderate to high
intensity physical activities results revealed a major reduction of the symptoms of ADHD
(Verret, Guay, Berthiaume, Gardiner & Beliveau, 2010; Smith et al., 2013). One study that
focused on relationship between physical activity and the behavioral change of children with

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ADHD shows that, according to post-program parent, teacher and staff ratings, that more than
two-thirds of the participants showed improvements (Smith et al., 2013). Another program
revealed that according to test results from before and after a 10 week physical activity
program, the children had noticeable behavioral changes (Verret et al., 2010). This study was
consistent with similar research on the subject matter: according to parent and teacher forms,
physical behavior improved (Verret et al., 2010; Smith et al., 2013). Permitting the behavioral
changes, parents noticed improvements with total, social, thought and attention problems, and
teachers noticed positive changes in anxiety-depression problems as well as social issues
(Verret et al., 2010). Not only have physical assistance programs been successful in helping
manage the symptoms of ADHD, the embodiment of natural or green outdoor space has been
equally successful (Kuo & Taylor, 2004).
Although most parents and teachers initially prefer the sole use of behavioral therapy
treatments, they may not be sufficient in stabilizing behavior (Groenewald, Emond & Sayal,
2009; Legget & Hotham, 2010; CDC, 2013c). Similarly, pharmaceutical interventions have
also given research little knowledge about long-term efficacy and reveal limitations on
effectiveness (Chronis et al., 2004). For example, a study conducted during an eight week
summer treatment program (STP) revealed no evidence that medication and non-medicated
groups differed in treatment success (Chronis et al., 2004). While also focusing on
withdrawal symptoms, this study also found that medicated groups had the most severe
withdrawal symptoms (though still being medicated) after the conclusion of the behavioral
modification treatment program (Chronis et al., 2004).
Environmental and social settings have been specifically effective in behavior
modification versus outpatient or individual treatment specifically due to the fact that many
mental health disorders are accompanied by low academic performance, unsettled
relationships with peers and parents, and little to no participation in activities (Coles et al.,

14. Monahan 14
2013). Group activities involving peer interaction proves beneficial to post-treatment
effectiveness (Santucci et al., 2009). In order to increase long-term effectiveness, consistency
is extremely important to behavior modification which can be reinforced by both parents and
school officials (Tiano, Grate & McNeil, 2013).
A child-focused form of treatment such as a summer treatment program (STP)
embodies the use of social settings as a criterion for behavioral treatment (AACAP & APA,
2013; Coles et al., 2005). They focus on helping children achieve independence, productivity,
self-esteem, peer interaction, academic performance and behavioral stabilization (Coles et al.,
2005). A major helping system of behavioral modification includes a token method (Coles et
al., 2005; Chronis et al., 2004). The token system acts as a means of reinforcement by
rewarding/deducting points for positive or negative behaviors (Chronis et al., 2004). Children
receive points for positive behaviors and may be deducted points for inappropriate actions
(Chronis et al., 2004). Children attending the STP were studied in both academic and
recreational settings and observed on their positive and negative behaviors (Chronis et al.,
2004). While all studies yielded positive behavioral changes, after the STP, long-term
effectiveness is still an area that remains unanswered (Chronis et al., 2004; Coles et al.,
2005).
Research shows that medications, psychotherapy, and a combination of both have all
proven effective in behavioral modification, but none have shown significant long-term
impacts on behavior (Harrison, Thompson & Vannest, 2009). Van Cleave & Leslie (2008)
classify long-term treatment effectiveness of ADHD as poor, and state that more is needed to
be established to increase efficacy. In order to provide long-term behavioral changes and
normalization, consistency in model treatment may lead to more positive outcomes. Because
ADHD has been described as a chronic condition, treatment must be an ongoing process that
cannot be remedied merely during the school or the summer months (Van Cleave & Leslie,

15. Monahan 15
2008). Uniformity in treatment approaches performed by program staff members, teachers
and parents are essential in treating the constant conditions of ADHD.
Research also suggests that treating adolescents may be more difficult yielding lower
treatment effectiveness (Bennett et al., 2013). It is important for children to learn concrete
coping strategies that can help prevent further mental disorders in adulthood—treatment at an
early age is essential. Furthermore, communication with school officials and parents is
essential in developing tangible coping techniques (Legget & Hotham, 2010). However, due
to the several inconsistencies in literature, long-term effectiveness needs to be considered
when creating a framework for a modified treatment system.
Analyzing the discrepancies in literature provides a basis for the need of a
strengthened and continuous treatment system. One study showed that behavior modification
therapy between both parents and children/adolescents can help maintain treatment
effectiveness (Tiano, Grate & McNeil, 2011). This form of rapport building in the home can
help children build strong relationships with their parents, but social settings outside of the
home must also be considered because ADHD symptoms also resonate in social
environments. Additionally, because ADHD affects children every day and not just during
the school year or summer months, it may be beneficial to combine programs that collaborate
with parents, STP staff, and school and health officials.
An improved system of behavior modification should include all persons associated
with the diagnosis and treatment processes. It is crucial to consider consistency in treatment.
Children with ADHD should experience treatment during both the school year and during the
summer. Children with ADHD who receive treatment in schools should have similar conduct
in STPs so they can focus solely on their individual progress. For example, a reinforcement
program in the classroom (during the school year), such as a token system should be the same
or very similar to an STP token system (i.e. positive behaviors should be reinforced with the

16. Monahan 16
same point system). Though it would be preferred for school/health officials and staff
members to work with the same children during both the school year in the summer months,
it may not be possible. Therefore, collaboration and communication is crucial to consistent
treatment. Treatment consistency allows for growth without confounding variables affecting
the long-term goal of solid coping strategies. Constructive relationship building and habit
forming methods may be the most efficient way to shape long-lasting, positive behavior.
Study Population
In the area of ADHD research among youth populations, middle school students have
been identified as a significant study population. Not only does the transition from childhood
to adolescence prove challenging for youth, the transition from elementary to middle school
also becomes difficult for students with ADHD (Evans, Langberg, Raggi, Aleen & Buvinger,
2005; Langberg, Epstein, Altaye, Molina, Arnold & Vitiello, 2008). Although adolescents
with ADHD seem to manifest their symptoms with more severe enormities (i.e. dropping out
of school), than children with ADHD, it is important to note that some research suggests as
brain maturation occurs with reaching adolescence, so does the decline of the major
symptoms of ADHD (Evans et al., 2005; Langberg et al., 2008). One study conducted by
suggests that environmental settings are crucial to the development or decline of ADHD
symptoms (Langberg et al., 2008). Although brain maturation and development coincides
with the reduction of ADHD symptoms, the transition from and elementary school setting to
middle school setting caused a disturbance in the predicted decline of the symptoms of
ADHD in middle school students (Langberg et al., 2008).
The adolescent population is not only significant to study for themselves as students,
but it is also important to analyze the involvement of parents and teachers. Research suggests
that as students transition from elementary to middle school, both teachers and parents

17. Monahan 17
become less involved (Evans, Axelrod & Langberg 2004). Often times, student to teacher
ratios become much larger making it difficult for teachers to focus on students as individuals
(Evans et al., 2008). This, in turn, leads to a lack of communication between parents and
teachers, decreasing the parent’s knowledge of their child’s individual status (Evans, Axelrod
& Langberg, 2004).
A study on a school-based treatment program among middle school students with
ADHD revealed that this treatment program known as the Challenging Horizons Program
(CHP) may be an effective program for youth with ADHD, but there were some
shortcomings in this study later recognized (Evans, Axelrod & Langberg, 2004). There was a
significant difference between parent and teacher reports after the study concluded in that
some behavioral changes reported were not in accordance among teachers and parents (Evans
et al., 2005). This fact supports the notion that parent and teacher communications decrease
once children transition to middle school.
The purpose of my ethnographic study was to gain a general understanding of the
classroom dynamics between teachers and students (ages 11-12) and compare these findings
to observations from a summer treatment program for youth with Attention-
Deficit/Hyperactivity Disorder (ADHD) in Meadville, Pennsylvania.
Fieldsite: The Achievement Center Summer Treatment Program at Allegheny College
The Achievement Center Summer Treatment Program is an eight week program for
children and adolescents ages 6-16 (Achievement Center, 2014). The Achievement Center
embodies the use of this program created by Dr. William Pelham by providing behavioral
modification techniques, recreation, and tips for parent training (Achievement Center, 2014).
This program is based out of Erie but offers services in Meadville, Pennsylvania. Most of the
activities took place on Allegheny College campus in and outside of academic buildings

18. Monahan 18
including Quigley Hall and Oddfellows Hall. We also held activities at the Wise Center for
swimming and activities in the gymnasium. The Achievement Center currently has several
partners including Crawford County Human Services and Allegheny College (Achievement
Center, 2014). They have also collaborated with several schools including General McLane
School District, Girard School District, the School District of the City of Erie, and the RB
Wiley Charter School (Achievement Center, 2014). However, there are currently no
collaborations between the Achievement Center Summer Treatment Program and Meadville
schools. For my ethnographic study, I used Meadville Area Middle School as a comparison
field site to the Achievement Center’s Summer Treatment Program. My role in the program
as a camp counselor was to follow the point system created by Dr. Pelham to help modify the
children’s ADHD behaviors. As a counselor, I facilitated physical activities and games while
calling points for positive and negative behaviors and asked campers a series of attention
questions during set activities. I was also required to track the behavior of three children that
related to their goals of improving behavior in a daily written report.
Field Site: Meadville Area Middle School
The Meadville Area Middle School (MAMS) is a public school part of the Crawford
Central school district, located in downtown Meadville, Pennsylvania (Crawford Central
School District, 2015). The middle school teaches grades 7 and 8 of about 447 students (City-
Data.com, 2009; Great Schools, 2015). Eighty-one percent of MAMS is white and 55% of the
school are male (Great Schools, 2015).

19. Monahan 19
Methods
Participant-Observations and Fieldnotes. As a camp counselor for the Achievement
Center’s Summer Treatment Program for the summer of 2014, I conducted participant-
observations and recorded fieldnotes of my experience. During the school year, beginning in
February 2015, I continued recording fieldnotes in the classrooms at the Meadville Area
Middle School, specifically with students aged 11-12 with varying levels of learning ability
in both traditional and special education classrooms. I observed two standard education
classrooms and one special education classroom. I visited the school once or twice a week for
about one month, conducting about 4-5 hours of observation per week. I also conducted daily
scans in each classroom where I recorded the number of students per classroom and observed
them by gender. My observations concluded in March 2015. During the first few visits, I
introduced myself to the class with a prepared script that was included in a verbal consent
form. Fieldnotes were kept confidential by using a numbering system and a master list where
the number is affiliated with the first name only (last initial used in case of multiple
individuals with the same first name).
Key Informant Interviews. Along with my visits, two semi-structured interviews were
conducted with one special education teacher and one regular education teacher. Interviews
were conducted at the school in a classroom of the teacher’s choosing. Interviews lasted
between 15-30 minutes. Key informant interviews were kept confidential by using a
numbering system. There is a master list where the number is affiliated with the first name
only (the last initial used in case of multiple individuals with the same first name).
Data Analysis. Qualitative data including fieldnotes and interviews were analyzed using a
grounded theory approach, which allowed me to develop theories that emerge from the data

20. Monahan 20
(Emerson, Fretz & Shaw, 2011). By viewing fieldnotes and interviews as a data set, data was
processed using an open coding technique. Codes were then transformed into categories and
analyzed using a thematic content analysis (Emerson, Fretz & Shaw, 2011).
IRB Approval. All research methods, including observations and semi-structured interviews
were reviewed and approved by the Institutional Review Board at Allegheny College.
Consent and assent was given by both the teachers and students to be participants in this
study. Debriefing forms and copies of the report were handed out at the conclusion of the
research.

21. Monahan 21
Results
General Classroom Observations
The special education classroom included an emotional support class, a resource class
and an English class. The special education classroom had about 8 students on a daily basis
with an average boy to girl ratio of 7:1. The regular education classrooms (both English and
math) had an average of 14 students daily, where there were more than three times as many
boys as girls. The building was fairly easy to navigate. The regular education English class
and the special education class were located on the same floor. Math class was upstairs.
The atmospheres between classrooms were very different. The special education
classroom had desks that were in rows but most of the students were isolated in corners. The
class was a little chaotic and very disruptive. The regular education English class had desks
grouped together and was less disruptive. The regular education math class had a mixture of
regular education and special education students and was also less disruptive than the special
education class.
The school has a light system instead of a bell system: the lights dim when class starts
and gets brighter to signify class is over. All classrooms I observed have excellent
technological equipment. The regular education math and English class utilized advanced
technology, but the special education used a projector only in the morning to play the news
and used a chalkboard for actual teaching purposes. All classrooms usually had more than
one adult. Along with the teacher there was a student-teacher, an assistant teacher or a
teacher’s aide.
Emergent Themes and Findings
In this section I will highlight the overlapping themes present through participant-
observations and interviews between the Achievement Center’s Summer Treatment Program
and the Meadville Area Middle School classrooms, while also underlining the differences

22. Monahan 22
between cultures that potentially disagree with the models for behavior modification
treatment.
Recognition of Mental Health and Its Effects on Progress
One of the most prevalent themes I observed in both settings was the recognition that
mental health disabilities are one of the main causes that can hinder a child’s or adolescent’s
development in social settings. At the Meadville Area Middle Schools, (MAMS) the teachers
recognize that students’ overall success in class is really dependent on their current mood or
mental state. Both teachers (Teacher 1 and Teacher 2) interviewed at MAMS were in
accordance that ADHD and reading disabilities are the most common learning disorders
witnessed in their classroom. But, there is also an acknowledgement that these learning
disorders may not be the only factors that negatively affect a student’s ability to learn.
Teacher 1, a special education teacher, acknowledges how difficult it can be for a student to
pay attention depending on events occurring in his/her life.
It [attentiveness] varies. They can be fine in the morning and then really inattentive in the
afternoon, but it changes a lot, sometimes a student will be more inattentive in the morning
and more attentive in the afternoon. It’s crazy. Their attentiveness is really dependent on their
current mental stage, like if they had problems that morning it might be more difficult for
them to learn.
Although the Achievement Center’s STP is primarily a summer camp that helps modify
the behavior in children and adolescents with ADHD, I became aware that for some of the
children/adolescents, ADHD was not their primary diagnosis, and, some were not even
diagnosed with ADHD. Several of them had comorbid disorders where ADHD was
sometimes a secondary diagnosis. Counselors acknowledge that several other mental health

23. Monahan 23
factors play a role in their overall progress at camp. It was apparent that, for several campers,
home life and events played a crucial role in their behavior at camp. It most cases, it became
difficult to reprimand negative behavior when becoming aware of negative events at home
that may be causing the reaction. A teacher’s aide at MAMS understands how personal life
has a prominent link between behavior and academics. While observing a regular education
math class, I noticed a couple students that regularly attend special education classes. I asked
the teacher’s aide if this was also a special education class and she said that “the kids are
smart, but a lot of them have problems.” During another day of observations, she reiterates
the link between life events and academics: “they’re smart…they just have other things that
hold them back. Imagine if you could harness that.” After a more in-depth conversation about
the specifics of her job as an aide for mentally/physically disabled students, she explained the
contrasts in mental status: “they’re nasty sometimes, but when you’re one on one with them,
they’re sweet.”
These dynamics were also common at the STP. In a lot of situations when a camper
exhibited abnormal amounts of negative behavior, it was helpful to pull him/her aside and
have personal conversations to find out what was going on. This practice allows you to find
out things you may not have known otherwise and allows you to view the
children/adolescents as individuals rather than solely being defined by their negative
behavior. Because STP is based on a point system, if a camper started losing large amounts of
points, it was necessary to pull them aside and talk to them one on one about his/her progress
at camp. I also noticed this behavior at MAMS. If a teacher noticed a student displaying
negative behavior (i.e. disrupting class, not paying attention), the teacher made it a point to
have a personal conversation with him/her about their grades and status in the class, which
was more apparent in the regular education classrooms. However, there is usually a threshold

24. Monahan 24
for negative behavior in the classroom, and at a certain point, removing the student from the
class was sometimes the only option.
Low Tolerance for Disobedient Behavior
Alike at both MAMS and the STP, reparation for disobedience was a common theme
observed. Noncompliance is one negative behavior that has the most serious consequences.
At camp, noncompliance results in a point loss and repeated noncompliance results in both a
point loss and a time out. In other words, if you have to repeat a command twice and the
action is not followed up with, a timeout will be assigned. I noticed at MAMS that most
teachers do not repeat themselves more than twice. Some students will comply after the first
command, but if a teacher has to repeat themselves more than twice, several reparations could
be assigned. Some actions included lunch detention, isolation, and being sent to the office.
First, if a teacher noticed a student not doing work after being told to get started, the teacher
would require the student make up the time he/she wasted in class during lunch detention.
Second, if a student continued to talk with peers after being advised to stop, the teacher
would isolate the student and move them to a different section of the classroom. Lastly was
the threat of being sent to the office. I observed that sometimes a teacher would use a couple
of different techniques to get students to listen:
Today the class was talking about the differences between primary and secondary sources.
Two students were goofing off and Teacher 1 told one of the students to go to back table and
complete his work. He listened right away. Today they needed to hand in two things, but it
was noticeable that the students were procrastinating. Teacher 1 told one student: “turn
forward and your feet need to be under your desk.” She then decided to move his desk up to
the front of the class…Teacher 1 told another student: “let’s get started or we’re going back
down to the office again.”

25. Monahan 25
Here, Teacher 1 uses the isolation technique as well as the threat of the office. During my
visits, only a few students were actually sent to the office and the principal came to get a
student on one occasion. The idea of being sent to the office is more of a threat than an actual
action at MAMS.
Threat vs. Action
At the STP, if a child/adolescent was issued a command twice and failed to comply,
he/she was assigned a timeout. However, I noticed that throughout camp, issuing a command
became almost taboo. We knew that if we said “stop talking,” for example, and the student
failed to comply twice, we have to assign them a timeout. Most of the time, we would just
call points for rule violations or interruptions instead of issuing a command because we knew
a timeout could follow if a camper did not comply. Sometimes timeouts became extremely
difficult for a counselor depending on the behavior of the camper. So, instead of always
issuing a command twice, we would issue it once and say “if you don’t listen you’re going to
get a timeout.” There are some similarities between the STP and MAMS when it comes to the
idea of threats. At MAMS, I noticed the teachers used a phrase often if a student was not
listening. Sometimes it would take the form of “do you need to leave?” or “you need go”
which was mainly a reference to being sent to the office. There may be a reason why being
sent to the office is more of a threat than an action. During one of my observations in a math
class, I was talking to the teacher’s aide who began to tell me a little about some of the
students’ negative behaviors. They may exhibit bad behavior to get sent to the office as an
excuse out of classwork. The teacher’s aide said that some of the students will simply say
“send me to the office” so they do not have to do work.

26. Monahan 26
Interactive Behavior
The most common forms of interactions at the STP or at MAMS were between
students/campers and staff members. At the STP, there were a few negative actions directed
towards a counselor that could result in a point loss and sometimes a time out: intentional
aggression toward a staff member or verbal abuse. Anytime a camper would speak
inappropriately to a staff member or talk back, they would lose twenty points for verbal
abuse. At MAMS, I noticed a lot of inappropriate language that is sometimes directed toward
the teacher but never really resulted in punishment. Most of the time, the situation gets
ignored or redirected. During math class, Teacher 3 started off by talking about his
disappointment in the students for their behavior with the substitute teacher the previous day:
He then told the class to complete the bell ringer and that he would be talking to some
students out in the hall. One student raised his hand but spoke out and interrupted. Teacher 3
replied “No, it’s my turn.” The student replied: “I don’t really care.” Teacher 3 ignored him
and instead commended those who did the right thing.
There were a few instances where a student would name call/tease a teacher that went
unnoticed, but it was more prevalent among peers. At the STP, there were a few negative
categories towards peers that resulted in a point loss and sometimes a time out: intentional
aggression toward a peer and name calling/teasing. Name calling/teasing another peer was
not acceptable at camp and always resulted in a point loss if a counselor witnessed it happen.
At MAMS, name calling/teasing others was a part of some students’ daily routine that went
unnoticed. Most of the teasing occurred among boys, which often led to anger and
aggression. At the STP, intentional aggression toward a peer results in a point loss of 50 and
an immediate time out. At MAMS, boys fighting became commonplace. The most common
forms of aggression included yelling, kicking, or pushing each other. It is also interesting to

27. Monahan 27
note that most almost all of the aggressions were carried out by special education students. I
never saw one student get sent to the office for violence or aggression. If the fights were
noticed by the teachers a simple “excuse me!” or “that’s enough” was the only response.
Maintaining Attention
Although breaking up fights may not be a teacher’s number one priority, maintaining a
student’s attention was definitely at the top of the list. This was also true for counselors at the
STP. Both counselors and teachers used similar techniques to help keep campers/students
attentive. Active engagement, monitoring, and individualized attention were three of the most
commonly used techniques to make sure students were paying attention. During camp,
counselors were required to ask attention questions during group discussion and recreational
activities. If answered correctly, the students received points. Campers also received points
for willingly participating in group discussion. In some of the classes at MAMS, teachers
were really passionate about getting the students actively engaged. One regular education
teacher, Teacher 2, comments on the importance of active engagement:
Participation accounts for 40-50% of their grade. They get three points per day per week, so a
total of 15 points per week. I don’t have any tests in my class—I really want the students to
be actively participating.
Both at camp and at MAMS, monitoring was another technique that was often used.
Counselors sat in the back of the classroom, walked up and down rows, and sat in between
campers during group discussion. At MAMS, the teachers were constantly walking around
making sure students were paying attention. This leads to the technique of individualized
attention. If a camper was having a really difficult time paying attention or completing a
certain task, a counselor addressed them. Individualized attention is even more prominent at

28. Monahan 28
MAMS. Those who have a hard time paying attention or are disruptive were usually the
students that received the most individualized attention. According to teachers, having your
head down or talking with peers are two major signs that a student is being inattentive, and
these were the actions that caught the attention of most teachers. In the regular education
classrooms, it usually took only one teacher to grasp the attention of the students in the class,
but for the special education classroom it took a teacher, a teacher’s assistant and somtimes a
teacher’s aide to help the students focus in a class that was only about half the size of a
regular education classroom. In some cases, not all the students got individualized attention
in the special education classroom. A lot of the students were isolated and placed on the
perimeter of the classroom.

29. Monahan 29
Discussion and Conclusions
A common theme of recognizing mental health disorders in children and adolescents
may be the first step in helping provide them with the resources. Because parents are the
ultimate decision-makers for the treatment of ADHD, the home life becomes increasingly
important (Carpenter-Song, 2009). In some cases, children and adolescents may not even be
diagnosed due to parent perceptions that ADHD is not a legitimate disorder (Carpenter-Song,
2009). Even if a child or adolescent becomes diagnosed with ADHD and receives treatment,
research suggests that the home life is still a major contributor to mental health and well-
being of the parents and their children (Klassen, Miller & Fine, 2004). In a study that
measures the health-related quality of life (HRQL) in children and adolescents, results
suggest that HRQL is much poorer in the ADHD population (Klassen, Miller & Fine 2004).
In conjunction with this finding, children and adolescents had higher rates of parent-reported
emotional health problems such as self-esteem issues (Klassen, Miller & Fine, 2004). As an
observer at MAMS, it was evident that students in the special education classroom had more
severe behavioral issues, and, teacher responses reveal that what happens at home plays a
large role in the school setting. Recognizing that other factors contribute to mental health
may help teachers realize an increased need for individualized attention.
Individualized attention was prevalent both at MAMS and the STP. Walking around
the classroom and paying specific attention to those off track seemed to be a common
practice at MAMS and the STP. Although this technique may be useful, as children and
adolescents grow older, teaching them more independent techniques may prove successful. A
study on self-monitoring practices of both attention and performance in students with ADHD
had promising results (Harris, Friedlander, Saddler, Frizzelle & Graham, 2005). Both
techniques yielded successful academic performances in the classroom without any external
influence (i.e. help of teacher) (Harris et al., 2005).

30. Monahan 30
One major difference between MAMS and the STP was the tolerance for aggressive
behavior. At the STP, there was zero tolerance for violence and aggression, but at MAMS,
aggressive behavior almost went unnoticed. For a child/adolescent attending the STP who
had a goal of reducing aggression, it may be difficult for him/her to maintain this modified
behavior in the classroom setting. In most cases, students got away with aggressive behavior
at MAMS, so an adolescent who attended the STP might revert back to his/her violent
behavior. Research about stress and teaching may reveal why action is not taken toward
aggressive behavior. According to an assessment of teachers’ stress levels, students with
ADHD who exhibited aggressive behavior were marked as being significantly more stressful
to teach than students who do not display aggressive behavior (Greene, Beszterczey,
Katzenstein, Park & Goring, 2002).
There are several similarities between a summer treatment program for children and
adolescents with ADHD and a middle school classroom setting. With these findings, it is
noted that like an STP, teachers are extremely focused on maintaining a student’s attention.
Disruptive behavior was undoubtedly a common theme that was often addressed, but there is
little room for disobedient behavior in an STP and in the classroom. One major difference
between the two settings was the tolerance for aggressive behavior, specifically among boys.
In MAMS, aggressive behavior, both physical and verbal, was sometimes tolerated and often
ignored.
This is where the diagnostic process of ADHD becomes increasingly difficult.
Although the DSM-5 has recently been reformed, the subtypes of ADHD (combined type,
predominantly hyperactive-impulsive and predominantly inattentive) are still in used in the
diagnostic process (CDC, 2015). The heteronormativity of these subtypes have often been
challenged and although the DSM-5 includes a note that an individual may present different
behaviors from the different subtypes and that they can change with age, but a

31. Monahan 31
child/adolescent may still be diagnosed with just one of the subtypes (Bell, 2011). Questions
about the differences in the three presentations and the relationship between them have
sparked particular interest in research (Bell, 2011). Several factors may lead to a
child/adolescent being diagnosed with a specific subtype which has often complicated the
diagnostic process (Bell, 2011). Some researchers believe that the different subtypes of
ADHD are unrelated and the predominantly inattentive behavior should be distinguished as a
whole separate disorder from ADHD (Bell, 2011). The behavior of the predominantly
inattentive subtype has often been observed as have completely diverse characteristics than
the predominantly hyperactive-impulsive and combined type of ADHD (NIMH, 2012). The
predominantly inattentive behavior is often classified as an internalizing disorder, whereas
the other two subtypes are observed as externalizing (Bell, 2011). These observations
contribute to the difficult nature of diagnosing ADHD and have larger implications for
specific populations.
Age, gender and comorbid disorders have added to the complexity of ADHD
diagnosis. These factors have also complicated the treatment process and the decision for
specific options. In one study comparing the nature of ADHD and gender differences, the
data suggests that prevalence rates were actually much lower than what was predicted, but
gender differences and prevalence rates were most prominent at the adolescent age
(Ramtekkar, Reiersen, Todorov & Todd, 2011). It was noted that males had more severe
symptoms due to the fact that they exhibit more unruly behavior than females which may
imply why ADHD in females is underreported (Ramtekkar et al., 2011). The prevalence of
overlapping and comorbid mental disorders was also found to be a major contributing factor
that made recognition and diagnosis of ADHD problematic (Delavarian, Towhidkhah,
Dibajnia & Gharibzadeh, 2010).

32. Monahan 32
Because behavioral issues have a major impact on academic success, it is crucial to
consider ways in which to distinguish between behavioral and mental impairments
(Gharibzadeh et al., 2010). Because all treatment options are different, diagnosing ADHD as
well as comorbid disorders becomes increasingly important (Gharibzadeh et al., 2010). One
study designed a decision support system to help differentiate between behaviors and
improve the diagnostic accuracy and aid in a psychiatrist’s decision (Gharibzadeh et al.,
2010). Although this study comments on the ineffective reporting by teachers, another study
comments on the need for teacher involvement in the ADHD diagnosis and treatment process
(Gharibzadeh et al., 2010; Sherman, Rausmussen & Baydala, 2008).
Teachers who were patient, showed positive behavior, engaged students and seemed
to be well-informed on ADHD and treatment interventions proved to have a positive impact
on the student (Sherman, Rausmussen & Baydala, 2008). However, it is still crucial to bridge
the gap between the school setting, psychological and medical fields (Graham, 2008). Figure
1 displays a potential model for overlapping systems.
Medicine Interdependency Psychology
Multi-modal
Treatment
Schooling
From Sherman, Rausmussen & Baydala, 2008
Figure 1. ADHD and Reciprocity. There is a need to bridge the gap between psychological
and medical professionals. By focusing on the interdependency and multi-modal treatment of
ADHD as factors that contribute to both the medical and psychological field, the treatment

33. Monahan 33
process of ADHD may be improved in the school setting (Sherman, Rausmussen & Baydala,
2008).
By increasing the number of professionals in the school setting and educating teachers
on the assessment, diagnostic and treatment process of ADHD, the likelihood of improving a
child’s success in the school performance increases (Gharibzadeh et al., 2008; Sherman,
Rausmussen & Baydala, 2008). Because there are currently no collaborations between the
Achievement Center and MAMS, it may be useful to set up relationships between the
institutions to further the treatment process of ADHD and treat it as a chronic disorder.
Creating a bridge between the two may help the teachers understand students better, allowing
specific areas of behavior to receive the needed attention. This, in turn, may help the
treatment process of ADHD to continue and increase the success rate of modified behavior,
leaving little room for regression.

34. Monahan 34
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40. Monahan 40
Appendix A
Semi-Structured Interviews for Teachers
Classroom Attentiveness
Learning Resources:
Main Questions Additional Questions Clarifying Questions
● Can you tell me about the
student’s attentiveness in the
classroom?
OR
● How attentive do you feel your
students are on a daily basis?
● How are you able to tell if a
student it attentive during class?
● How are you able to notice
when a student is being inattentive
during class?
● How much does participation
affect a student’s grade
OR
● Do students receive points for
participating?
● When do you notice students are
the most inattentive? (morning,
afternoon, etc.)
● Can you expand on this a little?
● Can you give me some
examples?
● Is there anything else you can
tell me?
Main Questions Additional Questions Clarifying Questions
● Can you tell me about the learning
resources available for students, if
any?
OR
● Are there any after school learning
resources or tutors available to the
students?
● What kinds of resources are
offered?
● When do you feel it is necessary
to refer a student to a tutor or
additional learning resources?
● If you have ever referred a
student to get extra help with
school work, did you notice
improvement afterwards?
● Do you feel that there are
enough resources available if a
student is having trouble learning?
● Are parents contacted before a
student receives learning help?
● Can you expand on this a little?
● Can you give me some
examples?
● Is there anything else you can
tell me?

41. Monahan 41
Special Education:
Main Questions Additional Questions Clarifying Questions
● Can you tell me about the special
education classes here?
OR
● How many special education
classrooms are installed in the
school?
● Do special education classes
teach the same courses and
content?
● What are some of most common
learning disorders witnessed in a
special education classroom?
● Who makes the decision about
whether or not a student needs to
receive special education?
● What are the kinds of teaching
techniques used when teaching
special education?
● Are classroom rules different in
a special education classroom?
● Can you expand on this a little?
● Can you give me some
examples?
● Is there anything else you can
tell me?

42. Monahan 42
Appendix B
Categories and Codes
Teacher Interviews
Category: Signs of Inattentiveness
Code: heads down
Code: talking with peers
Code: distracted by objects
Category: Reasons for Learning Difficulties
Code: ADHD
Code: Reading Disabilities
Code: mental status
Subcode: mental health stigma
Category: Helpful Solutions
Code: medication
Code: tutoring
Code: specialized classes
Code: parent-teacher collaboration
Category: Teacher Perceptions on Students with Disabilities
Code: crazy
Code: medication makes a difference
Code: extra support makes a difference
MAMS Fieldnotes
Category: Signs of Inattentiveness
Code: impulse behavior
Subcode: playing with objects
Subcode: turning around in seats
Subcode: shouting
Code: distracted by objects
Subcode: playing with books/paper/pencil
Code: distracted by others
Subcode: side conversations/talking with peers
Code: heads down
Code: disorganization
Category: Negative Student Behavior toward Teachers/Staff
Code: interruption
Code: name calling/teasing
Code: noncompliance
Subcode: talking back
Code: complaining/whining
Subcode: angry about school work
Subcode: don’t want to be in school

43. Monahan 43
Category: Teaching Practices
Code: monitoring
Subcode: walking around
Code: individualized attention
Subcode: focusing on students who aren’t focused
Code: encouraging class engagement
Code: passionate/positive attitude
Subcode: keeping the mood light
Subcode: telling jokes
Category: Teacher Responses to Negative Behavior
Code: threat
Subcode: countdown
Code: expressing disappointment
Code: giving them the decision
Subcode: “you need to go”
Code: sending to the office
Subcode: getting the principal
Code: isolating student
Code: three strikes you’re out
Category: Other Factors that Hinder Success
Code: mental problems/status/disabilities
Code: distraction
Subcode: students who are easily distracted often distract other students
Category: Student Interactions: Behavior that goes “Unnoticed”
Code: boy to boy
Subcode: violence/aggression (only recognized by male teacher)
Subcode: name calling/teasing
Subcode: inappropriate language
Code: boy to girl
Subcode: uncomfortable conversations
Subcode: distracting each other
STP Fieldnotes
Category: Counselor Practices
Code: calling points
Code: asking attention questions
Code: rewarding positive behavior
Subcode: giving points
Subcode: honor roll etc
Subcode: treat bag and field trip
Code: adolescents vs. children different system
Subcode: more independence
Code: regulation, taking control
Category: Facts that can Hinder Progress
Code: parents not involved

44. Monahan 44
Code: inconsistency
Subcode: missing days (counselors and campers)
Subcode: coming late
Subcode: not calling points
Code: Distracting Kids Control Situation
Subcode: too much focus on distracting kid
Subcode: not paying attention to those eager to participate
Code: Other mental disabilities
Subcode: RAD, ODD, Autism
Category: Most Common Negative Behavior
Code: interruption
Code: name calling/teasing
Code: complaining/whining
Code: noncompliance
Category: Negative Behavior that Results in a Time Out
Code: violence/aggression toward peer or staff
Code: destruction of property
Code: repeated noncompliance

45. Monahan 45
Appendix C
Classroom Scans
Special Education Traditional Classroom
Girls Boys Girls Boys
4-Feb 1 7 10-Feb 7 15
11-Feb 1 6 11-Feb 2 11
11-Feb 1 8 18-Feb 2 9
18-Feb 1 7 25-Feb 4 8
25-Feb 1 7
average 1 7 average 3.75 10.75

46. Monahan 46
Appendix D
STP Point System
Positive Interval Categories
Following Activity Rules +50
Good Sportsmanship +25 good sports only counts during RECs and Skill Drills
Behavior Bonus +25 a client can only get points for behavior bonus in the set interval as long
as they have not lost points for negative verbal and physical categories
Positive Frequency Categories
Attention +10
Compliance +10 a child will get points for compliance if they follow up with a command
within 10 seconds after it being asked by a counselor
Helping a Peer +10
Contributing to Group Discussion +10 a child will get points for group discussion as long as
the answer pertains to the question and has not already been said. Most contributions are
made when counselors ask the rules for set activities.
Ignoring a Negative Stimulus +25 whenever a child directs a negative verbal or physical
action toward another peer and that peer does not react, he/she earns +25 for ignoring
Negative Interval Categories
On most occasions, a child will be called for violating activity rules and poor sportsmanship.
All negative verbal and physical points should also be deducted along with violating activity
rules and poor sports
Violating Activity Rules -10
Poor Sportsmanship -10
Negative Physical Categories
Intentional Aggression Toward a Peer/Staff Member -50 *and a time out
Unintentional Aggression Toward a Peer/Staff Member -50
Intentional Destruction of Property -50 *and a time out
Unintentional Destruction of Property -50 *and a time out
Noncompliance -20 Whenever a child does not follow up with a command from a counselor
he/she will lose points for noncompliance
Repeated Noncompliance -20 points *and a time out When a counselor repeats the command
and the child does not comply, he/she will lose points again and must be assigned a time out.
Stealing -50
Leaving the Activity Area Without Permission -50
Negative Verbal Categories
Lying -20
Verbal Abuse to Staff -20 on most occasions, verbal abuse to staff relates to any child talking
back to a counselor or staff member.
Name Calling/Teasing -20 Whenever a child name calls/teases another peer, he/she will lose
points for this negative verbal category. If the other child does not react, he/she will earn 25
points for Ignoring a Negative Stimulus
Cursing Swearing -20
Interruption -20
Complaining/Whining -20