Extended Time on Academic Assignments: Does Increased Time Lead to Improved Performance for Children With Attention-Deficit/Hyperactivity Disorder?

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1 School Psychology Quarterly 2010 American Psychological Association 2010, Vol. 25, No. 4, /10/$12.00 DOI: /a Extended Time on Academic Assignments: Does Increased Time Lead to Improved Performance for Children With Attention-Deficit/Hyperactivity Disorder? Meaghan E. Pariseau, Gregory A. Fabiano, Greta M. Massetti, and Katie C. Hart State University of New York at Buffalo William E. Pelham, Jr. Florida International University Researchers examined the impact of an extended time accommodation on appropriate classroom behavior and rate of work completion for 33 children with attention-deficit/ hyperactivity disorder (ADHD). Participants received standard (30 min) or extended (45 min) time to complete seatwork in a within-subject, crossover design study. Appropriate behavior (i.e., rule-following behavior) and rate of problems completed accurately per minute were compared across conditions. Children completed significantly more problems correctly per minute when given standard time compared with extended time; however, no difference in appropriate behavior was found between the two conditions. Appropriate behavior over time was examined by segmenting each condition into time intervals. Analyses indicated that children s appropriate behavior significantly decreased over time in both conditions. The implications of these findings are discussed. Keywords: ADHD, extended time, accommodations, special education The issue of accountability has been at the forefront of the field of education during recent years. With the advent of several educational policy reforms such as the 2004 amendments to the Individuals with Disabilities Education Improvement Act (IDEA, 2004), the No Child Left Behind Act (NCLB, 2002), and the movement toward Response to Intervention (RTI; Fuchs, Mock, Morgan, & Young, 2003), schools and school districts are increasingly required to report student performance on a variety of academic achievement measures. Of importance, students with disabilities who receive special education services must also be included in these high-stakes measures. To maximize the potential for students with disabilities to fully Meaghan E. Pariseau and Gregory A. Fabiano, Department of Counseling, School and Educational Psychology, State University of New York at Buffalo; Greta M. Massetti and Katie C. Hart, Department of Psychology, State University of New York at Buffalo; William E. Pelham, Jr., Department of Psychology, Florida International University. Correspondence concerning this article should be addressed to Meaghan E. Pariseau, State University of New York at Buffalo, 106 Diefendorf Hall, Buffalo, NY mes45@buffalo.edu demonstrate their academic achievement on such accountability measures, states and districts are allowed to provide accommodations to students with documented disabilities (IDEA, 2004). The goal of such accommodations is to allow students to adequately demonstrate their skills and knowledge without the interference or influence of a disability (Fuchs et al., 2000). Despite the fact that the provision of accommodations to students with disabilities is mandated by educational policies such as IDEA (2004) and Section 504 of the Rehabilitation Act of 1973, evidence supporting the validity of these accommodations remains relatively understudied. Students with attention-deficit/hyperactivity disorder (ADHD) represent a significant proportion of students with disabilities who receive accommodations such as extended time on assignments and tests. Children with ADHD often experience considerable behavioral and academic difficulties in school that have a negative impact on their academic achievement (e.g., DuPaul & Stoner, 2003; Loe & Feldman, 2007; Raggi & Chronis, 2006). In a comprehensive review of the literature on school-related prob- 236

2 EXTENDED TIME ACCOMMODATION FOR ADHD 237 lems for students with ADHD, Raggi and Chronis (2006) documented that students with ADHD experience difficulties such as off-task and disruptive classroom behavior, negative interactions with peers and adults, academic underachievement, decreased work productivity, lack of study skills, homework incompletion, and difficulty with various executive functioning processes. Not only are these students more likely to perform lower on reading and math achievement tests and use additional services such as tutoring, they are also more likely than their peers to be suspended or expelled from school or required to repeat a grade (Loe & Feldman, 2007). Because of the considerable school-based impairment for children with ADHD, academic accommodations to remediate these issues appear to be warranted. While a great deal of research has been conducted on how to effectively address the behavioral difficulties of children with ADHD in school (e.g., DuPaul & Eckert, 1997; DuPaul & Stoner, 2003; Fabiano et al., 2009; Pelham & Fabiano, 2008), there is less evidence for effective academic interventions for children with ADHD (Raggi & Chronis, 2006). Similar to the overall pattern of research on accommodations for students with disabilities (e.g., Bolt & Thurlow, 2004; Elliott, Kratochwill, McKevitt, & Malecki, 2009; Tindal & Fuchs, 1999), Schnoes, Reid, Wagner, and Marder (2006) found that extended time was the most frequent accommodation provided to a sample of students with ADHD classified as having a disability (80.9% received additional time on tests and 71.1% received additional time on assignments). Despite these high percentages, however, the effectiveness of this accommodation was not reported. While some researchers have noted that students with disabilities may not be able to fully demonstrate their academic abilities under timed conditions (Tindal & Fuchs, 1999), several others have found that students with disabilities do not differentially benefit from receiving extended time compared with students without disabilities (e.g., Elliott & Marquart, 2004; Fuchs et al., 2000; Gilbertson Schulte, Elliott, & Kratochwill, 2001; Lewandowski, Lovett, Parolin, Gordan, & Codding, 2007). Previous work examining the effect of time limits on students seat work performance has found that performance on tasks such as math fluency and systematic reading instruction tends to increase when students are given shorter time periods to complete work or faster-paced instruction (e.g., Ayllon, Garber, & Pisor, 1976; Carnine, 1976; Darch & Gersten, 1985; Van Houten & Little, 1982; Van Houten & Thompson, 1976). Van Houten and Little (1982) demonstrated that the rate of accurate work completion increased dramatically when three students labeled as educable retarded were given 5 min to complete math problems, compared with a 20-min time condition. Similarly, Ayllon et al., (1976) found that the rate of math problems completed correctly increased when gradual reductions in time limits were presented (i.e., 20, 15, 10, 5). Segmenting a longer period of work completion into multiple, shorter intervals (i.e., a 30-min period divided into 1-min intervals) has also been shown to increase the rate of accurate problem completion for students identified as having poor school performance (Van Houten & Thompson, 1976). In addition, the rate of instructional presentation has been shown to influence on-task behavior and correct responses for students identified as low achieving or having a learning disability, where rapid presentation increases percentages of on-task behavior and correct responses compared with slower presentation (Carnine, 1976; Darch & Gersten, 1985). These results help to illustrate the benefits of providing multiple, shorter time periods for work completion, but do not specifically examine the frequently used accommodation of extended time (i.e., time and a half) on assignments and seatwork. The situation is further complicated because the majority of research examining the effect of varying time limits for work completion has grouped students either as disabled or nondisabled, according to IDEA disability category, or using vague terms such as low achieving. These studies do not distinguish the performance of students with ADHD and therefore do not allow for interpretation of results specifically associated with ADHD. This is an important distinction because the impairments associated with ADHD may require different remediation compared with other conditions that cause problems with learning. In one study, Lewandowski et al. (2007) examined the effect of giving extended time to fifth, sixth, and seventh grade students with ADHD on a mathematics test. The researchers administered a math calculation test to

3 238 PARISEAU, FABIANO, MASSETTI, HART, AND PELHAM students with and without ADHD, allowing them a standard (12 min) or extended (18 min) amount of time to complete the test. Results indicated that students with ADHD completed fewer items correctly in each condition compared with those without ADHD, and the control group benefited from having extended time more than the ADHD group did (Lewandowski et al., 2007). These results suggest that the extended time accommodation commonly provided to students with ADHD may not be effective for increasing work productivity. However, limited conclusions can be drawn based on these results because students were only assessed at one time point and on only one type of academic task (e.g., 3 digit by 3 digit addition problems). Finally, the provision of extended time as an accommodation for students with ADHD appears to be contradictory to evidence suggesting that sustained attention is an area of weakness for individuals with this disorder. As outlined by Barkley (1997), individuals with ADHD tend to have poor self-regulated sustained attention and experience greater difficulty when there is a lapse between the expected behavior or response and the consequence, which is likely a result of poor behavioral inhibition and deficits in executive function. Research based on the continuous performance task (e.g., Hooks, Milich, & Lorch, 1994), classroom observations (e.g., Kofler, Rapport, & Alderson, 2008; Rapport, Kofler, Alderson, Timko, & DuPaul, 2009) and multidimensional measures of attention (e.g., Heaton et al., 2001) indicate that children with ADHD exhibit deficits in attention or persistence over time compared with their peers without ADHD. Thus, although common practice (e.g., Schnoes et al., 2006), the rationale for providing extra time to a child with ADHD for completing a task that requires sustained effort is unclear. The purpose of this study was to systematically examine the effect of an extended time accommodation on the performance of students with ADHD during a seatwork period in a summer treatment program classroom. Students participated in a structured seatwork period that varied in length (30 vs. 45 min). Measures of academic performance included observations of appropriate behavior and rate of accurately completing problems. Given the study by Lewandowski et al. (2007), and the literature demonstrating children with ADHD have waning attention over time, the present study sought to address whether appropriate classroom behavior and rate of accurate work completion of students with ADHD differed when students were given extended time to complete seatwork assignments. In addition, we explored whether extended time differentially influenced performance for individuals based on age group, whether they received special education services during the school year, or whether they were prescribed medication for ADHD. Participants Method Data for the current research were collected during a Summer Treatment Program (STP). The STP is an intensive intervention for children with ADHD and related disorders (Pelham, Fabiano, Gnagy, Greiner, & Hoza, 2005; Pelham, Greiner, & Gnagy, 1998). Children attending the STP spend 2 hours daily in a classroom setting. The classroom has an operationalized and consistent set of rules. Children also receive daily report cards (DRC) that target individualized daily behavioral and academic goals. Daily and weekly camp and home-based rewards are contingent on meeting behavioral goals. Participants included 33 children with ADHD (25 boys) enrolled in the 2007 STP. As part of the STP, the children were divided into groups according to age; 16 children between 7 and 9 years of age were in one group, and 17 children ages 10 and 12 made up a second group. The mean age of participants was 9.59 (SD 1.51) years old. See Table 1 for participant characteristics. To be enrolled in the STP, children had to meet criteria for ADHD, which included an evaluation of symptoms of inattention and/or hyperactivity/impulsivity and significant impairment in more than one setting as defined by scores above the clinical cut-off on the Impairment Rating Scale (IRS; Fabiano et al., 2006). ADHD symptoms were assessed using parent and teacher ratings on the Disruptive Behavior Disorders (DBD) Rating Scale (Pelham, Gnagy, Greenslade, & Milich, 1992), which measures all symptoms of ADHD, Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD) as defined by the Diagnostic and Statistical Manual

4 EXTENDED TIME ACCOMMODATION FOR ADHD 239 Table 1 Participant Characteristics (N 33) M (SD) or percentage Participants Male 76 (n 25) Female 24 (n 8) Age 9.59 (1.51) Ethnicity Caucasian 84.8 (n 28) Hispanic/Latino 9.1 (n 3) Asian 3 (n 1) American Indian 3 (n 1) ADHD subtype Combined 75.8 (n 25) Inattentive 21.2 (n 7) Hyperactive 3 (n 1) Comorbidities ODD 42.4 (n 14) CD 12.1 (n 4) PPVT III score (14.13) WJ III Reading Composite (11.40) WJ III Math Composite (9.67) Special education status IEP 45.5 (n 15) 504 Plan 12.1 (n 4) Medication status Medicated 63.6 (n 21) Unmedicated 36.4 (n 12) Note. ADHD attention-deficit/hyperactivity disorder; ODD oppositional defiant disorder; CD conduct disorder; PPVT III Peabody Picture Vocabulary Test, Third Edition; WJ III Woodcock-Johnson Tests of Academic Achievement, Third Edition; IEP Individualized Education Plan. of Mental Disorders, 4th edition, text revision (DSM IV TR; American Psychiatric Association, 2000). A symptom endorsed as occurring Pretty much or Very much contributed toward the ADHD diagnosis. Table 1 includes details regarding ADHD subtype, comorbidities, medication, and special education status. Medication was not manipulated during the study, and medication status was held constant throughout the duration of the study. The present study was approved by the University at Buffalo Children and Youth Institutional Review Board. Academic testing was conducted with all participating children during the first week of the STP. Specific subtests from the Woodcock- Johnson Tests of Academic Achievement, Third Edition (WJ-III; Woodcock, McGrew, & Mather, 2000) were used to yield reading and math composite scores. The Peabody Picture Vocabulary Test, Third Edition (PPVT-III; Dunn & Dunn, 1997) was used as a brief measure of verbal IQ. Overall mean scores on academic and cognitive tests fell within the average range (Table 1). One child was an English language learner; therefore his PPVT score was not included in the overall mean. Study Procedures Appropriate behavior and rate of accurate seatwork completion during the afternoon classroom period were assessed using a within-group investigation of standard versus extended time allowances for classroom assignments. Children s seatwork consisted of three assignments; math fluency worksheets, a reading comprehension exercise, and a writing exercise. Math fluency worksheets were initially assigned based on the grade level indicated by achievement testing and the grade completed in the previous school year. Each child started with 100 math calculation problems and this number was adjusted as described below. Reading comprehension assignments were derived from the Specific Skills Series for Reading curriculum (Specific Skills Series for Reading, 2006) and initial level of difficulty was determined using the diagnostic test that accompanies the curriculum. The writing assignment required children to describe what was happening in a story-starter picture. Each child was initially required to write 5 sentences, and this number was adjusted based on completion rates as described below. Across all three types of assignments, difficulty level and the number of problems/ sentences assigned were titrated during the first week of the STP such that the total number of items assigned varied by child. Specifically, if children averaged less than 70% accuracy their work was moved down a grade/skill level, and if they consistently achieved greater than 80% accuracy, their work was moved up a grade/skill level. The number of problems/sentences assigned was adjusted based on the child s percentage of work completion; the rate of problems completed per minute was calculated and this number was used to assign children enough problems to fill 50 min (to prevent a ceiling of work completion during either time condition). In both conditions the child was given the same number of problems to complete with a consistent level of difficulty. These procedures were

5 240 PARISEAU, FABIANO, MASSETTI, HART, AND PELHAM used to ensure appropriate differentiation in an effort to minimize children s frustration with the academic tasks and maximize their potential for accurate work completion. During weeks 2 through 5, on Monday through Thursday (16 days total), each group of participants was randomized to one of two time conditions for completing seatwork. Each group received 8 days total per condition, and the order of conditions was presented in an alternating fashion. The time conditions are described below. Standard time. Students work was placed in a folder at their desks before they entered the classroom. Children were told they would have 30 min to complete their work. The teacher then set a digital timer for 30 min and told the children to begin working. The timer was located at the front of the classroom so all children could clearly see it. During this time, the teacher monitored children s behavior using the STP classroom point system and answered children s questions, and the teacher s aide corrected worksheets as they were completed. Components of the classroom point system included classroom rules, frequent feedback, social reinforcement, time out, daily report card targets for behavior and/or work completion, and contingent recess (Pelham et al., 1998). When children violated one of the classroom rules they were informed of the rule violation and it was marked on a publicly displayed board. Praise was given at a group ratio of 3 instances of positive feedback for every instance of negative feedback. Students were also given feedback as to the accuracy of their completed work and received points for each assignment they completed with a minimum level of accuracy (at least 80%). Seatwork completion and accuracy were assessed by recording the number of problems each student completed, as well as the number of problems each student answered correctly. When children completed one of their worksheets, they turned the sheet in to be scored. The classroom aide scored the worksheets and children were asked to make any corrections before continuing on the next worksheet. This was done to prevent children from rushing through assignments, and accuracy rates across the conditions were greater than 80%, indicating children completed most of the assigned work in an accurate fashion. Children also had a daily report card which could target seatwork completion, and children who met academic and behavioral goals were allowed free time for the remainder of the classroom period. Extended time. In this condition, students were provided 45 min to complete the work in their folders. All other procedures were consistent with those in the standard time condition. Dependent Measures Appropriate classroom behavior. An adapted version of The Classroom Observations of Conduct and Attention Deficit Disorder (COCADD; Atkins, Pelham, & Licht, 1985; Pelham, 2001; Pelham et al., 1993) and the Contingencies for Learning Academic and Social Skills (CLASS; Hops & Walker, 1988) observation schemes was used to code students behavior. Daily observations were conducted by a research assistant who was positioned at the front of the classroom away from classroom activity. The classroom was organized such that children were seated in four rows of four to five children each. The observations were divided into 15-s intervals and the research assistant observed the children in one row during each interval. At the end of the 15-s interval there was a 3-s recording period during which the research assistant recorded if each child in the observed row exhibited inappropriate behavior for any part of the 15-s interval. Inappropriate behavior was defined as any behavior in which the child was violating any of the seven operationally defined classroom rules (i.e., be respectful of others, obey adults, work quietly, use materials and possessions appropriately, remain in your assigned seat or area, raise hand to speak or to ask for help, stay on task; Pelham et al., 1998). Therefore, appropriate behavior was defined as the absence of rule violations. The 3-s recording period was followed by a 3-s reorienting period during which the research assistant focused on the next row to be observed. The 21-s observation cycle continued for the duration of the seatwork period. The observer listened to a beeper tape that cued when to observe, record, and reorient. An average percentage of appropriate classroom behavior was calculated for each participant for the standard and extended time conditions. During the standard time condition, children were observed an average of 21 intervals per classroom period, while during the extended time condition

6 EXTENDED TIME ACCOMMODATION FOR ADHD 241 they were observed an average of 32 intervals. The percentage of appropriate behavior was calculated for each child by dividing the total number of intervals where appropriate behavior was recorded by the total number of intervals observed. Reliability observations were conducted on 17% of the observations in the classroom by having a separate individual conduct identical observation procedures at the same time as the standard observer while listening to the recording prompts using a y-jack. Kappa (k) indices were calculated for each observation interval to determine agreement between the two observers across both conditions. Overall k averaged.75, which is considered to be excellent agreement (Cicchetti, 1994). Rate of problems completed per minute. The rate of children s accurate completion of work was calculated by dividing the number of problems completed correctly by the total number of minutes in the condition. This resulted in a rate of problems completed accurately per minute. Rate was used instead of accuracy or overall completion because the difficulty level of each participant s work was purposely tailored to be at his or her level of academic functioning and the amount of work assigned was specifically meant to prevent a ceiling effect for work completion. Appropriate behavior by segment. In order to assess changes in appropriate behavior over time, observations of behavior were broken down into time segments. The 30-min standard condition was divided into three 10-min segments. The 45-min extended condition was also divided into three 10-min segments to account for the amount of time included in the standard condition, as well as a fourth segment (15 min) that included children s behavior during the additional time. An average percentage of appropriate behavior was then calculated for each participant for segments 1, 2, and 3 in the standard condition and segments 1, 2, 3, and 4 in the extended condition. Treatment and Procedure Integrity and Fidelity A doctoral-level supervisor conducted observations to measure and ensure treatment integrity and fidelity. Observations were conducted during approximately 20% of the classroom periods using a detailed list of classroom procedures and requirements for each study condition. The observer coded whether each treatment (social reinforcement, commands, etc.) and study condition component (standard time vs. extended time) was accurately administered for each classroom period observed. The average percentage of appropriately administered treatment and study components was 97.9%. Data Analysis Results The primary dependent measures were observations of children s appropriate classroom behavior and their rate of accurate work completion. The overall percentage of work completed, as well as the percentage of work completed with accuracy, was also compared across conditions. A repeated measures multivariate analysis of variance (MANOVA) was conducted to assess if the appropriate classroom behavior and rate of work completion of students with ADHD differed when given standard versus extended time to complete seatwork, and one-sample t tests were used to examine differences in overall accuracy and completion rates across time conditions. Differences in performance based on age group, medication, and special education status were also examined as between-subjects factors in the repeated measures MANOVA. Preliminary, exploratory analyses were conducted to examine children s appropriate behavior over the standard and extended time periods using a mixed model analysis. Overall Results A repeated measures MANOVA with one factor (time 30 min, 45 min) was used to investigate outcomes on the dependent variables of appropriate behavior and rate of problems completed per minute. Because multiple comparisons of correlated dependent variables were conducted a Bonferonni correction was used to control for experimenter-wise error, resulting in an alpha level of for the repeated measures MANOVA. The overall multivariate test indicated a significant withinsubjects effect for time, F(2, 31) 25.62, p.001. The assumption of sphericity was not met for this analysis; therefore the Greenhouse- Geisser correction was used. Univariate tests

7 242 PARISEAU, FABIANO, MASSETTI, HART, AND PELHAM indicated no significant difference for students overall percentage of appropriate behavior in the 30-min standard condition compared with the 45-min extended condition, F(1, 32) 0.79, p.38, however, a significant difference was found for the rate of problems completed correctly per minute, F(1, 32) 37.54, p.001. An inspection of means indicated that students completed more problems correctly per minute in the standard time condition than in the extended time condition, yielding a moderate effect size (d 0.65; see Table 2 for means and SDs). In addition to the overall test, 2 one-sample t tests were conducted to compare the average percentage of seatwork items completed correctly out of the number of items attempted, and the average percentage of seatwork items completed out of the number of items assigned, across the standard and extended time conditions. The average percentage of items was used as opposed to the total number of items because each student was assigned a different number of items based on their ability level. A Bonferroni correction was used to account for multiple comparisons of these dependent variables, resulting in an alpha level of Results indicated that students completed a significantly greater percentage of problems overall in the extended time condition compared with the standard time condition, t(32) 33.56, p.001; see Table 2 for means. Of the items attempted, the percentage of items correct was also significantly greater in the extended time condition compared with the standard time condition, t(32) 47.62, p.001. Between-Subjects Analyses Analyses were also conducted to assess whether students performance varied based on several between-subjects variables, including age group (younger 7 9 vs. older 10 12), whether or not they had an IEP or 504 plan, and medication status. Each of these variables was added as a between subjects factor in the repeated measures MANOVA. No significant differences in performance were found across conditions for appropriate behavior or rate of problems completed accurately per minute based on whether children had an IEP/504 plan, or medication status (Table 3). For age group (younger vs. older), the time by group interaction was also nonsignificant for both appropriate behavior and rate, however, tests of between-subjects effects indicated a significant overall difference in appropriate behavior, F(1, 31) 4.51, p.042, with the older group displaying a higher percentage of appropriate behavior than the younger group across both time conditions. Exploratory Analyses Appropriate behavior by time segment. Given previous work on the difficulties individuals with ADHD have on tasks requiring sustained attention, exploratory analyses were conducted to examine the pattern of students appropriate behavior over the seatwork period. Specifically, we sought to explore whether students displayed more appropriate behavior during the beginning of each time condition and if appropriate behavior decreased over the course of the seatwork period. Therefore, observation data were divided into segments for each condition as described above. A mixed-model analysis was conducted to examine students appropriate behavior in each time segment across conditions. The condition, interval, and their interaction were entered as fixed factors. Measures were repeated for each child across all intervals in both conditions, thus Table 2 Performance Across Time Conditions M (SD) 30 min 45 min Test statistic p Appropriate behavior 81.53% (16.39) 80.25% (15.07) F(1, 32) Rate (seatwork items completed correctly/minute) 2.74 (1.10) 2.15 (0.69) F(1, 32) Overall completion 71.04% (19.13) 84.77% (14.51) t(32) Overall accuracy 84.89% (10.25) 87.89% (6.95) t(32) Note. p.0125 after Bonferroni correction.

8 EXTENDED TIME ACCOMMODATION FOR ADHD 243 Table 3 An Examination of Between-Subjects Variables for the Dependent Measures Appropriate behavior, 30 min M (SD) Appropriate behavior, 45 min Rate, 30 min Rate, 45 min Group Younger 76.74% (20.29) 74.06% (17.65) 2.57 (1.13) 1.96 (0.74) Older 86.05% (10.31) 86.07% (9.37) 2.89 (1.09) 2.33 (0.60) IEP/504 Yes 84.41% (13.02) 82.49% (12.18) 2.82 (1.14) 2.19 (0.62) No 77.59% (19.93) 77.2% (18.34) 2.62 (1.09) 2.10 (0.78) Medication status Yes 84.79% (14.16) 83.48% (14.7) 2.78 (0.97) 2.17 (0.64) No 75.84% (19.01) 74.6% (14.6) 2.67 (1.35) 2.13 (0.79) Note. IEP Individualized Education Plan; Plan. each child had 3 observations in the standard condition and 4 in the extended condition. Fixed effects were significant for the interval, F(3, 79) 3.70, p.015 but nonsignificant for the condition, F(1, 183) 1.09, p.299 and the condition interval interaction, F(2, 118) 0.43, p.65. Based on the estimated marginal means, pairwise comparisons for the interval factor indicated that the mean percentage of appropriate behavior was significantly different between interval 1 (Minutes 0 10) and interval 4 (Minutes 31 45) ( p.030), and marginally significant between interval 2 (Minutes 11 20) and interval 4 ( p.057). Pairwise comparisons between intervals 1 and 2 ( p 1.00), 2 and 3 ( p 1.00), and 3 and 4 ( p.401) were not significant. As a follow-up to the mixed model analysis, two repeated measures analyses of variance (ANOVA) were conducted to compare rates of appropriate behavior across intervals within the standard and extended time conditions. Means are presented in Table 4. The assumption of sphericity was not met for either analysis; therefore the Greenhouse-Geisser correction was used. For the standard time condition there was a significant difference in appropriate behavior across intervals 1, 2, and 3, F(2, 52) 7.98, p.002. Examination of means indicated that students exhibited less appropriate behavior during interval 3 than during intervals 1 or 2. For the extended time condition there was also a significant difference in appropriate behavior across intervals 1, 2, 3, and 4, F(3, 65) 20.83, p.001. Examination of means indicated that students displayed less appropriate behavior during interval 4 than during intervals 1, 2, or 3. Discussion The present study examined the effect of extended time on the seatwork performance of children with ADHD in a STP setting. Results indicated that appropriate classroom behavior was equivalent during extended time compared with standard time. Of interest, children with ADHD completed significantly more problems correctly per minute in the standard time condition than in the extended time condition. This pattern of results for appropriate behavior and rate of problems completed accurately did not differ based on age group, whether children Table 4 Appropriate Behavior Over Time in The Standard and Extended Time Conditions M (SD) Segment 1 Segment 2 Segment 3 Segment 4 Standard time 83.28% (16.44) 83.36% (17.25) 77.71% (18.71) NA Extended time 84.85% (12.85) 83.49% (14.80) 83.21% (16.58) 73.15% (18.72) Notes. NA not applicable.

9 244 PARISEAU, FABIANO, MASSETTI, HART, AND PELHAM were medicated for ADHD or whether they were determined to need accommodations through an IEP or 504 plan. However, as might be expected with additional time, children completed a greater percentage of problems overall in the extended time condition, albeit at a slower rate, compared with a more restricted time period. In addition, exploratory analyses indicated that, for both conditions, when appropriate behavior was divided into time segments, children displayed significantly less appropriate behavior during the final segment of each condition compared with the initial segment. Each of these results will be discussed in turn. The present results indicate that children with ADHD were no better or worse at maintaining appropriate behavior during seatwork completion tasks when they were given additional time to complete an equal amount of work. Therefore, for the seatwork tasks used in this study, extended time did not appear to ameliorate the difficulties students with ADHD have with maintaining appropriate behavior during classroom activities (e.g., DuPaul & Stoner, 2003; Loe & Feldman, 2007; Raggi & Chronis, 2006), which is important because appropriate accommodations should be specific to a student s disability (Phillips, 1994). In addition, children with ADHD completed more problems correctly per minute in the standard condition than in the extended condition. This indicates that children with ADHD used their time more efficiently (worked faster) when they knew they had a shorter amount of time to complete their work. This finding is also interesting when one considers that there was no difference in appropriate behavior across the two conditions, indicating that the significant difference in the rate of accurate work completion is not because of children exhibiting more inappropriate behavior when given extended time. This pattern of increased rate of work completion under shorter time constraints has been well documented in previous work (e.g., Ayllon et al., 1976; Van Houten & Little, 1982; Van Houten & Thompson, 1976). Lewandowski et al. (2007) found that there was no difference in the percentage of problems completed between groups of students with and without ADHD; students in the ADHD group just worked more slowly, and they fell behind early and stayed behind in terms of the number of problems attempted per time block. Furthermore, behavior worsened in both conditions during the last segment, suggesting that children with ADHD had difficulty persisting for the total duration of time, regardless of the amount of time allotted for work completion. Given that ADHD is a disorder characterized by problems with sustained attention (e.g., difficulty sustaining attention in tasks or play activities, fails to give close attention to details, reluctant to engage in tasks that require sustained mental effort; American Psychiatric Association, 2000), it is not surprising that more time on a sustained mental effort task such as seatwork is ineffective for increasing rates of work completion. With regard to work completion, it is important to note that children completed a greater overall percentage of work in the extended time condition compared with the standard time condition and also completed a greater percentage of problems with accuracy. This finding may be influenced by the fact that in order to prevent a ceiling effect of work completion, all children were given more work than they were reasonably expected to be able to complete in the longest allotted time. Children were also given the same amount of work in both the standard and extended time conditions. In a typical classroom setting, the goal would not be to prevent children from completing all of their assigned work in the allotted time, but rather to assign an amount of work that children would be expected to be able to complete. It is unknown how rates of accuracy and overall completion would differ across the standard and extended time conditions if the amount of work assigned was varied based on reasonable work completion expectations. Regarding children s appropriate behavior over time, exploratory analyses revealed that in both the 30- and 45-min conditions children displayed significantly less appropriate behavior during the last segment of the seatwork time. This finding is congruent with the view that individuals with ADHD show impairment on measures of sustained attention (e.g., Barkley, 1997; Rapport et al., 2009). Taken together, the results suggest that children with ADHD maintained more appropriate behavior and were more efficient during the beginning of the seatwork period. When provided longer amounts of time to complete work, they may have paced their work completion to fill the amount of time they were given.

10 EXTENDED TIME ACCOMMODATION FOR ADHD 245 Limitations Several limitations in this study affect the generalizability of the results. Most notably, the study was conducted in a summer camp classroom setting as part of an intensive summer treatment program for children with ADHD. Within this setting there was a smaller ratio of children to adults than may be found in a typical classroom and all aspects of the study were implemented in the context of an intensive behavior modification system. Classroom behavior was linked to reinforcers in the STP. Most children in the study had daily report card (DRC) targets related to work completion and accuracy and number of rule violations in the classroom. Therefore, the results of the present study must be interpreted within this background intervention context, as children had considerable incentive to complete their work. Additional limitations involve the task that was used and the manner in which results were assessed. For feasibility purposes within the classroom setting, children s performance on seatwork was assessed rather than their performance on a standardized test. While Schnoes et al. (2006) found that 71.1% of children with ADHD who were determined to have a disability received extended time on assignments, the present results may not generalize to other types of academic performance measures such as tests. Seatwork included three types of academic assignments (math, reading, writing), yet data was not collected in a way that allowed analysis of children s performance by assignment type. In addition, the order of assignments was not varied, so potential order effects of assignment type were not controlled. The time blocks used in the study (30 and 45 min) were chosen to reflect a period of seatwork that would be typical for an elementary school classroom. However, longer or shorter time blocks may yield different outcomes. The manner in which observations of appropriate behavior were conducted may have lead to an over or under estimation of rates of inappropriate and appropriate behavior because during each 15-s interval a child s behavior was coded as inappropriate if they engaged in any rule breaking behavior for any portion of the interval, regardless of how long the inappropriate behavior occurred for. However, the same procedure was used across both conditions, so comparison of rates of appropriate behavior can still be made. An additional methodological consideration is that children were told they were being timed and they could visibly see the digital timer at the front of the classroom. Previous work has found that simply telling a student they are being timed has an impact on their performance (Derr & Shapiro, 1989). This procedure was employed across both time conditions so the impact should be distributed equally across conditions. However, these results may not generalize to situations where a timer is not used. The small sample size in this study limited our ability to look at any possible effects of disability status. While over half of the sample had either an IEP or 504 plan, a larger number of participants are needed to determine if the effectiveness of extended time varies among children with ADHD who have different disabilities (i.e., learning disability, emotional disturbance, other health impaired), and our analyses in this regard are considered to be exploratory. An additional limitation related to the sample is that all participants had ADHD and there was no comparison group. The influence of extended time on academic performance may be the same for all children, which is especially important when discussing appropriate accommodations as the objective of an accommodation for students with disabilities is to differentially improve their performance compared with peers who do not have a disability (Phillips, 1994). Therefore future studies should compare the performance of students with ADHD to that of their peers without ADHD. Practical Implications Overall, results suggest that the academic performance of children with ADHD, as measured by appropriate classroom behavior and rate of accurate work completion, is not meaningfully improved when they are given extended time to complete seatwork. The finding that the rate of accurate problem completion was greater when children were given a shorter period of time is an important consideration when planning for the special and general education services for children with ADHD. Taken together, these results suggest that the use of extended time accommodations for students with ADHD should vary based on the goal of the task. For classroom assignments and homework, the goal is

11 246 PARISEAU, FABIANO, MASSETTI, HART, AND PELHAM typically to provide opportunities for practicing skills and developing fluency and timely completion. Therefore, the use of extended time as an accommodation seems counterproductive, as rate of accurate work completion appears to increase in the presence of shorter time limits. As suggested by Lewandowski et al. (2007) shorter time periods may actually minimize the performance gap between students with and without ADHD, a recommendation that appears to be supported by the present results as well. However, the effectiveness of extended time as a testing accommodation for students with ADHD may be different, as the goal of testing is for the student to demonstrate breadth and depth of knowledge. While the present study demonstrated that students worked at a slower rate when given more time, they still completed a greater percentage of their work with greater overall accuracy. Accommodations that improve the overall magnitude of completion and accuracy may be particularly relevant for testing situations. Furthermore, the behavior modification procedures utilized in the present study may have contributed to the higher rate of problems completed correctly per minute during the standard time condition by maintaining students appropriate behavior. Children with ADHD may benefit from having a behavior modification plan that includes monitoring of their behavior and incentives for accurate completion of work within shorter time frames. Alternatives to the use of extended time may not only increase the performance of students with ADHD, but may also reduce the burden for schools that are currently utilizing staff members to monitor students who receive additional time on assignments and tests. Being able to stay in the classroom and work on the same schedule as the rest of their classmates will also minimize the amount of instructional time that children with ADHD may miss while they are receiving additional time to complete work. The present results highlight the variability in academic performance among students with ADHD, and the need to carefully consider the goal of various academic tasks (i.e., seatwork, tests, high stakes assessments) when planning for individual children s education programming. As previously noted by DuPaul, Eckert, and McGoey (1997), a one-size-fits-all approach is not appropriate for students with ADHD. Future Research The present study helps to illustrate a number of directions for future research related to the use of extended time for students with ADHD. A primary consideration relates to the differential benefit of extended time across various tasks. Because of the differing goals associated with classwork/homework and testing situations, a comparison of the performance of students with ADHD under standard and extended time limits across various tasks is needed to help inform educational planning for these students. Similarly, the impact of this accommodation across academic skills (e.g., reading fluency, comprehension, math calculations) is also needed. Individual students with ADHD vary on a number of important factors related to academic performance and success, such as cognitive ability, achievement levels, learning disabilities and other comorbid conditions, and level of academic support needed. It is reasonable to predict that the effect of extended time for a student with ADHD and a learning disability may be different than for a student with ADHD who has no learning difficulties. Therefore, investigation of the effectiveness of accommodations such as extended time based on these factors is critical for making informed decisions regarding individual students educational programming. Additionally, it would be beneficial to examine if the effectiveness of accommodations such as extended time varies based on ADHD subtype (i.e., combined, inattentive, hyperactive/impulsive), as this may be related to differences in academic performance. Functional analyses of these questions may be the best approach for ensuring effective interventions are offered to individual students (DuPaul et al., 1997). The effect of extended time for students with ADHD must be evaluated with and without concurrent behavioral interventions (e.g., DRC, point system) in order to assess differential benefits of this accommodation and the use of incentives for work completion and appropriate behavior. References American Psychiatric Association (APA). (2000). Diagnostic and statistical manual of mental disor-

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