Effects of Multimodal Intervention on Academic and

Behavioural Performance of Children with Attention

Deficit Hyperactivity Disorder

By
PARUL SAXENA

Supervisor
Dr.G.VICTORIA NAOMI

A Thesis Submitted To
Avinashilingam Institute for Home Science
And Higher Education for Women
Coimbatore-641 043.

In partial fulfilment of the requirements for the degree of

DOCTOR OF PHILOSOPHY
IN PSHYCHOLOGY

JANUARY 2012
 CERTIFICATE

This is to certify that the thesis entitled “Effects of Multimodal

Intervention on Academic and Behavioural Performance of Children with
Attention Deficit Hyperactivity Disorder” submitted to the Avinashilingam
Institute for Home Science and Higher Education for Women, Coimbatore, in
partial fulfilment of the requirements for the award of the Degree of Doctor of
Philosophy in Psychology, is a record of original research work done by
PARUL SAXENA, during the period of her study in the Department of
Psychology, Avinashilingam Institute for Home Science and Higher Education
for Women, Coimbatore, under my supervision and guidance and the
dissertation has not formed the basis for the award of any Degree/
Diploma/Associateship/ Fellowship or similar title to any candidate of any
other University and it represents entirely an independent work on the part of
the candidate.

SIGNATURE OF THE SIGNATURE OF THE GUIDE

HEAD OF THE DEPARTMENT

SIGNATURE OF THE DEAN

 DECLARATION

I hereby declare that the dissertation “Effects of Multimodal

Intervention on Academic and Behavioural Performance of Children with
Attention Deficit Hyperactivity Disorder” submitted to the Avinashilingam
Institute for Home Science and Higher Education for Women, Coimbatore,
in partial fulfilment of the requirements for the award of the Degree of
Doctor of Philosophy in Psychology, is a record of original
research work done by me under the supervision and guidance of
Dr.(Smt.) G. Victoria Naomi, M.A., M.Ed., Ph.D, Associate Professor,
Department of Special Education, Avinashilingam Institute for Home Science
and Higher Education for Women, Coimbatore, and that it has not formed the
basis for the award of any Degree/Diploma/ Associateship/Fellowship or
similar title to any candidate of any other University and it represents entirely
an independent work on the part of the candidate.

SIGNATURE OF THE GUIDE SIGNATURE OF THE CANDIDATE

 ACKNOWLEDGMENT

First and foremost, the investigator bows her head to GOD Almighty in
deep gratitude for the merciful blessings showered upon her which enabled her
to complete the study successfully.

The investigator owes her respectful gratitude to

Dr. (Thiru) T. S. Avinashilingam, Founder and First Chancellor of
Avinashilingam Institute for Home Science and Higher Education for Women,
Coimbatore, for providing this temple of learning to do this research.
The investigator records her reverential gratitude to Padmashree, Hony.
Colonel Dr. (Smt.) RAJAMMAL P. DEVADAS Former Chancellor,
Avinashilingam Institute for Home Science and Higher Education for Women,
Coimbatore, for her heavenly blessings and for being the central inspiration.

The investigator expresses her sincere thanks and gratitude to

Thiru. T. K. SHANMUGANANDAM, B.A., B.L. Former Chancellor,
Avinashilingam Institute for Home Science and Higher Education for
Women, Coimbatore, for granting official permission to conduct
the study. The investigator expresses her sincere thanks to Dr. (Thiru) T.S.K.
MEENAKSHI SUNDARAM, Chancellor, Avinashilingam Institute for Home
Science and Higher Education for Women, Coimbatore, for providing
infrastructure facilities and amenities to complete the study.

The investigator expresses her profound gratitude to Hony. Colonel

Dr. (Smt.) SHEELA RAMACHANDRAN, Vice Chancellor, Avinashilingam
Institute for Home Science and Higher Education for Women, Coimbatore, for
giving official permission, academic support, providing all the infrastructure
facilities and necessities required for the conduct of the study and also for
being a centre of motivation.

The investigator expresses her thanks and gratitude to

Dr. (Smt.) GOWRI RAMAKRISHNAN, Registrar, Avinashilingam Institute
for Home Science and Higher Education for Women, Coimbatore, for
extending immense and all possible help for the smooth conduct of the study.

The investigator also thanks the former and present Controllers of

Examinations Dr. S. MEERA and Dr. G. P. JEYANTHI and the staff in the
examination unit for providing all time assistance, guidance and support thus
aiding in the successful completion of this research.

The investigator expresses her special thanks to

Dr. (Smt.) Premavathy Vijayan, Head of the Dept., Department of Special
Education, Faculty of Education for her motivation to the researcher to
execute this research.

The investigator doesn’t have enough words to express her gratitude to

her supervisor Dr. (Smt.) G. Victoria Naomi, Associate Professor,
Department of Special Education, who provided immense support, valuable
guidance, co-operation, inspiration, untiring help and valuable time. The
investigator is deeply grateful to her for the suggestions and critical discussions
which were the key parts in the completion of this study.

The investigator also extends her thanks to Dr. Kerry Schwanz,

Assistant Professor, Department of Psychology, Coastal Carolina University,
South Carolina, for her help and support, especially for improving the writing
skills.

The investigator is extremely thankful to the people who provided the

opportunity to conduct the study and collect the data. The investigator extends
her gratitude to Jennifer Alice, Roma Timothy and Gary Duke for their untiring
support in helping with student assessments and scoring of protocols.
Investigator extends her special thanks to Maria J. and Lisa T. for their
dedicated professional support and time to provide interventions to the
children. Without their support, help and professional services, the execution of
the study was not possible.
 The investigator has great regards for the University staff members who
provided basic help to complete the work successfully. The investigator also
extends great thanks to Ms. Lydia for all the help and support at all hours of
day to get the work presented nicely.

The investigator extends great thanks to her family for providing

constant encouragement, motivation and moral support to be persistent and
patient in completing the work. Investigator is extremely thankful to
Dr. Gregor Cedilnik for his support to keep a check on the timeline and
providing constant encouragement to compile the work adequately.

The investigator would be failing her responsibilities with expressing

her due gratitude to all the learned authors whose contribution in the specific
areas of research she consulted.

Last but not the least the investigator expresses her sincere and heartfelt
thanks to the children, parents and teachers who participated in the study. The
students were the constant source of learning and growing. The investigator
learned from them and could improve and refine her knowledge and work.
Without them the study was not meaningful and possible.

Parul Saxena
 CONTENTS

Chapter Page
Title
No. No.
LIST OF TABLES
LIST OF APPENDICES
I INTRODUCTION
1.0.0 Introduction
1.1.0 Diagnostic criteria
1.2.0 Prevalence of ADHD
1.3.0 Comorbid disorders
1.4.0 Associated problems
1.5.0 Academic underachievement in children with
ADHD
1.6.0 Current treatment practices for ADHD
1.7.0 Multimodal intervention program
1.8.0 Rationale of selecting the topic
1.9.0 Statement of the problem
1.10.0 Objectives
1.11.0 Hypothesis
1.12.0 Delimitations
1.13.0 Conclusion

II REVIEW OF LITERATURE
2.0.0 Introduction
2.1.0 Treatment practices
2.1.1 Medicinal interventions- stimulant
based medication
i. Prevalence of medicinal
interventions
ii. Effect of medicinal
interventions
2.1.2 Limitations of medicinal
interventions
2.2.0 Alternative interventions
Chapter Page
Title
No. No.
2.2.1 Meditation and yoga
2.2.2 Music therapy
2.2.3 Complementary medicines
2.2.4 Occupational therapy
2.2.5 Chiropractic care
2.3.0 Psych-educational uni-modal interventions
2.3.1 Behavioural treatment
i. Controlling motor excess/
hyperactive behaviours
ii. Developing inhibitory control
iii. Controlling off task behaviours
iv. Classroom based behaviour
modifications
v. Limitations of behaviour
interventions
2.3.2 Cognitive - behavior interventions
2.3.2.1 Cognitive behaviour
interventions: process
and utility
2.3.2.2 Limitations of cognitive
behaviour interventions
2.3.3 Self-management techniques
2.3.4 Parent centered interventions
i. Parent training
ii. Parenting skills interventions
iii. Parental perspective on
interventions
iv. Limitations of parent training
2.3.5 Teacher centered interventions
2.3.6 Social skills training
2.3.7 Peer tutoring
2.3.8 Attention training interventions
Chapter Page
Title
No. No.
2.3.9 Academic school based
interventions
2.4.0 Bimodal interventions
2.5.0 Comparison among various major treatment
modalities: methodological hurdles and
barriers
2.5.1 Heterogeneity of population and
sample
2.5.2 Subject sources and selection bias
2.5.3 Problem domain and time course
2.5.4 Heterogeneity in treatment
responsiveness
2.5.5 Adequacy and comparability of
assessment procedure
2.5.6 Difference in nature of treatments,
and procedural variations
2.5.7 Difference in the treatment goals
2.5.8 Long-term vs. Short term studies
2.5.9 Developmental course of ADHD
2.5.10 Summary
2.6.0 Multimodal approach of interventions
2.6.1 Limitations of multimodal approach
2.7.0 Conclusion

III METHOD
3.0.0 Introduction
3.1.0 Site description
3.2.0 Sample
3.3.0 Design of the study
3.3.1 Dependent variables
3.3.2 The independent variables
3.4.0 Tools
3.4.1 DSM - IV diagnostic criteria
Chapter Page
Title
No. No.
3.4.2 Connor’s rating scale (revised
version- short form)
3.4.3 Raven’s colored progressive
matrices.
3.4.4 Sclam rating scale (swanson, conner,
loney and milich) (swanson
3.4.5 Skamp rating scale
3.4.6 Snap-iv rating scale

3.4.7 Wiat- ii achievement test

3.4.8 Class based grades
3.5.0 Data collection procedure
3.5.1 Intervention procedure
3.5.2 i. Intervention with the students:
ii. Teacher training: five one hour
sessions
iii. Training of parents: six one hour
sessions
3.6.0 Data analysis
IV RESULTS AND INTERPRETATION
4.0.0 Introduction
4.2.0 Effectiveness of multimodal intervention
programme on three groups at pre and post
intervention level on the criteria of
deportment as measured by the teacher
ratings
4.3.0 Effectiveness of multimodal intervention
programme on three groups at pre and post
intervention level on the criteria of inattention
as measured by the parent ratings
4.4.0 Effectiveness of multimodal intervention
programme on three groups at pre and post
intervention level on the criteria of aggression
as measured by the parent ratings
Chapter Page
Title
No. No.
4.5.0 Effectiveness of multimodal intervention
programme on three groups at pre and post
intervention level on the criteria of peer
interaction as measured by the parent ratings
4.6.0 Effectiveness of multimodal intervention
programme on three groups at pre and post
intervention level on the criteria of inattention
as measured by the researcher’s ratings
4.7.0 Effectiveness of multimodal intervention
programme on three groups at pre and post
intervention level on the criteria of
impulsivity as measured by the researcher’s
ratings
4.8.0 Effectiveness of multimodal intervention
programme on three groups at pre and post
intervention level on the criteria of
hyperactivity as measured by the researcher’s
ratings
4.9.0 Effectiveness of multimodal intervention
programme on three groups at pre and post
intervention level on the criteria of english
reading performance as measured by the class
grades
4.10.0 Effectiveness of multimodal intervention
programme on three groups at pre and post
intervention level on the criteria of english
writing performance as measured by the class
grades
4.11.0 Effectiveness of multimodal intervention
programme on three groups at pre and post
intervention level on the criteria of English
spelling performance as measured by the
class grades
4.12.0 Effectiveness of multimodal intervention
programme on three groups at pre and post
intervention level on the criteria of math
calculation performance as measured by the
class grades
Chapter Page
Title
No. No.
4.13.0 Effectiveness of multimodal intervention
programme on three groups at pre and post
intervention level on the criteria of math
application performance as measured by the
class grades
4.14.0 Effectiveness of multimodal intervention
programme on three groups at pre and post
intervention level on the criteria of word
reading as measured by the WIAT-II
4.15.0 Effectiveness of multimodal intervention
programme on three groups at pre and post
intervention level on the criteria of reading
comprehension as measured by the WIAT-II
4.16.0 Effectiveness of multimodal intervention
programme on three groups at pre and post
intervention level on the criteria of decoding
as measured by the WIAT-II
4.17.0 Effectiveness of multimodal intervention
programme on three groups at pre and post
intervention level on the criteria of spellings
as measured by the WIAT-II
4.18.0 Effectiveness of multimodal intervention
programme on three groups at pre and post
intervention level on the criteria of written
expression as measured by the WIAT-II
4.19.0 Effectiveness of multimodal intervention
programme on three groups at pre and post
intervention level on the criteria of math
calculation as measured by the WIAT-II
4.20.0 Effectiveness of multimodal intervention
programme on three groups at pre and post
intervention level on the criteria of math
reasoning as measured by the WIAT-II
V FINDINGS AND DISCUSSION
5.0.0 Introduction
5.1.0 Findings
5.2.0 Findings pertaining to classroom based
behaviors
Chapter Page
Title
No. No.
5.2.1 Comparison of attention span and
deportment before and after
interventions
5.2.2 Comparison of attention span
5.2.3 Comparison of attention span
5.2.4 Discussion pertaining to classroom
based behaviors: combined ratings
by parents
5.3.0 Findings pertaining to academic skills and
performance
5.4.0 Findings pertaining to adjusted mean scores
at post intervention level for all criteria
VI SUMMARY AND CONCLUSION
6.0.0 Introduction
6.1.0 Rationale of the Study
6.1.1 Increasing Rate of Prevalence
6.1.2 Need for the Involvement of Parent
and Teachers
6.1.3 Lack of Research from Holistic/
Multimodal Intervention Approach
6.1.4 Impact of ADHD on Emotional
Wellbeing
6.2.0 Statement of problem
6.3.0 Objectives
6.4.0 Hypothesis
6.5.0 Sample
6.6.0 Design
6.7.0 Tools
6.8.0 Data collection procedure
6.9.0 Data analysis
6.10.0 Findings
6.11 Implications
REFERENCES
APPENDICES
 LIST OF TABLES

Table Page
Title
No. No.
A Data Description
B Data Description
1. Teacher Rated Attention
2. Teacher Rated Deportment
3. Parent Rated Inattention
4. Parent Rated Aggression
5. Parent Rated Peer Interaction
6. Researcher Rated Inattention
7. Researcher Rated Impulsivity
8. Researcher Rated Hyperactivity
9. Class Grades on English Reading
10. Class Grades in English Writing
11. Class Grades in English Spelling
12. Class Grades in Math Calculation
13. Class Grades in Math Application
14. WIAT-II scores on Word Reading
15. WAIT-II scores on Reading Comprehension
16. WAIT-II scores on Decoding Skills
17. WIAT-II scores on Spellings
18. WIAT-II scores on Written Expression
19. WIAT-II scores on Math Calculation
20. WIAT-II scores on Math Reasoning
 LIST OF APPENDICES

Appendices Title Page

No.
I Parent Consent Form i
II Conners Rating Scale- CADS Parent Version v
III Conners Rating Scale- CADS Teacher Version vi
IV Raven’s CPM- Sample Item vii
V DSM-IV Criteria viii
VI SCLAM Rating Scale xi
VII SKAMP Rating scale xii
VIII SNAP-IV Rating scale xiii
IX WIAT-II Cover Sheet xv
X WIAT-II Summary Report Sheet xvi
XI Weekly Behavior Chart xvii
XII Sample of Listening Skill Activity xviii
XIII Sample of Math Skill Training Activity xix
XIV Reading Intervention Method xxii
XV Sample of Reading Skill Training Activity xxix
XVI Student Report Card xxxv