School Psychology Review

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Students with ADHD in School Classrooms:

Teacher Factors Related to Compatibility,
Assessment, and Intervention

Ross W. Greene

To cite this article: Ross W. Greene (1995) Students with ADHD in School Classrooms: Teacher
Factors Related to Compatibility, Assessment, and Intervention, School Psychology Review, 24:1,
81-93, DOI: 10.1080/02796015.1995.12085753

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School Psychology Review
Volume 24, No. 1 1995, pp. 81-93

STUDENTS WITH ADHD IN SCHOOL

CLASSROOMS: TEACHER FACTORS RELATED
TO COMPATIBILITY, ASSESSMENT, AND
INTERVENTION
Ross W. Greene
Massachusetts General HospitaUHarmard Medical School
Abstract: Perhaps the most striking omission of school-based treatment outcome re-
search for students with ADHD has been the examination of teacher factors that may
have a significant bearing upon outcome. As a result, the conceptualization of ADHD
and its treatment is incomplete. A perspective incorporating goodness-of-fit/systems
theory may be a more adequate model from which to view interactions between stu-
dents with ADHD and their teachers and a more predictive model from which to hy-
pothesize anticipated treatment outcomes. Two compatibility issues are explored in
some detail: teacher-treatment compatibility (i.e., the match between teacher charac-
teristics and commonly recommended behavior management procedures) and
teacher-student compatibility (i.e., the match between teacher characteristics and
student characteristics). Potential teacher factors which might be important to con-
sider in such compatibility equations are discussed, along with the implications of
these variables for school-based assessment and intervention processes and future re-
search.

A substantial literature on children with (e.g., Abramowitz, Eckstrand, O’Leary, &

attention deficit/hyperactivity disorder
(ADHD) has accumulated over the past 2
decades. An impressive portion of this liter-
ature has addressed the difficulties students
with ADHD experience in school class-
rooms and the efficacy of interventions to
minimize these difficulties. Medication and
behavior management procedures remain
the two most commonly employed school-
based interventions for children with ADHD
(Rapport, 1992). Due to well-documented
limitations associated with both strategies,
some combination of the two is generally
accepted as the optimal approach to treat-
ment (e.g., Pelham, 1993). Nevertheless, an
increasingly common finding in studies
which examine the efficacy of such a com-
bined approach to treatment is the consid-
erable variability in treatment response
among individual students (Pelham, 1993).
As such, a case-by-case assessment of treat-
ment ingredients and potencies is necessary
Dulcan, 1992; Hoza, Pelham, Sams, & Carl-
son, 1992; Swanson, Cantwell, Lerner,
McBurnett, & Hanna, 1991). Hence, suc-
cessful school outcomes for students with
ADHD depend upon the degree to which
treatment components and potencies match
the needs of particular children. This
“match” between treatment and student
may best be conceptualized as a “compati-
bility equation” (in this case, studerzt-treat-
ment compatibility] in which characteris-
tics of both child and treatment are taken
into consideration in planning treatment
and evaluating outcome.
Studies examining student response to
treatment can be criticized for an almost
singular focus on treatment ingredients, as
well as a relative neglect of student charac-
teristics that may mediate treatment out-
come. Yet perhaps the most striking limita-
tion of school-based treatment outcome re-
search has been the lack of consideration of

The author would like to acknowledge the following individuals for their invaluable feedback on previous drafts
of this manuscript: Russell A. Barkley, Caryn L. Carlson, Susan G. O’Leary, Thomas H. Ollendick, Mark D. Rap-
port, Gary N. Siperstein, and Melissa S. Tomback.
Address all correspondence concerning this article to Ross W. Greene, PhD, Pediatric Psychopharmacology Unit,
WACC-725, Massachusetts General Hospital, Boston, MA 02114.

81
82 School Psychology Review, 1995, Vol. 24, No. 1
teacher characteristics that may have a sig-
nificant bearing on outcome. Two addi-
tional compatibility equations - person’s behavior (a unidirectional
teacher-treatment compatibility (the
match between different teachers and dif-
ferent treatment ingredients and potencies)
and student-teacher compatibility (the
match between a particular teacher and a
particular student with ADHD with regard
to a variety of factors) - have been virtu-
ally ignored. This article suggests that a
more adequate and predictive model from
which to conceptualize classroom outcome
for students with ADHD will be one in
which “teacher factors” are given greater
consideration.
Goodness-of-Fit and Systems Theory
The terms compatibility and match can
be traced most directly to the goodness-of-
fit literature (e.g., Thomas, Chess, & Birch,
1968). Goodness-of-fit is a concept that has
been applied productively to child-care-
giver interactions (e.g., Bell & Harper, 1977;
Thomas & Chess, 1980); several authors
have noted that the concept may be relevant
to child-teacher interactions involving a va-
riety of special student populations, includ-
ing those diagnosed with ADHD (e.g.,
Brooks, 1984; Conners & Wells, 1986; Shay-
witz & Shaywitz, 1988; see Whalen &
Henker, 1980 for a comprehensive discus-
sion of the “social ecology” of ADHD).
Goodness-of-fit can be defined as the de-
gree to which the capacities, motivations,
and style of behaving of an organism (the
child) are compatible with properties, ex-
pectations, and demands of the environ-
ment (the teacher and classroom). Conso-
nance and dissonance are two general
terms describing this compatibility between
an organism and its environment(s). Conso-
nance refers to a situation in which good
compatibility exists and under which opti-
mal development and progress is thought to
occur. Dissonance refers to the opposite sit-
uation; under such circumstances distorted
development and maladaptiveness
thought to occur.
There is a clear overlap between the
concept of goodness-of-fit and constructs
associated with systems theory; an avoid-
ante of linear, cause-and-effect thinking is
central to both perspectives. Rather than
seeing the cause of a problem in a single
explana-
tion), the systems viewpoint attempts to un-
derstand behavior as the product of various
forces that reciprocally influence each
other (Papero, 1983). In systems thinking,
the emphasis is on both the characteristics
of an individual and the contexts that may
influence the nature of the individual’s be-
havior (as well as the manner in which each
influences the other). No single event or
piece of behavior causes another; each is
linked in a reciprocal manner to other
events and pieces of behavior (Papp, 1983).
As such, issues of teacher-setting compati-
bility (e.g., job dissatisfaction) may influ-
ence, and be influenced by, issues of stu-
dent-teacher compatibility.
Goodness-of-fit and systems theory are
useful frameworks for conceptualizing the
classroom difficulties of students with
ADHD because they compel focus not only
upon the manner in which the student with
ADHD is compatible or incompatible with
the classroom environment, but also on the
manner in which the classroom environ-
ment is compatible or incompatible with
the student with ADHD. As a “situation-spe-
cific” disorder (e.g., Barkley, 1989; Whalen
& Henker, 1980; Zentall, 1985), ADHD char-
acteristics are apt to be more or less prob-
lematic depending on certain environmen-
tal contexts. If a student’s ADHD-related be-
havior is exacerbated or improved in cer-
tain situations - such as interactions with
certain teachers, classroom environments,
or specific tasks - then a goodness-of-
fit/systems approach necessitates examina-
tion of those aspects of the environment
contributing to positive and negative varia-
tions in behavior. From such a perspective,
it is impossible to conceptualize the deficits
in attention, self-regulation, and motivation
that characterize ADHD separately from the
environmental contexts in which they oc-
cur. Accordingly, a unidirectional perspec-
tive in which the difficulties exhibited by
is students with ADHD are viewed solely as a
function of their ADHD status (i.e., their or-
ganismic status) is apt to be less adequate
and predictive.
Since classroom teachers are a major
component of a child’s school environment,
 ADHD in School Classrooms
identifying relevant aspects of teacher be-
havior affecting students with ADHD is crit-
ical. Research suggesting that some teach-
ers are more effective in working with diffi-
cult students (Kauffman & Wong, 1991; Lar-
rivee, 1985; Lloyd, Kauffman, & Kupersmidt,
1990) supports the broader, more compre-
hensive goodness-of-fit/systems conceptu-
alization. Such findings oblige us to frame
the problems of students with ADHD differ-
ently: outcome is a function not only of
characteristics associated with the child but
also of characteristics associated with the
teacher. If we ignore teacher factors influ-
encing treatment efficacy (teacher-treat-
ment compatibility) and the general rela-
tionship between a teacher and student
(student-teacher compatibility), then we
will capture only a fraction of the variance
associated with outcome. Further, if we are
to begin conceptualizing characteristics of
students with ADHD and their teachers as
components in a compatibility equation, it
may be necessary to revise our definition of
outcome. Outcome no longer merely refers
to the question, “What was the response of
this child with ADHD to this teacher and
those treatment procedures in this class-
room environment?” Rather, it also refers to
the question, “What was this teacher’s re-
sponse to this child with ADHD and those
treatment procedures in this classroom en-
vironment?”
In the following section, two important
issues are discussed to underscore the no-
tion that failing to consider the impact of
situational factors increases the likelihood
of linear, unidirectional thinking, thereby
reducing the adequacy and predictive utility
of our conceptualizations about children
with ADHD. The first issue of unidirection-
ality relates to the assessment and diagnos-
tic process for ADHD, and the second to the
(sole) use of medication in reducing the
severity of ADHD-related behaviors.
Linear/Unidirectional
Conceptualizations
Although still a debated issue, none of
the direct measures developed to quantify
difficulties with attention span, impulse
control, and vigilance have thus far proven
to have satisfactory diagnostic utility (e.g.,
83
Barkley, 1990; DuPaul, Anastopoulos, Shel-
ton, Guevremont, & Metevia, 1992; Greene
& Barkley, in press-a). Thus, the ADHD di-
agnosis is frequently based on a child’s
standing on behavior checklists which com-
pare a child’s behavior to what normatively
is expected given their age and gender
(Costello, Loeber, & Stouthamer-Loeber,
1991). On such checklists, teachers and par-
ents rate the degree to which various be-
haviors are present or problematic. These
ratings provide the most objective data re-
garding the degree to which a child’s behav-
ior meets the criterion of developmental de-
viance central to the diagnosis of ADHD.
The limitations of behavior checklists
are fairly well-documented (e.g., Schaugh-
ency & Rothlind, 1991) and include reporter
bias (in which the rater over- or under-esti-
mates the occurrence of particular behav-
iors), inaccurate reporter recall regarding
certain behaviors, and reporter misinterpre-
tation of checklist items. Checklist ratings
also may be influenced by various charac-
teristics of the informants, including their
education, intelligence, and emotional sta-
tus at the time ratings are completed
(Barkley, 1990). Thus, there is some sugges-
tion that a teacher’s ratings of a particular
child are influenced by characteristics of
both child and teacher and are partially re-
flective of their compatibility. Although
data indicate that teachers are able to dis-
tinguish between children with and without
symptoms of ADHD (e.g., Atkins, Pelham, &
Licht, 1985), teachers’ detection thresholds
for perceiving children as deviant or defi-
cient and in need of special help may influ-
ence the likelihood that a child will be diag-
nosed. Little empirical information is avail-
able about the potentially powerful role of
individual differences in these person-per-
ception processes (Whalen, 1989).
There is, however, significant variability
in the way different teachers (and parents)
perceive and respond to various child be-
haviors; behaviors considered to be a major
problem by one teacher may not be viewed
as such by another (e.g., Walker & Rankin,
1983). Presumably, some teachers perceive
ADHD-related behaviors as more trouble-
some, are more reactive to such behaviors,
and respond to these behaviors less effec-
tively than others. These gerceptions and
84 School Psychology Review, 1995, Vol. 24, No. 1
responses are likely to influence the nature
of student-teacher interactions, a teacher’s
ratings of a given child, and referrals for
special education assistance and to mental
health professionals outside the school sys-
tem. For example, researchers have found
clear individual differences among teachers
not only in their views about what consti-
tutes unacceptable classroom behavior but
also in their willingness to accept responsi-
bility for students who exhibit unacceptable
behavior without technical assistance (e.g.,
Kauffman, Lloyd, & McGee, 1989).
Viewing a teacher’s ratings of a child as
a de facto portrayal of the child (rather than
as a description of this child’s interactions
with this teacher in this classroom environ-
ment) ignores the possible impact of these
differences in teachers’ perceptions and re-
sponses. Little attention has been paid to in-
terteacher variability in rating the presence
and severity of ADHD behavior and the pos-
sible explanatory mechanisms of this vari-
ability. Given the importance of making ac-
curate ADHD diagnoses, this would appear
to be an important area of inquiry. The vari-
ability in teachers’ perceptions and re-
sponses also strengthens the argument that
a more adequate and predictive diagnostic
process should include assessment not only
of the child but also of characteristics of the
teacher (as described below).
The second issue of unidirectionality
relates to the use of medication, which has
oecome common practice for intervening
with students with ADHD. As many as 88%
of children with ADHD receive Ritalin or
other stimulants at some point in childhood
(Wolraich et al., 1990). Numerous investiga-
tive teams have found that the classroom
functioning and academic performance of
many children with ADHD improves in re-
sponse to stimulant medication (e.g., Dou-
glas, Barr, O’Neill, & B&ton, 1986; Pelham,
Bender, Caddell, Booth, & Moorer, 1985;
Rapport, Stoner, & Jones, 1986). Nonethe-
less, debate continues regarding the extent
to which medication “normalizes” the be-
havior and performance of children with
ADHD (e.g., Pelham, 1993; Swanson et al.,
1991) especially when medication effects
are examined at the individual level (Du-
Paul & Rapport, 1993). Further, researchers
have concluded that a large minority of chil-
dren with ADHD do not evince a significant
medication treatment effect (Abikoff & Git-
telman, 1985; Pelham, 1993; this is still a de-
bated issue, as some research teams have
reported very low percentages of nonre-
spondents; e.g., Elia, Borcherding,
Rapoport, & Keysor [1991]).
When prescribed in the absence of
other intervention, pharmacotherapy may
represent a less comprehensive approach to
resolving the difficulties exhibited by chil-
dren with ADHD in the classroom because
it targets for change only one component
(the child) of the compatibility equation. AI-
though the effects of medication have been
shown to extend beyond the child - for ex-
ample, studies have shown that teachers
come to interact with and view students
with ADHD in a more positive manner after
the children are medicated (e.g., Whalen,
Henker, & Dotemoto, 1980) - such an ap-
proach implies that the problem emanates
from within the child (Henker & Whalen,
1980). In the context of a goodness-of-
fit/systems conceptualization, this is at best
an incomplete and at worst a counterpro-
ductive way in which to view the student
with ADHD. The problem can instead be
conceptualized as a product of a variety of
factors, including characteristics of the
child, teacher(s), parent(s), classroom and
school environments, task demands, and so
forth. Are there teacher characteristics
which may mediate medication effects? If
we focus exclusively on the medication
component of treatment are we apt to se-
verely limit our ability to predict outcome
accurately?
Before examining teacher-treatment
and student-teacher compatibility issues
more closely, it must be acknowledged that
two related and important compatibility is-
sues are not addressed in detail in the fol-
lowing discussion: teacher-setting compat-
ibility (the match between characteristics
of the teacher and characteristics of the
teaching setting) and child-setting compat-
ibility (the match between characteristics
of the child and characteristics of the learn-
ing setting). The latter area has already
been the focus of several studies. For ex-
ample, factors such as a high level of noise
has been shown to have detrimental effects
on the behavior of students with ADHD
 ADHD in School Classrooms
(e.g., Whalen, Henker, Collins, Finck, &
Dotemoto, 1979), while extra- and intratask
novelty stimulation have been found to re-
duce activity and improve performance, es-
pecially on easy, repetitive tasks (e.g., Zen-
tall & Meyer, 1987). Still, our understanding
of the child-setting compatibility issue can
hardly be characterized as complete; other
setting variables (e.g., size of class, ratio of
hyperactive to nonhyperactive children,
seating arrangements, and open versus
closed classes) are worthy of additional ex-
ploration (Pfiffner & O’Leary, 1993). With
regard to teacher-setting compatibility, is-
sues such as job satisfaction, teaching grat-
ification, grade preference, student popula-
tion preference, and general school envi-
ronment are potential areas of inquiry. Bor-
rowing terminology from Carlson and La-
hey (1988), our ability to “engineer settings
that optimize adaptation” for students with
ADHD, and our concepts of interactions be-
tween students with ADHD and their teach-
ers, will remain incomplete until these addi-
tional person-environment compatibility is-
sues are more closely examined.
Teacher-Treatment Compatibility
Classroom-based behavior modifica-
tion procedures typically involve a combi-
nation of token reinforcement and mild
punishment strategies. Fairly detailed de-
scriptions of such methods have been pro-
vided by numerous authors (e.g.,
Abramowitz, 1994; DuPaul, 1991; Pfiffner &
Barkley, 1990; Pfiffner & O’Leary, 1993).
Others have proposed various teaching
strategies and classroom modifications to
minimize the difficulties exhibited by stu-
dents with ADHD (e.g., Algozzine & Ys-
seldyke, 1992; McCarney, 1989).
Although behavior management pro-
grams enhance the academic performance
and behavior of students with ADHD, con-
tingency management procedures, even
more than medication, have not been found
to normalize children’s classroom behavior
(e.g., Abikoff & Klein, 1992). Studies have
shown that even when behavioral treat-
ments produce clinical improvements, chil-
dren with ADHD may still be significantly
more deviant than normal classroom con-
trols on a number of crucial dimensions
85
(Abikoff & Gittelman, 1984; Gittelman et al.,
1980; Pelham, Schnedler, Bologna, & Con-
teras, 1980).
Consideration of teacher-treatment
compatibility should improve our under-
standing of these treatment outcome issues.
Are commonly recommended behavior
management strategies compatible with the
expectations, capacities, motivations, and
behavioral styles of teachers? The treat-
ment acceptability literature suggests a va-
riety of factors related to characteristics of
both teachers and treatments relevant to
this question including: (a) perceived sever-
ity of a child’s problem, (b) nature of treat-
ment, (c) time demands involved in imple-
menting a treatment, (d) perceived effec-
tiveness of a treatment, and (e) teacher
background variables (see Elliott [1988] for
a comprehensive review of these factors).
For example, research has suggested
that teachers tend to prefer more time-effi-
cient behavioral treatments (e.g., Witt,
Martens, & Elliott, 1984), that greater
knowledge of and familiarity with behav-
ioral strategies increase treatment accept-
ability among teachers (Elliott, 1988), and
that teachers’ acceptability ratings are
higher for positive behavioral treatments
(e.g., praise, token economies) than for re-
ductive treatments (e.g., time-out, response
cost; Elliott, Witt, Galvin, & Peterson, 1984;
Witt et al., 1984). More recently, the latter
finding has been replicated as specifically
related to interventions for students with
ADHD (Power, Hess, & Bennett, 1993).
Teachers also may be more concerned with
group outcomes, whereas clinicians and
consultants may tend to focus on individual
outcomes (Fantuzzo & Atkins, 1992). This
may explain teachers’ preference for behav-
ioral interventions employing group contin-
gencies and relative lack of enthusiasm for
individually administered contingencies.
Recent findings further suggest that teach-
ers view combined behavioral and pharma-
cological interventions as more effective
and acceptable for students with ADHD
than medication alone (Power et al., 1993).
Other possible teacher factors related
to successful implementation can be ex-
trapolated from the literature regarding
parental implementation of behavior man-
agement strategies. As summarized by
86 School Psychology Review, 1995, Vol. 24, No. I
McMahon and Wells (1989), family compo-
sition (single- versus two-parent house-
holds), socioeconomic status, personal and
marital distress (including parenting
stress), parent personality traits, and
parental knowledge, attitudes, and beliefs
may be important to the successful imple-
mentation of behavior management pro-
grams with children exhibiting problems
similar to those seen in ADHD. Several of
these characteristics can be reframed for
application to teachers and their ability to
implement classroom behavior manage-
ment programs. For example, classroom
composition and structure (e.g., presence of
an aide, inclusion of other special needs stu-
dents), personal distress (including the
stress of having a given child in the class),
teacher personality traits, and knowledge,
attitudes, and beliefs about children with
ADHD (e.g., the degree to which certain
ADHD-related behaviors are interpreted as
“intentional”) may all be related to effective
implementation of behavior management
procedures. There has been little systematic
evaluation of these teacher and setting vari-
ables.
Although clearly nonexhaustive, the
above discussion strongly suggests that the
notion of treatment potency - defined ear-
lier as the practice of applying variable in-
tensities of specific treatment components
on a case-by-case basis depending on the in-
dividual needs of a given child with ADHD
- also must be applied as it relates to the
needs and characteristics of the teacher
charged with implementation. The charac-
teristics and potency of a behavior manage-
ment program deemed consonant for a
child may produce a high degree of disso-
nance in a teacher whose capacities, moti-
vations, style of behaving, and teaching de-
mands have not been taken into account.
Such a program would be expected to have
low compliance, effectiveness, and mainte-
nance (see Reimers, Wacker, & Koeppl
[1987] for a model of treatment acceptabil-
ity incorporating this perspective).
Student-Teacher Compatibility
The above discussion suggests that
teacher factors may play a critical role in
determining the acceptability and success-
ful implementation of a school-based be-
havior management program. It is unclear,
however, whether a teacher’s implementa-
tion of such a program is the most critical
component of overall school outcome for
students with ADHD. Other teacher charac-
teristics may bear even greater influence on
both student-teacher interactions and the
broader behavioral and academic prospects
of students with ADHD in classrooms.
The notion that school outcome for stu-
dents with ADHD may be related to stu-
dent-teacher compatibility has been sug-
gested by several authors (Whalen et al.,
1979), and similar suggestions have been
made regarding generically defined emo-
tionally or behaviorally challenging popula-
tions (Kauffman & Wong, 1991; Landrum,
1992). Theorists have posited that the diffi-
culties of students with EBD (emotional or
behavioral disorders) are often due in part
to incompatibilities between pupils and
teachers and mismatches in their behav-
ioral styles, perceptions, or expectations
(Wong, Kauffman, & Lloyd, 1991). Unfortu-
nately, there has been little systematic study
of which teacher characteristics are most
influential in facilitating successful interac-
tions with students with ADHD.
Good and Brophy (1991) have sug-
gested that a teacher’s classroom behavior
management skills/practices may con-
tribute to student-teacher interchanges and
compatibility. Much of the research examin-
ing interchanges between children and
adults has centered on parents and their
children, and it may again be helpful to ex-
trapolate from this research to generate hy-
potheses regarding interchanges between
students and teachers (Landrum, 1992). As
summarized by Kendziora and O’Leary
(1992), interactions between parent and
child are apt to be dysfunctional when a
parent is (a) uninvolved and not responding
to the child with sufficient warmth and
stimulation; (b) overly harsh and control-
ling; (c) unable to establish reasonable ex-
pectations and limits for the child; (d) inad-
vertently attentive to inappropriate behav-
ior; (e) vague or attacking in communicat-
ing with the child; (f) inconsistent and gen-
erally inept in handling situations calling for
discipline; and (g) too gentle, lengthy, or de-
layed in dealing with misbehavior. Teachers’
 ADHD in School Classrooms
problem-solving skills (i.e., facility at gener-
ating and implementing strategies) for deal-
ing with various ADHD-related behaviors
also may be an important factor. Many of
these characteristics have possible applica-
tion to interactions between teachers and
children with ADHD, but this possibility has
not been well-explored. At this juncture the
literature is neither sufficiently comprehen-
sive nor sophisticated for definitive conclu-
sions to be reached regarding the behavior
management practices or nature of
teacher-student interchanges that may opti-
mize behavior of students with ADHD.
Good and Brophy (1991) have further
suggested that teaching practices - and the
classroom “climate” emanating from these
practices - may also impact upon stu-
dent-teacher compatibility. A recent study
involving a nationwide panel of experts rep-
resenting general and special education
identified and validated 96 teaching prac-
tices as being essential to the effective
teaching of students with mild handicaps in
regular classrooms (Cannon, Idol, & West,
1992). These practices encompass the
broad areas of assessment and diagnosis
(i.e., of student learning needs and pat-
terns), instructional content, instructional
practices, management of student behavior,
planning and managing the teaching and
learning environment, and monitoring and
evaluation procedures (i.e., for gauging stu-
dent progress). Within these categories are
a variety of specific teacher behaviors, in-
cluding adjustment and modification of cur-
ricular materials to meet individual student
needs; providing content to students
through student-teacher interaction rather
than relying on curricular materials to con-
vey information; and minimizing student er-
rors by choosing tasks students can handle
without frustration and monitoring perfor-
mance to provide immediate help and cor-
rective feedback when needed. Although it
is unclear whether practices identified as
essential to the teaching of mildly handi-
capped students generalize to the disruptive
behavior disorders, these practices may
nonetheless be relevant to the current dis-
cussion. To date, however, no studies di-
rectly examine the extent to which the
presence (or absence) of specific teaching
practices influences school outcome for
students with ADHD.
A final category of teacher characteris-
tics is suggested by the literature on child
temperament and parent-child goodness-
of-fit. As noted by Seifer (unpublished man-
uscript), goodness-of-fit consists of objec-
tive and subjective constructs. Objectively-
defined goodness-of-fit can include expec-
tation-behavior matching (a process of
comparing adult expectations and child
characteristics for degree of fit). Subjec-
tively-defined goodness-of-fit can include
an individual’s cognitive appraisal of the de-
gree of fit (i.e., how is a behavior inter-
preted?) and affective response to the per-
ceived degree of fit (i.e., how do the ap-
praisals feel?).
Some of these goodness-of-fit compo-
nents have been studied in relation to teach-
ers and students, though typically not in di-
rect examination of student-teacher com-
patibility. For example, with regard to ob-
jectively-defined goodness-of-fit, re-
searchers have shown that most classroom
teachers have similar expectations and atti-
tudes regarding successful student adjust-
ment. Such adjustment is characterized by a
behavioral repertoire that (a) facilitates
academic performance (i.e., listening to the
teacher, following instructions and direc-
tions, working on assigned tasks, complying
with teacher requests, etc.) and (b) is
marked by the absence of disruptive and/or
unusual behaviors that challenge the teach-
ers’ authority and disrupt classroom atmos-
phere or are objectionable to teachers and
difficult for them to cope with (Hersh &
Walker, 1983; Kerr & Zigmond, 1986). Chil-
dren with ADHD clearly do not fit this de-
scription of the model behavioral profile. As
such, their style of behaving elevates the
risk for heightened tension in their interac-
tions with most teachers. There is, however,
little evidence to suggest that the disparity
between teachers’ behavioral expectations
and the behavior of students with ADHD in-
evitably leads to negative outcomes. At pre-
sent, we lack information regarding other
related, but more variable, aspects of
teacher expectations (e.g., cflexibility of ex-
pectations) that may be more potent con-
tributors to objectively-defined goodness-
of-fit.
88 School Psychology Review, 1995, Vol. 24, No. I
Other research seems germane to sub-
jectively-defined goodness-of-fit. For in-
stance, while there is general consensus
among teachers regarding the unacceptabil-
ity of maladaptive pupil behavior that
threatens classroom control, there is far
less agreement among teachers about the
degree to which various adaptive behaviors
are eriticaZ to a student’s success in their
classrooms (Lloyd, Kauffman, Landrum, &
Roe, 1991). This suggests that teachers have
different tolerances for various student be-
haviors, and that low teacher tolerance (in
this case, for ADHD-related behaviors) is
likely to result in negative outcomes for
both teacher and student (Hersh & Walker,
1983; Walker & Rankin, 1983). As noted ear-
lier, teachers may also interpret and react to
ADHD-related behaviors in diverse ways
(e.g., Whalen, 1989), and these interpreta-
tions and reactions may contribute to the
compatibility that exists between a student
with ADHD and his or her teacher (Brooks,
1984). These goodness-of-fit issues also
await exploration.
Implications for School-Based
Assessment and Intervention
It may be useful at this point to summa-
rize and expand upon many of the points
made above as they apply to school-based
assessment and intervention processes for
students with ADHD. Readers are referred
to other sources for reviews of the complex
array of factors that must be considered in
the assessment of ADHD (e.g., &Paul & 2. Assessments must be multimodal,
Stoner, 1994; Greene & Barkley, in press-b)
and other childhood behaviors (e.g., Mash &
Terdal, 1988; Ollendick & Greene, 1990).
These sources underscore the necessity of
assessing the contexts in which behaviors
occur; however, they typically do not pro-
vide detail about how to assess teacher
characteristics that may represent a major
aspect of such contexts. The assessment lit-
erature can, nevertheless, provide a useful
framework for discussing mechanisms by
which the assessment process can be ex-
panded to include teacher characteristics
and other contextual variables.
The following are suggested guidelines
for assessments and interventions for
ADHD in school settings, and are adapted
from the various references cited above.
1. Assessments must be systems-ori-
ented and must incorporate the possibility
of situational influences on behavior be-
cause behavior may not be consistent
across time and settings. Thus, school-
based assessments for ADHD should be
broad enough to include not only the child
but also the multiple adults (e.g., parents
and teachers) who interact (and have previ-
ously interacted) with the child in multiple
settings (e.g., various contexts within the
school and home). Diagnostic conclusions
will be more definitive if there is stability in
the child’s behavior across time and con-
texts. In instances of inconsistency across
situations - for example, the child’s ADHD-
related behavior is more frequent and inten-
sive in interactions with a particular class-
room environment - the evaluation
process must focus on finer compatibility
issues that may account for the inconsis-
tency. As discussed above, this expanded
assessment process will by definition in-
clude examination of teacher characteris-
tics that may be impacting upon a child’s be-
havior and vice versa. Such a process
should increase understanding of the com-
plex, reciprocal factors affecting child and
teacher behaviors and facilitate appropriate
interventions in the specific contexts where
incompatibility exists. Targets for interven-
tions may subsequently encompass specific
characteristics of the child, teacher, class-
room environment, tasks, and so forth.
in-
cluding different informants and methods.
These should include naturalistic observa-
tion (e.g., direct observation of the child in
different contexts), rating scales completed
by multiple sources, interviews with multi-
ple sources, and review of other relevant in-
formation (e.g., psychoeducational testing).
Although the necessity of naturalistic obser-
vation has been questioned, it is difficult to
imagine circumstances under which a com-
prehensive understanding of ADHD-related
behavior can be achieved in the absence of
such observation. Inconsistency among
sources would once again compel focus on
finer issues of incompatibility, as described
above, thereby allowing appropriate inter-
 ADHD in School Classrooms
ventions in the specific situations (and with
specific individuals) where incompatibility
is evident.
3, A diagnosis should be viewed as
merely descriptive, not explanatory. Thus,
assessments must focus less on assigning a
child to a category and more on obtaining
information that is directly relevant to treat-
ment. “Relevance for treatment” refers to
the usefulness of information in pinpointing
treatment goals, the selection of targets for
intervention, the design and implementa-
tion of interventions, and the evaluation of
intervention outcomes. By itself, conclud-
ing that a child has ADHD provides no use-
ful information about the contexts in which
the disorder is most problematic. Pinpoint-
ing situations in which ADHD-related be-
havior is exacerbated (e.g., transitions be-
tween classes or activities, group discus-
sions, standing in line for lunch, playing
softball, interacting with certain teachers)
helps identify the compatibility issues that
should be targeted for intervention and
thereby allow more educated and fme-
tuned selection of intervention options. Fur
thermore, assessment should be viewed as
an ongoing, fluid process, especially in
school settings where contexts can change
dramatically from class to class and year to
year.
4, Assessments must be conducted by
persons with the training and experience in
ADHD to execute them in an educated fash-
ion and take into consideration the complex
compatibility issues discussed above. Such
persons must have the skills to analyze, or-
ganize, integrate, and communicate the vast
array of information gathered in the assess-
ment process for the purposes of (a) arriv-
ing at a comprehensive understanding of a
child’s interactions with their environ-
ment(s); (b) requiring that additional infor-
mation be collected when such an under-
standing has not been achieved; (c) making
accurate judgments regarding the develop-
mental deviance of a child’s behavior; (d)
determining the most appropriate persons
and behaviors to be targeted for change and
the interventions most likely to produce
these desired changes; and (e) maintaining
contact over the long term with the various
adults who continue to interact with the
89
child, are charged with implementation of
interventions, and/or are targets of inter-
vention to monitor and maintain the ongo-
ing assessment process and facilitate refor-
mulation of “the problem” as necessary.
5. Interventions should be guided not
only by consideration of the needs of the
student with ADHD, but also by the degree
to which recommended strategies are ac-
ceptable to the teachers charged with im-
plementation. Selection of intervention
strategies should be viewed as a separate
assessment process; teachers should be as-
sessed along the various dimensions dis-
cussed above prior to design of an interven-
tion program and should be active partici-
pants in the design process. Assessment
should continue after intervention has been
initiated to determine responses of both
child and teacher. Finally, intervention
should include not only traditional child-tar-
geted strategies (medication, behavior man-
agement programs, accommodations, etc.)
but also teacher-targeted strategies (e.g., ed-
ucation and training).
Implications for Applied Research
The above discussion directly and indi-
rectly suggests a fairly extensive agenda for
future research. With regard to commonly
recommended classroom behavior manage-
ment strategies, our knowledge of the de-
gree to which behavioral programs are im-
plemented by teachers as instructed is still
quite limited. Also lacking is information re-
garding the amount of training required for
successful implementation, the points dur-
ing actual implementation at which teach-
ers begin to abandon the use of such strate-
gies, and the teacher characteristics (e.g.,
stress) associated with successful or unsuc-
cessful implementation and teachers’ will-
ingness to initiate and maintain the use of
various intervention approaches. Further,
much of the recent research in this area has
been conducted in experimental settings
(e.g., summer camps), and it is unclear
whether results from such settings general-
ize to typical school classrooms and teach-
ers,
The treatment acceptability research
has provided extremely useful information
regarding the limits of behavioral interven-
90 School PsychologyReview, 1995, Vol. 24, No. 1
tions in school classrooms and the teacher
characteristics that may impact upon ac-
ceptability. However, data gathered during
actual training and implementation of be-
havioral programs are needed, as much of
the information in this area has been ob-
tained via analogue methodology. More-
over, only recently have researchers begun
to examine the treatment acceptability is-
sue as it relates specifically to teachers of,
and interventions for, students with ADHD.
A wide range of teacher characteristics
were hypothesized to influence their inter-
actions with students with ADHD, including
expectations, attitudes, perceptions, attri-
butions, tolerance thresholds, level of
stress, and behavior management and
teaching practices. Although some mea-
sures of teacher characteristics have ac-
ceptable psychometric properties, addi-
tional valid and reliable instruments need to
be developed. The development of such
measurement technology must occur be-
fore the effects of these teacher character-
istics on student outcome can be fully eval-
uated.
Although teacher-setting and child-set-
ting compatibility issues were not discussed
in detail, exploration of various setting vari-
ables related to the former (e.g., job satis-
faction, teaching gratification, grade prefer-
ence, student population preference, and
general school environment) and the latter
(e.g., size of class, ratio of hyperactive to
nonhyperactive children, seating arrange-
ments, and open versus closed classes)
would likely yield important information.
Finally, teacher factors must be entered
into predictive equations of school-based
treatment outcomes. It would ultimately be
desirable to manipulate such factors to ex-
amine their causal influences. Future inves-
tigations along these lines might include ex-
amination of the differential effect of med-
ication and/or behavioral treatment on chil-
dren with ADHD depending on characteris-
tics of the teacher, and longitudinal evalua-
tion of the differential impact of various
teachers on a child’s outcome in the ele-
mentary or middle school years.
Summary
The focus of treatment outcome re-
search on ADHD has been primarily limited
to student responses to treatment. Although
our understanding of the effects of medica-
tion and behavior management strategies
on the classroom performance and behav-
ior of children with ADHD may be classified
as incomplete, our understanding of other
factors influencing outcome - especially
those associated with teachers - may best
be described as embryonic. Medication and
behavior management strategies are impor-
tant and beneficial interventions, but their
effectiveness may be further enhanced by a
goodness-of-fit/systems theory perspective
incorporating various contextual factors
that contribute to outcome.
Consideration of various teacher char-
acteristics would improve the assessment
and intervention processes related to stu-
dents with ADHD. Unfortunately, such re-
search efforts may meet resistance, due to
sensitivity on the part of teachers and
school systems regarding the examination
of these issues.
The glass ceiling of what can be learned
by merely examining student-treatment
compatibility may have been reached -
many important points beyond may not be
attainable unless we begin to examine the
contribution of teachers more closely. As
noted years ago by two leading ADHD re-
searchers (Whalen & Henker, 1980), as one
moves from the molecular level of research
(the individual child) to more macrolevels
of analysis (for example, consideration of
teachers and educational practices) the
phenomena under study require more quali-
tative methodologies and more speculative
inferential processes. Thus, ethnographc
methods may be useful in the early stages of
such research in identifying relevant vari-
ables and possible relationships among
them. Once researchers can develop rea-
sonable hypotheses about a more limited
set of variables, these hypotheses can be
tested using quantitative, multivariate meth-
ods of research design.
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Ross W. Greene, PhD, is Director of Behavioral Psychology and Clinical As-

sistant in Psychology at the Pediatric Psychopharmacology Unit at Massa-
chusetts General Hospital and Instructor in Psychology at Harvard Medical
School. His research interests include the influence of teacher characteris-
tics on student behavior, the development of instruments for measuring
teacher characteristics, the effectiveness and acceptability of behavioral
interventions for classroom teachers, and the development and effective-
ness of programs for training teachers in strategies for improving the be-
havior and social functioning of students with ADHD.