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Running Head: School-based self-monitoring interventions to support the development of selfregulation in children with ADHD: A literature review

School-based self-monitoring interventions to support the

development of self-regulation in children with ADHD:
A literature review

Amy Donovan
University of Calgary
EDPS 693

School-based self-monitoring interventions to support the development of self- regulation in children with
ADHD: A literature review

Evidence suggests that a child's ability to self-regulate is a predictor of their academic

achievement throughout formal schooling and into adulthood (McClelland & Cameron, 2012;
Zumbrunn, Tadlock & Roberts, 2011). While some children enter formal schooling with ageappropriate self-regulatory skills, many do not. For these children, the typical classroom
environment presents a variety of challenges (DuPaul, Gormley & Laracy, 2014). Though many
populations of students struggle with self-regulation in the school setting, children with Attention
Deficit/Hyperactivity Disorder (ADHD) are particularly vulnerable (Harris, Reid & Graham,
2004; Harris et al., 2005; Schunk & Bursuck, 2012).
A neurodevelopmental disorder, ADHD is defined by impaired levels of inattention,
disorganization, and hyperactivity/impulsivity with core deficits in the areas of cognitive control
and executive functioning (American Psychiatric Association, 2013). Resulting challenges with
self-regulation create functional impairment characterized by difficulty with sustained attention,
listening, task completion, and organization; all of which are required for optimal success in the
school setting (American Psychiatric Association, 2013; DuPaul, Weyandt & Janusis; 2011). Cooccurring delays in language, motor and/or social development, low frustration tolerance and
specific learning disorders are also common and can contribute to a poor academic prognosis
(American Psychiatric Association, 2013). Research related to the academic experience of
children with ADHD highlights many challenges with numerous studies showing that children
with ADHD are likely to have poor grades, a greater chance of referral to special education, have
a higher absentee rate, are three times more likely to be retained in elementary school and are at
a higher risk for dropping out (DuPaul, Weyandt & Janusis; 2011).
Considering this prognosis, research-based, early intervention is necessary to create
positive school experiences as well as improved outcomes for children with ADHD (DuPaul,

School-based self-monitoring interventions to support the development of self- regulation in children with
ADHD: A literature review

Gormley & Laracy, 2014; DuPaul, Weyandt & Janusis, 2011; Harris et al., 2005) Commonly
implemented, evidence-based interventions for this population include both behavioral, cognitive
and academic strategies which aim to address the symptomatic behaviors of ADHD, (inattention,
hyperactivity and impulsivity), reduce off-task and/or disruptive behavior, increase social
interactions and improve task accuracy and completion (DuPaul, Gormley & Laracy, 2014).
However, despite the proven benefits of these interventions, they do not address self-regulatory
needs (DuPaul, Gormley & Laracy, 2014; Guderjhan et al., 2013). As such, school-based
interventions, aimed at improving a childs ability to self regulate, are necessary to supplement
both behavior and academic interventions as part of a robust program of intervention (DuPaul,
Gormley & Laracy, 2014; Harris et al., 2005). School-based self-regulation interventions seek to
improve ones self-control in environments, such as the classroom, where listening, following
directions, completing assigned tasks, turn taking , and thinking before acting are just a few of
the daily requirements that present difficulties for children with ADHD (DuPaul, Gormley &
Laracy, 2014).
This literature review will examine the current research related to self-regulation and
explore the impact of self-monitoring interventions to support the development of self-regulation
in children with ADHD. It will explore the areas where self-regulation intervention can have the
most significant impact as well as the challenges associated with drawing firm conclusions from
the available research.
Self-regulation, or the ability to control ones thoughts, feelings and behaviors, is an
essential component of the learning process (Harris, Reid & Graham, 2004; McClelland &
Cameron, 2011). In the most basic sense, it is composed of the skills that enable individuals to
manage their behaviors and emotions; which includes the ability to set and accomplish goals,

School-based self-monitoring interventions to support the development of self- regulation in children with
ADHD: A literature review

initiate and cease behaviour and generally adapt to the cognitive and social demands required in
specific situations ( Berger et al., 2007; Zumbrunn, Tadlock & Roberts, 2011). Self-regulation
skills begin to develop in infancy and continue into young adulthood, gradually transitioning
from external control in young children to internal control in young adults (Berger et al., 2007;
McClelland et al., 2015; Ylvisaker & Feeney, 2008). Variability exists between individuals in
both the development and display of self-regulatory skills across tasks and settings (Berger et al.,
2007; Ylvisaker & Feeney, 2008). Factors contributing to this variability in development include
neurological maturation, stability of the home environment, attachment, parenting style, and
language development (Berger et al., 2007; Ylvisaker & Feeney, 2008).
As Schunk & Bursuck suggest, effective self-regulation requires knowing what to do and
how to do it, as well as regulating ones motivation and emotional involvement in the task
(Schunk & Bursuck, 2012). In the school setting, children who have developed the ability to selfregulate have an advantage over those who have not. Generally, they have been found to be more
engaged in their learning , are willing to seek out needed advice and information, are able to
control their actions, develop positive relationships with peers and experience overall academic
success (McClelland & Cameron, 2011; Zumbrunn, Tadlock & Roberts, 2011). Thoroughly
researched as effective for students with ADHD, intervention to support self-regulation has taken
many forms, from classroom games and activities that include physical activity, computer-based
instruction, mindfulness training, visualization and specific teacher-directed programs to the
more traditional, behavior based strategies which include self-monitoring, self-reinforcement,
self-evaluation and goal setting (Harris, Reid & Graham, 2004; McClelland et al., 2015).
Self-monitoring, an important component of self-regulated learning, is described by Schunk
& Bursuck as deliberate attention to some aspect of ones behavior (Schunk & Bursuck, 2012).

School-based self-monitoring interventions to support the development of self- regulation in children with
ADHD: A literature review

It requires observing and recording particular aspects of ones behavior with the goal of
increasing ones awareness of that behavior (Guderjahn et al., 2013; Harris et al., 2005; Reid et
al., 2012; Rock, 2005; Schunk & Bursuck, 2012). Self-monitoring strategies, for this purpose,
have been well-researched and have been shown to improve student engagement and
productivity, decrease disruptive behavior and improve academic skills across age groups,
particularly those with milder levels of ADHD (DuPaul, Weyandt & Janusis, 2011; Harris et al.,
2005; Harris, Reid & Graham, 2004; Mathes & Bender, 1997; Rock, 2005). In fact, the act of
consistently monitoring ones own behavior in itself has been shown to result in behavioral
improvements (DuPaul, Weyandt & Janusis, 2011; Reid et al., 2012; Schunk & Bursuck, 2012).
Self-monitoring places the responsibility for assessment on the student; it is immediate
response that serves to bridge the relationship between preceding behavior and longer term
consequences (Schunk & Bursuck, 2012). Monitoring progress toward a goal requires students
to take ownership of their learning and allows students to see growth which in turn can improve
self-efficacy and motivation for continued learning (Schunk & Bursuck, 2012; Zumbrunn,
Tadlock & Roberts, 2011).
The first step in teaching students to self-monitor involves selecting a target behavior; for
example, attention to the assigned task or the number of questions completed within fifteen
minutes. Target behaviors can be related to attention or performance; both of which have been
shown to increase on-task behavior; though improved academic performance has been linked in
particular to the self-monitoring of attention (Guderjahn et al., 2013). A method of recording is
then selected, which can be as simple as a record form where the student can jot or tally the
occurrence of the target behavior. A time frame or recording schedule is also determined which
establishes the frequency with which the behavior is to be recorded; for example, every math

School-based self-monitoring interventions to support the development of self- regulation in children with
ADHD: A literature review

period or the first ten minutes of each class...etc. Data will simultaneously be collected by the
teacher in order to determine the accuracy of the students self-monitoring and to provide the
student with feedback related to accuracy (DuPaul, Gormley & Laracy, 2014). Reinforcement is
not always utilized in conjunction with self-monitoring; however it has been shown to be
beneficial for children with ADHD (DuPaul, Gormley & Laracy, 2014; Harris et al., 2011).
Reinforcement can be provided by the teacher once the student has reached the target level of
performance or the student may be taught to self-reinforce.
Self-reinforcement is the process whereby (students) provide themselves with
reinforcement contingent on the performance of a response (Schunk & Bursuck, 2012). It
requires the student to set a goal or standard, select a reinforcer, self-evaluate and self-reward
once the predetermined criteria or target level of performance has been met (DuPaul, Gormley, &
Laracy, 2014; Reid et al., 2012). Self-reinforcement is akin to the natural developmental
process where a child learns that meeting expectations usually results in positive reinforcement,
while failing to meet expectations results in no response or negative consequences (Harris et al.,
2011). This differs from self-monitoring plus reinforcement as the student is now responsible for
providing the reinforcement for him or herself, rather than the teacher. Self-reinforcement is best
suited for those children, who are motivated, have been taught to monitor their own behavior and
have demonstrated the ability to self-monitor accurately (DuPaul, Gormley & Laracy, 2014).
Students are most successful with self-reinforcement in environments that provide consistency
through predictable routines (Reid et al., 2012).
Studies examining the impact of self-monitoring date back to the 1980s and have typically
been studied in relation to on-task behavior (Reid, 1996). In a review of the research between
1974 and 1996, twenty-two experiments examined the impact of self-monitoring on on-task

School-based self-monitoring interventions to support the development of self- regulation in children with
ADHD: A literature review

behavior with students with learning disabilities; only one showing no relationship between the
two (Reid, 1996). Overwhelmingly, these experiments demonstrated that self-monitoring
improves on-task behaviour across age levels and instructional settings, with improvements
maintained over several months (Reid, 1996). It is important to note however, that these studies
are relevant for learning disabled students and while students with ADHD may have been
included within the LD population, one must interpret the results with caution as they may not be
directly applicable to students with ADHD. Fortunately, the more recent explosion of research in
the area of ADHD has lead to increased interest in the study of this specific population related to
self-regulation and otherwise.
A meta-analysis by Reid, Trout & Schartz reviewed 16 studies which examined the effect of
self-regulation interventions on elementary children with ADHD. Specifically, they looked at
self-monitoring, self-monitoring plus reinforcement, self-rating and self-evaluation in relation to
the outcome variables of on-task-behavior; socially appropriate behavior, and academic accuracy
and productivity. Effect sizes for most interventions were greater than .8 with a combined effect
size for all four treatments greater than 1.0. Moreover, Reid, Trout & Schartz noted significant
effects in cases where children were treated with medication in conjunction with self-regulatory
interventions (Reid, Trout & Schartz, 2005).
Shimabukuro et al. used a single group, multiple baseline design across the academic areas of
reading comprehension, math and written expression. Participants included three male students
with co-morbid LD/ADHD, who were taught to self-monitor and graph their academic
performance in the three academic areas. Improvement in academic productivity, accuracy and
on-task behavior was noted across the three subject areas leading researchers to conclude that
self-monitoring is an effective intervention for helping students with LD/ADHD improve their

School-based self-monitoring interventions to support the development of self- regulation in children with
ADHD: A literature review

academic performance and attention to tasks (Shimabukuro, 1999). Similarly, research by Harris
et al., studied the effects of self-monitoring of attention and performance on the spelling study
behavior of 6 students with ADHD; each taking psychostimuants (Harris et al., 2005).
Reinforcements were not provided. Results indicate that both self-monitoring of attention and
self-monitoring of behavior had a positive impact on students on-task behavior as well as
spelling study behavior (Harris et al., 2005).
Though self-motivation with and without reinforcement appears to be a promising
intervention based on the above studies, contradictory evidence has also been noted in research.
Hodgson, Hutchinson & Denson, in their investigation of effective interventions for children
with ADHD (ages5-10), specifically examined self-monitoring using a behavior-based checklist.
Findings indicate that there was no statistically significant improvement in DSM-IV symptoms
of ADHD, neuropsychological test performance or behaviour (Hodgson, Hutchinson & Denson,
2012). Likewise, Guderjahn, Stadler & Gawrilow studied the use of goal setting, the creation of
an if-then plan followed by a self-monitoring technique with 57 children diagnosed with
ADHD between the ages of 10 and 18. Teacher ratings of self-regulation skills were used to
collect baseline data and to determine progress following the intervention. While goal-setting
alone did not improve self-regulation skills, goal-setting followed by the creation and
implementation of an if-then plan did improve self-regulation. A diary was kept by student
participants as a self-monitoring tool however no significant benefit was found, therefore leading
the authors to conclude that children with ADHD do not benefit from self-monitoring
(Guderjahn, Stadler & Garilow, 2013).
A 1991 study by Abikoff called the research into self-monitoring and self-reinforcement
for children with ADHD "disappointing", stating that the expectation that the development of

School-based self-monitoring interventions to support the development of self- regulation in children with
ADHD: A literature review

internalized self-regulation skills would facilitate generalization and maintenance has not been
realized (Abikoff, 1991). While Abikoffs research is over twenty years old, many recent studies
continue to lack evidence in relation to both generalization and maintenance. Studies that did
examine this aspect report maintenance of only a few months with generalization equally
problematic (Reid, 2005). Schunk & Bursuck discuss the notion of generalization in their
research and suggest that students must be provided with opportunities to adapt and practice selfregulation strategies to changing environments and task conditions if the intervention is to be
successful; few studies appear to consider this within their research design (Schunk & Bursuck,
Despite the interest in ADHD in recent years, research is limited in relation to the use of
self-regulation techniques with children diagnosed with ADHD and what is available is not
without weaknesses, particularly in the area of research design and interpretation (Guderjahn et
al., 2013; Harris et al., 2005; McClelland & Cameron, 2011). Early studies in the area lack
specificity in the definition of target behaviors necessary for reliable measurement, and
inadequate outcome measures and clinically-based research often resulted in findings that were
not generalizable or valid in the classroom setting; many of these issues continue to plague more
recent research (Harris et al., 2005). Furthermore, small sample sizes/single-subject research
designs limit the conclusions that can be drawn from such studies (Guderjahn et al., 2013). Also
problematic is the lack of clarity among professionals related to the definition of self-regulation,
due in large part to the diversity in theoretical perspectives surrounding self-regulation
(McClelland et al., 2015). In research, this translates into variations in how constructs are
operationalized, thus contradictory conclusions in the literature may be the result of the
measurement of distinct concepts. Finally, research in this area relies heavily on teacher ratings

School-based self-monitoring interventions to support the development of self- regulation in children with
ADHD: A literature review

which can be subject to bias (McClelland & Cameron, 2011). Additionally, McClelland et al.
document numerous studies demonstrating that error variance commonly occurs when using
observer-reported measures (McClelland et al., 2015). They detail one particular study where
one-fifth of the variance in teacher ratings of student self-regulation was the result of "non-child"
characteristics such as the teacher's ethnicity, their self-reported teaching efficacy and school
location (McClelland et al., 2015). Ecologically valid measures as well as multiple measures are
necessary in the future to assess and identify children with challenges in the area of selfregulation (Harris, Reid & Graham, 2004; McClelland et al., 2015).
There is no doubt that the research regarding evidence-based interventions to support
self-regulation in children with ADHD, particularly self-monitoring, contains contradictory
evidence. Whether due to weaknesses in research design, interpretation or otherwise, the
available research does not provide clear evidence to guide practitioners in selecting the most
effective intervention for students. However, there are elements within the literature that are
worthy of consideration. Specifically, self-regulation studies and interventions are most effective
when they occur in the classroom context as opposed to clinical settings, and used in conjunction
with a multi-component intervention plan (Harris et al., 2011; Mathes & Bender, 1997; Schunk
& Bursuck, 2012). Additionally, many students benefit from being taught self-regulation skills
when embedded within authentic academic tasks rather than in isolation, and are given the
opportunity to practice these skills frequently and in a variety of settings (Harris et al., 2011;
Schunk & Bursuck, 2012). Thus, it appears that despite discrepant results, there is value in the
research to indicate that self-monitoring, as an intervention for children with ADHD, is worthy of
consideration when developing a plan for student success.

School-based self-monitoring interventions to support the development of self- regulation in children with
ADHD: A literature review

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