Common classroom accommodations fail to improve outcomes for children with ADHD

Extra time on assignments, frequent breaks and quiet workspaces are among the most common ways schools support children with attention deficit hyperactivity disorder (ADHD). But a new Florida International University study finds these accommodations do not significantly improve students' classroom behavior or academic performance. 

The study, published in JAMA Pediatrics, evaluated four widely used accommodations: extended time, frequent breaks, standing at a desk and working in a low-distraction environment. None produced significant improvements, even when combined with behavioral interventions or stimulant medication. 

"We were surprised that none of the accommodations we tested had a significant effect, even when combined with behavioral interventions or medication," said Gregory Fabiano, professor of psychology at FIU and lead author of the study. 

Researchers at FIU's Center for Children and Families conducted a randomized clinical trial through the Summer Treatment Program, which provides structured classroom and recreational activities for children with ADHD. The study involved 255 children in kindergarten through sixth grade who began participating in the research between 2022 and 2025. Of those, 235 completed the study. 

Researchers evaluated classroom behavior, academic productivity and quiz scores under different treatment conditions. The findings showed: 

• Behavioral interventions reduced classroom rule violations by 37%, compared with a general classroom setting. 
• Stimulant medication reduced rule violations by 61% and increased the rate of correctly completed assignments by 22%, compared with a placebo. 
• None of the four accommodations improved classroom behavior or quiz scores significantly. Some were associated with reduced academic productivity. 

The findings raise questions about the use of common accommodations in Individualized Education Programs (IEPs) and Section 504 plans, which are tailored to each student's needs. 

"These approaches fail to build skills or address motivation," Fabiano said. 

Instead, researchers recommend greater emphasis on evidence-based behavioral strategies, including daily report cards, clear expectations, consistent feedback, praise and rewards for meeting individualized goals. 

"There may be times when accommodations may be helpful, but a 'one size fits all' approach to ADHD doesn't seem to be effective," he said. 

The study builds on decades of research by the late William E. Pelham Jr., founding director of FIU's Center for Children and Families, who helped design and conduct the study. A pioneer in ADHD treatment, Pelham also led landmark research showing that stimulant medication improved classroom productivity but did not significantly improve learning. 

Because the research was conducted in structured summer treatment classrooms rather than regular schools, additional studies are needed to determine whether the findings hold in everyday classrooms. 

"We need to rethink how we're supporting these students, with greater emphasis on effective treatments in everyday classrooms rather than relying so heavily on accommodations. Every child with ADHD deserves the opportunity to succeed and feel proud of what they've accomplished in the classroom, and it is our job to make sure we give them the best chance for that," Fabiano said.