Few studies examine the classroom behavior of children with attention deficit hyperactivity disorder (ADHD) in comparison with classroom peers and which teaching formats best support classroom engagement. Observations (N = 312) of second- and fourth-grade students with ADHD and their randomly selected classroom peers were conducted using a systematic classroom observation method. Linear regressions analyzed classroom behavior compared with peers and effects of teaching format, grade, and treatment status on classroom behavior. Children with ADHD displayed lower engagement (p <0.001) and higher inattention (p <0.001) during teacher-led instruction compared with other teaching formats, and lower engagement in fourth grade than in second grade (p <0.05). Despite treatment plans, children with ADHD present with increased classroom behavior challenges. Adapting teaching formats to benefit children with ADHD should be considered.