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IES Grant

Title: A Narrative Comprehension Intervention for Elementary School Children At-Risk for Attention-Deficit Hyperactivity Disorder
Center: NCER Year: 2012
Principal Investigator: Lorch, Elizabeth Awardee: University of Kentucky
Program: Cognition and Student Learning      [Program Details]
Award Period: 3 years (3/1/2012-2/28/2015) Award Amount: $1,481,432
Type: Development and Innovation Award Number: R305A120171

Co-Principal Investigators: Richard Milich (University of Kentucky Research Foundation), Janice F. Almasi and Paul van den Broek (University of Leiden), Richard Charnigo and Angela Hayden Boyd (University of Kentucky Research Foundation)

Purpose: Children with attention-deficit hyperactivity disorder (ADHD) often have cognitive processing deficits which may partially contribute to their well-documented academic difficulties. Additionally, traditional treatments for ADHD have not been shown to have a sustained positive impact on children's academic outcomes. One specific deficit that has been shown to be common among children with ADHD relates to difficulties with narrative/story comprehension. There are four specific areas of impaired cognition that have been identified as possible contributors to narrative comprehension problems among children with ADHD: (1) understanding the causal relations between events in a story; (2) using the characters' goals to understand the story; (3) identifying and using important information to guide story recall; and (4) making inferences and monitoring their own comprehension. The current study will develop a supplemental afterschool intervention aimed at improving these areas of impaired cognition, and thereby increasing narrative comprehension for second and third grade students at-risk for ADHD.

Project Activities: This project will involve three phases. During the first phase, intervention modules will be created and iteratively tested for feasibility in a laboratory setting. Over the course of the year, four groups of children at-risk for ADHD will receive four versions of their assigned module, providing feedback and time for iterative development in between administrations. During the second phase, the modules will be tested alone and in combination in an afterschool setting with a new sample of children so that each small group of children receives instruction in two modules. Modifications to the modules will be made as necessary during this phase. In the third and final phase, the four finalized modules will be pilot tested in an afterschool program with a group of children who did not participate in the previous two phases in order to determine feasibility and effect sizes. Children's narrative comprehension will be assessed at the beginning and end of the first semester and at the end of the second semester.

Products: The product for this study will be a fully developed narrative comprehension supplemental intervention for second and third grade students at-risk for ADHD. The intervention will include four fully-developed instructional modules of four to six 75-minute sessions each. Peer reviewed publications will also be produced.

Structured Abstract

Setting: This study will be conducted in an urban/suburban school district in Kentucky.

Sample: Participants include approximately 208 second and third grade students at-risk for ADHD.

Intervention: This intervention is designed to teach a set of story comprehension strategies to children who are considered at-risk for ADHD. The intervention will include four modules aligned with the difficulties many children with ADHD have with comprehension: understanding causal events; using goal structure; identifying and using important information; and making inferences and monitoring comprehension. Each of the four modules will consist of four to six 75-minute instruction sessions to be delivered during an afterschool program to small groups of students. Lessons will be designed to provide scaffolded support that gradually transfers cognitive responsibility from the teacher to the student. Clips of television programs, audiotaped stories, wordless picture books, and short stories/picture books read aloud will serve as the narrative stories for the lessons. Additionally, to address potential behavior problems associated with ADHD, each lesson will include instruction and reminders of appropriate and inappropriate behaviors, target goals for behaviors, and positive and negative consequences of meeting or not meeting the goals.

Research Design and Methods: During the first phase of the study, the four modules will be iteratively developed and tested in a laboratory setting. Sixty-four second and third grade students at-risk for ADHD will be placed into groups of four and each group will receive the same module four times across the school year, with modifications in between administrations. Researchers will collect data on feasibility using student surveys, instructor ratings, informal interviews, teacher focus groups, and observer ratings. During the second phase of the study, the four modules will be tested in an afterschool setting alone and in combination. A new group of 64 students at-risk for ADHD will be placed into groups of four, and each group will receive instruction in two of the four modules. Modifications to the modules will be made as needed. During the final phase of the project, 80 students at-risk for ADHD will be recruited to be part of the pilot study. Half of these participants will be randomly assigned to the treatment group and will receive the intervention during the first half of the school year (fall semester). Children will be placed in groups of four and will be instructed in all four modules for four instructional sessions (16 total sessions) over eight weeks. Assessments of children's narrative comprehension will occur at the start of the fall semester (pre-intervention), at the end of the fall semester (post-intervention for the treatment group; pre-intervention for the waitlist control group), and at the end of the spring semester (follow-up for the treatment group; post-intervention for the waitlist control group).

Control Condition: For the pilot study, 40 of the participants will be randomly assigned to a waitlist control group. Students in the treatment group will receive the intervention the fall semester of the year, while the waitlist control group will receive the intervention in the spring semester of the year.

Key Measures: Students will be screened for participation in the study using a behavior checklist completed by a parent and teacher. Feasibility of the intervention and specific modules and sessions will be measured weekly throughout the first two phases, including collecting both quantitative and qualitative data from students, instructors, and session observers. Additionally, a student efficacy rating scale will be developed and piloted throughout the study. This rating scale will assess children's efficacy in the four features of narrative comprehension with which children with ADHD often struggle (i.e. causal relations, goal structures, using information to guide recall, and making inferences). Narrative comprehension will be assessed both pre- and post-test for the pilot study in year three using free and cued recall of a television program or audiotaped store, narrative of a wordless picture book, and the creation of a new story.

Data Analytic Strategy: Analysis of the qualitative data will include two cycles: microcylce and macrocycle analysis. Microcycle analysis will occur weekly during the first two phases of the project and will involve descriptive coding of the interviews and focus groups, and pattern coding to identify and describe patterns of divergence and convergence across data sources. Macrocycle analysis will occur at the end of each year. The researchers will use constant comparative analysis to derive categories within the multiple sources of feasibility data. Descriptive statistics will be used to identify patterns in students', teachers', and observers' responses. Analysis of quantitative data will use hierarchical linear modeling in which students will be nested within their small groups. The waitlist control design of the study will allow the researchers to examine the impact of instruction on narrative comprehension six months after the end of the intervention.

Products and Publications

Journal article, monograph, or newsletter

Derefinko, K. J., Hayden, A., Sibley, M. H., Duvall, J., Milich, R., and Lorch, E. P. (2014). A Story Mapping Intervention to Improve Narrative Comprehension Deficits in Adolescents with ADHD. School Mental Health, 6(4): 251–263.