Purpose: Attention Deficit Hyperactivity Disorder (ADHD) is a serious condition defined by inattention and/or impulsivity and hyperactivity, and associated with significant academic and social impairment. It is estimated that 3 to 7 percent of students in the elementary grades meet criteria for a diagnosis of ADHD, but there is a lack of effective, potent, and sustainable school-based interventions to mitigate ADHD and to support optimal learning and social outcomes. To address this need, the research team developed the Collaborative Life Skills Program (CLS) through funding from the Institute of Education Sciences. CLS is a collaborative school-home behavioral intervention for ADHD consisting of an integrated delivery of child social and life skills training, parent training, and teacher consultation. CLS has demonstrated feasibility of implementation in elementary schools as well as promise for preventing and ameliorating problem behaviors in children with or at risk for ADHD, but the efficacy of the intervention has not yet been tested. The purpose of this study is to conduct a randomized efficacy trial to evaluate the effects of CLS on behavioral and academic outcomes for students with symptoms of ADHD.

Project Activities: The research team will evaluate CLS, a 12-week program for students with or at risk for ADHD. The program consists of teacher consultation (including use of daily report cards), parent training, and child social and life skills training. Approximately 168 elementary school students (grades 2–5) exhibiting ADHD-related problems, and approximately 24 district mental health professionals (Learning Support Professionals, LSPs; one per school) will participate. Schools/LSPs will be randomly assigned to either the CLS program or typical school services. Multiple measures will be used to assess student behavioral and academic outcomes. Researchers will also examine factors that may moderate or mediate the impact of the intervention on student outcomes.

Products: The products of this project will include evidence of the efficacy of CLS with elementary school students with or at risk for ADHD, peer-reviewed publications, and presentations.

Structured Abstract

Setting: The research will take place in urban elementary schools in California.

Sample: Participants will include 168 elementary school students (grades 2–5) exhibiting ADHD-related problems, and approximately 24 district mental health professionals (Learning Support Professionals, LSPs; one per school). Students will be referred to the intervention by the LSPs. Entry into the study will be staggered with two cohorts entering during each of the first 3 study years, with one cohort beginning in the Fall and one in the Winter of each school year.

Intervention: The Collaborative Life Skills Program (CLS) is a 12-week program that consists of three empirically supported treatments: teacher consultation and use of daily report cards, parent training, and child social and life skills training. Delivery is coordinated so that parents, children, and teachers are trained in their aspects of the treatment at roughly the same time via group and individualized methods. Reinforcement contingencies are set within and across settings (e.g., parents reward behaviors that occur at home and school, LSPs reward behaviors that occur at home, school, and group, etc.). The net effect is to implement around-the-clock support of child behavior in an active partnership of parents, teachers, and LSPs.

Research Design and Methods: This study uses a cluster randomized controlled design. The research team will use a 2-level (students, schools) design and randomly assign schools to the treatment or comparison condition. The randomization procedures are as follows: schools/LSPs will first be randomized to either the Fall or Winter cohort, then schools within each cohort will be randomized to the treatment or comparison condition. Measures will be collected at baseline, immediate outcome, and follow-up in the following school year. Schools in the comparison condition will receive the intervention the following year after follow-up measures are completed.

Control Condition: The comparison condition will be business as usual (BAU). BAU services to children with ADHD in the participating district are not standardized. The research team will track all services used by students in the comparison condition to describe the nature of the interventions received.

Key Measures: Student outcomes across the following four domains will be measured: (a) Attention-Deficit/Hyperactivity Disorder (ADHD) symptom severity as indicated by parent and teacher ratings on the Child Symptom Inventory; (b) academic performance as indicated by parent and teacher ratings of student organization, homework completion, academic enablers, and classroom observations of student engagement; (c) social functioning as indicated by parent and teacher ratings of social skills and by playground observations; and (d) emotional and behavioral dysregulation as indicated by parent and teacher ratings of problematic, oppositional behavior and by playground observations. Parenting practices will be assessed using the Alabama Parenting Questionnaire, and stress within the parent-child system will be measured by the Parenting Stress Index. Report card grades, special education referrals and placements, and office discipline referrals (e.g., office visits, suspensions) will be gathered from school records. California standardized achievement tests will also be collected.

A series of process and fidelity measures will assess fidelity of implementation and parent, teacher, and student treatment acceptability and satisfaction.

Data Analytic Strategy: The impact of the intervention on student behavioral and academic functioning will be tested using multilevel models comparing mean outcome scores between treatment conditions at the end of the treatment period and at follow-up controlling for clustering effects, baseline level of the outcome, and potentially confounding covariates. To examine the exploratory questions, the team will estimate and test models of multiple mediation to determine if improvement in proximal outcomes (e.g., ADHD symptoms and academic performance) from baseline to post-treatment explains improvements in distal outcomes (e.g., academic achievement) at follow-up. In addition, models will be estimated that examine the relationship between measures of treatment fidelity/strategy implementation and changes in proximal outcomes within the treatment group.

Related IES Projects: Collaborative School-Home Behavioral Intervention for ADHD (R324A080041)

Products and Publications

Book chapter

Haack, L., Araujo, E., Capriotti, M., Beaulieu, A., McBurnett, K., and Pfiffner, L. (2015). Addressing Disparities Between Latinos and Non-Latinos Accessing a School-Home Collaborative Behavioral Treatment for ADHD. In M. Gerlach, P. Riederer, L. Rohde, and A. Warnke (Eds.), ADHD Attention Deficit and Hyperactivity Disorders, Official Journal of the World Federation of ADHD, Volume 7, Supplement 1, 5th World Congress on ADHD—From Child to Adult Disorder. Vienna, Austria: Springer-Verlag.

Pfiffner, L., Rooney, M., Haack, L., Kunin, N., Capriotti, M., Beaulieu, A., Plageman, M., Delucchi, K., and McBurnett, K. (2015). Efficacy of a Collaborative School-Home Intervention for Attention-Deficit/Hyperactivity Disorder. In M. Gerlach, P. Riederer, L. Rohde, and A. Warnke (Eds.), ADHD Attention Deficit and Hyperactivity Disorders, Official Journal of the World Federation of ADHD, Volume 7, Supplement 1, 5th World Congress on ADHD—from Child to Adult Disorder. Vienna, Austria: Springer-Verlag.

Book chapter, edition specified

Pfiffner, L.J., and DuPaul, G. (2014). Treatment of ADHD in School Settings. In R.A. Barkley (Ed.), ADHD in Children and Adults: A Handbook for Diagnosis, Assessment, and Treatment (4th ed., pp. 596–629). New York: Guilford Press.

Pfiffner, L.J., and Haack, L.M. (2015). Nonpharmacological Treatments for Childhood ADHD and Their Combination With Medication. In P.E. Nathan, and J.M. Gorman (Eds.), A Guide to Treatments That Work (4th ed., pp. 55–84). New York: Oxford University Press.

Pfiffner, L.J., and Kaiser, N.M. (2016). Behavioral Parent Training. In M.K. Dulcan (Ed.), Dulcan's Textbook of Child and Adolescent Psychiatry (2nd ed., pp. 901–936). Arlington, VA: American Psychiatric Assocation Publishing.

Journal article, monograph, or newsletter

Pfiffner, L. J., Rooney, M., Haack, L., Villodas, M., Delucchi, K., and McBurnett, K (2016). A Randomized Controlled Trial of a School-Implemented School–Home Intervention for Attention-Deficit/Hyperactivity Disorder Symptoms and Impairment. Journal of the American Academy of Child & Adolescent Psychiatry, 55(9): 762–770. doi:10.1016/j.jaac.2016.05.023

Pfiffner, L.J. (2014). Meta-Analysis Supports Efficacy of Behavioral Interventions for ADHD-Related Problems. Journal of the American Academy of Child and Adolescent Psychiatry, 53(8): 830–832. doi:10.1016/j.jaac.2014.03.006

Pfiffner, L.J., and Haack, L.M. (2014). Behavior Management for School-Age Children With ADHD. Child and Adolescent Psychiatric Clinics of North America, 23(4): 731–746. doi:10.1016/j.chc.2014.05.014

Pfiffner, L.J., Rooney, M., Haack, L., Villodas, M., Delucchi, K., and McBurnett, K. (2016). A Randomized Controlled Trial of a School-Implemented School–Home Intervention for Attention-Deficit/Hyperactivity Disorder Symptoms and Impairment. Journal of the American Academy of Child and Adolescent Psychiatry, 55(9): 762–770. doi:10.1016/j.jaac.2016.05.023

Nongovernment report, issue brief, or practice guide

Rooney, M., Kunin, N., and Pfiffner, L.J. (2015). Translating EBPs for Attention and Behavior Problems to School Settings: Practical Guidelines for Training School Clinicians. New York: Guilford Press. doi:10.1521/adhd.2015.23.7.1