|Title:||Efficacy of an Organizational Skills Intervention for Middle School Students with ADHD|
|Principal Investigator:||Langberg, Joshua||Awardee:||Virginia Commonwealth University|
|Program:||Social and Behavioral Context for Academic Learning [Program Details]|
|Award Period:||4 years (8/1/2013-7/31/2017)||Award Amount:||$2,414,164|
|Type:||Efficacy and Replication||Award Number:||R305A130011|
Purpose: The purpose of this efficacy study was to test whether the Homework, Organization, and Planning Skills (HOPS) intervention, refined for use in school settings with funding from an IES Development and Innovation award, can help middle school students with Attention Deficit/Hyperactivity Disorder (ADHD) deal with the organization, time management, and planning (OTMP) challenges of school.
Project Activities: The research team randomly assigned 6th, 7th, and 8th graders with ADHD to receive HOPS or an alternative homework support intervention called Completing Homework by Improving Efficiency and Focus (CHIEF) from school-based mental health providers, or to a wait-list. They assessed fidelity-to-intervention procedures for both HOPS and CHIEF and collected students’ course grades and tracked their homework completion. Parents and teachers reported on students’ OTMP skills as well as homework completion immediately before and after the intervention period (16 HOPS or CHIEF sessions over 11 weeks) and again 6 months later.
Study Registration: This study is registered in the Registry of Efficacy and Effectiveness Studies as entry 466.1v1.
Key Outcomes: The main findings of this efficacy study are:
Setting: The researchers recruited students from seven middle schools in one large and diverse urban and suburban school district in Virginia.
Sample: The researchers identified 280 students in 6th through 8th grade who met full study criteria (ADHD symptoms and participating in general education classrooms).
Intervention: The HOPS intervention was designed to directly target the organizational, time management, and planning (OTMP) difficulties of middle school age children with ADHD. HOPS provides direct instruction in how to implement and self-monitor structured systems of backpack, locker, and binder organization using checklists and to effectively plan and manage time for the completion of homework, tests, and projects. The intervention uses behavioral principles such as modeling, rehearsal, prompting, shaping, and contingency management (a point system) to teach these skills. More basic skills (such as recording the date of a test in a planner) are taught first and shaping is used to train students in more complex behaviors (such as recording time to study for the upcoming test in the planner). School counselors work individually with students in 16 20-minute sessions. In addition, students meet with his or her parent and the school counselor in two 1-hour sessions to help the parent establish a point reward system at home to reinforce the taught strategies. In this study, students were pulled from elective periods to receive the intervention from school counselors. HOPS encourages skills generalization by gradually teaching students to first use simplified versions of the organization, homework, and time management checklists and then ultimately to schedule times for self-evaluation in their planners.
Research Design and Methods: The researchers enrolled students with ADHD in six consecutive cohorts. Within cohort, they randomly assigned students to one of two intervention conditions, the HOPS intervention or homework help, or to a waitlist control using a 2:2:1 ratio. The researchers assessed students’ implementation of the skills being taught and collected school grades, and parents and teachers rated students’ OTMP skills, homework problems, and academic impairment before and after the 11-week intervention period and at 6-month follow-up. The researchers monitored treatment fidelity and integrity.
Control Condition: The alternative homework support intervention (CHIEF) was designed to approximate homework interventions schools frequently provide for students with academic difficulties, while maintaining some features shared with the HOPS intervention. For example, children in the homework support condition met individually with a school counselor in sessions of the same duration and frequency as the HOPS condition (16 20-minute sessions). This condition also included meetings with parents and a point reward system.
Key Measures: The researchers determined ADHD status using a variety of measures, including the Vanderbilt ADHD Rating Scales and the Behavior Assessment Scale for Children, Second Edition (BASC-2). Research staff measured skills implementation using the Objective Academic Skills Measures, the Organization Checklist, and the Time Management Checklist, all of which were developed by the researchers in the prior IES Development grant. They assessed children's organizational skills using the Children's Organizational Scale (parent and teacher report). Parents completed the Homework Problem Checklist and the researchers tracked the number of assignments participants failed to turn in per grading period. The researchers assessed academic performance using core class grades (Math, Science, Language Arts, and History) and teachers completed the Classroom Performance Survey.
Data Analytic Strategy: The researchers analyzed the data using an intent-to-treat approach with mixed-effects models to account for repeated-measures. They investigated impact of baseline ADHD symptom severity, severity of organizational skills and homework problems, and comorbid symptoms of anxiety as potential moderators of outcomes. They investigated participants' use of organization and time management skills, including homework behavior, as potential mediating variables using structural equation modeling to evaluate the key mechanisms of change through which improvement is made. They used moderator and mediator analyses to answer important questions about the types of students most likely to benefit from organizational skills intervention and the key mechanisms of change that lead to improved academic performance.
Related IES Projects: Organizational Skills Interventions for Children with ADHD (R305A100996); Evaluation of Homework, Organization, and Planning Skills Program: A Conceptual Replication (R305A190222)
What Works Clearinghouse (WWC) Reviewed Publication
Langberg, J.M., Dvorsky, M.R., Molitor, S.J., Bourchtein, E., Eddy, L.E., Smith, Z.R., ... and Eadeh, H.M. (2018). Overcoming the Research-To-Practice Gap: A Randomized Trial with Two Brief Homework and Organization Interventions for Students with ADHD as Implemented by School Mental Health Providers. Journal of Consulting and Clinical Psychology, 86(1), 39-55. WWC Review.
Journal article, monograph, or newsletter
Breaux, R.P., Langberg, J.M., Bourchtein, E., Eadeh, H.M., Molitor, S.J., & Smith. Z.R. (2018). Brief Homework Interventions for Adolescents with ADHD: Trajectories and Predictors of Response. School Psychology Quarterly, 34(2), 201-211. DOI.10.1037/spq0000287.
Breaux, R.P., Langberg, J.M., Molitor, S.J., Dvorsky, M.R., Bourchtein, E., Smith, Z.R., & Green, C.D. (2018). Predictors and Trajectories of Response to the Homework, Organization, and Planning Skills (HOPS) Intervention for Adolescents with ADHD. Behavior Therapy, 50(1), 140-154. DOI: 10.1016/j.beth.2018.04.001.
Breaux, R.P., Langberg, J.M., McLeod, B.D., Molitor, S.J., Smith, Z., Bourchtein, E., and Green, C. (2018). The Importance of Therapeutic Processes in School-based Psychosocial Treatments of Homework Problems in Adolescents with ADHD. Journal of Consulting and Clinical Psychology, 86(5), 427-438. DOI: 10.1037/ccp0000300.
Langberg, J.M., Molitor, S.J., Oddo, L.E., Eadeh, H.M., Dvorsky, M.R., and Becker, S.P. (2017). Prevalence, Patterns, and Predictors of Sleep Problems and Daytime Sleepiness in Young Adolescents With ADHD. Journal of Attention Disorders, 1087054717690810.
Langberg, J.M., Smith, Z.R., Dvorsky, M.R., Molitor, S.J., Bourchtein, E., Eddy, L.D., Eadeh, H., and Oddo, L.E. (2018). Factor Structure and Predictive Validity of a Homework Motivation Measure for Use with Middle School Students with Attention-Deficit/Hyperactivity Disorder (ADHD). School Psychology Quarterly, 33(3), 390-398.
Molitor, S.J., Eadeh, H.M., Bourchtein, E., Smith, Z.R., and Langberg, J.M. (2018). Is the Rey Osterrieth Complex Figure Task a Useful Measure of Organizational Skills for Adolescents with ADHD? Journal of Pediatric Neuropsychology. DOI: 10.1007/s40817-018-055-6.
Molitor, S.J., Langberg, J.M., Evans, S.W., Dvorsky, M.R., Bourchtein, E., Eddy, L.D., ... and Oddo, L.E. (2017). Evaluating the Factor Validity of the Children's Organizational Skills Scale in Youth with ADHD. School Mental Health, 9(2), 143–156. DOI: 10.1007/s12310-016-9205-0
Molitor, S.J., Oddo, L.E., Eadeh, H.M., and Langberg, J.M. (2018). Executive Function Deficits in Adolescents With ADHD: Untangling Possible Sources of Heterogeneity. Journal of Emotional and Behavioral Disorders, DOI: 10.1177/1063426618763125.
Smith, Z.R., Becker, S.P., Garner, A.A., Rudolph, C.W., Molitor, S.J., Oddo, L.E., and Langberg, J.M. (2016). Evaluating the Structure of Sluggish Cognitive Tempo Using Confirmatory Factor Analytic and Bifactor Modeling With Parent and Youth Ratings. Assessment, 1073191116653471.
Smith, Z.R., Breaux, R.P., Green, C.D., and Langberg, J.M. (2018). Evaluation of the Interplay Between Homework Motivation and Sluggish Cognitive Tempo in Youth With ADHD: Associations With Homework Performance. Journal of Attention Disorders, DOI: 10.1177/1087054718763722.
Smith, Z. R., Eadeh, H.-M., Breaux, R. P., & Langberg, J. M. (2019). Sleepy, Sluggish, Worried, or Down? The Distinction Between Self-Reported Sluggish Cognitive Tempo, Daytime Sleepiness, and Internalizing Symptoms in Youth with Attention-Deficit/Hyperactivity Disorder. Psychological Assessment, 31(3), 365-375. dx.doi.org/10.1037/pas0000671
Smith, Z.R., and Langberg, J. M. (2017). Predicting Academic Impairment and Internalizing Psychopathology Using a Multidimensional Framework of Sluggish Cognitive Tempo With Parent and Adolescent Reports. European Child & Adolescent Psychiatry, 1–10. DOI. 10.1007/s00787-017-1003-1.