Previous Award Number: R324A180175
Previous Awardee: State University of New York (SUNY), Buffalo

Co-Principal Investigator: Pelham, William

Purpose: The purpose of this project is to test the efficacy of using a Daily Report Card (DRC) intervention as an enhancement to the individualized education program (IEP) for students with attention-deficit hyperactivity disorder (ADHD). Children with ADHD are at risk for negative academic and social outcomes due to difficulties with attention, impulse control, and activity modulation. Because of these problems, effective interventions aimed at improving academic performance and social/behavioral outcomes are needed. Although many children with ADHD have an IEP that may include evidence-based practices for students with learning and behavioral disabilities, prior research suggests that there is a need to supplement the IEP in order to make it more usable for teachers and to ensure that students receive supports that are directly linked to target behaviors that impact the child’s learning, achievement, and social development. The DRC provides teachers with a daily link to a child’s IEP goals and objectives and a mechanism for providing feedback to the child and parent on progress. Using a DRC as an enhancement to the IEP has shown promise for improving students’ behavior, academic achievement, and IEP goal attainment. Thus, the current study aims to build on these promising findings to determine whether linking a DRC to a child’s IEP goals and objectives shows efficacy for improving the academic and social outcomes for students with ADHD.

Project Activities: Researchers will conduct a randomized controlled trial to test the impact of linking a DRC to the IEP on the academic and social outcomes for students with ADHD. Students will be randomly assigned to the intervention or business-as-usual control condition. Students in the intervention condition will receive approximately 16-20 weeks of intervention. Outcome data will be collected at pre- and post-test, and fidelity data will be collected monthly. Data will be analyzed to determine whether linking a DRC to the IEP results in improved outcomes for students with ADHD and to explore a variety of potential moderators (i.e., class placement, medication status, comorbid learning difficulties, comorbid aggressive behavior, and IEP quality) and mediators (i.e., classroom environment, teacher feedback for targeted behaviors, and parent-implemented contingency management) of intervention impacts.

Products: The products of this project will include evidence of the efficacy of using a DRC intervention as an enhancement to the IEP to improve the academic and social outcomes of students with ADHD, as well as peer-reviewed publications and presentations.

Structured Abstract

Setting: The research will take place in elementary schools in New York and Florida.

Sample: Participants will include approximately 216 children in kindergarten through Grade 6 who have a diagnosis of ADHD and an IEP for a specific learning disability, emotional disturbance, or other health impairment. Each child’s primary special or general education teacher and their parents will also participate.

Intervention: Students in the intervention group will be assigned a behavioral consultant (i.e., psychologist or special education teacher appointed to the position) who will work with their primary special or general education teacher to establish a DRC, which is an operationalized list of target behaviors (e.g., “completes reading assignments with 80% accuracy or better,” “has no office time outs during the day”) that are evaluated daily by the teacher. During the first visit, consultants will work with teachers to develop the DRC so that it directly accounts for IEP goals as well as other target behaviors specified by the teacher. Teachers will implement the DRC during the week between the first and second visit. During the second visit, target behaviors will be refined and criteria for each target behavior will be modified based on data collected by the teacher. During the third visit, the DRC will be further refined. After the three initial meetings with the child’s teacher, consultants will meet monthly with the teacher (and parent if available) to review data on child’s behavior, provide feedback and adjust DRC goals as needed. The DRC will be completed by the teacher daily, and feedback will be provided to the student throughout the day on progress made toward DRC goals. Each day teachers will send the DRC home with the student so that the parent receives feedback regarding the child’s behavior at school. Parents will attend three individual parent training meetings to introduce them to the DRC and support them in establishing home-based rewards contingent on the child's DRC performance.

Research Design and Methods: The research team will use a randomized controlled trial in which students serve as the unit of randomization. Students will be randomly assigned to the intervention condition, where a behavioral consultant will work with their teacher to construct, implement, and monitor a DRC, or to the business-as-usual control condition. Students will be block randomized across medication status and grade level, so that there are approximately equal numbers of students per block. Students in the intervention condition will receive approximately 16-20 weeks of treatment. Data will be collected at baseline and immediately following intervention. Data on fidelity of implementation will be collected monthly over the course of the study. Analyses will be conducted to determine whether linking a DRC to the IEP results in improved academic and social/behavioral outcomes for students with ADHD. Analyses will also explore whether intervention effects are moderated by class placement, medication status, comorbid learning difficulties, comorbid aggressive behavior, and IEP quality. The potential mediating roles of classroom environment (i.e., student-teacher interactions), teacher feedback for targeted behaviors, and parent-implemented contingency management will also be examined.

Control Condition: Students in the control condition will receive the supports and services specified in the IEP as usual. To account for consultant contact with the teacher, consultants will meet with the teachers in the control group once per month, collect information on student functioning and interventions, and work with the teacher to construct a list of goals and criteria for meeting goals consistent with the approach used in the DRC group. This list of goals will not be used to develop DRCs or other classroom interventions.

Key Measures: Primary measures of student behavioral outcomes will include the following: the Student-Behavior Teacher-Response observation system (SBTR) to assess classroom behavior; the Disruptive Behavior Disorders (DBD) Rating Scale to measure symptoms of ADHD, oppositional defiant disorder, and conduct disorder; the Behavioral and Emotional Screening System to assess student behavior across a range of areas (e.g., internalizing and externalizing problems); the Impairment Rating Scale to measure the severity of the child’s problems and need for treatment and/or special services in important functional domains (e.g., relationships with peers, academic progress); and teacher and observer ratings of IEP goal attainment. Measures of students’ academic functioning will include the Academic Performance Rating Scale and the Wechsler Individual Achievement Test – III (WIAT-III) and student-teacher relationships will be assessed through the Student-Teacher Relationship Scale. Social validity will be assessed through a measure of teacher and parent satisfaction. Moderating variables will include the following: class placement (i.e., predominantly educated in the general education classroom vs. predominantly in special education), medication status, comorbid learning difficulties (as measured by the WIAT-III), comorbid aggressive behavior (as measured by the DBD Rating Scale), and IEP quality (from composite ratings by study investigators on the alignment between needs listed in the IEP with goals/objectives stated in the IEP). Mediators will include the ratio of positive to negative statements issued by the teacher on the SBTR observational measure, observational ratings of the frequency of teacher feedback for targeted behaviors, and parent reports of the number days contingent rewards were accurately provided will be considered as a mediating variable. Lastly, fidelity of implementation will be measured using observations of the fidelity of teacher-implemented interventions, DRC implementation, and targeted behavior feedback; parent report of the fidelity of home rewards for school performance; and consultant and observer ratings of the fidelity of consultant activities.

Data Analytic Strategy: To evaluate the efficacy of the intervention for improving student outcomes, the research team will use analyses of covariance (ANCOVA). Additional analyses will be conducted within the ANCOVA models to investigate moderators and mediators of intervention effects. In addition, researchers will conduct a cost analysis to compare the costs of receiving the intervention versus receiving services as usual.

Related IES Projects: Enhancing Individual Education Plans for Children with Attention-Deficit/Hyperactivity Disorder Using a Daily Report Card (R324J060024)