Co-Principal Investigator: Evans, Steven

Purpose: The purpose of this project is to develop and pilot test a computer-assisted behavior intervention, Athemos, for middle school students with attention-deficit hyperactivity disorder (ADHD). Many adolescents with ADHD experience high rates of disciplinary actions, academic failure, and grade retentions. Although research has identified evidence-based behavior management strategies, there are barriers to implementing these strategies in secondary schools, including low student motivation and knowledge, lack of teacher acceptability and feasibility, and poor implementation fidelity. Computer-based interventions for ADHD have the potential to address these challenges, but existing interventions are limited as they have failed to support and demonstrate the transfer of improvements made in the game to real-world settings. The current project will address these limitations by developing an intervention that is less burdensome to teachers and more motivating for students. Specifically, they will develop and test the Athemos intervention, which will include an educational game to teach coping skills to students with ADHD, and a teacher component that includes a teacher manual and consultation in how to support students in transferring coping skills to authentic education settings.

Project Activities: Athemos will be iteratively developed and tested across three years. In Year 1, the researchers will work with game designers to develop and refine an initial version of the intervention. In Year 2, they will conduct focus groups with middle school students with ADHD to get their feedback on the game, develop a teacher manual to support implementation, and conduct field tests with teachers and students to gather data on the feasibility. Athemos will be revised based on findings from the focus groups and feasibility studies. In Year 3, the research team will conduct a pilot randomized controlled trial to determine the promise of Athemos for improving the coping skills of students with ADHD.

Products: Products will include a fully developed computer-assisted behavior intervention, Athemos, for improving the coping skills of middle school students with ADHD, peer-reviewed publications, and presentations.

Structured Abstract

Setting: The research will take place in middle schools in urban, suburban, and rural areas of Ohio and North Carolina.

Sample: Approximately 75 middle school students (ages 11 to 14) with ADHD will participate in focus groups to evaluate the game, and up to 6 middle school students with ADHD and their teachers will participate in the field tests. Approximately 36 middle school students with ADHD and their teachers will participate in the pilot study.

Intervention: Athemos is a computer-assisted behavior and education intervention designed to motivate students to learn and rehearse coping skills through scaffolded activities. The coping skills taught in Athemos will be derived from the Challenging Horizons Program, an established, evidence-based psychosocial treatment program. Targeted coping skills include organization, note-taking, assignment tracking, and study strategies. The game is supplemented with a teacher consultation component that is designed to support the transfer of coping skills to authentic education settings. Consultants (i.e., doctoral students in pediatric school psychology) will work with teachers on supporting students in making connections between the game and classroom expectations. Specifically, teachers will monitor student game performance and then coach students to apply skills learned in the game to the classroom.

Research Design and Methods: In Year 1, the researchers will work with game designers to build a prototype of Athemos. In Year 2, they will conduct focus groups with middle school students with ADHD to get their reactions to the game and revise the game based on feedback. The research team will also develop a manual, with guidance from teachers, to support teachers in implementation, including supporting students to transfer skills to real-world situations. They will conclude Year 2 by conducting a feasibility study in two middle schools with approximately 6 students and their teachers during which time students will complete the game and teachers will receive consultation in and implement strategies to support the active transfer of skills to authentic education settings. The intervention will be further revised based on data from the feasibility study. In Year 3, the researchers will conduct a pilot study using a randomized controlled trial, in which students will be randomly assigned to the intervention or control condition, stratified by medication status (on or off psychoactive medication). Outcome data will be collected at pre- and post-test, and fidelity data will be collected on an ongoing basis through consultant report and system data (game analytics).

Control Condition: Students assigned to the control condition will not have access to the Athemos game; however, their teachers will receive consultation on how to support students with ADHD in using coping skills.

Key Measures: Student satisfaction with the intervention will be measured with the Game User Experience Satisfaction Scale and teacher acceptance of the intervention and consultation will be assessed with a researcher-developed survey. Fidelity will primarily be assessed by game analytics but supplemented with notes from consultant logs. Student outcomes will be measured by game analytics (motivation and learning), school academic and behavioral records (e.g., school grades, disciplinary actions), the Behavior Assessment Scale for Children, 3rd Edition, and the Working Alliance Inventory-Short, Revised (student-teacher relationship).

Data Analytic Strategy: Focus group data will be transcribed and analyzed qualitatively and descriptive analyses will be used to analyze data from the feasibility studies. Data from the pilot study will be analyzed using regression analyses to determine the promise of Athemos for improving the student outcomes.