Efficacy of an Organizational Skills Intervention for Middle School Students with ADHD
Purpose: Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most commonly diagnosed childhood disorders. Several of the primary symptoms of ADHD relate to problems with time management and materials organization, which can be seen in school settings as forgetting to complete or losing homework assignments, difficulty planning for the completion of long-term projects and tests, and problems keeping binders and backpacks organized. These difficulties become particularly problematic in middle school as academic demands and expectations for students' self-management increase, putting these students at risk for negative educational outcomes such as poor class grades, retention in grade, and school dropout. In this study, researchers will evaluate the efficacy of the Homework, Organization, and Planning Skills (HOPS) intervention, refined for use in school settings with funding from a previous IES Development award (Organizational Skills Interventions for Children with ADHD), to help middle school students with ADHD deal with the organizational and time management challenges of school.
Project Activities: Middle school age students (grades six through eight) with ADHD will be randomly assigned to receive the HOPS intervention or to a homework support condition. Fidelity-to-intervention procedures will be assessed in both conditions and outcome measures will be collected pre- and post-intervention and at 8-week and 6-month follow-ups. Moderator analyses will evaluate student characteristics that could predict whether a student is most likely to respond to organizational skills intervention versus a traditional homework tutoring approach. Mediation analyses will focus on evaluating key mechanisms of change within the interventions (e.g., use of materials organization skills and completion of homework assignments).
Products: The products of this project will be information about the efficacy of the HOPS intervention for middle school students with ADHD, the mechanisms by which the intervention improves outcomes, and for whom the intervention is most likely to be beneficial. These results will have clinical utility for schools in deciding how best to intervene with students with ADHD and homework problems. Peer reviewed publications will also be produced.
Setting: Students will be recruited from six middle schools in two large school districts near a large urban center in Virginia.
Sample: Participants in this project will be 260 youth (30 percent female to mirror the gender ratio of ADHD in the general population) who meet DSM-IV diagnostic criteria for ADHD and are attending public middle or junior high schools in general education classrooms. Children will range in age from 11-15 and be in grades six through eight.
Intervention: The HOPS intervention was designed to directly target the organizational and time management difficulties of middle school age children with ADHD. HOPS teaches students with ADHD 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 using a point system to teach these skills. More basic skills (e.g., recording the date of a test in a planner) are taught first and shaping is used to gradually train students in more complex behaviors (e.g., recording time to study for the upcoming test in the planner). The intervention is delivered in 16 20-minute sessions in which each student works individually with a school counselor. In addition, there are two 1-hour sessions where the student meets with his or her parent and the school counselor to help the parent establish a reward system at home to reinforce the taught strategies. Skills generalization is encouraged 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 efficacy of HOPS will be evaluated using a randomized controlled design. Two cohorts of 22 students at each of two schools (44 per cohort) will be stratified by ADHD medication status and randomly assigned within school to each of the two experimental conditions, the HOPS intervention or to an active control group (homework support). Skills implementation, parent and teacher ratings of organization, homework problems and academic impairment, and school grades will be examined pre- and post-intervention as well as at 8-week and 6-month follow-ups. Treatment fidelity and integrity will be closely monitored. Moderator and mediator analyses will be used 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.
Control Condition: The homework support condition was designed to approximate homework interventions schools frequently provide for students with academic difficulties, while at the same time having some features in common with the HOPS intervention. For example, children in the homework support condition will meet individually with a school counselor in sessions of the same duration and frequency as the HOPS condition (16 20-minute sessions). This condition will also include meetings with parents and a point reward system.
Key Measures: ADHD status will be assessed using a variety of measures, including the Vanderbilt ADHD Rating Scales and the Behavior Assessment Scale for Children, Second Edition (BASC-2). Research staff will measure 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. Children's organizational skills will also be assessed using the Children's Organizational Scale (parent and teacher report). Homework behavior will be assessed using the Homework Problem Checklist (parent report) and the number of assignments participants fail to turn in per grading period. Academic performance will be assessed using core class grades (Math, Science, Language Arts, and History) the Classroom Performance Survey (teacher report).
Data Analytic Strategy: Data will be analyzed using an intent-to-treat approach with mixed-effects models to account for repeated-measures. The impact of baseline ADHD symptom severity, severity of organizational skills and homework problems, and comorbid symptoms of anxiety will be investigated as potential moderators of outcomes. Participants' use of organization and time management skills, including homework behavior, will be investigated as potential mediating variables using structural equation modeling to evaluate the key mechanisms of change through which improvement is made.
Related IES Projects: Organizational Skills Interventions for Children with ADHD (R305A090305)