Organizational Skills Interventions for Children with ADHD
Previous Award Number: R305A090305
Previous Awardee: Cincinnati Children's Hospital Medical Center
Co-Principal Investigator: Jeff Epstein
Purpose: Attention Deficit/Hyperactivity Disorder (ADHD) is one of the most commonly diagnosed childhood disorders with a prevalence rate estimated at 8%. Children with ADHD often have difficulty with school-related tasks and activities such as completing or turning in homework, planning for long-term assignments, studying for tests, and keeping class materials and papers organized. These organizational and temporal difficulties become particularly problematic with the increased demands of middle school, a time when these children are at risk for failing grades, retention, and school dropout. In this study, the research team will adapt and refine an after-school program that targets the organizational difficulties of middle school students with ADHD, with the goal of making the intervention feasible for school counselors or psychologists to implement during the school day.
Project Activities: The organizational skills intervention in its current form consists of 20 minutes of individualized intervention targeting organizational skills and homework and time management issues followed by 55 minutes of group intervention. Using behavioral principles such as modeling, shaping, and contingency management, students are taught to develop and maintain systems of physical organization for school binders, book bags, and lockers. Students are also taught strategies to remember and successfully complete homework assignments and tests by recording them in a planner and breaking long-term tasks into smaller, more manageable components. Counselors also work with parents to promote transfer of the skills learned by students to the home setting. In this study, the researchers will use data from focus groups and case studies to determine what modifications are necessary for effective and feasible implementation of the program by middle school staff during the school day. Pilot data will be collected in an open field trial to assess the potential for the modified intervention to help middle school students with ADHD succeed in school.
Products: The expected product of this study is a program that is feasible for school personnel to implement during the school day to help middle school students with Attention Deficit/Hyperactivity Disorder (ADHD) deal with challenges related to organizational skills, homework, and time management.
Setting: The research will take place in five middle schools (6th to 8th grade) from four separate school districts located in Kentucky and Ohio.
Population: Forty children (20 in sixth grade and 20 in eighth grade) who meet the Diagnostic and Statistical Manual for Mental Disorders (DSM-IV) diagnostic criteria for ADHD, their families, 10 teachers (5 regular education teachers and 5 special education teachers) and 10 school counselors/psychologists will participate in the development and field testing activities.
Intervention: The intervention in its current form is an after-school program delivered in two sessions per week for 8 weeks by undergraduate psychology students. At the beginning of each session, 20 minutes is devoted to instruction on time management and materials organization. During the remaining 55 minutes, children complete homework assignments or engage in free time activities. Using behavioral principles such as modeling, rehearsal, prompting, shaping, and contingency management, students are taught specific strategies to keep materials organized, manage homework, and use time efficiently and effectively. For each component, students are taught the most basic skills first (e.g., recording homework assignments), and shaping is used to gradually train students in the more complex behaviors (e.g., recording study times and methods in the planners). All program skills are associated with rewards (e.g., points are earned to "buy" free time during the program or gift cards). To ensure that skills generalize and are maintained over time, parents learn about the program and work with the counselor to develop a system at home to monitor and provide contingencies. Two one-hour parent groups are offered in the evening at school during the 8-week program to develop a behavior contract that specifies when and how often monitoring will occur, who will complete the checklist, establish rewards/consequences, develop plans for what to do if the home schedule changes, and how to adjust rewards over time.
Potential modifications to the intervention that will be addressed in this project include individual versus small group delivery of the intervention; the number of sessions provided each week; appropriate rewards for counselors to give in the school setting; and a set of options or alternatives for involving parents that school counselors can choose from depending upon school and family needs.
Research Design and Methods: The research will proceed in two phases. In Phase I, middle school counselors/psychologists, teachers, and middle school students with ADHD and their parents will participate in focus groups. Participants will review the existing intervention protocol and provide detailed feedback. This qualitative data will be used to develop an initial draft of a new protocol for implementation by school staff during the school day. Ten case studies using the newly revised protocol will be completed, with a focus on data addressing treatment implementation, skills acquisition, and consumer satisfaction to inform changes to the protocol. In Phase II, the revised protocol will be implemented by each school counselor/psychologist who participated in Phase I with at least three new middle school students with ADHD. This open intervention trial will be used to determine the promise of the intervention for improving organizational skills and school grades. Student outcomes will be assessed again 8 weeks after the intervention period to determine if skills have generalized over time. Data will also be collected during the open intervention trial to assess implementation fidelity, skills acquisition, and user satisfaction. Finally, feedback from a series of follow-up focus groups with participating school clinicians, teachers, and parent-child dyads will be gathered and used to inform final revisions to the protocol.
Control Condition: There is no control condition.
Key Measures: To establish a clinical research diagnosis of ADHD, the following measures will be used: the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS), The Vanderbilt ADHD Rating Scales, the Behavior Assessment Scale for Children, Second Edition (BASC-2), the Wechsler Abbreviated Scale of Intelligence (WASI), and the Wechsler Individual Achievement Test — Abbreviated (WIAT-II). To measure preliminary outcomes, the Vanderbilt ADHD Rating Scales will be administered again, along with the Homework Problem Checklist (HPC), the Academic Performance Rating Scale (APRS), the Learning and Study Strategies Inventory, 2nd Edition (LASSI); and information about core class grades (math, science, language arts, and history) will be collected. To measure academic skills, two researcher-developed checklists — the Organization Checklist and the Time Management Checklist — will be used along with the Children's Organizational Scale (COSS). Potential moderators will be assessed with the Caregiver Working Alliance Inventory-Short Version and the Evidence-Based Practice Attitude Scale. To assess user satisfaction, all participants will be asked to rate their satisfaction with the intervention using researcher-developed forms and open-ended questions. The Services Use in Children and Adolescents-Parent Interview (SCA-PI) will be used to identify other treatments or school accommodations that participants may receive during the study period.
Data Analytic Strategy: Focus group data will be coded inductively for information relevant to feasibility and acceptability of the intervention protocol, and then analyzed qualitatively for emerging themes. Data from the open trial will be analyzed using one-way repeated-measures analysis of variance (ANOVA) to determine whether students improve on ADHD symptomatology, academic skills and school grades after participating in the intervention, and if any improvement is sustained to an 8-week follow-up. Exploratory analyses will be used to identify potential moderators and mediators of treatment effects including IQ, initial severity of symptoms, gender, grade, medication use, working alliance, attitudes toward evidence-based practice, attendance rate, and treatment fidelity.
Related IES Projects: Efficacy of an Organizational Skills Intervention for Middle School Students with ADHD (R305A130011)
Publications from this project:
Becker, S.P., and Langberg, J.M. (2012). Sluggish Cognitive Tempo Among Young Adolescents With ADHD: Relations To Mental Health, Academic, and Social Functioning. Journal of Attention Disorders. Advance online publication.
Langberg, J.M., Becker, S.P., Epstein, J.N., Vaughn, A.J., and Girio-Herrera, E. (2012). Predictors of Response and Mechanisms of Change in an Organizational Skills Intervention for Students with ADHD. Journal of Child and Family Studies.
Langberg, J.M. (2011). Homework, Organization and Planning Skills (HOPS) Interventions: A Treatment Manual. Bethesda, MD: National Association of School Psychologists (NASP) Publications.
Langberg, J.M., Epstein, J.N., Becker, S.P., GirioHerrera, E., and Vaughn, A.J. (2012). Evaluation of the Homework, Organization, and Planning Skills (HOPS) Intervention For Middle School Students With Attention Deficit Hyperactivity Disorder As Implemented By School Mental Health Providers. School Psychology Review, 41 (3): 342–364.
Langberg, J.M., Epstein, J.N., Girio-Herrera, E., Becker, S.P., Vaughn, A.J., and Altaye, M. (2011). Materials Organization, Planning, and Homework Completion In Young Adolescents With ADHD: Impact On Academic Performance. School Mental Health, 3 (2): 93–101.
Langberg, J.M., Vaughn, A.J., Williamson, P., Epstein, J.N., Girio-Herrera, E., and Becker, S.P. (2011). Refinement Of An Organizational Skills Intervention For Adolescents With ADHD For Implementation By School Mental Health Providers. School Mental Health 3(3): 143–155.