Project Activities
Athemos was iteratively developed and tested. In the first year, the researchers worked with game designers to develop and refine an initial version of the intervention. During the next 2 years, they conducted focus groups with middle school students with ADHD to get their feedback on the game, developed a teacher manual to support implementation, and conducted field tests with teachers and students to gather data on the feasibility. Athemos was revised based on findings from the focus groups and feasibility studies. In the final year, the research team conducted a pilot randomized controlled trial to determine the promise of Athemos for improving the coping skills of students with ADHD.
Structured Abstract
Setting
The research took place in middle schools in urban, suburban, and rural areas of Ohio and North Carolina.
Sample
Seventy-one middle school students (ages 11 to 14) with ADHD participated in focus groups to evaluate the game, and three middle school students and their teachers participated in the field tests. In the final year, 31 middle school students with ADHD and their teachers participated in the pilot study.
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 were 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) worked with teachers on supporting students in making connections between the game and classroom expectations. Specifically, teachers monitored student game performance and then coached students to apply skills learned in the game to the classroom.
Research design and methods
In the first year, the researchers worked with game designers to build a prototype of Athemos. In the following 2 years, they conducted focus groups with middle school students with ADHD to get their reactions to the game and revised the game based on their feedback. The research team also developed a manual, with guidance from teachers, to support teachers in implementation, including supporting students to transfer skills to real-world situations. They concluded by conducting a feasibility study in one middle schools with three students and their teachers during which time students completed the game and teachers received consultation in and implement strategies to support the active transfer of skills to authentic education settings. The intervention was further revised based on data from the feasibility study. In the final year, the researchers conducted a pilot study using a randomized controlled trial, in which students were randomly assigned to the intervention or control condition, stratified by medication status (on or off psychoactive medication). Outcome data were collected at pre- and post-test, and fidelity data were collected on an ongoing basis through consultant report and system data (game analytics).
Control condition
Students assigned to the control condition received traditional school consultation using an established approach (Challenging Horizons Program) but did not have access to the Athemos game.
Key measures
Main outcomes were assessed using the Classroom Performance Survey, School Functioning Survey, and the Children’s Organizational Skills Scale. Student satisfaction with Athemos was measured with the Game User Experience Satisfaction Scale and teacher acceptance of the intervention and consultation was assessed with a researcher-developed survey. Fidelity was primarily assessed by game analytics but supplemented with notes from consultant logs. Additional outcomes were measured by game analytics (motivation and learning), school academic and behavioral records (e.g., school grades, disciplinary actions), and the Working Alliance Inventory-Short, Revised (student-teacher relationship).
Data analytic strategy
Focus group data were quantified and tracked over time, and descriptive analyses were used to analyze data from the feasibility studies. Data from the pilot study were analyzed using regression analyses to determine the promise of Athemos for improving the student outcomes.
Key outcomes
The main findings of this project, as reported by the principal investigator, are as follows:
- Both conditions—the computer-assisted behavior intervention and the control group (receiving the Challenging Horizons Program consultation model)—resulted in statistically significant improvements on the main outcomes measures (Classroom Performance Survey [teacher report], School Functioning Scale [teacher report], and Children’s Organization Skills Scale [Parent Report]). In addition, significant improvements were noted for both conditions on a measure of ADHD symptomology (ADHD Rating Scale-5 [Parent and Teacher Report]). In all cases, there was a main effect of time, but not for the Time X Treatment interaction.
- Small but nonsignificant advantages were noted on child ratings of their relationship with their teachers (Working Alliance Inventory), as well as child and parent satisfaction with the videogame-enhanced treatment.
- No change was noted on teacher motivation for using technology in the classroom (Technology Acceptance Model Instrument), suggesting that exposure to the Athemos treatment package did not strengthen nor weaken teachers’ preexisting perceptions of classroom technology.
- In short, the computer-assisted behavior intervention (Athemos) appeared to perform as well as an established approach to school consultation for ADHD, with small advantages in terms of student satisfaction and relationship with their teachers.
People and institutions involved
IES program contact(s)
Project contributors
Products and publications
Project website:
Study registration:
Publications:
ERIC Citations: Find available citations in ERIC for this award here.
Select Publications:
Schultz, B. K., Evans, S. W., Bowditch, J., Carter, K., Rogers, E. E., Donelan, J., & Dembowski, A. (2023). Acceptability and playability of an organization training videogame for young adolescents with ADHD: The development of ATHEMOS. PLOS Digital Health, 2(11), e0000374.
Available data:
Interested individuals are invited to contact the research team.
Additional project information
Additional online resources and information:
Gameplay trailer: https://youtu.be/mclXiDsSXwI
Mentor introduction: https://youtu.be/vWfDE9WZ8_A
Questions about this project?
To answer additional questions about this project or provide feedback, please contact the program officer.
