Project Activities
This project involved three phases. During the first phase, intervention modules were created and iteratively tested for feasibility in a laboratory setting. Over the course of the year, four groups of children at-risk for ADHD received four versions of their assigned module, providing feedback and time for iterative development in between administrations. During the second phase, the modules were tested alone and in combination in an afterschool setting with a new sample of children so that each small group of children receives instruction in two modules. Modifications to the modules were made as necessary during this phase. In the third and final phase, the four finalized modules were pilot tested in an afterschool program with a group of children who did not participate in the previous two phases in order to determine feasibility and effect sizes. Children's narrative comprehension was assessed at the beginning and end of the first semester and at the end of the second semester.
Structured Abstract
Setting
This study was conducted in an urban/suburban school district in Kentucky.
Sample
Participants included approximately 208 second and third grade students at-risk for ADHD.
This intervention is designed to teach a set of story comprehension strategies to children who are considered at-risk for ADHD. The intervention includes four modules aligned with the difficulties many children with ADHD have with comprehension: understanding causal events; using goal structure; identifying and using important information; and making inferences and monitoring comprehension. Each of the four modules consists of four to six 75-minute instruction sessions to be delivered during an afterschool program to small groups of students. Lessons are designed to provide scaffolded support that gradually transfers cognitive responsibility from the teacher to the student. Clips of television programs, audiotaped stories, wordless picture books, and short stories/picture books read aloud serve as the narrative stories for the lessons. Additionally, to address potential behavior problems associated with ADHD, each lesson includes instruction and reminders of appropriate and inappropriate behaviors, target goals for behaviors, and positive and negative consequences of meeting or not meeting the goals.
Research design and methods
During the first phase of the study, the four modules were iteratively developed and tested in a laboratory setting. Sixty-four second and third grade students at-risk for ADHD were placed into groups of four and each group received the same module four times across the school year, with modifications in between administrations. Researchers collected data on feasibility using student surveys, instructor ratings, informal interviews, teacher focus groups, and observer ratings. During the second phase of the study, the four modules were tested in an afterschool setting alone and in combination. A new group of 64 students at-risk for ADHD were placed into groups of four, and each group received instruction in two of the four modules. Modifications to the modules were made as needed. During the final phase of the project, 80 students at-risk for ADHD were recruited to be part of the pilot study. Half of these participants were randomly assigned to the treatment group and received the intervention during the first half of the school year (fall semester). Children were placed in groups of four and were instructed in all four modules for four instructional sessions (16 total sessions) over eight weeks. Assessments of children's narrative comprehension occurred at the start of the fall semester (pre-intervention), at the end of the fall semester (post-intervention for the treatment group; pre-intervention for the waitlist control group), and at the end of the spring semester (follow-up for the treatment group; post-intervention for the waitlist control group).
Control condition
For the pilot study, 40 of the participants were randomly assigned to a waitlist control group. Students in the treatment group received the intervention the fall semester of the year, while the waitlist control group received the intervention in the spring semester of the year.
Key measures
Students were screened for participation in the study using a behavior checklist completed by a parent and teacher. Feasibility of the intervention and specific modules and sessions were measured weekly throughout the first two phases, including collecting both quantitative and qualitative data from students, instructors, and session observers. Additionally, a student efficacy rating scale was developed and piloted throughout the study. This rating scale assessed children's efficacy in the four features of narrative comprehension with which children with ADHD often struggle (i.e. causal relations, goal structures, using information to guide recall, and making inferences). Narrative comprehension was assessed both pre- and post-test for the pilot study in year three using free and cued recall of a television program or audiotaped store, narrative of a wordless picture book, and the creation of a new story.
Data analytic strategy
Analysis of the qualitative data included two cycles: microcylce and macrocycle analysis. Microcycle analysis occurred weekly during the first two phases of the project and involved descriptive coding of the interviews and focus groups, and pattern coding to identify and describe patterns of divergence and convergence across data sources. Macrocycle analysis occurred at the end of each year. The researchers used constant comparative analysis to derive categories within the multiple sources of feasibility data. Descriptive statistics were used to identify patterns in students', teachers', and observers' responses. Analysis of quantitative data used hierarchical linear modeling in which students were nested within their small groups. The waitlist control design of the study allowed the researchers to examine the impact of instruction on narrative comprehension six months after the end of the intervention.
People and institutions involved
IES program contact(s)
Project contributors
Products and publications
The product for this study was a fully developed narrative comprehension supplemental intervention for second and third grade students at-risk for ADHD. The intervention includes four fully-developed instructional modules of four to six 75-minute sessions each. Peer reviewed publications were also produced.
Publications:
Derefinko, K. J., Hayden, A., Sibley, M. H., Duvall, J., Milich, R., and Lorch, E. P. (2014). A Story Mapping Intervention to Improve Narrative Comprehension Deficits in Adolescents with ADHD. School Mental Health, 6(4): 251-263.
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Questions about this project?
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