Organizational Skills Interventions for Children With Attention Deficit Hyperactivity Disorder (ADHD)
Condition: Attention Deficit Hyperactivity Disorder
MeSH terms: Hyperkinesis; Attention Deficit Disorder with Hyperactivity
Study type: Interventional

Summary: 
      Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most commonly diagnosed
      childhood disorders, with prevalence rates estimated at 8% (Froehlich et al. 2007). Several
      of the primary symptoms of ADHD relate to problems with temporal and materials organization
      (i.e. often has difficulty organizing tasks and activities, often loses things, is often
      forgetful, and often fails to finish school-work, chores, or duties; APA, 2000). In the
      school setting, problems with organization manifest as forgetting to complete or losing
      homework assignments, difficulties planning for the completion of long-term projects and
      studying for tests, and problems keeping class materials organized. These organizational
      difficulties become particularly problematic in middle school and can result in considerable
      academic impairment (Evans, Serpell, & White, 2005). Children with ADHD underachieve
      academically and are more likely than their peers to receive failing grades, be retained and
      to drop out of school (Barkley, Fischer, Edelbrock, & Smallish, 1990).

      Given the relationship between temporal and materials organization and poor school
      performance, it is clear there is a need for interventions to address these difficulties. We
      recently sought to address this need by completing a small randomized trial of an
      organizational skills intervention for children with ADHD (Langberg, Epstein, Urbanowicz,
      Simon, & Graham, (2008). The intervention was highly effective in improving materials
      organization and homework management and resulted in significant improvements in homework
      problems and grade point average. These results demonstrate the considerable promise of
      organizational skills interventions for children with ADHD. However, the Langberg et al.
      intervention was implemented as an after-school program operated by research staff with
      minimal involvement from school personnel. In order to promote the widespread adoption of
      interventions that address the organizational skills deficits of children with ADHD, the
      intervention must be feasible for school counselors and psychologists to implement within the
      time constraints of a typical school day. Accordingly, the primary goal of this study is to
      adapt and refine the existing intervention protocol (Langberg et al., 2008) to create a
      product that is highly acceptable to parents, children, teachers, school counselors and
      school psychologists and is feasible for school personnel to implement during the school day.

      In Phase I of the proposed research, middle school counselors, psychologists, teachers,
      middle school students with ADHD and their parents will consult with the intervention
      developers to modify the after-school treatment protocol for in-school implementation. An
      intervention protocol will be developed. The intervention will be piloted with ten children
      in order to identify barriers to implementation. Measures of treatment fidelity, skills
      acquisition, and satisfaction will be completed. These data will inform additional
      modifications of the protocol and further improve feasibility/acceptability of the
      intervention procedures.

      In Phase II of the study, school counselors/psychologists from at least four separate school
      districts will implement the protocol developed in Phase I. Using a waitlist control design,
      sixty children with ADHD in grades 6, 7, and 8 will receive the intervention. Organizational
      skills, grade point average, and academic impairment will be evaluated at baseline, post
      intervention and at 8-week follow-up. After implementing the intervention, all participants
      (i.e., teachers, counselors, psychologists, children and parents) will participate in a
      series of focus groups and will complete intervention satisfaction questionnaires. These data
      will inform final revisions to the intervention protocol. The resulting product will be an
      intervention that targets organizational skills in children with ADHD that has potential for
      widespread school-based dissemination. The final intervention protocol and effect size
      estimates from the proposed research will lay the foundation for an IES Goal III test of
      efficacy.

      The specific aims of the project are as follows:

        1. Utilize the existing organizational skills intervention protocol (Langberg et al. in
           press), focus group and case study data to develop an empirically and clinically
           informed manualized temporal and materials organization intervention for middle school
           children with ADHD aimed at reducing academic impairment (Phase I).

        2. Refine and finalize the intervention protocol through a waitlist control trial (N=60) in
           a minimum of four diverse school districts, collection of clinical outcomes and
           completion of follow-up focus groups to assess satisfaction, feasibility, and
           acceptability (Phase II).
    


Intervention name(s): Homework, Organization, and Planning Skills (HOPS) Intervention
Intervention type(s): Behavioral
Intervention description(s): HOPS is a 16 session school-based intervention. School counselors and psychologists deliver the intervention during the school day. Each session lasts 20 minutes. Initially, sessions are 2 times per week and the entire HOPS intervention is completed in 11 weeks. The study uses a waitlist control design. HOPS intervention participants (Arm 1) receive the intervention in the fall quarter of the school year and Treatment As Usual participants (Arm 2) receive the intervention in the spring quarter.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: ADHD; School-Based; Organizational Skills; Homework; Time Management