Real-World School-Based Interventions May Ease Homework Challenges for Children with ADHD

MARCH 05, 2018
Amanda Warren
Joshua M. Landberg, PhD, director of the Promoting Adolescent School Success (PASS) program, and co-director for the Center for ADHD Research, Education and Service at Virginia Commonwealth UniversityJoshua M. Landberg, PhD
Researchers at Virginia Commonwealth University have discovered 2 brief school-based interventions for adolescents with attention-deficit/hyperactivity disorder (ADHD) may be effective in helping students overcome homework and organization challenges related to their ADHD.

The researchers, led by Joshua M. Landberg, PhD, director of the Promoting Adolescent School Success (PASS) program, and co-director for the Center for ADHD Research, Education and Service at Virginia Commonwealth University, found evidence that school provider-based interventions could serve as a successful model for facilitating the use of research-developed interventions in real-world settings, closing what Landberg calls "the oft-cited research to practice gap." 
 
Landberg and colleagues suggest that academic challenges faced by adolescents with ADHD often center on the management and completion of homework assignments, and that students with ADHD oftentimes fail to record assignments, lose materials, procrastinate and have difficulty completing work efficiently.

Interventions designed to mediate and improve homework problems have been proven via multiple evidence-based studies, according to Landberg and colleagues, to be more effective than ADHD medication. Despite the success of these interventions in the clinical setting Landberg and colleagues state that there has been a gap in implementation of those interventions in educational settings.

The study designed by the researchers that utilized 2 brief school-based interventions to assist students with ADHD to reduce homework challenges were the Homework, Organization and Planning Skills (HOPS) intervention, and the Completing Homework by Improving Efficiency and Focus (CHIEF) intervention. The study included 280 middle school students (median age 11.87-12.02) in 7 public middle schools assigned to 6 cohorts over 3 successive school years.

Participating students were selected by school counselors and psychologists, exhibited at least 4 of 9 DSM-IV-TR [Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition] ADHD symptoms of inattention, and were randomly assigned within middle school to either; (a) HOPS; (b) CHIEF, or (c) Waitlist using a 2:2:1 ratio.

Landberg and colleagues report that "across the 3-year study, 6 school mental health (SMH) providers who had recently graduated from a MEd in counselor education program implemented the interventions" (age 25–27).

The HOPS intervention (n=111) took place during 16, 20-minute sessions (avg= 17.42 min) throughout an 11 week period, with the first 10 sessions taking place twice a week, and the last 6 taking place weekly.

SMH providers completed skills tracking checklists at every intervention session that included operationalized definitions of materials organization, homework, recording and time-management, and students were rewarded for points for completed tasks.  

The CHIEF intervention model was the same as the HOPS model in terms of delivery, but students enrolled in the CHIEF intervention (n= 111) were told to bring homework to each 20-minute intervention period (avg= 19.42 min). Students in the CHIEF intervention worked with SMH providers to establish an operationalized work completion goal for their studies. During the meeting, students were rewarded for on-task behavior by a token system (1 token for each minute spent on task), with a 10 point bonus for reaching work completion goals during the session.

Both HOPS and CHIEF intervention participation was incentivized for students via a points system based on skills tracking checklists (HOPS) or on-task behavior awards (CHIEF). Points earned by students could be exchanged for gift cards (100 points = $10 gift card). The HOPS and CHIEF interventions also included 2, 1-hour meetings with parents on school grounds which were designed to teach parents how to implement the intervention methods and rewards program.

Parents and teachers of the students rated student skill at pre-, post- and 6-month periods using a Homework Problems Checklist (HPC), Homework Performance Questionnaire (HPQ), and the Children's Organizational Skills Scale (COSS) to measure intervention outcomes. Student GPA and responses by parents to a 13 question parental satisfaction survey related to the components of the intervention were also recorded.

The results of the interventions showed a high adherence to the program (HOPS : 92.5%; CHIEF: 89.23%), and significant effects at post-treatment according to research data. Landberg writes that "Participants in both HOPS and CHIEF made large, significant, pre- to post-improvements on parent ratings of homework problems and organization and planning skills as compared with a waitlist control (HOPS ds range from .79 –1.27; CHIEF ds range from .57–1.08)" and that the gains shown post-intervention were maintained at a 6-month follow-up.

Data also showed that while improvement data was not significantly different between the 2 intervention methods, HOPS showed greater performance for students with more severe psychopathology and executive function impairments. Although GPAs for students in the 2 intervention and waitlist groups did not vary significantly, there was a difference in responses of teachers and parent ratings of student improvement through the interventions with both groups. Teachers and parents noted fewer homework problems after intervention, with HOPS participants showing significantly fewer problems than those enrolled in CHIEF (ds= .30-51).
 
Clinical testing of interventions, as opposed to real-world testing, often carries design limitations that serve as barriers to real-world implementation and as a result, Landberg argues, "Little is known about the efficacy of evidence-based practices implemented in schools by typically trained school mental health providers."

Landberg and colleagues state that the success of their school-based study suggests that although there are perceived significant barriers to the implementation of evidence-based interventions in school and community contexts, they may be overcome by utilizing delivery models tested in real-world scenarios. The success of the HOPS and CHEIF interventions show that brief school-based interventions can be utilized to improve the homework problems of middle school students with ADHD.

"Overcoming the Research-to-Practice Gap: A Randomized Trial With Two Brief Homework and Organization Interventions for Students With ADHD as Implemented by School Mental Health Providers" appeared in the Journal of Consulting and Clinical Psychology's January 2018 issue.

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