Organizational Skills Interventions for Children With Attention Deficit Hyperactivity Disorder (ADHD)

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.
The PI 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).