Efficacy of an Organizational Skills Intervention for Middle School Students With ADHD

Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most commonly diagnosed
childhood disorders, with prevalence rates estimated at 8%. Several of the primary symptoms
of ADHD relate to problems with temporal and materials organization (i.e. has difficulty
organizing tasks and activities, loses things, is forgetful, and fails to finish
school-work). 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 are
associated with low school grades and high parent and teacher ratings of academic
impairment. In fact, organization of homework materials is one of the strongest predictors
of academic performance in students with ADHD, above and beyond the impact of intelligence,
school services, and ADHD medication use, and mediates the relationship between symptoms of
ADHD and school grades.

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 sought to address this need by completing an IES Goal 2 study to develop a
school-based intervention targeting organizational skills that was feasible for school
mental health (SMH) providers to implement. The Homework, Organization and Planning Skills
(HOPS) intervention was developed and refined based upon input from 20 school mental health
(SMH) providers, students with ADHD and their families. SMH providers implemented the HOPS
intervention, rated the intervention as highly user-friendly and feasible to implement, and
demonstrated excellent fidelity to intervention procedures. Students who received the HOPS
intervention made significant improvements in homework problems and organizational skills
compared to a waitlist control. The feasibility and fidelity data demonstrate that the
intervention has potential for widespread dissemination. Preliminary outcome data suggest
that the intervention may significantly improve the academic performance of students with
ADHD. However, the small sample size (N=23 HOPS & N=24 control) precludes firm conclusions
about efficacy and moderators and mediators of intervention response. Accordingly, the
primary goal of this Goal 3 study is to evaluate the efficacy of the HOPS intervention,
which focuses teaching students' organization and time-management skills, as compared to an
intervention targeting on-task behaviors during homework completion and efficiency of work
completion, the Homework Support Intervention (HSI), and to assess moderators and mediators
of intervention response.

Middle school students with ADHD (N=260) will be randomly assigned to receive the HOPS
intervention or the HSI intervention. Students in both groups will receive the same amount
of intervention in terms of duration and frequency of intervention sessions. Six cohorts of
students will be recruited for the project. Each cohort will consist of 22 students at each
of two schools (44 per cohort) who will be randomly assigned to each of the two conditions.
Objective measures of skills implementation, parent and teacher ratings of organization,
homework problems, and academic impairment, and school grades will be examined pre and post
intervention as well as at 8-week and 6-month follow-ups. Treatment fidelity and integrity
will be closely monitored. Moderator and mediator analyses will be used to answer important
questions about the types of students most likely to benefit from organizational skills
intervention and the key mechanisms of change that lead to improved academic performance.
This study has significant potential to improve the academic performance of students with
ADHD because the intervention was designed with SMH provider input and has clear potential
for widespread dissemination upon proof of efficacy.