The Effects of Self-Management in General Education Classrooms on the Organizational Skills of Adolescents With ADHD

Self-management interventions for reducing challenging behaviors among school-age students: A systematic review

Background

Challenging classroom behaviors can interfere with student social and academic functioning and may be harmful to everyone in schools. Self-management interventions within schools can address these concerns by helping students develop necessary social, emotional, and behavioral skills. Thus, the current systematic review synthesized and analyzed school-based self-management interventions used to address challenging classroom behaviors.

Objectives

The current study aimed to inform practice and policy by (a) evaluating the effectiveness of self-management interventions at improving classroom behaviors and academic outcomes and (b) examining the state of research for self-management interventions based on existing literature.

Search Methods

Comprehensive search procedures included electronically searching online databases (e.g., EBSCO Academic Search Premier, MEDLINE, ERIC, PsycINFO), hand-searching 19 relevant journals (e.g., School Mental Health, Journal of School Psychology), reference-list searching 21 relevant reviews, and searching gray literature (e.g., contacting authors, searching online dissertation/theses databases and national government clearinghouses/websites). Searches were completed through December of 2020.

Selection Criteria

Included studies employed either a multiple group-design (i.e., experimental or quasi-experimental) or single-case experimental research design and met the following criteria: (a) utilized a self-management intervention, (b) conducted in a school setting, (c) included school-aged students, and (d) assessed classroom behaviors.

Data Collection and Analysis

Standard data collection procedures expected by the Campbell Collaboration were used in the current study. Analyses for single-case design studies incorporated three-level hierarchical models to synthesize main effects, and meta-regression for moderation. Further, robust variance estimation was applied to both single-case design and group-design studies to account for dependency issues.

Main Results

Our final single-case design sample included 75 studies, 236 participants, and 456 effects (i.e., 351 behavioral outcomes and 105 academic outcomes). Our final group-design sample included 4 studies, 422 participants, and 11 total behavioral effects. Most studies occurred in the United States, in urban communities, in public schools, and in elementary settings. Single-case design results indicated that self-management interventions significantly and positively impacted both student classroom behaviors (LRRi = 0.69, 95% confidence interval [CI] [0.59, 0.78]) and academic outcomes (LRRi = 0.58, 95% CI [0.41, 0.76]). Single-case results were found to be moderated by student race and special education status, whereas intervention effects were more pronounced for African American students (F = 5.56, p = 0.02) and students receiving special education services (F = 6.87, p = 0.01). Single-case results were not found to be moderated by intervention characteristics (i.e., intervention duration, fidelity assessment, fidelity method, or training). Despite positive findings for single-case design studies, risk of bias assessment indicated methodological shortcomings that should be considered when interpreting findings. A significant main effect of self-management interventions for improving classroom behaviors was also revealed for group-design studies (g = 0.63, 95% CI [0.08, 1.17]). However, these results should be interpreted with caution given the small number of included group-design studies.

Implications for Policy Practice and Research

The current study, conducted using comprehensive search/screening procedures and advanced meta-analytic techniques, adds to the large amount of evidence indicating that self-management interventions can be successfully used to address student behaviors and academic outcomes. In particular, the use specific self-management elements (i.e., self-determining a performance goal, self-observing and recording progress, reflecting on a target behavior, and administering primary reinforcers) should be considered within current interventions as well as in the development of future interventions. Future research should aim to assess the implementation and effects of self-management at the group or classroom-level within randomized controlled trials.

Occupational performance goals and outcomes of time-related interventions for children with ADHD

BACKGROUND

Children with attention deficit hyperactivity disorder (ADHD) have difficulties with occupational performance, related to difficulties with time-processing ability.

AIMS

To examine the outcome of a multimodal time-related intervention designed to support children aged 9-15 years with ADHD, to achieve their occupational performance goals and improve satisfaction with occupational performance. A further aim was to compare the children's ratings of outcome with their parents' ratings and to analyse the occupational performance goals.

MATERIAL AND METHODS

A pre-post design was used. Participants were 27 children, aged 9-15 years. Children and parents rated occupational performance and satisfaction at baseline and follow-up, after 24 weeks, using the Canadian Occupational Performance Measure (COPM). The intervention consisted of time-skills training and time-assistive devices (TADs). Descriptive and non-parametric statistics were used.

RESULTS

Significant improvements were found in reported performance and satisfaction. Children's were higher than those of their parents. Most goals were about carrying out daily routines, knowing the duration of an activity and knowing what will happen in the near future.

CONCLUSION AND SIGNIFICANCE

The study contributes to knowledge about suitable interventions for children with ADHD who have time-related difficulties. Occupational therapy interventions, including TADs and time-skills training, resulted in significantly improved occupational performance.

Effectiveness of a Teacher Training Program for Students with Symptoms of Developmental Disorders: Data from a Correspondence High School in Japan

In the present study, a teacher training program based on behavioral therapy was conducted for high school correspondence course teachers of adolescents aged between 15 and 18 years who showed developmental difficulties. Participating teachers were assigned to either an immediate treatment (IT; n = 13) or delayed treatment control (DTC; n = 17) group to evaluate the effectiveness of the program, which comprised five 90-min sessions with small groups of three to six participants and was conducted over three months. The results showed significant improvement in students’ behaviors and social responsiveness and in teachers’ confidence among those in the IT group; however, those in the DTC group did not show any such improvement. We discuss the program’s feasibility in terms of developing support resources for teachers in Japanese high schools.

Cross Validation of Attention-Deficit/Hyperactivity Disorder-After School Checklist

Objectives

This study aimed to evaluate the efficacy of the attention-deficit/hyperactivity disorder (ADHD)-After School Checklist (ASK) by comparing the results of the Comprehensive Attention Test (CAT) and Clinical Global Impression-Severity (CGI-S) Scale and then by calculating the area under the receiver operating characteristic (ROC) curve.

Methods

We performed correlation analyses on the ASK and CAT results and then the ASK and CGI-S results. We created a ROC curve and evaluated performance on the ASK as a diagnostic tool. We then analyzed the test results of 1348 subjects (male 56.8%), including 1201 subjects in the general population and 147 ADHD subjects, aged 6-15 years, from kindergarten to middle school in Seoul and Gyeonggi province, South Korea.

Results

According to the correlation analyses, ASK scores and the Attention Quotient (AQ) of CAT scores showed a significant correlation of -0.20--0.29 (p<0.05). The t-test between ADHD scores and CGI-S also showed a significant correlation (t=-2.55, p<0.05). The area under the ROC curve was calculated as 0.81, indicating good efficacy of the ASK, and the cut-off score was calculated as 15.5.

Conclusion

The ASK can be used as a valid tool not only to evaluate functional impairment of ADHD children and adolescents but also to screen ADHD.

Development of the Attention-Deficit Hyperactivity Disorder-After School Checklist

OBJECTIVES

This study aimed to develop the attention-deficit hyperactivity disorder (ADHD)-After School Checklist (ASK) to evaluate the severity of ADHD symptoms and self-management ability in children and adolescents in South Korea. Additionally, we evaluated the reliability and validity of the scale.

METHODS

We developed the ASK to evaluate the effect of ADHD psychopathologies on self-management and interpersonal impulsivity. We investigated the reliability and validity of the scale with 1349 parents (male 56.9%; 1202 parents of non-ADHD children, 147 parents of children with ADHD) in Seoul and Gyeonggi Province, Korea.

RESULTS

According to the construct validity test using principal constant analysis with the varimax rotation method, two factors explained 60.7% of the cumulative variance in ASK scores. Cronbach's alpha for the whole scale was 0.71. There was no statistical difference between mean ASK scores at test and retest. Mean total ASK scores of the ADHD group were significantly higher than those of the non-ADHD group (p<0.001).

CONCLUSION

The ASK can be used as a reliable and valid tool to evaluate not only self-management capability of children and adolescents with ADHD in their academic and everyday life, but also their impulsiveness in interpersonal relationships.

Effectiveness of time-related interventions in children with ADHD aged 9-15 years: a randomized controlled study

Specific problems with time and timing that affect daily routines, homework, school work, and social relations have been recognized in children with ADHD. The primary treatments for children with ADHD do not specifically focus on time-related difficulties. The aim of this randomized controlled study (RCT) was to investigate how multimodal interventions, consisting of training in time-processing ability (TPA) and compensation with time-assistive devices (TAD), affect TPA and daily time management (DTM) in children with ADHD and time difficulties, compared with only educational intervention. Thirty-eight children on stable medication for ADHD in the 9-15-year age range were randomly allocated to an intervention or a control group. The children's TPA was measured with a structured assessment (KaTid), and the children's DTM was rated by a parent questionnaire (Time-Parent scale) and by children's self-reporting (Time-Self-rating). The intervention consisted of time-skill training and compensation with TAD. Data were analysed for differences in TPA and in DTM between the control and intervention groups in the 24-week follow-up. Children in the intervention group increased their TPA significantly (p = 0.019) more compared to the control group. The largest increase was in orientation to time. In addition, the parents in the intervention group rated their children's DTM as significantly (p = 0.01) improved compared with the parents in the control group. According to the children, their DTM was not significantly changed. In conclusion, a multimodal intervention consisting of time-skill training and TAD improved TPA and DTM in children with ADHD aged 9-15 years.

The Association between Sleep and Theory of Mind in School Aged Children with ADHD

Theory of Mind (ToM) is defined as the ability to infer a range of internal mental states of others, including beliefs, intentions, desires, and emotions. These abilities are associated with children’s ability to socialize effectively with peers. ToM impairments are associated with peer rejection and psychiatric disorders such as Attention-Deficit/Hyperactivity Disorder (ADHD). Previous studies have found poor sleep negatively impacts executive functioning (EF) and emotional information processing, which are essential for the effective use of ToM. Youth with ADHD have EF deficits and sleep problems. However, the relationship between sleep, executive functioning, and ToM in children with ADHD has not been studied. In this review, we propose that the poor social and interpersonal skills characterizing individuals with ADHD could be explained by the impact of poor sleep on the emotional and cognitive mechanisms underlying ToM.

Changing Academic Support in the Home for Adolescents with Attention-Deficit/Hyperactivity Disorder: A Family-Based Clinical Protocol for Improving School Performance

Attention-Deficit/Hyperactivity Disorder (ADHD) is highly prevalent among adolescent clinical populations and associated with myriad deficits in school functioning. Yet, behavior therapists have few developmentally appropriate tools for addressing school problems in this group. This article introduces a behavioral protocol designed to fill the gap: Changing Academic Support in the Home for Adolescents with ADHD (CASH-AA). CASH-AA is a family-based intervention that targets home environment, adolescent skills, and family-school partnership characteristics in order to improve school performance. Protocol components are derived from three evidence-based approaches for adolescent behavior problems: family psychoeducation, clinical family interventions to heighten adolescent and caregiver motivation to change, and training interventions for homework planning and organization skills. CASH-AA contains four treatment modules: (1) Psychoeducation: ADHD and Academic Functioning; (2) Motivation & Preparation: Home Academic Environment; (3) Behavior Change: School Attendance and Homework Plan; (4) Collaboration: Therapist-Family-School Partnership. The protocol can be implemented as a stand-alone intervention for ADHD or an adjunct to other behavioral interventions for co-occurring disorders. Two case examples with markedly different treatment profiles are presented to illustrate the utility and flexibility of the protocol.

Willingness to use ADHD Self-Management: Mixed Methods Study of Perceptions by Adolescents and Parents

Little is known about perceptions surrounding self-management for attention deficit hyperactivity disorder (ADHD), although such interventions appear commonly used and are considered essential components of the chronic care model. Our research is part of a mixed methods study that followed students at high and low risk for ADHD over 11 years. During the final study years, area-representative samples of 148 adolescents (54.8% participation; 97 ADHD high-risk group; 51 low-risk peers) and 161 parents (59.4% participation; 108 parents of high-risk adolescent; 53 parents of low-risk peer) completed a cross-sectional survey on community-identified self-management interventions for ADHD (activity outlets, sleep regulation, dietary restriction, homework help, family rules, and prayer). Respondents also answered open-ended questions addressing undesirable self-management effects, which were analyzed using grounded theory methods. High-risk adolescents expressed significantly lower willingness towards all self-management interventions than did adult respondents, except for increased activity outlets. They also reported lower receptivity towards sleep regulation and dietary restriction than did their low-risk peer group. No gender or race differences in self-management willingness were found, except for higher receptivity to prayer in African American respondents. Cost, perceived ineffectiveness, disruptions to routines, causation of interpersonal conflicts, and reduced future self-reliance were seen as potential undesirable effects. Findings suggest that activity-based ADHD interventions appear particularly acceptable across all demographic and risk groups, unlike sleep regulation and dietary approaches. Further research on self-care effectiveness is needed to incorporate adolescents' viewpoints about ADHD self-management, as interventions may be acceptable to adults, but resisted by adolescents.

Training Problem Solving and Organizational Skills in Adolescents With Attention-Deficit/Hyperactivity Disorder: A Randomized Controlled Trial

Attention-deficit/hyperactivity disorder (ADHD) is a highly prevalent psychiatric disorder in adolescence and results severe impairment. Few psychosocial interventions aim at ADHD in adolescence and are rarely evaluated in randomized controlled trials (RCTs). Therefore, an intervention combining adolescent-directed problem-solving and organizational skills training with behavioral parent and teacher training has been developed. Its efficacy in comparison to waiting list and active controls is reported.

One hundred thirteen adolescents (mean age = 13.99 years) with ADHD were randomly assigned to the training, a waiting list or an active control condition (progressive muscle relaxation [PMR]). Parents and teachers rated ADHD symptoms, academic enablers, and comorbid problems before and after. Results: The training significantly reduced ADHS symptoms and parent- and teacher-rated internalizing problems and increased teacher rated academic enablers compared to waiting list controls. Compared to active controls, results were in the range of small nonsignificant effects. A skills training is an efficacious treatment for adolescent ADHD, however, not significantly superior to PMR. Contrasts between both interventions need to be further investigated.

Evaluating the content of Individualized Education Programs and 504 Plans of young adolescents with attention deficit/hyperactivity disorder

The purpose of this study was to evaluate the degree with which Individualized Education Programs (IEPs) and 504 Plans prepared for middle school students with attention deficit/hyperactivity disorder (ADHD) conformed to best practices and included evidence-based services. Specifically, we examined the problem areas identified in the statement of students' present level of academic achievement and functional performance (PLAAFP) and targeted in the students' measurable annual goals and objectives (MAGOs). In addition, we compared services with lists of recommended services provided by the U.S. Department of Education (ED) and reviews of evidence-based practices. Participants were 97 middle school students with ADHD, 61.9% with an IEP, and 38.1% with a 504 Plan. Most (85%) IEP PLAAFP statements described nonacademic/behavior problems, but fewer than half had MAGOs targeting these areas of need. Services listed on IEPs and Section 504 Plans were frequently consistent with ED recommendations, but had little to no research supporting their effectiveness. In addition, services with evidence supporting benefit to students with ADHD were rarely included on IEPs or 504 Plans. Implications for special education policy and future directions are discussed.

Increased neurocognitive intra-individual variability is associated with declines in medication adherence in HIV-infected adults

OBJECTIVE

There is cross-sectional evidence that neurocognitive intra-individual variability (IIV), or dispersion, is elevated in human immunodeficiency virus (HIV) disease and is associated with declines in activities of daily living, including medication adherence.

METHODS

This longitudinal study extends this literature by examining whether increased neurocognitive IIV in HIV-positive persons over time predicts declines in medication adherence above and beyond changes in mean level of performance over a 6-month observation.

RESULTS

After controlling for drug use, declines in mean performance, and changes in depressive symptoms, results confirmed that increases in IIV were associated with overall poorer antiretroviral medication adherence. HIV-positive individuals with the greatest increases in dispersion demonstrated marked reductions in adherence by the third month that exceeded what was observed in less variable individuals.

CONCLUSIONS

Our results indicate that increases in dispersion are associated with poorer declines in medication adherence in HIV disease, which may have implications for the early detection and remediation of suboptimal antiretroviral adherence.

Schulbasierte Interventionen bei ADHS und Aufmerksamkeitsproblemen: Ein Überblick

Kinder mit einer Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) oder subklinischen Aufmerksamkeitsproblemen sind in ihrer schulischen Leistungsfähigkeit beeinträchtigt. Für Lehrkräfte stellen diese Beeinträchtigungen eine große Herausforderung dar. Im Zuge der Umsetzung der Behindertenrechtskonvention der Vereinten Nationen (UN) wird der Bedarf an effektiven Strategien zum Umgang mit diesen Verhaltensauffälligkeiten an allgemeinbildenden Schulen deutlich steigen. Ziel der vorliegenden Arbeit ist es, einen Überblick über effektive Klassen-, Lehrkraft- und Schüler-zentrierte Maßnahmen für Schüler mit Aufmerksamkeitsproblemen zu geben. Die aktuelle Studienlage zu Interventionen im Schulsetting bietet überwiegend Einzelfallstudien, die eine Generalisierung der Ergebnisse erschweren. Unter Berücksichtigung der Studienqualität können daher nur interdependente Gruppenverstärkerpläne (klassen-zentriert) als evidenzbasiert bezeichnet werden. Forschungsmethodische Einschränkungen und Forschungsperspektiven werden diskutiert.

Middle and High School Based Interventions for Adolescents with ADHD

The development and evaluation of psychosocial treatments for adolescents with attention-deficit/hyperactivity disorder has lagged behind the treatment development work conducted with children with the disorder. Two middle school-based and high school-based treatment programs have the most empirical work indicating beneficial effects. Treatment development research addressing many of the basic questions related to mediators, moderators, and sequencing of treatments is needed. Implications for future treatment development research are reviewed, including the potential benefits of combining treatments of a variety of modalities to address the large gaps in the literature.

Adaptive tele-therapies based on serious games for health for people with time-management and organisational problems: preliminary results

Attention Deficit with Hyperactivity Disorder (ADHD) is one of the most prevalent disorders within the child population today. Inattention problems can lead to greater difficulties in completing assignments, as well as problems with time management and prioritisation of tasks. This article presents an intelligent tele-therapy tool based on Serious Games for Health, aimed at the improvement of time management skills and the prioritisation of tasks. This tele-system is based on the use of decision trees within Django, a high-level Python Web framework. The technologies and techniques used were selected so as to boost user involvement and to enable the system to be easily customised. This article shows the preliminary results of the pilot-phase in an experiment performed to evaluate the use of adaptive tele-therapies within a group of typically developing children and adolescents aged between 12 and 19 years old without ADHD. To do so, we relied on the collection of parameters and the conduct of surveys for assessing time management skills, as well as measuring system usability and availability. The results of a time management survey highlighted that the users involved in the trial did not use any specific or effective time management techniques, scoring 1.98 and 2.30 out of 5 points in this area for ages under 15 and over 16 years old, respectively. The final calculations based on the usability questionnaire resulted in an average score of 78.75 out of 100. The creation of a customisable tool capable of working with different skills, in conjunction with the replication of the current study, may help to understand these users’ needs, as well as boosting time management skills among teenagers with and without ADHD.

Predictors of Response and Mechanisms of Change in an Organizational Skills Intervention for Students with ADHD

The purpose of the study was to evaluate predictors of response and mechanisms of change for the Homework, Organization, and Planning Skills (HOPS) intervention for middle school students with Attention-Deficit/Hyperactivity Disorder (ADHD). Twenty-three middle school students with ADHD (grades 6-8) received the HOPS intervention implemented by school mental health providers and made significant improvements in parent-rated materials organization and planning skills, impairment due to organizational skills problems, and homework problems. Predictors of response examined included demographic and child characteristics, such as gender, ethnicity, intelligence, ADHD and ODD symptom severity, and ADHD medication use. Mechanisms of change examined included the therapeutic alliance and adoption of the organization and planning skills taught during the HOPS intervention. Participant implementation of the HOPS binder materials organization system and the therapeutic alliance as rated by the student significantly predicted post-intervention outcomes after controlling for pre-intervention severity. Adoption of the binder materials organization system predicted parent-rated improvements in organization, planning, and homework problems above and beyond the impact of the therapeutic alliance. These findings demonstrate the importance of teaching students with ADHD to use a structured binder organization system for organizing and filing homework and classwork materials and for transferring work to and from school.

Prevention of serious conduct problems in youth with attention deficit/hyperactivity disorder

The purpose of this review is to discuss issues in the prevention of serious conduct problems among children and adolescents with attention deficit/hyperactivity disorder (ADHD). The authors began by reviewing research on the common genetic and environmental etiological factors, developmental trajectories, characteristics and impairments associated with ADHD and comorbid oppositional defiant and conduct disorders. Next, the authors presented empirically based models for intervention with children and adolescents with ADHD that are at risk of developing serious conduct problems and detailed the evidence supporting these models. Researchers have demonstrated the utility of medication and psychosocial intervention approaches to treat youth with these problems, but current evidence appears to support the superiority of multimodal treatments that include both approaches. Future directions for researchers are discussed.

Self-monitoring during spelling practice: effects on spelling accuracy and on-task behavior of three students diagnosed with attention deficit hyperactivity disorder

We used a multiple baseline across subjects design to investigate the effects of self-monitoring on the on-task behavior and spelling accuracy of three fifth-grade students diagnosed with attention deficit hyperactivity disorder (ADHD) during an independent spelling practice period in the general education environment. We also compared their on-task levels to that of peers without disabilities in the same classroom context before and after the self-monitoring intervention. Our results showed that time on-task and spelling accuracy increased for the students diagnosed with ADHD during independent spelling practice after the teacher taught them how to self-monitor. These same students' on-task behavior also increased to levels comparable to that of their peers. Suggestions for educators interested in teaching their students self-monitoring strategies are included following a discussion of the results of the analysis.

Strategies for implementing evidence-based psychosocial interventions for children with attention-deficit/hyperactivity disorder

An extensive amount of research has demonstrated the effectiveness of psychosocial interventions for children with ADHD. Historically, the research has focused on interventions targeting problems in the home or school setting, but more recent research has highlighted the importance of family – school partnerships and conjoint approaches to intervention involving family and school. Effective approaches to psychosocial intervention consist of strategies to address performance deficits, promote adaptive behavior, and improve children’s self-control and academic and social skills. Considerable evidence exists to indicate that combined approaches are more effective in reducing ADHD symptoms and related academic and social impairments than separate treatments.

Cognitive rehabilitation for children with acquired brain injury

Cognitive deficits are frequent consequences of acquired brain injury (ABI) and often require intervention. We review the theoretical and empirical literature on cognitive rehabilitation in a variety of treatment domains including attention, memory, unilateral neglect, speech and language, executive functioning, and family involvement/education. Because there are more well-designed studies examining the efficacy of cognitive rehabilitation in adults with brain injury, the major findings from this body of literature are also highlighted. In addition, given that similar cognitive and behavioral concerns are often apparent in children with certain neurodevelopmental disorders, selected literature focusing on interventions for these groups of children is included. Limitations and challenges inherent in examining cognitive interventions in children with ABI are also discussed. Overall, despite the growing body of literature examining the efficacy of cognitive rehabilitation in children with ABI, there continues to be a great need to develop well-designed studies to examine the efficacy of these interventions.

Effects of MPH-OROS on the organizational, time management, and planning behaviors of children with ADHD

OBJECTIVE

To evaluate the effects of stimulant medication on organizational, time management, and planning (OTMP) in children with attention-deficit/hyperactivity disorder (ADHD) and ascertain whether OTMP is normalized with medication.

METHOD

Participants included 19 stimulant-naïve children with ADHD (aged 8-13 years) and impaired OTMP functioning, defined as greater than 1 SD below norms on the Children's Organizational Skills Scale. A double-blind, placebo-controlled, crossover design, with 4 weeks of each condition, evaluated medication (methylphenidate-osmotic-release oral system [MPH-OROS]) effects on OTMP, based on the parent and teacher versions of the Children's Organizational Skills Scale. The parent and teacher Swanson, Nolan, and Pelham, Version IV, rating scales assessed ADHD symptoms. "Not impaired" in OTMP was defined as no longer meeting study entry criteria, and "not impaired" in ADHD symptoms was defined as having mean Swanson, Nolan, and Pelham, Version IV, scores of < or = 1.0.

RESULTS

MPH-OROS significantly improved children's OTMP behaviors. These improvements were correlated with significant reductions in ADHD symptoms. However, most of the children (61%) continued to show significant OTMP impairments on MPH-OROS.

CONCLUSIONS

The MPH-OROS reduced children's OTMP deficits, and these improvements were associated with improvements in ADHD symptoms. Some children remained impaired in OTMP even after effective stimulant treatment of ADHD symptoms. These youngsters may require other treatments that target OTMP deficits.

Bridging the gap from availability to accessibility: providing health and mental health services in schools

The state of child and adolescent overall health in the United States evidences the need for both prevention and treatment. Although much time and energy has been spent in recent years discussing and improving health benefit coverage and affordability for children, physical access to services has not kept pace with these changes. This article will introduce four major physical health issues (obesity, diabetes, asthma, and teen pregnancy/STD) and five key mental health issues (suicide, depression, ADHD, aggression, and violence) facing young people today. In an effort to answer the question, "What can be done?" school-based health clinics and their impact on health and educational outcomes are examined.

Organizational-skills interventions in the treatment of ADHD

Children with attention-deficit/hyperactivity disorder (ADHD) often experience problems with temporal and materials organization. These difficulties remain prominent throughout development. For children, organizational problems are most apparent in the school setting and result in impairments such as lost and forgotten homework assignments and inadequate planning for tests. Temporal aspects of organization tend to be most salient for adults with ADHD and manifest as procrastination and missed appointments and deadlines. Skills and strategy training interventions have been developed to address the organizational problems of children and adults with ADHD. Patients are taught systems for managing their time and materials more effectively. Contingency management is often used in conjunction with organizational skills training to promote the use of organizational skills and their generalization. Organizational skills interventions have been evaluated as standalone interventions and part of multicomponent interventions for children, adolescents and adults with ADHD. These interventions are associated with significant improvements in the organization of materials, homework management, time management and planning. There is also some evidence to suggest that organizational improvements lead to reductions in ADHD symptoms and gains in academic functioning. Additional research using randomized controlled research designs and long-term follow-up evaluation is necessary before organizational interventions may be considered established evidence-based interventions for patients with ADHD.

Feasibility and preliminary efficacy of an after-school program for middle schoolers with ADHD: a randomized trial in a large public middle school

OBJECTIVE

This pilot study tests the feasibility and preliminary efficacy of an after-school treatment program for middle schoolers with ADHD using a randomized clinical trial design.

METHOD

A total of 23 students with ADHD (25% female, 48% African American) from a large public middle school were randomly assigned to a 10-week program or to community comparison. Manualized treatment targeted educational, social, and recreational skills, homework completion, and school and home behavior. Parents participated.

RESULTS

Recruitment and randomization targets were easily met (87% completion). Parent and teacher satisfaction was positive. Small to medium treatment effects resulted despite greater medication use in the control group, with improvements in functioning for the program-treated youth or absence of deterioration relative to the comparison group.

CONCLUSION

Despite testing an abbreviated version of the after-school program (< 5 months), this study reveals feasibility and palatability for this intervention and modest beneficial effects on behavioral and academic outcomes.

1Controlled evaluation of a neurofeedback training of slow cortical potentials in children with Attention Deficit/Hyperactivity Disorder (ADHD)

BACKGROUND

Although several promising studies on neurofeedback training in Attention Deficit/Hyperactivity Disorder (ADHD) have been performed in recent years, the specificity of positive treatment effects continues to be challenged.

METHODS

To evaluate the specificity of a neurofeedback training of slow cortical potentials, a twofold strategy was pursued: First, the efficacy of neurofeedback training was compared to a group training program for children with ADHD. Secondly, the extent of improvements observed in the neurofeedback group in relation to successful regulation of cortical activation was examined. Parents and teachers rated children's behaviour and executive functions before and after treatment. In addition, children underwent neuropsychological testing before and after training.

RESULTS

According to parents' and teachers' ratings, children of the neurofeedback training group improved more than children who had participated in a group therapy program, particularly in attention and cognition related domains. On neuropsychological measures children of both groups showed similar improvements. However, only about half of the neurofeedback group learned to regulate cortical activation during a transfer condition without direct feedback. Behavioural improvements of this subgroup were moderately related to neurofeedback training performance, whereas effective parental support accounted better for some advantages of neurofeedback training compared to group therapy according to parents' and teachers' ratings.

CONCLUSION

There is a specific training effect of neurofeedback of slow cortical potentials due to enhanced cortical control. However, non-specific factors, such as parental support, may also contribute to the positive behavioural effects induced by the neurofeedback training.