Promoting Family-School Success for Students with ADHD

1. Promoting Family-School Success for Students with ADHD Thomas Power, Jennifer Mautone, Stephen Soffer, Katy Tresco, Michael Cassano Center for Management of ADHD The Children�s Hospital of Philadelphia Research supported by grants from the National Institute of Mental Health and Department of Education (MH068290, MH080782). Email: power@email.chop.edu

2. Goals of Presentation Description of how family factors influence school functioning Justification of a family-school intervention for students with ADHD Description of components of Family-School Success for students with ADHD Discussion of current status and future directions for research

3. Interventions for ADHD Stimulant medication (MED) Hundreds of studies support the effectiveness of stimulants (short �term effects generally are large) Effective in 80% of cases Behavior therapy (BEH) Numerous studies support its effectiveness Effect sizes are typically moderate Combined Treatment Most effective method for treating impairments Effective using lower doses of treatment (MED and BEH) � Fabiano, Pelham et al. (2007)

4. Behavioral Treatment of School Problems School problems � primary concern 90% - underachievers 80-90% - homework problems Focus of intervention Symptom reduction Less emphasis on impairments Emphasis on uni-systemic treatment School only Family only (focus on home) Failure to capitalize on family�s ability to influence school outcomes

5. Effect of Parent-Child Interaction on School Functioning Parent-child attachment Effect on teacher-student relationship Effect on peer relationships Self-regulation skills Effect on academic enablers (motivation, engagement) Effect on peer relationships

6. Effect of Family Involvement in Education Types of family involvement Involvement in learning at home (reading, homework, limiting TV and computer use) Family-school collaboration (home-school notes, parent conferences) Involvement in school activities (PTA, classroom aide) Family involvement can improve teacher-student relationships, self-regulation, and school performance

7. Risk of Children with ADHD for School Failure Direct effects on school functioning: Academic impairments Social relationship problems (teacher and peer) Indirect effects on school functioning: Interfere with parent-child attachments Interfere with development of self-regulation Reduce family involvement in education at home Adversely affect family-school relationship Conflictual, avoidant parent-teacher relationships

8. Evidence-Based Intervention Components Strengthening parent-child attachments Child-Directed Interaction Training Improving self-regulation skills Parent-Directed Interaction Training Enhancing family involvement at home Homework intervention Developing family-school partnerships Conjoint Behavioral Consultation Implementing daily report cards

9. Family-School Success (FSS) Focus on building parent-child relationships and improving self-regulation skills Focus on family-school interface Improve family involvement at home Improve family-school collaboration Homework problems a primary target for intervention Relatively brief (12 sessions) Targets students in grades 2 to 6

10. Conjoint Behavioral Consultation(Sheridan & Kratochwill, 2008) Model for promoting family-school collaboration Designed to form a partnership to build resources and solve problems Based on Behavioral Consultation Model (Bergan & Kratochwill, 1990)

12. Homework: A Keystone Target Homework is a natural means of family-school collaboration Targeting homework affords an opportunity to improve family-school relationships Homework involves parent-child relationships Targeting homework can reduce parent-child conflict and improve parent involvement in education Homework is an unobtrusive, acceptable way to shape relationships

13. Homework Intervention Context modification Assignment book Appropriate amount of work Proper time and place Goal setting and positive reinforcement. Parent and child collaborate to: Segment homework into units of work Establish goals for each unit � completion and accuracy Evaluate performance Provide positive reinforcement

14. Goal Setting Tool Step #1 - What is my goal? # of items completed: ___ # of items correct: ___ Time: ___ Step #2 - How did I do? # of items completed: ___ # of items correct: ___ Step #3 - Did I reach my completion goal? Yes - far above goal - 2 Yes - met my goal - 1 No - goal not met - 0 Step #4 - Did I reach my correctness goal? Yes - far above goal - 2 Yes - met my goal - 1 No - goal not met - 0 Step #5 - Total Points! =___ Step #3 + ___ Step #4 = ___ Total Points

15. Daily Report Card Teacher provides ratings on a daily basis on one or more target behaviors: Completes work Pays attention; listens to instruction Daily report is sent home to parents Parents provide reinforcement based for goal attainment

16. Sample Daily Report Card 1. Completed seatwork: (3) 95-100% (2) 85 - 94% (1) 70 - 84% (0) Less than 70% 2. Followed teacher instructions: (3) Excellent (2) Good (1) OK (0) Work harder Teacher initials:_____ Total Points:______ Comments:__________________________________

17. Targets of Treatment Family functioning Quality of parent-child relationship Behavior at home Family involvement in education Quality of the parent-teacher relationship Homework performance School functioning Behavior Academic performance

18. Current Research Effectiveness of FSS is being evaluated in a clinical trial 95 children in FSS 95 children in control group (education and support) Study is being conducted in clinic setting Future research will adapt FSS for application in school Current and future research is adapting FSS for younger and older students