Improving Academic Performance: Children With ADHD Research Paper

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[. . .] , 2012). Comparison of the demographic data, including socioeconomic status and race, revealed no significant difference between groups on any measure. At the end of the study period a total of 77 and 87 families in the FSS and CARE programs, respectively, had completed the study. A similar number of teachers were also enrolled in the trial. The outcome variables evaluated included intervention acceptability, homework performance, family investment, quality of parent-child interactions, ADHD symptomology, and academic performance. FSS was rated more acceptable than CARE by parents, but children and teachers rated both programs highly acceptable. Immediately post-intervention, parent as educator and parent-teacher interactions were significantly better for the FSS group, but after a three-month follow-up period only the parent-teacher interaction remained significantly different between groups. The FSS intervention was also associated with significantly better homework productivity and adherence, and lower inattention/avoidance at post-intervention, but any advantage FSS conferred to productivity and adherence was lost by the end of the follow-up period; however, inattention and avoidance remained significantly different between the groups by the end of the follow-up period, but the magnitude of the difference was diminished. The only other outcome measure that benefited from the FSS intervention was parent ratings of negative/ineffective discipline, a benefit that persisted into the follow-up period. Although academic performance was not significantly different between the two groups, it appeared to be trending towards significance (post-intervention, p = .0625; follow-up period, p = .0981).

The findings of Power and colleagues (2012) support the acceptance, feasibility, and academic advantages of the FSS program, when compared to the CARE program. What stands out about this study is the size of the sample, which allowed a research strategy that incorporated randomization to the two intervention groups. The main difference between the two interventions is the teacher-parent collaboration component of the FSS program, which improved parent as educator, homework productivity/compliance, and discipline outcomes; however, ADHD and oppositional-defiant disorder symptomology were equivalent between the two groups.

Teacher Investment

Teacher buy-in for ADHD interventions was formally investigated by Power and colleagues (2009). Approximately half the study participants were enrolled in the FSS intervention and the other half of the study participants were enrolled in the CARE program, with the latter acting as the control condition. Contrary to expectations, the primary predictor of teacher investment into ADHD academic interventions was collaboration prior to the intervention. In addition, family and school adversity, or the severity of attention and behavior problems exhibited by the child, did not have s significant impact on teacher investment. This finding suggests that teacher and school-organizational factors help determine the success of parent-teacher collaborations within an ADHD academic intervention.

Primary Care Investment

In inner-city neighborhoods, access to mental health services can be problematic, especially for minority, low-income families (reviewed by Power et al., 2010). For many families caring for a child with ADHD the Primary Care provider is often the only medical service utilized. Since effective treatment of ADHD depends on a multimodal approach, including primary care providers, Power and colleagues (2010) investigated the role that these medical professionals play in facilitating treatment initiation and adherence. The intervention of interest was the Partnering to Achieve School Success (PASS) program, which is primarily based in the primary care setting. Sessions are held in the clinic and schools, where family members are exposed to strategies designed to promote engagement in treatment and collaborative efforts between the school and primary care provider. The goals are to improve academic performance, educate families about ADHD, engage in behavioral therapy, manage medications effectively, and provide a resource for crisis management.

A total of 66 children diagnosed with ADHD and their families were enrolled in the PASS program (Power et al., 2010). The majority of children enrolled were African-Americans (89%) and most were on Medicaid (68%). During initial contact efforts by primary care clinicians, about 82% of families could be contacted by phone. Of these, nearly 90% agreed to schedule the first intake session and 90% attended. Overall, only 65% ever attended an initial intake session. The authors of this study further analyzed the data and found successful family contact by clinicians predicted an increased chance of family attendance at the first intake session (odds ratio [OR] = 49.0). By comparison, the chances of attending the first PASS session was increased to a lesser extend (OR = 4.3) when family members initiated contact with primary care clinicians. The amount of time spent on the phone discussing and scheduling the PASS program also predicted attendance, with 82% of families spending at least 10 minutes on the phone talking to clinicians attended the first session. By comparison, only 18% of families attended if the phone conversations with clinicians lasted less than 10 minutes.

The findings of this study (Power et al., 2010) revealed that in addition to teacher investment, primary care clinician investment is also important for successful initiation of a multimodal treatment strategy addressing the needs of families caring for a child with ADHD. The feasibility and effectiveness of implementing the PASS program in an inner-city primary care clinic was recently investigated (Power et al., 2014). Preliminary findings suggest that collaborations between schools, primary care clinicians, and families are important and feasible for effective ADHD treatment, although some barriers persist.

Conclusions

With over 10% of all U.S. school children suffering chronically from ADHD and nearly 20% of these remaining untreated, improving academic outcomes for all children depends on how effective ADHD is being diagnosed and treated. The most common treatment approaches are behavioral and stimulant medications, but even when a child is receiving the best medicines and behavioral counseling, academic performance could still suffer. For this reason, a number of psychosocial interventions have been designed to improve academic outcomes for these children.

The psychosocial interventions discussed in this review assume family factors play a critical role in determining academic outcomes, especially the parents. In support of this hypothesis, a number of investigations into the genetic determinants of ADHD revealed an overall modest effect, but one study revealed a strong correlation between families caring for a child with ADHD and family dysfunction (Kaplan et al., 2008). Family dysfunction was defined as problems with intimacy, trust, decision-making, and enjoyment of each other's company. When compared to the symptoms of ADHD, including poor listening skills, disorganized, easily distracted, and avoidance of mentally-challenging tasks, the possibility that the genetic factors contributing to the prevalence of ADHD could also be contributing to family dysfunction seems more than plausible. Regardless of whether this turns out to be true, psychosocial interventions encouraging the participation of parents, teachers, and primary care providers appear to be providing the best academic outcomes.

The HSP program trains and encourages parents to engage teachers in addressing the attention and behavioral problems that can occur at home and school (Habboushe et al., 2001), but to address variable teacher investment in psychosocial interventions parents were taught the skills necessary to become a parent-teacher and how to consult with teachers (Raggi et al., 2009). At the extreme end of the continuum the FSS program actually recruits teachers to become involved in sessions attended by parents and counselor (Power et al., 2012). The underlying message from these series of studies is that parents and their children will invest in treatment paradigms designed to increase academic performance, but teacher buy-in to these interventions will be highly variable.

The remaining stakeholders considered to be relevant to academic outcomes are primary care providers, because minority, low-income patients rarely have the resources to seek specialty care. The findings of Power and colleagues (2010) clearly reveal that the willingness to invest in a psychosocial intervention by the primary care provider plays a significant role in determining parent compliance with treatment recommendations. In contrast to the HSP and FSS programs, the PASS program sessions are held at primary care clinics and within the school setting.

Overall, these psychosocial interventions have been shown to improve academic outcomes, lower the incidence and severity of behavioral problems, and reduce parent stress. The only remaining issue seems to be increasing teacher and primary care provider investment in the academic outcomes of children suffering from ADHD.

References

CDC. (2013). Attention deficit hyperactivity disorder (ADHD): Data & statistics. Retrieved from http://www.cdc.gov/ncbddd/adhd/data.html.

CDC. (2014). Attention deficit hyperactivity disorder (ADHD): Symptoms and diagnosis. Retrieved from http://www.cdc.gov/ncbddd/adhd/diagnosis.html.

Dang, M.T., Warrington, D., Tung, T., Baker, D., & Pan, R.J. (2007). A school-based approach to early identification and management of students with ADHD. Journal of School Nursing, 23(1), 2-12.

DuPaul, G., & Power, T.J. (2008). Improving school outcomes for students with ADHD: Using the right strategies in the context of the right relationships. Journal of Attention Disorders, 11(5), 519-21.

Habboushe, D.F., Daniel-Crotty, S., Karustis, J.L., Leff, S.S., Costigan, T.E., Goldstein, S.G. et al., (2001). A family-school homework intervention program for children with attention deficit hyperactivity disorder. Cognitive and Behavioral Practice, 8(2), 123-36.

Hauk, L. (2013). AAP releases guideline on diagnosis, evaluation, and treatment of ADHD. American Family Physician, 87(1), 61-2.

Kaplan, B.J., Crawford, S.G., Fisher, G.C., Dewey,… [END OF PREVIEW]

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