Organizational skills training for students

Many students, both with and without diagnosed conditions, have executive functioning (EF) deficits that manifest as organization, time management and planning difficulties. EF deficits are highly common among students with ADHD. Our team has been evaluating the effectiveness of the Organizational Skills Training (OST) program, which was developed by researchers at New York University for students in grades 3 to 5. This program has been adapted for implementation in schools (DiBartolo et al., 2021), and our team further adapted it as a Tier 2 school intervention (OST-T2). The findings of our research demonstrated large intervention effects in improving organizational skills and strong effects in improving homework performance (Nissley-Tsiopinis et al., 2024). Our team has also conducted research on a key measure used for evaluating organizational skills deficits: the Children’s Organizational Skills Scale (Ryan et al., 2024).

Our team is also currently conducting a study of the Homework, Organization, and Planning Skills (HOPS) program for students in grades 6 to 8, which was developed by researchers at Virginia Commonwealth University. This study is examining how HOPS is implemented by school professionals in actual practice across a wide range of schools. In addition, the study will evaluate the effectiveness of HOPS and how the quality of implementation is related to outcomes.

Family behavior therapy: family-school success for children with ADHD

Behavior therapy applied at home and school is an evidence-based intervention for children with ADHD. Over the course of many years, our team has conducted research on a comprehensive behavior therapy for children with ADHD between the ages of 6 and 11, referred to as Family-School Success (FSS) for Children with ADHD. FSS has several components, including behavioral parent training, classroom behavioral intervention, family-school collaboration and behavioral homework intervention. This program is provided to families using motivational interviewing strategies to promote engagement in intervention and family implementation of strategies.

Research evaluating FSS has shown that it is effective in reducing negative parenting, improving family-school collaboration and reducing homework problems (Power et al., 2012). In addition, our research has shown that the more parents practice FSS strategies between therapy sessions, the better the outcomes (Clarke et al., 2016). The manual for providing FSS was recently updated in a book published by faculty in CHOP’s ADHD Center (Power et al., 2024). 

Family behavior therapy in primary care: partnering to achieve school success

Families of children with ADHD often face challenges getting access to evidence-based psychosocial care. This is especially the case for families from economically marginalized backgrounds. The Partnership to Achieve School Success program (PASS) was developed to improve access to behavioral interventions for families of children with ADHD from economically marginalized backgrounds. PASS was designed to be provided through pediatric primary care practices and includes behavioral parent training, collaboration with schools, caregiver distress tolerance and collaboration with primary care providers.

Our prior research on PASS demonstrated its promise in reducing barriers to care, improving parenting practices and reducing child impairment (Power et al., 2014). Our team is currently conducting research in partnership with CHOP’s Care Network and the Healthy Minds Healthy Kids program to evaluate the feasibility and effectiveness of PASS post-intervention and at follow-up (Mautone et al., 2024).

Get ready and engaged in ADHD treatment program (GetReady)

Although evidence-based interventions are available for children with ADHD, families often do not pursue these treatments. To promote family initiation of treatments for ADHD, our team has been conducting research on the GetReady program, formerly Bootcamp for ADHD. The GetReady program includes sessions to educate caregivers about ADHD and its treatment, introduce caregivers to effective parenting strategies, discuss medication as an option and educate caregivers about strategies to help their child in school.

Research on GetReady has shown its promise in improving caregiver perceptions of evidence-based interventions, as well as caregiver intent to pursue these treatments (Nissley-Tsiopinis et al., 2022). In addition, an open trial of GetReady indicated the program may be successful in improving actual initiation of evidence-based treatments for ADHD (Normand et al., 2024). 

Medication for preschool children with ADHD

Several studies on the use of medication for treating preschool children with ADHD have been conducted by researchers in our center in collaboration with researchers from other institutions through the Developmental and Behavioral Pediatrics Research Network (DBPNet). Investigators have demonstrated that alpha-2 agonists are commonly used to treat ADHD in preschoolers, and there is substantial variation among clinicians in the use of alpha-2 agonists versus stimulants (Blum et al., 2018).

Subsequent research, based on a review of electronic health records, has shown that a majority of children with ADHD respond favorably to alpha-2 agonists (66%) and stimulant medication (78%)(Harstad et al., 2021). In addition, these investigators have shown that children with ADHD who have low ratings of externalizing and internalizing problems generally respond better to stimulants than alpha-2 agonists, and that children with ADHD who have high ratings of coexisting symptoms generally respond equally well to both types of medication (Blum et al., 2023).

Supporting classroom behavioral interventions

Behavioral classroom management interventions (for example, using high rates of specific, contingent praise) are effective in improving outcomes for elementary school-age children with or at-risk of ADHD. However, teachers face many challenges that may make it difficult to use these interventions frequently. Our team has worked with teachers and other educators to develop the Positive Behavior Management Toolkit (PBMT), a set of resources to support teachers’ implementation of evidence-based classroom management interventions. The PBMT includes a library of resources, including written materials, videos and tangible resources, as well as optional text-message reminders and brief meetings with a consultant. 

We began this work by conducting surveys and interviews with teachers to identify key barriers and facilitators to their use of behavioral classroom management interventions (Lawson et al., 2022). Based on what we learned, we worked in partnership with educators to iteratively develop the PBMT to target these barriers and facilitators, obtaining feedback from teachers throughout its development (Lawson et al., 2024), and then evaluated it in a small-scale pilot study (Lawson et al., 2023). We are now extending this work by developing a complementary set of resources for parents and caregivers.