An Assessment of Generalization Across Settings of a Parenting Strategies Program for ADHD Children

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1 Western Mchgan Unversty ScholarWorks at WMU Dssertatons Graduate College An Assessment of Generalzaton Across Settngs of a Parentng Strateges Program for ADHD Chldren Barbara M. Todd-Nelson Western Mchgan Unversty Follow ths and addtonal works at: Part of the Dsablty and Equty n Educaton Commons, and the Expermental Analyss of Behavor Commons Recommended Ctaton Todd-Nelson, Barbara M., "An Assessment of Generalzaton Across Settngs of a Parentng Strateges Program for ADHD Chldren" (1997). Dssertatons Ths Dssertaton-Open Access s brought to you for free and open access by the Graduate College at ScholarWorks at WMU. t has been accepted for ncluson n Dssertatons by an authorzed admnstrator of ScholarWorks at WMU. For more nformaton, please contact mara.bundza@wmch.edu.

2 AN ASSESSMENT OF GENERALZATON ACROSS SETTNGS OF A PARENTNG STRATEGES PROGRAM FOR ADHD CHLDREN by Barbara M. Todd-Nelson A Dssertaton Submtted to the Faculty of The Graduate College n partal fulfllment of the requrements for the Degree of Doctor of Phlosophy Department of Psychology Western Mchgan Unversty Kalamazoo, Mchgan December 1997

3 L AN ASSESSMENT OF GENERALZATON ACROSS SETTNGS OF A PARENTNG STRATEGES PROGRAM FOR ADHD CHLDREN Barbara M. Todd-Nelson, Ph.D. Western Mchgan Unversty, 1997 When collapsed across gender and subject pools, Attenton-Defct/ Hyperactvty Dsorder (ADHD) affects three to fve percent of school-aged chldren (DSM- V, 1994). ntervenng upon envronmental contngences for ADHD-dagnosed chldren s one of the least ntrusve forms of treatment and s often very effectve (Atkeson & Forehand, 1978; Forehand & Kng, 1977; Barkley, 1986; Webster-! Stratton, 1993). As noted by many researchers (Allen, Tamowsk, Smonan, Ellott & Drabman, 1991; Drabman, Hammer, & Rosenbaum,1979; Stokes & Osnes, 1989), t s necessary to assess generalzaton of treatment effects across the behavor therapy lterature. Few have examned generalzaton from the home settng to the classroom. Snce many referrals occur when problem behavors are exhbted at school (Al-ssa, 1982) generalzaton to ths settng s of partcular nterest. The purpose of ths study was to assess mprovements n classroom behavor consstent wth those acheved at home, followng a Parentng Strateges Tranng Program. Results demonstrated «1 clncally sgnfcant mprovements for the expermental subjects at post-test (Tme 3) [ and follow-up (Tme 4 ). As such, there s evdence to suggest that treatment gans E obtaned through the Parentng Strateges Program can be generalzed to the classroom t settng. Furthermore, results suggest that ths nterventon s an effectve method for dong so. However, treatment gans were nconsstent for some dependent measures. Further study would be benefcal to determne whch varables are lkely to ncrease the chances of consstently obtanng treatment gans for any partcular subject.

4 NFORMATON TO USERS Ths manuscrpt has been reproduced from the mcroflm master. UM flms the text drectly from the orgnal or copy submtted. Thus, some thess and dssertaton copes are n typewrter face, whle others may be from any type of computer prnter. The qualty of ths reproducton s dependent upon the qualty of the copy submtted. Broken or ndstnct prnt, colored or poor qualty llustratons and photographs, prnt bleedthrough, substandard margns, and mproper algnment can adversely affect reproducton. n the unlkely event that the author dd not send UM a complete manuscrpt and there are mssng pages, these wll be noted. Also, f unauthorzed copyrght materal had to be removed, a note wll ndcate the deleton. Oversze materals (e.g., maps, drawngs, charts) are reproduced by sectonng the orgnal, begnnng at the upper left-hand comer and contnung from left to rght n equal sectons wth small overlaps. Each orgnal s also photographed n one exposure and s ncluded n reduced form at the back of the book. Photographs ncluded n the orgnal manuscrpt have been reproduced xerographcally n ths copy. Hgher qualty 6 x 9 black and whte photographc prnts are avalable for any photographs or llustratons appearng n ths copy for an addtonal charge. Contact UM drectly to order. UM A Bell & Howell nformaton Company 300 North Zeeb Road, Ann Arbor M USA 313/ /

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7 Copyrght by j Barbara M. Todd-Nelson 1997 v

8 ACKNOWLEDGMENTS There are so many who have contrbuted to the completon of my Ph.D. My husband Dr. Todd Nelson has provded constant encouragement throughout ths long process. am extremely thankful for hs patence and love, as well as bs tolerance for my lack of ncome over the past months. Next, to my Mother and Father, who nstlled n me the values, self-confdence, and optmstc outlook that kept me gong even when problems arose, owe a debt of grattude. Furthermore, thank each for provdng support (emotonal and fnancal), as well as housng at dfferent tmes throughout my graduate career. also want to thank my brother, John for hs great sense of humor and endless socal actvtes whch often broke the monotony durng ths process. To my advsor and dssertaton Char, Dr. Kevn J. Armstrong, extend my sncere apprecaton. Wthout hs gudance, flexblty, and avalablty (n person, by phone, E-mal, and FAX) ths research would never have been completed. Kevn has been a great role model and mentor throughout my tranng. n the future, hope to mantan the hgh standards he has mparted to me. am also grateful to my dssertaton commttee members, Dr. Lsa Baker, Dr. Helen Pratt, Dr. Pat Menhold, and especally Dr. Gna Pallotta whose supervson made t possble for me to conduct ths research n Calforna. extend my sncere apprecaton for ther support and flexblty. Fnally, owe a debt of grattude to Sydney and Baley who provded amusement and companonshp, as well as Mark Thompson and Bran Phelps of the Mark and Bran Rado Program and Adam Corrola and Dr. Drew of Love Lnes, all of whom provded entertanment durng the long hours n front of my computer. Barbara M. Todd-Nelson

9 TABLE OF CONTENTS ACKNOWLEDGMENTS... LST OF TABLES... LST OF FGURES... v v CHAPTER. NTRODUCTON... Descrpton of Attenton-Defct/Hyperactvty Dsorder... 1 Etologes... 1 Prevalence of Attenton-Defct/Hyperactvty Dsorder... 2 * * Assessment... 3 j Pharmacologcal Treatment... 4 \ Parentng Strateges Programs... 5 Operatonalzng Generalzaton... 7 Assessment of Settng Generalzaton... 9 Ratonale Purpose Hypotheses METHOD Partcpants j Exclusonary Crtera Settng Measures Dependent Varables Current Status Checklst... 22

10 Table of Contents contnued CHAPTER Home and School Stuatons Questonnares - Revsed Chld Behavor Checklst... Classroom Behavor Assessment nstrument... Drect Observaton... Classroom Observatons... Home Observatons... Observaton Procedures... nterobserver Relablty... Expermenters... ndependent Varables... Expermental Desgn... Threats to nternal Valdty... Procedure... Phase... Phase... m. RESULTS... Current Status Checklst (CSC) (Parent-Completed)... Current Status Checklst (CSC) (Teacher-Completed)... Home Stuatons Questonnare - Revsed (HSQ-R)... School Stuatons Questonnare - Revsed (SSQ-R)... Chld Behavor Checklst (CBCL)... Classroom Behavor Assessment nstrument (CBA)... Drect Observaton n the Classroom (D.O.C.) Baselnes v permsson of the copyrght owner. Further reproducton prohbted wthout permsson.

11 r Table of Contents contnued CHAPTER Drect Observaton n the Classroom (D.O.C.) Drect Observaton n the Home (D.O.H.) Global Parent Ratngs of Complance V. DSCUSSON APPENDCES Summary Parent and Teacher Satsfacton Questonnares Lmtatons and Drectons for Future Research Concluson ; A. Descrpton of the Parentng Strateges Tranng Program f» 1 B. Current Status Checklst (CSC) ' C. Classroom Behavor Assessment nstrument (CBA) D. Parental Permsson / nformed Consent for Expermental Subjects <, E. Recrutment Flyer and Newspaper Advertsement for Expermental Subjects [ J F. Recrutment Letter and Parental Permsson / nformed Consent for Control Subjects j G. Raw Scores for the Chld Behavor Assessment nstrument (CBA) ft H. Procedure for Parents for the Chld Behavor Assessment nstrument (CBA) Recrutment Letter and Outlne for Teacher Partcpaton ] J. Human Subjects nsttutonal Revew Board (HSRB) K. Parent and Teacher Satsfacton Forms BBLOGRAPHY

12 LST OF TABLES 1. Subject Demographc nformaton Percent of Weeks Parents Dd Not mplement nterventon Eghty Percent of the Tme Expermental Desgn Parent Trackng / Percent Complance Current Status Checklst (CSC) Parent (Total Scores) Current Status Checklst (CSC) Parent (nattenton) Current Status Checklst (CSC) Parent (Hyperactve/mpulsve) Current Status Checklst (CSC) Teacher (Total Scores) Current Status Checklst (CSC) Teacher (nattenton) Current Status Checklst (CSC) Teacher (Hyperactve/mpulsve) Home Stuatons Questonnare-Revsed (HSQ-R) School Stuatons Questonnare-Revsed (SSQ-R) Chld Behavor Checklst (CBCL) T-scores Chld Behavor Checklst (CBCL) Number of Scales Elevated j 15. Gassroom Behavor Assessment nstrument (CBA) r * 16. Classroom Observatons (Baselne) Gassroom Observatons. Percent Complance for Expermental Subjects f 18. Gassroom Observatons. Percent Complance for Control Subjects Number of Requests for School Observatons Percent of Classroom Observatons Conducted by Home Observer Percent of Gassroom Observatons When Chldren Were n a Dfferent Class Home Observatons Percent Complance v >

13 Lst of Tables contnued 23. Global Parent Ratngs of Complance... r } f s 5 v

14 LST OF FGURES 1. Parent Trackng Current Status Checklst (CSC) Parent (Total Scores) Current Status Checklst (CSC) Parent (nattenton) Current Status Checklst (CSC) Parent (Hyperactve/mpulsve) Current Status Checklst (CSC) Teacher (Total Scores) Current Status Checklst (CSC) Teacher (nattenton) Current Status Checklst (CSC) Teacher (Hyperactve/mpulsve) Home Stuatons Questonnare-Revsed (HSQ-R) > 9. School Stuatons Questonnare-Revsed (SSQ-R) Chld Behavor Checklst (CBCL) Clncal Scales Elevated Chld Behavor Checklst (CBCL) Summary Scales Elevated l2. Chld Behavor Assessment nstrument (CBA) School Observatons. (Baselne) School Observatons. Percent Complance for Expermental Subjects 75 j. 15. School Observatons. Percent Complance for Control Subjects J 16. Home Observatons Percent Complance r }

15 t CHAPTER NTRODUCTON Descrpton of Attenton-Defct/Hyperactvty Dsorder Attenton-Defct/Hyperactvty Dsorder (ADHD) s defned by the Dagnostc and Statstcal Manual of Mental Dsorders, Fourth edton (DSM-V, 1994) as "... a persstent pattern of nattenton and/or hyperactvty-mpulsvty that s more frequent and severe than s typcally observed n ndvduals at comparable levels of development" (p.78). n addton, some of the symptoms must have exsted pror to the chld's seventh brthday, even f referral occurs later, and those symptoms must be present n more than one settng. The pattern of behavor must be problematc n at! least two lfe areas such as academc, socal or occupatonal (school) domans, and must hnder age-approprate performance n those areas. Fnally, the symptoms must 1 not be better explaned by a dfferent dsorder or dagnoss. Secondary symptoms of ADHD often nclude behavoral noncomplance, reduced frustraton tolerance, poor \ academc performance, troubled relatonshps wth famly members, and more problems wth socal nteractons and peer relatonshps than occur for non-dagnosed j chldren the same age (Johnston, Pelham & Murphy, 1985). Etologes 7 Multple etologes have been suggested to underle the externalzng chld behavor dsorders. n a summary of ths topc, Barkley (1989) noted that early researchers hypotheszed that Attenton-Defct/Hyperactvty Dsorder (ADHD) was caused by bran njury, envronmental toxns or allergens, det, or elevated blood lead 1

16 2 levels. However, emprcal studes have not demonstrated consstent support for these theores (Barkley, 1989; Taylor, 1986). Rather, data suggest that less than fve percent of chldren qualfyng for the dagnoss have dentfable neurologcal abnormaltes (Rutter, 1977). Genetc and bologcal factors have also been nvestgated wth regard to ther relatonshp to ADHD. However, as noted by Ross and Ross (1976), even when ADHD s found to be more common n frst degree relatves than n the general populaton, t s not possble to rule out envronmental or nteractng extraneous factors whch may contrbute as much or more than genetcs. Furthermore, whle a genetc predsposton for ADHD may exst, emprcally studyng the relatonshp s possble ncorporatng only correlatonal methods. Presently, there s no sngle known or accepted cause for the dsorder. nstead, correlatonal research has suggested that several factors may nteract to result n qualfcaton for the dagnoss. Some of these specfc factors may nclude: complcatons durng pregnancy or delvery (Mlberger, Bederman, Faraone, Gute, & Tsuang, n press), maternal alcohol consumpton or smokng durng pregnancy (Mlberger, Bederman, Faraone, Chen, & Jones, 1996), heredtary/genetc or bologcal factors (Barkley, 1989; Ross & Ross, 1976) and envronmental contngences (Taylor, 1986). Prevalence of Attenton-Defct/Hyperactvty Dsorder Accordng to the DSM-V (1994), the dagnoss of ADHD exsts n approxmately three to fve percent of school-aged chldren, when collapsed across gender and subject pools. However, prevalence rates, whch dffer greatly across studes (Al-ssa, 1982) have been reported to range from l%-20%. Also, boys are four to nne tmes more lkely to receve the dagnoss than are grls (Barkley, 1990).

17 3 Assessment Unfortunately, the dagnoss of ADHD s typcally not clear cut Ths s due to the fact that no conclusve physologcal test can be conducted to determne a chld's qualfcaton for the dagnoss. Addtonally, chldren who do meet the crtera for the dagnoss may present qute dfferently due to the many possble combnatons of dagnostc crtera to be met. For nstance, a chld may meet any sx of the nne dagnostc crtera for nattenton, or any sx crtera out of nne for hyper- actvty/mpulsvty. Therefore, two chldren qualfyng for the dagnoss may demonstrate qute dfferent behavoral problems dependng on whch combnaton of crtera are met. As such, they may topographcally appear very dfferent. Gven ths, comprehensve assessment s always necessary when there s a [ queston of problems assocated wth attenton, hyperactvty, and/or mpulsvty. Ths v s further necesstated because the dagnoss of ADHD often overlaps wth Oppostonal Defant Dsorder (ODD), Conduct Dsorder (CD) (Semrud-Clkeman, Hynd, Lorys & F Lahey, 1993; Shapro, & Garfnkel, 1986), socal sklls defcts, mood dsorders, and f t anxety dsorders, as well as mental retardaton, Learnng Dsabltes (LD), and Communcaton Dsorders (DSM-V, 1994; Bederman, Newcom, & Sprch, 1991). * Accordngly, t s necessary to utlze assessment nstruments whch enable the therapst j to rule out these other dagnoses. deally, ths ncludes nstruments wth suffcent nor- [ matve nformaton to nsure that the behavors examned are truly "developmentally napproprate". Smlarly, assessment nstruments whch allow the examner to consder a chld s scores n terms of mental age as well as chronologcal age wll provde addtonal useful nformaton (Barkley, 1987). Furthermore, gven the requrements of the dagnostc crtera, t s necessary to assess the chld's behavor

18 4 wth dfferent caregvers and n dfferent settngs to determne whether problem behavors are due to lackng ablty (chld "can't behave approprately) versus lackng motvaton (chld "won't" behave approprately). t s then possble to determne whether the presentng concerns are pervasve or f the chld's problem behavors occur n specfc domans and are short-lved. Assessment of ths type can be accomplshed by conductng ntervews wth the parent(s), the chld and the teacher(s), by utlzng standardzed behavor checklsts wth multple caregvers, and by observng the chld at home and n school settngs (Barkley, 1986). Wth regard to assessment, Al-ssa (1982) notes that the referral of chldren tends to occur when ther behavor s problematc to adults; especally parents and teachers. n other words, most pathologes n chldren are subjectvely determned by adults. Furthermore, problematc behavors are often perceved to be more nterferng ( once a chld begns school. As such, ths s a common tme for referrals to begn (Al-! 1 ssa, 1982) Pharmacologcal Treatment 1 t! Stmulant medcatons, such as Rtaln (methylphendate), Dexedrne (dextroamphetamne or d-amphetamne), and Cylert (magnesum pemolne) are often r» j used to treat chldren wth the dagnoss of ADHD. However, whle these medcatons j may be effectve, they are not necessarly the best treatment opton. For nstance, they 2 often result n sde effects such as loss of appette, retarded development or growth, jr and dsrupted sleep patterns (Baldessarn, 1985; Barkley, McMurray, Edelbrook, and Robbns, 1990). n addton, the purpose of pharmacologcal treatment s to functon as an adjunct to other treatment modaltes (Julen, 1992), such as parentng strateges tranng, self-control tranng, and behavor management at home and n the classroom.

19 t s mportant to note, however, that there are many chldren today who are treated wth medcaton n the absence of any other form of treatment. n some cases, f a chld's problem behavors are reduced durng pharmacologcal treatment, t s consdered "proof' that the chld qualfes for the dagnoss. The logcal flaws regardng ths treatment outcome are obvous. n addton, n the past t was beleved that psychostmulants had opposng effects on ADHD chldren as compared to non-adhd chldren. Specfcally, t was beleved that a stmulant would ncrease actvty level n a control chld, but would have a paradoxcal or calmng effect on an ADHD chld. However, emprcal studes do not support ths theory (Baldessarn, 1985; Julen, 1992; Wengartner, Rapoport, Buchsbaum, Bunney, Ebert, Mkkelsen & Cane, 1980). Furthermore, treatment outcome studes for chldren undergong stmulant medcaton trals ndcate that mprovements n socal sklls and peer relatons as well as academc performance are lmted when no other treatment modaltes are used n combnaton wth medcaton (Henker & Whalen, 1989). Also, chldren treated wth medcaton typcally undergo "medcaton holdays" (such as on weekends or durng j summers) at whch tme the drugs are not used. n these cases, when no other [ treatment modalty s utlzed, parents may be unable to effectvely cope wth chldren's behavor durng these tmes (Wells, 1987). Fnally, there are some parents who smply prefer to utlze non-pharmacologcal nterventons to address the behavoral dffcultes > ther chldren are exhbtng. Also of nterest s the fact that some research has r suggested that the most effectve treatment outcome occurs when medcaton s used n conjuncton wth behavoral nterventons (Danforth, Barkley & Stokes, 1991). Parentng Strateges Programs ntervenng upon envronmental contngences for noncomplant, oppostonal,

20 conduct dsordered and ADHD-dagnosed chldren s one of the least ntrusve forms of treatment for the chld and s often very effectve (Atkeson & Forehand, 1978; Barkley, 1986; Forehand & Kng, 1977; Forehand, Sturgs, McMahon, Aguar, Green, Wells & Brener, 1979; O Dell, 1974; Webster-Stratton, 1993). For over two decades, behavor management tranng programs have been mplemented wth the parents of chldren dagnosed wth ADHD and other problematc behavors. These programs are typcally referred to as "parent tranng" or "behavoral management strateges tranng" programs, the overall goals of whch have been to ncrease complance rates and ontask behavor n ADHD chldren whle smultaneously decreasng hyperactve and mpulsve behavors (Wells, 1987). Specfcally, parents are taught to track or montor the chld s behavor, reward the chld when she or he s behavng approprately, and remove renforcement or punsh the chld when she or he msbehaves, (whch often s referred as "Tme-Out" from renforcement) (Armstrong, 1995; Forehand, Rogers, Steffe & Mddlebrook, 1984; Patterson, & Gullon, 1968). Numerous studes have examned the effectveness of parentng strateges programs for chldren dagnosed wth ADHD and other behavor problems. Overall, postve results have been demonstrated. For nstance, a revew artcle examnng 70 studes (O'Dell, 1974) ndcated that parentng strateges programs for modfcaton of ADHD-type behavors have provded promsng results. Although the content and the tranng approaches of the programs examned dffered greatly and some of the studes reled solely on subjectve data, most demonstrated effectve behavor change. Ths revew also noted the overall lack of emprcal support for the generalzaton and mantenance of changes n chldren s behavor followng the mplementaton of parentng strateges programs as well as the necessty and relevance of such research. Other studes have concurrently assessed changes n parents followng the permsson of the copyrght owner. Further reproducton prohbted wthout permsson.

21 mplementaton of behavoral nterventons such as those noted. For nstance, Forehand and Kng (1977) examned the effects of a specfc parent tranng program whle smultaneously assessng changes n parental behavor and atttude toward ther chld. Results ndcated that chld behavoral complance was mproved and mantaned over a three month perod. After the study was concluded, parents were found to have smlar atttudes regardng thers chld's level of adjustment as do parents of controls (Forehand & Kng, 1977). Another revew, (Atkeson and Forehand, 1978) examned 24 studes ncorporatng multple outcome measures to examne the effectveness of parentng strateges programs. Although some dfferences were noted across dependent measures, overall results from observatonal data, parent-collected data and questonnares completed by parents ndcated postve results. t was also noted, however, that when the parents were the source of nformaton obtaned, treatment outcome was consstently rated hgher as compared to data obtaned from ndependent observers. Gven ths, t s mportant to ncorporate dependent measures completed by parents as well as by ndependent observers or alternatve caregvers such as teachers or babystters. Dong so provdes the most complete data set possble and nsures that no sgnfcant dfferences exst between nformaton sources. Operatonalzng Generalzaton Drabman, Hammer and Rosenbaum (1979) revewed a number of studes addressng behavor modfcaton, chld behavor and generalzaton of treatment gans. Drabman, et al., (1979) noted that the defnton of generalzaton across studes has vared. For example, Stokes and Baer s (1977) defnton s noted: "The occurrence of relevant behavor under dfferent, non-tranng condtons (.e.,: across subjects,

22 settngs, people, behavors, and/or tme) wthout the schedulng of the same events n those condtons as has been scheduled n the tranng condtons" (p. 350). However, n order to offer a more operatonalzed defnton, the authors developed a "Generalzaton Map" whch provded specfc defntons of four broad categores of generalzaton. These nclude generalzaton across: 1. Tme (Response mantenance) "The contnuaton of a behavor change n the treatment settng followng the wthdrawal of a behavoral program" (p. 206). 2. Settngs "...a change n behavor n settngs separate from the specfc envronment n whch treatment occurred" (p. 207). 3. Behavors "...a change n a behavor not specfcally programmed for t \ change n the behavoral system" (p. 207). 4. Subjects "...a change n the behavor of nontarget subjects..." (p. 207). n addton, after examnng each of the above categores dchotomously and n combnaton, sxteen separate categores of generalzaton were suggested to offer more s J. operatonalzed defntons of generalzaton. The authors' revew of a large number of relevant artcles publshed from ndcated that a paucty of research (zero to fve studes) exsted for the majorty of the 16 generalzaton classes. The authors concluded ther revew by underlnng the mportance and relevance of the assessment of generalzaton of treatment gans n the parentng strateges lterature. Furthermore, they ponted out the necessty of ncludng numerous assessment measures n these t studes (Drabman, et al., 1979). A more recent revew of artcles pertanng to generalzaton of treatment gans n the behavor therapy research and ncorporatng the "Generalzaton Map" (Drabman, et al,. 1979) was conducted by Allen, Tarnowsk, Smonan, Ellott and Drabman (1991). The authors examned 15,141 studes from the years 1978 through 1989

23 f publshed n 28 dfferent behavoraly-based journals. Result ndcated that whle numerous addtonal studes have been conducted over the last two decades addressng generalzaton, almost all of the sxteen categores proposed by (Drabman, et al., 1979) stll lack emprcal scrutny. Stokes and Osnes (1989) also authored an artcle addressng the necessty of and attempts toward generalzaton of treatment effects. To effectvely examne the effects of settng generalzaton of treatment gans followng an nterventon, the authors noted two necessary consderatons. Frst, "Dd the behavor occur n generalzed crcumstances?", and second, "What are the functonal varables whch account for that generalzaton?" (Stokes & Osnes 1989) (p. 340). Furthermore, they ponted out that whle some studes attempt to address the frst consderaton, few have systematcally assessed the second. Assessment of Settng Generalzaton A number of studes have examned settng generalzaton of treatment gans obtaned through parentng strateges programs. However, few have systematcally! r and effectvely examned the generalzaton of treatment effects from the home to the! classroom settng. One reason for ths s that earler studes lacked suffcent [ assessment measures. n some cases, researchers neglected to nclude pretest nformaton, ncorporated only observatonal data, or solely reled on teacher or parent report. Those whch ncluded suffcent assessment procedures dd not consstently demonstrate sgnfcant generalzaton of treatment gans to the school or classroom settngs (Forehand & Atkeson, 1977; Stokes & Osnes, 1989). Wahler (1969) conducted a study to examne settng generalty of chld behavor therapy. Whle an nterventon was conducted n the home wth the parents, no such

24 nterventon took place n the classroom wth teachers. The author conducted functonal analyses at home and at school to assess for smlar contngences lkely to facltate comparable problem behavors as well as the generalzaton of postve treatment effects across settngs. Results demonstrated that napproprate behavors at home were reduced whle comparable behavors n the classroom remaned at baselne. As noted by Forehand and Atkeson (1977) and Stokes and Osnes (1989) ths s typcally the case when no nterventon procedures are n place n the classroom and no specfc programmng for generalzaton s utlzed. These result also suggests some degree of ndependence of settngs wth regard to the devant behavor of chldren. Specfcally, t s lkely that dfferent contngences are operatng across the two settngs. For nstance, teachers are generally less able to provde one-on-one feedback for napproprate behavor as quckly or consstently as are parents. Furthermore, whle teachers may be aware of and utlze general prncples? of behavor modfcaton n ther classrooms, t may be dffcult or mpossble to control the nadvertent renforcement a chld n a group settng receves for napproprate t behavor (e.g., other students laughng when the chld acts out). f! Another study utlzng drect observaton procedures was conducted to assess f the generalzaton of parent tranng treatment effects from the home to classroom r settngs (Forehand, Sturges, McMahon, Aguar, Green, Wells & Brener, 1979). The t. authors used the same drect observaton codng system n the classroom as was utlzed n the home. Ths ncluded measures of chld noncomplance, chld approprate behavor, teacher commands, and teacher attenton. mprovements n behavor were noted at home, however, no programmng for generalzaton was ncorporated. Pretest and Post-test measures demonstrated no evdence for generalzaton to classroom settng, whch s consstent wth the fndngs of Wahler, (1969), Forehand and

25 Atkeson, (1977), Stokes and Osnes (1989). Gven ths nformaton, n order to ncrease the lkelhood of obtanng generalzaton of treatment effects across settngs; specfcally ncreased complance and on-task behavor n the classroom, consstent wth treatment gans at home, t s necessary to ncorporate an nterventon wth the classroom teachers that s as smlar as possble to that whch s n place wth the parents. Ratonale As noted by Allen, et al. (1991), Drabman, et al. (1979), Edelsten (1989), and Stokes and Osnes (1989), the need exsts to address the generalzaton of treatment! effects across the behavor therapy lterature. t s mportant to examne ths ssue gven that chldren who exhbt problem behavors at home often do so n other settngs such as the classroom (Wahler, 1969). Consequently, snce many referrals occur when * problem behavors are exhbted at school (Al-ssa, 1982) generalzaton to the classroom settng s of partcular nterest. Furthermore, when generalzaton to another! settng occurs, more effcent treatment takes place wth fewer resources (Forehand & j' Atkeson, 1977). However, generalzaton to a non-tranng settng such as the classc room, where parents are not present and dfferent functonal varables may be n effect, j. s unlkely to occur unless some sort of nterventon s conducted wth the caregvers n! ths settng (Forehand & Atkeson, 1977; Stokes & Osnes, 1989; Wahler, 1969). ' * Purpose The purpose of ths study was to program and assess for mprovements n classroom behavor consstent wth those acheved at home, followng a Parentng Strateges Program (Armstrong, 199S) (See Appendx A). Specfcally, assessment of

26 » complance and on-task behavor (based on parent reported observatons, parent and teacher-completed behavor checklsts, and drect observatons n the home and classroom), was conducted to determne whether treatment gans were generalzed from the home to the classroom settng. As noted by Drabman et al., (1979), there were four broad categores of generalzaton to be consdered. These ncluded generalzaton across subjects, tme, behavors, and settngs. Assessng generalzaton across subjects was beyond the scope of ths study. That s, t was not possble to ncorporate the resources necessary to smultaneously observe every ndvdual chld n each of the sx classrooms. Furthermore, the mplementaton of ths program occurred at home, and past research ; provdes no evdence to suggest that the behavors of non-targeted subjects n the f classroom would be affected wthout our specfcally programmng for such an outcome. Ths desgn however, allowed assessment of two mportant factors relatng to the generalzaton of treatment effects. Frst, examnaton of generalzaton or mantenance of treatment gans across tme utlzng a two-month follow-up was conducted. For ethcal reasons, a reversal desgn whch would have requred teachers and parents to dscontnue utlzaton of the program (whch was demonstratng treatment gans) was not ncorporated. However, t was requested that partcpants contnue to utlze the treatment program at home and school utlzng at-home consequences through the follow-up assessments. As such, assessment of generalzaton across tme whle the behavoral contngences remaned n effect (Drabman, et al., 1979) was conducted. n the event that parents or teachers had dscontnued use of the program, ths would have been noted and the follow-up assessment would have provded nformaton regardng generalzaton across tme when the program was no longer n effect (Drabman, et al., 1979). However, ths was not

27 13 necessary as all partcpants contnued to use the program through the end of the school year. Second, generalzaton across settngs was the man emphass of ths study and s defned as:.. refer(ng) to a change n behavor n settngs dfferent from the specfc envronment n whch the treatment occurred." (Drabman, et al., 1979; p. 207). Past research has demonstrated that tactcs used to program for generalzaton vary greatly and are rarely done. Ths s most lkely due to the tme and resources requred to do so. Furthermore, n order for a program for generalzaton to become wdely adopted, t must be bref, smple, and easy to mplement for parents, teachers and therapsts. Also, t must bear enough resemblance to the home-based program to facltate generalzaton. Furthermore, as noted by Wahler, (1969), Forehand and Atkeson, (1977), and Stokes and Osnes, (1989), n order to ncrease the lkelhood of obtanng generalzaton from the home to a novel settng such as the classroom, t s necessary to ncorporate a classroom-based nterventon. n ths case, t was one wth consequences to be mplemented at home. Specfcally, parents were taught to mplement a postve pont/response cost program at home, based on the daly report of the teachers, for chld behavors that occurred n the classroom. Hypotheses Hypothess 1: t was expected that at post-test (Tme 3) and follow-up (Tme 4), each of the sx ndvdual expermental subjects' scores on the parent-completed Current Status Checklst (CSC) (See Appendx B) whch s a checklst of the DSM-V (1994) dagnostc crtera for ADHD, would be lower as compared to hs or her own pretest/baselne (Tme 1 and Tme 2) rates, ndcatng fewer problems wth behavors assocated wth the dagnoss of ADHD, (but not to be consdered as evdence that the subject no longer qualfes for the dagnoss).

28 Hypothess 2: t was expected that at post-test (Tme 3) and follow-up (Tme 4), each of the sx ndvdual expermental subjects' scores on the teacher-completed Current Status Checklst (CSC) (See Appendx B) whch s a checklst of the DSM-V (1994) dagnostc crtera for ADHD, would be lower as compared to hs or her own pretest/baselne (Tme 1 and Tme 2) rates, ndcatng fewer problems wth behavors assocated wth the dagnoss of ADHD, (but not to be consdered as evdence that the subject no longer qualfes for the dagnoss). Hypothess 3: t was expected that at post-test (Tme 3) and follow-up (Tme 4), each of the sx ndvdual expermental subjects' scores on the parent-completed Home Stuatons Questonnare- Revsed (HSQ-R) (DuPaul & Barkley, 1992) would be lower as compared to hs or her own pretest/baselne (Tme 1 and Tme 2) rates, ndcatng fewer problems payng attenton and concentratng across stuatons at home. Hypothess 4: t was expected that at post-test (Tme 3) and follow-up (Tme 4), each of the sx ndvdual expermental subjects' scores on the teacher-completed School Stuatons Questonnare- Revsed (SSQ-R) (DuPaul & Barkley, 1992) would be lower as compared to hs or her own pretest/baselne rates (Tme 1 and Tme 2), ndcatng fewer problems payng attenton and concentratng across stuatons at r school. Hypothess 5: t was expected that at post-test (Tme 3) and follow-up (Tme, 4), each of the sx ndvdual expermental subjects' scores on the parent-completed f Chld Behavor Checklst (CBCL) (Achenbach & Edelbrock, 1983) would be closer to the non-clncally sgnfcant range as compared to hs or her own pretest/baselne (Tme 1 and Tme 2) rates, ndcatng fewer problems wth the behavors assessed. Hypothess 6: t was expected that at post-test (Tme 3) and follow-up (Tme 4), each of the sx ndvdual expermental subjects' weekly average scores on the

29 teacher-completed Classroom Behavor Assessment nstrument (CBA) (See Appendx Q would be hgher as compared to hs or her own pretest/baselne (Tme 1 and Tme 2) rates, ndcatng an ncrease n teacher-reported global measures of task completon and complance n the classroom. Hypothess 7: t was expected that at both pretests (Tme 1 and Tme 2), each of the sx ndvdual expermental subjects' rates of complance (as measured by drect observaton) n the classroom would be lower than the sx ndvdual non-dagnosed control subjects observed smultaneously. Hypothess 8: t was expected that at post-test (Tme 3) and follow-up (Tme 4), each of the sx ndvdual expermental subjects' rates of complance (as measured k * by drect observaton) n the classroom would be ncreased as compared to hs or her, own pretest/baselne (Tme 1 and Tme 2) rates. j Hypothess 9: t was expected that, durng the three home observaton» sessons, each of the sx ndvdual expermental subjects' rates of complance (as ; measured by drect observaton) n the home would be ncreased as compared to hs or her own prevous rates. r - t.

30 CHAPTERn METHOD Partcpants The program was offered to ffteen famles to nsure that sx expermental subjects would complete all phases of the study. Followng the ntake, the study ncluded sxteen total subjects (eght control and eght expermental) rangng n age from sx to eleven at the start of the study (See Table 1). All subjects were n manstream elementary school classrooms at least 75% of the tme (due to the fact that t was not feasble to ncorporate ths partcular classroom-based nterventon wth j subjects who have more than one teacher). However, two expermental (and as a ; result, two control) subjects dscontnued partcpaton pror to Phase of the study, whch resulted n a total of twelve subjects (sx expermental and sx control) j completng partcpaton n the study. Durng the ntal phone contact, all parents gave permsson for ther chld's f j school to be aware of ther partcpaton n the Parentng Strateges Program (See ; k Appendx A). Durng the ntake ntervews all parents and teachers verbally reported r that each chld exhbted sgnfcant behavor problems both n the classroom and at k home. However, for some subjects, elevatons on pretest (Tme 1) data were not sgnfcant. These subjects dd contnue partcpaton, however, gven that both parents and teachers reported a need for nterventon and a desre to partcpate. Both sngle and dual parent famles were ncluded. Each control subject was selected from teacher- dentfed, non-dagnosed chldren wth parental permsson to partcpate. These sx controls were each matched wth the expermental subject n hs or her classroom solely 16

31 17 Table 1 Subject Demographc nformaton Subject Gender Age Grade Medcaton? Dagnosed? A Male 11 5 No No B Female 6 Yes Yes C Female 6 1 Yes Yes D Male 10 5 No Yes E Male 8 3 Yes Yes F Male 7 1 Yes Yes for comparsons durng the drect observaton procedures. Fve of the sx expermental subjects were dagnosed wth at least one of the subtypes of ADHD (by a psychologst, a pedatrcan, or a psychatrst) pror to ther ncluson n the study. Addtonally, for the fve who were dagnosed, at some pont t had been recommended that they undergo j treatment for ADHD wth a psychostmulant medcaton such as Rtaln (methylphendate), Dexedrne (dextroamphetamne or d-amphetamne), or Cylert (magnesum pemolne). n order to partcpate t was not necessary that expermental 1 subjects be takng medcaton at the present tme, as long as t had been recommended at»! some tme n the past. (One subject had not been formally dagnosed wth ADHD [A], f f but dd demonstrate elevatons on all pretest (Tme 1) measures. Also, parent and teacher ntake ntervews suggested a hgh lkelhood that ths chld would meet dagnostc crtera for ADHD). Fnally, all twelve subjects had parental permsson/nformed consent, n wrtng from ther parents, to partcpate (See Appendces D and F). Parents and teachers had the opportunty to rase questons or

32 18 concerns at any tme throughout the study. Expermental subjects were recruted n a number of ways. Ths ncluded: (a) Contact wth prncpals, counselors, and teachers at publc elementary schools n north-central Calforna; (b) Contact wth pedatrcans n the same geographcal area; and (c) Contact wth a local chapter of a natonal educatonal and support group for Attenton-Defct/Hyperactvty Dsorder (ChADD). Arrangements had been made for the program to be advertsed n local newspapers (See Appendx E), however, ths was not necessary. nterested parents, pedatrcans, and school professonals were gven flyers descrbng the study (See Appendx E). They were nformed that the goals of the study were to obtan mprovements n complance and task-related behavor at home and to generalze these treatment gans to the classroom settng. They were also nformed that partcpaton would requre approxmately fourteen to sxteen weeks of mplementaton of the sklls learned durng the Parentng Strateges Program (Phase ). The sx non-dagnosed control subjects were recruted by sendng letters nvtng partcpaton and parental consent forms (See Appendx F) to parents of all chldren of the same gender as the target chld n each of the sx classrooms, who were dentfed by the teacher as normal (non-dagnosed) controls wth average classroom behavor. The control subject n each classroom was selected from the pool of parental consent forms j returned to the teacher based on close seatng proxmty to the expermental subjects (as dctated by the drect observaton procedures). t No prerequste sklls were necessary for subjects' partcpaton, and ther hstory, wth the noted exceptons, pror to the study dd not afreet subject's ncluson. f Subjects, parents and teachers were not pad, and partcpaton or excluson had no bearng on grades. The program was provded free of charge.

33 19 Exclusonary Crtera n order to partcpate, t was requred that expermental subjects not undergo a sgnfcant change n ther medcaton status durng the study, such as begnnng or dscontnung medcaton. Throughout both phases of the study, parents were nstructed to nform nvestgators of any changes n dose or medcaton status and these changes were montored to the greatest extent possble. However, dffcultes were noted regardng the montorng of medcal complance. For nstance, one chld attended a prvate school and no supervson was provded regardng complance wth afternoon dose of medcaton. Smlarly, another subject was responsble for takng hs mornng dose, and n some nstances, t reportedly was not taken. t was also requred that no subject have a behavor modfcaton program that was requred to be mplemented wthn the classroom and that was determned to be ncompatble wth ths program. Furthermore, no subject was removed from the manstream classroom for more than 25% of the day for specal servces (.e., resource room support, speech and language servces, etc.). No subject had a pre-exstng!. Secton 504 of the Rehabltaton Act of 1973 or an ndvdualzed Educaton Program (EP) n place (Red & Katsyanns, 1995) whch would prohbt the mplementaton of j* ths nterventon. However, two of the subjects were nvolved n outpatent famly J t p therapy. Dscusson wth the two therapsts was conducted and both ndcated that ther treatment plans dd not address parentng strateges or behavoral nterventons. Pror to the partcpaton of these subjects, both therapsts agreed the program would be useful to ther clents. No subject had physcal dsabltes, gross neurologcal dsorders, psychoss, or mental retardaton (DuPaul, Guevremont, & Barkley, 1992). Subjects wth a dual dagnoss were excluded wth the excepton of those who had a prmary dagnoss of ADHD and a secondary dagnoss of Oppostonal Defant

34 20 Dsorder (ODD) or Learnng Dsorder (LD). These factors were assessed pror to the Parentng Strateges (Phase ) of the study va an ntake ntervew and a background nformaton form completed by parents. Settng The study was based n four north-central Calforna ctes wth populatons rangng from approxmately 20,000 and 300,000. All phases of data collecton for the study were conducted: (a) on the campus of Calforna State Unversty, Stanslaus, (CSUS); (b) n each of the expermental subjects' homes; and (c) n subjects' elementary schools. Meetngs for the Parentng Strateges Program were conducted n conference rooms at the elementary schools for the fve expermental subjects lvng more than ten mles away from the campus of CSUS. For all classroom observatons, to the greatest extent possble, measures were taken to nsure that the subjects were not aware they were beng observed. Specfcally, as n pror research (Schachar, t Sandberg & Rutter, 1986), at the ntal observaton sessons, teachers ntroduced the research assstants as student teachers n the class to observe. The target subjects (one expermental and one non-dagnosed control) were prvately desgnated to the observer(s) by the teachers. By the second set of observatons, ths was no longer necessary. n some cases, expermental subjects recognzed the research assstants from the home observatons as t was not always possble for dfferent undergraduate students to conduct classroom and home observatons. When ths occurred, parents were nstructed to tell the expermental subjects that observers were students from the Unversty who were observng a lot of famles and elementary school classes for a college class. n these nstances, other than sayng "Hello", no nteractons occurred between observers and subjects. Occasons such as these are noted. The

35 21 mplementaton of the contngency program took place n the subjects' homes and was admnstered by ther parents. Consequently, the subjects remaned n famlar, comfortable envronments throughout the study. Measures ntally, the study attempted to ncorporate a multple baselne desgn wth sx expermental subjects. n order to facltate better control over extraneous varables and to help nsure the possblty of replcaton for future studes, to the greatest extent possble, the selected dependent measures targeted objectve, easly defned behavors. n defnng the targets for the present study, two Socal Valdaton methods were ncorporated. Frst, Socal Comparson was utlzed (Kazdn, 1982). Specfcally, the teacher-completed CBA (See Appendx C) requred that teachers compare the behavor of the expermental subject to other students n hs or her class. Ths provded a sample of normatve nformaton pertanng to the ndvdual subject's classroom. Second, Subjectve Evaluaton was utlzed (Kazdn, 1982) by collectng data from both parents and teachers to specfcally dentfy problematc behavors. As noted, both completed the Current Status Checklst (CSC) whch s a checklst of the DSM-V (1994) dagnostc crtera for ADHD (See Appendx B), and the approprate versons of the Home and School Stuatons Questonnares -Revsed (DuPaul & Barkley, 1992) whch provded consensus across caregvers regardng behavors at home and n the classroom whch were n need of nterventon. Dependent Varables The dependent varables were collected va parent-completed checklsts of dagnostc crtera (See Appendx B), teacher-completed checklsts of dagnostc crtera

36 22 (See Appendx B), parent-completed Home Stuatons Questonnare - Revsed (HSQ- R) (DuPaul & Barkley, 1992), teacher-completed School Stuatons Questonnare - Revsed (SSQ-R) (DuPaul & Barkley, 1992), parent-completed Chld Behavor Checklst (CBCL) (Achenbach & Edelbrock 1983), teacher-completed Classroom Behavor Assessment nstrument (CBA) (See Appendx C), as well as drect observaton n the classroom and home. C u r r e n t S t a t u s - C h e c k l s t A number of studes have provded support for the utlty of parent and teacher! dentfcaton of the presence of ADHD symptoms when used n conjuncton wth professonal assessment (Pelham, Gnagy, Greenslade, & Mlch 1992; Newcom, Halpern, Schwartz, Pascualvaca, Wolf, Schmedler, & Sharma, 1994). Therefore, for the sx expermental subjects, parents and teachers completed the Current Status Checklst (CSC) (See Appendx B) whch s an 18 tem checklst of the DSM-V (1994) r dagnostc crtera for ADHD. The tems to be consdered specfcally address natten- [ ton, as well as hyperactvty and mpulsvty. Ths nformaton was obtaned to verfy agreement wth the ADHD dagnostc status and to provde general nformaton regard* t ng problem behavors present at home and n the classroom pror to the mplementaton of the nterventon (postve pont / response cost program). Global scores were totaled for all dagnostc crtera endorsed (scores could range from 0-18), for dagnostc crte- 7* ra endorsed addressng nattenton (scores could range from 0-9), and for dagnostc tr crtera endorsed addressng Hyperactvty/mpulsvty (scores could range from 0-9). Ths checklst was admnstered on four occasons. The frst, at baselne one (Tme 1) pror to the begnnng of the Parentng Strateges (Phase ) of the study. The second admnstraton (baselne two) (Tme 2) occurred after the Parentng Strateges

37 (Phase ) of the study and pror to the classroom nterventon (Phase ). The thrd admnstraton (Tme 3) occurred after approxmately two to four weeks of mplementaton of the classroom nterventon and the fourth admnstraton (Tme 4) occurred at two month follow-up. n addton, parents and teachers were asked to report specfcally on behavors occurrng n the past week to nsure they were reportng the "current" status of the subject's behavor. Ths provded data for the assessment of changes n behavors assocated wth the dagnoss of ADHD followng each stage of treatment as well as mantenance across tme and generalzaton across settngs and caregvers. v c Home and School Stuatons Questonnares - Revsed Parents and teachers also completed checklsts specfcally targetng attenton and concentraton across a number of dfferent stuatons. These ncluded the Home Stuatons Questonnare-Revsed (HSQ-R) (DuPaul & Barkley, 1992) (for parents) and the School Stuatons Questonnare-Revsed (SSQ-R) (DuPaul & Barkley, 1992) (for teachers). The HSQ-R asks parents whether ther chld s exhbtng problems n each of 16 stuatons. f so, parents are then asked to ndcate the severty of the prob-, lems n that gven stuaton on a scale of 1-9 (mld to severe). Total scores could range from 0-144, wth zero reflectng no problems. The SSQ-R asks teachers whether ther student s exhbtng problems n each of 13 stuatons. f so, teachers are then asked to 5 ndcate the severty of the problems n that gven stuaton on a scale of 1-9 (mld to se j4 vere). Total scores could range from 0-117, wth zero reflectng no problems. These questonnares have demonstrated the necessary relablty and valdty when used for ths purpose (DuPaul & Barkley, 1992). These measures were also admnstered on four occasons. The frst, at baselne one (Tme 1) pror to the

38 24 begnnng of the Parentng Strateges (Phase ) of the study. The second admnstraton (baselne two) (Tme 2) occurred after the Parentng Strateges (Phase ) of the study and pror to the classroom nterventon (Phase Q). The thrd admnstraton (Tme 3) occurred after approxmately two to four weeks of mplementaton of the classroom nterventon and the fourth admnstraton (Tme 4) occurred at two month follow-up. Ths allowed assessment for changes n attenton and concentraton across stuatons followng each stage of treatment as well as mantenance across tme and generalzaton across settngs. Chld Behavor Checklst The Chld Behavor Checklst (CBCL) (Achenbach & Edelbrock 1983) ncludes 20 questons related to socal competence and 118 questons addressng emotonal and physcal ssues. Resultng scores provded eght clncal scales as well as three summary scales whch nclude externalzng, nternalzng, and total ndces of global functonng. The CBCL has demonstrated adequate test-retest relablty (Achenbach & Edelbrock, 1983), and has been found to be useful n dscrmnatng chldren wth problems related to the dagnoss of ADHD from chldren wth problems relatng to other dagnoses (Mash & Johnson, 1983a). The CBCL was also admnstered at four * tmes of testng. The frst occurred at baselne one (Tme 1) pror to the begnnng of» the Parentng Strateges Program (Phase ) of the study. The second admnstraton ' (baselne two) (Tme 2) occurred after the Parentng Strateges (Phase ) of the study j and pror to the classroom nterventon (Phase ). The thrd admnstraton (Tme 3) occurred after approxmately two to four weeks of mplementaton of the classroom nterventon and the fourth admnstraton (Tme 4) occurred at two month follow-up.

39 25 Classroom Behavor Assessment nstrument Gven the mportance of a global assessment of how problematc classroom behavors were for each expermental subject (Kazdn, 1982), the study programmed for generalzaton by tranng teachers to report classroom behavor and workng wth parents to mplement a contngency program at home that was based on teacher- reported classroom behavor (Forehand & Atkeson, 1977). To accomplsh ths, teachers completed the Classroom Behavor Assessment nstrument (CBA) (See Appendx C) whch s a global measure assessng the frequency, ntensty, and severty of non-complant and off-task behavor occurrng n the classroom. Ths measure was desgned specfcally for ths study and s based on one devsed by Drabman, (personal communcaton, Aprl, 1995). t was used as a dependent measure to assess changes n each chld's on-task and complant behavor n the classroom. Specfcally, for each day that the nterventon was n effect, teachers provded two daly global ratngs on a L Lkert-type scale for the expermental subject n ther class. Scores could range from one to ten for complance and one to ten for on-task behavor resultng n daly scores rangng from two to twenty. A score of one descrbed complete absence of complant j and/or on-task behavor, whle a score of ten descrbed the subject's complant and/or [ ( on-task behavor as excellent when compared to the average student n the class. t (Scores of eght were "average" compared to the rest of the class and were the target scores for expermental subjects). The daly scores obtaned on the CBA were used to determne rewards and punshments for the contngency program to be mplemented by parents at home. The CBA also ncorporated a parent-teacher communcaton / homework sheet (bound nto a notebook) whch was returned wth each subject each day that the nterventon was n effect. Ths notebook was used to nform parents of the subjects' daly obtaned global ratngs, homework assgnments to be completed that

40 26 evenng, upcomng tests or quzzes, and test scores earned that day. Ths enabled parents to montor homework completon and grades earned for the expermental subjects throughout the study. The CBA was admnstered daly for one week, at baselne one (Tme ) pror to the begnnng of the Parentng Strateges Program (Phase )- The second admnstraton of the CBA (at baselne two, Tme 2) occurred daly for one week after the Parentng Strateges program and pror to the classroom-based postve pont / response cost program (Phase ). Durng these tmes of testng, scores were not sent home, parents and chldren were not nformed of scores, and no consequences were ncorporated regardless of subjects' obtaned scores. At the start of the classroom-based nterventon, the measure was completed daly by the teachers through the end of the school year (approxmately two-month follow-up). At ths tme, scores were sent home daly and expermental subjects earned rewards or lost prvleges based on those scores. Drect Observaton Unobtrusve drect observatons n the naturalstc settngs (home and classroom) were conducted to objectvely assess for complance followng parent and teacher requests and commands. Drect observaton of subjects pror to both the homet= (Tme 1) and school-based (Tme 2) nterventons were conducted to provde a baselne «of behavor and to examne for trends. Drect observatons durng (Tme 3) and after f» (Tme 4 ) mplementaton of the nterventon were conducted to provde assessment and mantenance of behavor change across tme. C l a s s r o o m O b s e r v a t o n s Whle the codng system used n the classroom would deally have been the

41 same as that used by parents n the home (Forehand, et al., 1979), the amount of tme requred (parents each observed for one hour daly) made ths mpossble. nstead, twelve observaton sessons per expermental subject were conducted by undergraduate research assstants. Multple observaton sessons were used to help prevent reactvty on the part of the teacher (better requests/ prompts resultng n chld behavor appearng mproved when no actual changes have occurred) or reactvty on the part of the chld (behavng better or worse) when an observer was present n the classroom. Furthermore, ths number of observatons more powerfully demonstrated generalzaton effects, enabled dentfcaton of trends n behavor, and demonstrated the stablty of behavor change n the classrooms Classroom observaton sessons occurred three tmes at baselne one (Tme 1) f pror to the begnnng of the Parentng Strateges Program (Phase ) of the study, three ( tmes followng Phase 1 and pror to the classroom nterventon (Phase ), (baselne 2, t} Tme 2) three tmes durng the frst two to four weeks of mplementaton of the classroom-based program (Tme 3), and three observatons n one week conducted at two month follow-up (Tme 4). : Home Observatons f j" Drect observatons were conducted n the homes of each of the expermental subjects on three occasons. These observatons were conducted to verfy that parents were correcdy mplementng the sklls learned n the Phase of the study (.e.: recogn- \ ton of chld complance or noncomplance, use of rewards and postve ponts, use of tme-out from renforcement, and use of back-up punshers). However, n contrast to other studes occurrng smultaneously, (Channell, 1997; McGrath, 1997), feedback was provded to the parents at the next sesson. Specfcally, acknowledgement was

42 28 made f they had been correctly mplementng the sklls, but when they were not, the method for dong so was revewed. Home observatons were also conducted to objectvely assess chld complance followng parent requests and commands. The three home observatons occurred durng each of the three stages of the Parentng Strateges program. The procedure for the frst home observaton regardng the assessment of complance was smlar to that utlzed for classroom observatons. The procedures for the second and thrd home observatons as well as the tranng of research assstants for these observatons s descrbed elsewhere (McGrath, 1997). Observaton Procedures r t Durng the ntal observaton sessons, observer(s) remaned n the home or } classroom for approxmately fve to ten mnutes pror to begnnng n order to allow subjects and other students and/or famly members to habtuate to ther presence. Observaton sessons lasted approxmately one hour, and behavors were observed and coded sequentally. For all classroom observatons and for the frst home observaton, the observer(s) recorded occurrence or nonoccurrence of complance, the type of request that occurred pror to the response, and the parent's or teacher's response to the. chld's behavor durng each tme perod. Therefore, the observer(s) also recorded functonal relatonshps of behavor (Stokes & Osnes, 1989), by collectng data on the antecedents and consequences of the occurrng behavor. These data provded f nformaton regardng behavors occurrng sequentally whch resulted n a greater knowledge base about the varables mantanng the behavor (Kazdn, 1982). To the greatest extent possble, all observatons for ndvdual subjects were conducted at the same tme of day, durng tmes when parents and teachers reported they were lkely to make numerous requests. For the teachers, these ncluded requests made to the class as

43 f. 29 a whole as well as to ndvdual students. Unfortunately, there were occasons when the class left the regular classroom for extra-currcular actvtes (Physcal Educaton, musc, etc.) that were not known about n advance. These are noted and when possble, the observatons were rescheduled. nterobserver Relablty As n pror research, (Channell, 1997; McGrath, 1997), observers were traned usng a revew of defntons, role playng and dscusson of codng categores. For one of every three observaton sessons, there were two observers (33% of the tme). Durng the other 66% of the tme, there was one observer who observed both subjects sequentally. Subjects were observed and behavors were recorded sequentally as opposed to usng a tme nterval. Ths was due to the fact that the behavors observed dd not occur at a hgh enough frequency to necesstate nterval codng. Durng the observaton sessons, observers were spaced at least three meters apart n the classroom or home to nsure they were observng ndependently. Agreement was calculated usng the formula (A / A + D * 100), where A = agreement and D = dsagreement. To the greatest extent possble, the behavors to be observed were operatonally defned and ^ dscrete n order to reduce the lkelhood of changes due to varyng judgements of ob- servers. Steps were also taken to control for nstrumentaton effects, and to ncrease the relablty, accuracy and consstency of behavors observed durng the drect observaf ton sessons. Despte ths, however, due n part to the fact that observers were typ- cally seated on opposte sdes of the classrooms, t was dffcult to obtan relable observatonal data. Specfcally, both observes often dd not hear or see all of the same nteractons between the expermental or control subjects and the teacher. Followng the ntal set of observatons at baselne one (Tme 1), nterobserver relablty was ex

44 tremely low, wth a mean of 64% (range 23% - 93%). Followng ths, observer retranng was conducted n attempt to ncrease relablty. However, sgnfcant ncreases were not noted, and followng the second set of observatons, nterobserver relablty remaned low, wth a mean of 68% (range 38% - 100%). However, once agreement on requests was controlled, agreement was generally hgher; wth a mean of 94% (range 84% -100%). E x p e r m e n t e r s All phases of the study were supervsed by a fully lcensed psychologst. There were sx expermenters n the study. The Parentng Strateges Program (Phase ) was presented by one specally traned doctoral level graduate student (who acheved 100% * accuracy on the Knowledge Checks used for parents; See Appendx A). The drect ob- [ servatons for the study were conducted by fve advanced undergraduate (or recently graduated) psychology students. No specal requrements or contngences exsted for not pad, however they had the opton to receve feld work course credt for ther part f'... tcpaton. j the undergraduate research assstants. They were selected based on pror experence wth chldren and an nterest n behavoral nterventons for ADHD chldren. They were No specfc renforcers or punshers were used n ths study other than prase and apprecaton expressed to parents and teachers for ther effort and adherence whle completng questonnares and forms and returnng them on tme. ndependent Varables n order to demonstrate behavor change across settngs, t was necessary to keep the same contngences n effect n the classroom that were n effect at home

45 (Drabman et al., 1979). To that end, expermenters strved to keep the same prncples of behavor n place across settngs as much as possble. Also, n order to nsure that the ndependent varables from Phase of the study were beng mplemented correctly, a number of technques were utlzed. Specfcally, daly observatons by parents, home and classroom observatons by research assstants, and parent-completed record sheets were used to montor ths as well as to determne whether or not the behavor of the subjects mproved at home. Furthermore, t was requred that complance rates for all subjects mprove durng the course of the Parentng Strateges Program (Phase ) (25% mprovement n complance rates from baselne to after 'tme-out' on at least one dependent measure) to contnue partcpaton. These data were ncluded to nsure that any lack of mprovement n a subject's data was not due solely to falure to acheve ntal treatment gans versus falure to generalze those treatment gans across settngs.! n order to establsh and keep contngences the same across settngs, the study ncorporated two phases. The frst phase, (Phase ) ncluded an ntal nterventon whch ncorporated a Parentng Strateges Program (See Appendx A) n whch the parents of the sx expermental subjects partcpated. Ths program was conducted n [ three stages: Trackng, Postve Pont, and Tme-Out. Knowledge checks were [ admnstered followng each stage to nsure that parents had learned the necessary sklls for the upcomng week (See Armstrong, 1995; McGrath, 1997 for addtonal detals) (See Appendx A). The second phase (Phase ) of the study took place wth the parents of the expermental subjects at home and wth the teachers of the subjects n ther classrooms. Whle Phase of the program was referred to as "classroom-based" ths s due to the fact that the classroom was the settng n whch data collecton occurred and treatment outcome for ths porton of the study was assessed. However, consequences for scores earned n the classroom were mplemented by parents at home.

46 The prmary ndependent varable for Phase of ths study was a postve pont/response cost contngency program mplemented by parents at home based on teacher-reported, global, daly obtaned scores on the Classroom Behavor Assessment nstrument (CBA) (See Appendx C). Consequences were smlar to those utlzed n Phase of the study durng the Parentng Strateges Program. Specfcally, each day that the nterventon was n effect, each of the sx expermental subjects obtaned two scores from hs or her teacher rangng from one to ten for complant behavor and from one to ten for on-task behavor. Ths resulted n a total daly score rangng from two to 20. These scores and the parent-teacher communcaton / homework sheet were bound nto a notebook whch was returned wth each subject each day that the nterventon was n effect. Each of the sx expermental subjects was responsble for brngng the notebook from the teacher to hs or her parent(s) at the end of each school day. Falure to do so resulted n a daly obtaned score of ten wth consequences to be mplemented accordngly. At the end of each week, teachers maled data sheets lstng scores earned each day that week and weekly check sheets ndcatng that they gave the notebook to the chld each day and that they had not nsttuted any new behavoral program for the target chld daly (See Appendx C). Rates were calculated to determne the teacher's rate of complance for each. Complance rates were at least 90% for returnng the form and 100% for not nsttutng a new behavoral program for contnued partcpaton n the study (wth the excepton of changng the classroom seatng arrangements, or changes to a program already n place that were appled to the whole class; such as puttng names on the board for msbehavor). Due to ther partcpaton n Phase of the study, subjects were famlar wth the postve pont / response cost program. As such, they were nformed by ther parents pror to the commencement of Phase n, that ther total daly obtaned scores (home

47 score -- school score) would determne ther bedtme and/or other consequences (chosen on an ndvdual bass) for that nght (See Appendx H). Dependng on the ages of the expermental subjects, parents were asked what the "usual" bedtme was for ther chld. f the parent(s) chose to use bedtme as a response cost, total daly obtaned scores of 16 (whch s consdered average behavor compared to the class wth mnmal off-task and noncomplant behavor) or hgher resulted n no change n bedtme. No parents chose to use later bedtme as a reward for hgher scores. Rewards were earned when expermental subjects obtaned total daly scores of 20+ (school score [range of 2-20 ponts]+ home score; complance [no maxmum] and chore ponts [two ponts maxmum]). Daly school scores below 16, resulted n the subject losng tme pror to bedtme n half hour ncrements, 21 loss of one back-up punsher. For example a score of could result n the subject gong to bed one half hour earler (e.g.: from 8:00 pm to 7:30 pm) q loss of one back-up punsher (e.g.: not watchng televson for that evenng). Scores of resulted n a one hour earler bedtme (e.g.: from 8:00 pm to 7:00 pm), q l one half hour earler bedtme and loss of one back-up punsher. Scores of resulted n a one hour earler bedtme (e.g.: from 8:00 pm to 7:00 pm) and loss of one back-up punsher, g one half hour earler bedtme and loss of two back-up punshers. Scores below 10 resulted n a one hour earler bedtme (e.g.: from 8:00 pm to 7:00 pm) and loss of two back-up punshers, or one half hour earler bedtme a n d loss of three back-up punshers. Three necessary consderatons should be noted. Frst, for the nterventon to be effectve, parents must have already been enforcng, or have been wllng to enforce a standard bedtme. Furthermore, they must have been wllng to make consstent adjustments based on the chld s daly obtaned score. Second, n order for these contngences to be effectve n changng the behavor of the chld, he or she must have

48 vewed gong to bed early as a punshment. n order to determne ths nformaton, parents were asked what was currently happenng at home wth regard to bedtme and how they felt about ncorporatng ths nto the nterventon. n conjuncton wth the use of bedtme as a punsher, consequences for classroom behavor were determned based on renforcer preference and effectve punshers from Phase of the study. Montorng of sleep deprvaton was not necessary as all parents declned use of a later bedtme as a reward for hgh scores. As noted, due to the partcpaton of the parents of the sx expermental subjects n Phase of the study, all subjects were famlar wth the postve pont / response cost system pror to ther ncluson n Phase of the study. n order to ncrease motvaton, at the start of Phase n, all subjects were asked about ther renforcer preferences and were able to choose what t was they wanted to earn n conjuncton wth parental approval. Lsts of sx to eght rewards were generated for each expermental subject. Approxmately half were socal and half were tangble. Some were mmedately avalable whle others were delayed. Rewards ncluded, but were not lmted to: Ffteen mnutes "free tme" wth mom or dad, playng a game wth mom or dad, havng a specal treat or dessert, rentng a vdeo move or game, gettng to choose a small, nexpensve "grab-bag" tem, choosng a "puzzle pece" of a large tem (bke, roller blades, etc.), sports tradng cards, gong out to a "fun park", havng a frend spend the nght, gettng a mancure or pedcure from mom or dad, gong out to eat at a favorte restaurant, etc. Daly rewards were chosen that could be realstcally ncorporated each day the chld acheved the necessary score. Gven ths, some rewards (such as gong out to eat n a restaurant) were ncorporated at the parents' dscreton (e.g., wth a lmt of once per week), and were not a regular choce for the chld's daly reward. Back-up punshers ncluded, but were not lmted to: No TV, no outsde play, no bcycle rdng,

49 f 35 no rollerbladng, no vdeo games, etc. for the rest of the nght. n order to nsure that parents were mplementng the approprate consequences at home, they were asked to keep weekly charts on whch they recorded the chld's earned home and school score each day and whether or not bedtme changed or other consequences were admnstered contngently. Ths was developed n conjuncton wth the forms from Phase of the study (See Appendx H). Parents were encouraged to be very honest as accurate data were to ther chld's beneft. These forms were returned n person durng Phase of the study and va postage pad envelopes durng Phase of the study. Unfortunately, n some nstances, parents were unable to mplement consequences at home each week (80% of the tme or 4 out of 5 school days) as was ntally requred. Ths was prmarly due to school vacatons, chld llness, jont parental cust j; tody, or year-round school attenders beng "off-track''. However, n each nstance, due to parental commtment and desre to contnue partcpaton, these ssues were ad- 1 dressed and montored ndvdually. The mportance of consstency was renforced wth the parents, and no subjects dscontnued partcpaton for ths reason. Ths oc-» * f curred as follows for each subject: Table 2 Percent of Weeks Parents Dd Not mplement nterventon Eghty Percent of the Tme Subject A B C D E F Mean Phase 40% 40% 40% 33% 0% 0% 29% Phase 43% 0% 14% 0% 0% 14% 12% t took between four and eght weeks for parents to complete Phase. Durng Phase, parents dd not progress to the next stage of treatment when the nterventon

50 36 had not been mplemented 80 percent of the tme. Durng Phase n, parent's were nstructed to contnue to mplement the nterventon when they were out of town, whch occurred some of the tme. Most often consequences were not mplemented because the chld was not wth the parent partcpatng n the program (vstng grandparents, wth father, etc.). Parents were contacted approxmately weekly by phone to assess ther complance wth the mplementaton of consequences for daly obtaned scores durng Phase n, and to nsure that parents were contnung to mplement the postve pont and tme-out program. The weekly forms were also used to montor each expermental subjects' rate of complance at home. Specfcally, n place of the observatons parents conducted durng Phase of the study, durng Phase n, they were asked to provde a daly global ratng of ther chld s complance (score 1 to 5) and to record the number of tme-outs ther chld had each day (See Appendx H). > f Expermental Desgn 1» non-dagnosed controls for the sole purpose of classroom drect observaton compart f As noted, a total of twelve chld subjects were ncluded. Sx of these served as sons. The other sx served as expermental subjects. n addton, one or both parents of each of the expermental subjects were ncluded. For the sx expermental subjects, characterstcs were relatvely smlar on such factors as ADHD dagnoss and medcaton status (wth one excepton), age, (6-11 years), SES level, and race. However, due to the lmted number of subjects avalable, the ntensve data collecton procedures to be ncorporated, and the uncontrollable homogenety and the possble varaton n subjects who met crtera for partcpaton (e.g., gender, type and dose of medcaton prescrbed, medcaton complance, parent martal status, pervasveness of problematc

51 behavor [home and school, etc.]), ths study ntally attempted to utlze a multple baselne desgn (Kazdn, 1982). Phase of the nterventon was appled randomly to expermental subjects at approxmately one week ntervals. However, due to cancelled appontments, sprng break, chld and/or parent llness, the up-comng end of the school year, as well as parents and teachers' strong desre to move to Phase of treatment, varaton n the schedules occurred. Nevertheless, usng a small number of expermental subjects allowed a more detaled assessment of the behavor of each of the expermental subjects over tme. Use of ths desgn wth multple cases provded nformaton about the stablty of behavors targeted and assessed changes n those behavors before, durng, and after the nterventon and over tme. Wthn subject compar- sons were made whereby each subject served as hs or her own control, and results provded nferences regardng each ndvdual's treatment outcome (Kazdn, 1982). As such, the goal of ths study was not to generalze to the entre populaton of chldren qualfyng for the dagnoss of ADHD, but to ntensely examne a cross-secton of ths, populaton. Whereas group studes do not always allow the expermenter to generalze results to the ndvduals recevng the treatment, ths desgn dd so (Kazdn, 1982). Threats to nternal Valdty Utlzaton of a multple baselne desgn would have provded greater control ( over threats to valdty than the ncorporaton of case studes or group desgns. Gven the aforementoned dffcultes, control for threats related to hstory may have been, compromsed. For nstance, although subjects began Phase at randomly assgned dfferent tmes, four of the sx expermental subjects began Phase at the same tme. Gven ths, there s less certanty that hstorcal events occurrng at the tme of the experment dd not extraneously affect the results. However, all of the expermental

52 38 subjects dd attend dfferent elementary schools n four dfferent ctes. The Parentng Strateges Program (Phase ) was completed wthn a sx to eght week perod and the classroom-based nterventon was completed wthn an addtonal twelve to sxteen week perod, and therefore, t s unlkely that tme passage or maturaton effects affected measures of settng generalzaton. Parents and teachers were requred to complete measures on only four occasons across a twenty week tme perod and chld subjects were not requred to complete any measure at any tme. Therefore, t s unlkely that extraneous effects due to repeated testng nfluenced the results. n order to control for nstrumentaton affects, drect observaton procedures utlzed two observers for 33% of the tme throughout both phases of the study. To the greatest extent possble, the behavors to be observed were operatonally defned and were dscrete whch should have reduced the lkelhood of changes due to varyng judgements of observers. However, as noted, dffcultes occurred regardng the relablty procedures when the requests were not controlled. Gven that each subject served as hs or her own control, (wth the excepton of the drect observaton procedures), and all sx who began Phase completed partcpaton, statstcal regresson and attrton dd not nfluence treatment outcome data. Smlarly, selecton bas was elmnated as a threat to nternal valdty as the nferences to be made dd not depend on comparsons across ndvduals. Fnally, because ths desgn ncorporated two phases of one treatment and no reversals, dffuson of treatment effects was unlkely to affect the results obtaned (Kazdn, 1982). Procedure Phase The frst phase of the study ncorporated a Parentng Strateges tranng program

53 39 for the parents of the sx expermental subjects (See Appendx A). Specfcally, ths program taught parents to: Observe and record ther chld's complant and noncomplant behavor (Stage 1, Trackng), reward ther chld wth attenton, prase and ponts for approprate behavor (Stage 2, Postve Pont), and utlze tme-out and back-up punshers effectvely for noncomplant behavor (Stage 3, tme-out). (For a more detaled descrpton of ths program, see Armstrong, 1995). Phase The second phase of the study ncorporated technques to facltate generalzaton of treatment gans from the home settng to the classroom settng. Steps were taken n each classroom to ncrease the lkelhood that generalzaton would take place n ths settng. Specfcally, ths ncluded the followng: f! 1. A postve pont/response cost contngency program was ncorporated wth consequences to be mplemented at home based on each expermental subject's ; behavor n the classroom. Ths allowed the ncorporaton of contngences n the classroom smlar to those utlzed at home. Specfcally, the teachers completed the ; Classroom Behavor Assessment nstrument (See Appendx C) daly. As noted, ths f measure globally assessed each chld's daly complance and on-task behavor, based on teacher report 2. A short handout was gven to the teachers descrbng the Parentng Strateges Program that the parents of the expermental subjects underwent (See Appendx ). 3. An approxmately fve to ten mnute long phone conference was held wth each teacher. Ths provded an opportunty for the educaton of teachers about ADHD (f necessary), dscusson regardng the necessty for classroom nterventons

54 Table 3 Expermental Desgn Parent Tranng Parent Tranng Parent Tranng Classroom Post-Test 2 Month (Trackng) (Postve Pont) (Tme Out) nterventon Follow-Up (4-8 Weeks) (1 Week) (2-4 weeks) (1 Week) Measure Tme 1 Tme 2 Tme 3 Tme 4 CSC X X X X HSQ-R X X X X SSQ-R X X X X CBA1 1 Week 1 Week Through *. * _ Follow-Up ** + D.O.H X X X X D.O.C. X X X X X X X X X X X X o

55 Table 3--Contnued Legend. CSC = Current Status Checklst. HSQ-R = Home Stuatons Questonnare - Revsed. SSQ-R = School Stuatons Questonnare - Revsed CBA = Classroom Behavor Assessment nstrument. CBCL = Chld Behavor Checklst. D.O.H. = Drect Observaton n the Home. D.O.C. = Drect observaton n the Classroom. * - = Assessment wthout the mplementaton of at-home consequences. ** + = Assessment wth the mplementaton of at-home consequences.

56 concurrent wth home nterventons, clarfcaton of the goals of the Parentng Strateges Program, determnaton when observaton sessons should take place, revew of the defnton of complance, assessment of subjects' baselne rate of classroom behavor, bref assessment of the degree of rules and structure n the classroom, and dscusson of specfcs regardng the nterventon to be mplemented n the classroom. Dependent measures were admnstered on four occasons. The frst, at baselne one (Tme 1) pror to the begnnng of the Parentng Strateges (Phase ) of the study. The second admnstraton (baselne two) (Tme 2) occurred after the Parentng Strateges Program (Phase ) of the study and pror to the classroom nterventon (Phase ). The thrd admnstraton (Tme 3) occurred after approxmately two to four weeks of mplementaton of the classroom nterventon and the fourth admnstraton : (Tme 4) occurred at two month follow-up. Ths allowed for assessment of changes n 1 behavor followng each stage of treatment as well as mantenance across tme. The ndependent varables were n effect for a total of twelve to sxteen nonconsecutve 1 weeks (See Table 3). J

57 CHAPTER m RESULTS Overall, t was expected that the expermental subjects would perform better on the dependent measures at post-test (Tme 3) and follow-up (Tme 4) than at pre-tests (Tme 1 and Tme 2). Multple baselne and case study desgns ncorporatng a small number of expermental subjects have hstorcally strved to acheve clncally sgnfcant treatment outcomes as opposed to statstcally sgnfcant ones. Gven ths, results are addressed usng vsual nspecton of data rather than statstcal analyses (Kazdn, 1982). Data are dsplayed n table and lne graph form. Specfcally, the followng areas have been examned: 1. Mean - The shft n average rate of performance across tme (calculated for all measures). 2. Trend - The systematc ncreases or decreases n scores (calculated for CBA only; See Appendx G). f j ntally, latency (defned as how quckly the behavor changes once the nterventon s n effect [Kazdn, 1982]), was to be examned, however gven the slow gradual m- provement n scores across the weeks, ths nformaton was not useful. As a manpulaton check, t was requred that all sx expermental subjects demonstrated change n behavor (a mnmum of 25% ncrease n complance) on at j least one dependent measure at the end of Phase followng the Parentng Strateges Program. All subjects dd so and contnued partcpaton nto Phase n. Although not all parents returned observatonal data every week, complance rates based on parent observaton mproved a mnmum of 66% and a maxmum of 466%. Mean 43

58 44 mprovement was 181% (See Table 4, Fgure 1). Observatons were conducted by both parents for two of the subjects (C, E). Table 4 Parent Trackng / Percent Complance Subject A B C D E F Week# Mean 32% 33% 31% 18% 44% 12% 28% 2 N/R 44% 32% 51% 44% 19% 38% 3 49% 54% N/R 43% 53% 25% 45% 4 53% 53% N/R 42% 62% 22% 46% 5 N/R 80% N/R N/R 63% 47% 63% 6 N/R N/R N/R N/R 82% 68% 75% 7 N/R N/R 90% N/R 82% N/R 86% Percent mproved 66% 142% 190% 133% 86% 466% 181% 1 tr For all dependent measures, when two parents were reportng on the same chld, the mother s score was used for comparson purposes, however, both scores are p ncluded on the table wth the fathers' scores n parentheses. The mother s score was used because, n all cases n whch both parents completed measures, the mother attended all tranng sessons durng Phase whereas the two fathers partcpatng dd not. Furthermore, past research has typcally emphaszed the report of the mother (Armstrong, Channell, McGrath, & Maertsch, 1997), and less nformaton s currently avalable regardng father-completed data.

59 Q <0 - s A B C 0 E F Mean Week Number Fgure 1. Parent Trackng. Current Status Checklst (CSC) (Parent-Completed) t was expected that at post-test (Tme 3) and follow-up (Tme 4), each of the sx ndvdual expermental subjects' total scores on the parent-completed Current Status Checklst (CSC) (See Appendx B) whch s a checklst of the DSM-V (1994) dagnostc crtera for ADHD, would be lower as compared to hs or her own pretest/baselne rates (Tme 1 and Tme 2), ndcatng fewer problems wth behavors assocated wth the dagnoss of ADHD (but not to be consdered as evdence that the subject no longer qualfes for the dagnoss). For all sx expermental subjects, scores at each of the four tmes of testng are presented n table and lne graph form. Scores have been vsually examned for

60 t 46 changes n mean across tme. Global scores have been examned for the total number of tems endorsed (scores could range from 0-18) (See Table 5, Fgure 2) as well as separately for tems endorsed addressng nattenton (scores could range from 0-9) (See Table 6, Fgure 3) and tems endorsed addressng Hyperactvty/mpulsvty (scores could range from 0-9) (See Table 7, Fgure 4). Overall, at pretest (Tme 1), expermental subjects had parent-reported mean scores on the CSC of 13 (range 6-16). At pretest 2 (Tme 2; followng the Parentng Strateges Program and pror to classroom nterventons), expermental subjects had parent-reported mean total scores on the CSC of 10 (range 5-14). At Tme 3, expermental subjects had parent-reported mean total scores on the CSC of 8 (range 2-12), and at Tme 4, expermental subjects had parent-reported mean total scores on the CSC of 8 (range 6-11). n summary, fve of the expermental subjects (all but B) demonstrated mprovement on ths measure based on ther parents' report. Average mprovement from Tme 1 to Tme 4 was 6 ponts (mprovement ranged from 3 ponts to 9 ponts) for those fve subjects demonstratng mprovement. However, two ; subjects demonstrated greater mprovements at Tme 3 than at Tme 4. For one (F), * treatment gans were acheved at Tme 3, but mantaned to a lesser degree at the end of ( the study. For the other subject (B), slght treatment gans were acheved at Tme 3, ^ but scores returned to baselne at Tme 4, demonstratng no consstent change n the behavors assessed for ths subject. However, t should be noted that floor effects may have played a part as scores at pretest (Tme 1) were qute low for one subject (B). No subject was rated hgher (worse) on ths measure followng ether Phase (Tme 2) or Phase (Tme 3) than at pretest (Tme ). Overall, results from ths measure provde moderate support for the effectveness of ths nterventon (See Table 5, Fgure 2).

61 Table 5 Current Status Checklst (CSC) Parent (Total Scores) Subject A B C(m) C(f) D E(m) E(f) F Mean Tme (14) (15) (8) (16) (6) 12 8 (15) ( 11) 9 8 (15) 6 8 mprove (3) 4 8 (0) 9 6 Legend. (m) = Measure completed by the chld's mother! (f) = Measure completed by the chld s father * 16 1 } 14 t \ } t t: FV t V 12 CA 2 10 o ogo Tme of Testng O A * B *---- C -o D «E a F Mean Fgure 2. Current Status Checklst (CSC) Parent (Total Scores).

62 n order to be dagnosed wth ADHD-nattentve Type, a chld must meet sx of the nne dagnostc crtera pertanng to nattenton. When examnng these scores separately n terms of the dagnostc crtera specfcally addressng nattenton (See Table 6, Fgure 3), fve of the sx subjects (all but B) met the crtera for a dagnoss of ADHD-nattentve Type at pretest/baselne (Tme ), based on parent report. At Tme 4, scores for three of the fve subjects (A, D, F) demonstratng mprovements were reduced to the pont that they no longer met the crtera for dagnoss of ADHD- nattentve Type based on ther parents' report. Two subjects (C, E) stll met the dagnostc crtera, but slght mprovements were noted for each. Fnally, as noted, one subject (B) dd not meet the dagnostc crtera for ADHD-nattentve Type at Tme 1, t ' and was scored as slghtly worse at Tme 4. Specfcally her score changed from 2 to 3, but she stll dd not meet dagnostc crtera. Once agan, due to low scores at pretest (Tme 1) for ths subject, floor effects may have made mprovements dffcult to reveal had they been present. f Table 6 \ Current Status Checklst (CSC) Parent (nattenton) Subject Tme A B C(m) C(f) D E(m) E(f) F Mean (7) 7 8 (6) (4) 5 6 (8) (4) 7 6 (6) (6) 4 6 (6) 4 Change 5 (-1) 1 ( 1) 3 2 (0) 7 4

63 fr v 49 Legend (m) = Measure completed by the chld's mother (f) = Measure completed by the chld's father 9 s / 2 oo CO Q- A B C D E F Mean Tme of Testng Fgure 3. Current Status Checklst (CSC) Parent (nattenton). n order to be dagnosed wth ADHD-Hyperactve/mpulsve Type, a chld must meet sx of the nne dagnostc crtera pertanng to Hyperactvty/mpulsvty. When examnng these scores specfcally n terms of the Hyperactvty/mpulsvty crtera (See Table 7, Fgure 4), results suggest that at Tme 1, the same fve expermental subjects met the dagnostc crtera for ADHD-Hyperactve/mpulsve Type. Consequently, these fve (not B) met the crtera for ADHD-Combned Type. Results suggest that at Tme 4 all subjects had demonstrated at least slght mprovements, and no subject met the dagnostc crtera for ADHD-Hyperactve/mpulsve Type at ths fnal tme of testng. No subject was rated as hgher (worse) on ths measure followng the nterventon.

64 t 50 Table 7 Current Status Checklst (CSC) Parent (Hyperactve/mpulsve) Subject Tme A B C(m) C(f) D E(m) E(f) F Mean (7) 6 8 (9) (4) 7 8 (8) (2) 5 2 (9) (5) 5 2 (9) 5 4 mprove (2) 1 6 (0) 2 3 Legend (m) = Measure completed by the chld's mother (f) = Measure completed by the chld's father CO 1 O A B C D E F Mean T T T 2 3 Tme of Testng Fgure 4. Current Status Checklst (CSC) Parent (Hyperactve/mpulsve).

65 51 n summary, based on ths parent-completed measure, fve subjects (not B) met the dagnostc crtera for ADHD-nattentve Type and Hyperactve/mpulsve-Type (resultng n dagnoses of ADHD Combned-Type) at pretest (Tme 1). At Tme 4, two subjects met the dagnostc crtera for ADHD nattentve-type (C, E), and none met the dagnostc crtera for ADHD-Hyperactve/mpulsve Type. Sgnfcant mprovements were noted for subjects demonstratng problems assocated wth both nattenton and Hyperactvty/mpulsvty. Current Status Checklst (CSC) (Teacher-Completed) t was expected that at post-test (Tme 3) and follow-up (Tme 4), each of the sx ndvdual expermental subjects' total scores on the teacher-completed Current Status Checklst (CSC) (See Appendx B) whch s a checklst of the DSM-V (1994) 1 { dagnostc crtera for ADHD, would be lower as compared to hs or her own pretest/baselne (Tme 1 and Tme 2) rates, ndcatng fewer problems wth behavors assocated wth the dagnoss of ADHD, (but not to be consdered as evdence that the subject no longer qualfes for the dagnoss). For all sx expermental subjects, scores at the four tmes of testng are presented n table and lne graph form. Scores have been vsually examned for changes n mean across tme. Global scores have been examned for total tems endorsed (scores could range horn 0-18) (See Table 8, Fgure 5) as well as for tems j endorsed addressng nattenton (scores could range from 0-9) (See Table 9, Fgure 6) ' and tems endorsed addressng Hyperactvty/mpulsvty (scores could range from 0-9) (See Table 10, Fgure 7). Overall, teacher-completed CSC scores were as follows (See Table 8, Fgure 5): at pretest (Tme 1), the sx expermental subjects had teacher-reported mean total t

66 52 scores on the CSC of 8 (range 3-14). At pretest 2 (Tme 2; followng the Parentng Strateges Program and pror to classroom nterventons), the sx expermental subjects had teacher-reported mean scores on the CSC of 6 (range 2-15). Despte repeated efforts to contact her, one teacher (F) dd not return questonnares from Tme 3 or Tme 4 of testng. However, her report ndcated that ths chld demonstrated mprovements of 5 ponts from Tme 1 to Tme 2 of testng (although contngences were not n place for ths). At Tme 3, the fve expermental subjects whose teachers returned the measures had teacher-reported mean scores on the CSC of 2 (range 0-5), and at Tme 4 of testng the fve expermental subjects whose teachers returned the measures had teacher-reported mean scores on the CSC of 2 (range 0-5). n summary, subjects wth complete data demonstrated mprovement on ths measure based on ther, teachers' report. However, due to low scores at pretest (Tme 1) for some subjects (C, D), these mprovements may be less obvous due to floor effects. Average mprovement from baselne to Tme 4 of testng was 5 ponts for subjects wth complete data (mprovement ranged from 1 pont to 14 ponts). Table 8 1 «? t > 1 r Current Status Checklst (CSC) Teacher (Total Scores) Subjects A B C D E F Mean Tme N/R N/R 2 mprove (5) 5

67 (A 12- o u CO o- A Teacher B Teacher C Teacher 0 Teacher E Teacher F Teacher Mean Tme of Testng Fgure S. Current Status Checklst (CSC) Teacher (Total Scores). As noted, n order to be dagnosed wth ADHD-nattentve Type, a chld must meet sx of the nne dagnostc crtera pertanng to nattenton. When examnng these scores n terms of the dagnostc crtera specfcally addressng nattenton (See Table 9, Fgure 6), two of the fve subjects wth complete data (A, E) met the crtera for a dagnoss of ADHD-nattentve Type at Tme 1 based on ther teacher's ratngs (one of these [E] also met the crtera for ADHD-Hyperactve/mpulsve Type, resultng n a dagnoss of ADHD-Combned Type for ths subject). At Tme 4, scores for both of these subjects were reduced to the pont that they no longer met the crtera for dagnoss of ADHD-nattentve Type. All subjects demonstrated at least slght mprovements on ths measure at Tme 4 as compared to Tme 1, wth no subjects meetng the dagnostc crtera for ADHD nattentve-type followng the study. *

68 54 Table 9 Current Status Checklst (CSC) Teacher (nattenton) Subjects Tme A B C D E F Mean N/R N/R 2 mprove (4) 3 CA 1 O CO \ A Teacher B Teacher C Teacher 0 Teacher E Teacher F Teacher Mean Tme of Testng Fgure 6. Current Status Checklst (CSC) Teacher (nattenton). n order to be dagnosed wth ADHD-Hyperactve/mpulsve Type, a chld must meet sx of the nne dagnostc crtera pertanng to these dagnostc crtera. When examnng these scores n terms of the dagnostc crtera specfcally addressng

69 Hyperactvty/mpulsvty (See Table 10, Fgure 7), one subject (E) met the crtera for a dagnoss of ADHD-Hyperactve/mpulsve Type at Tme 1 based on teacher's ratngs. Ths subject also met the crtera for ADHD nattentve Type, resultng n a dagnoss of ADHD Combned-Type. At Tme 4, the score for ths subject was reduced to the pont that he no longer met the crtera for dagnoss of ADHD- Hyperactve/mpulsve Type. Of the fve subjects wth complete data, none were rated as worse on ths measure at Tme 4 as compared to Tme 1, and four subjects demonstrated at least slght mprovements. Table 10 Current Status Checklst (CSC) Teacher (Hyperactve/mpulsve) Subjects Tme A B C D E F Mean N/R N/R 1 J» mprove ( 1) 2 Based on ths teacher-completed measure, two subjects met the dagnostc * crtera for ADHD nattentve Type, and one met the dagnostc crtera for ADHD \ Hyperactve/mpulsve Type as well, resultng n a dagnoss of ADHD - Combned Type at pretest (Tme 1). At Tme 4, no subjects met the dagnostc crtera for ADHD nattentve Type or Hyperactve/mpulsve Type.

70 56 r ' o CO 3 - -Q- A Teacher B Teacher C Teacher D Teacher E Teacher F Teacher Mean Tme of Testng 5 Fgure 7. Current Status Checklst (CSC) Teacher (Hyperactve/mpulsve). Home Stuatons Questonnare - Revsed (HSQ-R) t was expected that at post-test (Tme 3) and follow-up (Tme 4), each of the sx ndvdual expermental subjects' total scores on the parent-completed Home Stuatons Questonnare- Revsed (HSQ-R) (DuPau & Barkley, 1992) would be lower as compared to hs or her own pretest/baselne rates (Tme 1 and Tme 2), ndcatng fewer problems payng attenton and concentratng across home stuatons. Agan, for all sx expermental subjects, scores at each of the four tmes of testng are presented n table and lne graph form. Scores have been vsually examned for changes n mean across tme. Total scores could range from 0-144, wth zero reflectng no problems (See Table 11, Fgure 8). Overall, at pretest (Tme 1), expermental subjects had parent-reported mean scores on the HSQ-R of 75 (range ). At pretest 2 (followng the Parentng Strateges Program and pror to classroom nterventons) (Tme 2), expermental

71 t 57 subjects had parent-reported mean scores on the HSQ-R of 44 (range 4-100). At Tme 3, expermental subjects had parent-reported mean scores on the HSQ-R of 37 (range 19-64), and at Tme 4, expermental subjects had parent-reported mean scores on the HSQ-R of 35 (range 4-50). n summary, all sx expermental subjects demonstrated mprovement on ths measure based on ther parents' report. Average mprovement from baselne to Tme 4 of testng was 40 ponts (mprovement ranged from 3 ponts to 74 ponts). However, the amount mproved vared greatly (mean 40 ponts; range 3 to 74). For the subject whose parent-reported scores on ths measure only mproved 3 ponts (B), once agan, detecton of clncally sgnfcant mprovements was lmted wth ths measure gven the floor effects due to low a low scores at Tme 1. Table 11 Home Stuatons Questonnare - Revsed (HSQ-R) Subject A B C(m) C(f) D E(m) E(f) F Mean Tme (59) (80) (56) (54) (43) (57) (39) (55) mprove (20) (25) Legend. (m) = Measure completed by the chld's mother (f) = Measure completed by the chld's father

72 (A 2 o u V A B C D E F Mean Tme of Testng 4 5 Fgure 8. Home Stuatons Questonnare - Revsed (HSQ-R). School Stuatons Questonnare - Revsed (SSQ-R) t was expected that at post-test (Tme 3) and follow-up (Tme 4), each of the sx ndvdual expermental subjects' scores on the teacher-completed School Stuatons Questonnare- Revsed (SSQ-R) (DuPaul & Barkley, 1992) would be lower as compared to hs or her own pretest/baselne (Tme 1 and Tme 2) rates, ndcatng fewer problems payng attenton and concentratng across school stuatons. For all sx expermental subjects, scores at each of the four tmes of testng are presented n table and lne graph form. Scores have been vsually examned for changes n mean across tme. Total scores could range from 0-117, wth zero reflectng no problems (See Table 12, Fgure 9). Overall, at pretest (Tme 1), the sx expermental subjects had teacher-reported mean scores on the SSQ-R of 39 (range 12-85). At pretest 2 (Tme 2; followng the Parentng Strateges Program and pror to

73 59 classroom nterventons), the sx expermental subjects had teacher-reported mean scores on the SSQ-R of 34 (range 8-67). At Tme 3 of testng the fve expermental subjects whose teachers returned the measures had teacher-reported mean scores on the SSQ-R of 19 (range 3-44), and at Tme 4 of testng the fve expermental subjects whose teachers returned the measures had teacher-reported mean scores on the SSQ-R of 17 (range 0-51). Table 12 School Stuatons Questonnare - Revsed (SSQ-R) Subject A B C D E F Mean Tme N/R N/R 17 Change (-30) 6 85 (23) 37*? * Legend * = Average mprovement from baselne (Tme 1) to Tme 4 of testng was 37 ponts (range 6-85) for the four subjects wth complete data and - noted mprovements. t t l. n summary, of the fve expermental subjects wth complete teacher data, four demonstrated mprovements on ths measure based on ther teachers' report. However, once agan, due to low scores at pretest (Tme 1) for one subject (D), mprovements ; may be less obvous due to floor effects. * Average mprovement from baselne (Tme 1) to Tme 4 of testng was 37 ponts (range 6-85) for the four subjects wth complete data and noted mprovements. However, scores for one chld (C) got progressvely

74 60 worse across tme. Scores at Tme 4 of testng for ths chld were 30 ponts hgher than at baselne (Tme ). However, accordng to her parents, ths chld experenced a number of sgnfcant stressors durng ths tme perod (death of a good frend, mother workng longer than usual hours, etc). Also, as noted, despte repeated efforts to contact her, one teacher (F) dd not return questonnares from Tme 3 or Tme 4 of testng. However, her report ndcated that ths chld demonstrated mprovements of 23 ponts from Tme 1 to Tme 2 of testng (although contngences were not n place for ths). Overall, ths measure provded moderate support for the effectveness of ths nterventon based on teacher report g 60- o u co A Teacher B Teacher C Teacher D Teacher E Teacher F Teacher Mean Tme of Testng Fgure 9. School Stuatons Questonnare - Revsed (SSQ-R). Chld Behavor Checklst (CBCL) t was expected that at post-test (Tme 3) and follow-up (Tme 4), each of the sx ndvdual expermental subjects' scores on the parent-completed Chld Behavor ft

75 61 Checklst (CBCL) (Achenbach & Edelbrock, 1983) would be closer to the non-cln- cally sgnfcant range as compared to hs or her own pretest/baselne rates (Tme 1 and Tme 2), ndcatng fewer problems wth the school-based behavors assessed. For all sx expermental subjects, the T-scores for clncal and summary scales at each of the four tmes of testng are presented n table and lne graph form (See Tables 13 and 14, Fgures 10 and 11). A total of eght clncal scales could be elevated, and three summary scales could be elevated. Scales have been examned for changes n mean elevaton across tme. Overall, when consderng the total number of scale elevatons (See Table 14) at pretest (Tme 1), expermental subjects had an average of 2.3 elevated clncal scales (range 0-6), and an average of 2.2 elevated summary scales (range 1-3). At pretest 2 (Tme 2; followng the Parentng Strateges [Phase ] Program and pror to the classk room nterventons [Phase ]), expermental subjects had an average of 1.3 elevated clncal scales (range 0-5), and an average of 1 elevated summary scale (range 0-3). At Tme 3 of testng expermental subjects had an average of.67 elevated clncal scales (range 0-2), and an average of 1 elevated summary scale (range 0-3). At Tme 4 of testng, expermental subjects had an average of.33 elevated clncal scales (range 0-2), and an average of.5 elevated summary scales (range 0-2). n summary, fve subjects [ t (all but D) demonstrated mprovement on ths measure based on parent report. Average f r mprovement from Tme 1 to Tme 4 of testng was 2 elevated clncal scales and 1.67 f summary scales reduced to non-clncally sgnfcant range for those fve subjects. The sxth subject (D) had two scales elevated at Tmes 1 and 4 of testng demonstratng no change n parent-reported behavor assessed wth the CBCL (See Table 14).

76 Table 13 Chld Behavor Checklst (CBCL) T-scores Tme Scales Subjects Clncal A B C D E F 1. Wthdrawn T=50 T=50 T=54 T=54 T=54 T=67* 2 1. Wthdrawn T=50 T=50 T=50 T=50 T=54 T= Wthdrawn T=61 T=50 T=50 T=54 T=50 T= Wthdrawn T=50 T=50 T=50 T=54 T=50 T= Somatc T=61 T=54 T=64 T=50 T=82** T= Somatc T=56 T=50 T=50 T=67* T=67 T= Somatc T=61 T=50 T=62 T=56 T=50 T= Somatc T=56 T=58 T=50 T=56 T=50 T= AnxVDepress. T=52 T=50 T=66 T=62 T=79** T= Anx./Depress. T=50 T=50 T=59 T=58 T=72** T= AnxTDepress. T=64 T=50 T=52 T=58 T=64 T=50 * t 4 3. Anx./Depress. T=58 T=50 T=52 T=58 T=64 T=50 4. Socal Probs. T=56 T=52 T=52 T=64 T=73** T=68* 2 4. Socal Probs. T=50 T=50 T=52 T=60 T=80** T= Socal Probs. T=64 T=52 T=50 T=52 T=60 T= Socal Probs. T=56 T=52 T=50 T=52 T=64 T=56

77 63 Table 13 Contnued Tme Scales Subjects Clncal A B C D E F 1 5.Thought Probs T=64 T=65 T=70** T=64 T=70** T=70** 2 S.Thought Probs T=57 T=58 T=50 T=64 T=70** T= Thought Probs T=67* T=58 T=50 T=64 T=50 T=67* 4 S.Thought Probs T=57 T=65 T=50 T=64 T=50 T=67* 1 6. Attenton T=57 T=61 T=77** T=69* T=78** T=70** 2 6. Attenton T=51 T=51 T=63 T=70** T=75** T= Attenton T=60 T=58 T=50 T=63 T=65 T= Attenton T=54 T=54 T=58 T=63 T=65 T= Delnquent T=63 T=62 T=67* T=75** T=70** T=67* 2 7. Delnquent T=54 T=51 T=67* T=78** T=54 T= Delnquent t =70** T=51 T=51 T=72** T=59 T= Delnquent T=54 T=50 T=50 T=72** T=54 T= Aggressve T=68* T=64 T=78** T=83** T=69* T 73** 2 8. Aggressve T=55 T=50 T=62 T=88** T=70** T= Aggressve T=68* T=50 T=57 T=77** T=56 T= Aggressve T=55 T=50 T=57 T=77** T=55 T=65

78 Table 13-Contnued 64 Tme Scales Subjects Summary A B C D E F 1 nternalzng T=51 T=43 T=65** T=59 1 = 1 1 * * T=61* 2 nternalzng T=43 T=33 T=54 T=60* 1 = 1 0 * * T=43 3 nternalzng T=64** T=46 1 = = = 5 1 T=46 4 nternalzng T=53 T=46 T=46 1 = = 5 1 T=46 1 Externalzng T=68** T=64** 1 = 1 4 * * 1 = 1 8** 1 = 1 0 * * T=71** 2 Externalzng T=54 T=40 T-64#* T=82** 1 = 6 8 * * T=53 3 Externalzng T=69** T=42 T=56 1 = 1 4 * * 1 = 5 6 T=65** 4 Externalzng T=54 T=40 T=54 1 = 1 4 * * 1 = 5 4 T=65** 1 Total Probs. T=66** T=61* T=73** 1 = 1 2 * * 1 = 1 6 * * 1 = 1 2 * * 2 Total Probs. T=51 T=43 T=60* 1 = 1 4 * * 1 = 1 2 * * T=56 3 Total Probs. T=70** T=49 T=51 1 = 1 0 * * T=58 T=63* 4 Total Probs. T=56 T=49 T=50 1 = 1 0 * * T=57 T=63* Legend. * = Borderlne elevatons for clncal scales T= * = Borderlne elevatons for summary scales T= * * = Clncal elevatons for clncal scales T=70 or hgher. ** = Clncal elevatons for summary scales T=64 or hgher. For all sx expermental subjects, the T-scores for clncal and summary scales at each of the four tmes of testng are presented n table and lne graph form (See Table

79 13, Fgures 10 and 11). A total of eght clncal scales could be elevated, and three summary scales could be elevated. Scales have been examned for changes n mean elevaton across tme. Table 14 Chld Behavor Checklst (CBCL) Number of Scales Elevated Subjects A B C(m) C(f) D E(m) E(f) F Mean j Tone 1 0 / 2 0 /1 3/3 ( 1 / 2) 2 / 2 6 /3 (5/3) 3/2 2.3/ / 0 0 / 0 0 /1 (0 / 0) 3 /2 5 /3 (5/3) 0 / 0 1.3/1 3 2/3 0 / 0 0 / 0 (0 / 0) 2 / 2 0 / 0 (3/3) 0 / 1.67/1 4 0 / 0 0 / 0 0 / 0 (0 / 0) 2 / 2 0 / 0 (1/3) 0 / 1.33 /.5 mprove 0 / 2 0 / 1 3 /3 (1 / 2) 0 / 0 6 /3 (4/0) 3/1 2/ 1.7 LsgsmL (m) = Measure completed by the chld's mother V \ (f) = Measure completed by the chld's father } Regardng the total number of scale elevatons (See Table 14, Fgures 10 and 4 11) at pretest (Tme 1), expermental subjects had an average of 2.3 elevated clncal scales (range 0-6), and an average of 2.2 elevated summary scales (range 1-3). At r ; pretest 2 (Tme 2), expermental subjects had an average of 1.3 elevated clncal scales ' (range 0-5), and an average of 1 elevated summary scale (range 0-3). At Tme 3, expermental subjects had an average of.67 elevated clncal scales (range 0-2), and an average of 1 elevated summary scale (range 0-3). At Tme 4, expermental subjects had an average of.33 elevated clncal scales (range 0-2), and an average of.5 elevated

80 summary scales (range 0-2). 8 1 >o a o CO o.2 E A B C D E F Mean Tme of Testng Fgure 10. Chld Behavor Checklst (CBCL) Clncal Scales. 4 3 CO > U a *0 3 z O -m-- A B C - -- D E -a-- F Mean Tme of Testng Fgure 11. Chld Behavor Checklst (CBCL) Summary Scales.

81 67 n summary, fve subjects (all but D) demonstrated mprovement on ths measure based on parent report. Average mprovement from Tme 1 to Tme 4 of testng was 2 elevated clncal scales and 1.67 summary scales reduced to non-clncally sgnfcant range for those fve subjects. The sxth subject (D) had two scales elevated at Tmes 1 and 4 of testng demonstratng no change n parent-reported behavor assessed wth the CBCL (See Tables 13 and 14). Classroom Behavor Assessment nstrument (CBA) t was expected that at post-test and each consecutve weekly follow-up, each of the sx ndvdual expermental subjects' weekly average global scores (range from two to twenty) on the teacher-completed Classroom Behavor Assessment nstrument (CBA) would be hgher as compared to hs or her own pretest/baselne (Tme 1 and Tme 2) rates, ndcatng an ncrease n global measures of task completon and complance n the classroom (See Appendx C for score equvalents). For all sx expermental subjects, weekly average scores at pretest 1 (Tme 1) and pretest 2 (Tme 2) as well as the followng eght to ten consecutve weeks of testng are presented n table and lne graph form (See Table S, Fgure 12). (For raw scores for the CBA, See Appendx G). For ths measure, scores have been vsually examned for changes n mean. ntally, latency was to be examned, however gven the slow gradual mprovement n scores across the weeks, ths nformaton was not useful. Overall, at pretest (Tme 1), the sx expermental subjects had teacher-reported mean scores on the CBA of 13 (range 11-16). At pretest 2 (Tme 2; followng the Parentng Strateges Program and pror to classroom nterventons), the sx expermental subjects had teacher-reported mean scores on the CBA of 12 (range 10-15). For the followng weeks scores were as follows: *

82 68 Table 15 Classroom Behavor Assessment nstrument (CBA) Subject A B C D E F Mean Week# * N/A mprove ** «* Legend. * = The nterventon began at Week 3. ** = For the fve expermental subjects demonstratng mprovement. Week 3: teacher-reported mean scores on the CBA of 14 (range 12-19), Week 4:! teacher-reported mean scores on the CBA of 14 (range 12-17), Week 5: teacherreported mean scores on the CBA of 15 (range 13-16), Week 6: teacher-reported mean scores on the CBA of 15 (range 13-17), Week 7: teacher-reported mean scores on the CBA of 15 (range 14-16), Week 8: teacher-reported mean scores on the CBA of 15

83 { 69 (range 14-17), Week 9: teacher-reported mean scores on the CBA of 15 (range 13-16), Week 10: teacher-reported mean scores on the CBA of 16 (range 13-18), Week 11 (fve subjects only): teacher-reported mean scores on the CBA of 16 (range 13-20) (See Table 15, Fgure 12). n summary, fve of the sx expermental subjects demonstrated mprovements on ths measure based on ther teachers' report. However, once agan, due to hgh scores at pretest (Tme 1) for two subjects (C, D), mprovements may be less obvous due to celng effects. Average mprovement from baselne (Tme 1) to the end of Week 11 for the fve subjects demonstratng mprovement was 3 ponts (range 1 to 7). No chld demonstrated lower scores at the end of the study (Tme 4) than at pretest (Tme 1), however, one subject (D) demonstrated no change o u 10 - CO 1U A B C D E F Mean Week Number Fgure 12. Classroom Behavor Assessment nstrument (CBA).

84 Drect Observaton n the Classroom (D.O.C.) Baselnes 70 t was expected that at both pretests (Tme and Tme 2), each of the sx ndvdual expermental subjects' mean rate of complance (as measured by drect observaton) n the classroom would be lower than the sx ndvdual non-dagnosed control subjects observed smultaneously. For all sx expermental subjects, weekly average scores from each of the twelve classroom observaton sessons are presented n table and lne graph form (See Tables 16-18, Fgures 13-15). Agan, scores have been vsually examned for changes n mean across tme. Complance rates could range from 0% to 100%. Antecedents and consequences to the observed nstances of complance or noncomplance were examned post-hoc to assess functonal varables mantanng behavors. At each of the four tmes of testng, three observatons were conducted. Although possble trends were noted, for the ease of comparson, the results reported are the means of the three sessons for each subject at each of the four tmes of testng.. : celng effects. «As noted, the parents and teachers of all expermental subjects verbally reported sgnfcant behavor problems ncludng noncomplance, at home and n the classroom durng the ntake ntervew. Drect observatons, however, sometmes revealed less severe dffcultes. n such nstances, llustraton of treatment gans was dffcult due to Overall, complance rates for the sx control subjects ranged from 85% to 100% t (mean 92%) at all tmes of testng (See Table 18, Fgure 15). One excepton occurred n whch one control chld's (A) mean complance for Tme 4 of testng was 62% (range for the three observatons sessons was 54% to 67%). These numbers were lkely mpacted by the lower than typcal request rate durng the observaton sessons; (mean number of requests was 7 [range 3-13]), as well as the upcomng summer vaca- V

85 71 ton. Overall, expermental subjects were typcally less complant than ther non-dagnosed controls at baselne/pretest (Tme 1) (See Table 16, Fgure 13). Specfcally, complance rates for control subjects ranged from 86% to 100% (mean 95%), whle complance rates for expermental subjects at ths tme of testng ranged from 68% to 88% (mean 83%). At baselne one (Tme 1) for all sx expermental subjects, classroom observatons revealed average dfferences n complance rates of 12% (range l%- 32%) wth controls demonstratng more complance. Table 16 Classroom Observatons (Baselne) Subject A-E B-E C-E D-E E-E F-E Mean Tme 1 88% 6 8% 87% 87% 84% 81% 83% 2 90% 89% 96% 100% 97% 83% 93% Change +2 % +2 1% +9% +13% +13% +2% Subject A-C B-C C-C D-C E-C F-C Mean Tme 1 97% 100% 96% 88% 86% 100% 95% 2 92% 97% 100% 92% 83% 97% 94% Change -5% -3% +4% +4% -3% -3% Legend. E = Expermental Subjects C = Control Subjects

86 72 Overall, four expermental subjects remaned slghtly less complant than ther non-dagnosed controls at pretest 2 (Tme 2; after the Parentng Strateges [Phase ] Program and pror to school-based nterventons [Phase ]). However, although no contngences were n place for ths, complance rates for all expermental subjects mproved from between 2% to 21% (mean mprovement 10%) at ths second tme of testng. Complance rates for control subjects at pretest 2 (Tme 2) ranged from 83% to 100% (mean 93%), whle complance rates for expermental subjects at ths tme of testng ranged from 83% to 100% (mean 93%). For four of the subjects, control subjects were an average of 7% more complant (range 2%-14%) at Tme 2. However, for two expermental subjects (D, E), the mean complance rates were 11% (range 8% to 14%) better than the matched controls. Observaton Number Fgure 13. Classroom Observatons (Baselne). *

87 Drect Observaton n the Classroom (D.O.C.) 73 t was expected that at post-test (Tme 3) and follow-up (Tme 4), each of the sx ndvdual expermental subjects' rates of complance (as measured by drect observaton) n the classroom would be ncreased as compared to hs or her own pretest/baselne rates (Tme 1 and Tme 2) (See Table 17, Fgure 14). The thrd set of observatons (Tme 3) were conducted when the classroom- based nterventons had been n effect for two to four weeks. Gven that complance rates for the expermental subjects were comparable to the control subjects at the second tme of testng (Tme 2), t was dffcult to demonstrate sgnfcant mprovements based on classroom observatons at ths tme of testng. Overall, at Tme 3 complance rates for fve of the expermental subjects (not E) mproved from between 2% to 19% (mean mprovement 9%) from baselne (Tme 1). However, one expermental subject (E) demonstrated no change n complance from Tme 1 to Tme 3 of testng. Complance 1 rates for two of the expermental subjects (A, F) mproved from between 4% to 17% ( (mean mprovement 11 %) from Tme 2 to Tme 3 of testng. The other four expermen- 1 tal subjects demonstrated decreases n complance rates from 2% to 13% (mean def crease 7%) at ths tme of testng. Complance rates for control subjects at Tme 3 of testng ranged from 85% to 100% (mean 92%) (See Table 17, Fgure 14). For three of the subjects, control subjects (B, D, E) remaned an average of 7% more complant (range 1% to 13%). The other three expermental subjects (A, C, F), were an average of 6% more complant than controls (range 3% - 9%). The fourth set of observatons (Tme 4) occurred four to sx weeks after the commencement of Phase n. Four of the expermental subjects demonstrated decreases n rates of complance from Tme 3 to Tme 4 of testng. Mean decreases for these four was 7% decrease n complance (range 2% to 12%). Two expermental subjects (C, D) %

88 74 demonstrated slght ncreases n rates of complance from Tme 3 to Tme 4 of testng. Mean ncreases for these two was 3% (range 2% to 4%). Table 17 Classroom Observatons. Percent Complance for Expermental Subjects Subject Tme A-E B-E C-E D-E E-E F-E Mean 8 8% 6 8% 87% 87% 84% 81% 83% 2 90% 89% 96% 100% 97% 83% 93% 3 94% 87% 94% 89% 84% 100% 91% 4 82% 80% 96% 93% 82% 95% 88% Change (-6%) + 12% +9% +6 % (-2%) +14% LsgsosL E = Expermental Subjects Table 18 Classroom Observatons. Percent Complance for Control Subjects Tme A-C B-C C-C D-C E-C F-C Mean 1 97% 100% 96% 88% 86% 100% 95% 2 92% 97% 100% 92% 83% 97% 94% 3 85% 100% 89% 90% 92% 97% 92% 4 62% 87% 96% 85% 89% 100% 87% Change (-35%) (-13%) 0 % (-3%) +3% 0% Legend. C = Control Subjects %

89 * E CL 20 - v -o- A B C D E F Mean Observaton Number 5 Fgure 14. Classroom Observatons. Percent Complance for Expermental Subjects * 60- f A B C D E F Mean Observaton Number Fgure S. Classroom Observatons. Percent Complance for Control Subjects. n summary, four of the expermental subjects demonstrated ncreases n

90 76 complance from pretest 1 (Tme 1) to Tme 4 of testng (B, C, D, F). Mean mprovements for these four was 10% mprovement n complance (range 6% to 14%). Two expermental subjects (A, E) demonstrated decreases n complance from pretest (Tme 1) to Tme 4 of testng. Mean decreases for these two was 4% (range 2% to 6 %). However, the decreases may have been related to the upcomng summer vacaton and resultng changes n daly schedule. Ths s demonstrated by decreases n complance rates for the control subjects as well. Specfcally, three control subjects (A, B, D) demonstrated decreased complance rates rangng from 3% to 35% (mean decrease s 17% for those three subjects). Two of the control subjects (C, F) demonstrated no change n complance from Tme 1 to Tme 4 of testng. One control subject (E) demonstrated a 3% ncrease n complance at the fourth tme of testng. Table 19 Number of Requests for School Observatons Subject Tme A-E A-C B-E B-C C-E C-C C-E C-C E-E E-C F-E F-C Legend. -E = Expermental Subject -C = Control Subject The nconsstent results based on ths dependent measure may be due to numerous factors. Frst, consderaton must be gven to the number of requests made

91 to subjects by teachers (See Table 19). Overall, request rates were typcally hgher for expermental subjects, perhaps because teachers predcted they were less lkely to be complant wth the frst request. As such, lower request rates for control subjects resulted n one or two nstances of noncomplance n an observaton sesson, havng a greater mpact on the overall rate of complance for that observaton (See Table 19). Another ssue concerns reactvty on the part of expermental subjects durng classroom observatons (Schwegert, 1994). As noted, on a number of occasons, expermental subjects may have recognzed the research assstants from the home observatons as t was not always possble for dfferent undergraduate students to conduct classroom and home observatons (See Table 20). Ths was due to the hgh number of observatons conducted durng certan weeks, the class schedules of the ; research assstants, and the ctes n whch the research assstants and the expermental subjects lved (20 mle range). As noted, when ths occurred, parents nformed j expermental subjects that observers were students from the Unversty who were observng a lot of famles and classes for a college class. n these nstances, other than sayng "Hello", no nteractons occurred between observers and subjects. However, ; ths may have mpacted the results of the observatonal procedures. Table 20 Percent of Classroom Observatons Conducted by Home Observer A B C D E F 44% 31% 6% 31% 19% 25% Lack of generalzaton durng observaton procedures may have also been related to the fact that, unfortunately, there were occasons when the class left the

92 78 regular classroom for extra-currcular actvtes (computer, lbrary, Physcal Educaton, musc, etc.) (See Table 21). Despte the fact that every attempt was made to obtan such nformaton durng the teacher ntake pror to the study, schedule changes occurred due to vacatons, feld trps, achevement testng, etc., whch were not known to the expermenter n advance. Specfcally, the class was then engaged n another actvty (that may not have ncluded a hgh request rate), and that was dfferent from the actvty generally occurrng durng observatons. Furthermore, the teacher makng requests n these nstances was not ratng the chld on the CBA and therefore would be less lkely to obtan treatment gans smlar to that of the regular teacher. When possble, the observatons were rescheduled. However, nstances when ths was not, possble are noted. «f 1 Table 21 Percent of Classroom Observatons When Chldren Were n a Dfferent Class A B C D E F 8% 0% 25% 33% 25% 8% Drect Observaton n the Home (D.O.H.) t was expected that at each observaton sesson, each of the sx ndvdual expermental subjects' rates of complance (as measured by drect observaton) n the home would be ncreased as compared to hs or her own prevous rates. Drect observatons were conducted n the homes of the sx expermental subjects on three occasons durng the frst three stages of the Parentng Strateges program n order to objectvely assess complance followng parent requests and commands. Ths also provded nformaton regardng verfcaton that parents were correctly mplementng

93 79 sklls learned n the Parentng Strateges (Phase ) of the study (.e.: recognton of chld complance or noncomplance, use of rewards and postve ponts, use of tme-out from renforcement, and use of back-up punshers) whch were examned post-hoc. Furthermore, n contrast to other studes (Channell, 1997; McGrath, 1997), when parents were not correctly mplementng sklls learned, ths was revewed at the next Parentng sesson. Dependng on the error and the chld's complance rates from that week, judgment was made by the therapst as to whether to proceed to the next stage of the Parentng Strateges Program, or to repeat the current stage. For all sx expermental subjects, scores from each of the three home t observaton sessons are presented n table and lne graph form (See Table 22, Fgure 16). Scores have been vsually examned for changes n mean rates of complance j across tme. Complance rates may range from 0% to 100%. t ; Table 22 Home Observatons Percent Complance Observaton A B C D E F Mean 1 22% 48% 59% 38% 69% 42% 46% 2 24% 33% 55% 33% 100% 54% 50% 3 40% 40% N/A 62% 56% 84% 56% Change: +18% (-8%) (-4%) +24% (-13%) +42% ( Average complance rates for the sx expermental subjects were as follows: Tme 1 (Trackng phase); mean was 46% (range 22% to 69%), Tme 2 (Postve Pont Program); mean was 50% (range 33% to 100%), Tme 3 (Tme Out) (conducted for fve subjects only as home observatons for one was dscontnued), mean was 56%

94 F (range 40% to 84%). Only three subjects (A, D, F) demonstrated sgnfcant mprovements n complance based on these observatons (mean 28%, range 18% to 42%). The other three subjects demonstrated decreases n complance based on these observatons (mean decrease was 8%, range 4% to 13%). Whle ths s n contrast to the mprovements n complance reported by parents durng trackng procedures, t was not expected that parents and observers would obtan dentcal results as n pror research (Channell, 1997; McGrath, 1997), the observatons were generally conducted at dfferent tmes f - u O-» -a A B C D E F Mean Observaton Number Fgure 16. Home Observatons Percent Complance. Both parents and subjects reported dscomfort durng these observatons. Although every attempt was made to keep the observatons unobtrusve, t appeared that both expermental subjects and ther parents may have been exhbtng reactvty (Schwegert, 1994). For nstance, one parent reported that she thought she was %

95 81 supposed to make numerous requests whle the observer was there. Ths occurred to the pont that she neglected to determne whether the chld had completed one task before makng another request. The chld n ths case responded wth frustraton and anger. Other parents and chld subjects reported that havng an observer n the home (to whom they could not talk) made them feel nervous and uncomfortable. Therefore, the results of these observatons should be consdered conservatvely. Table 23 Global Parent Ratngs of Complance Subject A B C D E F Mean Week# N/R N/R N/R 4 2 N/R 3 N/R N/R N/R N/R N/R N/R N/R 3 7 N/R N/R 4 Legend. N/R = Not Returned Global Parent Ratngs of Complance At the start of Phase of the study, nstead of observng for an hour daly, parents were asked to provde daly global ratngs from one to fve for expermental subject's complance (See Table 23), based on the followng scale: 1= My chld was not complant wth any requests made at home today. *

96 2= My chld was complant wth less than half of the requests made at home today. 3= My chld was complant wth about half of the requests made at home today. 4= My chld was complant wth most of the requests made at home today. 5= My chld was complant wth au of the requests made at home today. Gven that these ratngs were taken durng Phase (after completon of the Parentng Strateges Program) and were based solely on complance at home, as expected, there were no sgnfcant changes across tme. t was mportant to collect ths nformaton, however, as contnued montorng of home behavor ensured that expermental subjects dd not begn actng out at home once contngences were n place targetng classroom behavor (See Appendx H).

97 CHAPTER V DSCUSSON At the present tme, there s lttle research n the behavor therapy lterature that addresses the generalzaton of treatment effects for nterventons used wth ADHD chldren (Allen, et al.,1991; Drabman, et al., 1979, Edelsten,1989, and Stokes & Osnes, 1989). Ths s an mportant ssue gven that chldren who exhbt problem behavors at home often do so n other settngs such as the classroom (Wahler, 1969) and many referrals occur when problem behavors are exhbted at school (Al-ssa, 1982). Furthermore, when generalzaton to another settng occurs, more effcent treatment takes place wth fewer resources (Forehand & Atkeson, 1977). However, generalzaton to a non-tranng settng such as the classroom, where parents are not present and dfferent functonal varables may be n effect, s unlkely to occur unless some sort of nterventon s conducted wth the caregvers n ths settng (Forehand & Atkeson, 1977; Stokes & Osnes, 1989; Wahler, 1969). Ths study examned a number of hypotheses related to the generalzaton of f [. treatment gans (from home to school) followng a Parentng Strateges Program for r. ADHD-dagnosed chldren. Below, ntal requrements for contnued partcpaton j f followng the parentng program wll be descrbed. Second, data from parent- and teacher- completed questonnares wll be dscussed. Thrd, nformaton obtaned va w drect observatons conducted n the classrooms and homes of the expermental subjects wll be revewed. Fnally, lmtatons to the present study wll be addressed, and drectons for future research wll be outlned. 83 *

98 84 Summary Pror to assessng for generalzaton, evdence of ntal treatment effcacy was requred. Specfcally, followng the the Parentng Strateges Program, and pror to the ntaton of strateges to facltate generalzaton, all sx expermental subjects demonstrated mproved complance at home on at least one dependent measure. Ths nformaton was collected to nsure that any lack of mprovement n a subject's data followng the study was not due solely to falure acheve ntal treatment gans verses falure to generalze treatment gans across settngs. Gven that all subjects met ths ntal requrement, the followng dependent measures were admnstered to all sx expermental subjects. f A number of the dependent measures demonstrated support for the effectveness of ths nterventon. For nstance, on the parent-completed Current Status Checklst (CSC), ndvdual expermental subjects' total scores were generally lower followng partcpaton n the study, ndcatng fewer problems wth behavors assocated wth the dagnoss of ADHD. Specfcally, fve of the sx expermental subjects demonstrated mprovement on ths measure. nterestngly, two subjects demonstrated greater m- j provements at Tme 3 than at Tme 4. For one of these, treatment gans were acheved f at Tme 3, but mantaned to a lesser degree at the end of the study. For the other, bt slght treatment gans were acheved at Tme 3, but scores returned to baselne at Tme 4, demonstratng no consstent change n the behavors assessed for ths subject. ( Overall, results from ths measure provde moderate support for the effectveness of * 1 ths nterventon, notng that treatment effects were not mantaned for one of the subjects over an eght week perod. n order to gan more specfc nformaton regardng the types of behavors mpacted durng the study, the Parent-completed CSC scores were separately examned n

99 V 85 terms of the dagnostc crtera specfcally addressng nattenton verses those addressng Hyperactvty/ mpulsvty. Results suggested that, at baselne, fve of the sx expermental subjects met the dagnostc crtera for ADHD-nattendve Type as well as Hyperactve-mpulsve Type, resultng n dagnoses of ADHD-Combned Type for these fve subjects. Based on parent-report, no subject solely met the dagnostc crtera for Hyperactve/mpulsve-Type at baselne. Followng the study, only two subjects met the dagnostc crtera for ADHD nattentve-type, and none met the dagnostc crtera for ADHD-Combned Type. Overall, mprovements n ADHD symptomatology followng the nterventon were were demonstrated for both nattenton and Hyperactvty / mpulsvty. Smlar results were obtaned wth the teacher-completed CSC. Whle the fve subjects wth complete data demonstrated mprovement on ths measure followng the study, low scores at pretest resulted n dffculty wth nterpretaton due to floor effects. When examnng these scores n terms of the separate dagnostc crtera, two of the fve subjects met the dagnostc crtera for ADHD nattentve-type, whle one of these also met the dagnostc crtera for ADHD Combned-Type at baselne. As wth the parents' responses on ths measure, no subject solely met the dagnostc crtera for Hyperactve/mpulsve-Type at baselne. Overall, results demonstrated at least slght mprovements for four of the fve subjects, and no subject was rated worse on ths measure followng the study. Furthermore, followng the study, no subjects met crtera resultng n any type of ADHD dagnoss. Results from ths measure also provde moderate support for the effectveness of ths nterventon. Another parent-completed measure revealed clncally sgnfcant changes for all sx expermental subjects. Followng the study, each of the sx ndvdual expermental subjects' scores on the parent-completed Home Stuatons Questonnare-Revsed

100 (HSQ-R) was lower as compared to baselne, ndcatng fewer problems payng attenton and concentratng across stuatons at home. Whle all subjects demonstrated mprovement on ths measure, the amount each mproved vared greatly. For the subjects whose parent-reported scores on ths measure mproved only slghtly, detecton of clncally sgnfcant mprovements was lmted due to floor effects because of low scores at baselne. Overall, results from ths measure provde moderate support for the effectveness of ths nterventon. Teachers completed a parallel verson of the HSQ-R enttled the School Stuatons Questonnare- Revsed (SSQ-R). As noted, fve expermental subjects had complete teacher data followng the study. Of these, four demonstrated mprovements on the SSQ-R based on ther teachers report. However, once agan, due to low scores at pretest for some subjects, mprovements may be less obvous due to floor effects. t should be noted that on ths measure only, scores for one chld got progressvely worse ; across tme. As such, there s nconsstent support for the effectveness of ths nter ] venton based on teacher report wth the SSQ-R. More consstent support was provded by the parent-completed Chld Behavor. Checklst (CBCL). Specfcally, fve subjects demonstrated mprovement on ths measure followng partcpaton n the study. Clncal scales that mproved followng nterventon ncluded: Somatc Complants (N=l), Anxous/Depressed (N=l), Socal j Problems (N=l), Thought Problems, (N=3), Attenton Problems (N=4), Delnquent Behavor (N=2), and Aggressve Behavor (N=3). All three summary scales mproved followng the nterventon. These ncluded: nternalzng Behavor (N=3), Externalzng Behavor (N=6), and Total Problems (N=5). Overall, ths measure also demonstrated clncally sgnfcant support for the effectveness of ths nterventon across tme. As earler noted, generalzaton to a non-tranng settng such as the classroom

101 (where parents are not present and dfferent functonal varables may be n effect) s unlkely to occur unless some sort of nterventon s conducted wth the caregvers n ths settng (Forehand & Atkeson, 1977; Stokes & Osnes, 1989; Wahler, 1969). Therefore, the prmary measure for ths study, the teacher-completed Classroom Behavor Assessment nstrument (CB A), served as both a dependent measure and an ndependent varable. Weekly average scores on the (CBA) were hgher followng the study for fve of the expermental subjects. Ths ndcated an ncrease n teacher-reported global measures of task completon and complance n the classroom. However, once agan, due to hgh scores at pretest for two subjects, mprovements may be less obvous due to celng effects. No chld demonstrated scores lower at the end of the study than at pretest on ths measure, however, one subject demonstrated no change. t should be noted that, whle scores gradually ncreased over tme, they dd not ncrease as quckly nor as much as was expected. n addton to ganng nformaton from parents and teachers va paper and pencl measures, more objectve nformaton was obtaned by conductng drect observatons (Atkeson and Forehand, 1978). As predcted, observatons n the classroom revealed that expermental subjects were typcally less complant than ther non-dagnosed controls at pretest, and remaned slghtly less complant at Tme 2. Overall, four of the expermental subjects demonstrated ncreases n complance from pretest to the completon of the study, and two expermental subjects demonstrated decreases n complance. Some of the decreases may have been related to the upcomng summer vacaton and resultng changes n daly schedule over whch there was unfortunately, lttle control (Kazdn, 1982). Ths s demonstrated by decreases n complance rates for the control subjects as well. Also of nterest regardng the observaton procedures are the antecedents and %

102 88 consequences to the request (Stokes & Osnes, 1989). Gven that these functonal relatons often contrbute greatly to the mantenance of a behavor, an attempt was made to assess these durng observatons. Overall, t was found that most requests made n the classroom were made to the group verses the ndvdual expermental subject (by a rato of approxmately 2:1). However, as noted earler, compared to control subjects, expermental subjects receved more requests drected at an ndvdual. Also, t was nterestng to note that n the classroom, teachers were extremely unlkely to acknowledge the noncomplance or complance. For nstance, n a sample of 200 requests, there were twelve nstances (6 %) of prase followng complance (40 nstances) and three nstances (2 %) of punshment followng noncomplance (160 ' nstances). However, t was often dffcult to accurately assess ths as teachers often smply repeated the request nstead of punshng or otherwse respondng to the \ noncomplance. n contrast, durng the second home observaton sessons (when parents had been nstructed to gve ponts for complance and gnore noncomplance), ponts were provded eght tmes for 28 nstances of complance (29%). Whle ths was lower than expected, t was noted that some parents were provdng ponts only durng the one hour they were observng. Durng the thrd home observaton sessons (when j, parents had been nstructed to gve ponts for complance and use Tme Out for j noncomplance), ponts were provded 24 tmes for 77 nstances of complance (31%), and Tme Out was provded 16 tmes for 43 nstances of noncomplance (37%). j Feedback was gven to parents at the subsequent Parentng Sessons remndng them to T gve ponts for every nstance of complance and use Tme Out for every nstance of r noncomplance the whole day. f necessary, the goals for that week were repeated nstead of progressng to the next week. Results suggest that parents provded consequences at a hgher rate than dd teachers. Ths may contrbute to the less than %

103 optmal levels of generalzaton of treatment gans to the classroom. Another ssue had to do wth nstances n whch parents were unable to mplement consequences at home each week (80% of the tme or 4 out of 5 school days) as was ntally requred. As noted, ths was prmarly due to school vacatons, chld llness, jont parental custody, or year-round school attenders beng "off-track". However, n each nstance, due to parental commtment and desre to contnue the program, these ssues were addressed and montored ndvdually. The mportance of consstency was renforced wth the parents, and no subjects dscontnued partcpaton for ths reason. Durng Phase, parents dd not progress to the next stage of treatment when the nterventon had not been mplemented 80% of the tme. However, durng Phase n, ths occurred for one parent (A) 43% of the tme. Despte ths, the chld t consstently demonstrated mprovements on the dependent measures. Whle consstency wth mplementaton of behavoral contngences s mportant n order to obtan maxmum mprovement followng an nterventon, these results suggest further \ research should be conducted to examne the mnmum requrements to obtan treatment [ gans. j When examnng the results of drect observatons conducted n the home by re- search assstants, only three subjects demonstrated sgnfcant mprovements n compl- ance, whle the other three subjects demonstrated decreases n complance. Ths s n contrast to the mprovements n complance reported by parents durng trackng procef t dures. However, t was not expected that parents and observers would obtan dentcal results as the observatons were generally conducted at dfferent tmes (Channell, 1997). Ths s nterestng gven that other research has suggested that parents may report greater mprovement than that obtaned through objectve measures (Atkeson and Forehand, 1978). Also, t s not certan that home observaton revealed accurate rates

104 90 of complance, as both parents and subjects reported dscomfort durng these observatons. Specfcally, although every attempt was made to keep the observatons unobtrusve (Schachar, et al., 1986), t appeared that both expermental subjects and ther parents may have been exhbtng reactvty (Schwegert, 1994). As a result these observatons should be nterpreted wth cauton. Furthermore, home observaton procedures provded nformaton regardng the mstakes parents made at each of the three stages of the Parentng Strateges Program. Ths study mproved upon an earler one (McGrath, 1997) n that nformaton from these observatons was revewed wth parents at the next Parentng Strateges meetng. When thngs were done correctly, ths was noted and parents were gven postve feedback. However, n most nstances, some error was beng made. These ncluded, but were not lmted to: statng the request as a queston, "Wll you.. repeatng the request pror to S seconds havng passed, statng double-barrelled requests, gvng but not announcng ponts or not gvng ponts, gvng more than one warnng before usng Tme-Out, and makng numerous mstakes when admnsterng Tme-Out. n these nstances, the correct procedure was revewed wth parent(s) and/or the prevous stage of the Parentng Strateges Program was repeated. As noted, nterobserver relablty for both home and school observatons was [ extremely low despte observer re-tranng. However, once agreement on requests was t establshed, agreement reached an acceptable level. Nevertheless, nterpretaton of the t results are lmted as observers dd not necessarly code the same requests. Reasons for ths ncluded not hearng all of the same requests (due to beng spaced apart) and not nterpretng requests the same way (e.g., dfferences n codng requests that were phrased as questons, were embedded n other requests, were delayed, or were repeated pror to the passage of ffteen seconds). One way to address ths would be to spend

105 91 part of a Parentng Sesson addressng approprate requests (that match the codng scheme), or changng the codng scheme to better separate such requests. Parent and Teacher Satsfacton Questonnares Fnally, although not used as a formal dependent measure, parents and teachers had the opton of anonymously completng and returnng questonnares (parents; 20 total tems, teachers; 16 total tems) regardng ther satsfacton (See Appendx K). Sx out of eght parents and four out of sx teachers returned these forms. Overall, results suggested that both parents and teachers were somewhat to extremely satsfed wth the program as well as the changes they observed n the expermental subjects' behavor (parent tems 1-4, 6, 9-13; teacher tems 1-4, 8, 11). However, some reported less j satsfacton wth changes n behavor at school (parent tem 14; teacher tems S, 9-14). { All ndcated that they beleved that the amount of paperwork and questonnares to be completed was excessve n lght of other demands (parent tems 5,7,8 ; teacher tems 6, 7). t Lmtatons and Drectons for Future Research t j t S n order to demonstrate behavor change across settngs, t was necessary to keep the same contngences n effect n the classroom that were n effect at home (Drabman et al 1979). To that end, contngences were structured to be the same at home and at school as much as possble. However, some factors could not be controlled. One of these concerned the less than optmal smlarty between the home and school nterventons. For nstance, the goal of the response of parents to nstances of complance and noncomplance was to be mmedate and have a 1:1 correlaton between the behavor and the consequence. n contrast, the scores reported by teachers

106 were daly global scores and the consequences were delayed untl the chld got home. Furthermore, there was lkely to be a much lower correlaton between the behavor and consequence as each score was based on a whole day's worth of behavor. The Parentng Strateges Program taught parents to mplement mmedate consequences for every nstance of complance and noncomplance. Teachers do not typcally admnster consequences consstently. However, t may be somewhat unrealstc to expect a teacher wth a class of students to effectvely do so n the same way a parent can. Ths s clearly an ssue whch warrants further examnaton. Another dffculty whch occurred on multple occasons was that pretest measures dd not always demonstrate the sgnfcant problems reported by parents and teachers durng the ntake. Thus, t became dffcult to use emprcally valdated nstruments to measure the reported concerns. nstead, these measures were used as ndces whch have been summarzed. As clncans, t s always necessary to consder the subjectve nature from whch much of the nformaton requested from parents and teachers comes. Specfcally, t s mportant to recognze that varables such as afreet,. optmsm or pessmsm, socal support and tme of school year may afreet the results. ' n ths case, when scores were not sgnfcantly elevated followng pretest, n-depth clncal ntervews were conducted wth each parent and teacher to verfy the necessty for nterventons. Although less quantfable, ths nformaton s probably more vald (Barkley, 1989; Sattler, 1988). Although results have been presented n a quantfable manner, the clncal aspect must also be addressed, as sometmes the two are compatble and at other tmes, they are dscrepant Also, as noted, ths study ntally attempted to utlze a multple baselne desgn (Kazdn, 1982). The Parentng Strateges Program was ntally appled randomly to expermental subjects at approxmately one week ntervals. However, due to cancelled

107 93 appontments, sprng break, llness, the up-comng end of the school year, as well as parents' and teachers' strong desre to move to Phase n of treatment, varaton n the schedules occurred. As a result, use of statstcs and control over threats to nternal valdty related to hstory, were lmted. One way to avod ths problem n a smlar future study would be to obtan more control over tme lnes enablng a cleaner multple baselne desgn. Ths would result n greater control over extraneous varables. Another sgnfcant lmtaton to ths study concerned the classroom observaton procedures durng whch the use of normal control subjects n the study was lmted. Ths was necessary as t was not practcal for control subjects to also be dagnosed wth ADHD. Ths s due to the fact these drect observaton procedures were conducted n the classroom of the sx expermental subjects. Therefore, t would not have been logstcally possble to recrut ADHD subjects n pars based on ther classroom placement. However, despte the dffcultes n dong so, desgnng such a study would provde addtonal valuable nformaton. As noted, other dffcultes occurred regardng the observatonal procedures. The nconsstent results obtaned may be a functon of numerous factors ncludng the fact that request rates were typcally hgher for expermental subjects. Lower request rates for control subjects resulted n one or two nstances of noncomplance havng a greater mpact on overall rates of complance for that observaton. A second ssue affectng observatons concerned reactvty on the part of expermental subjects durng classroom observatons (Schwegert, 1994). As noted, on a number of occasons, expermental subjects may have recognzed the research assstants from the home observatons as t was not always possble for dfferent undergraduate students to conduct school and home observatons. Also, lack of generalzaton durng observaton procedures may have been related to the fact that, unfortunately, there were occasons

108 94 when the class left the regular classroom for extra-currcular actvtes (computer, lbrary, Physcal Educaton, musc, etc.) that were not known about n advance. Specfcally, the class was engaged n another actvty (that may not have ncluded a hgh request rate), and that was dfferent from the actvty generally occurrng durng observatons. Also of relevance s the fact that the teacher makng requests n these nstances was not the same teacher ratng the chld on the CBA. Gven ths, there would be a reduced lkelhood of obtanng treatment gans smlar to that of the regular teacher, snce behavor wth ths second teacher was not drectly related to scores and consequences (Forehand & Atkeson, 1977; Stokes & Osnes, 1989). Fnally, as noted n prevous research (McGrath, 1997), t s possble that the observaton procedures may not have been conducted for long enough tme perods (one hour) to get a relable sample of behavor. Furthermore, t may be the case that the behavors observed were not generally the most mportant or relevant to those targeted. As such, observaton procedures, whch are necessary as a source of objectve data, should be revsed for future research. Another mportant lmtaton n ths study had to do wth medcaton ) noncomplance and dose ttraton (DuPaul & Kyle, 1995). Although t was ntally j requred that subjects not undergo a sgnfcant change n ther medcaton, ths was found to be the case wth at least one subject. Furthermore, the report o f parents and teachers suggested that there were tmes when expermental subjects dd not take ther 1 medcaton as prescrbed. More consstent control over ths ssue would be very benefcal to follow-up studes. Another lmtaton s that all teachers returned forms at all tmes of testng va Unted States mal. For a number of the teachers, the fnal two tmes of testng were returned together (although they were reportedly completed at the approprate tmes). %

109 Ths ssue s of concern because for all teachers, scores on the CSC remaned exactly the same from Tme 3 to Tme 4. Furthermore, despte repeated efforts to contact her, one teacher dd not return forms for ether of the fnal two tmes of testng. Concluson Gven that clncally sgnfcant mprovements were demonstrated for the expermental subjects at post-test (Tme 3) and follow-up (Tme 4), there s evdence to suggest that treatment gans obtaned through the Parentng Strateges Program can be generalzed to the classroom settng. Furthermore, these data suggest that ths nterventon s an effectve method for dong so. However, treatment gans were nconsstent for some measures. Thus, future research s necessary to determne whch varables are j lkely to ncrease the chances of consstendy obtanng treatment gans for any partcular subject. Future research could be mproved n a number of ways. For nstance, requr- ng that all subjects have sgnfcant elevadon on all dependent measures pror to ncluson n the study would better address dffcultes assocated wth floor or celng ef t fects. Another obvous factor s related to the necessty of mprovng observatonal procedures. t s of great mportance to nclude objectve data such as ths, n conjunc- ton wth the subjectve data collected va parent and teacher report. One such mprove ment mght nclude vdeo tapng nteractons n the home as opposed to havng observers present. Ths would reduce reactvty on the part of the parent and chld subjects as observatons would be unobtrusve. Ths would also make codng procedures more relable. Overall, parent-completed questonnares demonstrated the most consstent support for treatment gans followng partcpaton n ths study. Teacher-report revealed mprovements as well, however, these were less sgnfcant than those noted

110 f by parents. Ths nformaton s relevant because, as n prevous research, (Atkeson and Forehand, 1978) parents consstently rated mprovements as greater than objectve data (although observatonal data were not consstent) and teacher-reported data. Dfferences such as these underscore the necessty of utlzng dependent varables whch are obtaned from dfferent sources (parents, teachers, observers), and by dfferent methods (paper and pencl completed questonnares, unobtrusve drect observatons). Another ssue of relevance s that the referral of chldren tends to occur when ther behavor s problematc to adults; especally parents and teachers (Al-ssa, 1982). n other words, most pathologes n chldren are subjectvely determned by adults. As such, fndngs n whch parents and teachers report greater mprovements than objectve measures are stll useful as the referrng adults report mprovements n the behavors of most concern to them. Overall, gven the mprovements noted, ths study contrbuted to the lterature as there s currently lttle research addressng the generalzaton of treatment effects across the behavor therapy lterature (Allen, et al.,1991; Drabman, et al., 1979, Edelsten,1989, and Stokes & Osnes, 1989). Devsng a program whch effectvely targets the problem behavor of chldren n more than one settng results n more effectve treatment and better addresses the dentfed concerns. %

111 Appendx A Descrpton of the Parent Strateges Tranng Program t- l )! t 1 97 v

112 98 Parentng Strateges Program (See Armstrong, 1995 for more detal). About 15 years of research preceded development of ths program. Outcome research predcts t s effectve for 8/10 famles. The program wll ncorporate three basc sklls: #1: Seeng behavor and trackng t: Parents wll learn to observe and record the most mportant parts of ther chld's behavor. #2: Postve Pont Program: After dentfyng problem behavors, parents wll learn to take the opposte, prosocal behavors and reward them. By rewardng postve behavors that are ncompatble wth negatve behavors, problem behavors can be reduced and approprate behavors ncreased. By ncorporatng the Postve Pont Program, chldren wll be taught about what they should be dong, as well as what they shouldn t be dong. Ths phase of the program wll create a mechansm by whch a chld can earn ponts toward rewards. We are rewardng behavors the chld should be engaged n, our goal s to help the chld nternalze motvaton for dong the chore, so that they eventually do t on ther own. #3: "Tme Out : Parents wll learn to ncorporate a non-physcal, no hassle way to effectvely punsh napproprate behavors. Ths wll nvolve a very specal form of "tme-out" that s far more effectve than the most commonly used varatons. The tme-out program wll not be utlzed untl after the chld s hooked on the reward program and has learned more approprate and postve ways of respondng. Ths s mportant because punshment should never be used unless the chld s both capable of and knows how to act more approprately. By defnton, "Tme- out" s desgned to remove a chld from postve attenton (.e., removng the chld from socal renforcement). Another beneft s that t helps

113 99 keep nteractons from escalatng between parents and chldren-when thngs get too negatve, no learnng takes place. The goal here s to par boredom wth problem behavors whle removng everyone from a conflct stuaton. Parents also wll learn that nconsstent punshment s worse than no punshment at all. When parents punsh nconsstently, chldren become more nterested n fgurng out f the parents are really gong to punsh or not and, consequently, they don't get nto the good habt of smply gettng up and dong what the parent asks. Defnng Complance and Noncomplance Complance s ntatng dong what s asked wthn 15 seconds of the request beng made (excludng safety ssues lke "Put the knfe down." or "Get out of the street." whch should be done mmedately). Noncomplance s not ntatng dong what was asked wthn 15 seconds or usng talkng back, argung, or whnng as escape or avodance technques. Research suggests that kds who back-talk or argue wth parents and teachers are at greater rsk for beng labeled as "trouble-makers" or "problem chldren." These j behavors undermne a teacher's authorty n a classroom and make t dffcult for everybody to learn effectvely. Arguers and Back-talkers also end up learnng to use these behavors to escape or avod dffcult tasks. t may be approprate for a chld to ask ncely why somethng needs to be done but t s not approprate for chldren to use these questons as delay tactcs or as challenges to a teacher or a parent's authorty. k j Furthermore, research suggests that kds who whne are less popular wth classmates. ; t's alrght for a chld to feel sad or angry about havng to stop dong somethng they * enjoy but ts not alrght for the chld to use whnng as an escape or avodance tactc.

114 Quz One KNOWLEDGE CHECK 1. So, when you are home ths week, how long are you gong to wat after makng a request before you decde f t was a complance or noncomplance? C / What f your chld comples wth your request but argues wth you? What would you record? 3. What f your chld does the task but wats for 20 seconds before he/she begns? 4. Where are you gong to record your chld's responses to your requests? 5. Consder the tme perods (each of) you are gong to be montorng. How long wll you try to montor? 6. What f you asked your chld to turn off the T.V. and he/she dd so mmedately, but mumbled bad thngs under hs breath? What would you record? 7. What f your chld turns off the T.V. wthn S seconds and then opens up a book? 8. What f your chld snapped back, "But t's not my turn!" and ddn't budge? 9. What f your chld turns off the T.V. but stomps hs feet on the ground whle dong t? 10. What tme perods are (each of) you gong to montor? C / C / C / C / C / C / C / C / C /

115 Quz Two KNOWLEDGE CHECK Show me where you record the chld's total for each day. C / 2. When you frst explan the chores for the chld, who actually does the chore? C / 3. s t o.k. to steer the chld away from any of the lsted rewards? C / 4. magne a day where your chld gets all ther chore ponts and s good enough for most of the day to make hs/her pont total. However, he dsobeys you rght after supper. When you revew the day wth hm/her before bedtme, does s/he stll get hs reward for the day? C / 5. f you ask your chld to clean up ther toys and they begn the task wthn 15 seconds, but don't fnsh t before then, do they stll get ther ponts for complance? C / 6. f your chld comples wth your request what do you do? 7. How many ponts does your chld need to get to meet ther daly pont total? C / C /! 8. When you are revewng your chld's daly pont total, whch would t be correct to say?... " am very upset that you ddn't meet your pont total. You have dsapponted me once agan. You d better work harder tomorrow, or else!" O R... "Well, you ddn t get your ponts today, but maybe tomorrow you wll. Tomorrow s a brand new day! f you get XX ponts, then you can choose from all those good rewards!" C / j 9. f your chld successfully completes all steps of both of ther chores, how many ponts wll they get? C / 10. How many warnngs do you gve your chld before checkng on ther chore? C /

116 102 Qwfe Three KNOWLEDGE c h e c k 1. What mportant pece of equpment must you have before you begn to use tmeout? C / 2. Let's say that you make a request of your chld and they are noncomplant. You should send them to what? 3. Then they walk n the bathroom and quetly close the door as they are supposed to. How long do you set the tmer? 4. Let's say you've gven your chld a tme-out but s/he contnues to msbehave. What s the only thng that you can say? 5. What s the longest tme you can send your chld to tme-out? C / 6. f you get to 10 mnutes for a tme-out, what warnng do you gve your chld after you say, "That's 10 mnutes?" 7. f your chld contnues to be noncomplant wth tme-out, what do you say at ths pont? 8. Let's say that you ask your chld to wash hs hands and he says, " don't want to." You tell hm that's a tme-out and he says, " don t care." What do you say? 9. Then he stomps hs foot and says, "You can't make me." What do you say? 10. What f he gets up to 10 mnutes - what do you say? C / C / C / C / C / C / C / C /

117 Appendx B Current Status Checklst (CSC) 103 V-

118 104 Chld's Name Teacher's Name Chld's Code N um ber Grade School Person completng ths f o r m : Tme of Testng: Current Status Checklst NOTE: After you have completed ths form, please erase the chld's name at the top (but leave the code number). Please check as many of the followng statements that you beleve have appled to ths student for the past week, more so than for other chldren the same age. Ths chld often fals to gve close attenton to detals or makes careless mstakes n schoolwork, work, or other actvtes. Ths chld often has dffculty sustanng attenton n tasks or play actvtes. Ths chld often does not seem to lsten when spoken to drectly. Ths chld often does not follow through on nstructons and fals to fnsh schoolwork, chores, or dutes n the workplace (not due to oppostonal behavor or falure to understand nstructons). Ths chld often has dffculty organzng tasks and actvtes. Ths chld often avods, dslkes, or s reluctant to engage n tasks that requre sustaned mental effort (such as schoolwork or homework). Ths chld often loses thngs necessary for tasks or actvtes (e.g., toys, school l assgnments, pencls, books, or tools).» Ths chld s often easly dstracted by external stmul. j Ths chld s often forgetful n daly actvtes. Ths chld often fdgets wth hs or her hands or feet or squrms n hs or her { seat. Ths chld often leaves hs or her seat n classroom or n other stuatons when remanng seated s expected. Ths chld often runs about or clmbs excessvely n stuatons n whch t s napproprate. Ths chld often has dffculty playng or engagng n lesure actvtes quetly.

119 105 Ths chld s often "on the go", or often acts as f he or she s "drven by a motor". Ths chld often talks excessvely. Ths chld often blurts out answers before questons have been completed. Ths chld often has dffculty awatng hs or her turn. Ths chld often nterrupts or ntrudes on others (.e., butts nto conversatons or games). A=. H/= v

120 Appendx C Classroom Behavor Assessment nstrument (CBA) 106

121 107 Classroom Behavor Assessment nstrument Sometmes we ask teachers to use a ratng scale from 1-10 to descrbe a chld's classroom behavor. A scale lke ths helps us understand how a chld s dong from day to day. We can tell that a chld s tryng harder when he or she receves hgher scores day after day, and we can tell that the chld s not dong well when lower scores are earned. Number are clearer and easer to compare than verbal descrptons. They are also easer for parents and chldren to understand. n order to make the best use of the ratngs we have devsed the followng gudelne for usng the scale. Please remember that a chld should be compared wth hmself or herself and the average student n the class, not wth the best chld n the class. The chld should receve two scores; one for on-task behavor and one for complance. Homework that s not completed should be noted on the record sheet so that hs or her parents can follow up at home. The 1 chld wll receve approprate daly reward or punshment at home dependng on the * j score he or she earns at school. We do not expect chldren to be always make 9's or s 10's. Do not be dscouraged f a chld earns low scores occasonally. Testng authorty s a characterstc often assocated wth chldren wth behavor problems. The low score, a chld earns today wll serve as a remnder for tomorrow. We are also askng that you complete a smply data sheet (transfer the chld's daly scores) and weekly record sheet (smply crcle "yes" or "no: to each of two questons each day) to keep us nformed of \ any changes n your classroom. We wll provde you wth postage pad envelopes to f } drop n the mal to us at the end of each week. The chld's parents wll be contacted by phone regularly to keep us nformed of the chld s scores. We may also call you from tme to tme to see how thngs are gong. Please feel free to contact me f you have any questons. Thank you very much for your help. Wthout your cooperaton and accurate ratngs, ths program would not help your student mprove.

122 On-Task Behavor Complant Behavor 108 Ths chld's on-task behavor durng Ths chld's complant behavor ndependent seat work, large group (ntatng complance wthn S 1 0 actvtes, and small group actvtes seconds of request) s excellent s excellent compared to the average compared tq the average Stwtent fl student n hs or her class. h s o r h e r c l a s s - Ths chld's on-task behavor durng Ths chld's complant behavor ndependent seat work, large group (ntatng complance wthn S actvtes, and small group actvtes seconds of request) s excellent for s excellent for ths chld. ths chld. o Ths chld's on-task behavor durng ndependent seat work, large group actvtes, and small group actvtes s as good as the average student n hs or her class wth regard to frequency, ntensty and severty. Ths chld's complant behavor (ntatng complance wthn 15 seconds of request) s as good as the average student n_hs or her class wth regard to frequency, ntensty and severty. Ths chld's on-task behavor durng ndependent seat work, large group actvtes, and small group actvtes s acceptable wth regard to frequency, ntensty and severty, but he or she does engage n mnmal off-task behavor. Ths chld's complant behavor (ntatng complance wthn 15 seconds of request) s acceptable. wth regard to frequency, ntensty and severty, but he or she does exhbt mnmal noncomplance. Ths chld's on-task behavor durng ndependent seat work, large group actvtes, and small group actvtes occurs less than 3/4 of the tme. Ths chld's complant behavor (ntatng complance wthn 15 seconds of request) occurs less than Ths chld s on-task behavor durng Ths chld's complant behavor ndependent seat work, large group (ntatng complance wthn 15 actvtes, and small group actvtes seconds of request) occurs less than occurs l e s s t h a n 1 / 2 o f t h e t m e - Ths chld's on-task behavor durng Ths chld's complant behavor ndependent seat work, large group (ntatng complance wthn 15 actvtes, and small group actvtes seconds of request) occurs less than occurs l e s s t h a n 1/3 o f t h e t m e - 1/3 of the tme. Sm

123 109 On-Task Behavor fcont.) Complant Behavor (cont.) Ths chld's on-task behavor durng Ths chld's complant behavor 3 ndependent seat work, large group (ntatng complance wthn S actvtes, and small group actvtes seconds of request) occurs less than occurs less than 1/4 of the tme. 1/4 <?f tl? tfflg- Ths chld's on-task behavor durng Ths chld's complant behavor 2 ndependent seat work, large group (ntatng complance wthn 15 actvtes, and small group actvtes seconds of request) occurs less than occurs less than 1/8 of the tme. 1/8 of the tme. Ths chld so rarely exhbts on-task Ths chld so rarely exhbts behavor durng ndependent seat complant behavor (ntatng work, large group actvtes, and complance wthn 15 seconds of small group actvtes that he or she request) that he or she may be may be removed from the class. removed from the class. r

124 Student's name: Date: Total Daly Score: 1. HOMEWORK ASSGNMENTS 2. TESTS TO STUDY FOR:? 3. TEST SCORES RECEVED: \ 4. SCORE FROM 0 TO 1.0; j, On-Task Behavor f' Complance 5. TEACHER S SGNATURE: %

125 ll DATASHEETS Student's name: Teacher's Name: Date Scale Score / / On-Task Behavor Complance /10 /10 Total /20 / / On-Task Behavor Complance no /10 Total flo / / On-Task Behavor Complance /10 n o Total no / / On-Task Behavor Complance no /10 Total no / / On-Task Behavor Complance AO n o Total no Was the daly form (wth scores and homework nformaton) gven to the chld at the end of the day today? M yes no Y yes no -W Th F yes no yes no yes no Dd you nsttute a new behavoral program for ths chld today? yes no yes no yes no yes no yes no Please complete ths form each day and mal t back to us n the postage pad envelopes at the end of each week. Code (for offce use only)

126 [ Appendx D Parental Permsson / nformed Consent for Expermental Subjects t f 112 w

127 Calforna State Unversty, Stanslaus Letterhead 113 Prncple nvestgator: Kevn J. Armstrong, Ph.D. Research Assocate: Barbara M.Todd-Nelson, M.A. Research Assocate: Gna M. Pallotta, PhD. Dear Parents/Guardans: Two copes of ths form are enclosed. Please return one and keep the other for your records. Ths project s offered n conjuncton wth Calforna State Unversty, Stanslaus. We are from de Department of Psychology and are nterested n ganng useful nformaton regardng teachng parents effectve strateges for managng the behavor of chldren dagnosed wth Attenton Defct Hyperactvty Dsorder (ADHD). Ths nformaton wll enable us to better assess and treat chldren who present wth such concerns. We are especally nterested n the expermental effects ths home-based program has on the classroom behavor of each chld. The purpose of ths two-part study s to assess your chld's behavor at home and n the classroom and to mprove your chld's task completon and complance (followng drectons) whle at home and school. To do ths we are askng permsson for you and your chld to partcpate n the followng study. Ths study wll last approxmately sxteen weeks and wll nclude twelve chldren. The frst part of the study wll nclude a parentng strateges program desgned to reduce conflct at home, ncrease your chld's complance wth your requests and rules, decrease your chld's negatve behavors, and help your chld become more cooperatve wth others. n addton, most parents report ncreased confdence n ther ablty to successfully handle ther chld's problematc behavor. The frst part of the study wll be conducted over eght one-hour sessons. Your chld wll need to come to the frst and last sessons. Durng the frst sesson, you wll be asked to complete an ntervew and several paper and pencl questonnares. Durng the second sesson, parent(s) wll learn to defne and montor mportant chld behavors. Followng ths sesson, you wll be asked to perodcally montor your chld's behavor at home. Durng the next sesson, you wll revew your home observatons wth your traner. You wll then be ntroduced to the Postve Pont Program. Ths program teaches parents how to ncrease postve behavors n ther chldren. You wll then be asked to use ths unque prase and reward system at home to help your chld learn more cooperatve and desrable behavors. Once the Postve Pont Program has been successfully mplemented, you wll be ntroduced to a specally desgned tme-out procedure. Ths verson of tme-out s a non-physcal, no-hassle, yet hghly effectve substtute for punshment that s desgned to decrease negatve behavors n your chld. You wll be asked to try ths verson of tme-out at home n order to help your chld reduce undesrable behavors (defance, back-talk, or whnng). De remanng sessons (up to sesson 7) wll be used to address any problems specfc to the mplementaton of the parentng strateges program. Durng the last sesson, you wll agan be asked to complete an ntervew and several paper and pencl questonnares. We wll also ask your permsson to conduct observaton sessons on four separate

128 occasons durng a sxteen week tme perod n your home. Each sesson wll be conducted by one or two undergraduate research assstants and wll last about one hour. The type of observatons we are conductng are unobtrusve. That s, the research assstants wll st quetly and wll not nteract wth famly members durng the observatons. There are no unusual rsks to parents for partcpatng n these sessons. Pror outcome research suggests that the program s effectve for approxmately 80% of famles. f the program s not effectve for you and your famly and the requred servces are deemed beyond the scope of that offered through ths program, an approprate referral wll be made. The goal of the second part of the study s to obtan mprovements n your chld's behavor at school, smlar to those obtaned at home. n order to do so, your chld's teacher wll be asked to complete several paper and pencl questonnares on four occasons. S/he wll also be asked to complete a home/school report card and provde ratngs of your chld's behavor daly for eght to ten weeks. You wll then be asked to mplement consequences (smlar to those used n the frst part of the study) based on these teacher ratngs. We wll also ask your permsson to conduct observaton sessons on ffteen separate occasons durng a sxteen week tme perod n your chld's classroom. Each sesson wll be conducted by one or two undergraduate research assstants and wll last about j one hour. The type of observatons we are conductng are unobtrusve. That s, the research assstants wll st quetly n the back of the classroom and wll not nteract wth! any of the students n the class. No students wll be removed from the classroom at any ' tme, nor wll they be sngled out. Your chld's teacher wll prvately pont out the two \ chldren n the classroom to be observed to the research assstants. The chldren wll not be told they are beng observed. All tranng wll be supervsed by a doctoral level clncal psychologst (Fully lcensed n the state of Calforna for three years), and wll be conducted by a doctoral level graduate student. Partcpaton s completely voluntary and can be termnated at any tme wthout prejudce or penalty to you or your chld. Please read the followng secton before sgnng at the end. # * # * * 1^ * * * * * * * * * * * : ^ * * * * * * * * * % * : ^ * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * understand that my chld and /we have been nvted to partcpate n a research [ project enttled: An Assessment of Generalzaton Across Settngs of a Parentng (? Strateges Program for ADHD Chldren. further understand that the purpose of ths project s to fulfll Barbara Todd-Nelson's dssertaton requrement j YES N O understand that my consent for my chld to partcpate n ths project means that (and/or my chld's other parent) wll partcpate n an eght week program desgned to learn parentng strateges. further understand that the goal of ths program s to ncrease my chld's task completon and complance (followng drectons) whle at home. 114