Addressing Homework-Related Problems in Middle School Students through the Homework Intervention Program (HIP) Veronica Raggi, Ph.D. Acknowledgments: Andrea Chronis, Ph.D. and Steven Evans, Ph.D. Funded by an APA Division 53 Award and Milton Dean Havron Social Sciences Award
Objectives To discuss the association between ADHD and academic impairment To examine research on interventions to address academic impairment and homework problems in children and adolescents with ADHD To discuss treatment components and pilot testing of an intervention designed to address homework-related problems in middle school students with ADHD
ADHD and Academic Impairment Attention-Deficit Hyperactivity Disorder (ADHD) Executive Functioning Deficit Academic Underachievement Co-occurring Learning Problems Compared to children with no diagnosis, children with ADHD are more likely to have: A history of learning disabilities Repeated a grade Been placed in special education Received academic tutoring American Psychiatric Association, 2000; DuPaul, 2007; Loe & Feldman, 2007; Rogers et al., 2009; Barkley, 2011; Barkley, DuPaul, & McMurray, 1990; Faraone et al., 1993; Hinshaw, 1992, 1994; Silver, 1992
ADHD and Academic Impairment during Adolescence Developmental and environmental changes during adolescence create additional challenges and have implications for treatment Common difficulties of adolescents with ADHD include: Failure to complete homework Coming to class unprepared Poor comprehension of material Poor study skills Low test and quiz grades, poor achievement Disruptive behavior Loe & Feldman, 2007; Barkley, Fisher et al., 1990; DuPaul & Eckert, 1998; Hechtman, 2000; Hinshaw, 1992; Smith et al., 2000; Landrun et al., 1993; Robin, 1990; 1998
Research on Academic Interventions for Adolescents with ADHD Only a handful of published treatment outcome studies have directly addressed academic impairment in adolescents with ADHD Instruction in note-taking skills in a lecture-format classroom Study skills, organizational, and note-taking interventions in the context of a comprehensive treatment program Self-monitoring techniques to improve classroom preparation skills Evans, Axelrod, & Langberg, 2004; Evans, Langberg, Raggi, Allen & Buvinger, 2005; Evans, Serpell, Schultz & Pastor, 2007; Evans, Pelham & Grudberg, 1994; Gureasko-Moore, DuPaul, & White, 2006;
Research on Specific Homework Interventions for Children with ADHD Only one research study to date has examined a stand alone homework intervention in children with ADHD The Homework Success Program (HSP): a 7 session treatment for children in grades 2-6 Group parent training in cognitive and behavioral principles Emphasis on goal setting, contingency management and parentteacher consultation Preliminary case studies of five families indicate positive outcomes One research study examined an organizational skills and homework management program for adolescents with ADHD as implemented through an after-school program provided by undergraduate students (Habboushe et al., 2001; Langberg et al., 2008; 2011 )
Homework Intervention Program (HIP) for Middle School Students with ADHD Designed for middle school students with a diagnosis of ADHD Number of sessions (7 to 9) Incorporate evidence-based techniques Utilize a developmentally sensitive approach Practical for implementation by parents, teachers and adolescents Goal to intervene at the point of performance (Russell Barkley) Parent and teacher involvement is key Need collaborative action plans that involve parents, teachers, and the adolescent
Homework Intervention Program (HIP) for Middle School Students with ADHD Treatment components Individual Meeting with Parent Individual Meeting with Adolescent Development of a Homework Management Plan Managing the Assignment Notebook Managing Materials: Binder and Bookbag Time Management and Planning Strategies Parent-Teacher Consultation Behavior Management Strategies Booster Sessions as needed
Understanding and Analyzing the Environmental Context Social Learning Theory Antecedent: Anything that comes before the observed behavior Behavior: Something observable that a person does Consequence: Events that come after the behavior
Example of an ABC Worksheet Antecedents Behavior Consequence Sydney is talking to her friends Sydney does not know She spends less time on her HW because when she is supposed to write the HW down what she has for she does not know what the HW is homework HW is written on the board at the end of the class Has more free time in evening She does not have her assignment notebook out when it is time to copy the HW down Her penmanship is poor Negative attention from parents/teachers Completes less HW and receives lower grades Has her TV and computer privileges taken away every time she does not know what the HW is
Working with the Adolescent Gain empathic understanding of their situation and their beliefs about why the problem is present Work towards mutually agreed upon goals that are consistent with what is important to them Reframe the problem: Externalize ADHD Explore strengths Acknowledge ambivalence
Collaborative Development of a Homework Management Plan Negotiate the setting, schedule and location for doing homework Establish a daily mandatory study time Define behavioral goals clearly Establish a privilege system Agree upon parent and adolescent roles in the plan Sign a contract indicating agreement with the proposed plan
Mandatory Study Time Creates clear expectations Helps child/adolescent establish good study habits Provides for a consistent, daily routine Reduces daily conflict around when and how much homework to do Reduces reinforcement that occurs from not knowing what the homework is and having more free time as a result Evans et al. 2005; 2007
Effective Reward/Privilege Systems Includes desirable, salient reinforcement Includes a mix of short-term (daily) reinforcement/privileges as well as weekend and longterm rewards Rewards are provided immediately once earned System is implemented consistently Each day is a fresh start System is positive and focused on earning, not taking away Access to rewards are restricted at other times
Homework Plan MON TUES WED THUR FRI Sits at desk in room to do work Checks SchoolMax for missing work Starts homework at 4pm Completes 30 minute study block Completes 30 minute study block Takes 5 minute break in between blocks AMT OF PRIVILEGE TIME EARNED Each point = 10 minutes video game time
Prioritizing and Managing Time during the Homework Routine Work with the adolescent to develop a daily plan for use of the mandatory study time: A list of what assignments need to be completed What order to do each assignment in An estimate of how long each assignment will take After completed, recording how long each assignment actually took A plan for deciding when he or she might need help
Managing the Assignment Notebook Negotiate procedure for writing down assignments in assignment notebook Assignments for each class written down next to the correct subject heading If there is no assignment in a class, the adolescent can write none next to the correct subject heading All assignments written legibly Teacher initials to indicate that the assignment is accurate Schedule daily check-in time to review notebook Incorporate these goals into privilege system
Organization of the Assignment Binder Negotiate procedure for organization of the binder No loose papers in the binder Every subject has its own folder All papers in the correct subject folder One folder designated the homework to be turned in folder One folder designated the completed homework folder All homework should be put in correct homework folders Have adolescent self-monitor performance using the organization checklist daily Provide explicit support initially, fade support as adolescent masters task Incorporate this goal into privilege system
Parent/Teacher Communication Sharing of information and ideas Collaboratively develop action plans for school-based support for homework success Teacher prompts or spot checks for assignments written down Student cross-checks assignments with a peer HW assignments are posted in a consistent location A specific time is designated for the adolescent to write assignments Adolescent is given extra time to write assignments after class Weekly communication between parents and teachers Teacher initials on assignments written correctly Organizational checks at school Extra set of textbooks
Time Management for Long-Term Assignments Model/practice how to break down long-term assignments into more manageable, short-term personal goals/deadlines Have the adolescent practice using this technique with parent, teacher, or therapist support (which fades over time and as adolescent masters the skill) Track personal deadlines/goals for each long-term assignment on a monthly calendar Incorporate these goals into the mandatory study time and privilege system
General Behavior Management Principles Praise small successes and appropriate homework behavior even if it is for only a short period of time. Ignore minor inappropriate behavior during homework time. Be consistent when providing rewards or withholding privileges according to the HW contract. Avoid negative communication such as lecturing, scolding, arguing, and nagging. Provide clear, direct instructions consistent with contract Provide developmentally appropriate supervision (scaffolding) Review progress and check for agreement with adolescent Model calm behavior and stay positive despite obstacles Use active listening skills and problem solving with adolescent Involve adolescent in decision making process and give choices when appropriate
Results of Pilot Study Preliminary testing of the HIP was conducted with 11 middle school students diagnosed with ADHD using a multiple baseline design Testing resulted in large improvements in parentreported homework problems for 8 of 11 students compared to baseline conditions Improvement was also observed on GPA, test and quiz grades, teacher-reported academic productivity, and parent and teacher-reported inattentive symptoms Treatment responders used the techniques on average more frequently than non-responders Satisfaction surveys indicate that this intervention is acceptable, well-liked and considered practical by parents and adolescents (Raggi, Chronis-Tuscano, Fishbein & Groomes, 2009)
Jeffrey Tevonte Emma James Matthew Edgar Andrew Myron George Alex Bob 60 Baseline Treatment Follow-Up 60 Baseline Treatment Follow-Up 60 Baseline Treatment Follow-Up 50 50 50 40 40 40 30 30 30 20 20 20 10 10 10 0 4 8 12 16 20 24 0 4 8 12 16 20 24 28 0 4 8 12 16 20 24 28 32 36 40 60 60 60 50 50 50 40 40 40 30 30 30 20 20 20 10 10 10 0 4 8 12 16 20 24 0 4 8 12 16 20 24 28 0 4 8 12 16 20 24 28 32 36 40 60 60 60 50 50 50 40 40 40 30 30 30 20 20 20 10 10 10 0 4 8 12 16 20 24 0 4 8 12 16 20 24 28 Week 0 4 8 12 16 20 24 28 32 36 40 60 50 40 30 20 10 0 4 8 12 16 20 24 Week Homework Problems Checklist 50 45 40 35 30 25 20 15 10 5 0 4 8 12 16 20 24 28 32 36 40 Week