(PS4-9) School Consultation Process in Support of a Computer-Assisted Behavior Intervention for Adolescents: A Mixed Method Analysis

Abstract Text: Approximately 7 million children aged 3-17 years old in the United States have been diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD). Clinicians often collaborate with public school teachers to address ADHD-related impairments that affect school performance, but delivering evidence-based practices in those settings is challenging. With the rapid development of digital health technologies, new computer-assisted approaches have been proposed. For ADHD, most computer-assisted efforts to date involve cognitive training or neurofeedback to target the neurocognitive deficits related to ADHD, but results have been mixed.

We tested a novel approach to computer-assisted treatment in schools using a serious game, called ATHEMOS, that teaches organization, planning, and note-taking skills. Thirty-one middle school students with ADHD were recruited from public schools in Ohio and North Carolina and randomly assigned to either the computer-assisted behavior intervention (CABI) featuring ATHEMOS, or an established, evidence-based approach to school consultation called the Challenging Horizons Program-Mentoring model (CHP-M). In the CABI condition, participants were encouraged to play ATHEMOS during non-academic time on school days, and in the CHP-M condition, students received established ADHD interventions (e.g., organization, planning). All participants were paired with a teacher mentor for up to 24-weeks of intervention, with the support of a behavioral consultant. Bayesian and frequentist two-way mixed ANOVA models were used to analyze parent, teacher, and child self-report data. Our results show that participants in both treatments benefitted from intervention (ηp2 = 0.09 to 0.59) on academically relevant outcomes, with CABI providing similar benefits to the CHP-M on parent measures of organization skills (BF10 = 0.40 to 1.15) and teacher measures of classroom functioning (BF10 = 0.34 to 0.57). From these results, we conclude that the CABI approach is a reasonable alternative to traditional approaches that might engage otherwise reticent youths to participate in ADHD treatment.

In this follow-up study, we identify recurring themes and mechanisms within consultation transcripts for the CABI and CHP-M conditions and explore the processes that explain successful intervention across both conditions. Using a convergent parallel mixed method design, we uncover consultant behaviors associated with the largest benefits and compare the different processes in the CABI and CHP-M conditions. The goal is to determine which consultation processes are most useful, and to determine which approach might work best depending on child and teacher consultee needs.