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Symposia

Child /Adolescent - ADHD

Do Interventions for Children with ADHD Vary in Effectiveness by Family Socioeconomic Level?

2 - (SYM 50) Organizational Skills Training for Students Ages 8-11: Variations in Treatment by Socioeconomic Status

Sunday, November 23, 2025
10:32 AM - 11:01 AM CST
Location: Strand 1, Level 2
Keywords: ADHD, Clinical Trial, Vulnerable Populations
Recommended Readings: DuPaul, GJ, Evans, SW, Cleminshaw-Mahan, CL, & Fu, Q (2024). School-Based Intervention for Adolescents With ADHD: Predictors of Effects on Academic, Behavioral, and Social Functioning. Behavior Therapy, 55(4), pp 680-697, ISSN 0005-7894, https://doi.org/10.1016/j.beth.2024.01.010. (https://www.sciencedirect.com/science/article/pii/S0005789424000212),   Nissley-Tsiopinis, J., Power, T., Fleming, `P., Tremont, K.L., Poznanski, B., Ryan, S., Cacia, J., Egan, T., Montalbano, C., Holdaway, A., Patel, A., Gallagher, R., Abikoff, H., Localio, A.R., Mautone, J.A. : School-based Organizational Skills Training for Students in Grades 3 to 5: A Cluster Randomized Trial. Journal of Consulting and Clinical Psychology 2024, Oct;92(10):674-691. doi: 10.1037/ccp0000909. PMID: 39480288,   Lauren M. Haack, Linda J. Pfiffner, Sabrina M. Darrow, Jasmine Lai, Dulce Karely Alcaraz-Beltrán, Jassiel Ulises Martínez-Beltrán, Elva Moreno-Candil, Korinthya Delgado-García, María Fernanda Arriaga-Guerrero, Dulce Maria Ledesma-Saldaña, Maria Elena Urquídez-Valdez, Eva Angelina Araujo; Implementation of a Multi-Site Digitally-Enhanced School Clinician Training and ADHD/ODD Intervention Program in Mexico: Randomized Controlled Trial of CLS-R-FUERTE.; Journal of Technology in Behavioral Science; 2024,   Haack LM, Pfiffner LJ, Darrow SM, Lai J, Alcaraz Beltrán DK, Beltrán JUM, Moreno Candil E, Delgado García K, Arriaga Guerrero MF, Ledesma Saldaña DM, Urquídez Valdez ME, Araujo EA; Enhancing accessibility and scalability of school-based programs to improve youth attention and behavior: Open feasibility trial of the remote CLS-R-FUERTE program in Mexico.; School psychology (Washington, D.C.); 2023,   The Collaborative Life Skills Program in Spanish (CLS-S): Pilot Investigation of Intervention Process, Outcomes, and Qualitative Feedback. Evid Based Pract Child Adolesc Ment Health. 2019; 4(1):18-41. Haack LM, Araujo EJ, Delucchi K, Beaulieu A, Pfiffner L. PMID: 31938725; PMCID: PMC6959204.
Abstract Body


Organization, time management, and planning (OTMP) skills predict later academic achievement for students with ADHD and related problems. OTMP skills training has been found to be effective (Evans et al., 2018), but most participants in these studies are from economically advantaged backgrounds.  The Organizational Skills Training -Tier 2 (OST-T2) program is a skills training intervention for children ages 8 to 11 implemented by school staff that was shown to improve OTMP skills and homework performance (Nissley-Tsiopinis, et al, 2024). This study describes intervention fidelity among providers from schools varying in subsidized lunch levels. The study also examines whether subgroups of students varying in socioeconomic level respond differentially to OST-T2. Further, this study examines whether socioeconomic level moderates the mediating impact of OTMP skills on academic performance.

The study used a cluster-randomized design comparing OST-T2 with treatment as usual in 22 schools. Randomization was stratified by subsidized lunch level; 182 students were in moderation analyses and 133 in mediation analyses. We examined differences in implementation fidelity by subsidized lunch rate. Caregiver level of education and Area Deprivation Index (ADI; Kind & Buckingham, 2018) were used to assess socioeconomic level in analyses.


Both content (M = 85%) and process (M = 3.0 to 3.9 on a 1 [low] to 4 [high] scale) fidelity were high. Content fidelity did not differ by subsidized lunch level. Process fidelity differences by subsidized lunch level (high vs low) were found on use of positive reinforcement (3.09 vs 3.61) and coping reframe statements (2.98 vs 3.32) by school providers. Response to OST-T2 did not vary based on ADI score or caregiver education (e.g., effect size on caregiver-reported OTMP skills for the high vs. low ADI groups was 0.99 vs. 0.78). The mediating impact of caregiver-reported OTMP skills on academic outcome appeared greater at medium to high levels of disadvantage compared to low levels.
           
Findings indicated that, with consultative supports, OST-T2 was implemented with fidelity and produced similar outcomes across socioeconomic levels.