comparisons of accomodations

Overview

  • Study Title: Comparison of accommodations and interventions for youth with ADHD: A randomized controlled trial.

  • Authors: Judith R. Harrison, Steven W. Evans, Alyssa Baran, Fairooz Khondker, Kathryn Press, Daphney Noel, Shira Wasserman, Colleen Belmonte, Morgan Mohlmann.

  • Institution: Rutgers University and Ohio University.

  • Keywords: ADHD, Intervention, Accommodation, Organization, Note taking, Self-management, Extended time.

Abstract

  • Purpose of Study: To compare the efficacy of three interventions (organization training, self-management, note-taking instruction) and three accommodations (organization support, extended time, teacher notes) for middle school students with ADHD.

  • Participants: 64 middle school students with ADHD, randomized into intervention and accommodation groups.

  • Results Summary: The intervention group showed significantly better outcomes in organization and note-taking than the accommodation group. Willingness to follow intervention procedures affected engagement and accuracy.

ADHD Characteristics

  • Prevalence: Diagnosed in 10.2% of school-aged children.

  • Key Symptoms: Inattention, hyperactivity, impulsivity.

  • Academic Challenges: Higher likelihood of low academic achievement and failing grades than peers, with increasing impairment from elementary to middle school.

Importance of Interventions

  • Interventions vs. Accommodations:

    • Accommodations help to remove barriers but have limited evidence of effectiveness.

    • Interventions aim to improve student competencies and reduce impairments.

  • Importance of timely interventions for long-term success in adolescents with ADHD.

Types of Services in School Settings

  • Interventions: Meant to improve skills and functioning. E.g., organization training and self-management.

  • Accommodations: Adjustments made in the environment or expectations, often seen as easier but potentially detrimental if overused without skill-building.

Life Course Model (LCM)

  • Service Prioritization: Advocate for prioritizing interventions over accommodations for better long-term outcomes.

  • Categories of Service:

    1. Contextual adjustments

    2. Psychosocial interventions

    3. Medication

    4. Accommodations

  • Focus: Move towards ensuring students can meet age-appropriate expectations without ongoing accommodations.

Study Comparisons

  • Comparison of interventions and accommodations on three academic skills:

    1. Managing materials

    2. Managing verbal information

    3. Managing attention

Managing Materials (Organization)

  • Disorganization Impacts: Difficulty managing materials leads to impacting academic performance.

  • Organization Training (OT): Evidence-based intervention for teaching self-management of materials.

  • Organization Support: Accommodation assisting with material management; not extensively studied.

Managing Information (Note-taking)

  • Challenges: Students with ADHD struggle to maintain focus and correctly take notes during verbal instruction.

  • Note-taking Instruction: Shows potential improvements in note quality and accuracy but under-researched as a standalone intervention.

  • Providing Teacher Notes: Common accommodation but research shows it may reduce active engagement in note-taking.

Managing Attention (Self-management)

  • Inattention and Academic Impact: Direct correlation between on-task behavior and performance.

  • Self-management Training Effectiveness: Considered an evidence-based approach; aims to help students maintain attention similarly to their peers.

  • Extended Time Accommodation: Questions raised on its effectiveness, as it may not be as beneficial as interventions.

Social Validity in Interventions

  • Adolescents' Willingness: Student willingness to engage with interventions significantly affects their success.

  • Social Validity Indicators: Importance of perceived usefulness of interventions can influence student engagement and success.

Current Study Methodology

  • Participants: 64 adolescents aged 11-15, demographic information reported. Major demographics examined were gender, race, and IQ.

  • Design: Randomized controlled trial comparing interventions with accommodations.

Data Collection Methods

  • Measures for Eligibility: IQ, academic achievement, and psychiatric evaluations.

  • Dependent Variables: 1) Binder organization 2) Task engagement 3) Disruptive behaviors 4) Task completion and accuracy.

Results and Discussion

  • Findings:

    • Intervention Group Performance: Higher binder organization, more thorough note-taking, and maintained performance post-intervention.

    • Engagement: Increased among students willing to follow procedures of the intervention.

    • Social Validity: Higher ratings for interventions over accommodations; necessity of considering student perceptions in future studies.

    • Conclusion: Direct evidence supports prioritizing skills-based interventions over passive accommodations to foster long-term academic independence in students with ADHD.