Thomas J. Power’s research while affiliated with University of Pennsylvania and other places

Objective: Research has demonstrated the effectiveness of interventions to reduce organizational skills deficits and homework problems, including the clinic-based Organizational Skills Training (OST-C) program (Abikoff et al., 2013). In this study, OST-C was adapted for schools as a small-group (Tier 2) intervention delivered by school partners (OST-T2). Method: The study was conducted in 22 schools serving students from diverse backgrounds. Students (n = 186; 122 male) in Grades 3–5, ages 8–12 (M = 9.7 years; SD = 0.88) with organizational skills deficits referred by teachers were enrolled. Schools were randomly assigned to OST-T2 or treatment as usual with waitlist. OST-T2 consisted of sixteen 35-min child sessions, two caregivers, and two teacher consultations. Outcomes were evaluated with longitudinal mixed effects modeling at posttreatment, 5-month and 12-month follow-up using caregiver and teacher reports of organizational skills, homework, and academic performance. Results: OST-T2 resulted in reductions in organizational skills deficits on caregiver and teacher report (p < .001) at posttreatment and 5-month follow-up (effect sizes [ES], Cohen’s d = 0.96, 1.20). Findings also revealed a reduction in caregiver-reported homework problems at posttreatment and 5-month follow-up (p < .001, ES = 0.60, 0.72), and an improvement in teacher-rated homework at posttreatment (p = .007, ES = 0.64). Effects were attenuated at 12-month follow-up. The effects of OST-T2 on academic measures were not significant. Conclusions: Findings provide evidence for the immediate and short-term effectiveness of OST-T2 delivered by school professionals.

Although numerous studies have examined how child demographic characteristics may impact ratings of attention-deficit/hyperactivity disorder (ADHD) symptoms, there is limited research on how these factors are related to ratings of impairment. This study examined child characteristics (assigned sex, age, race, ethnicity) that may affect parent and teacher ratings of ADHD symptom-related impairments in relationships with family and/or teacher, peer relationships, behavior disruption, academic impairment, homework performance, and self-esteem. The study was conducted using independent U.S. national samples of parents (n = 2,075) and teachers (n = 1,070). Informants rated impairments related to inattention and hyperactivity–impulsivity using the ADHD Rating Scale–5. Rasch analyses were used to examine differential item functioning in relation to child characteristics. Separate analyses were conducted for inattention- and hyperactivity–impulsivity-related impairment for both the parent and teacher samples. For teacher ratings, only two items (behavior disruption, homework impairment) demonstrated differential item functioning with intermediate or large effect sizes (≥.426 logits) in relation to any child characteristic; whereas for parent ratings, all six items displayed differential item functioning with at least intermediate effect sizes in relation to one or more child characteristics. The findings indicated several areas in which child characteristics may have an impact on ratings of ADHD-related impairment, particularly based on parent ratings, which have potential implications for the diagnostic assessment of ADHD and highlight the need for further research.

Background Integrating behavioral health services into pediatric primary care can improve access to care, especially for children marginalized by poverty and racial/ethnic minority status. In primary care, a common presenting concern is attention-deficit/hyperactivity disorder (ADHD). Services in primary care for marginalized children with ADHD typically include medication alone; therapy to improve skills and build relationships is less available. This study evaluates the effectiveness of a behavioral intervention offered through primary care for marginalized families coping with ADHD (Partnering to Achieve School Success, PASS) compared to treatment as usual (TAU). Method Three hundred participants will be randomly assigned to PASS or TAU. Participants include children ages 5 to 11 who have ADHD and are from economically marginalized families. PASS is a personalized, enhanced behavioral intervention that includes evidence-based behavior therapy strategies and enhancements to promote family engagement, increase caregiver distress tolerance, and provide team-based care to improve academic and behavioral functioning. TAU includes services offered by primary care providers and referral for integrated behavioral health or community mental health services. Outcomes will be assessed at mid-treatment (8 weeks after baseline), post-treatment (16 weeks), and follow-up (32 weeks) using parent- and teacher-report measures of service use, child academic, behavioral, and social functioning, parenting practices, family empowerment, and team-based care. Mixed effects models will examine between-group differences at post-treatment and follow-up. Analyses will examine the mediating role of parenting practices, family empowerment, and team-based care. Subgroup analyses will examine differential effects of intervention by child clinical characteristics and socioeconomic factors. Discussion This study is unique in targeting a population of children with ADHD marginalized by low socioeconomic resources and examining an intervention designed to address the challenges of families coping with chronic stress related to poverty. Trial registration This study was registered on clinicaltrials.gov (NCT04082234) on September 5, 2019, prior to enrollment of the first participant. The current version of the protocol and IRB approval date is October 4, 2023. Results will be submitted to ClinicalTrials.gov no later than 30 days prior to the due date for the submission of the draft of the final research report to the Patient-Centered Outcomes Research Institute.

Schools need effective, sustainable implementation strategies to support teachers in using effective Tier 1 (i.e., whole class) and Tier 2 (i.e., targeted) behavioral interventions in the classroom. This paper describes an iterative, community-partnered process of developing implementation resources to support teachers in using Tier 1 and 2 positive behavior management interventions; we call these resources the Positive Behavior Management Toolkit (PBMT). There were two key aspects to the iterative development process: 1) working with a Program Development Team of district—and school-employed partners to identify priorities, interpret data, provide feedback on resources, and plan for sustainment; and 2) conducting a series of tryouts in which teachers used a version of the PBMT in their classrooms and provided quantitative and qualitative feedback on acceptability, appropriateness, feasibility, and recommendations for improvement. In partnership with the Program Development Team, we used data from the tryouts to inform revisions to the PBMT. This paper presents quantitative and qualitative data from the tryouts and describes how these data informed revisions to the PBMT. We also describe the processes by which we engaged the team, considerations related to contextual appropriateness, and lessons learned related to community-engaged intervention development research.

Objective Elevations in attention-deficit/hyperactivity disorder symptoms are associated with impaired self-esteem, but it is unknown how symptom levels contribute to self-esteem. Using cross-sectional samples from the general population, this study examined whether academic and peer interaction impairments contribute to the association between attention-deficit/hyperactivity disorder (ADHD) symptom levels and impaired self-esteem and whether child demographic characteristics moderate these patterns. Methods Parents and teachers rated ADHD symptom levels and impairments in independent samples of children from the general population using the ADHD Rating Scale-5 (n = 2,079 parents; n = 1,070 teachers). Models of indirect associations and potential moderators were analyzed. Results All models accounted for at least 38% of the variance in impaired self-esteem and models using teacher ratings accounted for more variance than those using parent ratings. Models with inattention as predictor demonstrated significant direct effects with impaired self-esteem and indirect effects of both academic and peer interaction impairment (point estimates ranged from 0.16 to 0.22). Models with hyperactivity-impulsivity as predictor demonstrated significant indirect effects of both academic and peer interaction impairment (point estimates ranged from 0.17 to 0.40), but no direct effects with impaired self-esteem. Conclusion Elevated inattention was associated with impaired self-esteem directly and indirectly through academic and peer interaction impairment, whereas elevated hyperactivity-impulsivity was associated with impaired self-esteem only through indirect associations. Inattention had a stronger adverse impact on behaviorally manifest self-esteem through academic impairment for adolescents vs younger children, and hyperactivity-impulsivity had a stronger adverse impact on behaviorally manifest self-esteem through academic impairment for White vs Black students. Longitudinal research is needed to examine patterns of mediation.

Organization, time management, and planning (OTMP) skills are behavioral manifestations of executive functioning linked to academic outcomes. Interventions to improve OTMP skills have shown favorable outcomes. The Children’s Organizational Skills Scale parent and teacher forms (COSS-P, COSS-T) are widely used for assessing OTMP skills, but there is limited research on this scale. This study examined the factor structure and construct validity of the COSS in a non-clinical and clinical sample of students in grades 2–8 (Study 1; n = 1138 COSS-T; 1155 COSS-P), and teacher-referred students with OTMP deficits in grades 3–5 (Study 2; n = 184). In Study 1, a bifactor model with a general factor and three subfactors demonstrated good fit for the COSS-P (RMSEA = .057) and COSS-T (RMSEA = .052). This model was replicated in Study 2. The general factor on both versions demonstrated an acceptable to high level of internal reliability. An acceptable degree of reliability was also identified for subfactor 1 (Task Planning). The COSS was shown to be effective in differentiating children with ADHD from a comparison group drawn primarily from the non-clinical sample (AUC = .84 COSS-P; .85 COSS-T). Sex differences of medium magnitude were identified on the total score of both COSS versions. Correlations between the COSS-P and COSS-T were variable across samples. The findings provide strong evidence for using the total score on the COSS-P and COSS-T as an index of overall OTMP skills deficits. Given variable cross-informant correlations on the COSS, multi-informant assessment of OTMP skills is strongly indicated.

Background Teacher-delivered behavioral classroom management interventions are effective for students with or at-risk for attention-deficit/hyperactivity disorder (ADHD) or other disruptive behavior challenges, but they can be difficult for teachers to use in the classroom. In this study, we will pilot test a package of implementation strategies to support teachers in using behavioral classroom interventions for students with ADHD symptoms. Methods We will use a 2-group, randomized controlled trial to compare outcomes for teachers who receive Positive Behavior Management Implementation Resources (PBMIR), a theory and data-driven implementation resource package designed to increase teacher implementation of behavioral classroom management interventions, with those who do not receive this additional implementation support. We will measure teacher implementation outcomes (e.g., observed fidelity to behavioral classroom interventions) and student clinical outcomes (e.g., ADHD-related impairment, ADHD symptoms, student–teacher relationship, academic performance) before and after an 8-week intervention period for both groups; we will also measure teacher-reported acceptability, appropriateness, and feasibility for the PBMIR group following the intervention period. Discussion If there is preliminary evidence of feasibility and effectiveness, this pilot study will provide the foundation for evaluation the PBMIR at a larger scale and the potential to improve outcomes for students with or at risk for ADHD. Trial registration This clinical trial was registered at ClinicalTrials.gov. ( https://clinicaltrials.gov/ ) on 8/5/2022 which was prior to the time of first participant enrollment. The registration number is: NCT05489081.