Zoe R. Smith

Evaluating the Structure of Sluggish Cognitive Tempo Using Confirmatory Factor Analytic and Bifactor Modeling With Parent and Youth Ratings.

The primary goals of this study were to evaluate the dimensionality of the Penny et al. Sluggish Cognitive Tempo Scale and to compare model fits for parent- and youth self-report versions. Participants were 262 young adolescents (ages 10-15) comprehensively diagnosed with attention-deficit/hyperactivity disorder. Both confirmatory factor analysis (CFA) and bifactor modeling were used to determine if the proposed three-factor structure previously identified through exploratory factor analysis could be confirmed. Results showed that although the three-factor CFA had better fit statistics than a one- or two-factor CFA, the bifactor model was the best-fitting model for both parent report and self-report. This implies that Sluggish Cognitive Tempo Scale is best conceptualized as having an underlying general factor, with three specific factors that may represent different etiologies. Importantly, results also showed low-to-moderate correlations between raters and equivalent or better fit statistics for self-report in comparison with parent report.

Predicting academic impairment and internalizing psychopathology using a multidimensional framework of Sluggish Cognitive Tempo with parent- and adolescent reports

Adolescents with Sluggish Cognitive Tempo (SCT) exhibit symptoms of slowness, mental confusion, excessive daydreaming, low motivation, and drowsiness/sleepiness. Although many symptoms of SCT reflect internalizing states, no study has evaluated the clinical utility of self-report of SCT in an attention-deficit/hyperactivity disorder (ADHD) sample. Furthermore, it remains unclear whether SCT is best conceptualized as a unidimensional or multidimensional construct. In a sample of 262 adolescents comprehensively diagnosed with ADHD, the present study used adolescent- and parent reports of SCT to evaluate the predictive utility of a general SCT factor from a bifactor modeling approach compared the utility of three specific SCT factors (slow, sleepy, and daydreamer) for predicting academic impairment and internalizing psychopathology. Overall, a multidimensional framework of SCT was supported, with the three SCT factors differentially predicting impairment and in one case (school grades), predicting impairment when the general factor did not. Consistent with prior research, SCT slow behaviors appear to be most strongly associated with impairment, predicting both academic impairment and internalizing psychopathology. Parent report of SCT was most useful for predicting academic functioning, whereas youth self-report was important for predicting anxiety and depression. Implications of the findings for the assessment and potential treatment of SCT are discussed.

Overcoming the research-to-practice gap: A randomized trial with two brief homework and organization interventions for students with ADHD as implemented by school mental health providers.

Objective: To evaluate the effectiveness of 2 brief school-based interventions targeting the homework problems of adolescents with attention-deficit/hyperactivity disorder (ADHD)—the Homework, Organization, and Planning Skills (HOPS) intervention and the Completing Homework by Improving Efficiency and Focus (CHIEF) intervention, as implemented by school mental health providers during the school day. A secondary goal was to use moderator analyses to identify student characteristics that may differentially predict intervention response. Method: Two-hundred and eighty middle school students with ADHD were randomized to the HOPS or CHIEF interventions or to waitlist, and parent and teacher ratings were collected pre, post, and at a 6-month follow-up. Results: Both interventions were implemented with fidelity by school mental health providers. Participants were pulled from elective periods and sessions averaged less than 20 min. Participants in HOPS and CHIEF demonstrated significantly greater improvements in comparison with waitlist on parent ratings of homework problems and organizational skills and effect sizes were large. HOPS participants also demonstrated moderate effect size improvements on materials management and organized action behaviors according to teachers. HOPS participants made significantly greater improvements in parent- and teacher-rated use of organized actions in comparison with CHIEF, but not on measures of homework problems. Moderation analyses revealed that participants with more severe psychopathology and behavioral dysregulation did significantly better with the HOPS intervention as compared to the CHIEF intervention. Conclusions: Brief school-based interventions implemented by school providers can be effective. This type of service delivery model may facilitate overcoming the oft cited research-to-practice gap.

Longitudinal Evaluation of the Cognitive-Behavioral Model of ADHD in a Sample of College Students With ADHD.

Objective: The primary aim of this study was to evaluate longitudinal pathways to impairment as outlined in the cognitive-behavioral model of ADHD in a sample of 59 college students diagnosed with ADHD. Method: Serial mediation models were used to test whether underachievement, defined as prior year GPA, would longitudinally predict self-reported impairment at the end of the next school year, through negative self-concept and associated changes in symptoms of anxiety and depression, while controlling for baseline impairment and changes in ADHD symptoms. Results: Findings supported the cognitive-behavioral model of ADHD. The association between prior year GPA and overall impairment at the end of the year was fully mediated through self-concept and symptoms of depression. Conclusion: These results help explain why impairment often persists even when ADHD symptoms remit and suggests that internalizing symptoms may be an important target for intervention in college students with ADHD.

Longitudinal evaluation of the importance of homework assignment completion for the academic performance of middle school students with ADHD.

The primary goal of this study was to longitudinally evaluate the homework assignment completion patterns of middle school age adolescents with ADHD, their associations with academic performance, and malleable predictors of homework assignment completion. Analyses were conducted on a sample of 104 middle school students comprehensively diagnosed with ADHD and followed for 18 months. Multiple teachers for each student provided information about the percentage of homework assignments turned in at five separate time points and school grades were collected quarterly. Results showed that agreement between teachers with respect to students assignment completion was high, with an intraclass correlation of .879 at baseline. Students with ADHD were turning in an average of 12% fewer assignments each academic quarter in comparison to teacher-reported classroom averages. Regression analyses revealed a robust association between the percentage of assignments turned in at baseline and school grades 18 months later, even after controlling for baseline grades, achievement (reading and math), intelligence, family income, and race. Cross-lag analyses demonstrated that the association between assignment completion and grades was reciprocal, with assignment completion negatively impacting grades and low grades in turn being associated with decreased future homework completion. Parent ratings of homework materials management abilities at baseline significantly predicted the percentage of assignments turned in as reported by teachers 18 months later. These findings demonstrate that homework assignment completion problems are persistent across time and an important intervention target for adolescents with ADHD.

Factor Structure and Predictive Validity of a Homework Motivation Measure for Use With Middle School Students With Attention-Deficit/Hyperactivity Disorder (ADHD).

Many students with attention-deficit/hyperactivity disorder (ADHD) exhibit deficits in motivation to pursue long-term goals. Students with ADHD have particular difficulty with motivation to complete homework-related tasks and often fail to complete assignments. Although these problems are common and may impact academic performance, no homework-motivation measures have been validated for use with students with ADHD. The primary goal of the present study was to evaluate the factor structure and predictive validity of a homework-motivation measure based upon the expectancy–value theory of achievement motivation. A sample of 285 middle school students with ADHD completed the measure, and confirmatory factor analysis was used to evaluate the proposed factor structure and associations with parent and teacher ratings of homework performance. A 2-factor structure emerged, and model fit was excellent. Further, student-rated ability–expectancy beliefs demonstrated significant associations with parent-rated homework problems and performance and with teacher-rated homework performance and percentage of assignments turned in above and beyond ADHD symptoms. Future directions for studying the importance of motivation in students with ADHD are provided, with particular attention to the role that reward sensitivity may play in motivation.

Brief homework intervention for adolescents with ADHD: Trajectories and predictors of response.

In the present study, we sought to examine response trajectories to brief (11-week) school-based homework interventions and factors that may help schools predict responses. Participants included 222 middle-school students (72% boys; Mage = 12.00 years, SD = 1.02) who had been diagnosed with attention-deficit/hyperactivity disorder (ADHD) and had received either a contingency-management or skills-based intervention for homework problems. Both interventions included 16 20-min student meetings with a school counselor and two parent meetings. Trajectories of response for ratings of homework problems and assignment completion were examined from baseline to a 6-month follow-up using growth-mixture models. Baseline variables routinely measured in school settings, including grade-point average (GPA), math and reading achievement, and externalizing and internalizing symptoms, were examined as predictors of treatment-response trajectories. The majority of students (68–81%) showed positive treatment response across outcomes. However, trajectories of students who did not respond to intervention were identified for each outcome. Baseline GPA significantly predicted trajectories for all outcomes and achievement scores significantly predicted trajectories of teacher-reported homework performance and parent-reported homework problems, such that youth with relatively higher baseline GPAs and achievement were most likely to respond. In contrast, neither externalizing nor internalizing symptoms were significant predictors of response trajectories. Schools can use GPA and academic-achievement data to determine whether brief school-based interventions for homework problems are likely to succeed. Students with ADHD who display severe academic impairment (i.e., GPA lower than 2.0 at baseline) may benefit from a more long-term, intensive intervention.

The importance of therapeutic processes in school-based psychosocial treatment of homework problems in adolescents with ADHD.

Objective: To evaluate the importance of therapeutic processes in two brief school-based psychosocial treatments targeting homework problems in adolescents with attention-deficit/hyperactivity disorder (ADHD) as delivered by school mental health professionals. Method: A sample of 222 middle school students (72% male; Mage = 12.00 years, SD = 1.02) diagnosed with ADHD was randomized to receive either a contingency-management or a skills-based treatment for homework problems. Both treatments included 16 individual sessions (20-min each) and 2 parent/family meetings. Adolescents and school mental health professionals reported on the working alliance in the middle of the treatment; professionals rated adolescent involvement at each of the 16 sessions, parent involvement during both parent meetings, and parent commitment to carry out the established homework plan. Attendance at parent meetings was also recorded. Results: Therapeutic processes predicted objective, parent-reported, and teacher-reported academic outcomes. Parent engagement was particularly important for the contingency-based treatment, whereas working alliance and adolescent involvement were most important for the skills-based treatment. Conclusions: Therapeutic processes such as developing a strong working alliance and engaging parents and students are key elements of treatment delivery and receipt in school-based mental health programming and should be explicitly trained and monitored.

Evaluation of the Interplay Between Homework Motivation and Sluggish Cognitive Tempo in Youth With ADHD: Associations With Homework Performance:

Objective: This study evaluated which Sluggish Cognitive Tempo (SCT) factors (i.e., Slow, Sleepy, Daydreamer) are most strongly associated with homework motivation, and whether homework motivation mediates the path between SCT and academic impairment. Method: Participants were 285 middle school students (boys 209) in Grades 6 to 8 (ages 10-15 years) who were comprehensively diagnosed with ADHD. Results: Parent- and self-report of SCT Slow behaviors predicted homework motivation above and beyond symptoms of ADHD, oppositional defiant disorder (ODD), anxiety, depression, and intelligence. The mediation models tested were multi-informant and cross-rater (parent-report of SCT to self-report of motivation to teacher-report of homework problems), and suggest that low motivation may help explain the associations between SCT and functional impairment. Conclusion: SCT and motivation are significantly associated constructs. Clinically, youth with ADHD and comorbid SCT may be more likely to present with low motivation, placing them at risk for academic failure. The manuscript discusses potential clinical implications of these findings.

Review of the Evidence for Motivation Deficits in Youth with ADHD and Their Association with Functional Outcomes

Preeminent theories of attention-deficit/hyperactivity disorder (ADHD) suggest that motivation deficits are core underlying features of the disorder. However, it is currently unclear whether empirical evidence supports the assertion that significant group (ADHD v. comparison) differences in motivation exist or that problems with motivation contribute to the functional impairments that youth with ADHD experience. Accordingly, this review focused on evaluating and summarizing the empirical literature on the presence of motivation deficits and their association with functional outcomes in samples of youth with ADHD. Twenty studies met the review inclusion criteria. Results support the assertion that youth with ADHD have lower academic-related motivation in comparison to their peers and that motivation plays an important role in academic outcomes, with the strongest evidence to date for reading achievement. However, the available evidence is limited, and few existing studies are aligned with the much larger theoretical and empirical motivation literature in typically developing youth. Given preliminary evidence that motivation plays a role in the academic impairments of youth with ADHD, the review concludes with a discussion of whether current ADHD interventions adequately target motivation and highlights important future directions.