Predictors and Trajectories of Response to the Homework, Organization, and Planning Skills (HOPS) Intervention for Adolescents with ADHD
Breaux RP, Langberg JM, Molitor SJ, Dvorsky MR, Bourchtein E, Smith ZR, Green CD. Behav Ther. 2019 Jan;50(1):140-154. doi: 10.1016/j.beth.2018.04.001.
Guest Commentary by Dr. Margaret Weiss: The target of helping the adolescent with organizational skills is with the adolescent rather than the parent.
The goal of the present study was to evaluate the relative importance of adolescent and parent skills acquired during participation in the Homework, Organization, and Planning Skills (HOPS) intervention in predicting intervention response. A sample of 111 middle school students with attention-deficit/hyperactivity disorder (66% male; Mage = 11.99, SD = 1.05) received the HOPS intervention, which includes 16 brief sessions with the adolescent and two parent meetings. Each session, school mental health providers completed checklists measuring students’ acquisition of homework recording, materials organization, and time management skills. Parents provided information on whether they monitored and used contingencies to reinforce skills use at home. Outcome measures included parent and teacher ratings of homework problems and organizational/time management skills post intervention. Grade point average and assignment completion were also evaluated as objective outcomes. Regressions found accurate homework recording and time management to be unique predictors of parent-reported homework and organizational skills outcomes. Growth mixture models examining organizational skills trajectories throughout the intervention significantly predicted parent- and teacher-reported outcomes, GPA, and assignment completion; homework recording trajectories predicted parent-reported outcomes and GPA. Sixty-eight percent of participants displayed high acquisition of organization and homework recording skills. Parent-reported use of monitoring and contingencies to support adolescent skills implementation was not associated with outcomes. Results highlight the importance of examining individual differences in school-based intervention studies targeting organization, time management, and planning. Importantly, for a school-based adolescent-focused intervention, improvement in outcomes does not appear to be dependent upon parent skills implementation.
* Dr. Margaret Weiss is Director of Clinical Research, Child Psychiatry at Cambridge Health Alliance, Harvard University. Her commentary reflects her own opinion. It is not approved or necessarily representative of the CADDRA board.