Final Research Report

View this project's final research report.

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Peer-Review Summary

Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.

The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments. 

Peer reviewers commented, and the researchers made changes or provided responses. The comments and responses included the following:

  • Reviewers noted that the study was not entirely a randomized trial because a portion of the schools in the second cohort chose their intervention, yet researchers combined analyses for all cases. The researchers said that the fact that 4 out of 24 schools chose to switch from their randomly assigned intervention for the second year of the project was an unexpected modification of the trial design. But the researchers said, they found that whether schools stayed in the randomized intervention arm or switched did not affect outcomes, which they have now explained in the report.
  • Reviewers asked for greater description of the participants, noting the small number of girls included in the autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) groups. Reviewers wondered whether this was a result of teacher expectations of student behavior, since teachers referred students to the study. Responding to the comment about teacher referral, the researchers said the study was community based and designed for implementation largely by school personnel, so it had to be compatible with school procedures. The researchers acknowledged that the gender distribution of participants may reflect some bias by school personnel but may also indicate that boys with ASD or ADHD and executive-functioning problems are more likely to have the target behavioral characteristics than are girls. The researchers said they collected extensive demographic data for the children but did not conduct a comprehensive diagnostic evaluation.  Therefore, they could not assess the extent of comorbidity across ASD and ADHD or with other conditions.
  • Reviewers asked for more information about school staff. The researchers said they only collected information about staff members’ professions, which was publicly available knowledge. They explained that  their Institutional Review Board (IRB) did not allow them to gather other information, such as ethnicity, without treating staff as study subjects and requiring their signed consent. The researchers considered this too burdensome but noted their IRB did allow them to collect extensive feedback from staff on their opinions of the interventions.
  • Reviewers commented that publications did not support the psychometric properties of the Executive Function Challenge Task (EFCT). The researchers responded that several projects have validated the EFCT and a paper is in preparation to report these results. The researchers added that they have found that performance on the EFCT predicts real-world outcomes, such as behavior in the classroom.
  • Reviewers wondered how to evaluate the improvement in executive function in both study groups without a control group, indicating that such an improvement might then be because of chance or maturation. The researchers noted that previously they compared their Unstuck and on Target (UOT) intervention with a social skills training intervention. They  found that only UOT delivered improvements in executive function, implying that improvements in executive function do not result only from developmental change. Also, their stakeholder partners strongly opposed having a non-intervention control group given their commitment to help underserved children.

Conflict of Interest Disclosures

Project Information

Lauren Kenworthy, PhD^
Children's Research Institute
$1,821,227
10.25302/06.2020.AD.13047379
A Community-Based Executive Function Intervention for Low-Income Children with ADHD and ASD

Key Dates

September 2013
April 2019
2013
2019

Study Registration Information

^Laura Gutermuth Anthony, PhD, was the original PI on this project.

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Last updated: March 4, 2022