Results Summary

What was the research about?

Attention deficit hyperactivity disorder, or ADHD, and autism spectrum disorder, or ASD, are health conditions that affect how people learn and relate to others. Students with either condition may have a hard time following classroom rules. These challenges may also make it harder for other children to learn.

In this study, the research team compared the support students with ADHD or ASD usually get with a new program called Unstuck and On Target, or UOT. In UOT, school staff actively teach students how to plan, set goals, and be flexible. The team looked at:

  • Students’ classroom behaviors after being in the program
  • Students’ problem-solving skills and parent reports about their behaviors after the program and one year later

What were the results?

After the program, classroom behavior improved both for students who were in UOT and those who received usual support. Across all students, UOT didn’t improve students’ behaviors more than usual support. For students with ADHD symptoms, both UOT and usual support improved students’ classroom behaviors. When only looking at students with ASD symptoms, UOT improved behaviors but usual support didn’t.

After the program and one year later, students’ problem-solving skills and parent-reported behaviors didn’t differ between UOT and usual support. Most of the program benefits remained.

Who was in the study?

The study included 148 students in grades 3–5 at 24 schools in Washington, DC, and northern Virginia. All schools served communities with limited resources. Of the students, 32 percent were Latino, 31 percent were white, 22 percent were African American, 11 percent were multiracial, and 3 percent were Asian. The average age was 10, and 82 percent were boys. In addition, 66 percent had ADHD symptoms, and 34 percent had ASD symptoms.

What did the research team do?

The research team assigned schools by chance to offer the UOT program or support as usual. Teachers chose students with ADHD or ASD symptoms to take part in the study. The team trained parents and school staff in both groups on rewarding flexible behaviors. For students in UOT, school staff led 21 group sessions over six months. Sessions taught students how to plan, set goals, and be flexible. For those getting usual support, school staff led 15 group and 5 in-class sessions. In these sessions, students practiced flexible behaviors but didn’t actively learn about them. In the second year, schools could choose to stay with their assigned program or switch programs.

The research team observed students before the program started and again after it ended. The team noted students’ behaviors, including

  • Social skills
  • Rule following
  • Taking part in class

Parents took surveys and students did problem-solving tasks before the program started, after the program ended, and again one year later. The surveys and tasks helped the research team learn more about students’ behaviors.

Parents, school officials, teachers, and mental health providers gave input on the study and program materials. They also helped choose students to take part in the study.

What were the limits of the study?

During the second year of the study, four schools switched from their assigned group. Results may differ if schools hadn’t switched. This study took place in only one area of the country. Results may differ in other places.

Future studies could compare classroom behavior in other places.

How can people use the results?

Schools can use results when considering ways to support students with ADHD or ASD symptoms.

Final Research Report

View this project's final research report.

More to Explore...

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.

Final Research Report

View this project's final research report.

Related PCORI Dissemination and Implementation Project

Innovative Implementation of a Robust Executive Function Intervention Delivered in Schools

Journal Articles

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Last updated: November 30, 2022