3 - (SYM 55) Predictors and Moderators of Treatment Response in Organizational Skills Across Two Integrated Home-school ADHD Intervention Studies

Introduction: Youth with attention-deficit/hyperactivity disorder (ADHD) often exhibit difficulties with organizational skills. Two established psychosocial treatments for ADHD, the Collaborative Life Skills (CLS) Program and the Child Life and Attention Skills (CLAS) Program, improve organizational skills (e.g., Pfiffner et al., 2014; 2016), but it is unclear whether all children with ADHD respond equally well. The current study examined predictors and moderators of treatment response in organizational skills.

Method: CLS and CLAS enrolled children with ADHD age 7-11; both interventions consisted of integrated child skills groups, parenting groups, and classroom-based daily report cards. For CLS (N = 159), participants were randomized into active treatment or business as usual, and for CLAS (N = 199), into to one of two treatment groups or treatment as usual. We conducted preliminary analyses examining potential predictors and moderators of organizational skill improvement using baseline measures of child (e.g., IQ, ADHD symptoms) and parent (e.g., parenting stress, parenting practices) characteristics. Organizational impairment was measured via the Children’s Organizational Skills Scale (COSS).

Results: From CLAS, linear mixed effects models revealed an interaction between baseline processing speed and timepoint (β = -0.09, p = 0.01), such that children with faster processing speed showed a greater reduction in parent-reported organizational impairment from pre- to post-treatment. There was no moderation by treatment group. From CLS, generalized estimating equations, used to account for nesting, found a significant group by parenting stress interaction (b = -5.23, p < .05). Simple slopes tests found that higher parenting stress was associated with greater improvement in parent-reported organizational impairment for participants within the active CLS treatment arm (b = -3.44, p < .05). No other predictors or moderators of COSS treatment effects were supported.

Discussion: Preliminary results suggest that the effects of an integrated-home school psychosocial treatment on organizational outcomes appear robust to many child and parent baseline characteristics. Still, slower child processing speed predicted reduced treatment response. In addition, parents reporting high stress were especially likely to report treatment benefit for their children’s organizational skills. Future research would benefit from uncovering mechanisms of these relationships as well potential treatment implications.