The Science of Organizational Skills in Children “Organizational Skills Study Program”

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					  The Science of Organizational
       Skills in Children?                          “Organizational Skills Study
                                                            Program”

                                                          Rosenberg Lecture March 5, 2008

                                                                         PI: Howard Abikoff, Ph.D.
                                                                    Co-I: Richard Gallagher, Ph.D.
                                                                          NYU Child Study Center
                                                                                Renee David, M.S.
                                                                   Louis Armstrong Middle School




    Background and Rationale                     Background & Rationale (cont.)
• Many children do not develop routines for      • No comprehensive, “real-life” assessment
  meeting the demands of home and school           measures of OTMP skills in children
• Deficits in organizational, time management,   • No systematic efforts to develop and test
  and planning (OTMP) skills are associated        interventions that specifically target OTMP
  features of limited school success               deficits
• Ineffective OTMP skills compromise school      • For those with the greatest problems, lack
  success, result in family conflict, and          of measures and interventions leave
  decreased work performance                       problems unresolved
• May worsen over time




            Impact on Real-Life                   Initial Measurement Research
• A teacher’s perspective on problems             • We developed “real-life” OTMP skills
• An administrator’s perspective
                                                    measures
                                                    – Developed the Children’s Organizational Skills
                                                      Scale (COSS)
• The effect of school demands
                                                    – Used to identify specific areas of impairment
   –   Elementary school circumstances
   –   Middle school demands                           • Lapses in Memory and Materials Management
   –   High school demands                             • Time Management Problems
   –   College demands                                 • Task Planning Problems
                                                    – Used to child status & assess treatment outcome




                                                                                                        1
  Initial Measurement Studies                             Initial Measurement Results I
• Administered the COSS to over 900 children in 3rd to   • Three factors were revealed –Teacher Form
  8th regular education settings                            – Use of Organized Actions
• The New York Metropolitan Region was sampled in              • …uses a calendar to remember dues dates
                                                               • …uses folders to separate papers
  public, parochial, and private schools including NYC
                                                            – Lapses in Memory and Materials Management
  and suburban districts
                                                               • …completes homework but can’t find it
• Teachers provided data on 5 randomly selected                • …comes home without needed books
  students                                                  – Task Planning Problems
• Analyzed through factor analysis                             • …does not know how to begin assignments
                                                               • …runs out of time before completing tasks
• Important comparisons were conducted
                                                               • …is able to manage schedule in order to complete several
                                                                 assignments




                                                           Simple & Probably Effective
Initial Measurement Results II
                                                                    Steps - I
• There were variations on these factors                 • Provide Overt Instruction in OTMP Skills
• Girls were more organized than boys
                                                         • Provide Physical Tools for Organization
• Those who had special educational support were less
  organized than those without                              – Planners
• Children with ADHD were less organized than               – Review the classroom environment for
  typically-developing children                               storage and placement of assignments
• Children with ADHD were less organized than            • Schedule Time to Complete Needed
  children with other emotional and behavioral
  problems                                                 Routines
• Parent observed variations as well as teachers         • Teach Kids How to Plan




Efforts to Assist Special Populations: The                                               Oh
           Story (so far) of ADHD                                                        No!!!!
• Deficits in organizational, time
  management, and planning (OTMP)
  skills are associated features of ADHD
   – DSM-IV: problems in organizing tasks &
     activities; disorganized work habits;
     tendency to scatter, lose, or carelessly
     mishandle task materials
• Ineffective OTMP skills compromise
  school success, result in family conflict,
  and decreased work performance




                                                                                                                            2
                                                              Initial Research: NIMH
                                                           Treatment Development Grant
                                                           • We developed “real-life” OTMP skills
                                                             measures
 “MY WHAT? IS DUE WHEN?”                                      – Developed Children’s Organizational Skills Scale (COSS)
                     (AND, Where Is It?)
                                                           • We developed an Organizational Skills
                                                             Training (OST) intervention to improve
                                                             OTMP skills

                                                           • We conducted pilot study to determine
                                                             program’s utility and to guide design of
                                                             current randomized controlled trial




                OST Intervention                               OST Intervention (cont’d)
 • For 3rd-5th graders with ADHD and                      • 20-session manualized program
                                                            – Clinic-based, after school
   OTMP impairments
                                                            – 3 Major Domain Modules
 • Remedial intervention, not 1st line Tx for                  • Materials management
   ADHD                                                        • Time management
 • Informed by several assumptions                             • Planning for short and long-term projects

     – Children with ADHD:                                • Treatment focuses on child but also involves
         • have organizational skills deficits              – Parents
         • can learn skills but do not access them          – Teachers
           appropriately




         Findings from Pilot Study:
                 Summary
                                                                    Current NIMH Study
• Significant improvement in Parent and Teacher ratings    • Primary aims
  on the COSS
• Significant improvement on Homework Problems                – Compare two OTMP treatment approaches
  Checklist and Academic Planning Task                           • “OST” --- Organizational Skills Training
• Improvements occurred regardless of children’s                 • "PATHKO"---Parents and Teachers Helping
  medication status or ADHD subtype                                Kids Get Organized"
• No drop-outs
                                                                 • Wait-list control – choice of Tx after wait period
• High level of attendance
   – All children had at least 17 sessions                    – Assess short and “long-term” effects
• Treatment satisfaction                                         • Evaluate children’s functioning in the next
   – Parents “very satisfied”                                      school grade, to determine if treatment effects
   – Teachers “satisfied”                                          have been maintained




                                                                                                                          3
                Secondary Aims                                          Study Outcome Measures
• Examine impact of level of parental ADHD                       • Academic measures
  symptoms on treatment implementation                               – report card grades
  and outcome                                                        – teacher ratings of academic performance
                                                                     – parent ratings of homework problems
• Examine maintenance of treatment                               •   Ratings of organizational skills
  strategies over time and relationship to                       •   Planning tasks
  child’s functioning at follow-up                               •   Family relations
                                                                 •   Children’s attitudes toward school and
                                                                     teachers




               Study Inclusion Criteria
• 8-11 year old boys and girls in 3rd-5th grade (medicated
                                                                          Potential Study Benefits
   or unmedicated)
                                                                 • Improvement in children’s organizational, time
● In mainstream education setting (resource room services          management and planning skills could:
   OK)                                                               – facilitate children’s academic functioning
         -- Not appropriate for children in an all-day special       – enable them to handle increasing task demands as they enter
            education classroom (or if child has a Para)               higher grades
                                                                     – result in less conflict with adults
• Meets diagnostic criteria for ADHD                                 – improve children’s attitudes toward school and teachers
       -- Questionnaires completed by parents and teachers       • Findings will yield essential information about the relative
                                                                   effectiveness of two different treatment approaches for
       -- Formal clinical evaluation done by study staff
                                                                   children with ADHD
• Has OTMP impairments at school or home                             – Influence clinical interventions for children with OTMP deficits
                                                                 • Teachers have the opportunity to learn new skills to help
• Estimated IQ > 85                                                students with organizational difficulties
• Teacher willing to participate




                 Practical Issues                                                Study Extensions
• Current status of the project                                  • Completing a Treatment Development
   – Study approved by NYU IRB and NYC DOE                         Project for Middle School
     Research Protocol Review Committee                            /Departmentalized Settings
• Cost                                                           • Louis Armstrong Middle School is the
   – Treatment is free of charge                                   Laboratory
                                                                 • Changes in program
• Availability of treatment                                          – Small group setting
   – Provided at Child Study Center Manhattan and Lake               – Change in characteristics of the students
     Success offices (located at Queens/Nassau border)               – Aiming to have school personnel deliver the program
      • Facilitates travel
      • Parents reimbursed for travel expenses
      • Children seen after school




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