Could an interesting new program meet the need for a behavioral management intervention to reduce ADHD symptoms in school?

There is a continuing need for behavioral management programs for children and their families, especially structured programs that incorporate home and school. A unique program through Hyperactivity, Attention and Learning Problems Clinic (HALP) at University of California, San Francisco offers a possible next step in behavioral management and parent training for elementary school children affected by ADHD.

The Collaborative Life Skills Program (CLS) is a parent-teacher-student behavioral intervention initiative that teaches strategies for home and school life. Parents attending weekly small group sessions learn strategies for helping their children manage ADHD symptoms at home. They also learn skills for working with their children’s teachers at school. Teachers receive specialized training to implement classroom behavioral strategies for ADHD and training on using a daily report card to help students meet goals and maintain positive contact with parents.

Students attend weekly child groups where they learn social skills and organizational skills that help them overcome some of the challenges presented by ADHD symptoms. After the initial 10-12 week program, students, parents, and teachers participate in “booster” workshops intended to keep skills fresh. The program is research-based and, in some ways, reflects the research and structure similar to parent training programs.

Program developer Linda Pfiffner, PhD, said the three-part approach—students, parents, and teachers—is part of the success of the program.

“The program is targeted for kids with ADHD and the kinds of impairments that they have at school and at home,” she says. “Most programs emphasize working with the parents or working with the teachers. We are looking at it as a partnership.”

Dr. Pfiffner and her research associates recently published the results of the pilot program in the Journal of the American Academy of Child & Adolescent Psychiatry. They followed 135 student participants, their parents, and teachers during two school years. Their results showed improvements to the students’ ADHD symptoms and related behaviors. The study shows the program—which includes the booster sessions—can have sustained benefits for the students.

“The kids become more invested in this program because they see their parents and teachers working on it,” Dr. Pfiffner says. “The kids learn in the context of their peer group, so they become motivated.”

Students receive rewards at home and in school when their goals are met and they experience the benefits of great parent-teacher communication through the daily report card.

Dr. Pfiffner says the program has a “three-prong” approach that contributes to its success, along with emphasizing the use of student’s skills in their regular environments, including home and school. 

“Having these three components gives this program the power it has because everyone is working together in a partnership,” she says. “People really like the program and are satisfied.”

CLS is provided through the school, with a school-based coordinator overseeing the program and working with parents and teachers. The school-based coordinator has usually been a school social worker, but Dr. Pfiffner says other education professionals could also take on that role in implementing the program. 

“There’s a variety of people who could potentially be trained,” she says. “Once they learn the program they can continue to implement it with multiple kids.”

The program is also well-received by the participating teachers, Dr. Pfiffner says. Teachers have regular in-service sessions that focus on building students’ skills and connecting with parents. A major part of the training is the use of daily report cards, a common tool when a student has an academic plan but one that tends to fall by the wayside.

“Most teachers are familiar with the daily report card but they were using them in a way that was ineffective,” Dr. Pfiffner says. “And then they stop using it and the communication between teacher and parent falls down. But with this program, I have teachers say to me, ‘We even have in-services around it but this is the first time I’ve learned how to do it.’”

By working with teachers on how to develop the daily report card, use it well, and keep it going, Dr. Pfiffner says there is better communication between home and school and that becomes reflected in the student’s success.

At the end of the two-year study, following the training sessions and the booster sessions, parents reported a decrease in their children’s ADHD symptoms and executive function challenges. Classroom improvement wasn’t reflected in teachers’ student assessments, but case-by-case reports showed benefits to many students. Dr. Pfiffner says the research team has some theories as to why the teacher reporting didn’t reflect improvements seen at home, including problems in the comparison reporting between students in the control group and those in the intervention group.

Dr. Pfiffner says the CLS program is ready to expand across the country and already has some inroads in Mexico. She and her colleagues are developing a training program for additional schools, including the use of remote training for the school-based coordinator using video conferencing for training. A training manual is also being developed for wider use. The program has been translated into Spanish and is being used in Sinaloa, Mexico, in addition to California school districts.

“The goal really is to get it out to the larger community,” she says. She says the comparisons to established parent-training programs are accurate. “It’s not just about reading a manual, but about being trained and having a supervisor to work with. The unique aspect is that it involves these other components and it’s implemented by school employees.”

She is also aware of the possible costs for the program in school districts.  One of the goals is to minimize the costs and resources a school would need while still able to deliver the program.

“In terms of the expense, we’ll need to cost it out and see what’s involved—the trainer time and the initial output that is needed,” she says. “The cost is in what personnel resources are needed to make this work. Our hope is the results will support that use of resources.”