Self-management

An Evaluation of SelfManagement to Increase OnTask Behavior with Individuals
Diagnosed with AttentionDeficit/ Hyperactive Disorder
Presented by: Lindsey Slattery
This product w as developed by F lorida’s Positive Behavior S upport Project t hrough the University of S outh F lorida, Louis de la Parte F lorida Mental Health Institute funded by t he S tate of F lorida, Department of Education, Bureau of Exceptional Education and S tudent S ervices, t hrough federal assistance under t he Individuals w ith Disabilities Education A ct (IDEA), Part B.
Negative Outcomes
• School
– Difficulties completing tasks
– Poor or limited organization skills
– Disruptive behavior
– Off-task behavior
– Poor social skills
Negative Outcomes
• Home
– Oppositional and aggressive behavior
– Off-task behavior
– Poor sleep patterns
– Strained family relations
Negative Outcomes
• Adulthood
– Work difficulties
– Frequent job changes
– Difficulties in interpersonal relationships
– Issues with tobacco use, substance abuse,
and comorbid psychiatric disorders
Interventions
Pharmacological
• Stimulant medication
• Non-stimulant medication
Non-pharmacological
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Working memory training
Neuro-feedback
Parent training
Daily report cards
Token reinforcement
Peer mediated reinforcement
Peer tutoring
School-home notes
Self-Regulation
Self-Regulation Interventions
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Self-monitoring (Amato-Zech & Gardner,
2010)
• Self-reinforcement (Olympia et al., 1994)
• Self-management (Axelrod, Zhe, Haugen, &
Klein, 2009)
- Evaluate accuracy of one’s own recording and
compare to someone
- Reinforcement is contingent on accuracy of
self-evaluations
Why Self-Management?
• ADHD is largely a deficit in self-regulated
behavior
• Individuals with ADHD have impaired executive
functions that impair their ability to self-manage
• Self-management can
– Teach skills that address these deficits
– Facilitate more independent living
– Require less parental/adult involvement
Steps to Using Self-Management
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Establish prerequisite conditions
Define target behavior
Design procedures and forms
Teach
Monitor data
Conduct maintenance and follow-up assessment
Self-Management within Schools
• Tier 2
– Social skills groups
– Academic groups (e.g., reading)
• Tier 3
– On-task behavior
– Organizational skills
– Task completion
– Academic accuracy, productivity, engagement
Taking what we know works in schools to the
home…
• Intervene on unaddressed academic- or schoolrelated issues at home
• Enhance collaboration/communication between
schools and families
• Provide families with tools to make their child
successful at home and subsequently more
successful at school
Self-Management for Homework Behavior
Axelrod, Zhe, Haugen, & Klein (2009)
• Participants: 4 adolescent males, 1 adolescent
female
• Setting: Residential treatment program for
adolescents with significant problem behavior
• Measures: On-task behavior, Incomplete homework
assignments
• Procedure: Self-monitoring
– 3-min interval
– 10-min interval
• Results:
Purpose of Current Study
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Examine the effectiveness of using a selfmanagement intervention to increase the ontask behavior of children diagnosed with
ADHD
Extend the research to examine the
effectiveness of using a self-management
intervention with children with ADHD in a
home setting
Extend the research to target a variety of
problematic routines
Method
Participants
Tommy, 11 yr old
• Dropped from
Gifted program
• Victim of
bullying
David, 9 yr old
Johnny, 12 yr old
• Tantrums
• Removed from
• Problems sleeping school
• Comorbid
• Prescribed
diagnosisFocalin
Diabetes
•Setting
§Participants’ homes
Method Cont…
• Dependent Variable:
– Target Routines
§ Tommy: Homework
§ David: Night time shower
§ Johnny: Leisure reading
– On-Task Behavior
§ Behavior Observation of Student in Schools (BOSS)
code
§ Passive engagement, active engagement, absence
of off-task behavior
§ Individualized by using examples
Homework: getting his homework materials together,
completing his homework and having his parents
check his homework to make sure it was correct.
On-Task
Off-Task
• Silently reading
• Looking at the computer screen
• Asking parent a question related to the assigned
homework
• Clicking the mouse to answer questions/advance
the screen on the appropriate site
• Writing notes or answers
• Turning the pages of a school book/journal
• Speaking out loud about the academic work
• Going to the bathroom
• Eating a snack
• Out of seat during homework time (except for
bathroom or bringing homework to parents to
check)
• Playing a video game/computer game during
homework time
• Playing with the computer mouse/keyboard when
the homework is not on the computer
• Playing with pen/pencil
• Spinning round in the chair
• Talking to others about anything other than asking
for help on the current homework assignment
• Singing/making loud noises
• Complaining/whining
• Looking away from the task at hand for more than
5 sec
Shower: getting his shower materials (e.g., towel) and
pajamas together, taking a shower, getting dressed and
taking his dirty clothes and towel to the laundry room.
On-Task
Off-Task
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Standing in front of his dresser
Standing in the shower
Washing his hair
Washing his body
Carrying his clothes to the laundry
room
• Drying his hair or body
• Getting undressed
• Getting dressed
Playing on the computer
Running around the house
Arguing with his parents
Screaming/crying
Laying on the floor
Reading: getting his book and writing materials (e.g.,
paper and pen) together, reading his book, and
writing a summary of what he had read
On-Task
Off-Task
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Silently reading
Picking out his book
Gathering his journal and pen
Turning the page
Writing in his journal
Going to the bathroom
Drawing
Playing with the pen/pencil
Getting up from the table
Playing with the book
Talking to his mom/brother about
anything other than the current book
• Arguing with his mom
• Looking away from the book/journal
for more than 5 sec
• Sitting with his head down/on the
table
Method Cont…
• Data Collection
- Percent of total time spent on-task
§ Time spent on-task / Total duration of the
routine X 100
- Duration of the routine
§ Measured from the beginning to ending of the
routine
Method Cont…
- Accuracy (Child’s implementation)
§ Below 80% = Retraining
§ Tommy M = 97.5%, David M = 83.3%, Johnny M = 100%
- Treatment Fidelity (Parent implementation)
§ Tommy = 4 sessions, David = 9 sessions, Johnny = 3 sessions
§ M = 96.9%, David M = 100%, Johnny M = 100%
- IOA
§ 33% of baseline, 33% of intervention conditions
§ Percent of time on-task:
• Tommy M = 95.8%, David M = 80.5%, Johnny M =
100%
§ Duration:
• M = 100%
Methods Cont.
• Social Validity
1-­‐strongly disagree
2-­‐ disagree
3-­‐undecided
Child Version
1. I think the self-management
intervention was beneficial and
helped me stay on-task.
2. The self-management intervention
was easy to learn.
3. The self-management intervention
was easy to use.
4. I would be willing to use the selfmanagement intervention in other
setting such as school.
5. I would recommend the selfmanagement intervention to other
kids.
4-­‐agree
5-­‐strongly agree
Parent Version
1. I think the self-management
intervention was beneficial to my
child.
2. The self-management intervention
was easy to learn.
3. The self-management intervention
was easy to use in the home.
4. I would be willing to continue
using the self-management
intervention in my home.
5. I would recommend the selfmanagement intervention to
other parents.
Method Cont…
• Experimental Design
– Multiple baseline across participants
– Evaluate the effects of a self-management
intervention
Method Cont…
• Procedures
– Initial interview
– Baseline
§ Behave as they normally would
§ Preference assessment
– Training
§ Participants
• 7 steps
• Mastery = 90% or more for 2 consecutive sessions
§ Parents
• 7 steps
• Mastery = 100% for 2 consecutive sessions
Participant Training
1. Provide participant with a rationale for the use of a selfmanagement intervention.
2. Provide an operational definition of the target behavior (on-task
behavior) and provide examples.
3. Describe the self-management procedure and introduce the selfmanagement form.
4. Have the participant describe the self-management procedure to
the researcher to ensure understanding.
5. Model the procedure for the participant.
6. Allow time for the participant to rehearse using the procedure.
• Participant will view videos from earlier baseline sessions to
practice identifying the target behavior.
• Participant will practice using the self-management form to
record occurrences of on-task or off-task behavior.
7. Provide feedback accordingly.
Parent Training
1. Provide an operational definition of the target behavior (on-task behavior)
and provide examples.
2. Introduce and provide instructions on the use of the self-management form.
3. Allow the parent time to practice using the self-management form.
• Parents will view videos from earlier baseline sessions to practice
identifying the target behavior.
• Parents will practice using the self-management form to record
occurrences of their child’s on-task or off-task behavior.
4. Provide instructions on determining accuracy scores.
5. Provide instructions on delivering the appropriate form of feedback and
preferred items depending on the accuracy score achieved.
6. Allow the parent time to practice comparing two self-management forms to
determine an accuracy score and allow time to practice providing feedback and
preferred items if earned.
7. Provide the parent with feedback accordingly.
Method Cont…
– Self-Management 3 min variable interval
§ Auditory beep on average every 3 min
§ Parents conducted accuracy checks
• 100% accuracy = praise and reward
• Less that 100% = feedback
• 3 consecutive sessions at 80% or more on-task = interval
was faded
– Self-Management 8 min variable interval
§ Auditory beep on average every 8 min
§ Accuracy checks, feedback and rewards stayed the
same
Method Cont…
– Self-Management plus Reinforcement
§ Occurred if increase in on-task behavior was
not observed
§ Reward contingent on accuracy and change in
on-task behavior
• 100% accuracy
• 80% or more on-task behavior
Baseline
Self-Man 3min
Self-Man 8min
2 week follow up
100
80
60
40
20
Tommy,
homework
0
Self-Man
3-min
Self-Man + Sr
100
Percent of Time On-Task
80
60
40
20
David, nighttime
shower
0
2 week follow up
100
80
60
Accuracy
40
On-task
Behavior
20
Johnny, leisure
reading
0
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
Sessions
Figure 1. Percentage of on-task behavior data is displayed above for Tommy, David, and Johnny
across all phases of the study. Accuracy data scores are also displayed for all three participants.
Baseline
Self-Man
3-min
Self-Man
8-min
2 week follow up
80
60
40
Tommy, homework
20
0
Duration of Routine (min.)
80
Self-Man 3min
Self-Man +
Sr
60
40
David, nighttime
shower
20
0
80
2 week follow up
60
40
Johnny, leisure
reading
20
0
0
1
2
3
4
5
6
7
8
9
10 11 12 13 14 15 16 17 18 19 20 21 22
Sessions
Figure 2. Duration of target routines data is displayed above for Tommy, David, and Johnny across all phases of the
study.
1-­‐strongly disagree
2-­‐ disagree
3-­‐undecided
4-­‐agree
5-­‐strongly agree
Child Version
Parent Version
1. I think the self-management
intervention was beneficial and
helped me stay on-task.
2. The self-management intervention
was easy to learn.
3. The self-management intervention
was easy to use.
4. I would be willing to use the selfmanagement intervention in other
setting such as school.
5. I would recommend the selfmanagement intervention to other
kids.
1. I think the self-management
intervention was beneficial to my
child.
2. The self-management intervention
was easy to learn.
3. The self-management intervention
was easy to use in the home.
4. I would be willing to continue using
the self-management intervention in
my home.
5. I would recommend the selfmanagement intervention to other
parents.
• Participants: Tommy
M = 5, David M =
2.8, Johnny M = 5
• Parents: Tommy M =
5, David M = 4.6,
Johnny M = 5
Discussion
• Benefits of Self-Management
- Effective at increasing on-task behavior
- Intervals can effectively be faded
- Duration of the target routine may decrease
as a result of effective self-management
- Perceived overall as an easy and acceptable
intervention by participants and parents
Discussion Cont...
• Self-management plus reinforcement may be
needed for some children
• Limitations
– Lack of long term maintenance data
– No fading of tangible rewards
– Low amount of participants
Future Directions
• Target a wider range of participants
• Examine different methods of fading
self-management intervals
• Examine different methods of fading
tangible rewards
• Collect long term maintenance data
Thank you!
Lindsey Slattery
[email protected]
References
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Amato-Zech, N., Hoff, K., & Doepke, K. (2006). Increasing on-task behavior in
the classroom: Extension of self-monitoring strategies. Psychology in the Schools, 43,
211-221.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental
disorders (4th edition). Washington, DC: Author.
Axelrod, M., Zhe, E., Haugen, K., & Klein, J. (2009). Self-management of on task
homework behavior: A promising strategy for adolescents with attention and
behavior problems. School Psychology Review, 38, 325-333.
Barkley, R. A. (1990). Attention-deficit hyperactivity disorder. (1 ed.). New York:
Guilford Publications.
Barkley, R. A. (1998). Attention-deficit hyperactivity disorder: A handbook for
diagnosis and treatment (2nd ed.). New York: Guilford.
Barkley, R. A. (2002). Major life activity and health outcomes associated with
attention-deficit/hyperactivity disorder. Journal of Clinical Psychiatry, 63, 10-15.
Amato-Zech, N., Hoff, K., & Doepke, K. (2006). Increasing on-task behavior in
the classroom: Extension of self-monitoring strategies. Psychology in the Schools, 43,
211-221.
•
•
•
•
•
•
•
•
•
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th
edition). Washington, DC: Author.
Axelrod, M., Zhe, E., Haugen, K., & Klein, J. (2009). Self-management of on task homework
behavior: A promising strategy for adolescents with attention and behavior problems. School
Psychology Review, 38, 325-333.
Barkley, R. A. (1990). Attention-deficit hyperactivity disorder. (1 ed.). New York: Guilford
Publications.
Barkley, R. A. (1998). Attention-deficit hyperactivity disorder: A handbook for diagnosis and
treatment (2nd ed.). New York: Guilford.
Barkley, R. A. (2002). Major life activity and health outcomes associated with attentiondeficit/hyperactivity disorder. Journal of Clinical Psychiatry, 63, 10-15.
Cantwell, D. P., & Baker, L. (1991). Association between attention deficit-hyperactivity disorder
and learning disorders. Journal of Learning Disabilities, 24, 88-95.
Centers for Disease Control and Prevention. (2010). Increasing prevalence of parent-reported
attention deficit/hyperactivity disorder among children: United states, 2003 and 2007. Morbidity
and Mortality Weekly Report (MMWR), 59, 1439–1443.
Davies, S., & Witte, R. (2000). Self-management and peer-monitoring within a group
contingency to decrease uncontrolled verbalizations of children with attentiondeficit/hyperactivity disorder. Psychology in the Schools, 37, 135-147.
De Haas-Warner, S. (1992). The utility of self-monitoring for preschool on-task behavior. Topics
in Early Childhood Special Education, 12, 478-495.
•
•
•
•
•
DuPaul, G. J., Ervin, R. A., Hook, C. L., & McGooey, K. E. (1998). Peer tutoring for
children with attention deficit hyperactivity disorder: Effects on classroom behavior
and academic performance. Journal of Applied Behavior Analysis, 31, 579-592.
Flood, W. A., Wilder, D. A., Flood, A. L., & Masuda, A. (2002). Peer-mediated
reinforcement plus prompting as treatment for off-task behavior in children with
attention-deficit hyperactivity disorder. Journal of Applied Behavior Analysis, 35, 199204.
Garfield, C., Dorsey, R., Zhu, S., Huskamp, H., Conti, R., Dusetzina, S.,
…Alexander, C. (2012). Trends in attention deficit hyperactivity disorder ambulatory
diagnosis and medical treatment in the united states, 2000–2010. Academic Pediatrics,
12, 110-116.
Graham-Day, K., Gardner, R., & Hsin, Y. (2010). Increasing on-task behaviors of
high school students with attention deficit hyperactive disorder: Is it enough?
Education and Treatment of Children, 33, 205-221.
Gureasko-Moore, S., DuPaul, G. J., & White, G. P. (2006). The effects of selfmanagement in general education classrooms on the organizational skills of
adolescents with adhd. Behavior Modification, 3, 159-183.
•
•
•
•
•
•
•
Harpin, V. A. (2005). The effect of adhd on the life of an individual, their family, and community
from preschool to adult life. Archives of Disease in Childhood, 90, 2-7.
Harris, K. R., Friedlander, B. D., Saddler, B., Frizzelle, R., & Graham, S. (2005). Self- monitoring
of attention versus self-monitoring of academic performance: Effects among students with adhd
in the general education classroom. The Journal of Special Education, 39, 145-156.
Johnston, C., & Mash, E. J. (2001). Families of children with attention-deficit/hyperactivity
disorder: Review and recommendations for future research. Clinical Child and Family Psychology
Review, 4, 183–207.
Jurbergs, N., Palcic, J., & Kelley, M. (2007). School-home notes with and without response cost:
Increasing attention and academic performance in low-income children with attentiondeficit/hyperactivity disorder. School Psychology Quarterly, 22, 358-379.
Neef, N., Bicard, D., Endo, S., Coury, D., & Aman, M. (2005). Evaluation of pharmacological
treatment of impulsivity in children with attention deficit hyperactivity disorder. Journal of Applied
Behavior Analysis, 38, 135-146.
Pelham, W. E., Foster, M. E., & Robb, J. A. (2007). The economic impact of attention
deficit/hyperactivity disorder in children and adolescents. Ambulatory Pediatrics, 7, 121-131.
Reid, R., Schartz, M., & Trout, A. (2005). Self-regulation interventions for children with
attention deficit/hyperactivity disorder. Exceptional Children, 71, 361-377.
•
•
•
•
•
Root, R. W., & Resnick, R. J. (2003). An update on the diagnosis and treatment of attention
deficit/hyperactivity disorder in children. Professional Psychology: Research and Practice, 34, 3441.
Shapiro, E. S. (2010). Direct observation: Manual for the behavioral observation of
students in school (boss). Academic Problems Skills Fourth Edition Workbook (pp. 42-45). New
York, NY: Guilford Press.
Shapiro, E. S., DuPaul, G. J., & Bradley-Klug, K. L. (1998). Self-management as a strategy
to improve the classroom behavior of adolescents with adhd. Journal of Learning Disabilities,
31, 545-555.
The Food and Drug Administration. (2011). FDA drug safety communication: Safety review
update of medications used to treat attention-deficit/hyperactivity disorder (adhd) in children and young
adults. Retrieved from
http://www.fda.gov/Drugs/DrugSafety/ucm277770.htm?utm_campaign=Google2&utm_
source=fdaSearch&utm_medium=website&utm_term=adhd&utm_content=4.
Toney, L. P., Kelly, M. L., & Lanclos, N. F. (2003). Self- and parental monitoring of
homework in adolescents: Comparative effects of parents’ perceptions of homework
behavior problems. Child and Family Behavior Therapy, 25, 35-51.