Using Daily Report Cards as a Progress Monitoring Tool for Students with ADHD in Special Education

1
Using Daily Report Cards as a Progress Monitoring
Tool for Students with ADHD in Special Education

• Gregory A. Fabiano, Ph.D.
• University at Buffalo
• Department of Counseling, School, and Educational
  Psychology
• Fabiano_at_buffalo.edu

2
Attention-deficit hyperactivity disorder (ADHD)

• ADHD is characterized by developmentally
  inappropriate levels of
• Inattention
• Hyperactivity
• Impulsivity
• ADHD behaviors are developmentally inappropriate,
  pervasive, chronic, and result in considerable
  impairment in social and academic functioning.

3
Impact of ADHD - Impairment

• Peer relationships
• Adult relationships
• Sibling relationships
• Academic Progress
• Self-esteem
• Group functioning
• Associated problems
• Cost of illness (Pelham, Foster, Robb, 2007)

4
ADHD and Special Education
5
Interface between ADHD and Special Education

• Difficult to describe precisely due to no ADHD
  category
• Majority of children in Other Health Impaired and
  Emotionally/Behaviorally disturbed categories.
• About 20 of children in Learning Disabled
  Category
• However, considerable number of children with
  ADHD are at risk for or receive special education
  in schools.

Bussing et al., 2002 Reid et al., 1994 Schnoes
et al., 2006
6
ADHD Impacts General and Special Education

• 63 of time is spent in a general education
  setting.
• Approximately 60-70 of children spend the
  majority of their time in general education
  settings.

Schnoes et al., 2006
7
General educators were asked Does this child
with ADHD have an IEP?
8
Progress Monitoring

• With the advent of the Response to Intervention
  (RtI) approach, progress monitoring has become
  emphasized.
• Progress monitoring is complicated for children
  with ADHD.
• Represented at all tiers
• Behavior is variable
• Typically in general and special education
  settings working with multiple teachers

9
(No Transcript)
10
Typical progress monitoring approach

• Progress monitoring
• 72 of children with ADHD are reported to have
  progress monitored by a special educator, but
  typically with long lags between assessments
  (i.e., weeks or months)

Fabiano et al., in preparation Schnoes et al.,
2006
11
Progress Monitoring Needs

• A hallmark of ADHD is behavioral variability
• Assessments need to be fluid, socially valid, and
  tied to important functional outcomes.
• These assessments cannot be static, but need to
  be ongoing and frequent (i.e., daily)
• Must work on an individual/idiographic level
• Based on these issues/criteria, the Daily Report
  Card may be a useful approach to progress
  monitoring

12
Daily Report Cards for Progress Monitoring
13
What is a Daily Report Card (DRC)?

• The DRC is an operationalized list of a childs
  target behaviors
• Specific criteria
• Immediate feedback
• Communication tool
• Home-based privileges contingent on meeting DRC
  goals

14
Why Use a DRC?

• Lack of evidence based interventions specified in
  the IEPs of students diagnosed with ADHD
• The DRC is an evidence-based intervention for
  ADHD in schools (Pelham Fabiano, 2008 DuPaul
  Stoner, 2004 Evans Youngstrom, 2006 U.S.
  Department of Education, 2003)
• Feasible for teachers (e.g., Fabiano et al.,
  2010 Murray et al., 2008)
• Students receive immediate feedback
• Explicit feedback from the teacher may also serve
  as an antecedent to future appropriate behavior
  (Sugai Colvin, 1997)

15
Why Use a DRC?

• Provides daily communication
• Important for an intervention to facilitate
  communication (Pisecco, et al, 1999)
• May contribute to amenable parent-teacher
  relationships (Dussault, 1996).
• May enhance relationships between teacher, parent
  and child (e.g., Pianta, 1996 Sheridan
  Kratochwill, 2008)
• Allow for continued progress monitoring
  monitoring outcomes (e.g., Chafouleas,
  Riley-Tillman, McDougal, 2002 Cheney, Flower,
  Templeton, 2008 DuPaul Stoner, 2003 Evans
  et al., 1995 Pelham, Fabiano, Massetti, 2005
  Riley-Tillman, Chafouleas, Breisch, 2007)

16
(No Transcript)
17
Creating the DRC
18
Pelham, Fabiano, Massetti (2005)
Evidence-based assessment for ADHD

• DRCs have adequate psychometric properties
• Alpha .77- .88
• r .62 for test-retest
• Correlates with symptom-based ratings of ADHD
• r .51 - .72
• Correlates with objective measures of behavior
  (i.e., observations)
• r .47- .84
• Discriminates between treatment conditions

19
Long History of Using Targeted Behavior Lists as
Measures of Outcome

• Patterson (1975)
• Used targeted behaviors listed by parents at
  referral (noncompliance, temper tantrum, teasing)
  as measures of treatment outcome
• Parent Daily Report (PDR) is a psychometrically
  sound measure (Chamberlain Reid, 1987).

20
Examples of Existing Studies of the DRC as a
Progress Monitoring Measure

• Cheney, Flower, and Templeton (2008)
• Used a Daily Progress Report
• Classified Students as responders/non-responders
  in an RtI model
• Used the DRC as a measure of on-going progress
  monitoring for students on Tier 2

21

• Chafouleas, Riley-Tillman, Christ, Briesch
• Direct Behavior Ratings (DBRs)
• Conducted a sophisticated and comprehensive
  program of research to validate DBRs as a measure
  of screening, progress monitoring, and outcome
• DBRs are reliable, valid, and sensitive to
  treatment (Chafouleas, Christ, Riley-Tillman,
  Briesch, Chanese, 2007 Chafouleas,
  Riley-Tillman, Christ, 2009 Christ,
  Riley-Tillman, Chafouleas, 2009)

22

• Pelham
• Developed the DRC as an intervention for ADHD
  (e.g., OLeary, Pelham, Rosenbaum, Price, 1976
  OLeary Pelham, 1978)
• More recently used the DRC as a method of
  progress monitoring
• Medication effects (Pelham et al., 2001 Pelham
  et al., 2005)
• Behavior Modification effects (Pelham et al.,
  2005)
• Combined treatment effects (Pelham et al., 2005)
• Ongoing Monitoring (Coles et al., 2010 Pelham et
  al., 2010 a,b)

23
Pelham et al., 2001 medication effects
24
Pelham Fabiano (2001) Behavioral Treatment
Effects
25
Pelham et al., 2005 single and combined
treatment effects
DRC
26
Enhancing the Effectiveness of Special Education
Services for Children with ADHD Using a Daily
Report Card Program
Institute of Education Sciences Goal 2 Grant
R324J06024 Fabiano, Vujnovic, Pelham, Waschbusch,
Massetti, Pariseau, et al., in press
27
Contributors

• Co-Investigators
• William E. Pelham, Jr.
• Daniel A. Waschbusch
• Greta M. Massetti
• Jihnhee Yu
• Martin Volker
• Christopher J. Lopata

• Clinicians
• Justin Naylor
• Meaghan Summerlee
• Rebecca Vujnovic
• Research Assistants
• Tarah Carnefix
• Melissa Robins
• Jenna Rennemann

28
Summary and Main Findings of Goal 2 Project
(Fabiano, et al., 2010)

• 63 children with ADHD and IEPs were randomly
  assigned to
• Business as Usual (BAU)
• BAU a DRC with targets based on IEP goals and
  objectives
• Children were assessed in October and May of the
  school year.

29
(No Transcript)
30
Main Findings

• DRC group was significantly better than BAU on
• Blind observations of disruptive behavior
• Teacher ratings of
• Academic productivity
• Disruptive behavior
• IEP goal attainment
• Normalization of functioning
• No difference on academic achievement, ratings of
  ADHD symptoms, or student-teacher relationship

Fabiano et al., 2010
31
Psychometric Properties of the DRC as a Progress
Monitoring Measure

• Correlations between odd and even days suggested
  considerable temporal stability (r .94,
  p lt .05)
• Correlation between the DRC and an independent
  observation code ranged from r -.45 to -.46

Fabiano et al., 2009
32

• Content validity
• academic goals represented in the IEP were at
  least adequately included on the DRC
• there was not a significant correspondence
  between social goals reported on the IEP and the
  DRC goals related to social functioning.
• It is notable that a considerable number of
  children with no IEP goals related to social
  behavior had a social goal added to the DRC
  during the school year.
• Social goals may not be well-represented on IEPs

Fabiano, et al., 2009
33
Top 10 Academic and Social Targets on DRCs/ITBEs
Fabiano et al., 2010
34
Box and whiskers plot for a sample month of
DRCs/ITBEs in the study
Fabiano, et al., 2009
35
Comparison of ITBEs vs. DRCs
36
Palatability

• Teachers report satisfaction with DRC procedures
  related to monitoring and intervention
  (Chafouleas, Riley-Tillman, Sassu, 2006
  Fabiano et al., 2010 Pelham et al., under
  review).

37
Discussion

• DRC is supported as a psychometrically sound
  progress monitoring tool.
• May be better for monitoring progress for social
  behavior relative to typical methods such as IEP
  goals/objectives.
• Due to significant behavioral variability, daily
  implementation is preferred frequency of
  measurement.
• Background intervention may impact variability

38
Future Directions

• Teachers/School staff are not trained in
  interpreting single-subject research results
• How will daily progress monitoring be utilized?
• Additional study of context effects
• Integration within a problem-solving model

39
Thank you!

• Greg Fabiano
• fabiano_at_buffalo.edu