Transcript Using Daily Report Cards as a Progress in Special Education

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
[email protected]
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.
Impact of ADHD - Impairment
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Peer relationships
Adult relationships
Sibling relationships
Academic Progress
Self-esteem
Group functioning
Associated problems
Cost of illness (Pelham, Foster, & Robb, 2007)
ADHD and Special Education
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
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
General educators were asked
“Does this child with ADHD have
an IEP?”
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
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
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
Daily Report Cards for Progress
Monitoring
What is a Daily Report Card (DRC)?
• The DRC is an operationalized list of a child’s
target behaviors
– Specific criteria
– Immediate feedback
– Communication tool
– Home-based privileges contingent on meeting
DRC goals
Why Use a DRC?
• Lack of evidence based interventions specified in the
IEP’s 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)
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)
Creating the DRC
Pelham, Fabiano, & Massetti (2005) – Evidencebased 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
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).
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
• 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, RileyTillman, & Christ, 2009; Christ, Riley-Tillman, &
Chafouleas, 2009)
• Pelham
– Developed the DRC as an intervention for ADHD
(e.g., O’Leary, Pelham, Rosenbaum, & Price, 1976;
O’Leary & 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)
Pelham et al., 2001 – medication
effects
Pelham & Fabiano (2001) –
Behavioral Treatment Effects
100
90
80
Percentage of DRC goals met
70
60
50
40
30
20
10
Before special
program
0
1
3
5
7
9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39
Program day number
Pelham et al., 2005 – single and
combined treatment effects
100
DRC %
90
80
70
60
50
Behavior Mod
40
No Behavior Mod
30
20
10
0
Placebo
Low Dose
Med Dose
High Dose
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
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
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.
Child with ADHD
referred for study
Random
assignment
Diagnosis confirmed
and intake completed
IEP +
DRC
IEP
Endpoint Assessment
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 studentteacher relationship
Fabiano et al., 2010
Psychometric Properties of the
DRC as a Progress Monitoring
Measure
• Correlations between odd and even days
suggested considerable temporal stability
(r = .94, p < .05)
• Correlation between the DRC and an
independent observation code ranged from
r = -.45 to -.46
Fabiano et al., 2009
• 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
Top 10 Academic and Social Targets on DRCs/ITBEs
Fabiano et al., 2010
Box and whiskers plot for a sample
month of DRCs/ITBEs in the study
Fabiano, et al., 2009
Comparison of ITBEs vs. DRCs
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).
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
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
Thank you!
• Greg Fabiano
[email protected]