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@buffalo.edu

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

• 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) – 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

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, Riley-Tillman, & 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

Pelham et al., 2005 – single and combined treatment effects

DRC %

Enhancing the Effectiveness of Special Education Services for Children with ADHD Using a Daily Report

Card Program

Institute of Education Sciences Goal 2 Grant # R324J06024Fabiano, Vujnovic, Pelham, Waschbusch, Massetti, Pariseau, et al., in press

Contributors

Co-InvestigatorsWilliam E. Pelham, Jr.Daniel A. WaschbuschGreta M. MassettiJihnhee YuMartin VolkerChristopher J. Lopata

CliniciansJustin NaylorMeaghan SummerleeRebecca Vujnovic

Research AssistantsTarah CarnefixMelissa RobinsJenna 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

IEPIEP + DRC

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 student-teacher 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

Fabiano et al., 2010

Top 10 Academic and Social Targets on DRCs/ITBEs

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 Fabianofabiano@buffalo.edu