Daily Behavior Report Cards with and without Home-Based Consequences (2010) - Jurberg et. al. - Artikel

ADHD is more commonly diagnosed in African American children from low socioeconomic (SES) backgrounds than in Caucasian children from all SES backgrounds. A particular concern is that stimulant medication can be very expensive and thus not affordable for parents with a low income. Furthermore, an incremental effect has been found for behavioral interventions over medication in ethnic minority and not in Caucasian children. This highlights the need for more research addressing low SES, minority samples.

Daily behavior report cards (DBRC) involve teachers evaluating students’ behavior daily and parents providing consequences at home based on the evaluation. This has shown to be an effective and socially valid treatment for improving a wide variety of inappropriate behavior. This strategy is simple to use and efficient. It promotes the involvement of parents and thereby gives the opportunity to use powerful reinforcers that are not available at school. DBRC allows for collaboration between teachers and parents and mutual problem solving.

Addressing parents to involve in the academic problems of their child may be especially important in families with a low SES who often feel disenfranchised by the school system. Teachers often complain that lower income parents do not respond to contact attempts, don’t show up for appointments and fail to follow through with recommendations. They therefore often assume these parents to be unwilling or unable to assist with their children’s educational problems. The behaviors of parents with a low SES may come from personal academic failure, feeling disempowered by the bureaucracy of schools or the believe that their values are different from those of school administrators. This causes an unproductive interaction between parents and school administrators, which counteracts with the effectiveness of DBRC.

DBRC with home-based consequences has shown to be effective for improving classroom behavior of low income, African American children. Unfortunately, the participation of parents isn’t always possible, especially in impoverished families. In such situations it often becomes necessary for teachers to provide consequences in order to minimize the need for parent involvement. However, these interventions must be easily incorporated into the classroom routine in order to remain acceptable to teachers. The question arises whether objective, calmly delivered feedback to students is the essential ingredient in effective DBRC and if this makes parent consequences unnecessary. If this would be the case, such a technique can be utilized with students whose parents are unable or unwilling to provide consequences at home.

Method

In this study, 43 children attending first through third grade participated. In order to be able to participate in the study they needed teacher referral for problematic classroom behavior, ADHD diagnosis, high levels of observed off-task behavior and attend an inner-city elementary school serving primarily low income families. All participants were African American, most of them male with an average age of 7,4 years. The majority of students were from single-parent homes with an average yearly income below 15.000 dollars. Despite the fact that all of them had the ADHD diagnosis, only 25% received prescribed medication at the time of the study.

Student behavior was coded during 30-minute sessions of 15 second intervals. Each interval was coded either on-task or off-task. An interval was coded on-task if the student engaged in appropriate, assignment-related activities for the entire 15-second interval, and off-task if the student wasn’t engaged in the assignment for at least 3 consecutive seconds during the interval. The dependent measure was the percentage of Intervals in which the student was engaged in on-task behavior for the entire 15 seconds.

At the end of each session, the observer collected and photocopied the child’s classwork completed during the morning independent work period. Assignments typically were worksheets that could be objectively graded. Copies of assignments were graded for percentage complete and percentage correct, which served as the two outcome measures.

Procedure

The effects of DBRC with parent consequences (PC), DBRC with no parent consequences (NPC) and no treatment control (CO) condition was compared using a between groups design with three treatment groups. A baseline assessment was conducted to determine whether participants met all the criteria for participating, including their ADHD diagnosis. The conclusions of this assessment were based on individual teacher and mother interviews conducted in the child’s classroom, three 30-minute direct observations in the classroom and behavior rating scales. After determining whether the participants met all the criteria, they were randomly assigned to one of the three treatment groups. After the baseline data were collected, the study ran for 5 weeks.

Control group

The participants in the control group were observed in their classrooms on three different days, three times for 30 minutes. The observations were conducted in the morning, during independent seatwork activities. The assignments completed during the observation were graded by the observer as described in the method.

No parent consequences

The students in this group were similarly observed and their work was also graded by the observer. Furthermore, the participants each morning received a DBRC and placed it on their desk. Teachers rated the students by ‘yes’, ‘so so’ or ‘no’ for each target behavior. Whenever the student was performing off-task behavior, they were instructed to cross of a smiley face from their DBRC. Every day before lunchtime, the teacher discussed the ratings on the DBRC with the student using a provided script.

With parent consequences

The DBRC procedure was performed exactly the same as in the DBRC-NPC group. After receiving feedback from the teacher, the students took their report card back home to review with their parents and to be given contracted consequences such as snacks, extra TV time or special time with a parent. The children were able to earn 2 points for behavior ratings worth a ‘yes’, one for ‘so so’ and non for ‘no’. Also, they received 1 point for every smiley face that wasn’t crossed of their card. Every day, a maximum of 13 points could be earned. Every family was assisted constructing a contract and generating a list of possible rewards for the child to pick from. The students actively participated in generating the list with rewards in an effort to promote high levels of motivation.

Results, conclusion and discussion

The results show that DBRC-NPC as well as DBRC-PC resulted in increased on-task behavior. In correspondence with the hypothesis, the PC group –exhibited significantly higher rates of on-task behavior than the NPC-students. Considering the fact that the PC-group received rewards, this is not very surprising.

The amount of work completion did not significantly increase in either of the treatments, although from the clinical perspective treatment resulted in very high percentages of classwork completion (PC; 96%, NPC; 94%, CO; 69%). The lack of significance might be due to the relatively high rates of work completion for all groups at baseline.The amount of work completed correctly was significantly higher for NPC students in comparison with the control group, though the PC student’s accurate work completion did not differ from either group. This could be due to the lack of power caused by the small sample size.

Teachers described both treatments as acceptable and effective. They indicated to prefer the DBRC program with parental consequences because they found it to be a more powerful intervention.

The results clearly show the superiority of the DBRC-PC intervention over DBRC-NPC, though both interventions appear to be effective in increasing on-task behavior in children with ADHD. It is striking that simply evaluating students’ behavior and giving them feedback resulted in significant improvement. This therefore might be considered as an initial treatment prior to implementing more complicated interventions.

Parent involvement has, in addition to being superior with regard to treatment outcome, many potential advantages over the use of DBRC-NPC. The mothers often reported feeling empowered by increased knowledge of their children’s daily classroom behavior. They also indicated that daily feedback from the teachers allowed them to provide their children with guidance and alter homework goals, as well as provide consequences. Daily feedback often promoted parents’ positive feelings about the classroom teacher and her efforts to help their children experience success. It thereby encouraged parents become more involved in their child’s classroom behavior and academic performance.