Addressing Disparities: A Pragmatic Comparative Effectiveness Trial of School-Based Executive Functioning...

Area of Science:

• Child Psychology
• Neurodevelopmental Disorders
• Educational Interventions

Background:

• Executive functioning (EF) challenges are prevalent in neurodivergent children, particularly those with autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD).
• EF deficits are linked to poorer academic outcomes and are often exacerbated by socioeconomic factors like poverty.
• EF skills are amenable to targeted interventions.

Purpose of the Study:

• To compare the effectiveness of two school-based EF interventions for children with ASD and/or ADHD.
• To enhance the accessibility of effective EF interventions in low-income (Title 1) school settings.
• To evaluate interventions delivered by school staff to support generalization of skills.

Main Methods:

• A pragmatic cluster-randomized study involving 148 children (3rd-5th grade) in 24 Title 1 schools.
• Interventions: Unstuck and On Target (cognitive-behavioral) vs. Parents and Teachers Supporting Students (behavioral management).
• Outcomes assessed via masked classroom observations, EF tasks, and parent reports; fidelity, acceptability, and moderation by income were examined.

Main Results:

• Both interventions demonstrated high fidelity and were well-received by children and parents.
• Significant improvements in child executive functioning were observed across both interventions and all outcome measures.
• Intervention effects persisted even after accounting for family income, indicating limited income-based moderation.

Conclusions:

• School-based delivery of EF interventions by school staff is effective in low-income settings.
• These accessible, low-cost programs can help mitigate income-based health disparities in neurodevelopmental care.
• The findings support the broader application of these interventions within school systems.