Slides for AHEAD - Learning Center

Slides for AHEAD - Learning Center

How Coaching Impacts The Academic Functioning of University Students with LD and/or ADHD A Study conducted at The Academic Success Program for Students with LD/ADHD University of North Carolina at Chapel Hill AHEAD 2011, Seattle, WA Kristen Rademacher, M.Ed, CPCC University of North Carolina at Chapel Hill [email protected] David R. Parker, Ph.D. (Research Consultant) CRG, Inc. [email protected] Research Team

Dr. Theresa E. Laurie Maitland, CPCC, Principal Investigator University of North Carolina at Chapel Hill, [email protected] Erica L. Richman, MSW, Social Work Doctoral student, Research Coordinator University of North Carolina at Chapel Hill Kristen Rademacher, M.Ed, CPCC, Research Assistant University of North Carolina at Chapel Hill [email protected] Dr. David Parker, Research Consultant Childrens Resource Group (CRG), Indianapolis, IN [email protected] Literature Review What do we know about college

students with LD/ADHD? Largest and fastest growing group of disabled students on college campuses Harbour, 2004; NCES, 2000; Henderson, 2001 Take longer to complete degree than non-disabled peers and the rate of sustained enrollment remains low Jorgenson et al., 2003; Newman 2005; Wagner, Newman, Cameto, Garza, & Levine, 2005 Graduate at a lower rate than non-disabled peers 64% non disabled, 53% disabled (all types) NCES, 2003; Wagner et al., 2005

May graduate at a lower rate than peers with other disabling conditions 13.1% LD/ADHD versus 24.8% other disabling conditions (after 4 years) Beginning Postsecondary Longitudinal Study Second Follow up, 2001 What are the possible reasons for their performance problems? Academic skill weaknesses Lower GPAs, more likely to be on probation DePaul et al., 2009; Gerber, 1998; Heiligenstein et al., 1999; Rabiner et al., 2008

Underdeveloped self-determination skills A combination of skills, knowledge and beliefs that enable a person to engage in goal-directed, self-regulated, autonomous behavior Field et al., 1998 Underdeveloped executive functioning skills An umbrella construct reflecting self-regulatory functions that organize, direct, and manage other cognitive activities, emotional responses and behavior Biederman et al., 2004; Gioia, Isquith, & Guy, 2001 Coexisting psychological and/or psychiatric issues

Can impact their attitudes, reactions, coping skills and social integration Barkley et al., 2007; DaDeppo, 2009; Hoy et al., 1997 Coaching: An emerging intervention model Coaching : a popular intervention model for individuals with ADHD Hallowell & Ratey,1994; Jaska & Ratey,1999; Quinn et al., 2000 Proliferation of opinion articles, books, and case reports , but limited research Points out the lack of any research to evaluate the impact of coaching

Challenged the field to become rigorous about empirical studies Goldstein, 2005 What are we learning about the impact of coaching on students with ADHD? Coaching appears to improve students learning and study skills Field et al., 2010; Parker et al., 2011; Reaser, 2008; Swartz et al., 2005; Zwart & Kallemeyn , 2001 Coaching appears to improve students selfregulation skills Field et al., 2010; Parker et al., 2011; Swartz et al., 2005

What are we learning about the impact of coaching on students ADHD? Coaching appears to improve students self awareness Coaching appears to improve students academic life improvements in goal setting and goal attainment Coaching appears to improve students overall wellbeing Coaching has not yet been shown to have a direct impact on students GPA Field et al., 2010; Parker & Boutelle, 2009; Reaser, 2008 What are we learning about the impact of coaching on other

populations? Coaching has a statistically significant impact on retention and graduation rates of 1st year students Bettinger & Baker, 2011 Coaching may significantly improve the functioning of adults with ADHD Kubik, 2010 Coaching Definition for UNCCH A creative, action-oriented partnership based on model created by Whitworth et. al. (2007) in which students: Set goals in any area of life in which the student desires change (i.e. academics, balance between study and recreation) Work with their coach to develop systems and structures

to reach these goals Design the format of their coaching sessions (in-person, phone/email check-ins, etc.) Agree to be held accountable for commitments made during sessions Deepen their learning about themselves including their values and ambitions which helps to define and refine future goals UNC-CH Website: Background of UNC Coaches Both coaches have comparable types/amount of coaching training Theresa Maitland, CPCC and Kristen Rademacher, CPCC were trained and certified through The Coaches Training Institute. http://

116 hours of training followed by 6 month certification program requiring successful completion of written and oral competency exams Theresa earned her certification in 2003 Kristen earned her certification in 2007 Methodology Methodology: Research Questions 1. Does coaching increase participants levels of self-determination? 2. Does coaching improve participants executive functioning skills? 3. Does coaching improve participants

overall academic skills? 4. From students perspective, what are the key benefits and limitations of coaching? Methodology: Procedures Eligible participants: Total number of potential participants = 354 All students with documented LD and/or ADHD who are registered at the ASP and were interested

in coaching Willing to be in either Treatment Group of Control Group Treatment group willing to commit to at least 16 weekly sessions of coaching over fall and spring semesters Both groups willing to take 3 surveys at the start of fall semester and again at end of spring semester Methodology: Procedures (contd) Recruitment ran for first 2 weeks of fall semester All ASP students received 2 personal emails Flyers describing the study were posted in the ASP office ASP coaches informed students of study during office visits

Incentives: coupons for free coffee, a gift card to UNC Student Stores and entry into a drawing for Student Stores merchandise Before receiving coaching, each treatment participant took 3 pre-intervention surveys (2 web-based surveys and 1 paper/pencil survey; 45 minutes total time) Methodology: Procedures (contd) Treatment participants received 16 - 20 coaching sessions throughout Fall 2010 and Spring 2011 semesters

After at least 16 total coaching sessions, treatment participants took the 3 post-intervention surveys Control Group Participants did not receive coaching, but took all 3 surveys at start of fall semester and again at end of spring semester Project Manger conducted qualitative interviews with purposive sample of 6 participants during Week 9. Methodology: Participants Demographics Total Participants Recruited Total Participants Completed

N= 26 N= 24 Total Treatment Group Recruited Total Treatment Group Completed N = 18 N = 16 * One student did not complete a survey Total Control Group Recruited Total Control Group Completed N=8 N = 8 * One student did not complete a survey Gender

12 male 8 Treatment 4 Control 12 female 8 Treatment 4 Control 18 Caucasian 12 Treatment 3 Af. Am All Treatment 2 Asian

1 Treatment 1 Control Race 6 Control Methodology: Participants (contd) Demographics University Status Disability (ADHD, LD or Both) * Additional Comorbid Diagnoses Undergraduates 10 Treatment 7

Control Graduates 5 Treatment 1 Control Post Baccalaureate 1Treatment ADHD (no LD) 12 Treatment 3 Control ADHD (with LD)

2 Treatment 3 Control LD 2 Treatment 2 Control Anxiety 1 Treatment 1 Control Anxiety and Depression

*Treatment Group: Adjustment Disorder 50% *Control Group: 25% Anxiety/Depression *All Participants: 38% Depression 2 Treatment 1Treatment 1 Control Methodology: Study Participants Coaching Goals 1. Improve in approach to academics All students wanted to stay on top of daily and longterm work, plan more regularly and follow plans, become more consistent and active learners,

improve work quality and grades. 2. Improve overall life balance and well-being Most students wanted to balance social life with academics, make time for exercise, sleep, healthier eating and recreation and pursuing talents/interests. 3. Be more organized with possessions and space A number of students wanted to improve how well they kept order in their environments and kept track of possessions. Methodology: Study Participants Coaching Goals (contd) 4.

Improve thinking skills Several students set goals to become more intentional and reflective to think critically before completing a task or making a decision. 5. Prepare for the future Several students set goals to identify possible careers or next steps for life after college. Intervention Intervention Structure of Coaching Sessions

Student met with coach for initial 60 minute intake session. Focus of meeting: Student set specific semester goals Coach asked student to reflect on strengths, values, passions Coach and student designed their alliance Intervention (contd) Student met with coach weekly for 30 minute sessions (face-to-face or phone) Student and coach reviewed progress on goals Coach guided students to reflect on both

their progress and setbacks within the context of their strengths, values and passions Coach also guided students to deepen their understanding of their disability as they reflected on their goals Student set goals for following week Measures Quantitative Measures Pre- and Post-Intervention Surveys

Self-Determination Student Scale (S-DSS) Hoffman, Field & Sawilowsky, 2004 92 item yes or no internet-based, self-report survey measuring self determination Higher scores indicate greater self-determination Behavior Rating Inventory of Executive Function Adult Version (BRIEF-A) Roth, Isquith & Gioia, 2005 75 item self-report survey measuring executive functioning Lower scores indicate higher level of executive functioning Learning and Study Strategies Inventory (LASSI) Weinstein, Palmer & Shulte, 2002 80 item self-report survey measuring learning and study strategies Higher scores indicate higher level of skill Qualitative Measures

Purposive sample 6 students (3 per coach) Balance of characteristics (undergrad/grad, gender, race/ethnicity, GPA) Individual Semi-Structured Interview 1 hour, with Project Manager 13 prompts generated by team Audio-recorded and transcribed

Qualitative Measures (contd) Analysis Hand-coding by Research Consultant to generate initial set of codes Initial inter-rater reliability check between Research Consultant and Project Manager Refinement of codebook, 2nd inter-rater reliability check Final refinement of emergent themes in consultation with the research team coaches

Results Research Question 1: Impact on Self-Determination Quantitative Results: S-DSS Scores Mean pre-intervention score (Treatment): 67 Mean post-intervention score (Treatment): 72 Mean pre-test score (Control): 72 Mean post-test score (Control): 75 S-DDS (Hoffman, Field & Sawilowsky, 2004)

Pre- and Post- S-DSS Total Scores for Treatment Group Pre- and Post- S-DSS Total Scores for Control Group Results of S-DSS Total Scores: Coaching started to close the gap between groups Pre-test: Medium gap d = .51 Post-test: Smaller gap d = .41 Research Question 1/Qualitative

Impact on Self-Determination Promoted students self-awareness (44) Promoted students self-esteem (24) Helped students work toward goals more effectively (21) Helped students establish goals (18) Encouraged students to stop and reflect (6) Research Question 1/Qualitative Impact on Self-Determination

Having Kristen really helps me have manageable goals. Whereas in the past, I probably have taken on chunks and didnt realize... It would just be too much in the end and I would kind of break down. - DP And that the goals that I set need to be realisticIf I never went to class and I skipped every class last semester, and I said, Well, Im going to go to every class next semester, thats just silly. Theres no way thats going to happen. Its much more productive and much more effective and efficient to set a more reasonable goal - go to half of your classes. - AD [Coaching] helped me see, because, in the end of every week Ive been able to go, This is what worked this week; this is what didnt work this week; this is where I need to improve; this is where Im doing okay.

- JH Research Question 2: Impact on Executive Functioning Skills Quantitative Results: BRIEF-A GEC (Global Executive Composite) Scores Mean pre-intervention score (Treatment): 83 Mean post-intervention score (Treatment): 78 Mean pre-test score (Control): 72 Mean post-test score (Control): 66 **Lower scores indicate greater executive functioning skills**

BRIEF-A (Roth, Isquith & Gioia, 2005) Pre- and Post BRIEF-A GEC* Scores for Treatment Group Lower scores indicate greater executive functioning skills * Global Executive Composite Pre- and Post BRIEF-A GEC Scores for Control Group Research Question 2/Qualitative Impact on Executive Functioning Skills

Enhanced students use of self-talk (24) Helped student regulate their emotions (21) Helped students problem solve (9) Helped students plan (8) Helped students create a more balanced life (7) Helped students initiate/persist at tasks (3) Research Question 2/Qualitative

Impact on Executive Functioning Skills But now when Im about to open a game or whatever, a goof-off page, it dawns on me that Im making a conscious decision not to do my work and this feels a little uncomfortable. Its not as easy as before, when Id just blame it on, Oh, I get really distracted. Now its like, I have to take accountability for it. And its a big difference than what it was before. - LG Im more willing to - rather than just give up on something - to take a deep breath and calm myself down and look at how I am going to approach it. - AD I think I see a strength in being able to do that analytical, reflective type of thing. Being able to just take the parts into pieces and make very specific plans or goals or whatever. And I think coaching has helped

improve that particular skill. - JH Research Question 3: Impact on Academic Functioning Pre- and Post- LASSI Cluster Scores Skill (Information Processing, Selecting Main Idea, & Test Strategies) Will (Attitude, Motivation, & Anxiety) Self Regulation (Self-testing, Study Aids, Time Management & Concentration) Treatment Group Pretest Posttest

Control Group Pretest Posttest Skill: 32 Skill: 45 Skill: 36 Skill: 54 Will: 29 Will: 36 Will: 43 Will: 44

Self Regulation: 23 Self Regulation: 28 Self Regulation: 35 Self Regulation: 39 LASSI (Weinstein, Palmer & Shulte, 2002) Pre- and PostLASSI Cluster Scores Treatment Group Control

Group Pre- and Post- LASSI Scale Scores (Will Cluster) Treatment Group Pretest Posttest Control Group Pretest Posttest Motivation: 24 Motivation: 31 Motivation: 58

Motivation: 61 Anxiety: 35 Anxiety: 46 Anxiety: 33 Anxiety: 46 Pre- and Post- LASSI Scale Scores (Self-Regulation) Treatment Group Pretest Posttest Control Group Pretest

Posttest Time Mgt: 15 Time Mgt: 24 Time Mgt: 35 Time Mgt: 34 Concentration: Concentration: Concentration: Concentration: Research Question 3/Qualitative Overall Academic Skills

Helped students self-advocate (9) Led to better grades (6) Helped students write papers (3) Helped students persist with college/attend full-time (2) Helped students study better (1) Helped students turn in assignments on time (1) Research Question 3: Overall Academic Skills (contd) Like at home, my husband; I often take on tasks because I feel like Ive got to

be the wife. So its complicated with school and other things. I take things on and then Im mad later. So a lot of times now I look at the things and Ill say, Is this worth my time? or Is there something else I need to be doing? or Can I ask him for help? - DP [Coaching] had a tremendous impact [on my grades]. I went from below a 2.0 student who was on the verge of dropping out to somebody who has totally acceptable grades, G.P.A., social life, academic and extracurricular involvement. - JP I think coaching is very much about taking the big picture and putting it into small, workable, manageable things, which is kind of how you would approach a big project. For an example, for a paper, saying, Im going to do this part and then Im going to do this part and then Im going to do this part. - JH

Research Question 4a: Benefits of Coaching (Students Perspective) Develop new skills/employ them more effectively (35) Created routine time to stop/focus on my goals (12) Held me accountable (11) Provided emotional support/reassurance (9) Exposed me to different perspectives (8)

Helped me access other services/professionals (4) Provided non-judgmental listening (3) A flexible service (3) Helped me develop healthier habits (2) Helped me access accommodations (1) Research Question 4a: Benefits of Coaching (Students Perspective) You know, Ive had some improvement with that as a result of being more organized and making little steps to reach a larger goal. - JH Id say the biggest advantage is that it keeps me accountable, because I know that we make certain goals together each week. And when I go the next week, I am going to be held accountable for whatever goals we had created together the week before.

- LG Well, its a place where I can discuss things but its not a mirror. Its not just, Here, look at yourself. Its maybe a compassionate mirror or its another person who has thoughts and feelings but is completely on my side or doesnt have an agenda. - AD Research Question 4b: Limitations of Coaching (Students Perspective) Hold me even more accountable (5)

Provide more than 30 minutes a week (2) Locate the office more centrally (1) Help me gain access to peers experiences (1) Only focused on college (would like to focus on life after college, too) (1) Research Question 4b: Limitations of Coaching (Students Perspective) And also, there being a more concrete element [in coaching]. Because so far, when I make the so-called promises, they were very informal. I rarely wrote them down, I wasnt really required to. But all the stuff would slip my mind and I would not actually do them. So maybe having some sort of a formal element where, at every session, you fill out a post-it that consists of three items or something so that I can carry around and incorporate into my life would be helpful. - JP

I think I would want to say the meetings will be longer. Maybe an hour. I dont know if reading should be twice a week. Because I dont think thatyou want students to want to come. If it becomes something like a burden, then that is a problem. But I think an hour wouldnt hurt. I think it was more effective for me. - AD Book Title for Coachings Impact on You When You Do a Little Bit of Thinking, You Can Do the Things You Didnt Think You Could. (BP) Coach Leads Student to 4th Quarter Victory (DP)

No Day But Today (JH) Going the Extra Mile (LG) Why a Single Is Better than a Home Run (AD) The Day I Found the Door (JP) Discussion Key Findings Treatment group different than control group

Greater variability in scores on every measure Lower pre-test scores on almost every measure Notably lower scores for Will and SelfRegulation clusters in LASSI Particularly in Motivation, Concentration and Time-management Treatment group showed trends to improve in all measures Rate of growth often greater than in control group

Anxiety a factor for both groups Key Findings (contd) Coaching appeared to have greatest impact on Self-Determination Coaching narrowed the gap in S-DSS scores between treatment and control group more than in any other measure Students reported greatest growth in self-awareness and self-esteem

Coaching appeared to help students make progress toward their goals Coaching was popular for those who chose it More students selected it than not, and very few students dropped out of study. Very few limitations reported by students Post-hoc Power Analysis Because our results were non-significant we did a post-hoc power analysis. Given our results, this analysis told us how many participants we would need to achieve significant outcomes.

To achieve 80% power (the appropriate level) we would need 112 participants to show a moderate effect size. Limitations Measures were subjective, self-report and not normed for older students. Some students found questions inappropriate and/or irrevelant. 2 treatment group students did not have ADHD. 2 students in control group had been coached in the past.

Mixing undergraduate and graduate students may complicate results. Post-tests administered during start of final exam period. Study does not account for other variables (i.e., other interventions participants may have used, co-morbid conditions). BRIEF-A survey not available online a disincentive in recruiting control-group participants.

Recruitment incentives were small. Conclusion Implications Further research necessary regarding: Student perspective of inquiry vs. didactic service delivery models Power of accountability in managing ADHD symptoms Long-term impact of coaching, including influence on GPA and retention. Service providers may want to consider a targeted outreach to students with likely self-management issues Use LASSI as a pre-test to identify students with low Self-Regulation and Will

Scores Implications (contd) Service providers may want to consider impact of anxiety in students overall functioning Students must be able to understand the differences between coaching and other traditional services Next Steps for ASP

Share results of study with campus constituents Write article for peer-reviewed journal Continue to offer coaching and evaluate its impact as part of broader program assessment Offer group coaching

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