The Moderating Effects of Implementation Factors on Improvement in Classroom Behaviors in Unstuck and on Target and Contingency Behavior Management

Background: Unstuck and On Target (UOT; Cannon, Kenworthy, Alexander, Werner, & Anthony, 2018), a manualized executive function intervention for children with autism spectrum disorder (ASD) or attention deficit hyperactivity disorder (ADHD), has demonstrated effectiveness in increasing children’s flexibility, organization, and planning skills. In a recent randomized effectiveness study comparing UOT to Parents and Teachers Supporting Students (PATSS), an enhanced contingency behavioral management intervention, neither interventionist profession (for the sample as a whole) nor average overall fidelity (for the sample as a whole and within each intervention group) was significantly related to improvements in students’ classroom behaviors pre- to post-intervention.

Objectives: To examine the potential moderating effects of implementation factors (i.e., fidelity and interventionist profession) on improvements in classroom behavior.

Methods: The current study analyzed data from the randomized, comparative effectiveness study of UOT and PATSS in 21 Title 1 elementary schools. Participants included 136 3^rd to 5^th grade students with ASD (n=45) or ADHD (n =91). The outcome of interest was pre to post changes in masked observations of students’ classroom behavior. The presence or absence of six behaviors were coded by observers and summed, yielding total scores ranging from 0 (i.e., the student exhibited every problem behavior during the observation) to 6 (i.e., the student exhibited no problem behaviors). Fidelity was measured through two observations of each interventionist, with observers rating ten items (e.g., content fidelity) on a 5-point scale (1 = strongly disagree, 5 = strongly agree) and an overall fidelity item on a 10-point scale. The potential moderating effects of the ten fidelity items rated at pre-intervention were explored within each intervention and diagnostic group as well as the sample as a whole, while the effect of interventionist position was explored within each intervention group and for the sample as a whole.

Results: For students in UOT (but not PATSS), interventionist profession had a significant effect on changes in classroom behavior, F(4,63)=3.338, p=.015. Specifically, the mean change in classroom behavior was significantly lower for students whose interventionist was a school social worker (M=.238) compared to students whose interventionist was a teacher. It did not matter whether the interventionist was a school psychologist, counselor, special education teacher, or school administrator. Significant intervention-specific relationships between fidelity and changes in classroom behavior were observed for students with ASD (but not for ADHD). For students with ASD who participated in UOT, greater use of visuals during sessions was associated with greater improvement in classroom behavior, r(21)=.435, p=.049. For students with ASD who participated in PATSS, greater adherence to content delivery was associated with greater improvement in classroom behavior, r(15)=.582, p=.023.

Conclusions: Interventionist profession was related to changes in classroom behavior for students in UOT but not PATSS; however, this finding should be interpreted with caution due to small numbers of certain interventionist positions in the analysis. Furthermore, although specific fidelity ratings were related to changes in classroom behavior for students with ASD, the aspects of fidelity that were related to improvements in behavior differed across treatment groups.