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 Hillwww.unc.edu/asp

AHEAD 2011, Seattle, WA

Kristen Rademacher, M.Ed, CPCCUniversity of North Carolina at Chapel Hill

krademacher@unc.edu

David R. Parker, Ph.D. (Research Consultant)CRG, Inc.

drdparker@gmail.com

Research Team

Dr. Theresa E. Laurie Maitland, CPCC, Principal InvestigatorUniversity of North Carolina at Chapel Hill, tmaitlan@email.unc.edu

Erica L. Richman, MSW, Social Work Doctoral student, Research CoordinatorUniversity of North Carolina at Chapel Hill

Kristen Rademacher, M.Ed, CPCC, Research AssistantUniversity of North Carolina at Chapel Hillkrademacher@unc.edu

Dr. David Parker, Research ConsultantChildren’s Resource Group (CRG), Indianapolis, INdrdparker@gmail.com

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 lowJorgenson 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 ADHDHallowell & 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’ self-regulation skillsField 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

well- being Coaching has not yet been shown to have a direct

impact on students’ GPAField 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 studentsBettinger & Baker, 2011

Coaching may significantly improve the functioning of adults with ADHDKubik, 2010

Coaching Definition for UNC-CH 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: http://www.unc.edu/asp/

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://www.thecoaches.com/coach-training/ 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 (cont’d)

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 (cont’d)

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: ParticipantsDemographics

Total Participants RecruitedTotal Participants Completed

N= 26N= 24

Total Treatment Group RecruitedTotal Treatment Group Completed

N = 18N = 16 * One student did not complete a survey

Total Control Group RecruitedTotal Control Group Completed

N = 8N = 8 * One student did not complete a survey

Gender 12 male 8 Treatment 4 Control

12 female 8 Treatment 4 Control

Race 18 Caucasian 12 Treatment

6 Control

3 Af. Am All Treatment

2 Asian 1 Treatment 1 Control

1 Unknown Control

Methodology: Participants (cont’d)

Demographics

University Status Undergraduates 10 Treatment 7 Control

Graduates 5 Treatment 1 Control

Post Baccalaureate 1Treatment

Disability (ADHD, LD or Both)

ADHD (no LD) 12 Treatment 3 Control

ADHD (with LD) 2 Treatment 3 Control

LD 2 Treatment 2 Control

* Additional Co-morbid Diagnoses

*Treatment Group: 50%*Control Group: 25%*All Participants: 38%

Anxiety 1 Treatment 1 Control

Anxiety and Depression 2 Treatment

Adjustment Disorder Anxiety/Depression

1Treatment 1 Control

Depression 1 Treatment

Bipolar 1 Treatment

Asperger’s Syndrome Anxiety/Depression

2 Treatment

Methodology: Study Participants’ Coaching Goals

1. Improve in approach to academics All students wanted to stay on top of daily and

long- term 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 (cont’d)

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 goalsCoach asked student to reflect on

strengths, values, passionsCoach and student “designed their

alliance”

Intervention (cont’d)

Student met with coach weekly for 30 minute sessions (face-to-face or phone) Student and coach reviewed progress on

goalsCoach 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 MeasuresPre- 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 (cont’d)

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 gapd = .51

Post-test: Smaller gapd = .41

Research Question 1/QualitativeImpact 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 didn’t 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 realistic…If I never went to class and I skipped every class last semester, and I said, ‘Well, I’m going to go to every class next semester,’ that’s just silly. There’s no way that’s going to happen. It’s 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 I’ve been able to go, ‘This is what worked this week; this is what didn’t work this week; this is where I need to improve; this is where I’m 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/QualitativeImpact 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/QualitativeImpact on Executive Functioning Skills

“But now when I’m about to open a game or whatever, a goof-off page, it dawns on me that I’m making a conscious decision not to do my work and this feels a little uncomfortable. It’s not as easy as before, when I’d just blame it on, ‘Oh, I get really distracted.’ Now it’s like, ‘I have to take accountability for it.’ And it’s a big difference than what it was before.”

- LG

“I’m 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

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

Skill: 32 Skill: 45

Will: 29 Will: 36

Self Regulation: 23

Self Regulation: 28

Control Group

Pretest Posttest

Skill: 36 Skill: 54

Will: 43 Will: 44

Self Regulation: 35

Self Regulation: 39

Research Question 3: Impact on Academic Functioning

LASSI (Weinstein, Palmer & Shulte, 2002)

Pre- and Post- LASSI Cluster Scores

Control Group

Treatment Group

Pre- and Post- LASSI Scale Scores (Will Cluster)

Treatment Group

Pretest Posttest

Motivation: 24 Motivation: 31

Anxiety: 35 Anxiety: 46

Control Group

Pretest Posttest

Motivation: 58 Motivation: 61

Anxiety: 33 Anxiety: 46

Treatment Group

Pretest Posttest

Time Mgt: 15 Time Mgt: 24

Concentration: 16

Concentration: 24

Control Group

Pretest Posttest

Time Mgt: 35 Time Mgt: 34

Concentration: 22

Concentration: 33

Pre- and Post- LASSI Scale Scores (Self-Regulation)

Research Question 3/QualitativeOverall 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 (cont’d)

“Like at home, my husband; I often take on tasks because I feel like I’ve got to be the wife. So it’s complicated with school and other things. I take things on and then I’m mad later. So a lot of times now I look at the things and I’ll 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, ‘I’m going to do this part and then I’m going to do this part and then I’m 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, I’ve had some improvement with that as a result of being more organized and making little steps to reach a larger goal.”

- JH

“I’d 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, it’s a place where I can discuss things but it’s not a mirror. It’s not just, ‘Here, look at yourself.’ It’s maybe a compassionate mirror or it’s another person who has thoughts and feelings but is completely on my side or doesn’t 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 peer’s

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 wasn’t 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 don’t know if reading should be twice a week. Because I don’t think that…you want students to want to come. If it becomes something like a burden, then that is a problem. But I think an hour wouldn’t hurt. I think it was more effective for me.”

- AD

Book Title for Coaching’s Impact on You

“When You Do a Little Bit of Thinking, You Can Do the Things You Didn’t 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 Self-

Regulation clusters in LASSIParticularly 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 (cont’d)

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 (cont’d)

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