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Organizational skills training for children with ADHD

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 Clinical Psychology Review 52 (2017) 108–123

Contents lists available at ScienceDirect

Clinical Psychology Review

journal homepage: www.elsevier.com/locate/clinpsychrev

Review

Meta-analysis of organizational skills interventions for children and

adolescents with Attention-Deficit/Hyperactivity Disorder
Aida Bikic a,b,⁎,1, Brian Reichow a,c, Spencer A. McCauley a, Karim Ibrahim a, Denis G. Sukhodolsky a,⁎⁎
a
Child Study Center, Yale School of Medicine, 230 South Frontage Road, 06511 New Haven, Yale University, USA
b
Institute of Clinical Research, University of Southern Denmark, Winsløwparken 19, Odense, Denmark
c
Anita Zucker Center for Excellence in Early Childhood Studies, University of Florida, 1345 Norman Hall 618 SW 12th Street, Gainesville, USA

H I G H L I G H T S

• Organizational skills interventions have positive effects on outcomes related to ADHD.

• Moderate improvements in organizational skills of children with ADHD rated by teachers
• Large improvements in organizational skills of children with ADHD rated by parents
• Modest improvements on the ratings of symptoms of inattention and academic performance
• The review notes methodological limitations of the organizational skills training trials

a r t i c l e i n f o a b s t r a c t

Article history: Background: In addition to problems with attention and hyperactivity, children with ADHD present with poor or-
Received 1 December 2015 ganizational skills required for managing time and materials in academic projects. Organizational skills training
Received in revised form 26 December 2016 (OST) has been increasingly used to address these deficits. We conducted a systematic review and meta-analysis
Accepted 27 December 2016 of OST in children with ADHD.
Available online 29 December 2016
Objectives: The objective of this study was to systematically review the evidence of the effects of OST for children
with ADHD for organizational skills, attention, and academic performance.
Keywords:
ADHD
Methods: We searched 3 electronic databases to locate randomized controlled trials published in English in peer-
Organizational skills training reviewed journals comparing OST with parent education, treatment-as-usual, or waitlist control conditions.
Behavioral treatment Standardized mean difference effect sizes from the studies were statistically combined using a random-effects
Time management meta-analyses across six outcomes: teacher- and parent-rated organizational skills, teacher- and parent-rated in-
Academic interventions attention, teacher-rated academic performance, and Grade Point Average (GPA). Risk of bias was assessed for
randomization, allocation concealment, blinding of participants and treatment personnel, blinding of outcome
assessors, incomplete outcome data, and selective outcome reporting.
Results: Twelve studies involving 1054 children (576 treatment, 478 control) were included in the meta-analyses.
Weighted mean effect sizes for teacher- and parent-rated outcome measures of organizational skills were g =
0.54 (95% CI 0.17 to 0.91) and g = 0.83 (95% CI 0.32 to 1.34), respectively. Weighted mean effect sizes of teacher-
and parent-rated symptoms of inattention were g = 0.26 (95% CI 0.01 to 0.52) and g = 0.56 (95% CI 0.38 to 0.74),
respectively. Weighted standardized mean effect size for teacher-rated academic performance and GPA were
g = 0.33 (95% CI 0.14 to 0.51) and g = 0.29 (95% CI 0.07 to 0.51), respectively.
Conclusions: OST leads to moderate improvements in organizational skills of children with ADHD as rated by
teachers and large improvements as rated by parents. More modest improvements were observed on the ratings
of symptoms of inattention and academic performance.
Protocol registration: PROSPERO (CRD42015019261).
© 2016 Elsevier Ltd. All rights reserved.

Abbreviations: AAPC, Adolescent academic problems checklist; ADHD, Attention-Deficit/Hyperactivity Disorder; APRS, Academic Performance Rating Scale; CPS, Classroom
Performance Survey; CSI, Child Symptom Inventory; COSS, Children's Organizational Skills Scale; DBD, Disruptive Behavior Disorders Rating Scale; HPC, Homework Problem Checklist;
OST, Organizational skills training; TAU, Treatment as usual.
⁎ Correspondence to: A. Bikic, Kresten Phillipsens Vej 15, 6200 Aabenraa, Denmark.
⁎⁎ Correspondence to: D.G. Sukhodolsky, Yale Child Study Center, 230 South Frontage Road, New Haven CT 06520, USA.
E-mail addresses: aida.bikic@rsyd.dk (A. Bikic), denis.sukhodolsky@yale.edu (D.G. Sukhodolsky).
1
Department of Child and Adolescent Mental Health, Kresten Phillipsens Vej 15, 6200 Aabenraa, Region of Southern Denmark, Denmark.

http://dx.doi.org/10.1016/j.cpr.2016.12.004
0272-7358/© 2016 Elsevier Ltd. All rights reserved.
 A. Bikic et al. / Clinical Psychology Review 52 (2017) 108–123 109

Contents

1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
2. Method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
2.1. Search strategy to identify studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
2.2. Selection of studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
2.3. Interventions included in meta-analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
2.4. Variable definition and coding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
2.5. Outcome measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
2.6. Effect size estimation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
2.7. Meta-analytic procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
3. Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
3.1. Study selection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
3.2. Description of studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
3.3. Risk of bias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
3.4. Meta-analytic results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
3.4.1. Teacher-reported organizational skills . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
3.4.2. Parent-reported organizational skills . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
3.4.3. Teacher-reported inattention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
3.4.4. Parent-reported inattention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
3.4.5. Teacher-rated academic performance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
3.4.6. Student's Grade Point Average (GPA) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
3.4.7. Outcomes not included in meta-analyses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118
4. Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118
4.1. Differences across studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
4.2. Limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120
5. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
Roles of each author . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
Conflict of interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
Funding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
Appendix A. Supplementary data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121

1. Introduction
Attention-Deficit/Hyperactivity Disorder (ADHD) is a common
neurodevelopmental disorder that affects approximately 5% of children
in the general population (Polanczyk, de Lima, Horta, Biederman, &
Rohde, 2007). The etiology of ADHD is still undetermined but may in-
volve a complex interaction between multiple genes and environmental
risk factors (Faraone, 2000). Children with ADHD have been shown to
be more prone to drop out of school (Kent et al., 2011) and to be more
susceptible to developing other psychiatric disorders, substance abuse,
criminality, and adverse health events (Dalsgaard, Mortensen,
Frydenberg, & Thomsen, 2002, 2013; Dalsgaard, Ostergaard, Leckman,
Mortensen, & Pedersen, 2015; Maibing et al., 2015). Thus, developing
effective treatments for ADHD is an important public health priority.
Besides ADHD symptoms, children with ADHD also show a range
of attention and executive functions deficits (Willcutt, Doyle, Nigg,
Faraone, & Pennington, 2005). As defined by the Diagnostic and Statisti-
cal Manual of Mental Disorders, 5th Edition (DSM-5) (American
Psychiatric Association, 2013), four out of the nine ADHD symptoms of
inattention relate directly to problems with organization and planning
(i.e., loses things, is forgetful, has difficulties organizing tasks, and fails
to finish tasks). These symptoms have been linked to poor academic
performance in children with ADHD (Nigg, 2005; Willcutt et al., 2005).
The topic of organizational skills in children with ADHD has emerged
as an area of research and clinical focus because of its potential impact
on academic success as children with ADHD also have problems manag-
ing school materials and meeting deadlines. Organizational skills
deficits often multiply with the increase of task demands (Booster,
Dupaul, Eiraldi, & Power, 2012; Langberg et al., 2010). In addition, prob-
lems such as procrastination and failure to plan, prioritize, and organize
academic tasks tend to increase from childhood to adolescence (Booster
et al., 2012; Langberg et al., 2010), and persist into adulthood (Barkley &
Fischer, 2011). Poor organizational skills are also associated with aca-
demic underachievement, as well as psychosocial, occupational, and
economic difficulties (Kent et al., 2011; Massetti et al., 2008; Murphy,
2002; Murphy, Barkley, & Bush, 2002). Even in gifted students with
ADHD, organizational skills deficits were shown to hinder academic
performance (Leroux & Levitt-Perlman, 2000). Thus, due to their chron-
ic course and adverse consequences, organizational skills have become a
focus of treatment and clinical research in children with ADHD.
Although OST targets a specific set of organizational skills, symptoms
of inattention are also an important outcome in OST treatment studies.
Most children with ADHD exhibit a range of neurocognitive deficits in
the domains of sustained attention, working memory, and cognitive
control (Diamond, 2013; Nigg, 2005; Willcutt et al., 2005). It is likely
that organizational skills such as task planning and materials manage-
ment also rely on the same executive functions that are impaired in
ADHD. Indeed, it has been noted that organizational problems may be
associated with skill deficits (not having the skill) and performance def-
icits (not having sufficient motivation to perform the skill) as well as
with the neurocognitive functions that may underlie specific organiza-
tional skills (Abikoff et al., 2013). Given that acquisition and practice
of a new behavior can influence neural development via mechanisms
of neuroplasticity (Rapoport & Gogtay, 2008; Skoe & Kraus, 2012), it is
possible that OST can engage the reciprocal associations of organiza-
tional skills with ADHD symptoms and neurocognitive functions. For
example, as children learn and practice organizational skills during
OST they also engage and exercise neurocognitive functions (such as
sustained attention and cognitive control). This practice of executive
functions may in turn translate into reduction of ADHD symptoms of in-
attention. Other mechanisms of change in inattention may be engaged
in multi-component OST interventions that include elements such as
110 A. Bikic et al. / Clinical Psychology Review 52 (2017) 108–123
daily report cards and study skills training, which can also contribute to
the improvement of ADHD symptoms (Owens et al., 2012). Parent
training in the multi-component programs may lead to contingent re-
wards for staying on task during homework and activities of daily living,
which might improve attention (Haack, Villodas, McBurnett, Hinshaw,
& Pfiffner, 2016). Of course, these are assumptions that will need to be
tested in individual randomized controlled trials by collecting data on
organizational skills, inattention, and executive function at multiple
time points in order to examine if change in ADHD symptoms is
mediated by change in OST skills and/or change in executive functions.
Evaluating the effects of OST on symptoms of inattention in this meta-
analysis is the first step to confirming (or disconfirming) that OST
can change these symptoms so that future studies can test the
neurocognitive and neural mechanisms of these effects.
Regarding available treatments, stimulant medication is the first-
line treatment for ADHD, although 20 to 30% of patients do not respond
to medication and the long-term effects of treatment with stimulants
are relatively unknown (Molina et al., 2009; Storebo et al., 2015;
Swanson & Volkow, 2009). While medication does improve symptoms
of inattention and hyperactivity, it has a modest effect on
neurocognitive tasks of executive functions (Coghill, Rhodes, &
Matthews, 2007; Pietrzak, Mollica, Maruff, & Snyder, 2006) and only
one study to date has investigated the effects of ADHD medication on
organizational skills, showing modest improvements that did not nor-
malize organizational deficits (Abikoff et al., 2009). Non-pharmacologi-
cal treatments for ADHD and associated behavioral difficulties include
parent training, classroom management, social skills training and,
more recently, computerized cognitive training. These non-pharmaco-
logical interventions are helpful for reducing hyperactivity and behav-
ioral problems such as noncompliance but have limited impact on
inattention and organizational skills deficits (Pelham & Fabiano,
2008). However, a notable exception is a training program of teaching
parents and teachers the strategies to increase children's motivation
with incentives for performing tasks that require organizational skill
(such as homework) without directly teaching organizational skills
to the children (Abikoff et al., 2013). Thus, over the past decade,
organizational skills training (OST) has emerged as a category of behav-
ioral interventions with a common focus on teaching children how to
organize both materials (e.g., contents of the child's backpack) and
time (e.g., how to pace a project that is due next week) (Langberg,
Epstein, & Graham, 2008a).
This meta-analysis is concerned with behavioral treatments for chil-
dren and adolescents focused on improving organizational skills that
are required for managing time, materials, and projects within age-ap-
propriate academic and daily living tasks. We included studies conduct-
ed in children and adolescents but for the sake of brevity we use the
term children in the paper. Specific organizational skills taught during
OST include homework management techniques and classroom prepa-
rations (e.g., learning to use checklists and time planners, discarding un-
necessary papers) (Abikoff et al., 2013; Langberg, Epstein, Becker,
Girio-Herrera, & Vaughn, 2012; Langberg et al., 2008a; Molina et al.,
2008; Pfiffner et al., 2014). As a key component of OST programs, chil-
dren are first taught what it means to be organized and to plan ahead.
The organizational skills are taught using behavioral techniques includ-
ing modeling, rehearsal, and contingency management. A defining fea-
ture of OST programs is the focus on organizational skills, where
children and their parents learn concrete skills necessary to keep orga-
nized in the context of age-appropriate academic tasks. Parents are also
involved in the treatment and their role is to prompt, praise, and reward
their child's learning and performance of specific skills with the intent to
reinforce desirable behaviors and to promote generalization of skills to
multiple contexts. Our literature search produced a number of interven-
tions with a relative difference in emphasis on specific treatment targets
such as organization of materials or steps in the process of successful
homework completion. However, all approaches shared the overarch-
ing goal of teaching specific skills for managing academic tasks and
activities. All OST programs also included parenting components, al-
though of varying duration, aimed at improving the quality of parental
monitoring, prompting, and rewarding of their child's initiation as
well as performance on homework and other school-related tasks.
Many programs set specific organization criteria for binders, bookbags,
and other materials, which are used to focus goals for the training
(Abikoff et al., 2013; Evans et al., 2016; Langberg, Epstein,
Urbanowicz, Simon, & Graham, 2008b; Langberg et al., 2012). Several
studies included in this meta-analysis utilized OST as part of multi-
component interventions that addressed other treatment targets such
social skills and daily living skills (Pfiffner et al., 2007; Pfiffner et al.,
2014) and family functioning (Power et al., 2012; Sibley, 2016).
With the increasing recognition of organizational skills as a separate
treatment target in children with ADHD, we were interested in estimat-
ing the effects of OST across well-designed randomized controlled stud-
ies. To our knowledge, two qualitative reviews (Langberg et al., 2008a;
Storer, Evans, & Langberg, 2014) have addressed this topic so far and,
to date, no quantitative reviews of organizational skills interventions
have been conducted. Thus, the purpose of this meta-analysis is to eval-
uate the effects of OST on three domains of outcomes: organizational
skills, symptoms of inattention and academic performance. Our primary
outcome domain includes ratings of the child's organizational skills de-
fined as their ability to (a) organize their books, papers, backpacks and
other materials required for school-work, and (b) keep track of sched-
ules and time required for homework and other academic tasks as
rated by teachers and parents. Our secondary outcome includes the
effects of OST on measures of inattention. Our rationale for including
inattention in this meta-analysis was two-fold: First, inattention was
one of the main outcomes reported in the majority of studies, and sec-
ond, inattention and organizational skills may be subserved by related
neurocognitive functions. Our third outcome domain examines the ef-
fects of OST on children's academic performance. Because different
raters contribute unique and complementary information about the
child's behavior, we conducted separate analyses of parent- and teach-
er-ratings within these three domains.
2. Method
The protocol of methods for this meta-analysis was registered a
priori with PROSPERO (CRD42015019261).
2.1. Search strategy to identify studies
We searched the electronic databases of Medline (1946 to April
Week 3 2016), PsycINFO (1967 to April Week 3 2016), and the Cochrane
Central Register of Controlled Trials (Issue 4 of 12, April 2016), EMBASE
(1974 to April 2016) for relevant trials using the following search terms:
“attention deficit and disruptive behavior disorders” or “attention defi-
cit disorder with hyperactivity”, “ADHD”, “Attention Deficit Disorder”,
“organization*” or “academic* skill* or train*”, or “performance”, “profi-
ciency” or “function (-ing)”, “time management”. In addition, we
screened relevant reviews and papers on this topic and hand-searched
the reference lists for additional relevant publications. We also
contacted all authors of the included studies and asked if they had addi-
tional papers in press.
2.2. Selection of studies
Two authors independently evaluated the title and abstract of stud-
ies to determine if the inclusion criteria were fulfilled. Inclusion criteria
for this meta-analysis were: (1) a diagnosis of ADHD according to the
DSM edition that was current at the time of data collection; (2) random-
ized trials with quantitative outcome measures; (3) compared a group
of patients receiving organizational skills intervention with a group in
a control condition (e.g., parent education, waitlist, Treatment-as-
Usual (TAU)); (4) included at least one measure of inattention,
 A. Bikic et al. / Clinical Psychology Review 52 (2017) 108–123
organizational skills, and/or academic performance; and (5) an age
range of 5–18 years. Because studies without random assignment
have been shown to have higher levels of bias (Sterne, Egger, &
Moher, 2008) and it is unclear at this time if inclusion of non-random-
ized studies reduces bias, we did not consider open trials, quasi-exper-
imental design studies, case studies, or single-case designs.
2.3. Interventions included in meta-analysis
For the purpose of this meta-analysis, we searched for psychosocial
or behavioral interventions aimed at improving organizational skills.
Organizational skills were defined broadly to include organization of
materials (e.g., school materials that need to be brought back home),
time (e.g., planning and scheduling of assignments due by the end of
the week), and tasks (e.g., items needed for today's homework project).
Psychosocial or behavioral treatments included activities such as teach-
ing, modeling, and feedback to build new skills or improve performance
of existing skills such as organizing notes in a binder. We only included
treatments delivered by humans in face-to-face interaction. However,
we acknowledge that the development of alternative methods to
teach organizational skills may be developed in the future including in-
structional videos, OST apps and robot-assisted interventions. We also
included several studies of multicomponent interventions that explicit-
ly addressed organizational skills as the main component. However, we
did not include studies of academic interventions such as tutoring that
aim to improve academic skills or knowledge in specific academic
areas (e.g., reading or math tutoring). We also did not consider inter-
ventions such as parent management training or cognitive behavioral
therapy, which are often used in children with ADHD for associated
symptoms of noncompliance, because these interventions do not
teach organizational skills.
2.4. Variable definition and coding
Two authors extracted data from the included studies independently
and resolved any discrepancies through resolution or a third party if
needed. The following variables were extracted: number of sessions,
study duration in weeks, parental inclusion in treatment procedures,
format of OST (group or individual), type of control condition, sample
size, mean pretreatment age, mean pretreatment IQ, outcome measure
used, type of data analysis used in study (completer or intention to
treat), and risk of bias. Thus, we coded 11 variables in total. We also ex-
tracted study-level risk of bias using the Cochrane Risk of Bias method-
ology (Higgins & Altman, 2008).
2.5. Outcome measures
As noted above, the primary domains of treatment outcomes were
selected a priori. The primary outcome for this review was parent-
and teacher-rated organizational skills. We also examined parent- and
teacher-rated inattention as the second domain of interest and academ-
ic performance as the third domain. Parent and teacher ratings were an-
alyzed separately within each domain. We also averaged data on Grade
Point Average (GPA) across studies. To address unit of analysis issues we
selected one parent and teacher measure for the domain in each study.
To reduce bias, we set an a priori hierarchy for the selection of a measure
from a study with multiple measures for one outcome. The hierarchy in-
dicated that we would prioritize a standardized measure over an un-
standardized measure or study-derived measure and that we would
select a measure reporting a total score over a subscale; if more than
one measure met both of these criteria, we selected the measure that
has been used most frequently in the research literature (determined
by comparing the number of citations for each measure in Google Schol-
ar). When a total score was not available, we selected a subscale with
the highest correlation to other measures of the construct.
111
Measures of parent- and teacher-rated organizational skills in-
cluded the Children's Organizational Skills Scale (COSS) (Abikoff &
Gallagher, 2009) and the Homework Problem Checklist (HPC)-Mate-
rials Management Scale (Anesko, Schoiock, Ramirez, & Levine, 1987).
The HPC has two subscales: (1) Homework Completion (also called
the Inattention/Avoidance Scale) and (2) Homework Materials Man-
agement (also called Poor Productivity and Non-adherence to Rules-
Scale). We prioritized the COSS-total score, if reported. When the
COSS-Total was not reported, we used the COSS-Organized Actions
subscale since it had the highest correlation of the three subscales
with the COSS total score. When the COSS was not reported, we
used the HPC-total or HPC-Materials Management/Poor Productivity
scale. The Homework performance questionnaire (HPQ) (Power
et al., 2015) was also included.
Measures of parent- and teacher-rated inattention included the Dis-
ruptive Behavior Disorders (DBD) Rating Scale inattention subscale
(Pelham, Gnagy, Greenslade, & Milich, 1992), the Child Symptom Inven-
tory (CSI) inattention subscale (Gadow & Sprafkin, 1994), the Vander-
bilt ADHD Diagnostic Parent Rating Scale inattention subscale
(Wolraich, Feurer, Hannah, Baumgaertel, & Pinnock, 1998), the HPC in-
attention subscale (Anesko et al., 1987), and the MTA Swanson, Nolan,
and Pelham Questionnaire-IV (SNAP-IV) inattention subscale
(Swanson et al., 2001). In studies that did not provide separate inatten-
tion outcomes we choose to use HPC Factor I score as a proxy for inat-
tention because the two HPC factors have shown moderate to high
correlation with the Behavior Assessment Scale for Children inattention
subscale (BASC-I). The correlation is 0.67 between Factor I (Inattention/
Avoidance of homework) and parent-rated BASC-Inattention and 0.61
between Factor II and parent-rated BASC-Inattention (Power, Werba,
Watkins, Angelucci, & Eiraldi, 2006).
Measures of teacher rated academic performance included the
Academic Performance Rating Scale (APRS) (DuPaul, Rapport, &
Perriello, 1991), Classroom Performance Survey (CPS) (Brady, Evans,
Berlin, Bunford, & Kerns, 2012), or Academic Competence Evaluation
Scale (DiPema & Elliott, 2000).
We found no studies that used parent-rated measures of academic
performance. We have included GPA as an additional estimate of aca-
demic performance. Five studies provided GPA data (Evans, Schultz, &
DeMars, 2014; Evans, Schultz, Demars, & Davis, 2011; Langberg et al.,
2012; Sibley et al., 2013; Sibley et al., 2014b; Sibley et al., 2016).
2.6. Effect size estimation
We estimated the difference between treatment and control groups
for primary and secondary outcomes for each study by calculating the
standardized mean difference effect size (ES), Hedges' g (Hedges &
Olkin, 1985). The ES estimate was calculated from the post-treatment
scores and standard deviations provided in each study report, or by es-
timating the standardized mean difference using the reported F- or p-
value transformations in the Comprehensive Meta-Analysis 2 software
program (CMA2). For studies reporting multiple measures within one
of our primary or secondary outcomes, we prioritized a measure that
had a total score of the outcome and if a total score was not available,
we used a subscale that contained items that had the strongest correla-
tion to an overall measure of the outcome. When a study reported both
parent-reported and teacher-reported outcomes, we calculated these
outcomes separately for this review.
We also used CMA2 to calculate ES for (a) five studies (Evans et al.,
2016; Mautone et al., 2012; Pfiffner et al., 2014; Power et al., 2012;
Sibley et al., 2016) that reported follow-up data for both the treatment
and comparison conditions, (b) outcomes from the Molina et al.
(2008) and Pfiffner et al. (2007) studies that were not included in our
meta-analyses, and (c) three studies reporting observational measures
of organizational skills (Langberg et al., 2008b; Sibley et al., 2013;
Sibley et al., 2016).
112 A. Bikic et al. / Clinical Psychology Review 52 (2017) 108–123
2.7. Meta-analytic procedures
We combined results for the studies using a random effects meta-
analysis with an inverse-variance weighted mean ES using the post-
treatment data. We conducted separate meta-analyses for parent- and
teacher-reported organizational skills and attention. We did not con-
duct a meta-analysis on the data from the follow-up time point due to
a small sample of studies that collected follow-up data and differences
in the length of follow-up. A random effects model was used for the
meta-analysis because there was evidence of considerable differences
between the trials (e.g., use of different treatment manuals, use of differ-
ent outcome measures). We estimated heterogeneity using the Q-statis-
tic and I2 (Heudo-Medina, Sanchez-Meca, Marin-Marinez, & Botella,
2006; Higgins & Thompson, 2002), which estimates the proportion of
between-studies variance. Our final meta-analytic consideration was
publication bias. Publication and related biases are often a problem
when conducting research syntheses (Rothstein, Sutton, & Borenstein,
2005). A funnel plot is often used to detect publication bias, which can
be analyzed visually; however, analysis of funnel plots with a small
number of studies (i.e., b10 studies) is not recommended due to the sig-
nificant effects additional studies might have (Sterne, Becker, & Egger,
2005; Sterne et al., 2008). Therefore, we were only able to examine
the presence of publication bias for one outcome, parent-rated atten-
tion, which was done using visual analysis of a funnel plot and the
Trim and Fill method (Duval & Tweedie, 2000).
3. Results
3.1. Study selection
We located 1071 studies in our search. Fourteen studies (Abikoff et
al., 2013; Evans et al., 2016; Evans et al., 2011; Evans et al., 2014;
Langberg et al., 2012; Langberg et al., 2008b; Mautone et al., 2012;
Molina et al., 2008; Pfiffner et al., 2014; Pfiffner et al., 2007; Power et
al., 2012; Sibley et al., 2014b; Sibley et al., 2016; Sibley et al., 2013)
met our inclusion criteria. Table 1 shows characteristics of the 14 includ-
ed studies. Twelve studies (Abikoff et al., 2013; Evans et al., 2011; Evans
et al., 2014; Evans et al., 2016; Langberg et al., 2008b; Langberg et al.,
2012; Mautone et al., 2012; Pfiffner et al., 2014; Power et al., 2012;
Sibley et al., 2013; Sibley et al., 2014b; Sibley et al., 2016) involving
1054 children (576 treatment, 478 control) contained outcome data
for at least one of our primary or secondary outcomes and were includ-
ed in the meta-analytic syntheses. Two studies (Molina et al., 2008;
Pfiffner et al., 2007) met our inclusion criteria but did not contribute
data to the meta-analyses due to their reporting methods. Molina et
al. (2008) reported the total score for the BASC-I but did not report
the attention problems subscale and reported percentage of passing
grades but not GPA. Pfiffner et al. (2007) reported combined parent-
and teacher-reported measures of organizational skills and attention
and therefore was not included in the meta-analysis because we ana-
lyzed our data separately based on parent or teacher report. Table 2
shows the outcome measures and the results for the 12 studies included
in the meta-analyses and the two studies included in the qualitative re-
view but not in the meta-analyses.
A PRISMA (Moher, Liberati, Tetzlaff, & Altman, 2009) flow diagram
of study selection is shown in Fig. 1.
3.2. Description of studies
The majority of the 14 selected studies included children with both
combined and inattentive ADHD subtypes (Abikoff et al., 2013; Evans
et al., 2014; Evans et al., 2016; Langberg et al., 2008b; Langberg et al.,
2012; Molina et al., 2008; Power et al., 2012; Sibley et al., 2013; Sibley
et al., 2014b; Sibley et al., 2016). Only two studies included all three
ADHD subtypes (Evans et al., 2011; Mautone et al., 2012), while one
group of researchers focused exclusively on the inattentive subtype
(Pfiffner et al., 2007; Pfiffner et al., 2014). Six trials focused on children
in elementary school (Abikoff et al., 2013; Evans et al., 2011; Mautone et
al., 2012; Pfiffner et al., 2007; Pfiffner et al., 2014; Power et al., 2012), six
on middle school pupils (Evans et al., 2016; Langberg et al., 2008b;
Langberg et al., 2012; Molina et al., 2008; Sibley et al., 2013; Sibley et
al., 2016) and two on high school students (Evans et al., 2014; Sibley,
Altszuler, Morrow, & Merrill, 2014a). Most of the interventions in the
studies were delivered in group format and two studies conducted indi-
vidual interventions with one-to-one sessions (Abikoff et al., 2013;
Langberg et al., 2012) or a combination of both group and individual for-
mats (Evans et al., 2011; Evans et al., 2016; Langberg et al., 2008b;
Molina et al., 2008). The majority of studies reported high rates of ad-
herence above 80%.
Although all studies included organizational skills as the main or one
of the main treatment targets, there were differences among specific el-
ements of the multicomponent OST interventions. Two OST approaches
were focused primarily on teaching organizational skills to children and
contained relatively few adjunctive therapeutic strategies. Thus, Abikoff
and colleagues (Abikoff et al., 2013; Gallagher, Abikoff, & Spira, 2014)
utilized a skills-building approach where organization of materials,
time management, and planning skills were broken down into sets of
steps and taught to children in a systematic manner in the format of
20 individual, twice-per week sessions. Parents and teachers were in-
formed about the skills taught to their children and trained to prompt,
praise, and reward the use of these skills. A similar skills-based ap-
proach, the Homework, Organization and Planning Skills (HOPS) inter-
vention, was developed by Langberg and colleagues (Langberg, 2011;
Langberg et al., 2008b; Langberg et al., 2012) and tested as an 8-week
afterschool program. The core elements of the HOPS included using or-
ganizational checklists with operationalized criteria for binders,
bookbags, and lockers, and homework trackers that were initialed by
teachers and checked by the program counselors on a regular basis.
The key elements of the HOPS approach were utilized in a multicompo-
nent intervention named the Challenging Horizons Program (CHP),
which integrated OST with educational, social, and recreational activi-
ties at home and in school (Evans et al., 2011; Evans et al., 2014;
Evans et al., 2016; Molina et al., 2008). In the largest study to date, the
CHP was tested as an afterschool program conducted twice per week
for 2 h and 15 min per day from September through May (Evans et al.,
2016). The program was delivered by trained undergraduate students
who served as counselors and taught children how to organize their
binders, bookbags, and lockers using specified criteria. The CHP also in-
cluded training children in study skills such as note taking, summariz-
ing, and writing, as well as three meetings with the parents that
provided information about the CHP intervention. Pfiffner and col-
leagues (Pfiffner et al., 2007; Pfiffner et al., 2014) developed a novel psy-
chosocial treatment, Child Life and Attention Skills (CLAS), which
included three components: group parent training, teacher consultation
with daily report card, and child training in organizational skills and so-
cial skills. The program combined teaching organizational skills to chil-
dren directly with a coordinated system of rewards for behavior change
across school and home settings. The CLAS program also included use of
instructional scaffolding, prompts, and guidance in task completion to
address executive dysfunction of the inattentive type of ADHD such as
sluggishness and alertness problems (McBurnett, Pfiffner, & Frick,
2001). Power and colleagues (Mautone et al., 2012; Power et al.,
2012) developed a program, Family-School Success (FSS), focused on
promoting family involvement in education and promoting collabora-
tive family-school problem solving. Children were taught organizational
skills such as time management for homework completion and estab-
lishing homework routines, although no direct training in material
management was provided. Consistent with the FSS emphasis on par-
enting, a recent study reported that improvements in inattention after
FSS were mediated by reduction in negative parenting practices
(Booster, Mautone, Nissley-Tsiopinis, Van Dyke, & Power, 2016). Sibley
and colleagues (Sibley et al., 2013; Sibley et al., 2014b; Sibley et al.,
 A. Bikic et al. / Clinical Psychology Review 52 (2017) 108–123 113

Table 1
Clinical trials of organizational skills training for children and adolescents with ADHD.

Study Participants n; age; Number of sessions and format Treatment duration Location
%boys; %medication (group vs. individual) (weeks)

Mautone et al. (2012) n = 61 6 parent group meetings + 6 child group 12 Clinic + 2 sessions
Age: kindergarten and first gradea sessions + 4 individualized family therapy at school
% boys: 57 (3 for parents and child; 1 for parents
only) + 2 family-school consultations
% on medication: 25
Abikoff et al. (2013) n = 97 20 child individual sessions (including 10 to 12 Clinic
Age range 8–11 the parent some of the time)
% boys: 64
% on medication: 36
Pfiffner et al. (2007) n = 69 12–15 child group + 12–15 parent group 12 School
Age range 7–11 sessions + 5 family sessions with teacher
% boys: 66%;
Elementary
% on medication: 2.9%
school
Pfiffner et al. (2014) n = 125 10 child group sessions + 10 parent group 10 to 13 Both
Age range 7 to 11 sessions + 5 family-teacher sessions
% boys: 55
% on medication: 5.7
Power et al. (2012) n = 199 6 parent group sessions, 6 child group 12 Clinic
Age: grades 2–6c sessions + 4 family sessions +
% boys: 68% 2 family-teacher sessions
% on medication 42.5
Evans et al. (2011) n = 49 40 child individual and child group 20 Both
Mean age:11(10−13) sessions + 3 family sessions
% boys: 71
% on medication: 67
Langberg et al. (2008b) n = 37 16 child individual and group 8 School
Age range 9–14 sessions + 2 parent group sessions
% boys: 83
% on medication: 43
Langberg et al. (2012) n = 47 16 child individual + 2 parent 11 School
Age range 11–14 group sessions
% boys: 76
% on medication: 69
Sibley et al. (2013) n = 36 8–11 family sessions + 4 parent group 6 Clinic
Age range: 11–15 sessions + 1 family-teacher session
% boys 72
% on medication: 38.9%
Middle school
Evans et al. (2016) n = 216 53 sessions child group and individual 32 School
Mean age: 12.1 sessions offered (31.9 average attended) + 3
% boys: 74 parent meetings
% on medication: 44.6
Molina et al. (2008) n = 23 20 child individual and group sessions + 3 10 School
Age: grade 6–8b parent group sessions
% boys: 75%
% on medication: 43%
Sibley et al. (2016) n = 128 10 family sessions with parent and child + 4 10 Clinic
Mean age: 12.7 (11–15) parent group sessions
% boys: 65
% on medication: 34.4%
Evans et al. (2014) n = 36 10 child group + 10 parent group + 27 child 26 School
Mean age: 15 (13–17) individual sessions
% boys: 83
% on medication: 50
High school
Sibley et al. (2014b) n = 23 8 child and 8 parent group sessions 8 Clinice
Age: grades 9–12d (some of the time together)
% boys 70
% on medication: 60.9%

Note: The age was not reported in many studies, but only grades.
a
Corresponds to age 5–6.
b
Corresponds to age 12–14.
c
Corresponds to age 7–12.
d
Corresponds to age 15–18.
e
Personal communication with Dr. Sibley.

2016) developed an OST treatment for adolescents, Supporting
Teens'Autonomy Daily (STAND), which enhanced standard OST tech-
niques with motivational interviewing to address motivational prob-
lems common in ADHD that tend to increase in adolescence (Toplak,
Jain, & Tannock, 2005). Another distinctive characteristic of the STAND
approach is that the treatment is conducted in the format of family ther-
apy attended by parent and teen (Sibley, 2016; Sibley et al., 2016).
3.3. Risk of bias
We assessed study level risk of bias using the Cochrane Risk of Bias
tool (Higgins & Altman, 2008). As shown in Supplemental Fig. 1, there
was high risk of bias for performance bias (i.e., blinding of participants
and personnel) and detection bias (blinding of outcome assessment).
These high risks of bias are not uncommon in psychosocial
114 A. Bikic et al. / Clinical Psychology Review 52 (2017) 108–123

Table 2
Differences between treatment and comparison groups at post-treatment and follow-up.

Study Sample size Control Intent to Measures Differences between groups at post-treatment
condition treat and follow-up, where applicable

Mautone et al. n = 61; (t = 29, Parent Yes (a) Parent-rated attention – MTA Swanson, Nolan, and (a) g = 0.42 (95% CI −0.18 to 1.02),
(2012)a c = 32) education Pelham Questionnaire-IV - Inattention scale; (b) 2-month follow-up – g = 0.28 (95% CI −0.33 to
teacher-rated attention – MTA Swanson, Nolan, and Pelham 0.89)
Questionnaire-IV - Inattention scale; (c) teacher-rated (b) g = 0.33 (95% CI −0.23 to 0.89),
academics – Academic Competence Evaluation Scales – 2-month follow-up – g = 0.33 (95% CI −0.26 to
Academic enablers scale. 0.92)
(c) g = 0.50 (95% CI −0.07 to 1.07),
2-month follow-up – g = 0.23 (95% CI −0.37 to
0.83)
Abikoff et al. n = 97; (t = 64, Waitlist Yes (a) Parent-rated organizational skills – Children's (a) g = 2.00 (95% CI 1.50 to 2.50)
(2013)a c = 33)b control Organizational Skills Scale – Total score; (b) teacher-rated (b) g = 1.04 (95% CI 0.59 to 1.48)
organizational skills – Children's Organizational Skills Scale – (c) g = 0.74 (95% CI 0.31 to 1.17)
Total score; (c) teacher-rated academics – Academic
Performance Rating Scale
Pfiffner et al. n = 69; (t = 36, No treatment Yes (a) Organizational skills – Children's Organizational Skills Scale (a) g = 0.20 (95% CI −0.42 to 0.82),
(2007) c = 33) control – Total score (reported as mean across parents and teachers); follow-up – g = −0.29 (95% CI −0.82 to 0.24)
(b) attention – Child Symptoms Inventory – Inattention scale (b) g = 0.91 (95% CI 0.40 to 1.41),
(reported as mean across parents and teachers) follow-up – g = 0.53 (95% CI −0.01 to 1.09)
Pfiffner et al. n = 125, Treatment as Not (a) Parent-rated organizational skills – Children's (a) g = 0.88 (95% CI 0.49 to 1.26),
(2014)a (t = 74, c = 51)c usual reported Organizational Skills Scale – Total; (b) teacher-rated 6-month follow-up – g = 0.56 (95% CI 0.18 to
organizational skills – Children's Organizational Skills Scale – 0.93)
Total; (c) parent-rated attention – Child Symptoms Inventory (b) g = 0.66 (95% CI 0.29 to 1.04),
– Inattention scale; (d) teacher-rated attention – Child 6-month follow-up – g = 0.18 (95% CI −0.19 to
Symptoms Inventory – Inattention scale 0.54)
(c) g = 0.72 (95% CI 0.34 to 1.09),
6-month follow-up – g = 0.72 (95% CI 0.34 to
1.09)
(d) g = 0.79 (95% CI 0.41 to 1.16),
6-month follow-up – g = 0.16 (95% CI −0.20 to
0.52)
Power et al. n = 199; Parent Yes (a) Parent-rated organizational skills – Homework Problems (a) g = 0.20 (95% CI −0.10 to 0.49)
(2012)a (t = 100, education Checklist – Poor productivity factord; (b) teacher-rated 3-month follow-up – g = 0.19 (95% CI −0.12 to
c = 99) organizational skills; Homework Performance Questionnaire 0.49)
– Teacher version; (c) parent-rated attention – Homework (b) g = 0.26 (95% CI −0.03 to 0.55),
Problems Checklist - Homework completion scaled; (d) 3-month follow-up – g = 0.32 (95% CI 0.02 to
teacher-rated academics – Academic Performance Rating 0.63)
Scale – Academic productivity (c) g = 0.63 (95% CI 0.33 to 0.93),
3-month follow-up – g = 0.11 (95% CI −0.18 to
0.41)
(d) g = 0.18 (95% CI −0.11 to 0.47),
3-month follow-up – g = 0.21 (95% CI −0.09 to
0.51)
Evans et al. n = 49; (t = 31, Community Not (a) Parent-rated attention – Disruptive Behavior Disorders (a) g = 0.08 (95% CI −0.49 to 0.66)
(2011)a c = 18) control reported Rating Scale - Inattention scale; (b) teacher-rated attention – (b) g = −0.04 (95% CI −0.62 to 0.53)
Disruptive Behavior Disorders Rating Scale - Inattention scale; (c) g = 0.09 (95% CI −0.48 to 0.66)
(c) teacher-rated academics – Classroom Performance (d) g = 0.28 (95% CI −0.30 to 0.85)
Survey; (d) GPA - 2nd semester grades
Langberg et al. n = 37; (t = 24, Waitlist Not (a) Parent-rated organizational skills – Homework Problems (a) g = 0.85 (95% CI 0.16 to 1.54)
(2008a, b)a c = 13) control reported Checklist – Noncompliance scaled; (b) parent-rated attention (b) g = 0.48 (95% CI −0.19 to 1.15)
– Homework Problems Checklist – Inattention/avoidance (c) g = 0.27 (95% CI −0.39 to 0.93)
scaled; (c) teacher-rated academics – Academic Performance
Rating Scale – Total score
Langberg et al. n = 47; (t = 23, Waitlist Not (a) Parent-rated organizational skills – Children's (a) g = 0.94 (95% CI 0.35 to 1.54)
(2012)a c = 24) control reported Organizational Skills Scale – Total score (b) teacher-rated (b) g = 0.19 (95% CI −0.38 to 0.75)
organizational skills – Children's Organizational Skills Scale – (c) g = 0.51 (95% CI −0.06 to 1.08)
Total score; (c) parent-rated attention – Vanderbilt ADHD (d) g = 0.64 (95% CI 0.07 to 1.22)
Diagnostic Parent Rating Scale – Inattention scale; (d) GPA
Sibley et al. n = 36, (t = 18, Treatment as Not (a) Parent-rated attention – Disruptive Behavior Disorders (a) g = 1.02 (95% CI 0.34 to 1.70)
(2013)a c = 18) usual reported Rating Scale – Inattention scale; (b) teacher-rated attention – (b) g = 0.21 (95% CI −0.56 to 0.98)
Disruptive Behavior Disorders Rating Scale – Inattention (c) g = −0.26 (95% CI −1.03 to 0.51)
scale; (c) GPA
Evans et al. n = 216; Community Yes (a) Parent-rated organizational skills – Children's (a) g = 0.27 (95% CI 0.003 to 0.54),
(2016)a (t = 112, control Organizational Skills Scale - Organized actions; (b) 6-month follow-up - g = 0.20 (95% CI −0.06 to
c = 104) parent-rated attention - Disruptive Behavior Disorders Rating 0.47)
Scale - Inattention scale; (c) teacher-rated attention – (b) g = 0.37 (95% CI 0.11 to 0.64),
Disruptive Behavior Disorders Rating Scale - Inattention scale; 6-month follow-up - g = 0.48 (95% CI 0.21 to
(d) teacher-rated academics – Classroom Performance Survey 0.75)
– Academic factor (c) g = 0.17 (95% CI −0.10 to 0.44),
6-month follow-up - g = 0.10 (95% CI −0.17 to
0.37)
(d) g = 0.20 (95% CI −0.07 to 0.47),
6-month follow-up - g = 0.09 (95% CI −0.18 to
0.36)
Molina et al. n = 23; (t = 11, Treatment as Not (a) Percentage of passing grades (a) g = 0.58 (95% CI −0.24 to 1.41)
 A. Bikic et al. / Clinical Psychology Review 52 (2017) 108–123 115

Table 2 (continued)

Study Sample size Control Intent to Measures Differences between groups at post-treatment
condition treat and follow-up, where applicable

(2008) c = 12) usual reported

Sibley et al. n = 128 Treatment as Yes (a) Parent-rated attention – Disruptive Behavior Disorders (a) g = 0.96 (95% CI 0.59 to 1.32),
(2016)a (t = 67, c = 61) usual Rating Scale – Inattention scale; (b) teacher-rated attention – 6-month follow-up – g = 0.80 (95% CI 0.41 to
Disruptive Behavior Disorders Rating Scale – Inattention 1.20)
scale; (c) GPA – cumulative GPA (b) g = 0.05 (95% CI −0.29 to 0.40),
6-month follow-up – g = 0.02 (95% CI −0.36 to
0.40)
(c) g = 0.22 (95% CI −0.13 to 0.57),
6-month follow-up – g = 0.14 (95% CI −0.25 to
0.52)
Evans et al. n = 36; (t = 24, Community Yes (a) Parent-rated attention – Disruptive Behavior Disorders (a) g = 0.09 (95% CI −0.59 to 0.77)
(2014)a c = 12) control Rating Scale – Inattention scale; (b) teacher-rated academics (b) g = 0.70 (95% CI 0.002 to 1.40)
– Classroom Performance Survey – Academic performance (c) g = 0.22 (95% CI −0.46 to 0.90)
scale; (c) GPA
Sibley et al. n = 23 Treatment as Not (a) GPA - quizzes and tests (a) g = 0.60 (95% CI −0.05 to 1.25)
(2014a, b)a (t = 10,c = 13) usual reported

References for measures: Academic Competence Evaluation Scales (DiPema & Elliott, 2000); Academic Performance Rating Scale (DuPaul et al., 1991); Classroom Performance Survey
(Brady et al., 2012); Child Symptom Inventory (Gadow & Sprafkin, 1994); Children's Organizational Skills Scale (Abikoff & Gallagher, 2009); Disruptive Behavior Disorders Rating Scale
(Pelham et al., 1992); Homework Performance Questionnaire (HPQ) (Power et al., 2015) Homework Problem Checklist (Anesko et al., 1987); Vanderbilt ADHD Diagnostic Parent Rating
Scale (Wolraich et al., 1998); MTA Swanson, Nolan, and Pelham Questionnaire-IV (Swanson et al., 2001).
a
Study included in meta-analyses.
b
Data from the organizational skills training group used for treatment; data from performance-based intervention excluded from this review.
c
Data from the Child Life and Attention Skills group used for treatment; data from parent–focused treatment excluded from this review.
d
The HPC has two subscales that are referred to differently across studies: (1) Homework Completion (also called the I-Inattention/Avoidance scale) and (2) HPC Materials Manage-
ment (also called NA-Non adherence to rules-scale or the poor productivity scale).

interventions, and it is not clear if they were responsible for systematic
differences that would over- or under-inflate estimates of the effects of
the intervention. Risk of bias for each study is shown in Supplemental
Fig. 2.
3.4. Meta-analytic results
3.4.1. Teacher-reported organizational skills
Four studies involving 445 children with ADHD (247 treatment, 198
comparison) comparing organizational skills intervention to control or
treatment-as-usual with teacher-reported organizational skills were lo-
cated (Abikoff et al., 2013; Langberg et al., 2012; Pfiffner et al., 2014;
Power et al., 2012). Fig. 2 shows the effect of OST on teacher-reported
organizational skills as measured by the COSS (k = 3) or the HPC-Teach-
er (k = 1). As shown in Fig. 2, OST was superior to the comparison con-
ditions for teacher-reported organizational skills (k = 4; g = 0.54; 95%
CI 0.17 to 0.91; z = 2.86; p = 0.004). We found moderate heterogeneity
(Q(3) = 10.15, p = 0.02; I2 = 70%); however, due to the small sample of
studies included in the meta-analysis, we deemed moderator analyses
inappropriate and were not able to examine the presence of publication
bias.

3.4.2. Parent-reported organizational skills

Six studies involving 697 children with ADHD (384 treatment, 313
comparison) comparing organizational skills intervention to control or
treatment-as-usual with parent-reported organizational skills were lo-
cated (Abikoff et al., 2013; Evans et al., 2016; Langberg et al., 2008b;
Langberg et al., 2012; Pfiffner et al., 2014; Power et al., 2012). Fig. 2
shows the effect of OST on parent-reported organizational skills as mea-
sured by the COSS (k = 4) or the HPC-Materials Management scale
(k = 2). As shown in Fig. 2, OST was superior to the comparison condi-
tions for parent-reported organizational skills (k = 6; g = 0.83; 95% CI
0.32 to 1.34; z = 3.22; p = 0.001). We found significant heterogeneity
(Q(5) = 46.77, p b 0.001; I2 = 89%); however, due to the small sample
of studies included in the meta-analysis, we deemed moderator analy-
ses inappropriate.

3.4.3. Teacher-reported inattention

Six studies involving 590 children with ADHD (320 treatment, 270
comparison) comparing organizational skills intervention to control or
treatment-as-usual with teacher-reported attention were located
Fig. 1. PRISMA flow diagram of study selection. (Evans et al., 2011; Evans et al., 2016; Mautone et al., 2012; Pfiffner et
116 A. Bikic et al. / Clinical Psychology Review 52 (2017) 108–123
Fig. 2. Forest plot of parent-rated organizational skills (top panel) and teacher-rated organizational skills (bottom panel). Description: Results of the meta-analysis for parent and teacher
reported organizational skills.
al., 2014; Sibley et al., 2013; Sibley et al., 2016). Fig. 3 shows the effect of
OST on teacher-reported attention as measured by the DBD-Inattention
subscale (k = 4), the SNAP-Inattention scale (k = 1), or the CSI-Inatten-
tion scale (k = 1). As shown in Fig. 3, OST was statistically superior to
the comparison conditions for teacher-reported attention (k = 6; g =
0.26; 95% CI 0.01 to 0.52; z = 2.00; p = 0.045). We found moderate het-
erogeneity (Q(5) = 10.62, p = 0.06; I2 = 53%); however, due to the
small sample of studies included in the meta-analysis, we deemed mod-
erator analyses inappropriate and were not able to examine the pres-
ence of publication bias.
3.4.4. Parent-reported inattention
Ten studies involving 893 children with ADHD (478 treatment,
415 comparison) comparing organizational skills intervention to
control or treatment as usual with parent-reported attention were
located (Evans et al., 2011; Evans et al., 2014; Evans et al., 2016;
Langberg et al., 2008b; Langberg et al., 2012; Mautone et al., 2012;
Pfiffner et al., 2014; Power et al., 2012; Sibley et al., 2013; Sibley et
al., 2016). Fig. 3 shows the effect of OST on parent-reported atten-
tion as measured by the DBD-Inattention subscale (k = 5), HPC-In-
attention subscale (k = 2), the CSI-Inattention scale (k = 1), the
Vanderbilt ADHD Diagnostic Parent Rating Scale-Inattention sub-
scale (k = 1), and the SNAP-Inattention subscale (k = 1). As
shown in Fig. 3, OST was superior to the comparison conditions for
parent-reported attention (k = 10; g = 0.56; 95% CI 0.38 to 0.74;
z = 6.11; p b 0.001). We found moderate levels of heterogeneity
(Q(9) = 13.88, p = 0.13; I2 = 35%); however, due to the small sam-
ple of studies included in the meta-analysis, we deemed moderator
analyses inappropriate. Because there were ten studies reporting
parent-rated attention, we were able to examine the presence of
publication bias. Visual analysis of a funnel plot (shown in Supple-
mental Fig. 3) and the Trim and Fill method suggest there are two
“missing” studies to the right of the weighted mean ES, indicating
the possibility that the point estimate we obtained is lower than
the “true” ES.
3.4.5. Teacher-rated academic performance
Seven studies involving 663 children with ADHD (364 treatment,
299 comparison) comparing organizational skills intervention to con-
trol or treatment as usual with teacher-rated academic performance
were located (Abikoff et al., 2013; Evans et al., 2011; Evans et al.,
2014; Evans et al., 2016; Langberg et al., 2008b; Mautone et al., 2012;
Power et al., 2012). Fig. 4 shows the effect of OST on teacher-rated aca-
demic behaviors as measured by the Academic Performance Rating
Scale (k = 3), the Classroom Performance Survey (k = 3), and the Aca-
demic Competence Evaluations Scale (k = 1). As shown in Fig. 4, OST
was statistically superior to the comparison conditions for teacher-re-
ported academic performance (k = 7; g = 0.33; 95% CI 0.14 to 0.51;
z = 3.48; p b 0.001). We found low levels of heterogeneity (Q(6) =
7.50, p = 0.28; I2 = 20%). Due to the small sample of studies, we were
not able to examine the presence of publication bias.
 A. Bikic et al. / Clinical Psychology Review 52 (2017) 108–123 117

Fig. 3. Forest plot of parent-rated attention (top panel) and teacher-rated attention (bottom panel).

3.4.6. Student's Grade Point Average (GPA) al., 2014; Langberg et al., 2012; Sibley et al., 2013; Sibley et al., 2014b;
Six studies involving 322 children with ADHD (179 treatment, 143 Sibley et al., 2016). Fig. 5 shows the effect of OST on GPA. As shown in
comparison) comparing organizational skills intervention to control or Fig. 5, the GPA of students in the OST group was statistically superior
treatment as usual with GPA were located (Evans et al., 2011; Evans et to the comparison conditions (k = 6; g = 0.29; 95% CI 0.07 to 0.51;

Fig. 4. Forest plot of teacher-rated academic performance.

118 A. Bikic et al. / Clinical Psychology Review 52 (2017) 108–123
Fig. 5. Forest plot of student GPA.
z = 2.61; p = 0.009). We found low levels of heterogeneity (Q(5) =
4.48, p = 0.48; I2 = 0%). Due to the small sample of studies, we were
not able to examine the presence of publication bias.
3.4.7. Outcomes not included in meta-analyses
Data from the Molina et al. (2008) study and the Pfiffner et al. (2007)
study were not included in the meta-analyses due to issues of compara-
bility of data and combined parent/teacher data, respectively. However,
we calculated ES for these studies using the same g statistic for qualita-
tive comparison. As shown in Table 2, Molina did not find a statistically
significant effect of OST on the percentage of passing grades (g = 0.58,
95% CI −0.24 to 1.41). Pfiffner et al. (2007) showed mixed results; there
was a statistically significant effect for the combined rating of children's
attention (g = 0.91, 95% CI 0.40 to 1.41) but not for the combined rating
of children's organizational skills (g = 0.20, 95% CI −0.42 to 0.68). Note,
while the difference between post-treatment means for the treatment
and control groups was not statistically significant, the authors did re-
port a significant time by group's effect using ANOVA.
Three studies (Langberg et al., 2008b; Sibley et al., 2013; Sibley et al.,
2016) reported data using behavioral observation of organizational
skills. Two studies (Sibley et al., 2013; Sibley et al., 2016) had research
assistants evaluate student's organization skills using the Organization
Checklist (Evans et al., 2009). In their 2013 study, Sibley et al. found
the treatment group had statistically significant better organizational
skills than the control group after treatment (g = 1.04, 95% CI 0.36 to
1.73). However, they did not find a statistically significant difference be-
tween treatment and control groups in their 2016 study (g = 0.33, 95%
CI − 0.04 to 0.69). Langberg et al. (2008b) reported an immediate in-
crease in binder, bookbag and locker organization after the second day
of the program; a statistical comparison between treatment and control
groups for this measure was not reported in this study.
4. Discussion
The aim of this study was to quantitatively review all available ran-
domized controlled trials of OST. To the best of our knowledge, this is
the first study to employ a quantitative review of organizational skills
interventions for children with ADHD. We located 14 randomized con-
trolled studies of OST that met our inclusion criteria. Twelve studies in-
volving 1054 children (576 treatment, 478 control) provided data that
was included in the quantitative syntheses (i.e., meta-analyses).
We evaluated outcomes in three domains of interest: (a) organiza-
tional skills (parent- and teacher-rated), (b) inattention (parent-and
teacher-rated), and (c) academics (teacher-rated academic perfor-
mance and student's GPA). Results showed significant effects of OST
across all outcomes. Overall, significant effects of large to moderate
magnitude were found for organizational skills outcomes for children
when assessed by teacher-rated (g = 0.54) and parent-rated (g =
0.83) measures, and for inattention outcomes for children when
assessed by parent-rated measures (g = 0.56). The effects for teacher-
rated inattention and academic performance, and student's GPA were
statistically significant, although smaller in magnitude: g = 0.26, g =
0.33, and g = 0.29, respectively. It is likely that the magnitude of ES
was related to differences among the studies in terms of specific fea-
tures of OST treatments, outcome measures, informants, and control
conditions. A relatively small number of studies available for this
meta-analysis did not allow us to investigate potential mediator vari-
ables of treatment effects. Thus, we discuss possible differences among
the studies that might have contributed to the differences in magnitude
of the observed ES.
The ES were the highest for the domain of parent-rated organiza-
tional skills. Four of six studies (Abikoff et al., 2013; Langberg et al.,
2008b; Langberg et al., 2012; Pfiffner et al., 2014) reported large ES
(range g = 0.85 to 2.00). It is possible that the smaller ES reported by
Evans et al. (2016) and Power et al. (2012), g = 0.20 and g = 0.27, re-
spectively, were due to a sole focus on organizational skills required
for homework (e.g., using a homework checklist) while organizational
skills in the home were not directly targeted during the intervention.
The duration of treatment in the Power et al. (2012) study was also rel-
atively short: 12 sessions versus 16 to 20 sessions in other studies. The
aspect of duration of OST was not addressed in this meta-analysis or
in the included individual randomized controlled trials, but future stud-
ies might test the effects of treatment duration/intensity on the out-
comes. Most importantly, the Power et al. (2012) and Mautone et al.
(2012) studies compared OST to an active control condition, “Coping
with ADHD through Relationships and Education” (CARE). The 12-ses-
sion CARE program provided support and education to parents includ-
ing: (a) discussing children's progress at home and school, (b)
establishing a context within which parents can support each other in
coping with their children's difficulties, and (c) providing education to
parents about ADHD. The ES might be smaller because the CARE con-
trolled for treatment factors such as attention from the therapists and
education about ADHD.
There was greater heterogeneity in ES in the domain of the teacher
ratings of organizational skills, ranging from large (Abikoff et al.,
2013) to moderate (Pfiffner et al., 2014) and small (Langberg et al.,
2012; Power et al., 2012). OST interventions in the studies with large
and moderate ES (Abikoff et al., 2013; Pfiffner et al., 2014) consisted
of approximately 20 sessions and had more extensive teacher compo-
nents than in the interventions in the Langberg et al. (2012) and
Power et al. (2012) studies, which might explain the differences in ES
across studies. However, all OST packages can be viewed as multi-
component interventions and the difference in relative contributions
of child-, parent- and teacher-focused components to the overall ES
 A. Bikic et al. / Clinical Psychology Review 52 (2017) 108–123
cannot be discerned from the existing studies. Future studies can utilize
dismantling designs to evaluate relative effects of the unique compo-
nents and techniques that comprise multi-componential OST interven-
tions. Furthermore, organizational skills are complex behaviors and not
unitary skills. It is unknown how the OST interventions affect specific
subsets of organizational skills as very few studies reported specific sub-
scales and including subscales in meta-analyses is methodologically
challenging.
The ES of parent-reported improvement in attention was moderate
while the ES of teacher-reported gain in attention was small. The ES
for parent-rated attention were highly heterogenic across studies rang-
ing from minimal (g = 0.08) to large (g = 1.02). The majority of studies
that used waitlist control conditions found moderate to large effects of
OST on inattention symptoms. In contrast, two studies that compared
OST to a community control condition (Evans et al., 2011; Evans et al.,
2014) reported small effects. In these studies families received a packet
of contact information for providers in their local community and a
summary of the intake evaluation was sent to the school psychologists
at their respective schools. However, it is unknown how many partici-
pants in the control group initiated treatment during the intervention.
Three of the six studies that reported teacher-rated outcomes of in-
attention also incorporated school personnel directly or indirectly into
the OST treatment process. Thus, in the “Challenging Horizons Program”
(Evans et al., 2011), undergraduate counselors communicated with the
teachers on a biweekly basis about students' progress and behavior in
classroom. The “Supporting Teens' Academic Needs” program (Sibley
et al., 2013), included one school consultation and parents were taught
how to be more involved with the schools and engage teachers. Despite
these teacher-directed portions of the OST, the teacher-report did not
reveal significant improvements in ADHD symptoms (while parent-re-
ports did). It is possible that improvements in attention noted by the
parents were not potent enough to manifest in the classroom or be sa-
lient to the teachers. However, it is worth commenting that one study
that reported the largest effect on the teacher-rated attention (Pfiffner
et al., 2014) (g = 0.79) also included a comprehensive training compo-
nent for teachers. Specifically, teachers were taught to scaffold and sup-
port attention toward classroom goals, implement a school-home
report card, and promote the generalization of skills across classes.
Discrepancies between parent- and teacher-ratings of inattention
may be also due to the difference in their involvement in the interven-
tions. A noteworthy bias in clinical trials of behavioral interventions is
that the outcome measures are not blinded for participants (children
and parents) because participants know that they are receiving treat-
ment. In OST, parents are active participants of the treatment and there-
fore they may be biased to report larger improvement on parent-rated
questionnaires (although, as noted above, some OST interventions also
included teacher components). This limitation can be addressed in fu-
ture studies by including additional outcomes such as naturalistic obser-
vation of organizational skills and behaviors at school and at home,
report cards, or academic tests. Three trials in this meta-analysis
(Langberg et al., 2012; Sibley et al., 2013; Sibley et al., 2016) have
used objective outcomes such as planner use and materials organization
checklists rated by research assistants. Of note, while observational
measures may reduce the rater bias, they are harder to standardize
and costlier to administer, which limits application of these measures
in clinical trials.
Furthermore, parent and teacher ratings are only weakly correlated
for inattention symptoms and moderately correlated for hyperactivity/
impulsivity symptoms (Narad et al., 2015). Parents report greater sever-
ity of ADHD symptoms than teachers, but the magnitude of parent-
teacher agreement does not vary across development (Narad et al.,
2015). Due to the difference in parent- and teacher-ratings of ADHD,
we opted to analyze the parent and teacher ratings separately in this
study.
Another consideration for the assessment of treatment outcomes in
OST studies is that four of nine DSM inattention symptoms (i.e., often
119
fails to finish schoolwork and chores, often has difficulty organizing
tasks and activities, often loses things, and often forgetful in daily
activities) describe organizational behavior, which make it difficult to
separate change in ADHD symptoms of inattention from change in
organizational skills ratings. This overlap in symptoms of inattention
and organizational skill can also contribute to high levels of correlations
between parent and teacher ratings of these constructs. For example,
the correlations of the total scale COSS score with the inattention sub-
scale of the Conners were 0.66 and 0.67 for the parent and teacher rat-
ings, respectively (Abikoff & Gallagher, 2009). To examine if and how
the OST affects symptoms of inattention, future OST studies can report
change in the four inattention symptoms that overlap with organiza-
tional behavior separately from change in the five inattention symp-
toms without such overlap.
We found that OST had a modest ES in the area of academic perfor-
mance. Although relatively small in magnitude, this ES was statistically
significant. Given the correlation between academic performance and
organizational abilities (Langberg et al., 2011a; Langberg et al., 2011b),
this finding suggests that organizational skills interventions can benefit
academic performance for children with ADHD. The small ES are diffi-
cult to detect in clinical trials of behavioral interventions even with sam-
ples that would be considered large in our field (e.g., N 200 subjects).
Nevertheless, even a small improvement in academic performance can
be clinically meaningful and practically important for children in gener-
al and for children with ADHD in particular. By aggregating results
across studies, meta-analyses can estimate the magnitude of ES and
confirm statistical significance of smaller effects of active treatments
versus control conditions, thus informing the field of evidence-based
practice in ways that are complementary to the information provided
by the randomized controlled trials.
4.1. Differences across studies
There were also differences among treatments that might have
contributed to heterogeneity of ES. Although a small number of individ-
ual studies precluded analyses of treatment characteristic as possible
mediators of treatment response, several key treatment variables can
be considered in future studies. As noted above, OST aims to improve
organizational skills by defining criteria for organizing time and
materials and setting realistic goals for staying organized. However,
the OST approaches varied across the studies in terms of the specific
treatment contents, the number and duration of sessions, the session
format (individual vs. group), and the extent of teacher and parent
involvements.
Parents played an important role in most of the trials as they were
asked to reinforce the targeted organizational skills at home. For the
twelve studies included in the meta-analysis, a parent component was
incorporated in different forms including: the parents joining their
child at the end of the session to review behavioral techniques such as
prompting, praise, and rewards (Abikoff et al., 2013; Langberg et al.,
2012); individualized parent sessions that addressed parenting skills
(Evans et al., 2014; Pfiffner et al., 2014); elements of family therapy
(Power et al., 2012); group parent sessions to discuss common behav-
ioral strategies such as positive reinforcement of expected behavior
(Langberg et al., 2008b; Sibley et al., 2013); and family sessions with
the parent and child together that address problem solving (Evans et
al., 2011; Evans et al., 2014; Sibley et al., 2013). Clearly, parent compo-
nents are important in any child-focused behavioral interventions but
the exact nature of the amount and content of parenting component
in OST cannot be easily identified from the existing studies. Similarly,
teacher involvement and school components varied across studies and
ranged from one consultation with the teacher, to facilitating the par-
ent-teacher meeting, to direct training of the teacher in prompting
and rewarding children's organizational skills during classes. It is likely
that teacher components are easier to incorporate in OST treatments
conducted in schools and parent components are more feasible when
120 A. Bikic et al. / Clinical Psychology Review 52 (2017) 108–123
OST is conducted in outpatient mental health settings. Table 1 shows
that six studies were conducted in school, five in clinics and three in
both clinics and schools.
Another notable difference among the studies was the inclusion
criteria. Only two studies required organizational deficits as an inclusion
criterion (Abikoff et al., 2013; Power et al., 2012). Most studies used ac-
ademic impairment for inclusion (Evans et al., 2011; Evans et al., 2014;
Evans et al., 2016; Sibley et al., 2016) and some also used social impair-
ments (Evans et al., 2011; Evans et al., 2014; Evans et al., 2016). This is
an important consideration for OST as not all children with ADHD
have organizational deficits. Including children without organizational
skills deficits into the studies might cause a ceiling effect where no fur-
ther improvement might be possible. Future studies of OST may consid-
er a priori inclusion criteria for organizational skills to assure that the
intervention is well-matched to the treatment needs of the study partic-
ipants. Age and developmental characteristic of OST participants is an-
other important consideration for future research as the number of
available studies precluded examination of participant characteristics
in this meta-analysis. Most OST studies included children 8 years of
age and older, with the exception of Mautone et al. (2012), who studied
children in kindergarten and first grade. Some OST interventions de-
scribed in the meta-analysis (Abikoff et al., 2013; Pfiffner et al., 2007;
Pfiffner et al., 2014; Power et al., 2012) were developed for elementary
school students, while others (Evans et al., 2014; Evans et al., 2016;
Langberg et al., 2012; Sibley et al., 2014b; Sibley et al., 2016) were devel-
oped for middle school students. These treatments differ from each
other because they address organizational skills required for age appro-
priate academic tasks.
Given that impairments in attention and organizational skill increase
in severity with age, due to the increase in academic demands and
decrease in adult supervision, clinical judgment suggests that earlier
interventions may promote the acquisition of skills and avert future
problems. However, behavioral interventions for young children with
ADHD are shown to reduce impulsivity and noncompliance (Barkley,
2013; M.T.A., 1999) and deficits in attention and organization may be
overlooked until older ages when compounded by functional impair-
ments. OST specifically addresses deficits in organization, time manage-
ment, and planning and it is important to recognize that these skills are
related to age and cognitive development. Complex executive functions
such as planning continue to mature during adolescence and young
adulthood, and many of the organizational skills taught to adolescents
are developmentally inappropriate for younger children. When children
enter middle school the demands on organizational skills change dra-
matically leading some children to exhibit greater difficulties in middle
school. Our review suggests that OST has been best tested mostly in 8 to
12 year-old children. Future studies might consider downward exten-
sions of OST approaches for younger children that might include age-
appropriate organizational skills that are required not only for school,
but also for play activities and daily living tasks.
Neurocognitive deficits in sustained attention, working memory, re-
sponse inhibition, and planning seen in children with ADHD (Nigg,
2005; Willcutt et al., 2005) are connected to organizational skills, and
future studies might test the effects of OST on neurocognitive profiles
as well as the utility of neurocognitive testing in predicting response
to OST. Also, children with ADHD show delays and heterogeneity in
brain maturation trajectories (Gopin & Healey, 2011; Shaw et al.,
2007). This calls for testing neural mechanisms and biomarkers of OST
toward a long-term goal of matching patients to treatments that can
engage neural mechanisms of attention and executive functions to
improve organizational skills.
Two studies of OST that met our a priori search criteria did not pro-
vide data for calculating ES in the domains of interest in this meta-anal-
ysis. Molina et al. (2008) reported the percentages of grades as a
measure of academic performance, a metric that could not be converted
to ES value. The study also reported the total BASC externalizing scale
that combines ratings of inattention with ratings of aggression,
hyperactivity, and conduct problems. We also could not include the
Pfiffner et al. (2007) study because the outcomes were averaged across
teacher and parent ratings and we were interested in evaluating ES
separately for the parent and teacher ratings. These two studies can be
included in future meta-analyses that may focus on other outcome
domains.
Regarding durability of OST treatment effects, five studies provided
follow-up data in a range from one to six months after treatment.
Three studies reported significant differences in parent-reported
inattention at 6 month follow-up in almost moderate (g = 0.48)
(Evans et al., 2016), moderate g = 0.72 (Pfiffner et al., 2014) and large
ES g = 0.80 (Sibley et al., 2016). Parent-rated organizational skills
were significant (g = 0.56) at the 6-months follow-up in one study
(Pfiffner et al., 2014). Teacher-rated organizational skills were signifi-
cant (g = 0.32) at the 3-month follow-up in another study (Power
et al., 2012). These results suggest that OST treatment gains are robust,
at least in the short term.
4.2. Limitations
Our review also revealed several limitations of the randomized
controlled studies of OST, most notably lack of consistency in outcome
assessments and failure to use independent or “blinded” outcome
assessment. This underscores a need for outcome measures with strong
psychometric properties and clinical utility in the area of testing organi-
zational skills interventions. One point to convey is that all outcome
measures (i.e., parent ratings, teacher ratings, observations, or grades)
are likely to have their unique strength and limitations. We note that
parent and teacher ratings in clinical trials of behavioral interventions
are not blinded and can be affected by expectation biases, but this
does not mean that they are “inferior” to observational measures.
Counting items in the backpack or number of turned-in homework as-
signments may be more objective (because the count can be done by
a researcher unaware of treatment assignments). However, behavioral
counts are subject to measurement error due to situational variability
and are hard to standardize across children. Also, in contrast to some
fields of behavioral research that have widely accepted “gold-standard”
measures (such as the Yale-Brown Obsessive Compulsive Scale in stud-
ies of behavioral therapy for OCD), the field of OST research is relatively
new and it appears that no single measure has emerged as a possible
gold standard. We suggest that future studies of OST clearly designate
one primary outcome and use a comprehensive set of secondary and
exploratory outcome measures.
The majority of studies of OST used the waitlist or treatment-as-
usual (TAU) as control conditions, but the description of allowed con-
comitant treatments was inconsistent across publications. The terms
“waitlist-control”, “treatment-as-usual”, and “community control” are
sometimes used interchangeably in studies of psychosocial interven-
tions and imply that subjects are allowed to continue mental health
and/or educational services that they have been receiving prior to enrol-
ment in the study. For example, clinical trials may include subjects on
concomitant medication but require that medication is stable for a peri-
od of time. An important distinction is whether or not subjects are asked
not to initiate new treatments for the duration of the active phase of the
study. Two studies in our dataset (Evans et al., 2011; Evans et al., 2014)
provided subjects with a list of resources in community and encouraged
them to pursue care. Other studies did not encourage or discourage sub-
jects in control conditions from pursuing additional services while in
the active phase of the study. Some control subjects initiated new treat-
ments, which might have led to greater symptom reduction compared
to control conditions that required no initiation of new treatments.
The results of this meta-analysis might have also been affected by
several limitations of the body of available randomized trials, including
uneven sample sizes (sometimes treatment was twice as large as con-
trol conditions), small number of studies to meta-analyze, high risk of
bias due to lack of blinding of outcome assessors, and few trials
 A. Bikic et al. / Clinical Psychology Review 52 (2017) 108–123
conducting intent to treat analysis. The small sample of studies in this
meta-analysis did not allow us to explore possible causes of heterogene-
ity, which for our primary outcomes was quite large. Also, the small
number of studies precluded our ability to examine the presence of pub-
lication bias in all but one meta-analysis (parent-rated attention),
which revealed the possibility of publication bias using the Trim and
Fill method. A limitation of our meta-analysis is that we did not include
a meta-analysis of observational measures of organizational skills, as
only three studies provided data for each of the measures, which is con-
sidered a small number to combine statistically. We also were unable to
synthesize data on parent-rated academic performance because this
outcome was not included in any study. Another limitation is that we
used HPC-I as a proxy measure for inattention, despite its specific
focus on behaviors related to homework. However, HPC-I shows a cor-
relation of 0.67 with BASC-PRS Inattention subscale (Power et al.,
2006), which is why it was used as a measure of attention. Among the
DSM symptoms of Inattention, four are indicative of organizational
problems. The attention improvements reported by parents and
teachers in the studies might be influenced by improvement of these
four organizational-related symptoms. However, it was not possible to
dismantle the improvement in specific attention symptoms as none of
the studies reported items beyond subscale scores. The same is true
for the specific effect on the organizational skill measures, where total
scores were preferably reported. The goal of meta-analysis is to estimate
treatment effects aggregated across studies and domains of
measurement, and this approach does not disentangle the complexity
of psychological functions such as organizational skills. Organizational
functioning involves a complex set of skills and as more clinical trials
of OST become available, future meta-analyses may investigate relative
effects on specific organizational skills, for example, as reflected by the
COSS subscales of organized actions, task planning, and materials man-
agement. It is unknown whether the improvements in organizational
functioning were uniform across the specific subskills in these studies.
Future studies should examine the effects of OST on the specific items
of attention and organizational skills measures.
5. Conclusion
OST leads to moderate improvements in organizational skills of chil-
dren with ADHD as rated by teachers and large improvements as rated
by parents. Modest improvements were also observed on the ratings of
symptoms of inattention and academic performance. The review notes
methodological limitations of studies to date including relatively small
samples of the majority of studies, heterogeneity of the outcome mea-
sures, and lack of attentional control comparison conditions. The clinical
implication of this meta-analysis is that OST is a helpful treatment for
organizational skills deficits in ADHD and it could be considered as
part of comprehensive treatment approaches for the core ADHD symp-
toms as well as associated functional impairments.
Roles of each author
Aida Bikic and Denis Sukhodolsky designed the study and wrote
the protocol. Aida Bikic and Spencer McCauley conducted literature
searches, provided summaries of previous research studies, and extract-
ed data. Brian Reichow conducted the statistical analysis and wrote the
results section. Aida Bikic, Denis Sukhodolsky, Brian Reichow, and Karim
Ibrahim wrote the manuscript and all authors read and approved the
final manuscript.
Conflict of interest
The authors have no conflict of interest.
121
Funding
Dr. Aida Bikic received support from Region of Southern Denmark
Psychiatry Research, TrygFonden (J.nr. 7-12-1137), The Region of
Southern Denmark's PhD pool (2011), University of Southern
Denmark (12/2/2011) and Lundbeck Foundation (j.nr. R169-2014-38).
Acknowledgments
We thank the founding organizations. We thank Ms. Shivani Kaushal
for her help with the literature search in preparation of revisions of this
paper and for proofreading the final manuscript.
Appendix A. Supplementary data
Supplementary data to this article can be found online at http://dx.
doi.org/10.1016/j.cpr.2016.12.004.
References
Abikoff, H., & Gallagher, R. (2009). The children's organizational skills scales: Technical man-
ual. North Tonawanda, NY: Multi-Health Systems.
Abikoff, H., Gallagher, R., Wells, K. C., Murray, D. W., Huang, L., Lu, F., & Petkova, E. (2013).
Remediating organizational functioning in children with ADHD: Immediate and long-
term effects from a randomized controlled trial. Journal of Consulting and Clinical
Psychology, 81(1), 113–128. http://dx.doi.org/10.1037/a0029648.
Abikoff, H., Nissley-Tsiopinis, J., Gallagher, R., Zambenedetti, M., Seyffert, M., Boorady, R., &
McCarthy, J. (2009). Effects of MPH-OROS on the organizational, time management,
and planning behaviors of children with ADHD. Journal of the American Academy of
Child and Adolescent Psychiatry, 48(2), 166–175. http://dx.doi.org/10.1097/CHI.
0b013e3181930626.
American Psychiatric Association, APA (2013). Diagnostic and statistical manual of mental
disorders (5th ed.) (Washington DC).
Anesko, K. M., Schoiock, G., Ramirez, R., & Levine, F. M. (1987). The homework problem
checklist: Assessing children's homework problems. Behavioral Assessment, 9,
1979–1985.
Barkley, R. A. (2013). Defiant children. A clinician's manual for assessment and parent train-
ing. Guilford Press.
Barkley, R. A., & Fischer, M. (2011). Predicting impairment in major life activities and oc-
cupational functioning in hyperactive children as adults: Self-reported executive
function (EF) deficits versus EF tests. Developmental Neuropsychology, 36(2),
137–161. http://dx.doi.org/10.1080/87565641.2010.549877.
Booster, G. D., Dupaul, G. J., Eiraldi, R., & Power, T. J. (2012). Functional impairments in
children with ADHD: Unique effects of age and comorbid status. Journal of Attention
Disorders, 16(3), 179–189. http://dx.doi.org/10.1177/1087054710383239.
Booster, G. D., Mautone, J. A., Nissley-Tsiopinis, J., Van Dyke, D., & Power, T. J. (2016). Re-
ductions in negative parenting practices mediate the effect of a family-school inter-
vention for children with attention deficit hyperactivity disorder. School Psychology
Review, 45(2), 192–208. http://dx.doi.org/10.17105/spr45-2.192-208.
Brady, C. E., Evans, S. W., Berlin, K., Bunford, N., & Kerns, L. (2012). Evaluating school im-
pairment with adolescents using the classroom performance survey. School
Psychology Review, 41, 429–446.
Coghill, D. R., Rhodes, S. M., & Matthews, K. (2007). The neuropsychological effects of
chronic methylphenidate on drug-naive boys with attention-deficit/hyperactivity
disorder. Biological Psychiatry, 62(9), 954–962. http://dx.doi.org/10.1016/j.biopsych.
2006.12.030.
Dalsgaard, S., Mortensen, P. B., Frydenberg, M., & Thomsen, P. H. (2002). Conduct prob-
lems, gender and adult psychiatric outcome of children with attention-deficit hyper-
activity disorder. The British Journal of Psychiatry, 181, 416–421.
Dalsgaard, S., Mortensen, P. B., Frydenberg, M., & Thomsen, P. H. (2013). Long-term crim-
inal outcome of children with attention deficit hyperactivity disorder. Criminal
Behaviour and Mental Health, 23(2), 86–98. http://dx.doi.org/10.1002/cbm.1860.
Dalsgaard, S., Ostergaard, S. D., Leckman, J. F., Mortensen, P. B., & Pedersen, M. G. (2015).
Mortality in children, adolescents, and adults with attention deficit hyperactivity dis-
order: A nationwide cohort study. Lancet, 385(9983), 2190–2196. http://dx.doi.org/
10.1016/S0140-6736(14)61684-6.
Diamond, A. (2013). Executive functions. Annual Review of Psychology, 64, 135–168.
http://dx.doi.org/10.1146/annurev-psych-113011-143750.
DiPema, J. C., & Elliott, S. N. (2000). Academic competence evaluation scales. San Antonio,
TX: The Psychological Corporation.
DuPaul, G., Rapport, M. D., & Perriello, L. M. (1991). Teacher ratings of academic skills: The
development of the academic performance rating scale. School Psychology Review, 20,
284–300.
Duval, S., & Tweedie, R. (2000). Trim and fill: A simple funnel-plot-based method of test-
ing and adjusting for publication bias in meta-analysis. Biometrics, 56, 455–463.
Evans, S. W., Langberg, J. M., Schultz, B. K., Vaughn, A., Altaye, M., Marshall, S. A., &
Zoromski, A. K. (2016). Evaluation of a school-based treatment program for young
adolescents with ADHD. Journal of Consulting and Clinical Psychology, 84(1), 15–30.
http://dx.doi.org/10.1037/ccp0000057.
122 A. Bikic et al. / Clinical Psychology Review 52 (2017) 108–123
Evans, S. W., Schultz, B. K., & DeMars, C. E. (2014). High school-based treatment for ado-
lescents with attention-deficit/hyperactivity disorder: Results from a pilot study ex-
amining outcomes and dosage. School Psychology Review, 43(2), 185–202.
Evans, S. W., Schultz, B. K., Demars, C. E., & Davis, H. (2011). Effectiveness of the challeng-
ing horizons after-school program for young adolescents with ADHD. Behavior
Therapy, 42(3), 462–474. http://dx.doi.org/10.1016/j.beth.2010.11.008.
Evans, S. W., Schultz, B. K., White, L. C., Brady, C., Sibley, M. H., & van Eck, K. (2009). A
school-based organization intervention for young adolescents with attention defi-
cit/hyperactivity disorder. School Mental Health, 1, 78–88.
Faraone, S. V. (2000). Genetics of childhood disorders: Xx. ADHD, part 4: Is ADHD genetical-
ly heterogeneous? Journal of the American Academy of Child and Adolescent Psychiatry,
39(11), 1455–1457. http://dx.doi.org/10.1097/00004583-200011000-00022.
Gadow, K. D., & Sprafkin, J. (1994). Child symptom inventories manual. Stony Brook, NY:
Checkmate Plus.
Gallagher, R., Abikoff, H. B., & Spira, E. G. (2014). Organizational skills training for children
with ADHD an empirically supported treatment. Guilford Press.
Haack, L. M., Villodas, M., McBurnett, K., Hinshaw, S., & Pfiffner, L. J. (2016). Parenting as a
mechanism of change in psychosocial treatment for youth with ADHD, predominant-
ly inattentive presentation. Journal of Abnormal Child Psychology. http://dx.doi.org/10.
1007/s10802-016-0199-8.
Gopin, C. B., & Healey, D. M. (2011). The neural and neurocognitive determinants of
ADHD. Journal of Infant, Child, and Adolescent Psychotherapy, 10, 13–31.
Hedges, L. V., & Olkin, I. (1985). Statistical methods for meta-analysis. New York, NY: Aca-
demic Press.
Heudo-Medina, T., Sanchez-Meca, J., Marin-Marinez, F., & Botella, J. (2006). Assessing het-
erogeneity in meta-analysis: Q statistic or i2 index. Psychological Methods(11), 193–206.
Higgins, J. P. T., & Altman, D. G. (2008). Assessing risk of bias in included studies. In J. P. T.
Higgins, & S. Green (Eds.), Cochrane handbook for systematic reviews of interventions.
John Wiley & Sons: Chichester, UK.
Higgins, J. P., & Thompson, S. G. (2002). Quantifying heterogeneity in a meta-analysis.
Statistics in Medicine, 21(11), 1539–1558. http://dx.doi.org/10.1002/sim.1186.
Kent, K. M., Pelham, W. E., Jr., Molina, B. S., Sibley, M. H., Waschbusch, D. A., Yu, J., ... Karch,
K. M. (2011). The academic experience of male high school students with ADHD.
Journal of Abnormal Child Psychology, 39(3), 451–462. http://dx.doi.org/10.1007/
s10802-010-9472-4.
Langberg, J. M. (2011). Homework, organization and planning skills (hops) intervention: A
treatment manual. Bethesda, MD: National Association of School Psychologists
Publications.
Langberg, J. M., Epstein, J. N., & Graham, A. J. (2008a). Organizational-skills interventions
in the treatment of ADHD. Expert Review of Neurotherapeutics, 8(10), 1549–1561.
http://dx.doi.org/10.1586/14737175.8.10.1549.
Langberg, J. M., Epstein, J. N., Urbanowicz, C. M., Simon, J. O., & Graham, A. J. (2008b). Ef-
ficacy of an organization skills intervention to improve the academic functioning of
students with attention-deficit/hyperactivity disorder. School Psychology Quarterly,
23(3), 407–417. http://dx.doi.org/10.1037/1045-3830.23.3.407.
Langberg, J. M., Arnold, L. E., Flowers, A. M., Altaye, M., Epstein, J. N., & Molina, B. S. (2010).
Assessing homework problems in children with ADHD: Validation of a parent-report
measure and evaluation of homework performance patterns. School Mental Health,
2(1), 3–12. http://dx.doi.org/10.1007/s12310-009-9021-x.
Langberg, J. M., Epstein, J. N., Becker, S. P., Girio-Herrera, E., & Vaughn, A. J. (2012). Evalu-
ation of the homework, organization, and planning skills (hops) intervention for mid-
dle school students with ADHD as implemented by school mental health providers.
School Psychology Review, 41(3), 342–364.
Langberg, J. M., Epstein, J. N., Girio, E. L., Becker, S. P., Vaughn, A. J., & Altaye, M. (2011a).
Materials organization, planning, and homework completion in middle school stu-
dents with ADHD: Impact on academic performance. School Mental Health, 3(2),
93–101. http://dx.doi.org/10.1007/s12310-011-9052-y.
Langberg, J. M., Vaughn, A. J., Williamson, P., Epstein, J. N., Girio-Herrera, E., & Becker, S. P.
(2011b). Refinement of an organizational skills intervention for adolescents with
ADHD for implementation by school mental health providers. School Mental Health,
3(3), 143–155. http://dx.doi.org/10.1007/s12310-011-9055-8.
Leroux, J., & Levitt-Perlman, M. (2000). The gifted child with attention deficit disorder: An
identification and intervention challenge. Roeper Review, 22(3), 171–177.
M.T.A., Cooperative Group (1999). A 14-month randomized clinical trial of treatment
strategies for attention-deficit/hyperactivity disorder. Archives of General Psychiatry,
56(12), 1073–1086.
Maibing, C. F., Pedersen, C. B., Benros, M. E., Mortensen, P. B., Dalsgaard, S., & Nordentoft,
M. (2015). Risk of schizophrenia increases after all child and adolescent psychiatric
disorders: A nationwide study. Schizophrenia Bulletin, 41(4), 963–970. http://dx.doi.
org/10.1093/schbul/sbu119.
Massetti, G. M., Lahey, B. B., Pelham, W. E., Loney, J., Ehrhardt, A., Lee, S. S., & Kipp, H.
(2008). Academic achievement over 8 years among children who met modified
criteria for attention-deficit/hyperactivity disorder at 4–6 years of age. Journal of
Abnormal Child Psychology, 36(3). http://dx.doi.org/10.1007/s10802-007-9186-4
17940863.
Mautone, J. A., Marshall, S. A., Sharman, J., Eiraldi, R. B., Jawad, A. F., & Power, T. J. (2012).
Development of a family-school intervention for young children with attention defi-
cit hyperactivity disorder. School Psychology Review, 41(4), 447–466.
McBurnett, K., Pfiffner, L. J., & Frick, P. J. (2001). Symptom properties as a function of adhd
type: An argument for continued study of sluggish cognitive tempo. Journal of
Abnormal Child Psychology, 29(3), 207–213.
Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2009). Preferred reporting items for
systematic reviews and meta-analyses: The PRISMA statement. PLoS Medicine, 6
(doi: e1000097).
Molina, B. S., Flory, K., Bukstein, O. G., Greiner, A. R., Baker, J. L., Krug, V., & Evans, S. W.
(2008). Feasibility and preliminary efficacy of an after-school program for middle
schoolers with ADHD: A randomized trial in a large public middle school. Journal of
Attention Disorders, 12(3), 207–217. http://dx.doi.org/10.1177/1087054707311666.
Molina, B. S., Hinshaw, S. P., Swanson, J. M., Arnold, L. E., Vitiello, B., Jensen, P. S., ... Houck, P.
R. (2009). The MTA at 8 years: Prospective follow-up of children treated for combined-
type ADHD in a multisite study. Journal of the American Academy of Child and Adolescent
Psychiatry, 48(5), 484–500. http://dx.doi.org/10.1097/CHI.0b013e31819c23d0.
Murphy, P. (2002). Cognitive functioning in adults with attention-deficit/hyperactivity
disorder. Journal of Attention Disorders, 5(4), 203–209.
Murphy, K. R., Barkley, R. A., & Bush, T. (2002). Young adults with attention deficit hyper-
activity disorder: Subtype differences in comorbidity, educational, and clinical histo-
ry. The Journal of Nervous and Mental Disease, 190(3), 147–157.
Narad, M. E., Garner, A. A., Peugh, J. L., Tamm, L., Antonini, T. N., Kingery, K. M., ... Epstein, J.
N. (2015). Parent-teacher agreement on adhd symptoms across development.
Psychological Assessment, 27(1), 239–248. http://dx.doi.org/10.1037/a0037864.
Nigg, J. T. (2005). Neuropsychologic theory and findings in attention-deficit/hyperactivity
disorder: The state of the field and salient challenges for the coming decade.
Biological Psychiatry, 57(11), 1424–1435. http://dx.doi.org/10.1016/j.biopsych.2004.
11.011.
Owens, J. S., Holdaway, A. S., Zoromski, A. K., Evans, S. W., Himawan, L. K., Girio-Herrera, E.
, & Murphy, C. E. (2012). Incremental benefits of a daily report card intervention over
time for youth with disruptive behavior. Behavior Therapy, 43(4), 848–861. http://dx.
doi.org/10.1016/j.beth.2012.02.002.
Pelham, W. E., Jr., & Fabiano, G. A. (2008). Evidence-based psychosocial treatments for at-
tention-deficit/hyperactivity disorder. Journal of Clinical Child and Adolescent
Psychology, 37(1), 184–214. http://dx.doi.org/10.1080/15374410701818681.
Pelham, W. E., Gnagy, E. M., Greenslade, K. E., & Milich, R. (1992). Teacher ratings of DSM-
III-R symptoms for the disruptive behavior disorders. Journal of the American Academy
of Child and Adolescent Psychiatry, 31, 210–218.
Pfiffner, L. J., Hinshaw, S. P., Owens, E., Zalecki, C., Kaiser, N. M., Villodas, M., & McBurnett,
K. (2014). A two-site randomized clinical trial of integrated psychosocial treatment
for ADHD-inattentive type. Journal of Consulting and Clinical Psychology, 82(6),
1115–1127. http://dx.doi.org/10.1037/a0036887.
Pfiffner, L. J., Yee Mikami, A., Huang-Pollock, C., Easterlin, B., Zalecki, C., & McBurnett, K.
(2007). A randomized, controlled trial of integrated home-school behavioral treat-
ment for ADHD, predominantly inattentive type. Journal of the American Academy of
Child and Adolescent Psychiatry, 46(8), 1041–1050. http://dx.doi.org/10.1097/chi.
0b013e318064675f.
Pietrzak, R. H., Mollica, C. M., Maruff, P., & Snyder, P. J. (2006). Cognitive effects of imme-
diate-release methylphenidate in children with attention-deficit/hyperactivity disor-
der. Neuroscience and Biobehavioral Reviews, 30(8), 1225–1245. http://dx.doi.org/10.
1016/j.neubiorev.2006.10.002.
Polanczyk, G., de Lima, M. S., Horta, B. L., Biederman, J., & Rohde, L. A. (2007). The world-
wide prevalence of ADHD: A systematic review and metaregression analysis. The
American Journal of Psychiatry, 164(6), 942–948. http://dx.doi.org/10.1176/ajp.2007.
164.6.942.
Power, T. J., Mautone, J. A., Soffer, S. L., Clarke, A. T., Marshall, S. A., Sharman, J., ... Jawad, A.
F. (2012). A family-school intervention for children with adhd: Results of a random-
ized clinical trial. Journal of Consulting and Clinical Psychology, 80(4), 611–623. http://
dx.doi.org/10.1037/a0028188.
Power, T. J., Watkins, M. W., Mautone, J. A., Walcott, C. M., Coutts, M. J., & Sheridan, S. M.
(2015). Examining the validity of the homework performance questionnaire: Multi-
informant assessment in elementary and middle school. School Psychology Quarterly,
30(2), 260–275. http://dx.doi.org/10.1037/spq0000081.
Power, T. J., Werba, B. E., Watkins, M. W., Angelucci, J. G., & Eiraldi, R. B. (2006). Patterns of
parent-reported homwork problems among ADHD-referred and non-referred chil-
dren. School Psychology Quarterly, 21, 13–33.
Rapoport, J. L., & Gogtay, N. (2008). Brain neuroplasticity in healthy, hyperactive and psy-
chotic children: Insights from neuroimaging. Neuropsychopharmacology, 33(1),
181–197. http://dx.doi.org/10.1038/sj.npp.1301553.
Rothstein, H. R., Sutton, A. J., & Borenstein, M. (2005). Publication bias in meta-analysis: Pre-
vention, assessment, and adjustments. Chichester, West Suffox, UK: John Wiley & Sons.
Shaw, P., Eckstrand, K., Sharp, W., Blumenthal, J., Lerch, J. P., Greenstein, D., ... Rapoport, J.
L. (2007). Attention-deficit/hyperactivity disorder is characterized by a delay in cor-
tical maturation. Proceedings of the National Academy of Sciences of the United States
of America, 104(49), 19649–19654. http://dx.doi.org/10.1073/pnas.0707741104.
Sibley, M. H. (2016). Parent-teen therapy for executive function deficits and ADHD. Build-
ing skills and motivation. New York: Guilford.
Sibley, M. H., Altszuler, A. R., Morrow, A. S., & Merrill, B. M. (2014a). Mapping the academ-
ic problem behaviors of adolescents with ADHD. School Psychology Quarterly, 29(4),
422–437. http://dx.doi.org/10.1037/spq0000071.
Sibley, M. H., Altszuler, A. R., Ross, J. M., Sanchez, F., Pelham, W. E., & Gnagy, E. M. (2014b).
A parent-teen collaborative treatment model for academically impaired high school
students with ADHD. Cognitive and Behavioral Practice, 1, 32–42.
Sibley, M. H., Graziano, P. A., Kuriyan, A. B., Coxe, S., Pelham, W. E., Rodriguez, L., ... Ward,
A. (2016). Parent-teen behavior therapy + motivational interviewing for adolescents
with ADHD. Journal of Consulting and Clinical Psychology, 84(8), 699–712. http://dx.
doi.org/10.1037/ccp0000106.
Sibley, M. H., Pelham, W. E., Derefinko, K. J., Kuriyan, A. B., Sanchez, F., & Graziano, P. A.
(2013). A pilot trial of supporting teens' academic needs daily (stand): A parent-ado-
lescent collaborative intervention for ADHD. Journal of Psychopathology and Behavioral
Assessment, 35(4), 436–449. http://dx.doi.org/10.1007/s10862-013-9353-6.
Skoe, E., & Kraus, N. (2012). A little goes a long way: How the adult brain is shaped by mu-
sical training in childhood. The Journal of Neuroscience, 32(34), 11507–11510. http://
dx.doi.org/10.1523/JNEUROSCI.1949-12.2012.
Sterne, J. A. C., Becker, B. J., & Egger, M. (2005). The funnel plot. In publication bias in
meta-analysis: Prevention, assessment, and adjustments. In A. J. Sutton, H. R.
 A. Bikic et al. / Clinical Psychology Review 52 (2017) 108–123
Rothstein, & M. Boernstein (Eds.), Publication bias in meta-analysis: Prevention, assess-
ment, and adjustments (pp. 75–98) (pp. 75–98).
Sterne, J. A. C., Egger, M., & Moher, D. (2008). Addressing reporting biases. In S.
Green, & J. P. T. Higgins (Eds.), Cochrane handbook for systematic reviews of inter-
ventions (pp. 297–333). Chichester, UK: John Wiley & Sons.
Storebo, O. J., Ramstad, E., Krogh, H. B., Nilausen, T. D., Skoog, M., Holmskov, M., ... Gluud,
C. (2015). Methylphenidate for children and adolescents with attention deficit hyper-
activity disorder (ADHD). Cochrane Database of Systematic Reviews, 11, CD009885.
http://dx.doi.org/10.1002/14651858.CD009885.pub2.
Storer, J., Evans, S. W., & Langberg, J. (2014). Organization interventions for children and
adolescents with attention-deficit/hyperactivity disorder (ADHD). In M. Weist, N.
Lever, C. Bradshaw, & J. S. Owens (Eds.), Handbook of school mental health
(pp. 385–398) (2nd ed.). New York: Springer.
Swanson, J. M., & Volkow, N. D. (2009). Psychopharmacology: Concepts and opinions
about the use of stimulant medications. Journal of Child Psychology and Psychiatry,
50(1–2), 180–193. http://dx.doi.org/10.1111/j.1469-7610.2008.02062.x.
View publication stats
123
Swanson, J. M., Kraemer, H. C., Hinshaw, S. P., Arnold, L. E., Conners, C. K., Abikoff,
H. B., ... Wu, M. (2001). Clinical relevance of the primary findings of the MTA:
Success rates based on severity of ADHD and odd symptoms at the end of treat-
ment. Journal of the American Academy of Child and Adolescent Psychiatry, 40(2),
168–179.
Toplak, M. E., Jain, U., & Tannock, R. (2005). Executive and motivational processes in ad-
olescents with attention-deficit-hyperactivity disorder (ADHD). Behavioral and Brain
Functions, 1(1), 8. http://dx.doi.org/10.1186/1744-9081-1-8.
Willcutt, E. G., Doyle, A. E., Nigg, J. T., Faraone, S. V., & Pennington, B. F. (2005). Validity of
the executive function theory of attention-deficit/hyperactivity disorder: A meta-an-
alytic review. Biological Psychiatry, 57(11), 1336–1346. http://dx.doi.org/10.1016/j.
biopsych.2005.02.006.
Wolraich, M. L., Feurer, I. D., Hannah, J. N., Baumgaertel, A., & Pinnock, T. Y. (1998).
Obtaining systematic teacher reports of disruptive behavior disorders utilizing
DSM-IV. Journal of Abnormal Child Psychology, 26, 141–152.