Reducing Disparities in Access to Evidence-Based Services for Attention Deficit Hyperactivity Disorder (ADHD) Through Technology

Parents and teachers will complete the Child and Adolescent Symptom Inventory-5 , which includes 78 items assessing DSM-5 symptoms of ADHD, ODD, CD, Mood, and Anxiety. It has demonstrated adequate reliability (rs = .66-.78) and internal consistency (αs = .90-.94).

Parents and teachers will complete the Children's Organizational Skills Scales (COSS), which includes subscales assessing organizational skills, management of materials/supplies, and task planning skills (parent = 58 items, teacher = 35 items), with items rated on a 4-point scale. The parent and teacher versions both have excellent internal consistency (αs = .98 and .97, respectively), test-retest reliability (rs = .99 and .94, respectively), and evidence of structural, convergent, and discriminant validity.

Parents and teachers will report about students' functioning (e.g., academic, behavioral, peer, etc.) on the Impairment Rating Scale using a 6-point scale (0 = "needs no treatment" to 6 = "definitely requires treatment") with a rating greater than 2 suggests significant impairment requiring intervention.

Parents will complete the Homework Problems Checklist which consists of 20 items rated on a 4-point scale and has evidence of excellent internal consistency (α = .90-.92) to assess child problems related to homework.

Teachers will complete the Academic Enablers scale of the Academic Competency Evaluation Scale, which measures behaviors that support adaptive learning in the classroom. This subscale demonstrates excellent psychometric properties, including high test-retest reliability (r = .96) and internal consistency (α = .98) for children in grades 3-5.

Parents will complete the Alabama Parenting Questionnaire (APQ), which consists of 42 parent-reported items and five subscales: involvement, positive parenting, monitoring, inconsistent discipline, and corporal punishment. The subscales have been validated using confirmatory factor analysis and have demonstrated evidence of reliability and validity.

Parents and teachers will complete the Parent-Teacher Involvement Questionnaire (PTIQ) which consists of 47 items and six subscales: parent-teacher contact, parent involvement at school, quality of parent-teacher relationship, teacher's perception of the parent, parent involvement at home, and parent endorsement of school. The subscales have been validated using confirmatory factor analysis and have demonstrated evidence of reliability and validity.

Fidelity monitoring observation checklists will be adapted in Year 1 from those previously developed for CLS to measure fidelity of SMHP training in CLS-M, as well as SMHP implementation of each component of the CLS-M. A separate measure of SMHP competence in executing the treatment will be adapted from the CLS Implementation Quality Form used in previous trials, which will be completed by the trainer after each "live" observation. Items assess clarity of skill presentation, thoroughness of homework review, use of practical examples, and effectiveness of handout review rated by the trainer on a 1- 5 scale (from 1 = not at all to 5 = most). The child-group version includes items such as use of effective commands, prompts and praise, and clarity of skill presentation rated by the trainer on a 1-5 scale (from 1 = not at all to 5 = most). An independent research team member (blinded to group assignment) will rate 15% of sessions to estimate inter-rater reliability

Each week, parents will complete the 5-item Parent Strategy Use Questionnaire, a scale used in previous CLS trials to assess the frequency (rated on a 5-point scale) of parent's self-rated use of specific strategies taught during the previous Behavioral Parent Training sessions over the past week.

The proportion of school days the school and home Daily Behavioral Report Cards (DBRCs) were implemented each week will be calculated based on the number of completed DBRCs, divided by the overall count of possible days during the week, as the investigators have done in previous trials.

School holidays (coded from the online student calendar for each school), child absence, special school events/field trips and substitute teacher days (when noted on the DBRC) will not be included in the overall count of possible school days during the week.

SMHPs, teachers, and parents will complete the Feasibility Rating Scale, which consists of items regarding the amount of time required to participate in the intervention, the level of effort needed to identify and enroll children in the program, the availability of physical space needed to run in-person groups, etc. The investigators will query SMHPs weekly about CLS-M demands on their time, with specific questions regarding their use of the mHealth tool. At post-intervention, SMHPs, teachers, and parents will be queried about factors that might affect CLS-M implementation, including school resources needed for CLS-M (e.g., staff, space, materials, technology), teacher and parent involvement, logistical barriers (e.g., parent work schedules, childcare), and competing responsibilities and school needs.

SMHPs, parents, teachers, and children will complete satisfaction measures adapted from those used in previous CLS trials. Parents, teachers, and children in the CLS-M group will complete satisfaction questionnaires after each session pertaining to the content (e.g., usefulness, clarity, engagement, and applicability of topics/activities) and format (e.g., videoconferencing features) of that session, as well as their perceptions of specific features and components of the tool (e.g., data visualization formats, skills content, behavior/reinforcement tracking). The participants will also complete questionnaires at post-treatment and follow-up about their overall satisfaction with CLS-M, the mHealth tool, and their perceived level of child improvement. All items will be rated on a 5-point scale (1 = not at all, 5 = great deal). SMHPs will also complete satisfaction measures weekly and at post-treatment and follow-up regarding their perceptions of CLS-M features.

Parents, teachers, and SMHPs will complete the System Usability Scale (SUS; Lewis & Sauro, 2009), a 10-item technology-agnostic scale assessing technology product usability. SUS scores above 80 indicating good usability (Lewis & Sauro, 2018). The SUS has high internal consistency (α = .91) and high convergent validity with a separate rating of usability and user satisfaction (r = .8). The SUS will be completed by SMHPs, teachers, and parents following usability tests, halfway through and at the end of the open trial, and at the post-intervention assessment of the cluster randomized trial.

The Services for Children and Adolescents Parent Interview assesses children's use of mental health services (including medication), primary care services, school-based interventions, and community services. In previous CLS trials, the investigators have included questions about specific CLS components (e.g., DBRC, child skills training, parenting groups).