School Consultation Process in Support of a Computer-Assisted Behavior Intervention for Adolescents: A Mixed Method Analysis

In November 2025, Yijing Lin led a presentation at the annual convention of the Association for Behavioral and Cognitive Theories (ABCT) describing a follow-up study conducted with the school consultation transcripts from our ATHEMOS study. A summary of that presentation and resources to support our findings below.

INTRODUCTION

ADHD often leads to academic impairments, including failing grades and a risk for school dropout (Fried et al., 2016; Schultz et al., 2009). Yet most educators receive limited training in evidence-based interventions for ADHD-related challenges (Sibley et al., 2016; Walters, 2022).

The Challenging Horizons Program–Mentorship Model (CHP-M) provides structured support in organization, planning, and study skills, and has demonstrated promising outcomes (Evans et al., 2016). But implementation demands are high, and benefits can emerge slowly.

ATHEMOS is a serious game designed to teach the same skills as the CHP-M, including planning, organization, and note-taking, and may offer an acceptable alternative to the CHP-M (Schultz et al., 2023; 2025). But the degree to which ATHEMOS alters interactions between the consultant and teacher consultee is unknown.

METHODS

Thirty-one middle school students with ADHD were recruited from public schools in Ohio and North Carolina and randomly assigned to either the ATHEMOS (n = 16) or CHP-M (n = 15) conditions. All students were paired with a teacher mentor for up to 24-weeks of intervention, with the support of four trained behavior consultants.

A subset of consultation sessions were audio recorded, and those recordings were digitally transcribed. A team of four coders then analyzed the transcripts. We used investigator triangulation, including all codes generated by the analytic team, rather than seeking consensus (Morgan, 2024).

Eight code definitions were informed by the Manual for the Motivational Interviewing Skill Code (2.1) (MISC; Miller et al., 2010), which is a detailed behavioral-coding system for analyzing motivational interviewing (MI) sessions. We chose this instrument because it enables researchers to assess both client and counselor behaviors during their interactions, and our focus was on basic helping microskills and evidence of motivation (e.g., questions, reflections, commitment). MI is often applied to school consultation (e.g., Herman et al., 2020), given the need to build motivation among teacher consultees. To this we added “Tech Talk” (novel code) to identify instances where the consultant or consultee spoke specifically about the game rather than the real-world intervention it supported.

Our final codebook below:

Codebook - ATHEMOS Process Analysis v3.pdf

Download PDF • 160KB

RESULTS

Seventy-five transcripts were ultimately transcribed and coded from 19.2 hours of audio; at least one transcribed session was analyzed for 19 of the 31 study participants (61%). Of those, 14 participants were in the ATHEMOS condition and 5 were in the CHP-C condition. Missing transcripts were most often due to a lack of teacher consent for recording, or less often, technical problems (e.g., corrupted files). In the ATHEMOS condition, 33% of all coded segments were “Tech Talk.” We then examined proportional differences between the two groups on all other coded segments. The results are summarized below:

We applied a Chi-square test to determine if the pattern of verbal behaviors differed across conditions. The result was significant, χ²(7, N = 2,994) = 81.24, p < .001, Cramer’s V = .16. Standardized residuals suggest consultants for ATHEMOS used higher rates of “Giving Information” (ASR = 7.88, p < .001) than in the CHP-M, with a standardized difference in proportions suggesting a small-to-medium effect (h = 0.33). In contrast, CHP-M consultants used more Closed Questions, Open Questions, and Simple Reflections than ATHEMOS consultants (ASRs = -2.45 to -4.77, ps < .05), but the magnitudes of those differences were trivial (hs = -0.10 to -0.19). There were no significant differences between conditions on any teacher verbal behavior (i.e., Ask, Commitment [Positive or Negative]).

DISCUSSION

ATHEMOS is a novel approach to ADHD intervention with implications for how school consultants and teachers interact. We coded and compared transcripts from school consultation sessions for ATHEMOS and the CHP-M. Results suggest that a substantial proportion of interactions in the ATHEMOS condition were focused on game setup and delivery (33%), which could extend meetings (Lojinger et al., 2024). ATHEMOS consultants also provided direct information more often than consultants in the CHP-M, consistent with professional development and unlike traditional collaborative models (Schultz et al., 2015).

Limitations: First, the set of transcripts was incomplete, and missing transcripts were disproportionately from the CHP-C for reasons that are unclear. Second, we used an investigator-triangulation strategy, which can enrich understanding, but may also yield different conclusions across coding teams.

Conclusion: Using a serious game steers school consultation toward “coaching” and professional development and away from the co-equal partnership of traditional models.

Handout below:

ABCT2025 Lin FINAL.pdf

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REFERENCES

Fried, R., Petty, C., Faraone, S. V., Hyder, L. L., Day, H., & Biederman, J. (2016). Is ADHD a risk factor for high school dropout? A controlled study. Journal of Attention Disorders, 20(5), 383–389. https://doi.org/10.1177/1087054712473180

Herman, K.C., Reinke, W.M., & Frey, A.J. (2020). Motivational Interviewing in Schools: Strategies for Engaging Parents, Teachers, and Students (2nd ed.). Springer.

Lojinger, K., Miller, A., Schultz, B.K., & Evans, S.W. (2024, April 25). Serious games in support of school consultation: An examination of a novel approach to behavior intervention in middle school classrooms [poster presentation]. Southeastern School Behavioral Health Conference, Myrtle Beach, SC, United States.

Miller, W. R., Moyers, T. B., Ernst, D., & Amrhein, P. (2010). Manual for the Motivational Interviewing Skill Code (MISC), Version 2.1. University of New Mexico, Center on Alcoholism, Substance Abuse, and Addictions.

Morgan, H. (2024). Using triangulation and crystallization to make qualitative studies trustworthy and rigorous. The Qualitative Report, 29(7), 1844-1856. https://doi.org/10.46743/2160-3715/2024.6071

Moyers, T. B., Manuel, J. K., & Ernst, D. (2014). Motivational Interviewing Treatment Integrity (MITI) 4.2.1: Manual. University of New Mexico Center on Alcoholism, Substance Abuse, and Addictions.

Sibley, M. H., Swanson, J. M., Arnold, L. E., Hechtman, L. T., Owens, E. B., Stehli, A. Abikoff, H., Hinshaw, S. P., Molina, B. S. G., Mitchell, J. T., Jensen, P. S., Howard, A. L., Lakes, K. D., & Pelham, W. E. (2016). Defining ADHD symptom persistence in adulthood: Optimizing sensitivity and specificity. Journal of Child Psychology and Psychiatry, 58(6), 655—662. https://doi.org/10.1111/jcpp.12620

Schultz, B.K., Arora, P., & Mautone, J.A. (2015). Consultation and coaching to increase the uptake of evidence-based practices: Introduction to the special issue. School Mental Health, 7, 1-5. https://doi.org/10.1007/s12310-015-9142-3

Schultz, B.K., Evans, S.W., Bowditch, J., Carter, K., Rogers, E.E., Donelan, J., & Dembowski, A. (2023). Acceptability and playability of an organization training videogame for young adolescents with ADHD: The development of ATHEMOS. PLOS Digital Health, 2(11). https://doi.org/10.1371/journal.pdig.0000374

Schultz, B.K., Evans, S.W., Schoemann, A.M., Murray, E.R. (2025). A pilot study of a game-supported organization and planning skills intervention for young adolescents with ADHD. Journal of School Psychology, 110. https://doi.org/10.1016/j.jsp.2025.101465

Schultz, B. K., Evans, S. W., & Serpell, Z. N. (2009). Preventing academic failure among middle school students with ADHD: A survival analysis. School Psychology Review, 38, 14-27.

Walters, M. J. (2022). Teacher preparedness to work with children diagnosed with ADHD. Current Psychology. https://doi.org/10.1007/s12144-022-03274-8

ACKNOWLEDGEMENTS

The research in this presentation was supported by the Institute of Education Sciences, U.S. Department of Education, through Grant R324A180219 to East Carolina University and Ohio University. The opinions expressed in this presentation are those of the authors and do not represent the views of the Institute or the U.S. Department of Education