Box 1. Summary and Recommendations for Clinicians Treating Adolescents with ADHD.

Deficits in organizational skills are common in adolescents with ADHD and are unlikely to be normalized with medication treatment.55 For this reason, the four school-based interventions that have been developed for adolescents with ADHD to date (note-taking, self-management, CHP, and HOPS) all target aspects of organizational skills as they apply to social, behavioral or academic impairment.56

Deficits in organizational skills are pervasive across domains of functioning and include problems with: Organization of time (e.g., planning ahead and time estimation) Organization of materials (e.g., filing and transferring school materials to and from home) Organization of writing (e.g., structure of writing and use of main ideas and supporting details) Organization of speech and social cues (e.g., turn taking, staying on-topic, and concise speech)

Deficits in organizational skills manifest clinically as: Lost and misplaced homework assignments Procrastination, often resulting in parent-adolescent conflict and inadequate preparation for tests Lack of structure and coherent themes in writing Difficulty maintaining structured and reciprocal social conversations

Organizational skills should be assessed and monitored during treatment using standardized ratings and/or with collection of data directly from teachers. Tools for measuring organizational skills include: Daily report cards (DRC)57, including teacher-report of homework assignment completion (e.g., number of assignments turned in and number of assignments due). DRCs that contain operationalized definitions of binder and bookbag organization. “There are no loose papers in the bookbag” or “All homework to be taken home is in the homework folder”. Classroom Performance Survey (CPS)58 – A teacher-completed rating scale that includes items related to organization and class preparation. Homework Problems Checklist (HPS)59 – A parent-completed rating scale that assesses homework materials organization and homework completion behaviors. Children's Organizational Skills Scale (COSS)60 – Includes parent, teacher, and self-report versions that assess organization, planning, and time-management skills Behavior Rating Inventory of Executive Function (BRIEF)61 – Includes parent and teacher versions that assess organizational skills as an important aspect of executive functioning Note: http://www.oucirs.org/resources/educator&mhprofessional - contains many of these resources