homework in primary school research

Mother supervising children doing homework

Primary school children get little academic benefit from homework

Lecturer and Researcher in Education, University of Hull

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Homework: a word that can cause despair not just in children, but also in parents and even teachers. And for primary school children at least, it may be that schools setting homework is more trouble than it’s worth.

There is evidence that homework can be useful at secondary school . It can be used to consolidate material learnt in class or to prepare for exams.

However, it is less clear that homework is useful for children at primary school (ages 5 to 11) or in early years education (ages 3 to 5).

What is homework for?

There are no current guidelines on how much homework primary school children in England should be set. In 2018 then education secretary Damien Hinds stated that “We trust individual school head teachers to decide what their policy on homework will be, and what happens if pupils don’t do what’s set”.

While there is not much data available on how much homework primary school pupils do, a 2018 survey of around 1,000 parents found that primary pupils were spending an average of 2.2 hours per week on homework.

The homework done by primary school children can include reading, practising spellings, or revising for tests. Charity the Education Endowment Foundation suggests that the uses for homework at primary school include reinforcing the skills that pupils learn in school, helping them get ready for tests and preparing them for future school lessons.

Homework can also act as a point of communication between home and school, helping parents feel part of their child’s schooling.

However, the 2018 Ofsted Parents’ Panel – which surveyed the views of around 1,000 parents in England on educational issues – found that 36% of parents thought that homework was not helpful at all to their primary school children. The panel report found that, for many parents, homework was a significant source of stress and negatively affected family life.

Little academic benefit

Not much academic research has been carried out on the impact of homework for children in primary school. The available meta-studies – research that combines and analyses the findings of a number of studies – suggest that homework has little or no positive benefit for the academic achievement of children of primary school age . A central reason for this seems to be the inability of children to complete this homework without the support provided by teachers and the school.

Some research has suggested that primary pupils lack the independent study skills to do homework, and that they are not able to stay focused on the work.

What’s more, homework may actually have a negative effect if parents set unrealistic expectations, apply pressure or use methods that go counter to those used at school.

Homework may also increase inequalities between pupils. High achievers from economically privileged backgrounds may have greater parental support for homework, including more educated assistance, higher expectations and better settings and resources.

However, it is possible that setting homework for primary school children has benefits that cannot be easily measured, such as developing responsibility and independent problem-solving skills. It could also help children develop habits that will be useful in later school life.

A common task set for homework in primary schools is for children to read with their parents. There is some evidence that this has a positive impact as well as providing enjoyment, but the quality of interaction may be more important than the quantity.

If the purpose of homework is to develop the relationship between home and school and give parents more stake in the schooling of their children then this may well be a positive thing. If this is its purpose, though, it should not be used as a means to improve test scores or school performance metrics. For the youngest children, anything that takes time away from developmental play is a bad thing.

Rather, any homework should develop confidence and engagement in the process of schooling for both children and parents.

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Primary school children get little academic benefit from homework

Paul Hopkins , Lecturer and Researcher in Education, on the usefulness of homework for primary school pupils.

There is evidence that homework can be useful at secondary school. It can be used to consolidate material learnt in class or to prepare for exams.

However, it is less clear that homework is useful for children at primary school (ages 5 to 11) or in early years education (ages 3 to 5).

What is homework for?

Homework can also act as a point of communication between home and school, helping parents feel part of their child’s schooling.

Little academic benefit

Not much academic research has been carried out on the impact of homework for children in primary school. The available meta-studies – research that combines and analyses the findings of a number of studies – suggest that homework has little or no positive benefit for the academic achievement of children of primary school age. A central reason for this seems to be the inability of children to complete this homework without the support provided by teachers and the school.

Some research has suggested that primary pupils lack the independent study skills to do homework, and that they are not able to stay focused on the work.

What’s more, homework may actually have a negative effect if parents set unrealistic expectations, apply pressure or use methods that go counter to those used at school.

Rather, any homework should develop confidence and engagement in the process of schooling for both children and parents.

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Is Homework Good for Kids? Here’s What the Research Says

A s kids return to school, debate is heating up once again over how they should spend their time after they leave the classroom for the day.

The no-homework policy of a second-grade teacher in Texas went viral last week , earning praise from parents across the country who lament the heavy workload often assigned to young students. Brandy Young told parents she would not formally assign any homework this year, asking students instead to eat dinner with their families, play outside and go to bed early.

But the question of how much work children should be doing outside of school remains controversial, and plenty of parents take issue with no-homework policies, worried their kids are losing a potential academic advantage. Here’s what you need to know:

For decades, the homework standard has been a “10-minute rule,” which recommends a daily maximum of 10 minutes of homework per grade level. Second graders, for example, should do about 20 minutes of homework each night. High school seniors should complete about two hours of homework each night. The National PTA and the National Education Association both support that guideline.

But some schools have begun to give their youngest students a break. A Massachusetts elementary school has announced a no-homework pilot program for the coming school year, lengthening the school day by two hours to provide more in-class instruction. “We really want kids to go home at 4 o’clock, tired. We want their brain to be tired,” Kelly Elementary School Principal Jackie Glasheen said in an interview with a local TV station . “We want them to enjoy their families. We want them to go to soccer practice or football practice, and we want them to go to bed. And that’s it.”

A New York City public elementary school implemented a similar policy last year, eliminating traditional homework assignments in favor of family time. The change was quickly met with outrage from some parents, though it earned support from other education leaders.

New solutions and approaches to homework differ by community, and these local debates are complicated by the fact that even education experts disagree about what’s best for kids.

The research

The most comprehensive research on homework to date comes from a 2006 meta-analysis by Duke University psychology professor Harris Cooper, who found evidence of a positive correlation between homework and student achievement, meaning students who did homework performed better in school. The correlation was stronger for older students—in seventh through 12th grade—than for those in younger grades, for whom there was a weak relationship between homework and performance.

Cooper’s analysis focused on how homework impacts academic achievement—test scores, for example. His report noted that homework is also thought to improve study habits, attitudes toward school, self-discipline, inquisitiveness and independent problem solving skills. On the other hand, some studies he examined showed that homework can cause physical and emotional fatigue, fuel negative attitudes about learning and limit leisure time for children. At the end of his analysis, Cooper recommended further study of such potential effects of homework.

Despite the weak correlation between homework and performance for young children, Cooper argues that a small amount of homework is useful for all students. Second-graders should not be doing two hours of homework each night, he said, but they also shouldn’t be doing no homework.

Not all education experts agree entirely with Cooper’s assessment.

Cathy Vatterott, an education professor at the University of Missouri-St. Louis, supports the “10-minute rule” as a maximum, but she thinks there is not sufficient proof that homework is helpful for students in elementary school.

“Correlation is not causation,” she said. “Does homework cause achievement, or do high achievers do more homework?”

Vatterott, the author of Rethinking Homework: Best Practices That Support Diverse Needs , thinks there should be more emphasis on improving the quality of homework tasks, and she supports efforts to eliminate homework for younger kids.

“I have no concerns about students not starting homework until fourth grade or fifth grade,” she said, noting that while the debate over homework will undoubtedly continue, she has noticed a trend toward limiting, if not eliminating, homework in elementary school.

The issue has been debated for decades. A TIME cover in 1999 read: “Too much homework! How it’s hurting our kids, and what parents should do about it.” The accompanying story noted that the launch of Sputnik in 1957 led to a push for better math and science education in the U.S. The ensuing pressure to be competitive on a global scale, plus the increasingly demanding college admissions process, fueled the practice of assigning homework.

“The complaints are cyclical, and we’re in the part of the cycle now where the concern is for too much,” Cooper said. “You can go back to the 1970s, when you’ll find there were concerns that there was too little, when we were concerned about our global competitiveness.”

Cooper acknowledged that some students really are bringing home too much homework, and their parents are right to be concerned.

“A good way to think about homework is the way you think about medications or dietary supplements,” he said. “If you take too little, they’ll have no effect. If you take too much, they can kill you. If you take the right amount, you’ll get better.”

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The Great British Homework Debate 2024 – Is It Necessary At Primary School?

Alexander Athienitis

The homework debate is never much out of the news. Should homework be banned? Is homework at primary school a waste of time? Do our children get too much homework?

Not long ago, UK-based US comedian Rob Delaney set the world alight with a tweet giving his own personal view of homework at primary school. We thought, as an organisation that provides maths homework support on a weekly basis, it was time to look at the facts around the homework debate in primary schools as well as, of course, reflecting the views of celebrities and those perhaps more qualified to offer an opinion!

Here’s how Rob Delaney kicked things off

Gary Lineker leant his support with the following soundbite:

And even Piers Morgan weighed in, with his usual balance of tact and sensitivity:

Piers Morgan had more to say on the homework debate

A very experienced and knowledgeable Headteacher, Simon Smith, who has a well-earned following on Twitter (for someone working in education, not hosting Match of the Day) also put his neck on the line and, some might think controversially, agreed with the golden-heeled Crisp King of Leicester…

Simon Smith (Headteacher)'s Tweet On The Homework Debate

Fortunately Katharine Birbalsingh, Conservative Party Conference keynote speaker and Founding Headteacher of the Michaela School, was on hand to provide the alternative view on the importance of homework. Her op-ed piece in the Sun gave plenty of reasons why homework should not be banned.

She was informative and firm in her article stating: “Homework is essential for a child’s education because revisiting the day’s learning is what helps to make it stick.”

Katharine Birbalsingh, Headteacher, Michaela Community School waded in on the homework debate too.

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How much homework do UK primary school children get?

Sadly, there’s little data comparing how much homework primary school-aged children in the UK and across the globe complete on a weekly basis. A study of teenagers used by The Telegraph shows that American high-schoolers spend an average of 6.1 hours per week compared with 4.9 hours per week of homework each week for UK-based teens.

Up until 2012, the Department of Education recommended an hour of homework a week for primary school Key Stage 1 children (aged 4 to 7) and half an hour a day for primary school Key Stage 2 children (aged 7-11). Many primary schools still use this as a guideline.

Teachers, parents and children in many schools across the land have seen more changes of homework policy than numbers of terms in some school years.

A ‘no-homework’ policy pleases only a few; a grid of creative tasks crowd-sourced from the three teachers bothered to give their input infuriates many (parents, teachers and children alike). For some parents, no matter how much homework is set, it’s never enough; for others, even asking them to fill in their child’s reading record once a week can be a struggle due to a busy working life.

Homework is very different around the world

We’d suggest that Piers Morgan’s argument for homework in comparing the UK’s economic and social progress with China’s in recent years based on total weekly homework hours is somewhat misguided – we can’t put their emergence as the world’s (if not already, soon to be) leading superpower exclusively down to having their young people endure almost triple the number of hours spent completing homework as their Western counterparts.

Nonetheless, there’s certainly a finer balance to strike between the 14 hours a week suffered by Shanghainese school-attendees and none whatsoever. Certainly parents in the UK spend less time each week helping their children than parents in emerging economies such as India, Vietnam and Colombia (Source: Varkey Foundation Report).

Disadvantages of homework at primary school

Delaney, whose son attends a London state primary school, has made it plain that he thinks his kids get given too much homework and he’d rather have them following more active or creative pursuits: drawing or playing football. A father of four sons and a retired professional footballer Gary Linaker was quick to defend this but he also has the resources to send his children to top boarding schools which generally provide very structured homework or ‘prep’ routines.

As parents Rob and Gary are not alone. According to the 2018 Ofsted annual report on Parents Views more than a third of parents do not think homework in primary school is helpful to their children. They cite the battles and arguments it causes not to mention the specific challenges it presents to families with SEND children many of whom report serious damage to health and self-esteem as a result of too much or inappropriate homework.

It’s a truism among teachers that some types of homework tells you very little about what the child can achieve and much more about a parent’s own approach to the work. How low does your heart sink when your child comes back with a D & T project to create Stonehenge and you realise it’s either an all-nighter with glue, cardboard and crayons for you, or an uncompleted homework project for your child!

This tweet on the homework debate showed off the fun side of primary homework

Speaking with our teacher hats on, we can tell you that homework is often cited in academic studies looking at academic progress in primary school-aged children as showing minimal to no impact.

Back on Twitter, a fellow teacher was able to weigh-in with that point:

Benefits of homework at primary school

So what are the benefits of homework at primary school? According to the Education Endowment Foundation (EEF) (the key research organisations dedicated to breaking the link between family income and educational achievement) the impact of homework at primary is low, but it also doesn’t cost much.

They put it at a “+2 months” impact against a control of doing nothing. To put this into context, 1-to-1 tuition is generally seen as a +5 months impact but it’s usually considered to be expensive.

“There is some evidence that when homework is used as a short and focused intervention it can be effective in improving students’ attainment … overall the general benefits are likely to be modest if homework is more routinely set.”

Key to the benefit you’ll see from homework is that the task is appropriate and of good quality. The quantity of homework a pupil does is not so important. In this matter Katharine Birbalsingh is on the money. Short focused tasks which relate directly to what is being taught, and which are built upon in school, are likely to be more effective than regular daily homework.

In our view it’s about consolidation. So focusing on a few times tables that you find tricky or working through questions similar to what you’ve done in class that day or week often can be beneficial. 2 hours of worksheets on a Saturday when your child could be outside having fun and making friends probably isn’t. If you really want them to be doing maths, then do some outdoor maths with them instead of homework !

At Third Space Learning we believe it’s all about balance. Give the right sort of homework and the right amount at primary school and there will be improvements, but much of it comes down to parental engagement.

One of our favourite ways to practise maths at home without it become too onerous is by using educational games. Here are our favourite fun maths games , some brilliant KS2 maths games , KS1 maths games and KS3 maths games for all maths topics and then a set of 35 times tables games which are ideal for interspersing with your regular times tables practice. And best of all, most of them require no more equipment than a pen and paper or perhaps a pack of cards.

Homework and parents

One of the key benefits cited by EEF is in regard to parental engagement. Time after time, the greatest differentiator between children who make great progress at school – and those, frankly – who don’t is due to the same factor in the same studies: parental engagement .

It is a fair assumption that if a parent is engaged in their child’s learning, they’re probably going to be the same parents who encourage and support their child when they’re completing their homework.

Whereas parents who are disengaged with their child’s school and schooling – for whatever reason (sorry, Piers, it’s rarely due to laziness), are highly unlikely to be aware of what homework gets set each week, let alone to be mucking in with making sure it gets handed in completed and on time.

We also encounter time and again, the issue of parents’ own lack of confidence in maths. A survey by Pearson found that:

30 percent of parents “don’t feel confident enough in their own maths skills to help their children with their primary school maths homework”
53 per cent insisted they struggled to understand the new maths teaching methods used in modern classrooms. Fortunately that’s what we’re here to address.

Setting the right homework at primary school can be tricky

Although we disagree with Piers, we can see what he may be driving at in terms of setting appropriate homework.

Piers Morgan had strong opinions on the homework debate

The question quickly becomes what would Piers think of as being ‘interesting’ homework, and if all four of his children would agree upon the same thing being ‘interesting’.

That’s the problem.

One would imagine Piers would find it hard enough finding one task to satisfy the interest of all of his four children – it’s almost impossible to find a task that will engage the interest of 30 or more children in their out of school hours.

Each with different emotional, behavioural and learning needs, then sprinkle in the varying levels of poverty each family suffers (be it financial or in terms of time), and you can see how it isn’t just about being a good or bad teacher – whatever that means – in regards to being able to set Morgan-approved homework tasks.

What does this mean for my child?

Ultimately, the question at the top of mind whenever a parent thinks about homework is a more general one – am I doing the best for my child?

Although the world is changing at a faster pace than ever before in human history, what’s best for children hasn’t changed that much (if at all).

One-to-one support is best, and young people benefit most from adult-child conversations where they acquire new vocabulary and language structures to form and share their thoughts and opinions.

These insights – that one-to-one support is best and that regular, structured adult-child conversations are life-changing within a child’s development – are what inspired us to create Third Space Learning.

A platform where children can engage with a community of specialist tutors in a safe, structured learning environment where they are able to engage in one-to-one conversations that enable them to progress in their learning with confidence.

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Since 2013 these personalised one to one lessons have helped over 150,000 primary and secondary students become more confident, able mathematicians.

Learn about our experience with schools or request a personalised quote for your school to speak to us about your school’s needs and how we can help.

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John Hattie

John Hattie on BBC Radio 4: “Homework in primary school has an effect of zero”

“Homework in primary school has an effect of around zero”, says Professor John Hattie. But what does really work in education, schools and classrooms around the world? Every week Sarah Montague interviews the people whose ideas are challenging the future of education, like Sugata Mitra, Sir Ken Robinson and the headmaster of Eton College Tony Little. In August John Hattie, Professor of Education at the University of Melbourne, was her guest at BBC Radio 4. You can listen to the whole interview with John Hattie following this link (28 mins). Here are some quick takeaways. If you want to read further about what works best in education you can order the books Visible Learning and Visible Learning for Teachers .

Visible Learning: Buy the book VL for Teachers: Buy the book

John Hattie about class size

“Well, the first thing is, reducing class size does enhance achievement. However, the magnitude of that effect is tiny. It’s about a hundred and fifth out of a hundred and thirty odd different effects out there and it’s just one of those enigmas and the only question to ask is why is that effect so small? Because it is small. And the reason, we’ve found out, that it’s so small is because teachers don’t change how they teach when they go from a class of thirty to fifteen and perhaps it’s not surprising.”

John Hattie about public vs private schools

“Here in England, if you take out the prior differences from going to a private school where they tend to get parents who choose, as oppose to them sent to the local school, they tend to get a brighter student, you take that out, there’s not much difference. In many places the government school would be better. So, it’s kind of ironic, in the last twenty years where we’ve pushed this notion that parents have choice, so they can choose the school that may not be in the best interest of their student.”

John Hattie about homework

“Homework in primary school has an effect of around zero. In high school it’s larger. (…) Which is why we need to get it right. Not why we need to get rid of it. It’s one of those lower hanging fruit that we should be looking in our primary schools to say, “Is it really making a difference?” If you try and get rid of homework in primary schools many parents judge the quality of the school by the presence of homework. So, don’t get rid of it. Treat the zero as saying, “It’s probably not making much of a difference but let’s improve it”. Certainly I think we get over obsessed with homework. Five to ten minutes has the same effect of one hour to two hours. The worst thing you can do with homework is give kids projects. The best thing you can do is to reinforce something you’ve already learnt.”

John Hattie about streaming

“It doesn’t make a difference.” Sarah Montague: “But bright kids aren’t held back by less bright and less bright not suffering?” “No. No difference at all. No. Teachers think it’s easier for them and it may be but in terms of the effects of students, no. Now you’ve got to remember that a lot of students gain a tremendous amount of their learning from their other students in the class and variability is the way that you get more of that kind of learning from other students.”

Listen to the whole interview with John Hattie at BBC Radio 4 . If you want to read further you can order the books Visible Learning and Visible Learning for Teachers.

BBC Radio 4: The Educators . Sarah Montague interviews the people whose ideas are challenging the future of education. Episode 2: John Hattie Duration: 28 minutes First broadcast: 20 August 2014 Presenter: Sarah Montague Producer: Joel Moors.

38 comments on “ John Hattie on BBC Radio 4: “Homework in primary school has an effect of zero” ”

John Hattie Homework I beg to differ, depends on what type ! E.g. Cook a meal with mum or day, explain today’s Math to a family member, read the last chapter of a book, make a touch cast report of your pet, use time laps photography with your iPad to show the growth of a seed into a plant, find Mars using an iPad app, create a billboard online that promotes one of the current issues ….

And I quote: So, don’t get rid of it. Treat the zero as saying, “It’s probably not making much of a difference but let’s improve it”.

I agree. What can we do to give it a greater effect? “Flipped” classrooms for example have a great effect on student learning as modern research shows.

Spot on.I work in Dubai and that’s how we plan homework. No rote but just enriching linkage to lessons learnt. Our kids enjoy these and are eager to share their experiences and learn tremendously from each other! !

All well and good if the parents can afford an iPad……….

Spot on John. Also, maybe let them chose from several options an activity which is of interest to them.

Why Is no one pointing out the fact of once these kids go to a higher grades the shock of how much of a load of homework will be a complete wreck them. My son was in 4th and he had homework and he hated doing it now he’s in 5th and the no homework rule is in place but once he hits 6th grade he will have it as again and i know sixth grade is always a shock for most kids. So I strongly disagree so we give him reading every night and review with him what he learned in class each day

Good revision routines prepare kids adequately

I use to be an advocate for streaming but I was wrong… kids learn best when there are varied abilities in the room. Class sizes don’t matter… quality instruction … minimal instruction .. maximum participation for students… and yes homework is over rated.

Based on what research? Im not saying you’re wrong, just curious what facts you’re using to support your opinion.

very simple data and anecdotal evidence.

Empirical research from over 800 meta-analysis — hardly “simple data” nor “anecdotal”. Evidence-based.

It’s John Hattie, are you a dinosaur? What current educational research sites don’t draw on his ongoing research?

These comments are reflecting what research the Sutton trust has accumulated. It shows that homework and class size make no difference and the thing that makes the most difference is noticing children’s responses and adjusting immediately according to them. In my head, this is obviously easier to do well with a smaller class. So if you want good teaching and not burn teachers out trying to individually respond to 32 children in each lesson, then reducing class size will make a difference. But class size in itself doesn’t. I also think that we have a large number of children who need nurturing not just teaching facts. So again a smaller class is beneficial to this end.

When a class size goes down to 5 then there are massive differences in learning. I was on a college course and for some reason, which I have forgotten, there were only 5 students on my engineering course. The teacher had a much better understanding of what we knew and on the effect of his teaching. We all got straight A’s.

It’s all about the quality of what is happening in the learning environment not the number students. A good teacher will have a good impact with 14 or 40 kids. You have to change what you do to meet the needs of the students.

I believe class size does make a difference. It certainly did with my daughter. Not from a teaching perspective, but from a learning perspective. The more students in a classroom, the more distractions and behavioral issues there are. My daughter is not a child who is easily distracted, but two years ago, she left public school and switched to online learning with a small amount of students in her class. She said there is a huge difference in the number of times the teacher has to stop the lesson in order to reprimand a student.

If students spent the first 3 years K-2 learning to get along in a classroom-how to work as a group and other social skills, there would be less disruptions in classrooms. Sone children at that you age are not neurologically developed enough to handle all of the reading, writing and math thrown at the lower grade levels. Throw some numbers and letters at them while building on their social skills and they will be much more successful students from 3rd grad and up.

The problem with Hattie’s research is that it is not primary school based but rather based across all schools from preschool to tertiary. Smaller classes make a huge difference especially in the junior school and it is covert teacher bashing to say that the teachers don’t change with smaller classes. They can and they do. They can’t with larger classes no matter how skilled they are. It’s the same with home work. If the homework is being encouraged to work with mum or dad in the kitchen or the garden por encouraging parents to read and act out stories with their children these will make massive differences to achievement.

I agree completely. Last year I was lucky enough to have a class of 18 for the best part of the year. I do believe the spring in my step made me a better teacher. A number of my D students became B’s. I believe in a normal class grouping I would have been lucky to get them to a C. I don’t think Prof. Hattie can measure my stress levels. There was so much joy in teaching my little group of children!

Jules, I completely agree with you. Hattie has, as far as I’m aware, never done research on the effect of larger/smaller class sizes on teacher stress levels and less/more time to think, prepare and spend more time with individual students. Of course, there are methods designed to maximise the learning of larger classes, but there is a huge time saving in marking a class of 18 essays to marking, say, 30. The time saved can be invested in lesson preparation, or even, time to just think! John Hattie was a maths teacher, though, so I guess he didn’t mark too many essays…

Jules you are so right! With the complexities of children’s personal lives having a smaller class enables us to have time to address their individual needs both personally and academically. We can then feel happier in our ability to fulfill each child’s needs which gives another avenue to help reduce our stress levels.

Not a fan of homework, except as a little revision, especially in primary school. My 5 children attended a state primary school, which had multi-age classrooms, which assisted children to learn at their own pace. It worked. It was also a Glasser school, which helped with socialisation. My eldest child is 27, and has Asperger’s Syndrome. The other 4 have all been accepted at tertiary institutions. All but one of those 4 were educated completely at state schools, with 1 attending a private school for her last 3 years of school, at her own request, for social (not academic) reasons. Perhaps children, especially boys, should begin school at a later age.

Having read and used Professor Hattie’s research in order to make positive impacts on student learning and outcomes, and having listened to many interviews, I can honestly say I have never felt that he covertly bashes teachers with his findings. The opposite in fact. I have always found Professor Hattie to speak positively of teachers. As a teacher, I wish more people in the public arena would validate what we do.

hang on. I remember like it was yesterday that when I was put down a group I immediately sank down to the equivalent level in that group. Ie in footballing terms, relegation zone in premiership led to relegation zone in championship. And how come nobody mentions the threat of being beaten up (let’s call it bullied) for doing well in the “second set” group? That was also a very real threat. You certainly didnt want to shine once you were relegated. Why does nobody mention this? Presumably this is a neutral site?

I agree as a parent i believe homework makes a difference….provided parent/s are involved. 1. I know what my child is learning in school. 2. I can pick up what my child needs extra attention to work on, help her with it and bring this to the teacher’s attention. 3. Show an interest in what my child is doing during her day. Only helps build on a stronger family unit.

Why is it, that never is there a word about student behaviour and the huge effect it has on learning, not just for the behaviour problem students, but for all children within that classroom! Unacceptable behaviour can keep a classroom in an upheaval . Also, the undesirable effects of hard drugs while in the womb…also alcohol! Then we have undernourishment and exhausted children. And we must not forget the trauma many are experiencing…separated parents, bickering parents, living in households where adults are smoking inside, eating a diet of processed foods, a parent or parents drinking to extremes on a daily basis, sexual abuse, seeing a parent being abused… and I could go on! All of these things and more are what many children are experiencing on a daily basis. Change will take place in the classroom and learning will take place when things change first in our homes and in our lives. It is the parents responsibility and we need to hand it back to them!

Couldn’t agree more with Elizabeth’s comments – but when you have an inspired and passionate teacher who can see beyond the behaviour and identify the effects of trauma in a youngster – the impact on that child, that class can be huge! Critical skills training can be invaluable – visible learning at worst can lead to children becoming statistics in the forensic analysis of data when actually they will gain more and teachers will have more of an impact with 5 minutes of care and concern and perhaps being the only person that has spent 5 minutes 1:1 with that child! Real relational trust takes time and genuine concern and interest in children developing and progressing – what is an assessment capable learner? Sounds like a robot!

Behavior is a big learning factor for the student with behaviors and those around them. Our son has a diagnoses with multiple co-morbids ADHD/Anxiety/OCD/Depresson/PTSD/Sensory disorder. The depression and PTSD was brought on in his therapist’s opinion by using peers to assist in helping other students, which doesn’t always have a positive impact and bullying at school.

It got to the point where he was taking 3 stimulants, a mood stabilizer and an anxiety med just to make it through the school day. And then he’d come home and have so much homework he never got to go outside to run off his excessive energy and then 3 more pills to bring him down so he could sleep. Not to mention the ill side effects of weight gain (he’s a 7th grader now 5’5 and weighs 200 pounds thats horrifying).

We pulled him out of mainstream school last year, weaned him off all meds and home school now. His self confidence is building, the weight is slowly coming off and he’ll be done early with the program we bought mainly because he can fly thru what interests him and he already has a wealth of information on and he can spend more time working on new information. We APPLY his lessons to his every day life.

All that being said maybe less pressure should be put on the child having homework and more time spent on educating parents about what their child is being taught and how to apply it to their every day life. As a daycare provider I know that not all parents will back a teacher up but I do think that they’d be surprised how many parents would.

Very interesting thoughts. To say it has zero effect seems a bit far fetched for all students. It depends on the quality of the school and quality of life at home. I work with low income students who seem to not have much education at home. The homework the teachers send helps us evaluate where the children are and help increase their education even if the parents are not involved in their education. Children with strong support systems probably benefit by helping around the house more and being a great part of the community.

Hattie’s work should be taken for what it is–superficial with blunders https://ollieorange2.wordpress.com/2014/09/24/half-of-the-statistics-in-visible-learning-are-wrong-part-2/

Yes I agree with Hattie when he says, “a lot of students gain a tremendous amount of their learning from their other students in the class.” Empirical evidence in my class has shown for those who are “not into” a particular subject, their influence (teaching) on others to fall behind, not engage in activities and not do the work is infectious. Make it more interesting people say, how interesting can you make a football game for those wanting to do ballet? Put them on the field and they will learn though, they will learn to avoid playing against the Alphas at all costs so the best solution, get into trouble to avoid having to integrate, cause trouble so the lessons gets dragged out. All of these theories I’m sure work, but it needs a tag line: They work “in the ideal world.” The fact is that we don’t live in one.

I’m not sure what you mean by integrate? Please forgive me if I’m wrong. I take your comment to say that if a child doesn’t itegrate into the classroom setting, they’ll fail at adulthood?

We have two older children with ADHD and they never truly integrated into the school system but outside school in their ongoing education and career’s they’ve chose career’s in fast paced, every changing fields one medical, one education and they’re excelling. Failure to integrate into a classroom setting does not automatically set a child up for failure in their adult life.

It’s parents who drive the homework. They think it’ll make their kids smarter. Teachers are under pressure to give kids extra work. A lot of teachers would rather not give homework. Reading with an adult is the best thing you can do for your child.

Teaching kids to be happy versus give them more work so they dont have time to find out for themselves or worse keeping them miserable

Homework that reinforces the application of skills and knowlegde already taught will prove to be purposeful. The time spent on homework must be in keeping with the concentration span of the child. It should not be an extension of the school day. 6 to 9 year olds learn best through play. Written tasks rob them of that opportunity to explore whilst developing valuable life skills.

When we know better, our moral obligation is to do better. Saying, “Yeah, I see this research. It just doesn’t fit with what I believe” is a profession of non-professionalism.

Hattie is a fraud. Unfortunately, many seem to have been taken in by his profoundly flawed research and his political motives.

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What’s the Right Amount of Homework?

Decades of research show that homework has some benefits, especially for students in middle and high school—but there are risks to assigning too much.

Many teachers and parents believe that homework helps students build study skills and review concepts learned in class. Others see homework as disruptive and unnecessary, leading to burnout and turning kids off to school. Decades of research show that the issue is more nuanced and complex than most people think: Homework is beneficial, but only to a degree. Students in high school gain the most, while younger kids benefit much less.

The National PTA and the National Education Association support the “ 10-minute homework guideline ”—a nightly 10 minutes of homework per grade level. But many teachers and parents are quick to point out that what matters is the quality of the homework assigned and how well it meets students’ needs, not the amount of time spent on it.

The guideline doesn’t account for students who may need to spend more—or less—time on assignments. In class, teachers can make adjustments to support struggling students, but at home, an assignment that takes one student 30 minutes to complete may take another twice as much time—often for reasons beyond their control. And homework can widen the achievement gap, putting students from low-income households and students with learning disabilities at a disadvantage.

However, the 10-minute guideline is useful in setting a limit: When kids spend too much time on homework, there are real consequences to consider.

Small Benefits for Elementary Students

As young children begin school, the focus should be on cultivating a love of learning, and assigning too much homework can undermine that goal. And young students often don’t have the study skills to benefit fully from homework, so it may be a poor use of time (Cooper, 1989 ; Cooper et al., 2006 ; Marzano & Pickering, 2007 ). A more effective activity may be nightly reading, especially if parents are involved. The benefits of reading are clear: If students aren’t proficient readers by the end of third grade, they’re less likely to succeed academically and graduate from high school (Fiester, 2013 ).

For second-grade teacher Jacqueline Fiorentino, the minor benefits of homework did not outweigh the potential drawback of turning young children against school at an early age, so she experimented with dropping mandatory homework. “Something surprising happened: They started doing more work at home,” Fiorentino writes . “This inspiring group of 8-year-olds used their newfound free time to explore subjects and topics of interest to them.” She encouraged her students to read at home and offered optional homework to extend classroom lessons and help them review material.

Moderate Benefits for Middle School Students

As students mature and develop the study skills necessary to delve deeply into a topic—and to retain what they learn—they also benefit more from homework. Nightly assignments can help prepare them for scholarly work, and research shows that homework can have moderate benefits for middle school students (Cooper et al., 2006 ). Recent research also shows that online math homework, which can be designed to adapt to students’ levels of understanding, can significantly boost test scores (Roschelle et al., 2016 ).

There are risks to assigning too much, however: A 2015 study found that when middle school students were assigned more than 90 to 100 minutes of daily homework, their math and science test scores began to decline (Fernández-Alonso, Suárez-Álvarez, & Muñiz, 2015 ). Crossing that upper limit can drain student motivation and focus. The researchers recommend that “homework should present a certain level of challenge or difficulty, without being so challenging that it discourages effort.” Teachers should avoid low-effort, repetitive assignments, and assign homework “with the aim of instilling work habits and promoting autonomous, self-directed learning.”

In other words, it’s the quality of homework that matters, not the quantity. Brian Sztabnik, a veteran middle and high school English teacher, suggests that teachers take a step back and ask themselves these five questions :

How long will it take to complete?
Have all learners been considered?
Will an assignment encourage future success?
Will an assignment place material in a context the classroom cannot?
Does an assignment offer support when a teacher is not there?

More Benefits for High School Students, but Risks as Well

By the time they reach high school, students should be well on their way to becoming independent learners, so homework does provide a boost to learning at this age, as long as it isn’t overwhelming (Cooper et al., 2006 ; Marzano & Pickering, 2007 ). When students spend too much time on homework—more than two hours each night—it takes up valuable time to rest and spend time with family and friends. A 2013 study found that high school students can experience serious mental and physical health problems, from higher stress levels to sleep deprivation, when assigned too much homework (Galloway, Conner, & Pope, 2013 ).

Homework in high school should always relate to the lesson and be doable without any assistance, and feedback should be clear and explicit.

Teachers should also keep in mind that not all students have equal opportunities to finish their homework at home, so incomplete homework may not be a true reflection of their learning—it may be more a result of issues they face outside of school. They may be hindered by issues such as lack of a quiet space at home, resources such as a computer or broadband connectivity, or parental support (OECD, 2014 ). In such cases, giving low homework scores may be unfair.

Since the quantities of time discussed here are totals, teachers in middle and high school should be aware of how much homework other teachers are assigning. It may seem reasonable to assign 30 minutes of daily homework, but across six subjects, that’s three hours—far above a reasonable amount even for a high school senior. Psychologist Maurice Elias sees this as a common mistake: Individual teachers create homework policies that in aggregate can overwhelm students. He suggests that teachers work together to develop a school-wide homework policy and make it a key topic of back-to-school night and the first parent-teacher conferences of the school year.

Parents Play a Key Role

Homework can be a powerful tool to help parents become more involved in their child’s learning (Walker et al., 2004 ). It can provide insights into a child’s strengths and interests, and can also encourage conversations about a child’s life at school. If a parent has positive attitudes toward homework, their children are more likely to share those same values, promoting academic success.

But it’s also possible for parents to be overbearing, putting too much emphasis on test scores or grades, which can be disruptive for children (Madjar, Shklar, & Moshe, 2015 ). Parents should avoid being overly intrusive or controlling—students report feeling less motivated to learn when they don’t have enough space and autonomy to do their homework (Orkin, May, & Wolf, 2017 ; Patall, Cooper, & Robinson, 2008 ; Silinskas & Kikas, 2017 ). So while homework can encourage parents to be more involved with their kids, it’s important to not make it a source of conflict.

Positive Affect Variability is Associated with Homework Management Difficulties in Children with ADHD

Original Paper
Published: 15 May 2024

Cite this article

Helena F. Alacha ORCID: orcid.org/0000-0001-8418-8626 1 ,
Paul J. Rosen 2 , 3 &
Sara J. Bufferd ORCID: orcid.org/0000-0003-2915-4225 1

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Children with Attention-Deficit/Hyperactivity Disorder (ADHD) often experience academic challenges such as frequent homework difficulties. A subset of children with ADHD exhibit clinically significant levels of affect variability that may contribute to ADHD-related impairment such as homework difficulties. The present study sought to examine the relations between negative and positive affect variability and the two domains of homework problems (i.e., homework management and homework completion) in children with ADHD. It was hypothesized that both negative and positive affect variability would be associated with homework completion and homework management difficulties in children with ADHD. Participants ( n = 47) included parents of 7–11-year-old children ( M = 8.36, SD = 1.31) with ADHD. During the baseline session, parents completed a structured diagnostic interview and questionnaire measures to assess children’s homework problems, ADHD symptoms, and related psychiatric conditions. Subsequently, parents provided ecological momentary assessments (EMA) ratings of their children’s positive and negative affect three times daily over a one-week period. Results indicate that, while controlling for ADHD symptom severity, positive affect variability was significantly associated with homework management but not completion difficulties in children with ADHD; negative affect variability was not associated with homework problems in either domain. The current study highlights the importance of positive affect regulation in children’s navigation of the homework process, and results suggest that children with ADHD who struggle with homework management difficulties might benefit from homework interventions that incorporate positive affect regulation strategies.

Positive affect variability is associated with homework management difficulties in children with ADHD.

Negative affect variability is not significantly associated with homework problems in children with ADHD.

Positive affect variability estimates homework management difficulties even when controlling for ADHD symptom severity.

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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. https://doi.org/10.1037/a0029648 .

Article PubMed Google Scholar

Alacha, H. F., & Lefler, E. K. (2021). Negative halo effects in parent ratings of ADHD, ODD, and CD. Journal of Psychopathology and Behavioral Assessment , 43 (3), 466–477. https://doi.org/10.1007/s10862-020-09860-1 .

Article Google Scholar

American Psychiatric Association (APA) (1994). Diagnostic and statistical manual of mental disorders (4th ed.).

Anastopoulos, A. D., Smith, T. F., Garrett, M. E., Morrissey-Kane, E., Schatz, N. K., Sommer, J. L., Kollins, S. H., & Ashley-Koch, A. (2011). Self-regulation of emotion, functional impairment, and comorbidity among children with AD/HD. Journal of Attention Disorders , 15 (7), 583–592. https://doi.org/10.1177/1087054710370567 .

Anesko, K. M., Shoiock, G., Ramirez, R., & Levine, F. M. (1987). The homework problem checklist: Assessing children’s homework difficulties. Behavioral Assessment , 9 (2), 179–185.

Google Scholar

Ayano, G., Demelash, S., Gizachew, Y., Tsegay, L., & Alati, R. (2023). The global prevalence of attention deficit hyperactivity disorder in children and adolescents: An umbrella review of meta-analyses. Journal of Affective Disorders , 339 , 860–866. https://doi.org/10.1016/j.jad.2023.07.071 .

Ballentine, K. L. (2019). Understanding racial differences in diagnosing ODD versus ADHD using critical race theory. Families in Society: The Journal of Contemporary Social Services , 100 (3), 282–292. https://doi.org/10.1177/1044389419842765 .

Baracchini, G., Mišić, B., Setton, R., Mwilambwe-Tshilobo, L., Girn, M., Nomi, J. S., Uddin, L. Q., Turner, G. R., & Spreng, R. N. (2021). Inter-regional BOLD signal variability is an organizational feature of functional brain networks. NeuroImage , 237 , 118149. https://doi.org/10.1016/j.neuroimage.2021.118149 .

Barkley, R. A. (1997a). Attention-deficit/hyperactivity disorder, self-regulation, and time: Toward a more comprehensive theory. Journal of Developmental and Behavioral Pediatrics , 18 (4), 271–279.

Barkley, R. A. (1997b). Behavioral inhibition, sustained attention, and executive functions: Constructing a unifying theory of ADHD. Psychological Bulletin , 121 (1), 65–94. https://doi.org/10.1037/0033-2909.121.1.65 .

Barkley, R. A., & Fischer, M. (2010). The unique contribution of emotional impulsiveness to impairment in major life activities in hyperactive children as adults. Journal of the American Academy of Child & Adolescent Psychiatry , 49 (5), 503–513. https://doi.org/10.1016/j.jaac.2010.01.019 .

Bear, G. G., Minke, K. M., Thomas, A., & National Association of School Psychologists (Eds.). (1997). Children’s needs II: Development, problems, and alternatives . National Association of School Psychologists.

Bempechat, J. (2004). The motivational benefits of homework: a social-cognitive perspective. Theory Into Practice , 43 (3), 189–196. https://doi.org/10.1207/s15430421tip4303_4 .

Biederman, J., Faraone, S. V., Monuteaux, M. C., Bober, M., & Cadogen, E. (2004). Gender effects on attention-deficit/hyperactivity disorder in adults, revisited. Biological Psychiatry , 55 (7), 692–700. https://doi.org/10.1016/j.biopsych.2003.12.003 .

Bikic, A., Reichow, B., McCauley, S. A., Ibrahim, K., & Sukhodolsky, D. G. (2017). Meta-analysis of organizational skills interventions for children and adolescents with Attention-deficit/hyperactivity Disorder. Clinical Psychology Review , 52 , 108–123. https://doi.org/10.1016/j.cpr.2016.12.004 .

Bodalski, E. A., Flory, K., Canu, W. H., Willcutt, E. G., & Hartung, C. M. (2023). ADHD symptoms and procrastination in college students: The roles of emotion dysregulation and self-esteem. Journal of Psychopathology and Behavioral Assessment , 45 (1), 48–57. https://doi.org/10.1007/s10862-022-09996-2 .

Bokor, G., & Anderson, P. D. (2014). Attention-deficit/hyperactivity disorder. Journal of Pharmacy Practice , 27 (4), 336–349. https://doi.org/10.1177/0897190014543628 .

Bos, E. H., De Jonge, P., & Cox, R. F. A. (2019). Affective variability in depression: Revisiting the inertia–instability paradox. British Journal of Psychology , 110 (4), 814–827. https://doi.org/10.1111/bjop.12372 .

Bowen, R., Baetz, M., Hawkes, J., & Bowen, A. (2006). Mood variability in anxiety disorders. Journal of Affective Disorders , 91 (2–3), 165–170. https://doi.org/10.1016/j.jad.2005.12.050 .

Boyer, B. E., Geurts, H. M., Prins, P. J. M., & Van Der Oord, S. (2015). Two novel CBTs for adolescents with ADHD: The value of planning skills. European Child & Adolescent Psychiatry , 24 (9), 1075–1090. https://doi.org/10.1007/s00787-014-0661-5 .

Braaten, E. B., & Rosén, L. A. (2000). Self-regulation of affect in attention deficit-hyperactivity disorder (ADHD) and non-ADHD boys: Differences in empathic responding. Journal of Consulting and Clinical Psychology , 68 (2), 313–321. https://doi.org/10.1037/0022-006X.68.2.313 .

Breaux, R., Dunn, N. C., Swanson, C. S., Larkin, E., Waxmonsky, J., & Baweja, R. (2022). A mini-review of pharmacological and psychosocial interventions for reducing irritability among youth with ADHD. Frontiers in Psychiatry , 13 , 794044. https://doi.org/10.3389/fpsyt.2022.794044 .

Article PubMed PubMed Central Google Scholar

Breaux, R., Langberg, J. M., Swanson, C. S., Eadeh, H.-M., & Becker, S. P. (2020). Variability in positive and negative affect among adolescents with and without ADHD: Differential associations with functional outcomes. Journal of Affective Disorders , 274 , 500–507. https://doi.org/10.1016/j.jad.2020.05.027 .

Breaux, R. P., Langberg, J. M., Bourchtein, E., Eadeh, H.-M., Molitor, S. J., & Smith, Z. R. (2019). Brief homework intervention for adolescents with ADHD: Trajectories and predictors of response. School Psychology , 34 (2), 201–211. https://doi.org/10.1037/spq0000287 .

Bunford, N., Evans, S. W., & Wymbs, F. (2015). ADHD and emotion dysregulation among children and adolescents. Clinical Child and Family Psychology Review , 18 (3), 185–217. https://doi.org/10.1007/s10567-015-0187-5 .

Classi, P., Milton, D., Ward, S., Sarsour, K., & Johnston, J. (2012). Social and emotional difficulties in children with ADHD and the impact on school attendance and healthcare utilization. Child and Adolescent Psychiatry and Mental Health , 6 (1), 33. https://doi.org/10.1186/1753-2000-6-33 .

Coghill, D., Soutullo, C., d’Aubuisson, C., Preuss, U., Lindback, T., Silverberg, M., & Buitelaar, J. (2008). Impact of attention-deficit/hyperactivity disorder on the patient and family: Results from a European survey. Child and Adolescent Psychiatry and Mental Health , 2 (1), 31. https://doi.org/10.1186/1753-2000-2-31 .

Coker, T. R., Elliott, M. N., Toomey, S. L., Schwebel, D. C., Cuccaro, P., Tortolero Emery, S., Davies, S. L., Visser, S. N., & Schuster, M. A. (2016). Racial and ethnic disparities in ADHD diagnosis and treatment. PEDIATRICS , 138 (3), e20160407. https://doi.org/10.1542/peds.2016-0407 .

Cooper, H. M. (2007). The battle over homework: Common ground for administrators, teachers, and parents (3rd ed) . Corwin Press.

Cooper, H., Robinson, J. C., & Patall, E. A. (2006). Does homework improve academic achievement? A synthesis of research, 1987–2003. Review of Educational Research , 76 (1), 1–62. https://doi.org/10.3102/00346543076001001 .

Cordova, M. M., Antovich, D. M., Ryabinin, P., Neighbor, C., Mooney, M. A., Dieckmann, N. F., Miranda-Dominguez, O., Nagel, B. J., Fair, D. A., & Nigg, J. T. (2022). Attention-deficit/hyperactivity disorder: Restricted phenotypes prevalence, comorbidity, and polygenic risk sensitivity in the ABCD baseline cohort. Journal of the American Academy of Child & Adolescent Psychiatry , 61 (10), 1273–1284. https://doi.org/10.1016/j.jaac.2022.03.030 .

De Vries, M., Van Der Oord, S., Evans, S. W., DuPaul, G. J., & Boyer, B. E. (2023). The homework problems checklist: Psychometric properties and usefulness in teens with and without ADHD. School Mental Health , 15 (1), 260–271. https://doi.org/10.1007/s12310-022-09548-9 .

Defoe, I. N., Farrington, D. P., & Loeber, R. (2013). Disentangling the relationship between delinquency and hyperactivity, low achievement, depression, and low socioeconomic status: Analysis of repeated longitudinal data. Journal of Criminal Justice , 41 (2), 100–107. https://doi.org/10.1016/j.jcrimjus.2012.12.002 .

DeVries, L. N., Hartung, C. M., & Golden, T. L. (2017). Negative halo effects in parent ratings of ADHD and ODD. Journal of Psychopathology and Behavioral Assessment , 39 (2), 179–188. https://doi.org/10.1007/s10862-016-9560-z .

DuPaul, G. J., Evans, S. W., Owens, J. S., Cleminshaw, C. L., Kipperman, K., Fu, Q., & Benson, K. (2021). School-based intervention for adolescents with attention-deficit/hyperactivity disorder: Effects on academic functioning. Journal of School Psychology , 87 , 48–63. https://doi.org/10.1016/j.jsp.2021.07.001 .

Ebner-Priemer, U. W., Eid, M., Kleindienst, N., Stabenow, S., & Trull, T. J. (2009). Analytic strategies for understanding affective (in)stability and other dynamic processes in psychopathology. Journal of Abnormal Psychology , 118 (1), 195–202. https://doi.org/10.1037/a0014868 .

Ebner-Priemer, U. W., & Trull, T. J. (2009). Ecological momentary assessment of mood disorders and mood dysregulation. Psychological Assessment , 21 (4), 463–475. https://doi.org/10.1037/a0017075 .

Epstein, M. H., Polloway, E. A., Foley, R. M., & Patton, J. R. (1993). Homework: A comparison of teachers’ and parents’ perceptions of the problems experienced by students identified as having behavioral disorders, learning disabilities, or mo disabilities. Remedial and Special Education , 14 (5), 40–50. https://doi.org/10.1177/074193259301400507 .

Factor, P. I., Reyes, R. A., & Rosen, P. J. (2014). Emotional impulsivity in children with ADHD associated with comorbid—not ADHD—symptomatology. Journal of Psychopathology and Behavioral Assessment , 36 (4), 530–541. https://doi.org/10.1007/s10862-014-9428-z .

Faraone, S. V., Rostain, A. L., Blader, J., Busch, B., Childress, A. C., Connor, D. F., & Newcorn, J. H. (2019). Practitioner review: Emotional dysregulation in attention-deficit/hyperactivity disorder - implications for clinical recognition and intervention. Journal of Child Psychology and Psychiatry , 60 (2), 133–150. https://doi.org/10.1111/jcpp.12899 .

Flynn, M. M., Rosen, P. J., Reese, J. S., Slaughter, K. E., Alacha, H. F., & Olczyk, A. R. (2023). Examining the influence of irritability and ADHD on domains of parenting stress. European Child & Adolescent Psychiatry , 32 (2), 353–366. https://doi.org/10.1007/s00787-021-01868-6 .

Frazier, T. W., Youngstrom, E. A., Glutting, J. J., & Watkins, M. W. (2007). ADHD and achievement: Meta-analysis of the child, adolescent, and adult literatures and a concomitant study with college students. Journal of Learning Disabilities , 40 (1), 49–65. https://doi.org/10.1177/00222194070400010401 .

Garcia, A. M., Medina, D., & Sibley, M. H. (2019). Conflict between parents and adolescents with ADHD: Situational triggers and the role of comorbidity. Journal of Child and Family Studies , 28 (12), 3338–3345. https://doi.org/10.1007/s10826-019-01512-7 .

Gavin, B., Holme, I., Minihan, E., O’Reilly, G., & McNicholas, F. (2023). Understanding the “battleground” of homework and ADHD: A qualitative study of parents’ perspectives and experiences. Social Sciences & Humanities Open , 8 (1), 100587. https://doi.org/10.1016/j.ssaho.2023.100587 .

Gisbert, L., Richarte, V., Corrales, M., Ibáñez, P., Bosch, R., Casas, M., & Ramos-Quiroga, J. A. (2018). The impact of emotional lability symptoms during childhood in adults with ADHD. Journal of Attention Disorders , 22 (6), 581–590. https://doi.org/10.1177/1087054717719534 .

Goh, P. K., Lee, C. A., Martel, M. M., Karalunas, S. L., & Nigg, J. T. (2020). Subgroups of childhood ADHD based on temperament traits and cognition: concurrent and predictive validity. Journal of Abnormal Child Psychology , 48 (10), 1251–1264. https://doi.org/10.1007/s10802-020-00668-x .

Graziano, P. A., & Garcia, A. (2016). Attention-deficit hyperactivity disorder and children’s emotion dysregulation: A meta-analysis. Clinical Psychology Review , 46 , 106–123. https://doi.org/10.1016/j.cpr.2016.04.011 .

Groves, N. B., Wells, E. L., Soto, E. F., Marsh, C. L., Jaisle, E. M., Harvey, T. K., & Kofler, M. J. (2022). Executive functioning and emotion regulation in children with and without ADHD. Research on Child and Adolescent Psychopathology , 50 (6), 721–735. https://doi.org/10.1007/s10802-021-00883-0 .

Gumora, G., & Arsenio, W. F. (2002). Emotionality, emotion regulation, and school performance in middle school children. Journal of School Psychology , 40 (5), 395–413. https://doi.org/10.1016/S0022-4405(02)00108-5 .

Gureasko-Moore, S., DuPaul, G. J., & White, G. P. (2007). Self-management of classroom preparedness and homework: Effects on school functioning of adolescents with attention deficit hyperactivity disorder. School Psychology Review , 36 (4), 647–664. https://doi.org/10.1080/02796015.2007.12087923 .

Harris, K. R., Danoff Friedlander, B., Saddler, B., Frizzelle, R., & Graham, S. (2005). Self-monitoring of attention versus self-monitoring of academic performance: effects among students with ADHD in the general education classroom. The Journal of Special Education , 39 (3), 145–157. https://doi.org/10.1177/00224669050390030201 .

Hartung, C. M., Canu, W. H., Serrano, J. W., Vasko, J. M., Stevens, A. E., Abu-Ramadan, T. M., Bodalski, E. A., Neger, E. N., Bridges, R. M., Gleason, L. L., Anzalone, C., & Flory, K. (2022). A new organizational and study skills intervention for college students with ADHD. Cognitive and Behavioral Practice , 29 (2), 411–424. https://doi.org/10.1016/j.cbpra.2020.09.005 .

Hartung, C. M., Lefler, E. K., Tempel, A. B., Armendariz, M. L., Sigel, B. A., & Little, C. S. (2010). Halo effects in ratings of ADHD and ODD: Identification of susceptible symptoms. Journal of Psychopathology and Behavioral Assessment , 32 (1), 128–137. https://doi.org/10.1007/s10862-009-9135-3 .

Jahng, S., Wood, P. K., & Trull, T. J. (2008). Analysis of affective instability in ecological momentary assessment: Indices using successive difference and group comparison via multilevel modeling. Psychological Methods , 13 (4), 354–375. https://doi.org/10.1037/a0014173 .

Jensen, S. A., & Rosén, L. A. (2004). Emotional reactivity in children with Attention-Deficit/Hyperactivity Disorder. Journal of Attention Disorders , 8 (2), 53–61. https://doi.org/10.1177/108705470400800203 .

Karalunas, S. L., Fair, D., Musser, E. D., Aykes, K., Iyer, S. P., & Nigg, J. T. (2014). Subtyping attention-deficit/hyperactivity disorder using temperament dimensions: Toward biologically based nosologic criteria. JAMA Psychiatry , 71 (9), 1015 https://doi.org/10.1001/jamapsychiatry.2014.763 .

Karalunas, S. L., Fair, D., Musser, E. D., Aykes, K., Iyer, S. P., & Nigg, J. T. (2018). Notice of retraction and replacement. Karalunas et al. Subtyping attention-deficit/hyperactivity disorder using temperament dimensions: Toward biologically based nosologic criteria. JAMA Psychiatry , 71 (9), 1015–1024. https://doi.org/10.1001/jamapsychiatry.2018.0013 .

Katz, I., Alesi, M., & Moè, A. (2022). Homework stress and learning disability: the role of parental shame, guilt, and need frustration. Learning Disabilities Research & Practice , 37 (4), 231–241. https://doi.org/10.1111/ldrp.12294 .

Kent, K. M., Pelham, W. E., Molina, B. S. G., Sibley, M. H., Waschbusch, D. A., Yu, J., Gnagy, E. M., Biswas, A., Babinski, D. E., & Karch, K. M. (2011). The academic experience of male high school students with ADHD. Journal of Abnormal Child Psychology , 39 (3), 451–462. https://doi.org/10.1007/s10802-010-9472-4 .

King, R. B., McInerney, D. M., Ganotice, F. A., & Villarosa, J. B. (2015). Positive affect catalyzes academic engagement: Cross-sectional, longitudinal, and experimental evidence. Learning and Individual Differences , 39 , 64–72. https://doi.org/10.1016/j.lindif.2015.03.005 .

Klein, R. J., Rapaport, R., Gyorda, J. A., Jacobson, N. C., & Robinson, M. D. (2023). Second-to-second affective responses to images correspond with affective reactivity, variability, and instability in daily life. Experimental Psychology , 70 (1), 14–31. https://doi.org/10.1027/1618-3169/a000564 .

Kwon, K., Kupzyk, K., & Benton, A. (2018). Negative emotionality, emotion regulation, and achievement: Cross-lagged relations and mediation of academic engagement. Learning and Individual Differences , 67 , 33–40. https://doi.org/10.1016/j.lindif.2018.07.004 .

Langberg, J. M., Arnold, L. E., Flowers, A. M., Altaye, M., Epstein, J. N., & Molina, B. S. G. (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. https://doi.org/10.1007/s12310-009-9021-x .

Langberg, J. M., Arnold, L. E., Flowers, A. M., Epstein, J. N., Altaye, M., Hinshaw, S. P., Swanson, J. M., Kotkin, R., Simpson, S., Molina, B. S. G., Jensen, P. S., Abikoff, H., Pelham, W. E., Vitiello, B., Wells, K. C., & Hechtman, L. (2010). Parent-reported homework problems in the MTA study: evidence for sustained improvement with behavioral treatment. Journal of Clinical Child & Adolescent Psychology , 39 (2), 220–233. https://doi.org/10.1080/15374410903532700 .

Langberg, J. M., Dvorsky, M. R., & Evans, S. W. (2013). What specific facets of executive function are associated with academic functioning in youth with attention-deficit/hyperactivity disorder? Journal of Abnormal Child Psychology , 41 (7), 1145–1159. https://doi.org/10.1007/s10802-013-9750-z .

Langberg, J. M., Dvorsky, M. R., Molitor, S. J., Bourchtein, E., Eddy, L. D., Smith, Z., Schultz, B. K., & Evans, S. W. (2016). Longitudinal evaluation of the importance of homework assignment completion for the academic performance of middle school students with ADHD. Journal of School Psychology , 55 , 27–38. https://doi.org/10.1016/j.jsp.2015.12.004 .

Langberg, J. M., Epstein, J. N., Becker, S. P., Girio-Herrera, E., & Vaughn, A. J. (2012). Evaluation of the Homework, Organization, and Planning Skills (HOPS) intervention for middle school students with adhd as implemented by school mental health providers. School Psychology Review , 41 (3), 342–364.

Lawrence, D., Houghton, S., Dawson, V., Sawyer, M., & Carroll, A. (2021). Trajectories of academic achievement for students with attention‐deficit/hyperactivity disorder. British Journal of Educational Psychology , 91 (2), 755–774. https://doi.org/10.1111/bjep.12392 .

Leaberry, K. D., Rosen, P. J., Fogleman, N. D., Walerius, D. M., & Slaughter, K. E. (2020). Comorbid internalizing and externalizing disorders predict lability of negative emotions among children With ADHD. Journal of Attention Disorders , 24 (14), 1989–2001. https://doi.org/10.1177/1087054717734647 .

Leaberry, K. D., Walerius, D. M., Rosen, P. J., & Fogleman, N. D. (2017). Emotional Lability. In V. Zeigler-Hill & T. K. Shackelford (Eds.), Encyclopedia of Personality and Individual Differences (pp. 1–10). Springer International Publishing. https://doi.org/10.1007/978-3-319-28099-8_510-1 .

Letkiewicz, A. M., Funkhouser, C. J., Umemoto, A., Trivedi, E., Sritharan, A., Zhang, E., Buchanan, S. N., Helgren, F., Allison, G. O., Kayser, J., Shankman, S. A., & Auerbach, R. P. (2023). Neurophysiological responses to emotional faces predict dynamic fluctuations in affect in adolescents. Psychophysiology , e14476. https://doi.org/10.1111/psyp.14476 .

Madaus, M. M. R., Kehle, T. J., Madaus, J., & Bray, M. A. (2003). Mystery motivator as an intervention to promote homework completion and accuracy. School Psychology International , 24 (4), 369–377. https://doi.org/10.1177/01430343030244001 .

Maire, J., Galéra, C., Meyer, E., Salla, J., & Michel, G. (2017). Is emotional lability a marker for attention deficit hyperactivity disorder, anxiety and aggression symptoms in preschoolers? Child and Adolescent Mental Health , 22 (2), 77–83. https://doi.org/10.1111/camh.12168 .

Mathis, E. T. B., & Bierman, K. L. (2015). Dimensions of parenting associated with child prekindergarten emotion regulation and attention control in low‐income families. Social Development , 24 (3), 601–620. https://doi.org/10.1111/sode.12112 .

Melnick, S. M., & Hinshaw, S. P. (2000). Emotion regulation and parenting in AD/HD and comparison boys: Linkages with social behaviors and peer preference. Journal of Abnormal Child Psychology , 28 (1), 73–86. https://doi.org/10.1023/A:1005174102794 .

Merrill, B. M., Morrow, A. S., Altszuler, A. R., Macphee, F. L., Gnagy, E. M., Greiner, A. R., Coles, E. K., Raiker, J. S., Coxe, S., & Pelham, W. E. (2017). Improving homework performance among children with ADHD: A randomized clinical trial. Journal of Consulting and Clinical Psychology , 85 (2), 111–122. https://doi.org/10.1037/ccp0000144 .

Miller, D. J., Vachon, D. D., & Lynam, D. R. (2009). Neuroticism, negative affect, and negative affect instability: Establishing convergent and discriminant validity using ecological momentary assessment. Personality and Individual Differences , 47 (8), 873–877. https://doi.org/10.1016/j.paid.2009.07.007 .

Mohammadi, M. R., Zarafshan, H., Khaleghi, A., Ahmadi, N., Hooshyari, Z., Mostafavi, S. A., Ahmadi, A., Alavi, S. S., Shakiba, A., & Salmanian, M. (2021). Prevalence of ADHD and its comorbidities in a population-based sample. Journal of Attention Disorders , 25 (8), 1058–1067. https://doi.org/10.1177/1087054719886372 .

Navarro, J., Curioso, F., Gomes, D., Arrieta, C., & Cortes, M. (2013). Fluctuations in work motivation: Tasks do not matter! Nonlinear Dynamics, Psychology, and Life Sciences , 17 (1), 3–22.

PubMed Google Scholar

Nigg, J. T. (2022). Parsing ADHD with temperament traits. Current Directions in Psychological Science , 31 (4), 324–332. https://doi.org/10.1177/09637214221098079 .

Nisbett, R. E., & Wilson, T. D. (1977). The halo effect: Evidence for unconscious alteration of judgments. Journal of Personality and Social Psychology , 35 (4), 250–256. https://doi.org/10.1037/0022-3514.35.4.250 .

Pfiffner, L. J., Villodas, M., Kaiser, N., Rooney, M., & McBurnett, K. (2013). Educational outcomes of a collaborative school–home behavioral intervention for ADHD. School Psychology Quarterly , 28 (1), 25–36. https://doi.org/10.1037/spq0000016 .

Phillips, L. H., Smith, L., & Gilhooly, K. J. (2002). The effects of adult aging and induced positive and negative mood on planning. Emotion , 2 (3), 263–272. https://doi.org/10.1037/1528-3542.2.3.263 .

Piot, M., Mestdagh, M., Riese, H., Weermeijer, J., Brouwer, J. M. A., Kuppens, P., Dejonckheere, E., & Bos, F. M. (2022). Practitioner and researcher perspectives on the utility of ecological momentary assessment in mental health care: A survey study. Internet Interventions , 30 , 100575. https://doi.org/10.1016/j.invent.2022.100575 .

Polderman, T. J. C., Boomsma, D. I., Bartels, M., Verhulst, F. C., & Huizink, A. C. (2010). A systematic review of prospective studies on attention problems and academic achievement. Acta Psychiatrica Scandinavica , 122 (4), 271–284. https://doi.org/10.1111/j.1600-0447.2010.01568.x .

Power, T. J., Werba, B. E., Watkins, M. W., Angelucci, J. G., & Eiraldi, R. B. (2006). Patterns of parent-reported homework problems among ADHD-referred and non-referred children. School Psychology Quarterly , 21 (1), 13–33. https://doi.org/10.1521/scpq.2006.21.1.13 .

Qian, Y., Chang, W., He, X., Yang, L., Liu, L., Ma, Q., Li, Y., Sun, L., Qian, Q., & Wang, Y. (2016). Emotional dysregulation of ADHD in childhood predicts poor early-adulthood outcomes: A prospective follow up study. Research in Developmental Disabilities , 59 , 428–436. https://doi.org/10.1016/j.ridd.2016.09.022 .

Riley, A. W., Spiel, G., Coghill, D., Döpfner, M., Falissard, B., Lorenzo, M. J., Preuss, U., & Ralston, S. J., ADORE Study Group*. (2006). Factors related to Health-Related Quality of Life (HRQoL) among children with ADHD in Europe at entry into treatment. European Child & Adolescent Psychiatry , 15 (S1), i38–i45. https://doi.org/10.1007/s00787-006-1006-9 .

Rosen, P. J., Epstein, J. N., & Van Orden, G. (2013). I know it when I quantify it: Ecological momentary assessment and recurrence quantification analysis of emotion dysregulation in children with ADHD. ADHD Attention Deficit and Hyperactivity Disorders , 5 (3), 283–294. https://doi.org/10.1007/s12402-013-0101-2 .

Rosen, P. J., & Factor, P. I. (2015). Emotional impulsivity and emotional and behavioral difficulties among children With ADHD: An ecological momentary assessment study. Journal of Attention Disorders , 19 (9), 779–793. https://doi.org/10.1177/1087054712463064 .

Rosen, P. J., Walerius, D. M., Fogleman, N. D., & Factor, P. I. (2015). The association of emotional lability and emotional and behavioral difficulties among children with and without ADHD. ADHD Attention Deficit and Hyperactivity Disorders , 7 (4), 281–294. https://doi.org/10.1007/s12402-015-0175-0 .

Shaffer, D., Fisher, P., Lucas, C. P., Dulcan, M. K., & Schwab-Stone, M. E. (2000). NIMH diagnostic interview schedule for children Version IV (NIMH DISC-IV): Description, differences from previous versions, and reliability of some common diagnoses. Journal of the American Academy of Child & Adolescent Psychiatry , 39 (1), 28–38. https://doi.org/10.1097/00004583-200001000-00014 .

Shaw, P., Stringaris, A., Nigg, J., & Leibenluft, E. (2014). Emotion dysregulation in attention deficit hyperactivity disorder. American Journal of Psychiatry , 171 (3), 276–293. https://doi.org/10.1176/appi.ajp.2013.13070966 .

Shea, T., & Fisher, B. E. (1996). Self ratings of mood levels and mood variability as predictors of Junior I-6 impulsivity and ADHD classroom behaviors. Personality and Individual Differences , 20 (2), 209–214. https://doi.org/10.1016/0191-8869(95)00164-6 .

Sibley, M. H., Graziano, P. A., Ortiz, M., Rodriguez, L., & Coxe, S. (2019). Academic impairment among high school students with ADHD: The role of motivation and goal-directed executive functions. Journal of School Psychology , 77 , 67–76. https://doi.org/10.1016/j.jsp.2019.10.005 .

Singh, L. J., Gaye, F., Cole, A. M., Chan, E. S. M., & Kofler, M. J. (2022). Central executive training for ADHD: Effects on academic achievement, productivity, and success in the classroom. Neuropsychology , 36 (4), 330–345. https://doi.org/10.1037/neu0000798 .

Slaughter, K. E., Leaberry, K. D., Fogleman, N. D., & Rosen, P. J. (2020). Reactive and proactive aggression in children with and without ADHD and negative emotional lability. Social Development , 29 (1), 320–338. https://doi.org/10.1111/sode.12402 .

Sobanski, E., Banaschewski, T., Asherson, P., Buitelaar, J., Chen, W., Franke, B., Holtmann, M., Krumm, B., Sergeant, J., Sonuga-Barke, E., Stringaris, A., Taylor, E., Anney, R., Ebstein, R. P., Gill, M., Miranda, A., Mulas, F., Oades, R. D., Roeyers, H., & Faraone, S. V. (2010). Emotional lability in children and adolescents with attention deficit/hyperactivity disorder (ADHD): Clinical correlates and familial prevalence: Emotional lability in ADHD. Journal of Child Psychology and Psychiatry , 51 (8), 915–923. https://doi.org/10.1111/j.1469-7610.2010.02217.x .

Soler-Gutiérrez, A.-M., Pérez-González, J.-C., & Mayas, J. (2023). Evidence of emotion dysregulation as a core symptom of adult ADHD: A systematic review. PLoS ONE , 18 (1), e0280131 https://doi.org/10.1371/journal.pone.0280131 .

Solhan, M. B., Trull, T. J., Jahng, S., & Wood, P. K. (2009). Clinical assessment of affective instability: Comparing EMA indices, questionnaire reports, and retrospective recall. Psychological Assessment , 21 (3), 425–436. https://doi.org/10.1037/a0016869 .

Spencer, T. J., Faraone, S. V., Surman, C. B. H., Petty, C., Clarke, A., Batchelder, H., Wozniak, J., & Biederman, J. (2011). Toward defining deficient emotional self-regulation in children with attention-deficit/hyperactivity disorder using the child behavior checklist: A controlled study. Postgraduate Medicine , 123 (5), 50–59. https://doi.org/10.3810/pgm.2011.09.2459 .

Speyer, L. G., Brown, R. H., Ribeaud, D., Eisner, M., & Murray, A. L. (2023). The role of moment-to-moment dynamics of perceived stress and negative affect in co-occurring ADHD and internalising symptoms. Journal of Autism and Developmental Disorders , 53 (3), 1213–1223. https://doi.org/10.1007/s10803-022-05624-w .

Spindler, G., Stopsack, M., Aldinger, M., Grabe, H. J., & Barnow, S. (2016). What about the “ups and downs” in our daily life? The influence of affective instability on mental health. Motivation and Emotion , 40 (1), 148–161. https://doi.org/10.1007/s11031-015-9509-7 .

Steger, M. F., & Kashdan, T. B. (2013). The unbearable lightness of meaning: Well-being and unstable meaning in life. The Journal of Positive Psychology , 8 (2), 103–115. https://doi.org/10.1080/17439760.2013.771208 .

Steinberg, E. A., & Drabick, D. A. G. (2015). A developmental psychopathology perspective on ADHD and comorbid conditions: The role of emotion regulation. Child Psychiatry & Human Development , 46 (6), 951–966. https://doi.org/10.1007/s10578-015-0534-2 .

Stone, A. A., & Shiffman, S. (1994). Ecological Momentary Assessment (Ema) in behavioral medicine. Annals of Behavioral Medicine , 16 (3), 199–202. https://doi.org/10.1093/abm/16.3.199 .

Theodore, L. A., DioGuardi, R. J., Hughes, T. L., Aloiso, D., Carlo, M., & Eccles, D. (2009). A class-wide intervention for improving homework performance. Journal of Educational and Psychological Consultation , 19 (4), 275–299. https://doi.org/10.1080/10474410902888657 .

Thompson, R. J., Mata, J., Jaeggi, S. M., Buschkuehl, M., Jonides, J., & Gotlib, I. H. (2012). The everyday emotional experience of adults with major depressive disorder: Examining emotional instability, inertia, and reactivity. Journal of Abnormal Psychology , 121 (4), 819–829. https://doi.org/10.1037/a0027978 .

Thorell, L. B., Sjöwall, D., Diamatopoulou, S., Rydell, A.-M., & Bohlin, G. (2017). Emotional functioning, ADHD symptoms, and peer problems: A longitudinal investigation of children age 6–9.5 years: Emotional functioning, ADHD symptoms and peer problems. Infant and Child Development , 26 (4), e2008. https://doi.org/10.1002/icd.2008 .

Valle, A., Regueiro, B., Núñez, J. C., Rodríguez, S., Piñeiro, I., & Rosário, P. (2016). Academic goals, student homework engagement, and academic achievement in elementary school. Frontiers in Psychology , 7 . https://doi.org/10.3389/fpsyg.2016.00463 .

Van Der Oord, S., & Tripp, G. (2020). How to improve behavioral parent and teacher training for children with ADHD: integrating empirical research on learning and motivation into treatment. Clinical Child and Family Psychology Review , 23 (4), 577–604. https://doi.org/10.1007/s10567-020-00327-z .

Visser, L., Linkersdörfer, J., & Hasselhorn, M. (2020). The role of ADHD symptoms in the relationship between academic achievement and psychopathological symptoms. Research in Developmental Disabilities , 97 , 103552. https://doi.org/10.1016/j.ridd.2019.103552 .

Vohs, K. D. & Baumeister, R. F. (Eds.) (2011). Handbook of self-regulation: Research, theory, and applications (2nd ed) . (Guilford Press.

Wåhlstedt, C., Thorell, L. B., & Bohlin, G. (2009). Heterogeneity in ADHD: neuropsychological pathways, comorbidity and symptom domains. Journal of Abnormal Child Psychology , 37 (4), 551–564. https://doi.org/10.1007/s10802-008-9286-9 .

Walcott, C. M., & Landau, S. (2004). The relation between disinhibition and emotion regulation in boys with attention deficit hyperactivity disorder. Journal of Clinical Child & Adolescent Psychology , 33 (4), 772–782. https://doi.org/10.1207/s15374424jccp3304_12 .

Walerius, D. M., Fogleman, N. D., & Rosen, P. J. (2016). The role of ADHD and negative emotional lability in predicting changes in parenting daily hassles. Journal of Child and Family Studies , 25 (7), 2279–2291. https://doi.org/10.1007/s10826-016-0381-1 .

Walerius, D. M., Reyes, R. A., Rosen, P. J., & Factor, P. I. (2018). Functional impairment variability in children With ADHD due to emotional impulsivity. Journal of Attention Disorders , 22 (8), 724–737. https://doi.org/10.1177/1087054714561859 .

Wehmeier, P. M., Schacht, A., & Barkley, R. A. (2010). Social and emotional impairment in children and adolescents with ADHD and the impact on quality of life. Journal of Adolescent Health , 46 (3), 209–217. https://doi.org/10.1016/j.jadohealth.2009.09.009 .

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-analytic review. Biological Psychiatry , 57 (11), 1336–1346. https://doi.org/10.1016/j.biopsych.2005.02.006 .

Witte, T., Fitzpatrick, K., Joinerjr, T., & Schmidt, N. (2005). Variability in suicidal ideation: A better predictor of suicide attempts than intensity or duration of ideation? Journal of Affective Disorders , 88 (2), 131–136. https://doi.org/10.1016/j.jad.2005.05.019 .

Witte, T. K., Fitzpatrick, K. K., Warren, K. L., Schatschneider, C., & Schmidt, N. B. (2006). Naturalistic evaluation of suicidal ideation: Variability and relation to attempt status. Behaviour Research and Therapy , 44 (7), 1029–1040. https://doi.org/10.1016/j.brat.2005.08.004 .

Wolraich, M. L., Lambert, E. W., Bickman, L., Simmons, T., Doffing, M. A., & Worley, K. A. (2004). Assessing the impact of parent and teacher agreement on diagnosing attention-deficit hyperactivity disorder. Journal of Developmental & Behavioral Pediatrics , 25 (1), 41–47. https://doi.org/10.1097/00004703-200402000-00007 .

Wu, D., Li, H., Zhu, S., Yang, H. H., Bai, J., Zhao, J., & Yang, K. (2023). Primary students’ online homework completion and learning achievement. Interactive Learning Environments , 1–15. https://doi.org/10.1080/10494820.2023.2201343 .

Xu, J., & Wu, H. (2013). Self-regulation of homework behavior: homework management at the secondary school level. The Journal of Educational Research , 106 (1), 1–13. https://doi.org/10.1080/00220671.2012.658457 .

Zendarski, N., Galligan, R., Coghill, D., Payne, J. M., De Luca, C. R., & Mulraney, M. (2023). The associations between child irritability, parental distress, parental irritability and family functioning in children accessing mental health services. Journal of Child and Family Studies , 32 (1), 288–300. https://doi.org/10.1007/s10826-022-02390-2 .

Zentall, S. S., Harper, G. W., & Stormont-Spurgin, M. (1993). Children with hyperactivity and their organizational abilities. The Journal of Educational Research , 87 (2), 112–117. https://doi.org/10.1080/00220671.1993.9941174 .

Zgodic, A., McLain, A. C., Eberth, J. M., Federico, A., Bradshaw, J., & Flory, K. (2023). County-level prevalence estimates of ADHD in children in the United States. Annals of Epidemiology , 79 , 56–64. https://doi.org/10.1016/j.annepidem.2023.01.006 .

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Alacha, H.F., Rosen, P.J. & Bufferd, S.J. Positive Affect Variability is Associated with Homework Management Difficulties in Children with ADHD. J Child Fam Stud (2024). https://doi.org/10.1007/s10826-024-02852-9

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Published: 23 May 2024

Effectiveness of school oral health programs in children and adolescents: an umbrella review

Upendra Singh Bhadauria 1 ,
Harsh Priya 2 ,
Bharathi Purohit 1 &
Ankur Singh 3

Evidence-Based Dentistry ( 2024 ) Cite this article

Metrics details

To evaluate the systematic reviews assessing the effectiveness of any type of school-based oral health programs in children and adolescents.

Methodology

A two-staged search strategy comprising electronic databases and registries based on systematic reviews was employed to evaluate the effectiveness of school-based interventions. The quality assessment of the systematic reviews was carried out using the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2) tool. The Corrected Covered Area was used to evaluate the degree of overlap.

Nine reviews were included in this umbrella review. The Critical Covered Area reported moderate overlap (5.70%) among the primary studies. The assessment of risk of bias revealed one study with a high level confidence; one with moderate whereas all other studies with critically low confidence. Inconclusive evidence related to improvements in dental caries and gingival status was reported whereas, plaque status improved in a major proportion of the reviews. Knowledge, attitude, and behavior significantly increased in students receiving educational interventions when compared to those receiving usual care.

Conclusions

The evidence points to the positive impact of these interventions in behavioral changes and clinical outcomes only on a short term basis. There is a need for long-term follow-up studies to substantiate the outcomes of these interventions.

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School dental screening programmes for oral health: Cochrane systematic review

How can children be involved in developing oral health education interventions?

Could behavioural intervention improve oral hygiene in adolescents?

Data availability.

The data are available from the corresponding author on reasonable request.

Oral Health in America: Advances and Challenges [Internet]. Bethesda (MD): National Institute of Dental and Craniofacial Research (US); 2021 Dec. Section 1, Effect of Oral Health on the Community, Overall Well-Being, and the Economy. Available from: https://www.ncbi.nlm.nih.gov/books/NBK578297/ .

Dadipoor S, Ghaffari M, Alipour A, Safari-Moradabadi A. Effects of educational interventions on oral hygiene: a systematic review and meta-analysis. Research Square; 2019. https://doi.org/10.21203/rs.2.15898/v1 .

Stein C, Santos NML, Hilgert JB, Hugo FN. Effectiveness of oral health education on oral hygiene and dental caries in schoolchildren: systematic review and meta-analysis. Community Dent Oral Epidemiol. 2018;46:30–7. https://doi.org/10.1111/cdoe.12325 .

Article PubMed Google Scholar

Bramantoro T, Santoso CMA, Hariyani N, Setyowati D, Zulfiana AA, Nor NAM, Nagy A, et al. Effectiveness of the school-based oral health promotion programmes from preschool to high school: a systematic review. PLoS One. 2021;16:e0256007. https://doi.org/10.1371/journal.pone.0256007 .

Article CAS PubMed PubMed Central Google Scholar

Hakojärvi HR, Selänne L, Salanterä S. Child involvement in oral health education interventions - a systematic review of randomised controlled studies. Community Dent Health. 2019;36:286–92.

PubMed Google Scholar

Gurav KM, Shetty V, Vinay V, Bhor K, Jain C, Divekar P. Effectiveness of oral health educational methods among school children aged 5-16 years in improving their oral health status: a meta-analysis. Int J Clin Pediatr Dent. 2022;15:338–49.

Article PubMed PubMed Central Google Scholar

Geetha Priya PR, Asokan S, Janani RG, Kandaswamy D. Effectiveness of school dental health education on the oral health status and knowledge of children: a systematic review. Indian J Dent Res. 2019;30:437–49.

Article CAS PubMed Google Scholar

Akera P, Kennedy SE, Lingam R, Obwolo MJ, Schutte AE, Richmond R. Effectiveness of primary school-based interventions in improving oral health of children in low- and middle-income countries: a systematic review and meta-analysis. BMC Oral Health. 2022;22:264.

Prabhu S, John J. Oral Health Education for improving oral health status of school children – a systematic review. IOSR-JDMS. 2015;14:101–6.

Google Scholar

Pollock M, Fernandes RM, Becker LA, Pieper D, Hartling L Chapter V: overviews of reviews. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA, eds. Cochrane handbook for systematic reviews of interventions version 6.3 (updated 2022) . editors. Cochrane; 2022. Available from. [Accessed on December 1, 2022]. www.training.cochrane.org/ .

Aromataris E, Munn Z, eds. JBI manual for evidence synthesis. Editors. JBI; 2020. https://doi.org/10.46658/JBIMES-20-01 . Available from https://synthesismanual.jbi.global .

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. https://doi.org/10.1136/bmj.n71 .

Pieper D, Antoine S-L, Mathes T, Neugebauer EAM, Eikermann M. Systematic review finds overlapping reviews were not mentioned in every other overview. J Clin Epidemiol. 2014;67:368–75.

Sardana D, Ritto FP, Ciesla D, Fagan TR. Evaluation of oral health education programs for oral health of individuals with visual impairment: an umbrella review. Spec Care Dentist. 2023;43:751–64.

Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, et al. AMSTAR2: a critical appraisal tool for systematic reviews that include randomised or nonrandomized studies of healthcare interventions, or both. BMJ. 2017;358:j4008. https://doi.org/10.1136/bmj.j4008.j4008 .

Cooper AM, O’Malley LA, Elison SN, Armstrong R, Burnside G, Adair P, et al. Primary school-based behavioural interventions for preventing caries. Cochrane Database Syst Rev. 2013;5:CD009378. https://doi.org/10.1002/14651858 .

Article CAS Google Scholar

Bhadauria US, Gupta V, Arora H. Interventions in improving the oral hygiene of visually impaired individuals: a systematic review. Health Soc Care Community. 2022;30:e1092–e1100. https://doi.org/10.1111/hsc.13517 .

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Division of Public Health Dentistry, CDER-AIIMS, New Delhi, India

Upendra Singh Bhadauria & Bharathi Purohit

Division of Public Health Dentistry, Centre for Dental Education and Research, AIIMS, New Delhi, India

Harsh Priya

Australian Research Council DECRA Senior Research Fellow, The University of Melbourne, Parkville, Victoria, Australia

Ankur Singh

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USB: Concept, design, drafting of manuscript, BP: Data assembly, revising of article, HP: Data assembly, AS: Critical revision of the article.

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Correspondence to Harsh Priya .

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Bhadauria, U.S., Priya, H., Purohit, B. et al. Effectiveness of school oral health programs in children and adolescents: an umbrella review. Evid Based Dent (2024). https://doi.org/10.1038/s41432-024-01013-7

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Published : 23 May 2024

DOI : https://doi.org/10.1038/s41432-024-01013-7

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Russia Denies U.S. Charge That It Put Anti-Satellite Weapon in Space

FILE PHOTO: Russian Deputy Foreign Minister Sergei Ryabkov attends a meeting chaired by Russian President Vladimir Putin on operational issues, including the course of Russia-Ukraine conflict and the continuing conflict between Israel and Hamas, at the Novo-Ogaryovo state residence outside Moscow, Russia October 16, 2023. Sputnik/Gavriil Grigorov/Pool via REUTERS

By Guy Faulconbridge

MOSCOW (Reuters) -Russia's top arms control diplomat dismissed as "fake news" on Wednesday an assertion by the United States that Russia had launched a weapon into low-Earth orbit that was capable of inspecting and attacking other satellites.

The Kremlin has flatly denied assertions by U.S. officials that Moscow is developing a space-based anti-satellite nuclear weapon.

U.S. Space Command on Tuesday pointed to the launch earlier this month of a Soyuz rocket from Russia's Plesetsk launch site, saying it likely involved "a counterspace weapon presumably capable of attacking other satellites in low Earth orbit".

Russia's defence ministry said the May 17 launch had a spacecraft on board but gave no details what it was for.

"I don't think we should respond to any fake news from Washington," Russian Deputy Foreign Minister Sergei Ryabkov was quoted as saying by the Interfax news agency.

"The Americans can say whatever they want but our policy does not change from this," said Ryabkov, adding that Moscow had "always consistently opposed the deployment of strike weapons in low-Earth orbit".

President Vladimir Putin and then-defence minister Sergei Shoigu denied U.S. assertions in February that Russia was developing a space-based anti-satellite nuclear weapon designed to disrupt everything from military communications to phone-based ride services.

U.S. Space Command said the May launch, which it dates as May 16, included COSMOS 2576, a type of Russian military "inspector" spacecraft that U.S. officials have long said exhibits reckless space behaviour.

INTERNATIONAL LAW

Kremlin spokesman Dmitry Peskov declined specific comment on the U.S. assertion but said Russia acted in full accordance with international law.

"We are not violating anything. We have repeatedly advocated a ban on the deployment of any weapons into space. Unfortunately, our initiatives were rejected, including by the United States," Peskov told reporters.

U.S. intelligence agencies had been expecting the launch of COSMOS 2576 and informed allies of their assessment of the satellite before its deployment in space, according to a U.S. official familiar with the intelligence. The launch also included civilian satellites deployed to different orbits.

COSMOS 2576, as of Tuesday, has not gone near a U.S. satellite, but space analysts observed it to be in the same orbital ring as USA 314, a bus-sized NRO satellite launched in April 2021.

Ryabkov said Russia's space programme was developing as planned, including tasks aimed at strengthening defence capability but added that "this is also not news".

He said the United States was wrong to have dismissed Russian proposals on strengthening the security of space activities, including a proposal on developing a treaty on preventing an arms race in space.

(Reporting by Reuters; Writing by Guy FaulconbridgeEditing by Andrew Osborn and Gareth Jones)

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eTable. Characteristics of the 61 Municipalities Meant to Implement a School-Based Component, Depending on Whether Its School Had Dropped Out

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Thilly N , Michel M , Simon M, et al. Effectiveness of a School- and Primary Care–Based HPV Vaccination Intervention : The PrevHPV Cluster Randomized Trial . JAMA Netw Open. 2024;7(5):e2411938. doi:10.1001/jamanetworkopen.2024.11938

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Effectiveness of a School- and Primary Care–Based HPV Vaccination Intervention : The PrevHPV Cluster Randomized Trial

1 Université de Lorraine, APEMAC, Nancy, France
2 Département Méthodologie, Promotion, Investigation, Université de Lorraine, CHRU-Nancy, Nancy, France
3 Université Paris Cité, ECEVE, UMR 1123, Inserm, Paris, France
4 Unité d’épidémiologie clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France
5 CIC-1408 Vaccinologie, CHU de Saint-Etienne, Saint-Priest-en-Jarez, France
6 Centre International de Recherche en Infectiologie, Team GIMAP, Univ Lyon, Université Jean Monnet, Université Claude Bernard Lyon 1, Inserm, U1111, Lyon, France
7 Institut Presage Chaire Prevacci, Université Jean Monnet, Saint-Priest-en-Jarez, France
8 Université Savoie Mont Blanc, Université Grenoble Alpes, LIP/PC2S, Grenoble, France
9 Department of General Practice, Université Paris Cité, Paris, France
10 Centre Régional de Coordination des Dépistages des cancers-Pays de la Loire, Angers, France
11 Department of General Practice, Jacques Lisfranc Faculty of Medicine, Université Saint-Etienne-Lyon, Saint-Etienne, France
12 Health, Systemic, Process UR 4129 Research Unit, Université Claude Bernard Lyon 1, Lyon, France
13 Emerging Disease Epidemiology Unit, Institut Pasteur, Université Paris Cité, Paris, France
14 Université de Rennes, EHESP, CNRS, Inserm, Arènes - UMR 6051, RSMS (Recherche sur les Services et Management en Santé) - U 1309, Rennes, France
15 Université de Tours, Université de Nantes, SPHERE U1246, Inserm, Tours, France
16 Inserm CIC 1415, CHRU de Tours, Tours, France

Question What is the effectiveness of a school- and primary care–based multicomponent intervention on human papillomavirus (HPV) vaccination coverage?

Findings This cluster randomized trial carried out in 91 municipalities found that free HPV vaccination on school premises was the only component that consistently and significantly increased vaccination coverage 2 months after the end of the intervention. No significant effect was found of training general practitioners and educating and motivating adolescents and their parents.

Meaning This study suggests that at-school vaccination is a useful tool to increase HPV vaccination coverage.

Importance The human papillomavirus (HPV) vaccine is safe and effective, yet vaccination coverage remains below public health objectives in many countries.

Objective To examine the effectiveness of a 3-component intervention on HPV vaccination coverage among adolescents aged 11 to 14 years 2 months after the intervention ended, each component being applied alone or in combination.

Design, Setting, and Participants A cluster randomized trial with incomplete factorial design (PrevHPV) was conducted between July 1, 2021, and April 30, 2022, in French municipalities receiving 0, 1, 2, or 3 components of the intervention. Randomization was stratified by school district and municipalities’ socioeconomic level. Analyses were carried out on 11- to 14-year-old adolescents living in all participating municipalities, regardless of what had been implemented.

Intervention The PrevHPV intervention had 3 components: (1) educating and motivating 11- to 14-year-old adolescents in middle schools, along with their parents; (2) training general practitioners (GPs) on up-to-date HPV information and motivational interviewing techniques; and (3) free HPV vaccination at school.

Main Outcomes and Measures The primary outcome was HPV vaccination coverage (≥1 dose) 2 months after the intervention ended among 11- to 14-year-old adolescents living in participating municipalities, based on the French national reimbursement database and data collected during the trial in groups randomized to implement at-school vaccination.

Results A total of 91 municipalities comprising 30 739 adolescents aged 11 to 14 years (15 876 boys and 14 863 girls) were included and analyzed. Half the municipalities were in the 2 lowest socioeconomic quintiles and access to GPs was poor in more than two-thirds of the municipalities. Thirty-eight of 61 schools (62.3%) implemented actions and 26 of 45 municipalities (57.8%) had at least 1 trained GP. The median vaccination coverage increased by 4.0 percentage points (IQR, 2.0-7.3 percentage points) to 14.2 percentage points (IQR, 9.1-17.3 percentage points) at 2 months. At-school vaccination significantly increased vaccination coverage (5.50 percentage points [95% CI, 3.13-7.88 percentage points]) while no effect was observed for adolescents’ education and motivation (−0.08 percentage points [95% CI, −2.54 to 2.39 percentage points]) and GPs’ training (−1.46 percentage points [95% CI, −3.44 to 0.53 percentage points]). Subgroup analyses found a significant interaction between at-school vaccination and access to GPs, with a higher effect when access was poor (8.62 percentage points [95% CI, 5.37-11.86 percentage points] vs 2.13 percentage points [95% CI, −1.25 to 5.50 percentage points]; P = .007 for interaction).

Conclusions and Relevance In this cluster randomized trial, within the context of the late COVID-19 pandemic period and limited school and GP participation, at-school HPV vaccination significantly increased vaccination coverage. The trial did not show a significant effect for training GPs and education and motivation, although it may be observed after more time has elapsed after the intervention.

Trial Registration ClinicalTrials.gov Identifier: NCT04945655

Human papillomavirus (HPV) infection is the most common viral sexually transmitted infection, and approximately 85% of sexually active people will get infected in their lifetime. 1 - 3 Although most HPV infections resolve spontaneously, persistent infection with high-risk HPV types can cause cancer, 1 with 690 000 new cancer cases being attributable to HPV in 2018 worldwide. 4 As a result, HPV is a major public health concern.

Most high-income countries have recommended HPV vaccination for preteens and adolescents, 5 - 8 as it is the only effective form of primary prevention against HPV infection. The vaccine is both safe and effective, 1 , 9 - 12 including at reducing the risk of invasive cervical cancer, 13 , 14 through an individual direct effect but also an indirect herd protection effect. 15 , 16

However, vaccination coverage (VC) remains lower than expected in many countries. 5 , 6 In France, where HPV vaccination has been recommended for all adolescents aged 11 to 14 years since 2021 after being initially recommended only for girls since 2007, with 2 injections and a catch-up of 3 injections up to 19 years of age, 17 full VC was 41.5% among girls aged 16 years and 8.5% among boys aged 16 years in 2022. 18

It is therefore of great importance to identify effective means of increasing HPV VC. To date, too few interventions have included a multilevel approach, despite research showing its effectiveness, or indeed have reported their effect on VC. 19

The PrevHPV research program was launched in 2018 to improve HPV acceptability and VC in France. It used the Integrated Behavior Change Model as the theoretical background. 20 First, published evidence on facilitators and barriers to the uptake of HPV vaccination, and on existing interventions to improve vaccination in general and for HPV in particular among adolescents helped identify the framework of a 3-component intervention: (1) educating and motivating adolescents in middle schools; (2) training general practitioners (GPs) on up-to-date HPV information and motivational interviewing techniques; and (3) free HPV vaccination at school. A diagnostic phase was then carried out to identify—among others—knowledge, beliefs, barriers, and preferences around HPV vaccination and the sociodemographic factors associated with each, 21 - 24 to define the exact content of each component to appropriately address vaccine hesitancy in our population. The final version of the PrevHPV multicomponent intervention was constructed with the target populations to fit to all French adolescents, regardless of their sociodemographic characteristics. It was then assessed in an experimental phase. The objective of the present study is to evaluate the effectiveness of the PrevHPV intervention on VC 2 months after the end of the intervention, each of its components being applied alone or in combination.

A pragmatic, open-label, cluster randomized trial using an incomplete factorial design was carried out between July 1, 2021, and April 30, 2022, to evaluate the effectiveness of the PrevHPV intervention under routine conditions. It was granted approval by the French Ethics Committee Comité de Protection des Personnes–CPP Sud-Est VI. No individual consent was required for this type of research because in accordance with French law, this type of study is considered not to pose any risk to participants and as such investigators are required to make sure that participants do not oppose participation, and not that they consent. All participants (adolescents, parents, and GPs) were informed of their rights, in particular, not to participate or to oppose the collection of data concerning them. The Consolidated Standards of Reporting Trials ( CONSORT ) reporting guideline, statement, and its relevant extensions were used as a reporting guide for the present article. 26

The study protocol has been published previously and can be found in Supplement 1 . 25 In brief, the cluster was the municipality. Municipalities were eligible if (1) they were located in 1 of 14 school districts (ie, close to two-thirds of all districts), selected to ensure a diversity of geographical, demographic, and socioeconomic profiles; (2) there was only 1 middle school in the municipality; and (3) at least two-thirds of 11-to 14-year-old adolescents living in that municipality attended the middle school. A group of eligible municipalities was selected by random sampling. Only municipalities whose middle school agreed to participate were included in the study and randomized. At the individual level, all GPs practicing in participating municipalities were eligible unless they practiced alternative medicine (eg, homeopathy or acupuncture) exclusively, planned to stop their professional activity in the municipality before the end of 2021, or had no internet access. Adolescents were eligible to be vaccinated at school if they had never been vaccinated against HPV, were 11 years of age or older, had no contraindication, and if their parents had given written consent for them to be vaccinated.

The factorial design allows for the evaluation of multiple factors simultaneously—here, the different components of the intervention, explored alone and in combination. Under a full factorial design, all possible combinations of the components are assessed; however, our design was incomplete because at-school vaccination was never carried out without prior education and motivation of adolescents to allow for an informed decision, as there is suboptimal knowledge in France about HPV and its vaccine. 27

Municipalities were randomized all at once into 1 of 6 groups ( Figure ), using block randomization (block size = 6) stratified by school district and municipalities’ socioeconomic level—assessed by a French ecological index, the French Deprivation Index (FDep). 28 Randomization was computer generated with SAS software, version 9.4 (SAS Institute Inc), by a senior researcher of the PrevHPV Study Group (N.T.) not involved in the selection process of the municipalities.

The PrevHPV intervention was composed of 3 components. Details about its development and content have been published previously. 29

Component 1 (adolescents’ education and motivation) was carried out in middle schools. Parents were first invited by the school to a webconference to receive information on HPV infection and vaccination (from December 2021 to January 2022). Pupils in grades 8 and 9 (13-14 years of age) then attended 2 educational group sessions on those topics during school hours (from January to March 2022). Each session used participatory learning and e-health tools (videos, serious game) developed by the PrevHPV program.

Component 2 (GPs’ training) offered individual e-learning training to eligible GPs on a voluntary basis (available from January to April 2022). It included up-to-date information on HPV infection and vaccination, an introduction to motivational interviewing techniques, and a decision aid tool developed by the PrevHPV program, provided to GPs in attendance. Its goal was to help hesitant parents and adolescents come to a shared decision regarding HPV vaccination.

Component 3 (HPV vaccination at school) consisted in offering free vaccination on school premises on specific days (from March to April 2022 [ie, after the educational group sessions had been completed]). Vaccines were administered by health professionals from local vaccination centers to eligible adolescents.

The primary outcome was HPV VC (≥1 dose) among adolescents aged 11 to 14 years who lived in participating municipalities, 2 months after the end of the intervention (June 30, 2022).

Two data sources were used. The French national reimbursement database (Système National des Données de Santé [SNDS]), which contains pseudonymized data on all health care consumption reimbursed by the statutory health insurance for more than 99% of the French population, 30 provided beneficiaries’ postcode of residence (ie, their municipality) and information on vaccines delivered in community pharmacies for vaccinations prescribed by GPs and other authorized health care professionals, as well as the age and sex of beneficiaries.

Data collected during the trial provided information on the number of adolescents vaccinated at school (not recorded in the SNDS database) in the groups randomized to implement this component, along with the child’s age, sex, and municipality of residence. The total number of vaccinated adolescents was obtained by summing vaccines recorded in each data source.

The sample size calculation assumed a mean number of pupils per middle school of 466, with a coefficient of variation of 0.5 (based on data from the National Education Ministry). It was performed in 2019, when HPV VC (≥1 dose) among French adolescents in the age group of 11 to 14 years was estimated at 8% (due to boys having a 0% VC at the time). A 10–percentage point increase in VC between 2 groups was expected, whatever the intervention component. Considering an intraclass correlation of 0.05, a sample of 15 municipalities per group (ie, 90 municipalities in total) was needed to achieve a 90% power considering a 5% α risk. The calculation was carried out using the Shiny app calculator. 31

The analysis was carried out on all municipalities included in the trial, regardless of what was implemented. A descriptive analysis of their characteristics was first carried out by group using numbers and percentages for categorical variables and median (IQR) values for continuous variables. Vaccination coverage was described at baseline (June 30, 2021) and 2 months after the end of the intervention (June 30, 2022), along with its evolution in percentage points. The effectiveness of each component was assessed using a cluster-level analysis in which each cluster was weighted by its size (number of adolescents aged 11-14 years living in the municipality according to the SNDS database). Analysis units were therefore independent, which led us to fit a linear model including 3 fixed effects (1 per component), adjusted on baseline HPV VC (derived from the SNDS database) and their associated 2-level and 3-level interactions terms. A likelihood ratio test was used to compare this model and the embedded model without any interaction term. A nonsignificant likelihood ratio test was considered as an argument to discard all interaction terms from subsequent analyses.

A priori–specified subgroup analyses were carried out based on (1) sex, because the recommendation to vaccinate boys against HPV was still recent, and (2) municipalities’ socioeconomic level, because socioeconomic disparities have been evidenced in HPV VC in France, 32 and prevention programs may affect social inequalities in health. 33 For sex, because it is an individual-level variable, we reran the main analysis considering 2 distinct outcomes (ie, 1 outcome for each sex). For socioeconomic level—a cluster-level variable—municipalities were split into 2 groups: the 2 lowest quintiles based on the FDep’s national distribution (quintiles 4 and 5) vs the other 3 quintiles. Vaccination coverage was first calculated regardless of the intervention group, to evidence eventual social inequalities in our sample. A 2-sided Wilcoxon-Mann-Whitney test compared VC in the 2 groups, before and after the intervention. Then, the subgroup analysis was conducted by fitting a linear model considering the dichotomized FDep variable as a fixed effect and 3 interaction terms, one for each component of the intervention. We also refitted the linear model used for the main analysis after adding the continuous FDep variable as an adjustment variable.

Finally, an a posteriori subgroup analysis was performed based on access to GPs in the municipality using the local potential accessibility indicator, 34 because the effectiveness of the intervention may affect or be affected by territorial inequalities in access to care. 32 We used the same strategy as for the FDep, except the lowest quintiles corresponded to quintiles 1 and 2. All analyses were performed using SAS, version 9.4 (SAS Institute Inc). P < .05 was considered statistically significant.

Ninety-one municipalities were included and randomized all at once into 6 groups ( Figure ), comprising 30 739 adolescents aged 11 to 14 years (15 876 boys and 14 863 girls). The median number of 11- to 14-year-old adolescents living in those municipalities ranged from 180 (IQR, 68-571) to 306 (IQR, 192-390), reflecting chance imbalance ( Table 1 ). Approximately half the municipalities belonged to the 2 lowest socioeconomic quintiles of French municipalities, and access to GPs was poor in more than two-thirds of the municipalities. Most middle schools were public, and their median number of pupils ranged from 370 (IQR, 303-602) to 506 (IQR, 248-600) ( Table 1 ).

Between 25.0% (4 of 16) and 53.3% (8 of 15) of schools randomized to a school-based component dropped out of the study, while overall 62.3% of schools (38 of 61) implemented at least part of a component ( Figure ). The characteristics of municipalities whose school did and did not drop out were similar (eTable in Supplement 2 ). Among schools that implemented the intervention at least in part, all but 1 invited parents to the webconference, and the mean (SD) proportion of educational sessions carried out was between 89.1% (21.2%) and 99.2% (2.1%) ( Figure ). Most schools invited students in all eligible grades to be vaccinated, apart from 2 that invited only students from grades 8 and 9. In groups randomized to GPs’ training, 57.8% of municipalities (26 of 45) had at least 1 GP trained. The mean (SD) proportion of trained GPs was between 19.8% (31.0%) and 30.7% (33.7%).

At baseline, the median VC was 13.6% (IQR, 10.2%-17.2%) among 11- to 14-year-old adolescents living in participating municipalities. The median VC varied between groups from 8.9% (IQR, 6.7%-14.5%) to 15.0% (IQR, 10.7%-19.4%) ( Table 2 ).

Two months after the end of the intervention, the median VC increased in all groups, from 4.0 percentage points (IQR, 2.0-7.3 percentage points) to 14.2 percentage points (IQR, 9.1-17.3 percentage points). The increase was highest in the 2 groups with at-school vaccination (8.1 percentage points [IQR, 2.7-20.3 percentage points] and 14.2 percentage points [IQR, 9.1-17.3 percentage points] compared with baseline), while in the control group, the median VC increased from 13.8% (IQR, 10.9%-17.2%) to 17.8% (IQR, 14.0%-24.1%) ( Table 2 ).

At-school vaccination was shown to significantly increase VC in the regression model (5.50 percentage points [95% CI, 3.13-7.88 percentage points]) ( Table 3 ). We did not observe any significant effect for adolescents’ education and motivation (−0.08 percentage points [95% CI, −2.54 to 2.39 percentage points]) and GPs’ training (−1.46 percentage points [95% CI, −3.44 to 0.53 percentage points]). The likelihood ratio test that globally assessed the significance of the interaction terms was not significant ( P = .44).

At baseline, the median VC varied between 16.0% (IQR, 11.8%-24.7%) and 27.3% (IQR, 16.4%-31.7%) among girls and between 1.8% (IQR, 0%-4.7%) and 5.2% (IQR, 1.9%-7.7%) among boys ( Table 2 ). The increase in the median VC at 2 months was higher among boys in all groups, especially in the 2 groups with at-school vaccination. In the control group, the median VC increased from 3.4% (IQR, 2.2%-5.9%) to 7.2% (IQR, 5.5%-13.8%) among boys and from 27.3% (IQR, 16.4%-31.7%) to 29.1% (IQR, 25.8%-34.6%) among girls.

In the regression model, at-school vaccination was shown to have an effectiveness of similar magnitude among both sexes after adjusting for baseline VC: 5.51 percentage points for girls (95% CI, 2.85-8.17 percentage points) and 5.74 percentage points for boys (95% CI, 2.95-8.52 percentage points) ( Table 3 ). We did not observe any significant effect for the other components.

At baseline, a lower median VC was observed in the municipalities with the lowest socioeconomic level compared with those with the highest socioeconomic level (11.5% [IQR, 8.2%-16.9%] vs 14.7% [IQR, 11.2%-19.5%]; P = .02). This difference was no longer significant at 2 months (20.1% [IQR, 11.7%-28.5%] vs 20.2% [IQR, 16.1%-28.3%]; P = .32).

The median increase in VC was highest in the municipalities with the lowest socioeconomic level in the 2 groups where at-school vaccination was implemented ( Table 2 ). In the control group, the median VC increased from 13.8% (IQR, 10.9%-16.3%) to 17.8% (IQR, 14.0%-18.5%) in the municipalities with the highest socioeconomic level and from 14.4% (IQR, 10.6%-17.4%) to 20.5% (IQR, 13.7%-26.5%) in the municipalities with the lowest socioeconomic level.

The effect of the at-school vaccination component found in the main regression model remained significant and of the same magnitude when adjusting for the socioeconomic level of the municipality (5.58 percentage points [95% CI, 3.17-7.99 percentage points]) ( Table 3 ). It was estimated at 6.12 percentage points (95% CI, 2.70-9.54 percentage points) vs 4.98 percentage points (95% CI, 1.65-8.31 percentage points) in the municipalities with the lowest socioeconomic level compared with the municipalities with the highest socioeconomic level, although this difference was not significant ( P = .64) ( Table 4 ).

Although the median baseline VC was lower in municipalities with poor access to GPs than in municipalities with most access to GPs (11.8% [IQR, 9.1%-15.4%] vs 14.6% [IQR, 10.9%-18.4%]), the difference was not significant ( P = .06). The same was observed at 2 months (18.4% [IQR, 11.9%-28.1%] vs 23.8% [IQR, 15.9%-28.5%]; P = .16).

The increase in the median VC was highest in the groups with at-school vaccination in municipalities with the least access ( Table 2 ). In the control group, the median VC increased from 12.9% (IQR, 10.7%-15.1%) to 18.0% (IQR, 16.5%-21.2%) in municipalities with the least access and decreased from 16.9% (IQR, 10.9%-17.7%) to 14.6% (IQR, 12.8%-28.1%) in municipalities with the most access.

The effect of at-school vaccination found in the main regression model was still significant when adjusting for access to GPs (5.51 percentage points [95% CI, 3.13-7.88 percentage points]) ( Table 3 ). In addition, there was a significant interaction between access to GPs and at-school vaccination, with a higher effect of the component in municipalities with the least access (8.62 percentage points [95% CI, 5.37-11.86 percentage points] vs 2.13 percentage points [95% CI, −1.25 to 5.50 percentage points]; P = .007) ( Table 4 ).

In this cluster randomized trial, of the 3 components of the PrevHPV intervention, at-school vaccination led to a significant 5.50–percentage point increase in VC among 11- to 14-year-old adolescents 2 months after the end of the intervention. Its effectiveness was not significantly different between sexes. Municipalities’ socioeconomic level did not modify the effect on VC, but there was a higher effect of at-school vaccination among adolescents living in municipalities with poor access to GPs.

Our results align with the literature. At-school vaccination has long been shown to increase VC, leading many countries, such as the UK, Spain, and Scandinavian countries, to implement it. 6 In France, local experimentations found it to be effective, 35 , 36 and the PrevHPV national trial reinforces its effectiveness and feasibility. Although the increase reported in PrevHPV may appear modest, one-third of middle schools dropped out before implementing the intervention, so its effect is likely underestimated due to it being calculated on all randomized municipalities regardless of what was truly implemented.

Regarding the effect of training GPs, the literature appears more mixed, with some studies reporting an increase in VC 37 , 38 and others not. 39 , 40 This discrepancy may be due to differences in interventions (eg, education session, integrated reminder in health records, and decision-aid tools), making it difficult to compare findings among themselves and with our own. In addition, there was limited GP participation in our study: close to half of municipalities had no GP trained, which could explain why we did not find a significant effect for this component. In addition to lack of time, GPs’ own vaccine hesitancy may have influenced their participation. 41 , 42

Similarly, we did not find that the education and motivation component for adolescents had a significant effect on VC; the literature tends to show that while informing people increases knowledge and is therefore necessary, it does not lead to significant increases in VC. 43 - 45 In both cases, there may also be a financial barrier because, while at-school vaccination was free, families of adolescents vaccinated by GPs had to pay a copayment if they had no complementary health insurance, which is more often the case among low-income households. 46

Studies have reported social inequalities in HPV vaccination, with localities with a lower socioeconomic level having lower HPV VC, 32 which is consistent with our findings at baseline. This difference was no longer significant at 2 months; however, we did not find any significant interaction between the intervention and municipalities’ socioeconomic level, which may be due to a lack of power. Population prevention strategies may also negatively affect social health inequalities, 33 as people with lower socioeconomic status may participate less in prevention programs, 47 , 48 but we did not find any evidence for this with PrevHPV.

Regarding territorial inequalities, a French study found that HPV vaccine initiation increased with the number of contacts with GPs or gynecologists, 32 and in territories with poorer access, vaccination rates were lower. We showed a significantly higher effect of at-school vaccination when access to GPs was poor, so this component may be a useful tool to mitigate territorial inequalities by providing vaccination regardless of GPs’ local availability.

To our knowledge, our study is the first to evaluate a multicomponent intervention aimed at improving HPV VC in France. It was coconstructed with its target populations and its evaluation was carried out with a high level of evidence thanks to its cluster randomized design. Its factorial design also allowed us to evaluate the effectiveness of its 3 components. Finally, all randomized municipalities were analyzed, and despite a low participation or high dropout rate, at-school vaccination was still found to significantly increase VC.

Our study has some limitations. The implementation started in July 2021 (for GPs) and October 2021 (for schools), after 18 months of COVID-19–related mobilization. Schools were dealing with contact tracing and COVID-19 vaccination, which led to many schools electing to drop out or being unable to implement the full intervention. Likewise, many health care professionals were overworked after the pandemic, 49 which led to difficulties in involving GPs. Our findings are therefore likely to have been affected by the context, and an analysis considering the intervention dose actually delivered at the municipality level will be undertaken to enrich our results.

Because the factorial design was incomplete, it was not possible to evaluate the interaction between at-school vaccination and education and motivation of adolescents, as the former was never carried out without the latter. As such, the effect of at-school vaccination is based on the hypothesis that there is no interaction between the 2, which cannot be verified. This hypothesis may have led to a misestimation of the effect of this component delivered by itself. Its effect should also always be interpreted by considering it in adjunction to the effect of the education and motivation component.

Another limitation is that only municipalities with 1 middle school in their territory were included. Municipalities are the smallest geographical unit available in the SNDS database and doing otherwise would have required that all schools in a municipality agree to participate, which was less feasible. As a result, larger French municipalities were de facto excluded and participating municipalities are mostly small and rural, which raises the question of the generalizability of our results. However, the effect of that choice is likely to be minimal, as a previous study found that HPV vaccine uptake did not vary significantly according to the number of inhabitants in a municipality. 32

Regarding the primary outcome, it is possible that the time horizon was too short to highlight the benefits of the education and motivation and GPs’ training components. They require that parents schedule 2 visits with their GP (1 for the vaccine prescription and 1 for the vaccination) and they may delay 1 or both visits until they have another reason to consult their GP. This possibility will be investigated in analyses of VC at 6 and 12 months, as will whether adolescents vaccinated at school receive the second dose of the vaccine.

In February 2023, after the end of the PrevHPV trial, the French government announced that both doses of the HPV vaccine would be offered free of charge to all grade 7 pupils, at school, from autumn 2023. 50 Preliminary reports show that approximately 10% of pupils have received the first dose, with much concern raised around unfounded vaccine safety concerns. The results of the PrevHPV trial, and the evaluation of its implementation in particular, could provide vital information on how to best carry out this policy and improve VC.

Accepted for Publication: March 18, 2024.

Published: May 23, 2024. doi:10.1001/jamanetworkopen.2024.11938

Corresponding Author: Morgane Michel, PhD, Université Paris Cité, site Villemin, ECEVE, UMR1123, 10 avenue de Verdun, 75010 Paris, France ( [email protected] ).

Author Contributions: Drs Thilly and Giraudeau had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs Thilly and Michel are co–first authors and contributed equally to this work.

Concept and design: Thilly, Michel, Bocquier, Gagneux-Brunon, Gauchet, Gilberg, Le Duc-Banaszuk, Bruel, Mueller, Giraudeau, Chevreul.

Acquisition, analysis, or interpretation of data: Thilly, Michel, Simon, Bocquier, Gagneux-Brunon, Mueller, Giraudeau, Chevreul.

Drafting of the manuscript: Thilly, Michel, Chevreul.

Critical review of the manuscript for important intellectual content: All authors.

Statistical analysis: Michel, Simon, Giraudeau, Chevreul.

Obtained funding: Thilly, Michel, Gauchet, Gilberg, Le Duc-Banaszuk, Bruel, Mueller.

Administrative, technical, or material support: Bocquier, Gagneux-Brunon, Bruel.

Supervision: Thilly, Gauchet, Gilberg, Chevreul.

Conflict of Interest Disclosures: Dr Gagneux-Brunon reported receiving honoraria from MSD, Moderna, and Pfizer paid to her institution and financial support for attending meetings and/or travel from MSD and Moderna, all outside the submitted work. Dr Gauchet reported receiving honoraria from MSD paid to her institution and finanical support for attending meetings and/or travel from MSD, all outside the submitted work. No other disclosures were reported.

Funding/Support: This study was conducted with the support of IReSP and Inserm and with financial support from ITMO Cancer AVIESAN (Alliance Nationale pour les Sciences de la Vie et de la Santé/ National Alliance for Life Sciences & Health) within the framework of the Cancer Plan 2014-2019.

Role of the Funder/Sponsor: The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Group Information: The members of the PrevHPV Study Group appear in Supplement 3 .

Data Sharing Statement: See Supplement 4 .

Additional Contributions: The authors thank the representatives of the following institutions who participated in the steering committee of the research program: Inserm; IReSP; ITMO Cancer AVIESAN; ITMO Public Health AVIESAN; INCa (the French National Cancer Institute); the French Public Health Agency (Santé Publique France); Ministry of Health; Ministry of National Education, especially Dr Brigitte Moltrecht from the Direction Générale de l’Enseignement Scolaire; and the Ile-de-France Regional Health Agency. We also thank all professional stakeholders who participated in the working groups and all individuals who accepted to participate in the diagnostic and/or the co-construction phase of the PrevHPV Programme. Finally, we thank the principals of the 91 middle schools who agreed to participate in the PrevHPV study and their staff members, as well as the pupils and parents who participated in the study. We also thank the general practitioners who agreed to participate in the training, and the staff of the vaccination centers involved in the vaccination of adolescents at school.

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ASU, UA rank in top 1% of global universities, per a recent study. Here’s why

Both Arizona State University and the University of Arizona ranked among the top 1% of schools across the world in this year’s Center for World University rankings , putting them ahead of schools like the University of Connecticut and Georgetown University.

The group compiled data from more than 20,000 institutions internationally, studying graduate employability and academics. Among the U.S. rankings, UA landed in 48th, ASU in 67th and NAU in 185th. All three schools were credited for their research influence.

That was key in developing the overall rankings according to the organization. Faculty citations and research made up 40% of the scores given.

In fiscal year 2022, ASU spent $797.2 million on research, growing by 18% from the year prior. In fiscal year 2023, UA spent even more with $954 million in investments. Both schools are in the top 4% nationally for research spending. A large portion of research funding in the state is from federal investments.

While NAU spent less at around $77.5 million in fiscal year 2023, the school has continued to expand its research budget. NAU is also likely to reach R1 status next year after the new criteria goes into effect . An R1 institution is a school recognized within the highest tier of research universities.

The Arizona Board of Regents, the body overseeing the state's public university system, sets research spending targets for each year to support what the board said is "essential to our state’s economic future" in a 2023 report . The system has surpassed those benchmarks.

This year’s rankings come at a critical point for UA, which is working to recover from a multimillion-dollar budget shortfall discovered last fall. Through a hiring freeze and several other budget cuts, school officials now expect to bring a deficit that was once $117 million down to $52 million by next year.

The fiscal headaches were blamed on a variety of issues including a decentralized budgeting model and inflation. But in the fall, UA President Robert Robbins acknowledged large investments on merit scholarships for out-of-state students and research initiatives also made an impact.

"We made a bet on spending money," Robbins said in a November meeting. "We just overshot."

In February, Robbins told The Arizona Republic the school would grow its research spending to $1 billion in the coming years. He said he didn’t regret the move but admitted the school had been using money from its reserves to fund it.

UA searching for its next president Here's what students, faculty want to see

UA was ranked among the top 0.5% of schools internationally this year, compared to ASU in the top 1% and NAU in the top 4%. The study placed UA faculty highly, at 69th globally, making it one of the school’s standout characteristics in the rankings.

Throughout ongoing budget discussions, faculty have long called on university leaders to protect its academic staff, citing it as the “engine” of the R1 land-grant university. While the school’s president and interim chief financial officers have said they too are committed to protecting UA’s academic mission, many faculty are uneasy, saying cuts on the horizon would go on to hurt students.

Hundreds of people attended a general faculty meeting last month to go over the school’s deficit. The group later passed a resolution asking the administration to stop ongoing layoffs until “detailed, transparent, and clear financial data and guidance on financial rules” is available.

Helen Rummel covers higher education for The Arizona Republic. Reach her at [email protected] . Follow her on X, formerly Twitter: @helenrummel .

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Primary school children get little academic benefit from homework

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Primary school children get little academic benefit from homework

What is homework for?

Little academic benefit

Is Homework Good for Kids? Here’s What the Research Says

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What’s the Right Amount of Homework?

Small Benefits for Elementary Students

Moderate Benefits for Middle School Students

More Benefits for High School Students, but Risks as Well

Parents Play a Key Role

Positive Affect Variability is Associated with Homework Management Difficulties in Children with ADHD

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