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IES Grant

Title: Developing a Peer to Peer Behavioral Intervention for High School Students with ADHD
Center: NCER Year: 2015
Principal Investigator: Sibley, Margaret Awardee: Florida International University
Program: Social and Behavioral Context for Academic Learning      [Program Details]
Award Period: 3 years (9/1/2015-8/31/2018) Award Amount: $1,378,988
Type: Development and Innovation Award Number: R305A150433

Purpose: In this study, researchers developed and tested school-based procedures to provide behavioral intervention for ninth grade students with attention deficit/hyperactivity disorder (ADHD) or similar symptoms that interfere with success in school. About 5 to 10 percent of high school students have ADHD or related symptoms that cause organization and time management problems that often lead to course failure and dropout. These academic problems can further compound risk for deviant behaviors such as substance use and delinquency that are typical in this population. The researchers took existing behavioral interventions known to help these adolescents and developed procedures for their implementation by older peers supervised by school staff in high schools. The STRIPES (Students Taking Responsibility and Initiative through Peer-Enhanced Support) program is intended to promote engagement with school to improve behavioral and academic outcomes for students with ADHD symptoms.

Project Activities: In the first two years of the project, the researchers conducted development team meetings and focus groups (students, teachers, administrators) in one high school to generate ideas for school-based implementation of the behavioral interventions. STRIPES was implemented twice to test these ideas and inform needed modifications. In the final project year, eligible ninth grade students were randomly assigned to STRIPES or a control group to assess feasibility and fidelity of the school-based procedures involving peer interventionists and promise of the model for improving student education outcomes.

Key Outcomes: The main features of the intervention and findings of the project's pilot study are as follows:

  • The research team produced STRIPES, a program for academically- and socially-successful eleventh and twelfth grade students supervised by school staff to help ninth grade students with ADHD-like symptoms be more successful in school. All materials to support school-based implementation including manuals and fidelity of implementation measures were also produced. The research team is testing STRIPES in a 2021 initial efficacy study.
  • In the pilot study of promise, three schools employed unique implementation strategies and results varied. An elective pullout model engaging 12th grade peer interventionists under teacher supervision demonstrated good fidelity, attendance, and population-fit. This model also resulted in significant between group differences in bookbag organization (d=1.11), academic motivation (d=.85 to 2.05), and class attendance (d=1.47) over time compared to students in the comparison group. With the appropriate implementation strategy, STRIPES shows promise for preventing declining school engagement across ninth grade.

Structured Abstract

Setting: The study took place in three high schools in a large urban area in Florida.

Sample: Ninth grade students (n = 96) with teacher-identified attention and organization problems consistent with attention deficit/hyperactivity disorder (ADHD) and an IQ greater than 70 participated. In addition, 31 eleventh and twelfth grade students participated as mentors. Teachers and school counselors also participated.

STRIPES Core Intervention Components Implementation Strategies
Materials Management (EF strategy) Task Shifting to Peers to overcome shortage of school staff interventionists
Recording Homework (EF strategy) Peer Retrieval to Overcome Forgetfulness
Consistently Monitoring Online Gradebook (EF strategy) Pullout from elective to avoid loss of highly valued social time and academic instruction
Time management and Planning Skills (EF Strategy) Frontloading skill introduction to increase skill exposure for intermittent attenders
Goal Setting and Implementation Intentions (motivation strategy) Voluntary attendance and drop-in model (16 sessions offered with goal of providing 8)
Strength-based Feedback from Peers (motivation strategy) Leveraging technology (electronic organization apps and monitoring online gradebook)
Social rather than tangible reinforcement to overcome school resource shortages

Intervention: STRIPES is a weekly 30-minute meeting between two 9th graders and one peer, delivered in a teacher-supervised large group. STRIPES is conceptualized as a 16-week drop-in intervention with the goal of delivering 8 sessions per student. A defining feature is allowing schools to decide how STRIPES is held. However, as a result of the trial, the research team standardized peer-retrieval (i.e., mitigating ADHD-related forgetfulness) and elective pull-out features (a compromise between school staff interest in preserving academic instruction and student interest in preserving social time) in the final STRIPES manual. During the first week of STRIPES, students set long-term goals that peer interventionists track and discuss at each session. Core STRIPES skills are: (1) materials management, (2) recording homework assignments, (3) monitoring online gradebook platforms with peers to discuss performance and problem-solve difficulties, (4) time management and homework planning, and (5) short-term goal setting such as turning in all homework assignments). Peers are trained to affirm at least one positive action taken by each 9th grader per week. The researchers frontload STRIPES skill instruction in the first week to ensure that students with intermittent attendance have exposure to all elements of STRIPES upfront.

Peer interventionists are selected by school staff and receive community service hours (required for graduation) for participation. Prior to the first session, a mixer is held between 9th graders and peer interventionists. Using a "speed-dating" model, peers and 9th graders become acquainted in brief conversations and rank preferred partners. School staff use these ranking to perform pairings. Peers receive 4 hours of training and 30 minutes of weekly supervision from the school staff sponsor after each weekly STRIPES meeting. The school staff sponsor receives brief consultation and feedback on fidelity observations from the research team after supervision sessions. The sponsor is coached to discuss each 9th grade student's progress, challenges faced by peers, and to ensure that peers appropriately complete paperwork (recording weekly goals).

Research Design and Methods: In Year 1, the researchers worked in one high school to develop the school-based implementation model. They held monthly meetings with key stakeholders including students and teachers to generate ideas for STRIPES' implementation and tried out a prototype version with a small group of ninth grade students. The research team assessed student outcomes at baseline, during intervention, immediately post-intervention, and at the end of the school year. In Year 2, the modified version was implemented in the same school with a larger sample following the same measurement plan. Researchers made necessary modifications based on the feedback obtained during this implementation. In the final project year, the researchers randomly assigned eligible ninth grade students in this school and two additional schools to receive the STRIPES intervention or typical services.

Control Condition: Students randomly assigned to the control group experienced business-as-usual in their high schools and were monitored by the research team.

Key Measures: The researchers screened students for intervention using IQ tests such as the Wechsler Individual Achievement Test-III and ADHD rating scales. They evaluated feasibility using a variety of measures including checklists, the Client Credibility Questionnaire, and direct observations. The researchers measured school performance using school grades and the Adolescent Academic Problems Checklist. They measured targeted skills such as organization using direct observations. The research team also measured school connectedness and peer affiliations (the Psychological Sense of School Membership Scale and the Adolescent Report on Peers) focusing on motivation. The team assessed deviant behavior using school records of attendance and discipline, but it proved to be an irrelevant outcome for this specific sample. The researchers also assessed academic motivation using the motivational interviewing (MI) change ruler.

Data Analytic Strategy: In Year 1, the researchers used content analysis of development team meeting and focus group transcriptions and single-subject case analyses (A-B-A treatment withdrawal design) to inform development. They used repeated measures t-tests and calculation of Cohen's d effect sizes to analyze Year 2 data. They used linear mixed models to analyze the data from the pilot study in Year 3. Finally, the researchers explored the potential benefits for peer interventionists by calculating Cohen's d effect sizes to measure any change over time (pre- to post-intervention).

Related IES Project: Efficacy of a Peer-Delivered Intervention for High School Students with ADHD (R305A210462)

Publications and Products

Sibley, M.H., Morley, C.M., Rodriguez, L.M., Coxe, S.J., Evans, S.W., Morsink, S., & Torres, F. (2020). A Peer-Delivered Intervention for High School Students with Impairing ADHD Symptoms. School Psychology Review, 49(3), 275-290.

Sibley, M.H., Graziano, P.A., Ortiz, M., Rodriguez, L.M., & Coxe, S.J. (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.

Sibley, M.H., Ortiz, M. Graziano, P.A., Dick, A., & Estrada, E. (2019). Metacognitive and Motivation Deficits, Exposure to Trauma, and High Parental Demands Characterize Adolescents with Late-Onset ADHD. European Child and Adolescent Psychiatry, 29, 537548.