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IES Grant

Title: Efficacy of a Peer-Delivered Intervention for High School Students with ADHD
Center: NCER Year: 2021
Principal Investigator: Sibley, Margaret Awardee: Seattle Children's Hospital
Program: Social and Behavioral Context for Academic Learning      [Program Details]
Award Period: 5 years (07/01/2021 – 06/30/2026) Award Amount: $3,799,316
Type: Efficacy Award Number: R305A210462

Co-Principal Investigator: Raiker, Joseph

Purpose: High school students with ADHD have poor access to evidence-based interventions in schools due to documented population-specific and setting-specific barriers. To overcome these barriers, the purpose of this project is to successfully implement and evaluate a peer- delivered low intensity intervention that targets organization, time management, and planning (OTP) and motivation deficits in high school students with ADHD and related impairments (STRIPES; Students Taking Responsibility and Initiative through Peer-Enhanced Support).

Project Activities: Year 1 will include planning and implementation preparation activities. In Years 2–4, the research team will conduct a randomized controlled trial with 144 regular education 9th grade students with impairing ADHD symptoms at two sites: Miami and Seattle. The team will randomly assign students to receive STRIPES or enhanced school services using a 1:1 allocation ratio.  Researchers will follow participants for one year to measure student outcomes and target mechanisms. Year 5 will include continued follow-up, data analysis, and dissemination efforts.

Products: Researchers will generate knowledge about the effectiveness of STRIPES, which will inform dissemination efforts in the future. The research team will share the findings from this research via conference presentations and peer-reviewed publications, as well as through accessible summaries of research, research reports and briefs, and webinars. The products from the project also include the STRIPES treatment manual, which will be publicly available to school personnel and will be easily accessed online. In addition, the research team will share findings from the cost analysis and cost-effectiveness analysis to describe the cost necessary to implement the intervention and to determine the cost per unit of outcome change to facilitate comparison to other interventions, respectively.

Structured Abstract

Setting: The project will take place in two unique and culturally diverse locations: Seattle, Washington and Miami-Dade County, Florida. These urban and ethnically diverse metropolitan regions will afford the project an opportunity to test implementation and intervention efficacy across two different contexts.

Population/Sample: Participants in the study include 9th grade students with teacher- identified attention problems consistent with ADHD and will be demographically representative of Seattle, WA and Miami-Dade County, FL. As a result, participants include approximately 33%  Non-Hispanic White, 45% Hispanic Any Race, 10% Asian, 10% African-American and 2.0% Other (Mixed Race, Native American). Participants will be approximately 75% male as this gender rate is representative of epidemiological prevalence estimates for ADHD (American Psychiatric Association, 2013). Peer interventionists will be academically successful and socially competent 11th or 12th grade peers supervised weekly by a school staff sponsor.

Intervention: The intervention is  a low-burden peer-delivered OTP (i.e., materials and time management, recording homework, self-monitoring grades) and motivation (i.e., goal setting and implementation intentions) intervention that was developed and previously piloted during an IES Goal 2 study (R305A150433). STRIPES utilizes a 16-week drop-in attendance model with population-specific implementation features: task-shifting to peers, peer retrieval from class, elective pullout, frontloading skill instruction, leveraging existing technology infrastructures to monitor performance, and social reinforcement.

Research Design and Methods: The research team will tailor the model for delivery (e.g., when, where, supervised by whom) to each school using a stakeholder informed process in Year 1. In Years 2-4,  the researchers will conduct a two-school randomized controlled trial of STRIPES (N=144). They will randomize ninth grade students to either: 1) STRIPES (N=72 9th grade students assigned to 36 STRIPES interventionists) or 2) an enhanced school services control group (SSU plus; N=72). Outcomes (GPA, class attendance) will be tracked the fall of 9th grade until the fall of 10th grade through three core assessments (baseline, follow-up 1, follow-up 2) and five monthly assessments of target mechanisms (executive functioning, academic motivation) during the intervention phase.

Control Condition: The research team will use an enhanced school services as usual (SSU plus) comparison condition to test whether STRIPES improves upon school services as usual.  They will refer students assigned to SSU plus to their school counselor for services available in the school setting. In addition, researchers will systematically track services received by students in the SSU plus condition.

Key Measures: Student outcomes include report card grades and attendance records. Target mechanisms include observable executive functioning indices (homework recording, bookbag organization, missing assignments according to grade book) and academic motivation (change ruler, Basic Psychological Needs Scale). Mediators include: cognitive and rewards processing indices (working memory task, go/no go task, flanker task, dimensional card sort task, Iowa gambling task, choice delay task) and compensatory skills (i.e., teacher ratings of OTP strategy use on Adolescent Academic Problems Checklist, goal setting from Self-regulated Learning Interview Schedule). Moderators will include baseline grades, classroom behavior, and ADHD diagnosis.

Data Analytic Strategy: The researchers will evaluate STRIPES (vs. enhanced school services) on target mechanisms (executive functioning and academic motivation) and student outcomes (GPA and class attendance) through a 12-month randomized controlled trial evaluated using Linear Growth Models. Using an SEM framework, they will examine the extent to which the active lever in STRIPES is directly remediating basic student EF/motivation deficits versus developing compensatory skills that overcome the impact of potentially unmalleable deficits. The research team will also examine whether differences in basic cognitive profiles moderate response to intervention. They will also investigate treatment moderators to build the knowledge base on what works for whom and whyin the context of school mental health through Linear Growth Modeling.

Cost Analysis: Cost analysis will describe the cost necessary to implement the intervention, and cost-effectiveness analysis will determine the cost per unit of outcome change to facilitate comparison to other interventions. The research team will compile costs for each trial arm at the student, school, and district level. Primary learner outcomes for the cost effectiveness analyses are class attendance and GPA.

Related IES Projects: Developing a Peer-to-Peer Behavioral Intervention for High School Students with ADHD (R305A150433)