Multisite Study of School-Based Treatment Approaches for Adolescents with ADHD
Co-Principal Investigator: Julie Owens
Purpose: Attention-deficit hyperactivity disorder (ADHD) is a prevalent and chronic mental health disorder associated with significant adverse outcomes at school. Empirically supported treatments for students with ADHD consist of medication, behavioral interventions, and the combination of the two. Most of the treatments developed for students with ADHD focus on elementary age students, but adolescents with ADHD are at increased risk for school suspensions, academic failure, classroom behavior problems, homework completion difficulties, and school dropout. Aside from medication treatment, there are no empirically supported interventions for older adolescents. The purpose of this study is to test the efficacy of a school-based treatment program for adolescents with ADHD, the Building Futures Program (BFP), which targets academic achievement, social functioning, and family relations with the primary goal of improving behavior and academic success. Preliminary research shows that BFP is effective in enhancing classroom functioning, reducing family conflict, and improving inattention. This study will evaluate the efficacy of BFP with high school students diagnosed with ADHD, identify variables that moderate and mediate treatment response, and identify characteristics of staff and schools necessary to successfully implement BFP within authentic school settings.
Project Activities: Researchers will recruit 192 students with ADHD in grades 9-11 across two sites over two years. ADHD diagnosis will be determined by collecting ratings of student behavior from parents and teachers, as well as a semi-structured parent interview. Within schools, students will be randomly assigned to the intervention or community care (services as usual) group. Researchers will implement the intervention over the course of a full school year. The BFP coaches will spend approximately 15 hours per week at each high school, and spend time with participating students during the school day twice per week. Participants also attend an interpersonal skills group that is provided one evening per week, at the same time as weekly parent group meetings. Fidelity of implementation will occur through recording of sessions and checklists for the various components of the intervention. Monthly calls will be made to all participants in the intervention and comparison conditions to determine whether students in the intervention group received the interventions as intended, and to track the interventions received by students in the control condition. Multiple measures will be used to assess student behavioral and academic outcomes. Researchers will also examine factors that moderate or mediate the impact of the intervention on student outcomes.
Products: The products of this project include evidence of the efficacy of the SPP intervention for adolescents with ADHD. Presentation and peer reviewed publications will also be produced.
Setting: This project will take place in 11 urban, suburban and rural high schools in Ohio and Pennsylvania.
Sample: Participants will include 192 high school students with ADHD in grades 9-11. They will represent a diverse racial, ethnic and socioeconomic range and be recruited from urban, rural and suburban schools.
Intervention: The BFP integrates five specific interventions over the course of one academic year. The first is Academic and Organization Skills, where coaches check in with teachers to monitor student assignment completion then work with students to develop academic study strategies (e.g. note-taking, use of flashcards) and methods to organize materials, assignments and time. Second is an Interpersonal Skills Group (IGP), which focuses on helping students understand relationships between their behavior and others’ reactions. Third is a Parenting Group, which focuses on parent-teen communication and negotiation and development of a homework completion plan. The fourth piece is Self-Management, in which students are given tools (e.g. checklists) to self-monitor their performance on specific target behaviors identified through IGP or student/ teacher rating scales. The final intervention is Check & Connect, which provides a framework for coaches to build relationships with students through systematic monitoring of student engagement and functioning in school and by establishing constructive mentoring relationships with students.
Control Condition: Students in the control group will receive assistance typically provided in the school or in the community.
Research Design and Methods: Students will be randomly assigned to the intervention or community care group. The intervention will last throughout the school year, with coaches and researchers providing the aspects of the intervention program. Outcome data will be collected before, during, and after the intervention.
Key Measures: Researchers will use a group of measures to collect demographic, descriptive, and diagnostic information, including the Behavior Assessment System for Children-Second edition (BASC-2) and the child version of the Schedule for Affective Disorders and Schizophrenia (K-SADS). Outcomes related to school functioning and social skills improvement will be measured using the Classroom Performance Survey, Impairment Rating Scale, ADHD Rating Scale, Conflict Behavior Questionnaire, the Social Skills Improvement System, student and parent surveys, and reviews of academic records (e.g. grade reports and disciplinary actions). Researchers will collect data on potential moderating and mediating factors such as attendance, depression levels, parental signs of ADHD, and intelligence.
Data Analytic Strategy: Researchers will analyze data using an intent-to-treat approach. Researchers will use hierarchical linear modeling for its advantage in dealing with nested data (repeated measures within individuals from two groups) and attrition across time. Researchers will analyze qualitative data from student and parent surveys descriptively, looking specifically at school and staff characteristics that are necessary to successfully implement BFP.