Developing a Peer to Peer Behavioral Intervention for High School Students with ADHD
Purpose: In this study, researchers will develop and test 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 behavior (e.g., substance use and delinquency) typical in this population. The researchers will take existing behavioral interventions known to help these adolescents and develop 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 will conduct 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 will be implemented twice and the researchers will collect data to inform needed modifications. In the final project year, eligible ninth grade students will be 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.
Products: The research team will produce a fully developed program for academically and socially successful eleventh and twelfth grade students supervised by school staff to improve school outcomes for ninth grade students with ADHD-like symptoms. All materials to support school-based implementation (e.g., manuals, fidelity of implementation measures) will also be produced, along with peer-reviewed publications.
Setting: The study will take place in three high schools in a large urban area in Florida.
Sample: Approximately 100 ninth grade students with teacher-identified attention and organization problems consistent with Attention Deficit/Hyperactivity Disorder (ADHD) and an IQ greater than 70 will participate. In addition, about 30 eleventh and twelfth grade students will participate as mentors. Teachers and school counselors will also participate.
Intervention: STRIPES (Students Taking Responsibility and Initiative through Peer-Enhanced Support) will consist of intervention modules that incorporate best practices for working with students with ADHD. Introductory modules will focus on building therapeutic rapport, examining short and long term goals, and creating an intervention plan. Skill modules will focus on targeted training (organization, homework, planning) and the behavioral reinforcement of student performance. Maintenance modules will focus on long-term plans for continued skill use as intervention support is gradually withdrawn. The researchers will develop implementation strategies to support school-wide adoption in ways that are sustainable over time, with older, successful high school peer mentors serving as the interventionists while supervised by a high school faculty member.
Research Design and Methods: In Year 1, the researchers will work in one high school to develop the school-based implementation model. They will hold monthly meetings with key stakeholders (e.g., students, teachers) to generate ideas for STRIPES' implementation. Researchers will implement a prototype version with a small group of ninth grade students. The research team will assess student outcomes at baseline, during intervention, immediately post-intervention, and at the end of the school year. In Year 2, the modified version will be implemented in the same school with a larger sample following the same measurement plan. Researchers will make necessary modifications based on the feedback obtained during implementation. In the final project year, researchers will randomly assign 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 will experience business-as-usual in their high schools.
Key Measures: The researchers will screen students for intervention using IQ tests (e.g., the Wechsler Individual Achievement Test-III) and ADHD rating scales. The researchers will evaluate feasibility using a variety of measures (e.g., checklists, the Client Credibility Questionnaire, and direct observations). The researchers will measure school performance using school grades and the Adolescent Academic Problems Checklist. The researchers will measure targeted skills (e.g., organization) using direct observations. The research team will also measure school connectedness and peer affiliations (the Psychological Sense of School Membership Scale and the Adolescent Report on Peers). The team will assess deviant behavior using school records of attendance and discipline.
Data Analytic Strategy: In Year 1, the researchers will use 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 will use repeated measures t-tests and calculation of Cohen's d effect sizes to analyze Year 2 data. They will use linear mixed models to analyze the data from the pilot study in Year 3. Finally, the researchers will explore the potential benefits for peer interventionists by calculating Cohen's d effect sizes to measure any change over time (pre- to post-intervention).