Multisite Study of High School-based Treatment for Adolescents With ADHD
Condition: Attention Deficit Hyperactivity Disorder
MeSH terms: Attention Deficit Disorder with Hyperactivity
Study type: Interventional

Summary: 
      We evaluated the extent to which receiving the school-based multi-component treatment of the
      Challenging Horizons Program (CHP) would lead to significant improvements in levels of
      symptoms of attention deficit hyperactivity disorder (ADHD) and social and academic
      functioning for high school aged adolescents diagnosed with ADHD. We intended to recruit 200
      high school aged adolescents with a diagnosis of ADHD who would be randomly assigned to
      either CHP or a Community Care condition within each of 12 participating high schools.
      Outcome measures included parent, teacher and adolescent reports as well as observational
      data. Measures were collected at initial evaluations which preceded the one academic year of
      treatment, during the treatment period, and at six-months after treatment ended. Based on
      previous research with this treatment in middle and high schools, we anticipated meaningful
      gains for those in the treatment condition at post-treatment and larger gains on some
      variables at the 6-month follow-up evaluation.
    

Detailed description: 
      We evaluated the extent to which receiving the school-based multi-component treatment of the
      Challenging Horizons Program (CHP) would lead to significant improvements in levels of
      symptoms of attention deficit hyperactivity disorder (ADHD) and social and academic
      functioning for high school aged adolescents diagnosed with ADHD. We intended to recruit 200
      high school aged adolescents with a diagnosis of ADHD who would be randomly assigned to
      either CHP or a Community Care condition within each of 12 participating high schools.
      Outcome measures included parent, teacher and adolescent reports as well as observational
      data. Measures were collected at initial evaluations which preceded the one academic year of
      treatment, during the treatment period, and at six-months after treatment ended. Based on
      previous research with this treatment in middle and high schools, we anticipated meaningful
      gains for those in the treatment condition at post-treatment and larger gains on some
      variables at the 6-month follow-up evaluation. Eligible participants were stratified for
      medication status and sex following the completion of all eligibility assessments for each of
      3 cohorts and were randomly assigned (within schools) to either the CHP or CC condition.
      Siblings were assigned together such that they would be in the same condition. All measures
      (except the achievement test which was given at eligibility and post-treatment assessment
      points) were administered on at least three occasions including pre-treatment (i.e.,
      eligibility or baseline), post-treatment, and 6-month follow-up. Rating scales were completed
      online using REDCap (Harris et al., 2009) with the exception of the School Functioning Scale.

      Participants randomized to the treatment group met with their coaches individually for
      approximately 15-20 minutes twice per week throughout the academic year, typically during
      lunch, study hall, or an elective class. Individual sessions included study skills,
      organization, problem solving, and interpersonal skills training. Ten, 90-minute group
      sessions were offered to adolescents and parents in the evenings and ran concurrently. The
      organization intervention occurred during each individual session. During initial sessions,
      students and coaches worked collaboratively to develop a system of organizing the student's
      binders or folders and tracking assignments in a daily planner or electronic calendar.
      Subsequent sessions included a binder and daily planner check in which the student's
      adherence to the system was recorded and then the student practiced addressing
      disorganization (e.g., put assignments in the correct folders, update planner). After meeting
      objective criteria for organization (e.g., at least 80% planner completion for two
      consecutive weeks), adolescents independently completed organization and planner checks under
      supervision by coaches.

      Each month, coaches checked with students and school records regarding six areas of risk
      including tardiness, absenteeism, in-school disciplinary actions, out-of-school suspension,
      failing classes, and missing assignments. If students met a predetermined threshold for risk
      (e.g., 80% or fewer assignments turned in on time), then the student and coach had a
      problem-solving discussion. The goal was to both develop a solution to the relevant problem
      as well as teach students how to use problem-solving skills. The process included (1)
      defining the problem, (2) setting a goal, (3) brainstorming ways to achieve that goal, (4)
      selecting one or more of these solutions, (5) determining how to know if the plan is working,
      (6) setting a date to start implementation, and (7) setting a date to review the success of
      the plan. During a subsequent session, the coach and student reviewed the results of the plan
      relative to stated goals and determined if they should continue the plan or make changes.
      During individual sessions, students and coaches critically reviewed social events and the
      student's behavior in relation to goals. This was an extension of the evening sessions
      focused on ISG and involved applying the skills learned in the group meetings to individual
      social events in the participants' daily lives. For students who were not performing well on
      tests and quizzes, coaches provided study skills intervention. Coaches reviewed test-taking
      strategies regarding different styles of test questions (e.g., planning an outline for an
      essay question). Students were tested on these strategies to demonstrate mastery and then
      practice the skills on practice tests. Students also learned strategies for using flashcards
      and class notes effectively to prepare for tests. In the ten evening sessions offered for
      students the adolescents participated in an interpersonal skills group (ISG) to improve
      social skills. During the first group, students were introduced to the concepts of ideal self
      - how they want to be seen, and real self - how they really are seen. Students developed
      ideal self goals and practiced behaving in ways that aligned with these goals during games
      and activities and frequently reviewed progess with staff. Parents were offered 10 evening
      sessions concurrent with students' ISG. Program staff provided psychoeducation about ADHD and
      common difficulties faced by teenagers, including sleep hygiene. Parents also worked with
      project staff to develop a homework management plan that determined when students would
      complete homework each night and for how long.

      Participants who were randomized to the CC condition were given a list of available resources
      in their community and received no services from research staff. Participants in both CC and
      the treatment condition were informed that they could receive any community services during
      the duration of the trial.
    

Intervention name(s): Challenging Horizons Program
Intervention type(s): Behavioral
Intervention description(s): Intervention delivered in high schools provided by school mental health professional over the course of an academic year with twice-weekly meetings with students and 10 evening group meetings with students and 10 group sessions with parents.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment