Interventions for High School Students with Attention-Deficit/Hyperactivity Disorder: Considerations for Future Directions.

Abstract. Attention-deficit/hyperactivity disorder is now widely conceptualized as a life course-persistent disorder, present from early childhood, and it results in pronounced impairment in functioning within educational settings, including high school. Current intervention approaches are briefly reviewed, and an approach to framing interventions within a developmental model are discussed. Treatment parameters in need of future study include treatment intensity, strategies for training in adaptive skills and reducing impairment, and the inclusion of multiple adults within intervention efforts. ********** Attention-deficit/hyperactivity disorder (ADHD) is now widely conceptualized as a life course-persistent disorder, present from early childhood, and it results in pronounced impairment in functioning within educational settings. More than a decade has passed since the American Academy of Pediatrics (2001) officially stated to the field of primary care providers that ADHD should be treated as a chronic condition--meaning that it persists beyond childhood into adolescence. This countered the long-standing clinical lore that ADHD was a childhood disorder that remitted during adolescence, despite many early studies showing high school problems experienced by youth identified in childhood with ADHD (e.g., Huessy & Cohen, 1976; Milich & Loney, 1979) and consistent, contemporary evidence (e.g., Biederman, Petty, Evans, Small, & Faraone, 2010; Kent et al., 2011; Langberg et al., 2011). Part of this misperception might be attributed to the historical bias in the literature weighted toward elementary school-aged samples in studies of prevalence (Polanczyk, Silva de Lima, Horta, Biederman, & Rohde, 2007) and treatment (DuPaul, Eckert, & Vilardo, 2012; Fabiano et al., 2009). For instance, in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition field trials that were formative for selecting the symptoms used for an ADHD diagnosis, only 23% of participants were at a typical high school age of 14 years or older (Frick et al., 1994). Recent changes within the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (American Psychiatric Association, 2013) are more inclusive of adolescents with ADHD (i.e., many of the inattentive and hyperactive/impulsive symptoms now include developmentally appropriate descriptors for teenagers). Though perhaps underrepresented within the larger research literature, it is clear that youth with ADHD experience impaired academic and behavioral functioning at the high school level relative to same-age peers (Kent et al., 2011; Molina et al., 2009). This necessitates the development of intervention programs appropriate for high school and beyond. Unfortunately, aside from clinic-based parent-training approaches (Barkley et al., 2001), historically, there have been few school-based interventions developed that are suitable for youth with ADHD at the high school level (Smith, Waschbusch, Willoughby, & Evans, 2000). In fact, a recent meta-analysis of contemporary school-based interventions for ADHD yielded zero studies within the high school age range (DuPaul et al., 2012). Beyond a need for more studies of efficacy and effectiveness within high school--aged samples of youth with ADHD, there are a number of considerations that must also be addressed. This includes the need for a developmental model covering early childhood through adulthood, consideration of intervention intensity, the need to train teens and adults in adaptive functional skills, the need to reduce impairment in functional domains, and the inclusion of multiple adults within the teen's treatment plan. These considerations are briefly reviewed, followed by a discussion of future directions within ADHD intervention research in high school settings. Framing Intervention Within a Developmental Model The chronicity of a disorder such as ADHD must be considered in treatment efforts at the high school level. …