High School-Based Treatment for Adolescents with Attention-Deficit/Hyperactivity Disorder: Results from a Pilot Study Examining Outcomes and Dosage.

Abstract. The purpose of this study was to examine the efficacy and dose-response relationship of a school-based treatment program for high school students with attention-deficit/hyperactivity disorder (ADHD). Two paraprofessionals provided interventions to 24 students with ADHD randomly assigned to the treatment condition at two public high schools. They met in dyadic coaching sessions during one school year. In addition, parents attended weekly parent meetings and adolescents attended group sessions targeting social functioning in the evenings for 10 weeks in the fall semester. Intent-to-treat analyses showed little statistically significant benefit for the participants; however, effect sizes indicated moderate improvements in parent ratings of inattention, relationships with peers, academic impairment, and family functioning. There was large variability in the dosage of services received across participants, and an analysis of outcomes by dosage suggests large differences in response based on the number of sessions attended. This school-based intervention provides a viable option for educators and school mental health professionals who wish to provide interventions for high school students with ADHD, but further development and evaluation are needed. ********** Longitudinal studies support the consensus that 50%-80% of children diagnosed with attention-deficit/hyperactivity disorder (ADHD) continue to meet diagnostic criteria in adolescence (Wolraich et al., 2005). The functional impairments associated with adolescents with ADHD have more serious consequences than impairment in children, partly as a function of emerging freedoms and responsibilities. For example, adolescents with chronic ADHD exhibit higher rates of school dropout and vocational impairment (Kuriyan et al., 2013), automobile accidents (Fischer, Barkley, Smallish, & Fletcher, 2007), and difficulty in romantic relationships (Canu & Carlson, 2007) when compared with typically developing peers. Similarly, the severity and chronicity of ADHD in childhood appear to predict substance use and abuse in adolescence (Molina & Pelham, 2003). However, the impairment associated with adolescents with ADHD may be most consistently manifested at school. Although achievement test scores tend to fall in or near the average range, high school students with ADHD exhibit higher than expected rates of poor report card performance (even after controlling for cognitive ability), grade retention, suspension, expulsion, and dropout (Kent et al., 2011). Thus, many adolescents with ADHD experience considerable failure at school during a developmental period typically marked by increasing autonomy and self-reliance. Despite the serious impairment shown by adolescents with ADHD, the psychosocial treatment literature for adolescents is less developed than the literature for young children with ADHD (Evans, Owens, & Bunford, 2013). One likely explanation for this lapse is the decline in hyperactivity and impulsivity symptoms as children enter adolescence (Evans, Brady et al., 2013), which led some investigators to believe that most children outgrew the disorder. We now know that even among adolescents who no longer meet the diagnostic criteria for combined presentation, large proportions continue to meet criteria for predominantly inattentive presentation in adolescence (Wilens et al., 2006). Most of the recent treatment development work regarding adolescents has involved middle school-based approaches (e.g., Evans, Schultz, DeMars, & Davis, 2011; Gureasko-Moore, DuPaul, & White, 2007; Langberg, Epstein, Becker, Girio-Herrera, & Vaughn, 2012), although the debilitating impairment associated with high school students with ADHD warrants the evaluation of treatments in high schools (Kent et al., 2011). School districts are spending considerable funds to prevent these poor outcomes, with costs averaging between $5,007 and $6,510 per student per year for special education services, grade retention, and disciplinary procedures (Robb et al. …