Attention Magazine December 2023

This research update reviews two recent studies that investigated the outcomes of school-based programs for youth with ADHD. What are researchers learning about such interventions?

The first study examined an intervention delivered by mental health professionals to support youth with ADHD in social and academic functioning, involving individual, group, and parent sessions. Students in the program showed improved parent- and youth-reported social skills, parent-reported inattention symptoms, and parent-reported emotion regulation.

The second study investigated an intervention delivered by peers, which included goal-setting, homework and materials management, school performance problem-solving, and time management. The program was generally viewed as acceptable, and showed effectiveness in supporting organization skills, attendance, and academic motivation.

Taken together, these school-based interventions appear effective in supporting adolescents with ADHD in various areas.

A school-based mental health intervention

Adolescents with ADHD likely experience both academic and social difficulties. Challenges in these domains can influence each other and often endure into adulthood, potentially resulting in risky behaviors like substance abuse, as well as increased susceptibility to bullying and victimization.

The Challenging Horizons Program (CHP) is a mental health intervention that aims to support adolescents with ADHD in academic and social functioning through a range of interventions conducted by mental health professionals in schools. The program includes various components, such as individual, group, and parent sessions. In individual and group sessions, interventions cover such areas as organizational skills, problem-solving for academic behaviour and study skills, goal-setting, and interpersonal skills. Parents attend sessions that covered such topics as creating a plan for and reinforcing homework management, and education on ADHD and common adolescent challenges.

This study investigated how the CHP influenced the mental health and functioning of high-school adolescents with ADHD. One hundred and eighty-six students from ninth to eleventh grade from a total of twelve schools in the United States participated over a three-year period. Participants were randomly assigned to receive either the CHP or community care. Participants in community care were provided with a list of resources in their community. CHP participants and their parents received questionnaires that examined areas such as social functioning, attention and behavioural symptoms, anxiety, mood difficulties, and emotion regulation.

The adolescents who participated in the CHP showed improvements in social skills as rated by both themselves and their parents. Other areas that showed improvement included parent-reported youth inattention symptoms, youth emotion regulation, and parental stress. Self-ratings of anxiety and depression also showed trends favoring the program over community care.

These findings contribute to the growing body of literature supporting the CHP as a promising school-based intervention for supporting social functioning and related outcomes. Future directions for research include investigating the feasibility of the program as delivered by staff or other individuals in the schools.

Evans SW, DuPaul GJ, Benson K, Owens JS, Fu Q, Cleminshaw C, Kipperman K, & Margherio S. (2023). Social functioning outcomes of a high school-based treatment program for adolescents with ADHD. Journal of Clinical Child and Adolescent Psychology, 1-16. https://doi.org/10.1080/15374416.2023.2235693

A peer-delivered skills training program

High schools face a continual struggle to find professionals who are available and trained to provide evidence-based interventions to students with ADHD. Peers with strong academic skills are a potential group of interventionists to support these students.

The Students Taking Responsibility and Initiative through Peer Enhanced Support (STRIPES) intervention is a peer-delivered program that includes short- and long-term goal setting, managing materials, planning homework, problem-solving and discussing school performance, and time management. This study investigated how the STRIPES program supports high school students with ADHD symptoms in the United States. Two studies were conducted.

The first study included eighteen ninth-grade students at one school and examined the practical application of the program as well as student’s perspectives on the program’s advantages and limitations. The intervention consisted of sixteen weekly sessions where feasibility was measured, and students who participated shared their post-intervention feedback through questionnaires. Students found the program acceptable overall, but attendance issues were observed, primarily due to after-school conflicts, being sick or absent that day, and forgetfulness. The reasons of after-school conflicts and forgetfulness prompted suggestions to deliver the program during the school day.

In the second study, seventy-two ninth-grade students from three different schools were randomly assigned to either the STRIPES program or a monitored group that did not participate in the program. Schools were advised to explore different approaches that could address the challenges identified in the first study. Each school chose a different delivery method. The ninth-grade students participating in the intervention received the program for a duration of sixteen weeks, with participation from eighteen peer interventionists.

Academic improvement, organization skills, and motivation were examined along with whether differences in delivery impacted the effectiveness of the program. Results differed by delivery method. A pull-out model, in which the program took place during an elective class period, met effectiveness metrics including achieving better attendance, and preventing decreases in class attendance, academic motivation, and organizational skills.

These findings suggest that a peer-delivered skills training program for high school students with ADHD symptoms could help support organization skills, academic motivation, and attendance. Additional research is needed to assess the program’s alignment with the school population, and its impact on additional student outcomes to better support students with ADHD symptoms.

Sibley MH, Morley C, Rodriguez L, Coxe SJ, Evans SW, Morsink S, & Torres F. (2020). A peer-delivered intervention for high school students with impairing ADHD symptoms. School Psychology Review, 49, 275-290. https://doi.org/10.1080/2372966X.2020.1720803

Ivy Debinski is an educator holding a Bachelor of Arts in Psychology and a Bachelor of Education from the University of British Columbia. She is dedicated to studying social and emotional learning assessments and interventions, with an emphasis on their implementation to benefit children with ADHD.

Yuanyuan Jiang, PhD, CPsych, is an assistant professor in school and applied child psychology at the University of British Columbia and a registered clinical psychologist. She directs the Attention, Behaviour, and Cognitions (ABC) Lab, which focuses on studying how attention, behavior, and cognitions interact to improve assessments and interventions for children with inattentiveness and/or hyperactivity/impulsivity.