Effects of Compliance to a Training Intervention for High School Students with ADHD.

OBJECTIVE: We evaluated the effects of treatment compliance with the Challenging Horizons Program (CHP) for high school aged adolescents with attention-deficit hyperactivity disorder (ADHD). METHOD: Participants were 185 high school aged adolescents (65% non-Hispanic White; 79% male) with a diagnosis of ADHD who were randomly assigned to either CHP or community control. Outcomes included parent-rated academic functioning, parent- and self-rated social-emotional functioning, and GPA. The complier average causal effect (CACE) was estimated using propensity-weighted models for youth engaging in ≥ 30 CHP individual sessions (15-20 min) across the academic year. RESULTS: Most (78%) CHP participants engaged in≥30 CHP sessions. CACE analyses using latent growth curve modeling revealed significant treatment effects among treatment compliers across ratings of academic and social outcomes relative to similar control participants. For most outcomes, CACE estimates were larger than those found in intent-to-treat analyses, especially at 6-months follow-up. CONCLUSIONS: Compliance with 30 or more individual CHP sessions appeared to be an attainable threshold associated with incremental gains across several academic and social outcomes. Effects of compliance were amplified at 6-months follow-up, supporting the hypothesized theory of change of training interventions. Future work should focus on facilitators of treatment engagement and feasibility of the CHP as delivered by high school personnel.

Cost-Effectiveness of a Training Intervention for Adolescents with ADHD.

OBJECTIVE: The aim of this study was to examine the costs and cost-effectiveness of a school-based training intervention delivered at varying levels of intensity with adolescents with attention-deficit/hyperactivity disorder (ADHD). Costs were examined in relation to post-treatment and 6-month follow-up effects of the Challenging Horizons Program (CHP), a training intervention for adolescents with ADHD. METHOD: A total of 326 middle-school students (71% male; 77% White) with ADHD were randomized to an after-school version of the CHP (CHP-AS), a less-intensive mentoring version (CHP-M), or routine community care. Detailed time logs were maintained throughout the study and were used to estimate costs associated with each condition. Student grade point average (GPA) and parent-rated ADHD symptoms and organization skills were collected at post-treatment and 6-month follow-up. RESULTS: The cost analysis revealed that CHP-AS was more costly per student than CHP-M, both in terms of overall costs and direct expenses to the school. However, CHP-AS was less costly per hour of intervention provided to the youth than CHP-M. Incremental cost-effectiveness ratios revealed that CHP-M may be the more cost-effective option for post-treatment effects, yet CHP-AS may be the more cost-effective option in the long term for sustained gains in organization skills and GPA. CONCLUSIONS: This study provides stakeholders important information to make decisions regarding allocation of finite monetary resources to meet their prioritized goals.

Social Functioning Outcomes of a High School-Based Treatment Program for Adolescents with ADHD.

OBJECTIVE: We evaluated the extent to which receiving the multi-component treatment of the Challenging Horizons Program (CHP) would lead to significant improvements in social functioning, as well as in inattention, internalizing symptoms, parent stress, and emotion dysregulation for high-school-aged adolescents with attention-deficit hyperactivity disorder (ADHD). METHOD: Participants were 186 high-school-aged adolescents (74% White) with a diagnosis of ADHD who were randomly assigned to either CHP (n = 92; 80% boys; M age = 15.0; SD = 0.8) or Community Care (CC; n = 94; 78% boys; M age = 15.1; SD = 0.9) within each of 12 participating schools. Parent and adolescent reports of social functioning were the primary outcome measures. Secondary outcomes included ratings of symptoms of ADHD and related disorders, parent stress, and emotion regulation. RESULTS: Intent-to-treat analyses using hierarchical linear modeling revealed significant group-by-time interactions of medium magnitude (d range = .40 to .52) on parent-rated social skills. Significant group-by-time benefits were also identified for adolescent self-rated social skills as well as the secondary outcomes of parent-rated inattention symptoms, emotion regulation, and parenting stress. DISCUSSION: CHP appears to benefit social skills along with related characteristics for adolescents with ADHD. Understanding these unique findings for this population informs additional research related to treatment mechanisms and effectiveness trials.

Effects on alcohol and substance use of a school-based training intervention for adolescents with ADHD.

INTRODUCTION: Adolescents with attention-deficit/hyperactivity disorder (ADHD) may be at risk for early, escalating patterns of alcohol and substance use via academic, peer, and familial impairment. Existing school-based interventions for youth with ADHD effectively target these risk factors, yet their effects on alcohol and substance use have not been explored. We examined the immediate and long-term alcohol and substance use outcomes of an evidence-based school-based intervention for adolescents with ADHD. METHOD: A total of 186 (Mage = 15, 79 % boys, 78 % White, 11 % Hispanic) adolescents with ADHD were randomized to either a school-based training intervention targeting academic and social skills or a treatment-as-usual control group. A subset of youth was followed into emerging adulthood (5 year follow-up; n = 73). Participants reported on their alcohol and substance use behaviors and problems at post-treatment, 6-month follow-up, and 5-year follow-up. RESULTS: Two-part hurdle models controlling for prior use and demographics indicated treatment was associated with improvements in substance use outcomes among youth using any substances at 6-month follow-up (ß = -0.45). However, among youth reporting any alcohol use at the 5-year follow-up, treatment was associated with worse alcohol use problems relative to the control condition (ß = 0.27). Approximately 22 % of intervention participants met criteria for risky drinking behavior compared to 5 % of participants in the control group. CONCLUSION: We found mixed evidence that a school-based intervention associated with positive outcomes on academic, social, and emotional functioning for adolescents with ADHD also prevented adverse alcohol and substance use outcomes. These unexpected results serve as a call for extended follow-up periods to identify the durability of intervention benefits and potential for downstream iatrogenic effects. Additional research is needed to identify school-based intervention strategies that can effectively deter substance use risk among select populations.

Promoting Diversity in the Biomedical Sciences with the Teen Science Ambassador Program.

Mental health and substance use fields suffer from underrepresentation of racially and ethnically minoritized, first-generation college student, and female members. The homogeny of the current workforce can impede scientific productivity, creativity, and problem-solving in addressing health-related issues. Our team developed the Teen Science Ambassador Program (TSAP) to provide underrepresented minoritized (URM) high school students with science-focused education, research opportunities, and mentoring within their community. The goals of the current study were to describe the logic model and structure of TSAP, provide access to a resource bank to facilitate replication across communities, and present preliminary mixed-methods outcome data to guide development of the program. Qualitative and quantitative results from our first two cohorts (N = 18; 89% girls; 72% Black or African American; 22% Hispanic or Latino; 40% of parents did not have a college degree) indicated TSAP contributed to sustained interest, increased confidence, and enhanced sense of belonging in science-related fields, especially those pertaining to mental health and substance use. These findings highlight the program's promise to facilitate entry and sustainment of URM and female youth within the biomedical sciences. Given the urgent need to promote diversity in the mental health and biomedical workforce, we provide readers with a resource bank to facilitate replication across communities.

The role of perceived parent drinking motives on alcohol use among adolescents with and without childhood attention-deficit/hyperactivity disorder.

OBJECTIVE: Parent history of alcohol-related problems and antisocial behaviors contribute to adolescent alcohol use and are associated with offspring attention-deficit/hyperactivity disorder (ADHD). Youth with ADHD may be susceptible to intergenerational transmission of alcohol-related cognitions, which may model drinking motives that enhance risk for adolescent alcohol use. We examined whether childhood ADHD and parent history of alcohol use disorder, with or without antisociality, were associated with adolescents' perceptions of their parents' drinking motives and whether these perceptions predicted their alcohol use behaviors. METHOD: Adolescents (N = 199; 56% with ADHD; Mage = 15.73) completed the Drinking Motives Questionnaire regarding perceptions of their parents' drinking motives. Participants subsequently reported their past-year alcohol use behaviors (Mage = 16.95). Parents reported their history of alcohol-related problems and antisocial symptoms. Covariates included adolescent gender (7% girls), race (9% self-identified Black), and parental education and marital status. RESULTS: Perceived parent drinking motives were highest for social and lowest for conformity motives, consistent with adult self-reports in the literature. Parent alcohol use and antisociality history predicted perceptions of parent drinking motives, and child ADHD only predicted perceptions of parent social drinking motives. Perceived parent drinking motives predicted adolescent alcohol use, but only among youth without ADHD. CONCLUSION: Findings reflect the potential importance of assessing adolescent perceptions of parent drinking motives for adolescents without ADHD and a possible need for supporting parents in communicating about their own alcohol use. Future research should consider alternative strategies (e.g., assessing implicit cognitions) for studying the link between alcohol-related cognitions and behaviors for adolescents with ADHD. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Romantic Relationships and Sexual Behavior Among Adolescents With ADHD.

Objective: Both qualitative and quantitative analyses were used to (a) describe the romantic and sexual relationships of adolescents with ADHD and (b) examine how ADHD-related impairments (e.g., social skill deficits and emotion dysregulation [ED]) are associated with romantic relationship outcomes in this group. Method: Adolescents with ADHD (N = 171; 80% male; 70% White) responded to questions about their romantic and sexual relationship experiences and ED. Parents provided ratings of ADHD symptoms, ED, and social skills. Results: Adolescents with ADHD reported high rates of romantic relationship turnover and low rates of physical intimacy. More severe self-reported ED was associated with increased likelihood of engaging in romantic relationships, having more romantic relationship partners, increased likelihood of engaging in sexual intercourse, and increased likelihood of engaging in unprotected sex. Conclusion: Early intervention programs that alter the developmental trajectory of romantic relationships among individuals with ADHD may benefit from targeting ED among these youth.

Organization interventions as a mediator of change in grades in the Challenging Horizons Program.

This study evaluated whether an organization intervention was a mediator of change for grade point average (GPA) in a randomized clinical trial of a school-based treatment program for adolescents with attention deficit hyperactivity disorder (ADHD). A demographically diverse sample of 148 participants (105 males) with a diagnosis of ADHD were recruited from nine middle schools. Comprehensive diagnostic evaluations were completed and participants were randomized into one of three conditions (two active treatment conditions, one control condition) for a randomized clinical trial that lasted an entire school year. The results of the trial are reported elsewhere (Evans et al., 2016; Schultz et al., 2017); in this study we evaluated four of the criteria for determining mediation as reported by Kazdin (2007) to determine whether response to the organization intervention in this school-based treatment program mediated the relationship between dosage and GPA beyond previous GPA. The results provided evidence that response to the organization intervention mediated the relationship between intervention dosage and change in GPA.

The role of emotion regulation in alcohol use among adolescents with attention-deficit/hyperactivity disorder.

The purpose of the present study was to determine the role of emotion regulation in the pathway to problematic alcohol use among adolescents with attention-deficit/hyperactivity disorder (ADHD), specifically investigating the total effect of emotion regulation on problematic alcohol use and the indirect effect of emotion regulation through social skills on problematic alcohol use within a 2-wave longitudinal design. The potential protective effect of parent knowledge of these effects was assessed. Participants were 149 adolescents with ADHD (mean [M] = 15.11 years old; 78% male), and approximately 19% endorsed problematic alcohol use at Time 2. Contrary to our hypothesis, emotion regulation was not associated with subsequent problematic alcohol use without social skills in the model, and parent knowledge did not moderate this pathway. The results supported an indirect effect of emotion regulation on problematic alcohol use via social skills, although the direction of this effect was unexpected. Greater emotion regulation skills were associated with greater social skills, which in turn were associated with a higher likelihood of problematic alcohol use. Parent knowledge was protective against this indirect effect, such that the indirect effect was only present in the context of low parent knowledge. The findings delineate the roles of risk and protective factors associated with the progression from experimentation to alcohol use disorder among adolescents with ADHD. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Universal screening in middle and high schools: Who falls through the cracks?

Navigating academic demands in middle and high school may be particularly challenging for youth experiencing emotional and behavioral difficulties, and screening practices are a necessary first step in identifying youth in need of services. The goal of this study was to inform efficient universal screening practices in secondary schools by comparing 3 common methods of screening, including self- and teacher report on the Strengths and Difficulties Questionnaire, and grade point average (GPA) to indicate moderate and high levels of risk. Participants were 2,350 secondary students (47% female; 94% non-Hispanic White) and their teachers in 1 socioeconomically diverse school district. Using the moderate-risk criteria, there was low agreement among methods, and almost half the sample (46%) was identified as at risk by at least 1 of the 3 methods, indicating that responding to the needs of students who cross this liberal cutoff may not be feasible given school resources. Using the high-risk criteria reduced the agreement among screening measures. Self-report identified the most students as high risk and was more sensitive to teacher-rated concerns than the converse. If students were uniquely identified by teacher report, teachers rated them at high levels of risk, and predominant concerns were related to conduct problems. GPA captured few students with self- or teacher-rated internalizing or externalizing difficulties. Implications for universal screening within secondary schools are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).