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.

School-based intervention for adolescents with attention-deficit/hyperactivity disorder: Effects on academic functioning.

Multi-component training interventions such as the Challenging Horizons Program (CHP) improve organization skills and academic functioning of middle school students with attention-deficit/hyperactivity disorder (ADHD); however, few studies have investigated treatment for high school students. We explored the extent to which CHP adapted for high school would improve proximal (e.g., organization skills, homework performance) and distal (e.g., report card grades) academic outcomes through 6-month follow-up relative to a community care (CC) condition. Participants included 186 adolescents who were randomly assigned to CHP (n = 92; 80% male; M age = 15.0; SD = 0.8) or CC (n = 94; 78% male; M age = 15.1; SD = 0.9) with CHP delivered over one school year. Parent, teacher, and self-report ratings of organization skills and academic performance, report card grades, and achievement tests were collected across multiple occasions. Intent-to-treat analyses using hierarchical linear modeling revealed significant improvements of small to medium magnitude (d range = 0.32 to 0.58) for parent-rated organization skills, homework performance, and academic functioning at 6-month follow-up. CHP effect on grades was small, but associated with a less steep decline than that found for CC. No statistically significant effects on teacher or self-report ratings were obtained. CHP appears efficacious for ameliorating organization skills and homework performance deficits exhibited by high school students with ADHD and can protect against decline in report card grades experienced by these students. CHP may require supplementation with academic skills instruction for some students and may need implementation beyond one school year to produce durable effects.

Social deficits in high school students with attention-deficit/hyperactivity disorder and the role of emotion dysregulation.

Attention-deficit/hyperactivity disorder (ADHD) is strongly associated with social functioning deficits in adolescents. However, the factors underlying this relationship are not well understood. Prior research has established that emotion dysregulation (ED) mediates the relationship between ADHD symptoms and social skills in middle school students and that the mediational role of ED is moderated by youth's level of depression. The current study examined whether this model holds true in high school students with ADHD, despite developmental and environmental changes during maturation. Cross-sectional measures of ADHD symptoms, emotion regulation, depression, and social functioning were collected from 174 high school students with ADHD (M age = 14.51; 81.4% male). Analyses were conducted using the PROCESS macro for SPSS. Bootstrapping results of the omnibus effect of a multiple-mediational model indicated that ADHD and ED jointly account for 49% of the variance in parent-rated social skills (i.e., evidence of mediation by ED). However, counter to our hypothesis, depression did not moderate this relationship. This study provides evidence that ED accounts for the relationship between ADHD and social deficits in an older adolescent population. Results have significant implications for intervention strategies to improve emotional self-awareness and control in adolescents with ADHD. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Alcohol use longitudinally predicts adjustment and impairment in college students with ADHD: The role of executive functions.

The primary aim of this study was to evaluate whether alcohol consumption longitudinally predicts the adjustment, overall functioning, and grade point average (GPA) of college students with ADHD and to determine whether self-report of executive functioning (EF) mediates these relationships. Sixty-two college students comprehensively diagnosed with ADHD completed ratings at the beginning and end of the school year. Regression analyses revealed that alcohol consumption rated at the beginning of the year significantly predicted self-report of adjustment and overall impairment at the end of the year, above and beyond ADHD symptoms and baseline levels of adjustment/impairment but did not predict GPA. Exploratory multiple mediator analyses suggest that alcohol use impacts impairment primarily through EF deficits in self-motivation. EF deficits in the motivation to refrain from pursuing immediately rewarding behaviors in order to work toward long-term goals appear to be particularly important in understanding why college students with ADHD who consume alcohol have a higher likelihood of experiencing significant negative outcomes. The implications of these findings for the prevention of the negative functional outcomes often experienced by college students with ADHD are discussed. (PsycINFO Database Record