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.

Longitudinal Examination of Sexual Risk Behavior in College Students With and Without Attention-Deficit/Hyperactivity Disorder.

The present study sought to identify differences in the rates and predictors of risky sexual behavior among college students with and without attention-deficit hyperactivity disorder (ADHD). Current ADHD diagnosis, medication status among those with ADHD, executive functioning, substance use, comorbid anxiety, comorbid depression, and gender were identified as potential predictors of increased risky sexual behavior. Multiple group latent growth curve modeling was used to estimate trajectories of risky sexual behavior across four years of college among college students with ADHD (nmedicated = 99, nunmedicated = 105) and a comparison group (n = 217) recruited from colleges throughout the eastern United States (M age = 18.23 years, 53% female, 70% White). First-year college students with ADHD reported significantly higher rates of sexual risk behavior than their peers without ADHD, with no significant differences found based on medication status. Students with ADHD who were taking medication for ADHD reported significant decreases in risky sexual behavior over time. Among college students with ADHD, anxiety was related to increased current risky sexual behavior in the medicated group, while depression was predictive of decreased future risky sexual behavior in the unmedicated group. Alcohol and cannabis use were significantly associated with increased mean levels of risky sexual behavior across all three groups, and cannabis use was associated with decreased future risky sexual behavior within the comparison group. Executive functioning deficits and male gender were predictive of risky sexual behavior within the comparison group. The results demonstrate that college students with ADHD, regardless of medication status, are at an increased likelihood of engaging in risky sexual behavior.

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.

The conceptual and diagnostic importance of ADHD-related impairment: a Commentary on Arildskov et al. (2021).

Arildskov et al. (2021) provide compelling evidence regarding the importance and nature of functional impairment in advancing diagnostic assessment and treatment of attention-deficit/hyperactivity disorder (ADHD). Their findings indicate that (a) ADHD is dimensional for both symptom severity and impairment, (b) symptoms and impairment are related but separate constructs, (c) diagnostic assessment should focus equally on symptoms and impairment, and (d) the symptom threshold for ADHD diagnosis is arbitrarily defined with respect to presence of impairment. Results from this study can be extended to raise the profile of functional impairment in research and clinical practice in terms of diagnostic assessment, treatment outcome measurement, improvements to diagnostic systems, and advancements in our understanding of ADHD as a disorder.

Factor Structure of the Sexual Risk Survey Among U.S. College Students with and without ADHD: Assessing Clinical Utility with a High-Risk Population.

Young adults, particularly college students, report a higher prevalence of risky sexual behavior than the general population, increasing their likelihood for unplanned pregnancy, sexually transmitted infections (STIs), and negative psychological outcomes. Although sexual risk behavior and its consequences are a major public health concern, current prevention literature is insufficient and relies on sexual risk measures with limited psychometric support. The present study, therefore, examined the psychometric properties of a sexual risk survey (SRS; Turchik, Garske, in Arch Sex Behav 38:936-948, 2009), using data from the first year of a longitudinal study following the outcomes of college students with and without attention-deficit/hyperactivity disorder (ADHD; N = 410). Principal components analyses were conducted to assess the factorial structure of the SRS comparing results from a general college population and a college population considered to be high-risk (ADHD). Results revealed four components across both samples. Internal consistency estimates for component scores and total scores ranged from .627 to 918. Implications of the findings are discussed and suggestions for future studies are advanced.

Academic Trajectories of College Students with and without ADHD: Predictors of Four-Year Outcomes.

Objective: Completing a college degree is associated with success in employment, financial earnings, and life satisfaction. Mental health difficulties, including attention-deficit/hyperactivity disorder (ADHD), can compromise degree completion.Method: We examined 4-year academic performance trajectories of 201 college students with ADHD (97 receiving medication [ADHD-Med], 104 not receiving medication [ADHD-NoMed]) relative to 205 non-ADHD Comparison students. Demographic (e.g., sex, race/ethnicity), psychological (e.g., self-reported depression and anxiety symptoms), and service-related (e.g., receipt of academic support) variables were included as predictors of intercept (i.e., Year 1 performance) and slope (yearly change) of semester GPA, progress toward graduation, and self-reported study skill strategies.Results: College students with ADHD obtained significantly lower GPAs (Hedge's g = -0.46 and -0.63) and reported less frequent use of study skills strategies (Hedge's g range from -1.00 to -2.28) than Comparison students. Significantly more Comparison students (59.1%) persisted through eight semesters relative to ADHD-NoMed students (49%). Multiple variables predicted outcomes with parent education, fewer depressive symptoms, better executive functioning, and receipt of high school Section 504 accommodations and college academic support services among the strongest predictors.Conclusions: Findings suggest support services for students with ADHD should begin prior to college matriculation and focus on improving executive functioning skills and depressive symptoms to increase chances of academic success.

Future Directions for Psychosocial Interventions for Children and Adolescents with ADHD.

Multiple psychosocial interventions are efficacious for children and adolescents with attention-deficit/hyperactivity disorder (ADHD) including behavioral parent training, behavioral classroom management, behavioral peer interventions, and organization training programs. Unfortunately, there is a significant gap between research and practice such that evidence-based treatments often are not implemented in community and school settings. Using a life course model for ADHD treatment implementation, we discuss future research directions that support movement from the current, fragmented system of care to a more comprehensive, integrated, and multisystemic approach. Specifically, we offer six recommendations for future research. Within the realm of treatment development and evaluation, we recommend (1) identifying and leveraging mechanisms of change, (2) examining impact of youth development on treatment mechanisms and outcomes, and (3) designing intervention research in the context of a life course model. Within the realm of implementation and dissemination, we recommend investigating strategies to (4) enhance access to evidence-based treatment, (5) optimize implementation fidelity, and (6) examine and optimize costs and cost-effectiveness of psychosocial interventions. Our field needs to go beyond short-term, efficacy trials to reduce symptomatic behaviors conducted under ideal controlled conditions and successfully address the research-to-practice gap by advancing development, evaluation, implementation, and dissemination of evidence-based treatment strategies to ameliorate ADHD-related impairment that can be used with fidelity by parents, teachers, and community health providers.

Exploring how adolescents with ADHD use and interact with technology.

INTRODUCTION: The ubiquity of technology is reshaping the way teens express themselves and interact with peers. Considering that teens with attention-deficit/hyperactivity disorder (ADHD) experience a range of social impairments and that risk behaviors have the potential to be more widespread and damaging online, understanding how teens with ADHD use the Internet is important. METHODS: The current study included 58 teens (72.4% boys; 13-16 years old) from the United States of America with ADHD. Study aims were to examine these teens' Internet use frequency, preferred online activities, Facebook interactions, and online risk behaviors (i.e., cyberbullying and sexting). Associations between online behaviors and offline symptoms and behaviors were explored to identify potential risk and protective factors. RESULTS: Findings suggested that teens with ADHD use technology in similar ways as do the general population of teens described in previous research but appeared at unique risk of cyberbullying behaviors. Offline risks were associated with online risk behaviors. Using Facebook was associated with online risks (e.g., weak online connections) and offline risks (e.g., poorer social skills and more internalizing symptoms). CONCLUSIONS: Online social platforms permit the exploration of social behaviors via naturalistic observation. It is imperative researchers gain understanding of the increasingly prevalent online social worlds of teens. Such an understanding may enable researchers to formulate effective social interventions for teens with ADHD.

A National Description of Treatment among United States Children and Adolescents with Attention-Deficit/Hyperactivity Disorder.

OBJECTIVE: To characterize lifetime and current rates of attention-deficit/hyperactivity disorder (ADHD) treatments among US children and adolescents with current ADHD and describe the association of these treatments with demographic and clinical factors. STUDY DESIGN: Data are from the 2014 National Survey of the Diagnosis and Treatment of ADHD and Tourette Syndrome, a follow-back survey of parents from the 2011-2012 National Survey of Children's Health. Weighted analyses focused on receipt of ADHD treatment among children aged 4-17 years with current ADHD (n = 2495) by 4 treatment types: medication, school supports, psychosocial interventions, and alternative treatments. RESULTS: Medication and school supports were the most common treatments received, with two-thirds of children and adolescents with ADHD currently receiving each treatment. Social skills training was the most common psychosocial treatment ever received (39%), followed by parent training (31%), peer intervention (30%), and cognitive behavioral therapy (20%). Among alternative treatments, 9% were currently taking dietary supplements, and 11% had ever received neurofeedback. Most children (67%) had received at least 2 of the following: current medication treatment, current school supports, or lifetime psychosocial treatment; 7% had received none of these 3 treatment types. CONCLUSIONS: A majority of school-aged children and adolescents with ADHD received medication treatment and school supports, whereas fewer received recommended psychosocial interventions. Efforts to increase access to psychosocial treatments may help close gaps in service use by groups currently less likely to receive treatment, which is important to ensure that the millions of school-aged US children diagnosed with ADHD receive quality treatment.

Face-to-Face Versus Online Behavioral Parent Training for Young Children at Risk for ADHD: Treatment Engagement and Outcomes.

Attention deficit/hyperactivity disorder (ADHD) is associated with significant challenges in child functioning. Although behavioral parent training (BPT) can reduce ADHD symptoms, factors associated with traditional face-to-face (F2F) delivery results in only about half of families receiving BPT. The purpose of this pilot randomized controlled trial was to examine parent engagement and program acceptability of F2F and online BPT, as well as the efficacy of both formats relative to a waitlist control (WLC) group. Participants were 47 families with preschool children (30 boys, 17 girls) who were between the ages of 3 years 0 months (3;0) and 5 years 11 months (5;11) old who were identified at risk for ADHD. Children were randomly assigned to F2F or online BPT or to WLC; parents in the two treatment conditions received 10 sessions of BPT. Assessment data for all groups were collected at pre-, mid-, and posttreatment. Both intervention formats resulted in high attendance (M = 80%) and significantly improved parent knowledge of interventions, treatment implementation fidelity, and child behavior (reduced restlessness and impulsivity, improved self-control, affect, and mood) compared with WLC. However, parents in the F2F group reported significantly higher acceptability ratings than parents in the online group. Findings indicate a streamlined BPT delivered online or F2F results in high levels of engagement, acceptability, as well as parent treatment knowledge and fidelity. Online BPT is associated with similar efficacious outcomes with F2F BPT, suggesting the need for further research to determine variables that predict greater acceptability for and adoption of this format.

Rates and Patterns of Comorbidity Among First-Year College Students With ADHD.

The purpose of this study was to examine rates and patterns of non-attention-deficit/hyperactivity disorder (non-ADHD) psychiatric diagnoses among a large group of 1st-year college students with and without ADHD. A total of 443 participants, including 214 men and 229 women ranging in age from 18 to 22 years of age (M = 18.2), were recruited from 9 colleges involved in a large-scale, multisite longitudinal investigation. Non-Hispanic Caucasian students represented 67.5% of the total sample. A comprehensive multimethod assessment approach was used in conjunction with expert panel review to determine both ADHD and comorbidity status. Significantly higher rates of overall comorbidity were found among college students with well-defined ADHD, with 55.0% exhibiting at least one comorbid diagnosis and 31.8% displaying two or more, relative to the corresponding rates of non-ADHD diagnoses among Comparison students, which were 11.2% and 4.0%, respectively. These differences in overall comorbidity rates were, in large part, attributable to the increased presence of depressive and anxiety disorders, especially major depressive disorder (active or in partial remission) and generalized anxiety disorder, among the students with ADHD. Within the ADHD group, differential comorbidity rates were observed as a function of ADHD presentation type and gender but not ethnic/racial diversity status. The current findings fill a gap in the literature and shed new light on the rates and patterns of comorbidity among emerging adults with ADHD in their 1st year of college. Implications for providing clinical and support services to college students with ADHD are discussed.

Multi-Informant Assessment of ADHD Symptom-Related Impairments Among Children and Adolescents.

Existing methods of assessing attention-deficit/hyperactivity disorder (ADHD) are limited because they do not examine impairments in relation to symptoms of ADHD. This study investigated parent and teacher ratings of multiple domains of impairment, assessed in relation to the symptom dimensions of ADHD using the ADHD Rating Scale-5. Nationally representative samples of children rated by parents and teachers were recruited through commercial research firms. One sample included 2,079 parents who rated one of their children of age 5 to 17 years. The second sample included 1,070 teachers in grades K to 12 who rated 2 randomly selected students on their class rosters. Informants rated the extent to which each child displayed the 18 behaviors symptomatic of ADHD over the previous 6 months, as well as symptom-related impairments in the areas of family/teacher relationships, peer relationships, academics, behavior problems, homework, and self-esteem. Respondents were asked to complete the 6 impairment items after rating each of the Inattention and Hyperactivity/Impulsivity symptom items. For both informants a 6-factor model that combined impairment items across source of impairment was adequate and superior to a 2-factor structure based on source of impairment (i.e., impairment due to Inattention vs. Hyperactivity-Impulsivity). Impairment ratings were impacted by child demographic factors, but effect sizes were low. In contrast, impairment ratings were strongly related to ratings on the ADHD symptom dimensions. The study provides support for assessing 6 symptom-related domains of impairment but does not support differentiating whether Inattention or Hyperactivity-Impulsivity is the source of impairment.

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.

School-Based Intervention for Adolescents With ADHD: Predictors of Effects on Academic, Behavioral, and Social Functioning.

Adolescents with attention-deficit/hyperactivity disorder (ADHD) experience significant academic, behavioral, and social skill difficulties including underachievement, risk for school dropout, poor peer relations, and emotion dysregulation. Although stimulant medication reduces ADHD symptoms, psychosocial and educational interventions are necessary to address functional impairments. We examined the nature and predictors of academic, behavioral, and social skills trajectories in response to multicomponent organizational and interpersonal skills training in 92 high school students with ADHD. Latent trajectory class analyses revealed positive treatment response ranging from 61.5% (report card grades) to 100% (inattention symptoms, organizational skills, social skills). Organizational skill and academic grade treatment response trajectories were predicted by assigned sex, pretreatment anxiety, and treatment dosage, while improvement in behavioral and social functioning was associated with better emotion regulation and family relations prior to treatment along with stronger working alliance with treatment coach at midtreatment. Multicomponent organizational and interpersonal skills training appears effective for most high school students with ADHD and the degree treatment-induced change is associated with multiple malleable factors can be leveraged to enhance intervention response.

Assessing attention-deficit/hyperactivity disorder-related impairment: Differential item functioning based on child demographic characteristics.

Although numerous studies have examined how child demographic characteristics may impact ratings of attention-deficit/hyperactivity disorder (ADHD) symptoms, there is limited research on how these factors are related to ratings of impairment. This study examined child characteristics (assigned sex, age, race, ethnicity) that may affect parent and teacher ratings of ADHD symptom-related impairments in relationships with family and/or teacher, peer relationships, behavior disruption, academic impairment, homework performance, and self-esteem. The study was conducted using independent U.S. national samples of parents (n = 2,075) and teachers (n = 1,070). Informants rated impairments related to inattention and hyperactivity-impulsivity using the ADHD Rating Scale-5. Rasch analyses were used to examine differential item functioning in relation to child characteristics. Separate analyses were conducted for inattention- and hyperactivity-impulsivity-related impairment for both the parent and teacher samples. For teacher ratings, only two items (behavior disruption, homework impairment) demonstrated differential item functioning with intermediate or large effect sizes (≥ .426 logits) in relation to any child characteristic; whereas for parent ratings, all six items displayed differential item functioning with at least intermediate effect sizes in relation to one or more child characteristics. The findings indicated several areas in which child characteristics may have an impact on ratings of ADHD-related impairment, particularly based on parent ratings, which have potential implications for the diagnostic assessment of ADHD and highlight the need for further research. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Psychometrics of rating scales for externalizing disorders in Japanese outpatients: The ADHD-Rating Scale-5 and the Disruptive Behavior Disorders Rating Scale.

OBJECTIVES: This study validated the Japanese version of the Attention-Deficit/Hyperactivity Disorder-Rating Scale-5 (ADHD-RS-5) and the Disruptive Behavior Disorders Rating Scale. We extended the ADHD-RS-5 by adding the oppositional defiant disorder and conduct disorder subscales to compare the two rating scales psychometrically. METHODS: We examined the internal consistency, test-retest reliability, construct validity and criterion validity of the two rating scales in 135 Japanese outpatients aged 6-18 years. RESULTS: The internal consistency and test-retest reliability were good for all the subscales of the two rating scales except for the conduct disorder subscale of the ADHD-RS-5 extended. Good construct validity was revealed by expected correlational patterns between subscales from the two rating scales and the Children Behavior Checklist. The criterion validity was good for all the subscales of the two rating scales rated by parents, while teacher-ratings revealed substantially lower predictive ability for all the subscales. Agreement between parent- and teacher-ratings of the two rating scales was generally moderate and using predictive ratings alone of both ratings showed the best predictive ability among the integration methods examined. CONCLUSION: The two rating scales have sound psychometric properties and will aid in screening and severity assessment of externalizing disorders in Japanese clinical settings.

Educational diagnostic label and teacher self-efficacy: Impact on classroom intervention choice.

Children with attention-deficit/hyperactivity disorder (ADHD) and specific learning disabilities (SLD) face similar academic and behavioral challenges. Although combined behavioral and academic interventions (AIs) are among the most effective for each disability, a child's diagnostic label and teacher self-efficacy may influence teacher intervention choice. This study examined the relationship between diagnostic label and teacher self-efficacy on intervention choice using a sample of 206 general education elementary school teachers (female = 69.9%; White = 60.7%). Results showed that teachers were significantly more likely to endorse AIs for children with SLD as compared to ADHD (ds = 0.29-0.35), even when children had identical academic needs. Furthermore, self-efficacy did not moderate this relationship but was an individual predictor of intervention endorsement. Findings indicate the need to increase teacher awareness of academic impairments related to ADHD and to further identify teacher factors that could impact choice of intervention and decrease intervention selection biases. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

School-Based Interventions for Elementary School Students with Attention-Deficit/Hyperactivity Disorder.

Children with attention-deficit/hyperactivity disorder experience significant academic, social, and behavioral impairments in elementary school settings. Although psychopharmacologic treatments can improve symptomatic behaviors, these rarely are sufficient for enhancing school performance. Thus, medication should be supplemented by one or more school interventions, including behavioral strategies, academic interventions, behavioral peer interventions, organizational skills training, and self-regulation strategies. Although all of these school interventions have been found effective, classroom behavioral strategies, organizational skills training, and self-regulation strategies have the strongest empirical support. Clinicians should collaborate with school mental health professionals to encourage implementation of effective school interventions across school years.