Comparing School Based Interventions for Adolescents With Attention Deficit Hyperactivity Disorder

Attention deficit hyperactivity disorder (ADHD) is characterized by inattention,
hyperactivity, and impulsivity. Approximately 50% to 70% of children who had ADHD continue
to meet its criteria in adolescence, but the problems stemming from adolescent ADHD can be
more serious—including an increased risk of substance use, delinquency, academic failure,
serious social impairment, and legal problems. Problems in school more than double when
students with ADHD move from elementary school to middle and high school.

Treating ADHD with medications alone is often ineffective, but adding other methods, such as
behavioral treatments, may be beneficial. Researchers have developed a psychosocial
treatment for adolescents with ADHD, called the Challenging Horizons Program (CHP), that is
delivered in school and targets social impairment, family conflict, and academic failure.
Two versions of CHP were developed, an after-school model and a consultation model. The
after-school model involves 2 to 3 days of individualized treatment per week and has a
higher cost than the consultation model because it involves hiring specialized counseling
staff and finding space to house the program after school. The consultation model involves
teaching CHP intervention strategies to school staff, who then mentor students with ADHD and
deliver interventions as needed to solve problems. This model is less expensive, but it does
not deliver treatment as often or consistently as the after-school model. This study will
compare the after-school and consultation models of the CHP to determine their relative
efficacy and cost effectiveness. The study will also evaluate factors that may predict which
adolescents would benefit most from either of the two models.

Participation in this study will last a full school year. Participants from schools taking
part will be randomly assigned to one of three groups: after-school CHP, consultation CHP,
or standard community care. Participants receiving after-school CHP will attend two 2.5-hour
after-school sessions per week in which they will work with counselors on homework
management, educational skills, and interpersonal skills. Participants receiving
consultation CHP will be assigned a teacher mentor (who will volunteer to work with the
student), and the mentor and student will meet as needed. A study clinician will provide
support to the teacher mentors, who will learn the same interventions as counselors in the
after-school condition. Participants in the community care condition will not receive any
intervention but will receive a list of community psychosocial and medical service providers
for children and their families. All participants will undergo study assessments
pre-treatment; in November, January, and March of the school year; post-treatment; and at a
6-month follow-up. Assessments will include questionnaires and clinical interviews completed
by student, their parents, and their teachers. ADHD symptoms, academic performance, relevant
skills of adolescents, and program costs will be assessed.

Inclusion Criteria:

- Meets DSM-IV criteria for ADHD, including all ADHD subtypes (predominately
inattentive, predominately hyperactive/impulsive, and combined)

- All common comorbid conditions not listed as exclusionary will be included.

Exclusion Criteria:

- Full Scale Intelligence Quotient (FSIQ) less than 80

- Anticipated attendance for participant or parent less than 80% for scheduled
activities

- Meets diagnostic criteria for bipolar disorder, psychotic disorder, substance
dependence (but not substance abuse), or obsessive-compulsive disorder (OCD)