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Barney S, Sibley MH, Coxe SJ, Meinzer MC, Pelham WE. High Versus Low Intensity Summer Adolescent ADHD Treatment Effects on Internalizing, Social, and Self-Esteem Problems. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2024; 53:389-396. [PMID: 35617099 DOI: 10.1080/15374416.2022.2062761] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The current study aims to evaluate the effectiveness of a high-intensity (HI) versus a low-intensity (LI) skills-based summer intervention delivered to adolescents with ADHD by school staff in improving depressive symptoms, anxiety symptoms, social problems, and self-esteem. Participants were 325 ethnically diverse rising sixth and ninth graders with ADHD randomized to an HI versus an LI intervention (n = 218) or recruited into an untreated comparison group (n = 107). Group x time and group x grade x time one-year outcome trajectories were compared using linear mixed models. Across the transitional year (sixth or ninth grade), adolescents in the HI group were found to experience significantly greater decreases in depressive symptoms (p = .022, d = .25) compared to the LI group. There was no significant impact of the HI intervention (vs. LI) on anxiety symptoms (p = .070, d = .29), social problems (p = .054, d = .34), or self-esteem (p = .837, d = 0.21); however, secondary analyses of the non-randomized untreated comparison group indicated a significant effect of HI versus the untreated comparison group on social problems (p = .009, d = 43). These significant treatment effects suggest that comprehensive academic and organizational skills interventions for adolescents with ADHD may have a secondary impact of relieving adolescent depression for teens with this comorbidity. Given mixed evidence for the efficacy of the HI intervention on social skills, future work should further evaluate this effect.
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Affiliation(s)
| | - Margaret H Sibley
- Psychiatry and Behavioral Sciences, University of Washington School of Medicine
| | - Stefany J Coxe
- Department of Psychology, Florida International University
| | | | - William E Pelham
- Center for Children and Families, Florida International University
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Nguyen T, Elkins SR, Curtis DF. Peer-Based Intervention for Socioemotional Concerns Among Children with ADHD. Child Psychiatry Hum Dev 2023; 54:1386-1395. [PMID: 35307775 DOI: 10.1007/s10578-022-01345-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/27/2022] [Indexed: 11/03/2022]
Abstract
This study examined the potential benefits of peer-based dyadic interventions for improving the socioemotional functioning of children with ADHD. Participants included children ages 8-12 diagnosed with ADHD-combined type (n = 34) pooled from a larger randomized study comparing peer-based dyadic interventions. Self-concept and depressive symptoms were evaluated at pre- and post-treatment using single group design. Results showed significantly positive child responses to intervention for self-concept. Further, improvements in self-concept were not moderated by the type of dyadic intervention received or by treatment related changes in externalizing behaviors. The severity of reported depressive symptoms, however, did not significantly change. This suggests therapeutic interaction with peers, as demonstrated in peer-based dyadic intervention models, can improve self-concept in children with ADHD even when socioemotional concerns are not a primary target of treatment and independent of behavioral outcomes achieved. These preliminary findings support promoting prosocial peer behavior as a critical domain for ADHD intervention for children.
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Affiliation(s)
- Thu Nguyen
- Department of Clinical, Health, and Applied Sciences, University of Houston-Clear Lake, Houston, TX, 77058, USA.
- Department of Clinical, Health, and Applied Sciences, University of Houston-Clear Lake, 2700 Bay Area Blvd., Houston, TX, 77058, USA.
| | - Sara R Elkins
- Department of Clinical, Health, and Applied Sciences, University of Houston-Clear Lake, Houston, TX, 77058, USA
| | - David F Curtis
- Department of Behavioral and Social Sciences, University of Houston College of Medicine, Houston, TX, 77004, USA
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Zulauf-McCurdy CA, Coxe SJ, Lyon AR, Aaronson B, Ortiz M, Sibley MH. Study protocol of a randomised trial of Summer STRIPES: a peer-delivered high school preparatory intervention for students with ADHD. BMJ Open 2021; 11:e045443. [PMID: 34344674 PMCID: PMC8336126 DOI: 10.1136/bmjopen-2020-045443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION High schoolers with attention-deficit/hyperactivity disorder (ADHD) experience substantial impairments, particularly in the school setting. However, very few high school students with ADHD receive evidence-based interventions for their difficulties. We aim to improve access to care by adapting evidence-based psychosocial intervention components to a low-resource and novel school-based intervention model, Summer STRIPES (Students Taking Responsibility and Initiative through Peer Enhanced Support). Summer STRIPES is a brief peer-delivered summer orientation to high school with continued peer-delivered sessions during ninth grade. METHODS AND ANALYSIS Participants will be 72 rising ninth grade students with ADHD who are randomised to receive either Summer STRIPES or school services as usual. Summer STRIPES will be delivered by 12 peer interventionists in a school setting. Outcomes will be measured at baseline, start of ninth grade, mid-ninth grade and end-of-ninth grade. At each assessment, self, parent and teacher measures will be obtained. We will test the effect of Summer STRIPES (compared with school services as usual) on ADHD symptoms and key mechanisms (intrinsic motivation, extrinsic motivation, executive functions) as well as key academic outcomes during the ninth-grade year (Grade Point Average (GPA), class attendance). ETHICS AND DISSEMINATION Findings will contribute to our understanding of how to improve access and utilisation of care for adolescents with ADHD. The protocol is approved by the institutional review board at Seattle Children's Research Institute. The study results will be disseminated through publications in peer-reviewed journals and presentations at scientific conferences. TRIALS REGISTRATION NUMBER NCT04571320; pre-results.
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Affiliation(s)
| | - Stefany J Coxe
- Department of Psychology, Florida International University, Miami, Florida, USA
| | - Aaron R Lyon
- Psychiatry & Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Ben Aaronson
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Mercedes Ortiz
- Psychiatry & Behavioral Sciences, Seattle Children's Research Institute, University of Washington, Seattle, Washington, USA
| | - Margaret H Sibley
- Psychiatry & Behavioral Sciences, Seattle Children's Research Institute, University of Washington, Seattle, Washington, USA
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Sibley MH, Coxe SJ, Page TF, Pelham WE, Yeguez CE, LaCount PA, Barney S. Four-Year Follow-Up of High versus Low Intensity Summer Treatment for Adolescents with ADHD. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2020; 51:750-763. [PMID: 33210938 DOI: 10.1080/15374416.2020.1833734] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Despite an emergence of psychosocial treatments for adolescent ADHD, their long-term effects are unknown. METHOD We examine four-year outcomes of a randomized controlled trial (N = 218) comparing high-intensity (HI; 412 h, $4,373 per participant) versus low-intensity (LI; 24 h, $97 per participant) skills-based summer intervention delivered to adolescents with ADHD at two secondary school transitions (6th/9th grade). Quantitative and qualitative analyses evaluated group×time and group×grade×time effects on 4-year outcomes. RESULTS Relative to LI, a single dose of HI had modest but lasting effects on teen organization skills (d =.40) and ADHD symptoms (9th grade only: d =.27 to.31) at 4-year follow-up. There was no long-term incremental effect of HI (vs. LI) for parent-teen conflict, GPA, or parent use of contingency management. Treatment appeared most effective when delivered to older adolescents (i.e., 9th versus 6th grade), suggesting the long-term impact of ADHD treatment may increase with age. Qualitative data corroborated that the primary long-term benefit of HI (vs. LI) treatment was to organization skills; many of the remaining perceived benefits were to parent and teen psychological variables (i.e., increased self-esteem, self-awareness, parental optimism). HI offered no incremental benefit to long-term educational or clinical service utilization or costs. CONCLUSIONS Modest therapeutic benefits of adolescent ADHD treatment are maintained long term. However, HI treatment did not impact outcomes that could defray the intervention's high costs ($4,373) compared to LI treatment ($97).
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Affiliation(s)
- Margaret H Sibley
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine.,Center for Child Health, Behavior, and Development, Seattle Children's Research Institute
| | - Stefany J Coxe
- Department of Psychology, Florida International University
| | - Timothy F Page
- Department of Psychology, Florida International University
| | | | | | - Patrick A LaCount
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute
| | - Samantha Barney
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute
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Babinski DE, Huffnagle SM, Bansal PS, Breaux RP, Waschbusch DA. Behavioral Treatment for the Social-Emotional Difficulties of Preadolescent and Adolescent Girls with ADHD. ACTA ACUST UNITED AC 2020; 5:173-188. [PMID: 33718608 DOI: 10.1080/23794925.2020.1759470] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Girls with attention-deficit/hyperactivity disorder (ADHD) are at high risk for peer difficulties that often persist into adolescence and adulthood and portend risk for additional difficulties, such as depression, anxiety, and borderline personality disorder. However, very little research has examined interventions that address the widespread peer difficulties of girls with ADHD. This paper describes two open trials of behavior therapy aimed at addressing their social-emotional difficulties. The first trial includes 33 preadolescent girls (ages 7-11) with ADHD enrolled in an eight-week treatment and the second trial includes 22 adolescent girls (ages 12-16) with ADHD enrolled in a 12-week treatment. Measures of treatment feasibility and acceptability and measures of social functioning and psychopathology were collected in both trials. High levels of treatment feasibility and acceptability were reported in both the preadolescent and adolescent trial. In addition, improvements were reported in areas of social functioning and reductions in psychopathology, although the magnitude and specific areas of improvement differed somewhat in the preadolescent versus adolescent group. These preliminary findings provide a first step towards addressing the widespread social-emotional difficulties of girls with ADHD and offer insight into continuing efforts to address their treatment needs.
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Fabiano GA. Interventions for High School Students With Attention-Deficit/Hyperactivity Disorder: Considerations for Future Directions. SCHOOL PSYCHOLOGY REVIEW 2019. [DOI: 10.1080/02796015.2014.12087445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Sibley MH, Coxe SJ, Campez M, Morley C, Olson S, Hidalgo-Gato N, Gnagy E, Greiner A, Coles EK, Page T, Pelham WE. High versus Low Intensity Summer Treatment for ADHD Delivered at Secondary School Transitions. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2019; 47:248-265. [PMID: 29498550 DOI: 10.1080/15374416.2018.1426005] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Spikes in symptom severity are noted for adolescents with attention deficit/hyperactivity disorder (ADHD) at the transitions to middle and high school that are attributed to developmental maladjustment. This study evaluated the effectiveness of high-intensity (HI; 412 hr, $4,373 per participant) versus low-intensity (LI; 24 hr, $97 per participant) skills-based summer intervention delivered to adolescents with ADHD by local school district staff. Participants were 325 ethnically diverse rising sixth and ninth graders with ADHD randomized to HI versus LI (n = 218) or recruited into an untreated comparison group (n = 107). Group × Time 1-year outcome trajectories were compared using linear mixed models. Both interventions possessed high fidelity and were viewed by families as enjoyable and beneficial. Youth attendance was higher for HI (~80%) versus LI (~45%). Parent training attendance was uniform across groups (~50%). Parent and student attendance did not impact trajectories. Primary benefits of HI over LI were to note taking (d = .50), parent contingency management (d = .43), and parent-rated ADHD symptoms (d = .40-.46; ninth grade only). Secondary analyses suggested that HI may produce additional benefits compared to no treatment for home organization skills (HI vs. untreated d = .54), parent-teen conflict (HI vs. untreated d = .39), and grade point average (HI vs. untreated d = .47, ninth grade only). Summer HI treatment was superior to LI in engagement and uptake of certain skills. However, the extent to which these medium benefits on a limited number of outcomes justify high costs compared to LI remains an open question. Delivering treatment during the summer instead of school year may limit generalizability.
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Affiliation(s)
- Margaret H Sibley
- a Department of Psychiatry & Behavioral Health , Florida International University
| | - Stefany J Coxe
- b Department of Psychology, Florida International University
| | - Mileini Campez
- b Department of Psychology, Florida International University
| | - Candance Morley
- c Center for Children and Families, Florida International University
| | - Sandra Olson
- c Center for Children and Families, Florida International University
| | - Nick Hidalgo-Gato
- c Center for Children and Families, Florida International University
| | - Elizabeth Gnagy
- c Center for Children and Families, Florida International University
| | - Andrew Greiner
- c Center for Children and Families, Florida International University
| | - Erika K Coles
- b Department of Psychology, Florida International University
| | - Timothy Page
- d Department of Health Policy and Management, Florida International University
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Babinski DE, Waxmonsky JG, Waschbusch DA, Pelham WE. Behavioral Observations of Parents With ADHD During Parent Training. J Atten Disord 2018; 22:1289-1296. [PMID: 25870203 DOI: 10.1177/1087054715580843] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Several studies suggest that parental ADHD impedes behavioral parent training (BPT) outcomes. Parental ADHD symptoms exhibited during BPT may interfere with the acquisition of new skills. This study explored the observed behavior of parents with ADHD during BPT. METHOD Parents of children with ADHD attending group BPT completed self-ratings of their ADHD symptoms. Parents indicating a moderate level of ADHD symptoms were administered a clinical interview, and 37.3% of parents met ADHD criteria based on Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) clinician-rated symptom counts. RESULTS Parents with high ADHD symptoms displayed more total and off-task violations compared with parents with low ADHD symptoms, although no significant differences emerged for other behaviors (i.e., working quietly, using materials appropriately, and remaining in seat), absences, or tardiness. CONCLUSION Parental ADHD symptoms were manifested during BPT. Future research should clarify the nature of parental behavior in BPT as a possible mechanism explaining the relation between parental ADHD and impaired BPT outcomes.
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Meinzer MC, Hartley CM, Hoogesteyn K, Pettit JW. Development and Open Trial of a Depression Preventive Intervention for Adolescents With Attention-Deficit/Hyperactivity Disorder. COGNITIVE AND BEHAVIORAL PRACTICE 2018; 25:225-239. [PMID: 31787832 DOI: 10.1016/j.cbpra.2017.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Adolescents with attention-deficit/hyperactivity disorder (ADHD) are at elevated risk for experiencing unipolar depressive symptoms and disorders. The current study describes the development of a behaviorally oriented depression preventive intervention tailored for adolescents with ADHD targeting variables empirically shown to mediate ADHD and depression (i.e., reward responsivity, emotion regulation, and family support). Eight adolescents with a history of ADHD and currently elevated depressive symptoms and their parents participated in an open trial of the Behaviorally Enhancing Adolescents' Mood (BEAM) program. Adolescents and their parents reported high satisfaction with BEAM. Staff reported BEAM was easy to implement with high adherence. Following BEAM, there were significant reductions in parent-report of adolescents' depressive symptoms and emotion regulation at posttreatment and the 6-week follow-up and adolescent-report of reward responsivity at posttreatment. Case vignettes are also provided to illustrate implementation of the BEAM program. In spite of the small sample, lack of a control group, and some discrepancies across informants, results overall support the feasibility and acceptability of the BEAM program, and suggest it has promise in reducing depressive symptoms in adolescents with ADHD.
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Abstract
OBJECTIVE Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) A-criteria for ADHD were expanded to include new descriptors referencing adolescent and adult symptom manifestations. This study examines the effect of these changes on symptom endorsement in a sample of adolescents with ADHD (N = 259; age range = 10.72-16.70). METHOD Parent ratings were collected and Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR) and DSM-5 endorsement of ADHD symptoms were compared. RESULTS Under the DSM-5, there were significant increases in reported inattention, but not hyperactivity/impulsivity (H/I) symptoms, with specific elevations for certain symptoms. The average adolescent met criteria for less than one additional symptom under the DSM-5, but the correlation between ADHD symptoms and impairment was attenuated when using the DSM-5 items. Impulsivity items appeared to represent adolescent deficits better than hyperactivity items. Results were not moderated by demographic factors. CONCLUSION In a sample of adolescents with well-diagnosed DSM-IV-TR ADHD, developmental symptom descriptors led parents to endorse slightly more symptoms of inattention, but this elevation is unlikely to be clinically meaningful.
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Abstract
PURPOSE OF REVIEW Many children and adolescents with attention-deficit/hyperactivity disorder (ADHD) have difficulties in their social skills and peer relationships. Because social problems exacerbate later maladjustment in ADHD populations, it is important to address this serious impairment. Although social skills training (SST) is a common intervention approach, evidence to date suggests that SST has limited efficacy, at least when provided in traditional, clinic-based settings. The current review summarizes recent advances to traditional SST approaches that may potentially enhance their efficacy. RECENT FINDINGS We identify two promising directions in which SST may be modified to make it more efficacious for ADHD populations. The first direction involves providing increased reinforcement and reminders of appropriate social behavior at the point of performance to youth with ADHD (e.g., in vivo, in real life peer situations as opposed to in the clinic). We note the importance of ensuring that youth with ADHD are receptive to such reminders. The second direction involves encouraging peers to be more socially accepting and inclusive of youth with ADHD. This avenue has been understudied in the literature to date. SST for children and adolescents with ADHD may be enhanced by providing more in vivo reminders and feedback at the point of performance and by making efforts to alter peers' impressions about youth with ADHD.
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Affiliation(s)
- Amori Yee Mikami
- University of British Columbia, 2136 West Mall, Vancouver, BC, V6T 1Z4, Canada.
| | - Sophie Smit
- University of British Columbia, 2136 West Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Adri Khalis
- University of British Columbia, 2136 West Mall, Vancouver, BC, V6T 1Z4, Canada
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Pelham WE, Smith BH, Evans SW, Bukstein O, Gnagy EM, Greiner AR, Sibley MH. The Effectiveness of Short- and Long-Acting Stimulant Medications for Adolescents With ADHD in a Naturalistic Secondary School Setting. J Atten Disord 2017; 21:40-45. [PMID: 23460704 DOI: 10.1177/1087054712474688] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Stimulant medication is an efficacious and first-line approach to treating ADHD in adolescence. However, less is known about the effectiveness of this approach as a treatment in real-world settings. The complicated nature of the secondary school environment and documented adolescent nonadherence with stimulant medication may undermine the exportability of this approach. METHOD This study investigates stimulant medication effectiveness and adherence in a sample of adolescents with ADHD who were observed in their natural secondary school environment. RESULTS Results indicated that the effect of stimulant medication on adolescent functioning is smaller in naturalistic settings than in previous analogue studies. Long-acting pemoline produced greater adherence than the short-acting methylphenidate (MPH), but parents and adolescents preferred the short-acting MPH. CONCLUSIONS Overall, adolescents reported very low satisfaction with stimulant medication. Findings are discussed.
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Affiliation(s)
| | | | | | - Oscar Bukstein
- 4 University of Texas Health Sciences Center-Houston, TX, USA
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Pelham WE, Gnagy EM, Sibley MH, Kipp HL, Smith BH, Evans SW, Bukstein O. Attributions and Perception of Methylphenidate Effects in Adolescents With ADHD. J Atten Disord 2017; 21:129-136. [PMID: 23893533 DOI: 10.1177/1087054713493320] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Although a number of studies demonstrate that children with ADHD do not attribute their behavior to taking medication, it remains unstudied whether adolescents, who have a longer history of taking medication for ADHD, show performance attributions to medication. METHOD A sample of 46 adolescents completed daily attributions for success or failure as a part of their participation in a summer treatment program with a double-blind, placebo-controlled assessment of methylphenidate. RESULTS Results demonstrated that adolescents with ADHD did not reliably discern active medication from placebo, rarely attributed their performance to the pill, and showed no differences in attributional style as a function of medication status. CONCLUSION These data indicate that adolescents with ADHD may possess inaccurate beliefs about the effect of stimulant medication on their behavior.
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Affiliation(s)
| | | | | | - Heidi L Kipp
- 2 University of Pittsburgh Medical Center, PA, USA
| | | | | | - Oscar Bukstein
- 5 University of Texas Health Sciences Center-Houston, USA
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Pelham WE, Meichenbaum DL, Smith BH, Sibley MH, Gnagy EM, Bukstein O. Acute Effects of MPH on the Parent-Teen Interactions of Adolescents With ADHD. J Atten Disord 2017; 21:158-167. [PMID: 23543401 DOI: 10.1177/1087054713480833] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study explored the nature of interactions between adolescent males with ADHD and their mothers, and the effects of methylphenidate (MPH) on an analogue parent-teen interaction task. Twenty-five adolescent males with ADHD ( M = 13.6 years) and their mothers and 14 non-ADHD adolescent males ( M = 13.4 years) and their mothers completed ratings of perceived dyadic conflict. Behavioral observations of dyads during 10-min conflict-resolution tasks were also collected. The ADHD dyads completed these tasks twice, with adolescents receiving either 0.3 mg/kg MPH or placebo. Videotaped sessions were coded using the Parent-Adolescent Interaction Rating Scale. Following the conflict-resolution task, participants rated their perceived conflict and affect during the interaction. Findings indicated higher conflict in the ADHD dyads, and minimal MPH effects on parent-teen interactions during the analogue task. Results suggest that stimulant medication does not produce meaningful acute effects on parent-teen interactions.
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Affiliation(s)
| | | | | | | | | | - Oscar Bukstein
- 4 University of Texas Health Sciences Center-Houston, USA
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Abstract
Although side effects and family concerns are common and long-term medication adherence is low, stimulant medications are a front-line treatment for attention-deficit/hyperactivity disorder (ADHD). Psychosocial treatments include classroom, family, and child-focused interventions that teach caregivers and teachers how to implement contingencies to shape behavior and provide children with skills to compensate for ADHD deficits. Such programs have a growing evidence-base and can be implemented alone or in conjunction with pharmacological treatments. The most efficacious psychosocial treatments for children with ADHD include Behavioral Parent Training, Behavioral Classroom Management, and Behavioral Peer Interventions, which all focus on contingency management by adults. Training interventions are increasingly used to teach organizational and interpersonal skills to children and adolescents. These treatments are found to improve functional outcomes associated with ADHD, including on-task behavior, compliance, academic performance, social relationships, and family functioning. Clinicians play an important role in educating families about psychosocial treatments for ADHD, increasing family motivation and engagement, and including these interventions in multimodal treatment plans for youth with ADHD across development. [Pediatr Ann. 2016;45(10):e367-e372.].
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Vidal R, Castells J, Richarte V, Palomar G, García M, Nicolau R, Lazaro L, Casas M, Ramos-Quiroga JA. Group therapy for adolescents with attention-deficit/hyperactivity disorder: a randomized controlled trial. J Am Acad Child Adolesc Psychiatry 2015; 54:275-82. [PMID: 25791144 DOI: 10.1016/j.jaac.2014.12.016] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 12/15/2014] [Accepted: 01/21/2015] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To determine the efficacy of group cognitive-behavioral therapy (CBT) on adolescents with attention-deficit/hyperactivity disorder (ADHD) who were in pharmacological treatment but still had persistent symptoms. METHOD We conducted a multicenter, randomized, rater-blinded, controlled trial between April 2012 and May 2014 in a cohort of 119 adolescents (15-21 years of age). Participants were randomly assigned to 12 manualized group CBT sessions (n = 45) or a waiting list control group (n = 44). Primary outcomes were assessed by a blinded evaluator (ADHD Rating Scale [ADHD-RS], Clinical Global Impression Scale for Severity [CGI-S], Global Assessment of Functioning [GAF]) before and after treatment, as well as by self-report and parent informant ratings. RESULTS Of the initial 119 participants enrolled, 89 completed treatment. A mixed-effects model analysis revealed that participants who were assigned to the group CBT sessions experienced significantly reduced ADHD symptoms compared to the control group (ADHD-RS Adolescent: -7.46, 95% CI = -9.56 to -5.36, p < .001, d = 7.5; ADHD-RS Parents: -9.11, 95% CI = -11.48 to -6.75, p < .001, d = 8.38; CGI-S Self-Report: -0.68, 95% CI = -0.98 to -0.39, p < .001, d = 3.75; CGI-S Clinician: -0.79, 95% CI = -0.95 to -0.62, p < .001; d = 7.71). Functional impairment decreased significantly in the CBT group according to parents (Weiss Functional Impairment Scale -4.02, 95% CI = -7.76 to -0.29, p < .05, d = 2.29) and according to the blinded evaluator (GAF: -7.58, 95% CI = -9.1 to -6.05, p < .001, d = 7.51). CONCLUSION Group CBT associated with pharmacological treatment is an efficacious intervention for reducing ADHD symptoms and functional impairment in adolescents. Clinical trial registration information-CBT Group for Adolescents With ADHD: a Randomized Controlled Trial; http://clinicaltrials.gov/; NCT02172183.
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Affiliation(s)
- Raquel Vidal
- Hospital Universitari Vall d'Hebron, ADHD (Attention-Deficit/Hyperactivity Disorder) Program, Centro de Investigación Biomédica En Red de Salud Mental (CIBERSAM), Barcelona, Spain, and Universitat Autònoma de Barcelona
| | | | - Vanesa Richarte
- Hospital Universitari Vall d'Hebron, ADHD Program, Barcelona, Spain
| | - Gloria Palomar
- Hospital Universitari Vall d'Hebron, ADHD Program, Barcelona, Spain
| | | | | | - Luisa Lazaro
- Hospital Clinic of Barcelona, (CIBERSAM), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and with the University of Barcelona
| | - Miguel Casas
- Hospital Universitari Vall d'Hebron, ADHD (Attention-Deficit/Hyperactivity Disorder) Program, Centro de Investigación Biomédica En Red de Salud Mental (CIBERSAM), Barcelona, Spain, and Universitat Autònoma de Barcelona
| | - Josep Antoni Ramos-Quiroga
- Hospital Universitari Vall d'Hebron, ADHD (Attention-Deficit/Hyperactivity Disorder) Program, Centro de Investigación Biomédica En Red de Salud Mental (CIBERSAM), Barcelona, Spain, and Universitat Autònoma de Barcelona.
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The Life Course Model for providing empirically supported school-based services for adolescents. SCHOOL MENTAL HEALTH 2015. [DOI: 10.1017/cbo9781107284241.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Steeger CM, Gondoli DM, Gibson BS, Morrissey RA. Combined cognitive and parent training interventions for adolescents with ADHD and their mothers: A randomized controlled trial. Child Neuropsychol 2015; 22:394-419. [PMID: 25731907 DOI: 10.1080/09297049.2014.994485] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
This study examined the individual and combined effects of two nonpharmacological treatments for attention deficit/hyperactivity disorder (ADHD): Cogmed working memory training (CWMT) for adolescents and behavioral parent training (BPT) for mothers. Ninety-one adolescents (ages 11-15) and their mothers were randomized to one of four CWMT and BPT treatment and active control (placebo) group combinations of 5-week interventions. At pre- and posttest, mothers and teachers completed rating forms, and adolescents completed neuropsychological measures of working memory (WM). Individual intervention effects showed that treatment CWMT significantly improved WM spans, whereas there were no significant differences for treatment or control BPT on reports of parent-related outcomes. Combined treatment effects indicated an overall pattern of greatest improvements for the control CWMT/treatment BPT group, as compared to the other three groups, on adolescent WM deficit, behavioral regulation problems, and global executive deficit. Most significant effects for outcomes were main effects of improvements over time. A combination of CWMT and BPT did not result in increased treatment gains. However, potential effects of combined treatment may have been masked by greater perceived benefits arising from lack of struggle in the nonadaptive, CWMT active control condition. Future combined intervention research should focus on specific, theoretically driven WM deficits among individuals with ADHD, should include possible adaptations to the standard CWMT program, should examine effectiveness of cognitive treatments combined with contextual interventions and should utilize appropriate control groups to fully understand the unique and combined effects of interventions.
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Affiliation(s)
- Christine M Steeger
- a Department of Psychology , University of Notre Dame , Notre Dame , IN , USA
| | - Dawn M Gondoli
- a Department of Psychology , University of Notre Dame , Notre Dame , IN , USA
| | - Bradley S Gibson
- a Department of Psychology , University of Notre Dame , Notre Dame , IN , USA
| | - Rebecca A Morrissey
- a Department of Psychology , University of Notre Dame , Notre Dame , IN , USA
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Derefinko KJ, Hayden A, Sibley MH, Duvall J, Milich R, Lorch EP. A Story Mapping Intervention to Improve Narrative Comprehension Deficits in Adolescents with ADHD. SCHOOL MENTAL HEALTH 2014; 6:251-263. [PMID: 25436018 PMCID: PMC4244711 DOI: 10.1007/s12310-014-9127-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The current study examined the effects of an 8-week Story Mapping Intervention (SMI) to improve narrative comprehension in adolescents with ADHD. Thirty 12 - 16 year-old adolescents with ADHD who were participating in a summer treatment program for adolescents with ADHD received the SMI instruction ten times and completed SMI homework ten times in a structured environment with teacher feedback. Recall of fables and story creation were assessed before and after the SMI. At post-test, fable recalls included more of the most important events, were more coherent, and included a greater number of plausible inferences than pre-test fable recalls. SMI homework scores accounted for increases in recall of important events and plausible inferences, suggesting that consistent practice and feedback with story mapping could contribute to important recall gains. In contrast, the inclusion of goal-based events and the rated coherence of created stories did not improve, suggesting that more explicit instruction in applying story mapping to story creation may be required.
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Evans SW, Langberg JM, Egan T, Molitor SJ. Middle and High School Based Interventions for Adolescents with ADHD. Child Adolesc Psychiatr Clin N Am 2014; 23:699-715. [PMID: 25220081 PMCID: PMC4167775 DOI: 10.1016/j.chc.2014.05.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The development and evaluation of psychosocial treatments for adolescents with attention-deficit/hyperactivity disorder has lagged behind the treatment development work conducted with children with the disorder. Two middle school-based and high school-based treatment programs have the most empirical work indicating beneficial effects. Treatment development research addressing many of the basic questions related to mediators, moderators, and sequencing of treatments is needed. Implications for future treatment development research are reviewed, including the potential benefits of combining treatments of a variety of modalities to address the large gaps in the literature.
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Affiliation(s)
- Steven W. Evans
- Department of Psychology, Center for Intervention Research in Schools, Ohio University, Athens, Ohio 45701
| | - Joshua M. Langberg
- Department of Psychology, Virginia Commonwealth University, 806 W. Franklin Street, P.O. Box 842018, Richmond, Virginia 23284-2018
| | - Theresa Egan
- Department of Psychology, Center for Intervention Research in Schools, Ohio University, Athens, Ohio 45701
| | - Stephen J. Molitor
- Department of Psychology, Virginia Commonwealth University, 806 W. Franklin street, P.O. Box 842018, Richmond, Virginia 23284-2018
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Fabiano GA, Schatz NK, Pelham WE. Summer Treatment Programs for Youth with Attention-deficit/hyperactivity Disorder. Child Adolesc Psychiatr Clin N Am 2014; 23:757-73. [PMID: 25220085 PMCID: PMC4788789 DOI: 10.1016/j.chc.2014.05.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Children with attention-deficit/hyperactivity disorder (ADHD) require intensive treatments to remediate functional impairments and promote the development of adaptive skills. The summer treatment program (STP) is an exemplar of intensive treatment of ADHD. STP intervention components include a reward and response-cost point system, time-out, use of antecedent control (clear commands, establishment of rules and routines), and liberal praise and rewards for appropriate behavior. Parents also participate in parent management training programming to learn how to implement similar procedures within the home setting. There is strong evidence supporting the efficacy of the STP as an intervention for ADHD.
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Sibley MH, Kuriyan AB, Evans SW, Waxmonsky JG, Smith BH. Pharmacological and psychosocial treatments for adolescents with ADHD: an updated systematic review of the literature. Clin Psychol Rev 2014; 34:218-32. [PMID: 24632046 DOI: 10.1016/j.cpr.2014.02.001] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 01/08/2014] [Accepted: 02/13/2014] [Indexed: 01/19/2023]
Abstract
Smith, Waschbusch, Willoughby, and Evans (2000) reviewed a small treatment literature on ADHD in adolescents and concluded that methylphenidate stimulant medication was a well-established treatment and behavior therapy (BT) demonstrated preliminary efficacy. This review extends and updates the findings of the prior one based on the previous 15years of research. Studies published since 1999 were identified and coded using standard criteria and effect sizes were calculated where appropriate. Highlights of the last 15years of research include an expansion of pharmacological treatment options and developmentally appropriate psychosocial treatment packages for adolescents with ADHD. Additionally, nonstimulant medications (e.g., atomoxetine) are now approved for the treatment of ADHD in adolescence. The review concludes that medication and BT produce a similar range of therapeutic effects on the symptoms of adolescents with ADHD. However, results suggest that BT may produce greater overall benefits on measures of impairment. There was no evidence that cognitive enhancement trainings, such as working memory training or neurofeedback improved the functioning of adolescents with ADHD. Whether to use medication, BT, or their combination to treat an adolescent with ADHD is complicated and we provide evidence-informed guidelines for treatment selection. The reviewed evidence does not support current American Academy of Pediatrics and American Academy of Child and Adolescent Psychiatry professional guidelines, which state that stimulant medication is the preferred treatment for adolescents with ADHD. Recommendations for assessment, practice guidelines, and future research are discussed.
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Affiliation(s)
| | | | | | - James G Waxmonsky
- Pennsylvania State University Milton Hershey Medical Center, Hershey, PA, USA
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A Parent-Teen Collaborative Treatment Model for Academically Impaired High School Students With ADHD. COGNITIVE AND BEHAVIORAL PRACTICE 2014. [DOI: 10.1016/j.cbpra.2013.06.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Sibley MH, Pelham WE, Derefinko KJ, Kuriyan AB, Sanchez F, Graziano PA. A Pilot Trial of Supporting teens’ Academic Needs Daily (STAND): A Parent-Adolescent Collaborative Intervention for ADHD. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2013. [DOI: 10.1007/s10862-013-9353-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Babinski DE, Sibley MH, Ross JM, Pelham WE. The effects of single versus mixed gender treatment for adolescent girls with ADHD. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2013; 42:243-50. [PMID: 23330787 PMCID: PMC3587658 DOI: 10.1080/15374416.2012.756814] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study evaluated the social behavior of adolescents with attention deficit hyperactivity disorder (ADHD) in single and mixed gender treatment settings. We collected ratings of social behavior (i.e., prosocial peer interactions, assertiveness, self-management, compliance, physical aggression, relational aggression) during single and mixed gender games within the Summer Treatment Program-Adolescent for 10 girls (M age = 13.17, 80% Hispanic) and 11 boys (M age = 12.89, 54.55% Hispanic). Counselors completed ratings immediately following 10 recreational periods for each adolescent they supervised (5 single gender games, 5 mixed gender games). Gender (female vs. male) × Setting (single vs. mixed gender) ANOVAs were conducted. If a significant interaction emerged, post hoc tests were also conducted. Several Gender × Setting interactions emerged, suggesting that girls benefit more from single gender formats than mixed gender formats. Girls showed more assertiveness, self-management, and compliance in single compared to mixed gender settings. A somewhat different pattern of results emerged for boys, which showed more appropriate social behavior (i.e., self-management, compliance) and less inappropriate social behavior (i.e., physical and relational aggression) in mixed gender settings compared to single gender settings. In contrast to previous ADHD treatment studies, these findings suggest that gender may impact treatment response for adolescents. Therefore, it is important that future studies evaluate whether current treatments for ADHD are appropriate for girls with ADHD and whether gender-specific treatments are necessary to address the unique difficulties of adolescent girls with ADHD.
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Affiliation(s)
- Dara E Babinski
- Department of Clinical and Health Psychology, University of Florida, Miami, FL 33186, USA.
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An Intensive Summer Treatment Program for ADHD Reduces Parent–Adolescent Conflict. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2012. [DOI: 10.1007/s10862-012-9314-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sibley MH, Smith BH, Evans SW, Pelham WE, Gnagy EM. Treatment response to an intensive summer treatment program for adolescents with ADHD. J Atten Disord 2012; 16:443-8. [PMID: 22344319 DOI: 10.1177/1087054711433424] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE There are presently almost no empirically validated treatments for adolescents with ADHD. However, in childhood, behavioral treatments for ADHD typically include behavioral parent training, classroom interventions, and intensive child-directed interventions. METHOD The present investigation examines treatment gains following an 8-week intensive summer day treatment program for adolescents with ADHD (STP-A). Baseline measures of functioning and parent improvement ratings were obtained for 34 STP-A participants. RESULTS Parent ratings indicated that adolescents who attended the STP-A improved across all target domains. Across domains, 63.0% to 90.9% of adolescents improved during the STP-A. There was no evidence of iatrogenic effects during the STP-A. Correlates of treatment response included adolescent effort, oppositional-defiant behavior, and cognitive/scholastic functioning. CONCLUSION Findings are discussed with regard to effective treatment delivery for adolescents with ADHD.
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Affiliation(s)
- Margaret H Sibley
- Center for Children and Families, Florida International University, 11200 SW 8th Street, Miami, FL 33199, USA.
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Evans SW, Schultz BK, DeMars CE, Davis H. Effectiveness of the Challenging Horizons After-School Program for young adolescents with ADHD. Behav Ther 2011; 42:462-74. [PMID: 21658528 PMCID: PMC3517170 DOI: 10.1016/j.beth.2010.11.008] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2010] [Revised: 11/15/2010] [Accepted: 11/18/2010] [Indexed: 10/18/2022]
Abstract
There are no empirically supported psychosocial treatments for adolescents with attention-deficit hyperactivity disorder (ADHD). This study examined the treatment benefits of the Challenging Horizons Program (CHP), a psychosocial treatment program designed to address the impairment and symptoms associated with this disorder in young adolescents. In addition to evaluating social and academic functioning outcomes, two critical questions from previous studies pertaining to the timing, duration, and family involvement in treatment were addressed. Forty-nine students recruited in two cohorts were randomly assigned to receive either the CHP or a community care condition. Outcomes suggested that students who received the CHP improved compared to students in the control condition on measures of symptoms and impairment. Implications related to timing, duration, and family involvement are reported, as well as recommendations for future studies.
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Kent KM, Pelham WE, Molina BSG, Sibley MH, Waschbusch DA, Yu J, Gnagy EM, Biswas A, Babinski DE, Karch KM. The academic experience of male high school students with ADHD. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2011; 39:451-62. [PMID: 21103923 PMCID: PMC3068222 DOI: 10.1007/s10802-010-9472-4] [Citation(s) in RCA: 154] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study compared the high school academic experience of adolescents with and without childhood ADHD using data from the Pittsburgh ADHD Longitudinal Study (PALS). Participants were 326 males with childhood ADHD and 213 demographically similar males without ADHD who were recruited at the start of the follow-up study. Data were collected yearly from parents, teachers and schools. The current study used assessment points at which the participants were currently in or had recently completed grades 9, 10, 11, and 12. Results indicated that adolescents with ADHD experienced significant academic impairment in high school relative to comparison adolescents, including lower overall and main academic subject grade point averages (GPA), lower levels of class placement (e.g. remedial vs. honors), and higher rates of course failure. In addition, teacher reports indicated that adolescents with ADHD completed and turned in a significantly lower percentage of assignments and were significantly less likely to be working up to their potential. Adolescents with ADHD were also significantly more likely to be absent or tardy during the academic year, and they were over eight times more likely than adolescents without ADHD to drop out of high school. These findings demonstrate that children with ADHD continue to experience severe academic impairment into high school.
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