Development of a school-wide behavior program in a public middle school: an illustration of deployment-focused intervention development, stage 1

Feasibility of School-Based ADHD Interventions: A Mixed-Methods Study of Perceptions of Adolescents and Adults

OBJECTIVE

Little is known about perceptions surrounding academic interventions for ADHD that determine intervention feasibility.

METHOD

As part of a longitudinal mixed-methods research project, representative school district samples of 148 adolescents (54.8%), 161 parents (59.4%), 122 teachers (50.0%), 46 health care providers (53.5%), and 92 school health professionals (65.7%) completed a cross-sectional survey. They also answered open-ended questions addressing undesirable intervention effects, which were analyzed using grounded theory methods.

RESULTS

Adolescents expressed significantly lower receptivity toward academic interventions than adult respondents. Stigma emerged as a significant threat to ADHD intervention feasibility, as did perceptions that individualized interventions foster inequality.

CONCLUSION

Findings suggest that adolescents' viewpoints must be included in intervention development to enhance feasibility and avoid interventions acceptable to adults, but resisted by adolescents.

Feasibility and preliminary efficacy of an after-school program for middle schoolers with ADHD: a randomized trial in a large public middle school

OBJECTIVE

This pilot study tests the feasibility and preliminary efficacy of an after-school treatment program for middle schoolers with ADHD using a randomized clinical trial design.

METHOD

A total of 23 students with ADHD (25% female, 48% African American) from a large public middle school were randomly assigned to a 10-week program or to community comparison. Manualized treatment targeted educational, social, and recreational skills, homework completion, and school and home behavior. Parents participated.

RESULTS

Recruitment and randomization targets were easily met (87% completion). Parent and teacher satisfaction was positive. Small to medium treatment effects resulted despite greater medication use in the control group, with improvements in functioning for the program-treated youth or absence of deterioration relative to the comparison group.

CONCLUSION

Despite testing an abbreviated version of the after-school program (< 5 months), this study reveals feasibility and palatability for this intervention and modest beneficial effects on behavioral and academic outcomes.

Developing evidence-based interventions for deployment into school settings: A case example highlighting key issues of efficacy and effectiveness

This paper describes the development of an after-school program for middle-school students that simultaneously addressed issues of efficacy and effectiveness in an effort to create an evidence-based intervention (EBI) that can be implemented in school settings. The topics highlighted in this case example are intended to address the growing concern that over-focusing on efficacy in well-controlled, grant-funded studies has resulted in a generation of EBI that are not acceptable, feasible, or sustainable in the majority of applied settings. Our case example focuses on six key issues highlighted in the published research literature: sustainability, recruitment, methodological design, flexibility, training, and meaningful outcomes. We briefly summarize each of these issues and relate them to our experiences conducting a successful pilot study. A summary of the pilot study results is also presented to lend support for the utilization of the EBI model of dissemination described in this paper.

Development of a school-based treatment program for middle school youth with ADHD

The authors conduct an evaluation of a middle school-based treatment program for youth with ADHD during early stages of treatment development. The studies focus on interpreting outcome trends in preliminary data and identifying assessment issues that will be important to consider when conducting a clinical trial. Parent reports indicate that the majority of students benefit from improvements in academic, social, and overall functioning. Although teachers report beneficial effects for the majority of the participants in the program, there is little agreement about individual students. Measurement problems are associated with understanding normal change during a school year, accounting for normal behavior changes in December and May, and considerable disagreement between teachers. Suggestions to guide future work in this area are provided.