Academic journal article Education & Treatment of Children

Developing Coordinated, Multimodal, School-Based Treatment for Young Adolescents with ADHD

Academic journal article Education & Treatment of Children

Developing Coordinated, Multimodal, School-Based Treatment for Young Adolescents with ADHD

Article excerpt


Adolescents with ADHD experience serious impairment that taxes our education, mental health, and healthcare systems as well as the children and families. The development and evaluation of effective treatments for these youth have lagged far behind that of many other disorders and age groups. This manuscript describes the treatment development process for a school-based comprehensive care model for treating middle-school aged youth with ADHD. An overview of the development process is described as well as future directions. Specific interventions that comprise the Challenging Horizons Program (CHP) are explained as well as their feasibility in public middle schools.


According to the Centers for Disease Control and Prevention (CDC, 2005), the rate of ADHD in the general population of children in the U.S. is approximately 7.8%. In child clinical settings, however, the rate often exceeds 50% (Barkley, 1998); making ADHD one of the most commonly diagnosed psychiatric disorders for children. Longitudinal studies indicate that these children continue to suffer ADHD related impairment into adulthood and the majority of the children diagnosed with ADHD continue to meet age-adjusted diagnostic criteria in adolescence (Barkley, Fischer, Smallish, & Fletcher, 2002). Children with ADHD typically present at clinics with problems including academic difficulties, discipline problems at school and at home, and conflict with peers. Adolescents with ADHD have many of these same problems, but often with more serious consequences such as school drop out and legal problems. School dropout, family conflict, serious social impairment, failing grades, and problems obtaining and holding a job are common outcomes for these adolescents (Barkley, Anastopoulos, Guevremont, & Fletcher, 1991, 1992). Moreover, due to physical and social maturation, adolescents encounter new sets of problems such as automobile accidents, traffic tickets, difficulty in romantic relationships, vocational problems, and substance use or abuse (Barkley, Murphy, & Kwasnik, 1996; Molina & Pelham, 2001). While some of these new problems do not fully materialize until high school, the path towards these negative outcomes frequently begins in middle school.

Outcomes are often much worse when an adolescent meets diagnostic criteria for a comorbid disorder, especially Oppositional Defiant Disorder (ODD) or Conduct Disorder (CD). Between 25% and 75% of adolescents with ADHD are reported to meet diagnostic criteria for ODD or CD (Fischer, Barkley, Smallish & Fletcher, 2002). These comorbidities increase the difficulty of working with adolescents with ADHD; hence, treatments for this subset of the population will need to address a wide range of potential impairments. Although comorbid conditions contribute to impairment, many serious problems are directly linked to ADHD. For example, research suggests that the persistence of ADHD contributes more to peer rejection than a diagnosis of CD (Bagwell, Molina, Pelham, & Hoza, 2001). In addition, severity of inattention in childhood ADHD predicts substance use and abuse in adolescence (Molina & Pelham, 2003). Thus, ADHD in and of itself is expected to lead to serious impairments that warrant treatment for adolescents, even among those who received intensive multimodal treatments in childhood (Bagwell et al.).

Impact on Society

Although schools have been required to meet the needs of students with ADHD since 1991, there has been very little research on effective interventions for secondary school students to guide this effort. The need to do something has rapidly outpaced the knowledge of what to do. Currently, children and adolescents with ADHD constitute the largest portion of students in special education under the category of "Other Health Impaired". Since 1993, adolescents (ages 12 to 17) classified as OHI comprise the special education category and age group that has grown more than any other (574%). …

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