Development of a Peer-Delivered Organization Intervention for Ninth Grade Students with ADHD Traits

Introduction: Attention Deficit/Hyperactivity Disorder (ADHD) is characterized by inattention, overactivity, and impulsivity and affects 5-10% of adolescents (CDC, 2013). Course failure is common for high schoolers with ADHD and can eventually lead to elevated rates of high school dropout (up to 38%; Barkley et al., 2006; Barbaresi et al., 2007). Performance during 9th grade is one of the strongest predictors of high school dropout (Neild et al., 2008). Additionally, developmental risk models indicate that key traits associated with ADHD increase risk for serious negative behaviors only in the presence of precipitating negative life events such as school failure (Sher et al., 2005). Age of risk behavior initiation is approximately 14 in ADHD samples (Molina & Pelham, 2003). Thus, 9th grade academics are an ideal intervention target for students with ADHD traits both to prevent dropout and to reduce risk behaviors.

Despite this need, most 9th graders with ADHD traits do not receive intervention, which may be due in part to the limited infrastructure and resource pool of high schools. One group of potential interventionists who are available, qualified, and willing may be academically successful 11th grade peers. High school students can successfully deliver a range of school-based interventions and peers can serve as salient reinforcers during treatment. Deficits in organization, time management, and planning (OTP) appear to be the strongest mechanisms of failure for students with ADHD traits (Langberg et al., 2013). Therefore, we developed a peer-based academic intervention that targets OTP skills for 9th graders with ADHD traits.

Methods: Intervention development occurred in collaboration with the fourth largest and second most ethnically diverse school district in the nation. Intervention development was a collaborate process that involved soliciting feedback from key stakeholders (e.g., teachers and students). The prototype version of the intervention was also assessed implemented with a small group of 9th graders (N=24) in an open trial. 

Results: This presentation will provide an overview of the development process, share audio from actual peer meetings, and present qualitative data from school focus groups and development team meetings. We will also present quantitative data from an open trial highlighting a single subject case study to provide a detailed demonstration of how the intervention engages key mechanisms of change (peer reinforcement, OTP skill improvements).

Conclusions: This peer-based academic intervention may be a feasible and promising approach that engages peers in providing academic support to 9th graders with ADHD traits.