Grant Number:
R01MH082865 – National Institute of Mental Health (NIMH)
PIs: Joshua Langberg, PhD; Steven Evans, PhD
 Jeffery Epstein, PhD; Mekibib Altaye, PhD; Aaron Vaughn, PhD 

The long-term objective of this study is to examine the relative effectiveness of two different models of school-based intervention for middle school students with ADHD in comparison to treatments for ADHD typically provided in the community.  Building on behavioral and cognitive theories about the nature of the disorder, the Challenging Horizons Program (CHP) targets the most common areas of impairment associated with ADHD in adolescence, including difficulties with organization, time-management, and homework completion, social impairment, and behavior problems.  

A sample of 315 middle-school aged children with ADHD will be recruited across two sites (Cincinnati Children’s Hospital and Ohio University) and randomly assigned to one of three groups:

After-School Program - CHP interventions are implemented by undergraduate and graduate level counselors through a 2 day per week after school program. The counselors consult regularly with the students' teachers and parents to inform intervention development and to monitor students’ progress.

Consultation Program - CHP interventions are provided during the school day by school staff (e.g., teachers, school counselors).   Each student is paired up with a school staff member called a mentor. The mentor establishes a supportive relationship with their assigned student and provides selected CHP interventions through one-on-one weekly meetings.

Community Care Program – Students and their parents are provided with a list of resources and programs available in their community and encouraged to participate in those services.

Academic, social, and behavioral outcomes are assessed through parent and teacher ratings completed pre-intervention, three times during the school year, post-intervention and at a 6-month follow-up. In addition, students’ school grades and disciplinary records are examined. Costs of providing the services for all three conditions are carefully tracked and will be calculated in relation to students’ improvements in academic, social, and behavioral functioning.

Consistent with findings from preliminary studies, it is expected that students in the Consultation and After School models will make significant improvements in functioning relative to the Community Care group and that response to intervention will vary across participants. Moderators and mediators of treatment response will be examined in order to identify child and parent characteristics and treatment processes (e.g. attendance) that predict response to treatment.  These data will be combined with cost data to determine how schools can allocate intervention resources most efficiently.

Specifically, this study aims to:

  1. Evaluate the efficacy of the after-school program model and the consultation model of CHP as compared to each other and as compared to care routinely received in the community.
  2. Estimate the cost-effectiveness ratios for each of the two levels of services.
  3. Identify moderators and mediators of response to treatment for the two CHP intervention models. In addition, the findings should inform treatment decisions about which children need which level of care.

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