3 - (SYM 50) Do Parent Education and Family Income Impact the Implementation and Outcomes of the Collaborative Life Skills (CLS) School-based ADHD Program: Examination Across Four Trials

Abstract Body
Attention-Deficit/Hyperactivity Disorder (ADHD) significantly impacts youth across cultures (Cortese et al., 2023). Evidence-based treatments (EBTs) improve symptoms compared to typical community practices (Pfiffner & Haack, 2014), but, worldwide, most youth in need do not receive any treatment and even fewer receive EBTs (Duong et al., 2021; Danielson et al., 2018). School-based services can be effective and accessible (Pfiffner & Haack, 2014) and may address unmet need for ADHD treatment, particularly when time and financial resources limit access care in traditional settings (Sanchez et al., 2018). The current work examines the implementation and effectiveness of the Collaborative Life Skills (CLS) program (Pfiffner et al., 2016), a school-based multicomponent EBT for ADHD, across four distinct trials targeting diverse populations in the United States (U.S.) and Mexico. 
In each trial, school personnel recruited six to eight youth per school (N=275). Parents and teachers rated youth behavior at baseline, then schools were randomized to CLS or School Services as Usual (SAU). We trained school clinicians in CLS, monitored fidelity and adherence, collected acceptability ratings and post-study ratings of youth behavior from all parents and teachers to compare effectiveness of CLS to SAU.
Participant characteristics varied considerably between families across the four trials. English-speaking, U.S. families had more college degrees and higher incomes compared to Spanish-speaking families in the U.S. and in Mexico. Nevertheless, CLS showed similar implementation findings and effectiveness outcomes across trials. School clinicians delivered between 91-99% of program content at high quality (average ratings 4.36-4.95 out of 5), participants attended 72-94% of sessions, average daily report card use was between 3.6 and 4.3 days out of five, and over 90% of participants reported high satisfaction. CLS students showed significantly greater improvement in parent- and teacher-rated ADHD (our primary outcome), compared to SAU, and this effect appeared robust to effects of parental education and family income.
These results suggest that comprehensive, school-based ADHD treatments may be resistant to SES impacts historically found in single-component, clinic-based treatment studies. Discussion will focus on potential explanations for these findings, such as the multilingual and school-based CLS context being more accessible and less stigmatizing, as well as the multicomponent CLS design providing more wrap-around support.