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Symposia

Child /Adolescent - ADHD

Novel Strategies for Promoting Treatment Engagement for Individuals with ADHD

4 - (SYM 74) Enhancing Engagement in a Peer-delivered Intervention for High School Students with ADHD: A Randomized Controlled Trial

Sunday, November 23, 2025
3:09 PM - 3:30 PM CST
Location: Strand 11A&B, Level 2
Keywords: ADHD, Treatment, Clinical Trial
Recommended Readings: Evans, S. W., Owens, J. S., Wymbs, B. T., & Ray, A. R. (2018). Evidence-based psychosocial treatments for children and adolescents with attention deficit/hyperactivity disorder. Journal of Clinical Child & Adolescent Psychology, 47, 157-198.,   Chacko, A., Jensen, S. A., Lowry, L. S., Cornwell, M., Chimklis, A., Chan, E., ... & Pulgarin, B. (2016). Engagement in behavioral parent training: Review of the literature and implications for practice. Clinical Child and Family Psychology Review, 19, 204-215.,   Sibley, M. H., Link, K., Torres Antunez, G., & Greenwood, L. (2023). Engagement barriers to behavior therapy for adolescent ADHD. Journal of Clinical Child & Adolescent Psychology, 52, 834-849.,   Chronis, A. M., Chacko, A., Fabiano, G. A., Wymbs, B. T., & Pelham, W. E. (2004). Enhancements to the behavioral parent training paradigm for families of children with ADHD: Review and future directions. Clinical Child and Family Psychology Review, 7, 1-27.,   Sibley, M. H., Coxe, S. J., Stein, M. A., Meinzer, M. C., & Valente, M. J. (2022). Predictors of treatment engagement and outcome among adolescents with attention-deficit/hyperactivity disorder: An integrative data analysis. Journal of the American Academy of Child & Adolescent Psychiatry, 61, 66-79.
Abstract Body

The transition to high school represents a vulnerable period for adolescents with ADHD both academically and socioemotionally (Kent et al., 2011). While schools offer an accessible setting for intervention, traditional school-based programs for adolescents with ADHD often struggle with low engagement from both school interventionists and students (Sibley et al., 2016). Peer-delivered interventions for adolescents with ADHD (Sibley et al., 2020) may address school staff time and resource limitations that inhibit implementation and effectiveness while simultaneously increasing adolescent attendance and engagement in support services with a socially relatable peer. 


This randomized controlled trial (N=72) evaluated a peer-delivered intervention (STRIPES+) for ninth grade students with ADHD compared to school services as usual (SSAU). STRIPES+ enhanced the existing STRIPES peer-delivered executive function skills intervention (30-minute 2:1 sessions with a peer for 16 weeks) with parent training components, integrated school to home communication, and a one-week peer-led high school summer orientation that focused on executive function skills training. Group x time one-year outcome trajectories were compared using linear mixed models. 


Adolescent and peer attendance was strong across intervention phases. On average, parents received two of six offered parent training sessions. Peer interventionist and school staff intervention fidelity was also strong, indicating that the model was feasible to implement. Acceptability, credibility, and satisfaction for STRIPES+ were additionally positive for both phases. Significant group x time interactions indicated that compared to SSAU, adolescents in the STRIPES+ demonstrated significant gains in observed school materials organization (b=.01, SE=.01, p=.04), use of a daily planner (b=.64, SE=.31, p=.04), self-report of autonomy (b=.02, SE=.01, p=.02), and three indices of parent reporting reduced academic assistance (b=-0.02, SE=.01, p=.01; b=-.10, SE=.04, p=.02;b=-.01, SE=.00, p=.02). 


While SSAU and STRIPES+ students had similar grades and attendance in ninth grade, evidence suggests a transfer of academic responsibility from parents to adolescents in the STRIPES+ group relative to an increase in parent assistance in SSAU across the ninth grade year. Use of peer interventionists, parent behavior training, and school to home communication may be effective intervention engagement strategies for adolescents with ADHD who struggle with executive function.