(PS4-2) Evaluation of Multi-Dimensional Indicators of Treatment Engagement in a School-Based Training Intervention for Adolescents with ADHD

Abstract Text: Youth with attention-deficit/hyperactivity disorder (ADHD) are at particular risk for engagement barriers in behavioral treatment, which can lead to premature termination and worse therapeutic outcomes (Chacko et al., 2017; Danko et al., 2016; Sibley et al., 2023). Johansson and colleagues (2023) identified predictors of engagement barriers for adolescents with ADHD (e.g., comorbid ODD/CD, parental ADHD) who received treatment in a clinic; however, it is unclear if these predictors persist in school settings where most adolescents receive behavioral health services (Green et al., 2013). This study aimed to extend evaluations of potential engagement facilitators and barriers to a school-based training intervention for adolescents with ADHD in the context of a multidimensional framework for engagement (see Becker & Chorpita 2023)

A total of 315 students with ADHD (grades 6-11) participated in the Challenging Horizons Program (CHP) which targets academic and organizational skills throughout one school year via repeated practice and performance feedback in twice weekly after-school sessions (M = 31.8) or weekly individual in-school sessions (M = 25.2) for middle school students (Evans et al., 2016) and twice weekly individual in-school sessions (M = 40.3) for high school students (DuPaul et al., 2021). Baseline student/family characteristics included grade level; household income; race; ethnicity; sex; comorbid ODD; and parent ratings on organizational skills (Abikoff & Gallagher, 2008), parenting practices (Elgar et al., 2007) and parent-adolescent relational stress (Sheras et al., 1998). School characteristics included size, rurality (ERS, 2013), and percentage of students who qualify for subsidized lunch, receive special education services, and identify as White. Students’ percentage adherence to organizational skills checklists and attendance to sessions offered (from November-May of the treatment year) as well as averaged student-rated working alliance (Hatcher & Gillaspy, 2006; i.e., mid- and post-treatment) were examined as treatment engagement measures.

Correlational analyses examined associations among student, family, and school characteristics and treatment engagement. Greater session attendance was associated with higher household income (r = .17), less positive parenting (e.g., frequency of praise; r = -.13), and larger schools (r = .14). Adherence to organizational checklists was negatively associated with student Hispanic identity (r = -.17), ODD (r = -.17), inconsistent parental discipline (r = -.20), and adolescent-parent relational stress (r = -.22) and positively associated with parental involvement (r = .14) and urban school locations (r = .22). Greater working alliance was only associated with urban school locations (r = .15).

This study examined predictors of multi-dimensional indicators of engagement within school-based interventions. Effect sizes were generally small, yet reflected unique associations between baseline student, familial, and school characteristics and domains of treatment engagement, highlighting the need to consider engagement in a multi-faceted manner to understand which factors promote, and which impede, engagement in school-based interventions.