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Symposia

Child /Adolescent - ADHD

Do Interventions for Children with ADHD Vary in Effectiveness by Family Socioeconomic Level?

1 - (SYM 50) Underrepresentation and Moderation of Parent Education Levels in ADHD Treatment Trials: A Meta-analysis

Sunday, November 23, 2025
10:03 AM - 10:32 AM CST
Location: Strand 1, Level 2
Keywords: ADHD, Clinical Trial, Vulnerable Populations
Recommended Readings: DuPaul, GJ, Evans, SW, Cleminshaw-Mahan, CL, & Fu, Q (2024). School-Based Intervention for Adolescents With ADHD: Predictors of Effects on Academic, Behavioral, and Social Functioning. Behavior Therapy, 55(4), pp 680-697, ISSN 0005-7894, https://doi.org/10.1016/j.beth.2024.01.010. (https://www.sciencedirect.com/science/article/pii/S0005789424000212),   Nissley-Tsiopinis, J., Power, T., Fleming, `P., Tremont, K.L., Poznanski, B., Ryan, S., Cacia, J., Egan, T., Montalbano, C., Holdaway, A., Patel, A., Gallagher, R., Abikoff, H., Localio, A.R., Mautone, J.A. : School-based Organizational Skills Training for Students in Grades 3 to 5: A Cluster Randomized Trial. Journal of Consulting and Clinical Psychology 2024, Oct;92(10):674-691. doi: 10.1037/ccp0000909. PMID: 39480288,   Lauren M. Haack, Linda J. Pfiffner, Sabrina M. Darrow, Jasmine Lai, Dulce Karely Alcaraz-Beltrán, Jassiel Ulises Martínez-Beltrán, Elva Moreno-Candil, Korinthya Delgado-García, María Fernanda Arriaga-Guerrero, Dulce Maria Ledesma-Saldaña, Maria Elena Urquídez-Valdez, Eva Angelina Araujo; Implementation of a Multi-Site Digitally-Enhanced School Clinician Training and ADHD/ODD Intervention Program in Mexico: Randomized Controlled Trial of CLS-R-FUERTE.; Journal of Technology in Behavioral Science; 2024,   Haack LM, Pfiffner LJ, Darrow SM, Lai J, Alcaraz Beltrán DK, Beltrán JUM, Moreno Candil E, Delgado García K, Arriaga Guerrero MF, Ledesma Saldaña DM, Urquídez Valdez ME, Araujo EA; Enhancing accessibility and scalability of school-based programs to improve youth attention and behavior: Open feasibility trial of the remote CLS-R-FUERTE program in Mexico.; School psychology (Washington, D.C.); 2023,   The Collaborative Life Skills Program in Spanish (CLS-S): Pilot Investigation of Intervention Process, Outcomes, and Qualitative Feedback. Evid Based Pract Child Adolesc Ment Health. 2019; 4(1):18-41. Haack LM, Araujo EJ, Delucchi K, Beaulieu A, Pfiffner L. PMID: 31938725; PMCID: PMC6959204.
Abstract Body

A recent study examined the moderating role of parent education levels on response to psychosocial treatments by youth with ADHD (Margherio et al., 2025). Clinical trials that met evidence-based update criteria from 2008 through 2024 were included in the review. The authors reported that the relationship between psychosocial treatment and symptom outcomes were moderated by parent education levels. Samples with higher portions of parents with bachelor’s degrees or higher (in US 38% of population has a bachelor’s degree or higher) showed greater benefit than reported in studies where samples were equivalent to or less than 38% with bachelor’s degrees. Age of the sample and location of study (i.e., school or clinic) influenced this effect. We examined the extent to which the moderation effect applies to treatments that include organization training.

 

Studies that evaluated treatments with a major emphasis on organization interventions (14 studies) were selected from all treatment studies included in the Margherio and colleagues (2025) manuscript. The portion of the samples with bachelor’s degrees or higher for each ranged from 17% to 76%. Using the criteria in the Margherio et al. paper we sorted them into two groups including high parent education (7 studies; 44% - 76% w/bachelor’s degrees or higher) and representative parent education (7 studies; 17% - 44%). Hedge’s g was calculated for each study to indicate the difference between the treatment group and control group on ratings of inattention symptoms. Three studies in the high parent education group and two in the representative parent education group did not include adequate data for this calculation.

 

Findings align with Margherio et al., showing larger effect sizes in studies with highly educated parents compared to representative samples. A further breakdown of the studies show that among the three treatment programs with studies in both groups, the difference in outcomes for the family based treatment (STAND) is greater and in the opposite direction of the differences for the two school-based treatments (CHP & HOPS). These findings are based on a small number of studies so should be interpreted with caution; however, if replicated these findings suggest that the moderating effect of parent education levels may be a function of the degree with which the parents are involved in the treatment. These findings have important implications for the recruitment of representative samples and for better defining the populations for which our treatments have been evaluated and found to be effective.