A longitudinal study of risk and protective factors associated with successful transition to secondary school in youth with ADHD: prospective cohort study protocol

BACKGROUND: Attention-Deficit/Hyperactivity Disorder (ADHD) has a significant impact on child and adolescent development, especially in relation to school functioning and academic outcomes. Despite the transition to high school being a potentially critical period for children with ADHD, most research in this period has focused on academic outcomes. This study aims to extend previous research by describing academic, school engagement, behaviour and social-emotional outcomes for young people with ADHD in the first and third years of high school and to identify risk and protective factors predictive of differing outcomes across these four domains. METHODS AND DESIGN: The Moving Up study is a longitudinal, prospective cohort study of children with ADHD as they transition and adjust to high school (age 12-15 years). Data are collected through direct assessment and child, parent and teacher surveys. The primary outcome is academic achievement, obtained by linking to standardised test results. Secondary outcomes include measures of behaviour, ADHD symptoms, school engagement (attitudes and attendance), and social and emotional functioning, including depressive symptoms. The mean performance of the study cohort on each outcome measure will be compared to the population mean for same aged children, using t-tests. Risk and protective factors to be examined using multiple regression include a child, family and school factors know to impact academic and school functioning. DISCUSSION: The Moving up study is the first Australian study prospectively designed to measure a broad range of student outcomes for children with ADHD during the high school transition period. Examining both current (cross sectional) and earlier childhood (longitudinal) factors gives us the potential to learn more about risk and protective factors associated with school functioning in young people with ADHD. The richness and depth of this information could lead to more targeted and effective interventions that may alter academic and wellbeing trajectories for young people at risk of poor outcomes.<br /

Risk and protective factors associated with successful transition to high school in youth with ADHD: a prospective cohort study

© 2017 Dr. Nardia Jane ZendarskiIntroduction: Limited research has examined the transition to high school in adolescents with ADHD, despite this period being a critical determinant of future schooling. This thesis aims to describe school functioning in adolescents with ADHD at an academic, social-emotional and school engagement level and to identify risk and protective factors that are predictive of differing levels of functioning as well as trajectories of social-emotional functioning over the transition and their impact on early high school functioning. Methods: This is a prospective cohort study of adolescents (n=130) with ADHD in the first and third years of high school. Primary outcomes included: (1) academic achievement (National Assessment Program-Literacy and Numeracy (NAPLAN) five test domains); (2) social-emotional functioning and trajectories of functioning (parent and teacher-reported Strengths and Difficulties Questionnaire (SDQ)) and (3) school engagement (self-rated attitudes toward school and recorded suspensions). A broad range of adolescent, family and school risk and protective factors were examined in relation to key outcomes including: child IQ, working memory, ADHD symptom severity, behavioural problems, peer victimisation, family functioning, parent mental health, family socioeconomic status (SES) as well as school SES, sector and location. Analyses: Mean scores on outcomes were compared to state benchmarks or normative data using t-tests. Multivariable regressions analyses were used to model risk and protective factors associated with each transition outcome. Results: Academic achievement: Adolescents with ADHD performed below the state average across all NAPLAN test domains and 40% achieved scores below the national minimum standard in one or more areas (e.g. writing and spelling). Higher IQ and SES were associated with better scores. Gender differences were not observed with the exception of writing, where girls outperformed boys. Modifiable factors associated with poorer academic outcomes on individual domains included symptoms of inattention, peer victimisation and poor family management. Social-emotional functioning (SEF): Adolescents exhibited poorer SEF across multiple domains (e.g. internalising symptoms, externalising problems and peer problems) in comparison to norms. The strongest modifiable factors on these three domains were middle childhood SEF on the domain being examined and parent-rated ADHD symptoms. Additional factors varied by domain; concurrent sleep problems, age (younger) and gender (girl) were associated with higher internalising problems; parent mental health problems and peer problems were associated externalising problems. Three trajectories (never, intermittent and persistent) of SEF were identified for internalising, externalising and peer problems. Compared to the never trajectory, children with persistent internalising and externalising trajectories had poorer maths achievement and more school suspensions. School engagement: Adolescents with ADHD in the first year of high school were less motivated and less connected to peers in comparison to state data. There were high rates of suspension across the first and third year of high school in comparison to peers (21% vs 6%, p<.01). Modifiable factors associated with poor attitudes toward school included adolescent depression and poor family management. The risk of suspension increased for adolescents who exhibited higher levels of conduct and hyperactivity symptoms and lower intelligence. Higher family SES and attending an independent school decreased this risk. Conclusion: Findings highlight the large achievement gap and increased risk for adolescents with ADHD in this critical period. Most adolescents will require additional support and intervention and difficulties are likely to be multifaceted spanning multiple domains of functioning. A tailored rather than standard approach to improving outcomes is needed for most students with ADHD. Optimising educational outcomes for all students with ADHD will require both health and educational experts to work together to target potentially modifiable variables associated with poor functioning. Findings point toward a review of current evidence-based interventions addressing modifiable variables that could be adapted, piloted and then rigorously trialled in Australian adolescents with ADHD in early high school

Early high school engagement in students with attention/deficit hyperactivity disorder

BACKGROUND: Students with attention/deficit hyperactivity disorder (ADHD) continue to languish behind their peers with regard to academic achievement and education attainment. School engagement is potentially modifiable, and targeting engagement may be a means to improve education outcomes. AIMS: To investigate school engagement for students with ADHD during the crucial high school transition period and to identify factors associated with low school engagement. SAMPLE: Participants are adolescents (12-15 years) in the first and third year of high school with diagnosed ADHD (n = 130). Participants were recruited from 21 paediatric practices. METHODS: Cross-sectional study assessing school engagement. Data were collected through direct assessment and child, parent, and teacher surveys. School engagement is measured as student attitudes to school (cognitive and emotional) and suspension rates (behavioural). Multivariable regression analyses examined student, family, and school factors affecting engagement. RESULTS: In comparison with state data, students with ADHD in the first year of high school were less motivated (p < .01) and less connected to peers (p < .01). Overall, there was no discordance in third year attitudes. There were high rates of suspension in both years in comparison to state-wide suspensions (21% vs. 6%, p < .01). Explanatory factors for poor attitudes include adolescent depression, poor adolescent supervision, and devaluing education. Conduct problems and increased hyperactivity were related to increased likelihood of being suspended, whilst higher cognitive ability, family socio-economic status, and independent schools reduced risk. CONCLUSIONS: Potentially modifiable individual and family factors including adolescent depression, behavioural problems, education values, and family supervision could be targeted to better manage the high school transition for students with ADHD

Recent Attitudes toward ADHD in the Broader Community:A Systematic Review

Objective: This review aimed to understand the broader community’s attitudes toward ADHD, which could facilitate public health interventions to improve outcomes for individuals with ADHD. Methods: A standardized protocol identified peer-reviewed studies focusing on attitudes of broader community samples, published from January 2014 to February 2020 (inclusive). Results: A total of 1,318 articles were screened and 10 studies were included, examining attitudes of broader community samples from Australia, Sweden, Germany, Finland, Korea, Indonesia, and the United States. Findings revealed that broader community samples displayed varying degrees of ADHD-related knowledge, negative attitudes (that ADHD is over-diagnosed; that pharmacological treatment is not acceptable; that those with ADHD are more likely to exhibit poor behavior), and a desire for maintaining social distance from individuals with ADHD. Conclusion: Findings suggest that community attitudes are generally negative toward those with ADHD. Targeted mental health literacy could provide an important avenue for improving the broader community’s attitudes toward those with ADHD. </jats:sec

Peer Victimization and Poor Academic Outcomes in Adolescents With ADHD: What Individual Factors Predict Risk?

Objective: Examine individual factors associated with peer victimization (PV) in adolescents with attention-deficit/hyperactivity disorder (ADHD) and to examine the association between PV and educational outcomes. Method: Participants were 121 adolescents ( Mage = 13.62, SD = 1.03; 89% boys) with diagnosed ADHD. Using path analysis, we tested whether general adolescent factors (ADHD symptoms, comorbid autism spectrum disorder, cognitive and social functioning, and age) were associated with experiences of PV, and associations between PV and academic outcomes. Results: Deficits in working memory (WM) and peer relationship problems were weakly and moderately associated with PV, respectively. PV was in turn was associated with adolescents’ attitudes about school, academic competence, and academic achievement. Conclusion: Adolescents with poor social skills and/or WM difficulties who have ADHD may be particularly vulnerable to being victimized by peers. Failure to identify and manage PV during early adolescence may be connected to poor educational outcomes. </jats:p