A Randomized Controlled Trial of a School-Implemented School–Home Intervention for Attention-Deficit/Hyperactivity Disorder Symptoms and Impairment

Abstract

This study evaluated the efficacy of a novel psychosocial intervention (Collaborative Life Skills [CLS]) for primary-school students with attention-deficit/hyperactivity disorder (ADHD) symptoms. CLS is a 12-week program consisting of integrated school, parent, and student treatments delivered by school-based mental health providers. Using a cluster randomized design, CLS was compared with usual school/community services on psychopathology and functional outcomes. Schools within a large urban public school district were randomly assigned to CLS (12 schools) or usual services (11 schools). Approximately 6 students participated at each school (N= 135, mean age 8.4 years, grade range 2-5, 71% boys). Using PROC GENMOD (SAS 9.4), the difference between the means of CLS and usual services for each outcome at posttreatment was tested. To account for clustering effects by school, the generalized estimating equation method was used. Students from schools assigned to CLS compared with those assigned to usual services had significantly greater improvement on parent and teacher ratings of ADHD symptom severity and organizational functioning, teacher-rated academic performance, and parent ratings of oppositional defiant disorder symptoms and social/interpersonal skills. These results support the efficacy of CLS compared with typical school and community practices for decreasing ADHD and oppositional defiant disorder symptoms and improving key areas of functional impairment. They further suggest that existing school-based mental health resources can be redeployed from non-empirically supported practices to those with documented efficacy. This model holds promise for improving access to efficient evidence-based treatment for inattentive and disruptive behavior beyond the clinic setting. Clinical Trial Registration Information-Study of the Collaborative Life Skills Program; http://clinicaltrials.gov/; NCT01686724.