Attention-Deficit Hyperactivity

Disorder 9
Jenelle Nissley-Tsiopinis, Caroline Krehbiel,
and Thomas J. Power

ADHD, Combined Type (American Psychiatric

Introduction Association, 2000). In order to meet criteria for
ADHD, it is also necessary to demonstrate that
Attention-Deficit Hyperactivity Disorder (ADHD) symptoms contribute to significant impairment in
is one of the most common disorders of child- one or more domains, including social and aca-
hood. It is characterized by two dimensions of demic or occupational and that there are impair-
behavior: inattention and hyperactivity–impul- ments in multiple settings (home, school or work,
sivity. The presence of significant elevations on and peer-related activities).
one dimension or both determine the subtype of ADHD typically begins in early childhood
ADHD. Individuals with six or more symptoms but often persists into adolescence and adult-
of hyperactivity–impulsivity and fewer than six hood. Research has demonstrated that hyper-
symptoms of inattention meet partial criteria for active symptoms generally decrease with age,
ADHD, Hyperactive–Impulsive Type. Individuals and that inattentive symptoms persist, and may
with six or more symptoms of inattention but even increase, across age (DuPaul, Power,
fewer than six symptoms of hyperactivity– Anastopoulos, & Reid, 1998; Monuteaux, Mick,
impulsivity meet partial criteria for ADHD, Faraone, & Biederman, 2010). In adolescence,
Inattentive Type. Individuals with six or more impairments due to inattention and impulsivity
symptoms of both dimensions meet criteria for are particularly salient. Although the combined
subtype of ADHD is most prevalent in childhood,
the inattentive type is most common in adoles-
J. Nissley-Tsiopinis, Ph.D. (*) cence (Hurtig et al., 2007).
The Children’s Hospital of Philadelphia, The majority of the treatments for ADHD
3535 Market Street, Room 1465, Philadelphia,
PA 19104, USA have been developed for elementary school chil-
e-mail: [email protected] dren, the age when ADHD is most often first
C. Krehbiel diagnosed. Research in adolescence is much less
School Psychology Program, Lehigh University, developed than it is for younger children.
111 Research Drive, Bethlehem, PA 18015, USA Furthermore, fewer interventions have been
e-mail: [email protected] developed to target the functional challenges
T.J. Power adolescents with ADHD often face. Now that the
The Children’s Hospital of Philadelphia, evidence has clearly indicated that ADHD per-
CHOP North—Room 1471, 34th Street and Civic
Center Blvd., Philadelphia, PA 19104, USA sists into adolescence and adulthood, researchers
e-mail: [email protected] have begun to fill this gap, investigating ADHD

T.P. Gullotta et al. (eds.), Handbook of Adolescent Behavioral Problems: Evidence-Based 151
Approaches to Prevention and Treatment, DOI 10.1007/978-1-4899-7497-6_9,
© Springer Science+Business Media New York 2015
152 J. Nissley-Tsiopinis et al.

in adolescence and developing or adapting inter- anxiety disorders, and mood disorders. About
ventions to be used with teenagers with ADHD. 25 % of clinic-referred youth with ADHD
In this entry, we review the research on demonstrate serious conduct problems, with
adolescents with ADHD. We evaluate the inter- somewhat higher rates for boys than girls. The
vention research to differentiate effective, prom- risk of substance abuse among youth with ADHD
ising, and non-effective approaches. Further, we is elevated among those who exhibit serious con-
identify promising approaches to preventing the duct problems by adolescence (Molina, 2011).
emergence of significant functional impairments
among adolescents with ADHD.
Biological/Genetic Factors

DSM-V and Incidence/ ADHD is a neurodevelopmental, neurobehav-

Prevalence Rates ioral disorder. These descriptors emphasize the
neurological basis of ADHD. The former empha-
Changes in the diagnostic criteria for ADHD pro- sizes the fact that the symptoms of ADHD are
posed by DSM-V are relatively subtle but signifi- displayed differently across the course of devel-
cant, especially for the assessment of ADHD opment, whereas the latter term refers to the fact
among adolescents and adults. First, the descrip- that the symptoms of ADHD are primarily mani-
tion of many of the ADHD symptoms has been fested as variations from typical behavior.
modified to include examples that are relevant for Research has repeatedly found brain differences
adolescents and adults. For example, the symptom associated with ADHD.
“often runs about or climbs in situations where it Following Barkley’s (2006) theory that execu-
is inappropriate” has been modified to stipulate tive functioning deficits underlie ADHD, many
that for adolescents the behavior “may be limited researchers have looked at areas of the brain
to feeling restless.” Second, the age of onset of the associated with executive functioning, which
disorder has been proposed as 12 years, instead of refers to a set of brain processes that enable indi-
7 years, which had been stipulated in the viduals to organize thoughts and activities,
DSM-IV. This change accounts for elevations in prioritize tasks, manage time efficiently, and
inattention and/or hyperactivity–impulsivity that make decisions. Castellanos, Sonuga-Barke,
sometimes occur later in childhood and may not Milham, and Tannock (2006) have proposed that
become significant and impairing until the middle both “cool” executive functioning and “hot”
school years (Willcutt et al., 2012). executive functioning deficits may be associated
The prevalence of ADHD varies according to with ADHD. Cool executive functioning deficits
developmental level. Among elementary-age refer to those that are evident when children are
children, the prevalence is estimated to be about completing a quiet, perhaps boring, task; whereas
8 % (American Academy of Pediatrics [AAP], hot executive functioning deficits are those that
2011). The disorder is more prevalent among are evident during completion of an emotionally
boys than girls with estimates of the gender ratio exciting task.
varying from 2:1 to 6:1 depending on whether Studies of children with ADHD have also
estimates are based on community versus clinical found differences in corticostriatal loops that are
samples. The disorder is chronic in nature, and it related to reward processing, motivation, and
has been estimated that about 75 % of children learning (Kohls, Herpertz-Dahlmann, & Konrad,
with ADHD continue to have the disorder into 2009). Adolescents with ADHD have also been
their teenage years (Barkley, 2006), although a found to have significant reductions in white
higher rate of youth continue to have some residual matter relative to typically developing controls
symptoms that could be somewhat problematic. (Castellanos et al., 2002). More recently, studies in
ADHD often occurs along with other mental adolescents have found that ADHD is associated
health conditions, the most common including with less efficient connections between parts of
oppositional defiant disorder, conduct disorder, the brain (Konrad & Eickhoff, 2010). Some
9 Attention-Deficit Hyperactivity Disorder 153

researchers have hypothesized that decreased Larsson, & Lichtenstein, 2004). These results
efficiency of connections in the brains of youth highlight the importance of genetically influ-
with ADHD may be associated with a loss of enced developmental changes in ADHD symp-
long-range connections between distant sections toms from childhood to adolescence.
of the brain (Wang et al., 2009). Research to date has failed to identify a spe-
Research has also found evidence that brain cific gene or set of genes associated with
differences are associated with greater persis- ADHD. Instead, the research evidence suggests
tence of ADHD symptoms into adolescence and that several distinct clusters of genes may under-
adulthood. For example, Schulz, Newcorn, Fan, lie the development of ADHD, and clusters of
Tang, and Halperin (2005) found that persis- genes may differ across families (Elia et al.,
tence of ADHD into adolescence after initial 2010). Furthermore, research suggests that sev-
diagnosis during early childhood was associ- eral identifiable environmental factors mediate
ated with greater activation of the ventrolateral the expression of these genes in such a way as to
prefrontal cortex, an area of the brain associated increase the severity of clinical symptoms among
with executive function. One study (Hermens, susceptible individuals (Seeger, Schloss,
Kohn, Clarke, Gordon, & Williams, 2005) Schmidt, Rüter-Jungfleisch, & Henn, 2004).
found differences in brain activation between
adolescent boys and girls with ADHD, suggest-
ing that different brain mechanisms may under- Individual Factors Influencing
lie the expression of ADHD symptoms in girls Risk and Resiliency
than boys.
ADHD is increasingly understood to have a Various factors, including childhood severity of
remarkably complex etiology. Genetics research ADHD and psychiatric comorbidity have been
has found that there is a genetic contribution to found to predict persistence of ADHD into ado-
this disorder. Greater risk for ADHD has been lescence among clinic-referred children
reported among first and second degree family (Biederman & Faraone, 2002). Children in a com-
members of individuals with ADHD. Further, a munity sample who had major depressive disor-
higher risk for ADHD has been reported in bio- der or oppositional defiant disorder were more
logical parents, but not in adoptive parents, of likely than children without these disorders to
individuals with ADHD (Sprich, Biederman, meet criteria for ADHD when they became ado-
Crawford, Mundy, & Faraone, 2000). Twin stud- lescents. The presence of specific inattentive
ies have provided estimates of heritability, which symptoms in childhood (e.g., being forgetful, los-
is the proportion of a trait that can be accounted ing things, difficulty following instructions, diffi-
for by genetic factors. In younger cohorts (2 years culty organizing tasks, avoiding tasks) was also
of age or less) the heritability of ADHD has been associated with the persistence of ADHD into
estimated to be 76 %, whereas lower rates, around adolescence (Biederman et al., 1996). Although
30 %, have been reported in older cohorts ADHD is more common in boys than in girls,
(Ehringer, Rhee, Young, Corley, & Hewitt, 2006; findings regarding its persistence were similar for
Price et al., 2005; Schultz, Rabi, Faraone, both boys and girls (Hurtig et al., 2007).
Kremen, & Lyons, 2006). Research has shown that ADHD subtype
Family studies suggest that genetic influ- often changes from childhood to adolescence
ences related to ADHD are less important in (Hurtig et al., 2007). Children who met criteria
cases that remit before adolescence compared to for the combined subtype of ADHD in childhood
persistent cases (Faraone, 2000). Twin studies most often meet criteria for the inattentive sub-
also indicate that hyperactive symptoms are type in adolescence. Individuals who continue to
more stable in early and middle childhood, meet criteria for the combined subtype in adoles-
whereas attention problems are more stable in cence are more likely to have comorbid opposi-
late childhood and adolescence (Larsson, tional defiant disorder or conduct disorder than
154 J. Nissley-Tsiopinis et al.

adolescents with other subtypes of more likely to feel helpless than parents of children
ADHD. Females with ADHD and anxiety in without ADHD (Deault, 2010).
childhood appear to be more likely to have a Parent–child communication is essential to
comorbid anxiety disorder in adolescence, sustaining strong relationships and enabling par-
whereas the presence of a childhood anxiety dis- ents to be involved in a useful way in their child’s
order in boys with ADHD did not predict the decision making regarding peers and community
presence of an anxiety disorder in adolescence. activities (Robin, 2009). Communication prob-
A number of individual factors have been lems are common among families of teens with
associated with impairments in adolescents with ADHD and are associated with negative out-
ADHD. Both male and female adolescents with a comes. For example, when a child has ADHD,
history of ADHD were more likely than their parent–child communication difficulties during
peers without ADHD to also have another psy- childhood have been shown to predict tobacco
chiatric condition (Monuteaux et al., 2010). use in early adolescence (Burke, Loeber, &
Adolescents with ADHD who also had a comor- Lahey, 2001). Resilience factors have been iden-
bid psychiatric condition showed significantly tified with novice drivers that likely have applica-
greater impairments in functioning than their bility to those with ADHD include strong
peers who had ADHD without comorbidity. parent–child communication, increased parental
ADHD is associated with an increased surveillance, and use of an accountability system
likelihood of unsafe driving behaviors, includ- based on parent–teen negotiation, contracting,
ing receiving citations, being involved in motor and positive reinforcement for goal attainment
vehicle crashes, and being involved in accidents (Fabiano et al., 2011).
resulting in injuries and fatalities (Barkley & Cox, Parental surveillance is essential for prevent-
2007). Potential mechanisms of action have been ing youth from engaging in harmful activities in
proposed, including poor ability to anticipate the community and promoting adaptive peer
driving hazards, willingness to engage in risky functioning. Working out the right level of paren-
driving behaviors, inadequate self-assessment tal supervision can be challenging in families in
of skills in relation to challenging driving situ- which there is a teen with ADHD. Once again,
ations, and vulnerability to influence from peers strong communication between parent and child
(Pollatsek, Fisher, & Pradhan, 2006). lays the foundation for success in negotiating a
Research identifying protective factors has system of accountability that acknowledges the
been limited. One study found that greater self- teen’s emerging need for greater autonomy and is
perceived sense of control and meaningfulness effective in protecting the teen from harm
about life among youth with ADHD predicted (Barkley, Edwards, & Robin, 1999).
higher reductions in ADHD symptoms from
childhood to adolescence, especially for teens
with severe symptoms (Edbom, Malmberg, Social and Community Factors
Lichtenstein, Granlund, & Larsson, 2010). Influencing Risk and Resiliency

The presence of ADHD poses serious risks to

Family Factors Influencing adolescents with ADHD in school and commu-
Risk and Resiliency nity contexts. This section describes the risks as
well as factors that promote resilience and suc-
ADHD has a significant effect on children and cessful coping in school and community settings
adolescents and their families. Youth with ADHD for these individuals.
require greater supervision and encouragement
than their peers without this disorder (Barkley, School factors. Students with ADHD are at high
2006). Parents of children with ADHD typically risk for poor school performance, including more
feel more frustrated and stressed and they are homework problems, lower rates of class work
9 Attention-Deficit Hyperactivity Disorder 155

completion, lower grades, poorer performance on social success in school (Pianta, 1999).
standardized achievement tests, higher rates of Although the manner in which families are
classification in special education, and higher involved changes in secondary school in
rates of grade retention (DuPaul & Stoner, 2003). response to emerging student autonomy and
A pattern of poor school performance often changes in school structure, it is critical for par-
becomes established early in schooling, persists ents to actively participate in their child’s edu-
through the elementary and middle school years, cation and remain closely connected with the
and results in increased risk of dropout in high school (Grolnick, Kurowski, Dunlap, & Hevey,
school. School dropout, in turn, has been shown 2000). In addition, connecting students to a
to be a serious risk factor for poor outcomes later mentoring program promotes a sense of student
in life, including chronic health conditions, alco- belonging to the school, provides ongoing mon-
hol and substance abuse, serious mental illness, itoring of academic performance and behavior,
unemployment, and incarceration (National and coordinates the efforts of school personnel
Research Council, 2001). to assist the student (Sinclair, Christenson, &
Research has identified student engagement as Thurlow, 2005).
a key factor in preventing dropout and promoting
successful school performance. Student engage- Community factors. Adolescence is marked by a
ment has multiple dimensions (Betts, Appleton, heightened desire for autonomy from parents
Reschly, Christenson, & Huebner, 2010). and other adults, an increased interest in form-
Behavioral engagement, the extent to which a ing relationships with peers, greater involve-
student is in a position to participate in school, is ment in activities outside of home and school,
measured by attendance, suspensions, and par- and increasing access to privileges (e.g., driv-
ticipation in extracurricular activities. Academic ing, intimate relationships). Adolescence poses
engagement, the extent to which students are substantial challenges and risks to youth and
involved in instruction and practice activities, is their families, but the presence of ADHD often
differentiated into active responding (asking confers additional risk, such as engaging in
questions, working on class work) and passive potentially harmful sexual behavior (Barkley &
responding (looking at teacher during instruc- Gordon, 2002), using tobacco (Molina, 2011),
tion). Cognitive engagement refers to internal and engaging in dangerous driving behavior
factors related to learning, including self- (Barkley, 2004).
regulation, academic motivation, goal directed- Psychosocial adversity, such as lower socio-
ness, and use of learning strategies. Finally, economic status, single parenting, and parental
psychological engagement refers to a student’s psychopathology, predicts the persistence of
connectedness with school, including perceived ADHD into adolescence (Biederman & Faraone,
support from teachers and classmates and a sense 2002). Several factors that promote resilience
of belonging. among adolescents have relevance for youth with
Research on student engagement has identi- ADHD. Involvement in meaningful community
fied multiple factors that have relevance to pro- activities (e.g., afterschool programs) has been
moting resilience for students with ADHD who identified as a key factor in promoting positive
are at risk for school failure (see National youth development (Lerner & Benson, 2003). In
Research Council and Institute of Medicine, these contexts, it is important for youth to have
2004). One factor is ensuring that instructional the opportunity to form meaningful relationships
and practice activities include the appropriate with adults outside the home, engage in support-
ratios of familiar to unfamiliar material and are ive peer relationships, and pursue activities that
meaningful and interesting to students (Burns, have intrinsic value to them; however, youth with
2004). A critical factor is to establish and main- ADHD face unique challenges in becoming
tain a strong relationship between student and involved in meaningful extracurricular activities
teacher, which has been related to academic and at school and in the community.
156 J. Nissley-Tsiopinis et al.

oped by Barkley to train parents in behavioral

Evidence-Based Treatment management techniques. It was found effective
Interventions for ADHD in reducing parent–child conflict and child non-
compliance in children with ADHD and disrup-
Unlike research regarding psychosocial interven- tive behavior disorders. PSCT teaches family
tions for children with ADHD, psychosocial members behavioral skills (e.g., problem solving,
treatment development for adolescents with communication strategies, contingency manage-
ADHD is in its infancy. Nonetheless, there are ment), uses family therapy approaches to address
many promising approaches to psychosocial family structure and communication patterns,
intervention for youth with this disorder. and uses cognitive therapy approaches to reframe
irrational beliefs. These studies found that ado-
lescents in both treatment groups improved sig-
What Works nificantly from pre-treatment to post-treatment,
although neither study included a treatment as
A review of the literature to date indicates that no usual group to control for non-treatment effects.
treatment has met the criteria of being tested in However, less than one third of teenagers showed
three randomized controlled trials and shown to be significant improvements and less than one fifth
successful. As a result, a work group of the AAP of teenagers improved to the point of being in the
concluded that there is not sufficient research sup- normal range, suggesting that the effectiveness of
port for the effectiveness of psychosocial treat- these treatments was somewhat limited.
ments for adolescents with ADHD (American Additional studies have found improvements
Academy of Pediatrics, 2011). A meta-analysis of in response to structural family therapy (Barkley
behavior modification treatments for ADHD (parent et al., 1992) and a summer treatment program
behavioral therapy, classroom consultation, and with parent training intervention (Sibley et al.,
summer treatment programs) found moderate to 2011, 2012, Sibley, Smith, Evans, Pelham, &
large effect sizes, but few of the reviewed stud- Gnagy, 2012) suggesting that these interven-
ies examined the effectiveness of such treatments tions also show promise in treating adolescents
with adolescents (Fabiano, Pelham, Coles, Gnagy, with ADHD. For two studies, parent involve-
& Chronis-Tuscano, 2009). ment was limited to parent psychoeducation
and did not include behavioral parent training.
One of these studies found positive improve-
What Might Work ments (McCleary & Ridley, 1999), whereas the
other study (Antshel, Faraone, & Gordon, 2012),
Researchers have begun to address the need for which combined parent education with adoles-
effective psychosocial treatments for adolescents cent cognitive-behavioral therapy, failed to find
with ADHD that address teenagers’ functioning positive results. These mixed results suggest that
at home, school, and elsewhere. further research is needed to determine the effec-
tiveness of parent education.
Family-based interventions. Table 9.1 lists the Similarities among the interventions that
six studies investigating the effectiveness of a appear promising consist of elements of behavior
family-based intervention for adolescents with therapy, goal setting, contingency management,
ADHD. Two large-scale studies conducted by and frequent use of positive reinforcement. In
Barkley, Guevremont, Anastopoulos, and Fletcher addition, these interventions include components
(1992), Barkley, Edwards, Laneri, Fletcher, and to make the treatment developmentally appropri-
Metevia (2001) found significant improvements ate for adolescents, such as communication and
as a result of Behavior Management Training negotiation training. Each of these treatments
(BMT) and Problem-Solving Communication needs additional randomized controlled trials in
Training (PSCT). BMT provided in this study order to conclusively determine that they are
was an adapted version of the program devel- effective for teenagers with ADHD. Furthermore,
Table 9.1 Family interventions for adolescents with ADHD adapted by authors
Study authors (N,
Tx age range) Design (Gender) ethnicity Outcome measures Findings
CBT + Family Ed Antshel et al. (2012) Within-subjects (66 % Male) GPA, attendance, BASC-2 • No statistically significant findings
(N = 68, 14–18) 81 % Caucasian (P&T), IRS, ADHD-RS (P&T), • Larger ES for school absences/tardiness,
13 % Af. Am. med adherence, med dose parent and teacher ratings of inattention,
3 % Latino and parent ratings of externalizing problems
PSCT, BMT, SFT Barkley et al. (1992) Randomized (Gender NR) CBCL (P&Y), Conflict • Statistically significant improvements for
(N = 61, 12–17) control trial 100 % Caucasian Behavior Questionnaire, all three Tx groups on parent- and
Issues Checklist, Locke- youth-report of communication, # conflicts,
Wallace Marital Adjustment anger intensity; and parent ratings of school
Test, Family Beliefs adjustment, internalizing and externalizing
Inventory, BDI, PAICS-R problems
• Only 5–30 % reliably improved from
9 Attention-Deficit Hyperactivity Disorder

treatment, only 5–20 % recovered following

treatment
PSCT, BMT Barkley et al. (2001) Pre-/Post- (90 % Male) Conflict Behavior • Statistically significant improvements for
(N = 97, 12–18) 86 % Caucasian Questionnaire, Issues both Tx groups (PSCT, BMT + PSCT) on
9 % Latino Checklist, Parent–Teen parent, teacher, adolescent, and direct
3 % Asian Conflict Tactics Scale, observation ratings
2 % Af. Am. Conflict Rating System, DBD
STP-A + Parent Sibley et al. (2011) Within- (68 % Male) Program-specific ratings • Parent, youth, and counselor reported
Train. (N = 19, 11–16) subjects + Single 58 % Caucasian of target behaviors improvements in target behaviors
Case Ex. 21 % Latino • Moderate treatment effects for case study
11 % Af. Am.
11 % Other
STP-A + Parent Sibley et al. (2012) Within-subjects (88 % Male) Improvement Rating Scale • Parent ratings show some improvement
Train. (N = 34, M = 13.9) 82 % Caucasian across target behavior from baseline
Parent education McCleary and Pre-/Post- (77 % Male) Conflict Behavior Questionnaire, • Statistically significant improvements in
and skills training Ridley (1999) Ethnicity NR Issues parent–youth conflict and child problem
(N = 103, 12–17) Checklist behavior
Abbreviations: BMT Behavior Management Training, CBT Cognitive-Behavioral Therapy, PSCT Problem-Solving Communication Training, SFT Structured Family Therapy;
STP-A Summer Treatment Program for Adolescents
157
158 J. Nissley-Tsiopinis et al.

the relatively low response rate to intervention in examined in two separate studies, the Thinking
the Barkley studies suggests that modifications Before Reading, While Reading, After Reading
may be needed to increase the effectiveness of intervention (TWA) and the Self-Regulated
family treatments for adolescents. Strategy Development intervention (SRSD). The
It is important to note that each of the previ- other interventions were only evaluated in one
ously mentioned interventions has been designed study. An additional five studies investigated the
for and applied in an outpatient setting. When effectiveness of interventions targeting disruptive
adolescents experience significant impairment, behavior. Similar behavioral techniques were
requiring more intensive intervention than can be used in each of these studies, but approaches were
provided in an outpatient setting, similar family not standardized across studies. Improvements
interventions can be applied in an inpatient, resi- were found in all five studies, although each
dential, or day treatment setting, although addi- study used a single case design and therefore the
tional research is needed in these settings. results are limited with regard to generalizability
to adolescents with ADHD.
School interventions. Table 9.2 lists the 28 stud- Nine studies have investigated interventions
ies that have investigated the effectiveness of addressing organizational skills and homework
school-based intervention for adolescents with problems. The sample sizes for all of these stud-
ADHD. Six studies investigated the Challenging ies were small, with four of them including fewer
Horizons Program (CHP; Evans, Schultz, than five participants. All of these studies found
DeMars, & Davis, 2011). CHP is an afterschool positive improvements in response to interven-
program developed for middle school students tion, although only one study assessed the statis-
with ADHD, which was adapted and is currently tical significance of results. All of the studies
being evaluated for use with high school students used behaviorally based techniques but differed
with ADHD. This program addresses students’ in their specific interventions, with the exception
academic, behavioral, and social functioning of two studies that used self-monitoring of class
through a variety of after-school intervention, preparation behavior. An additional three studies
parent education, and teacher consultation activi- examined social skills interventions applied in
ties that include elements of behavioral parent the school setting and found positive improve-
training and teacher consultation, as well as the ments on some measures of social behavior.
application of behavioral interventions to teach Overall, a review of these studies reveals
organization and social skills. The middle school that the effective interventions shared some
version of CHP has been found to have medium common elements, specifically the applica-
to large effect sizes on a variety of outcome mea- tion of behavioral principles to address school
sures and to move 38–60 % of middle school stu- problems and the involvement of both students
dents with ADHD into the average range on a and teachers in the implementation of inter-
measure of impairment. CHP has been evaluated ventions. Interventions differed in the extent
in multiple studies and could be considered an to which students were the primary treatment
efficacious treatment for middle school students agent (e.g., self-monitoring interventions) versus
with ADHD. However, it is classified as a pro- teachers or other school personnel (e.g., group
gram that “might work” for adolescents given contingency management). With the exception
that there have not been any outcome studies of the CHP, the generalizability of study results
determining the effectiveness of this program is limited by the failure of studies to standard-
with high school students. ize their interventions so that results can be
Five studies investigated interventions to compared across studies.
address academic skill deficits in adolescents It is important to note that each of the previ-
with ADHD. Each found significant treatment ously mentioned interventions have been
effects on measures of academic performance designed for and applied in a regular education
and/or on-task behavior. Two interventions were classroom placement setting. When adolescents
Table 9.2 School interventions for adolescents with ADHD adapted by authors
Tx Authors (N, age range) Design (Gender) Ethnicity Outcome measures Findings
Multimodal Interventions
CHP Evans et al. (2004) Within (71 % Male) Grades, GPA slope, • Large effect sizes for parent- and teacher-rated
(N = 7, 6–8) subjects Ethnicity NR ADHD-RS, CIS inattention, academics, teacher-rated hyperactivity and
classroom behavior
CHP Evans et al. (2005) Pre-/Post- (78 % Male) 100 % GPA, IRS • Maintenance of GPA in Tx group vs. decline in
(N = 27, 11–14 ) Cauc. comparison group
• Improvement to “normal range” on IRS for 38–60 % of
Tx group
CHP Evans et al. (2005) Within (83 % Male) 100 % IRS, ADHD-RS • Average effect size across raters indicates overall
(N = 35, 11–14) subjects Cauc. improvement
• Raters agreed on only 27 % of kids
CHP-C Evans et al. (2007) Between (77 % Male) 94 % BASC, DBD, IRS, SSRS, • Improvements in parent ratings of ADHD symptoms
9 Attention-Deficit Hyperactivity Disorder

(N = 79, 10–14) group Cauc. Grades and social functioning

• Trends suggested benefits for Tx group grades
CHP Evans et al. (2011) (71 % Male) DBD, IRS, CPS, Grades • Improved teacher ratings of academic impairment for
(N = 49, 10–13) 70 % Cauc. Tx group
14 % Af. Am. • Improved teacher-reported language arts and social
12 % Hisp. studies progress for Tx group
4 % Asian • Better grades in math for Tx group
• Unspecified site-specific contextual factors may have
contributed to differences for some outcome measures
CHP Molina et al. (2008) (Gender NR) BASC, IRS, Grades, • Medium ES for parent ratings of internalizing, and
(N = 20, 6–8) Ethnicity NR Aggression and Conduct adolescent-reported school adjustment
Problems Scale • Prevention effect on grades and conduct problems
• Small ES for parent-reported externalizing problems
Academic Skills Interventions
SSIC Diliberto et al. (2008) Pre-/Post- (65 % Male) WJ-III Reading Subtests, • Statistically significant effects on WJ-III subtests,
(N = 83 [7 ADHD], 6–8 61 % Cauc. Reading Fluency favoring Tx group
grade) 27 % Af. Am. • Interaction effect for reading fluency approached
12 % Hisp. significance (p = .06)
Planning strategy Iseman and Naglieri Pre-/Post- (72 % Male) WJ-III Math Fluency, WIAT-II • Gains for Tx group on all three measures
instruction (2011) (N = 29, 10–15) 89.7 % Cauc. Numerical Operations, Math • Maintained at 1-year follow-up
scores
TWA & SRSD Johnson et al. (2012) Mult. BL (100 % Male) Recall of main ideas and • PND main ideas >80 %
(N = 3, 14–15) 100 % Cauc. details • PND details >60 %
159

(continued)
Table 9.2 (continued)
160

Tx Authors (N, age range) Design (Gender) Ethnicity Outcome measures Findings
TWA-WS & SRSD Rogevich and Perin Pre-/Post- (100 % Male) Summarization of main ideas • Improvements on post-test, near and far transfer tasks,
(2008) (N = 63, [31 35 % Cauc. and follow-up
ADHD], 13–16) 41 % Af. Am.
24 % Hisp.
Self- Shimabukuro et al. Mult. BL (100 % Male) Academic accuracy, • Stronger improvements for productivity and accuracy
monitor + reward (1999) (N = 3, 12–13) Ethnicity NR Productivity, On-task behavior in reading and math classes vs. writing class
• On-task behavior showed similar pattern across subject
areas
Behavioral Interventions
Func. Assess. & Int. Ervin et al. (1998) Single subj. (100 % Male) On-task behavior • % intervals of on-task behavior increased to >88 % for
(N = 2, 13–14) 50 % Cauc. both participants
50 % Hisp.
Self-monitor Graham-Day et al. . (67 % Male) 100 % On-task behavior, Grades • On-task behavior increased across all 3 participants to
(2010) (N = 3, 16) Cauc. >90 %
• Grades showed little change
Group contingency Jones et al. (2008) (Gender NR) Disrespectful verbal behavior • Reductions in verbally disrespectful behavior across
(N = 7, 6–8) Ethnicity NR participants
Func. Assess. & Int. Majeika et al (2011) (100 % Male) On-task behavior • % intervals of on-task behavior increased to roughly
(N = 1, 17) 100 % Cauc. 80 %
Self- Shapiro et al. (1998) (100 % Male) ADHD-RS, CTRS-R, • Improved classroom behavior ratings
monitor + reward (N = 2, 12) Ethnicity NR Classroom behavior ratings, • Improved levels of on-task behavior
On-task behavior • Some improvements on CTRS-R and ADHD-RS
Organizational Skills and Homework Interventions
Self-monitor Creel et al. (2006) Mult. BL (75 % Male) Class preparation behaviors • Improvements in teacher ratings of classroom
(N = 4, 11–12) 50 % Af. Am. preparedness
25 % Cauc. • PND of 0 % for all participants
25 % Hisp.
PDAs for HW Currie et al. (2005) Mult. BL (100 % Male) Homework completion • Average % of homework completed met or exceeded
(N = 4, 12–14) Ethnicity NR criterion of 80 % for 3 of 4 students
Org. Checklist Evans et al., (2009) With-in- (77 % Male) Mastery of organizational • 71 % of the sample met a mastery criterion of 90 %
(N = 28, 11–15) subjects 70 % Cauc. checklist, Grades over three weeks
14 % Af. Am. • Performance on specific organizational skills correlated
12 % Hisp. with student math and English grades
4 % Asian
J. Nissley-Tsiopinis et al.
Tx Authors (N, age range) Design (Gender) Ethnicity Outcome measures Findings
Self-monitor Gureasko-Moore et al Mult. BL (100 % Male) Class preparation behaviors
Overall improvements across all three participants, with
(2006) (N = 3, 12) Ethnicity NR gains maintained
Org. Strategies Langberg et al. (2008) (84 % Male) APRS, HPC, Grades, • Improvements to >90 % on Organization Checklist
(N = 37, 4–7) 70 % Cauc. Organization Checklist, • Improvements to 72 % on Homework Checklist
30 % Af. Am. Homework Management • Statistically significant improvements for Tx group on
Checklist HPC
• Some improvement of GPA for Tx group
Goal setting and Merriman and Codding Mult. BL (67 % Male) Homework completion and • Stable improvements in both completion and accuracy
coaching (2008) (N = 3, 9–10) Ethnicity NR accuracy for 2 of 3 students
Self- and parent- Meyer and Kelley (86 % Male) 93 % HPC, CPS, Homework Grades • Self- and parent-monitoring groups both increased %
monitoring, SQ4R (2008) (N = 42, 11–14) Cauc. homework turned in and reduced homework problems
on HPC
HIP Raggi et al. (2009) Mult. BL (91 % Male) APRS, BIRS, DBD, Grades, • 8 of 11 participants improved on HPC; 6 maintained
(N = 11, 11–13) 36 % Cauc. HPC, Homework Process improvements
45 % Af. Am. Questionnaire • 7 of 8 students with grades showed improvement
9 Attention-Deficit Hyperactivity Disorder

9 % Hisp. • 7 of 11 kids improved on parent DBD ratings

9 % Bi-racial • 6 of 10 students were rated improved on the Academic
Productivity subscale of the APRS
Daily Planner & Sadler et al. (2011) Pre-/Post- (86 % Male) Mastery of planner and • 62 % of kids mastered checklist
Org. Checklist (N = 36, 13-17) 92 % Cauc. checklist • Mixed findings for planner
STUDY 1 6 % Biracial • Positive correlations found between adherence to
3 % Hisp. checklist/planner and GPA
Social Skills Interventions
Social rules and Kuester and Zentall (47 % Male) % problems cooperatively • Fewer problems solved in no-rule condition
group prob. solving (2012) (N = 34, 10–14) 94 % Cauc. solved • Some increases in pro-social behavior under rules
6 % Af. Am. Pro-social behavior condition
ISG Sadler et al. (2011) Pre-/Post- (Gender NR) IRS, SSRS, ISG Cards • 33 % of student mastered social goals
(N = 15 , 13–17) Ethnicity NR • Mastery was associated with greater decreases in IRS
STUDY 2 social impairment
• All students improved on SSRS ratings
Peer scaffolding Watkins and Wentzel Pre-/Post- (100 % Male) Behavioral observation of a • Joint participation increased through scaffolding
(2008) (N = 24, 9–13) Ethnicity NR problem-solving task • Solitary participation decreased
• Passive behaviors remained stable
Abbreviations: NR Not Reported, CHP Challenging Horizons Program, CHP-C CHP with Consultation, ADHD-RS ADHD-Rating Scale, BASC Behavior Assessment System for
Children, CIS Children’s Impairment Scale, CPS Classroom Performance Survey, DBD Disruptive Behavior Disorders Rating Scale, IRS Impairment Rating Scale, SSRS Social
Skills Rating Scale, SSIC Syllable Skills Instruction Curriculum, TWA Thinking Before Reading, While Reading, After Reading, SRSD Self-Regulated Strategy Development,
TWA-WS TWA-with Written Summarization, CTRS-R Connors Teacher’s Rating Scale-Revised, SQ4R Survey, Question, Read, Write, Recite study strategy, HIP Homework
Intervention Program, ISG Interpersonal Skills Group, APRS Academic Performance Rating Scale, BIRS Behavior Intervention Rating Scale, CPS Classroom Performance
161

Survey, HPC Homework Problems Checklist

162 J. Nissley-Tsiopinis et al.

Table 9.3 Other interventions for adolescents with ADHD adapted by authors
Study authors (Gender)
Tx (N, age range) Ethnicity Design Outcome measures Findings
STEER Fabiano et al. (43 % Male) Mixed Methods/ Electronically monitored • Hard braking, top weekly
(2011) (N = 7, 100 % Multiple-baseline driving behaviors speed improved
16–17) Caucasian (CarChip Pro), Driving • Ratings on DBQ and IRS
Behavior Questionnaire suggestive of positive
(P&Y), IRS effects, though not tested
for significance
Abbreviation: STEER Supporting a Teen’s Effective Entry to the Roadway

experience more significant impairment, so that However, studies that have investigated their
they cannot be effectively and safely taught in a effect on ADHD symptoms via blind parent and
regular education classroom setting, they typi- teacher reports have failed to demonstrate treat-
cally receive similar interventions at a greater ment effects (Shipstead, Redick, & Engle, 2012).
intensity in a special education classroom place-
ment. As such, there remains a need for addi- Biofeedback. Some initial studies of biofeedback
tional research regarding the effectiveness of as a treatment for ADHD have found promising
school interventions in more restrictive academic results for children. One study found that biofeed-
settings for students with ADHD. back had positive results compared to controls on
independent clinician ratings of diagnostic status
Other interventions. The majority of interven- (e.g., Bakhshayesh, Esser, & Wyschkon, 2010),
tions have been focused on improving youth suggesting that this treatment shows promise.
functioning at home and/or school. However, the However, studies with adolescents that look
following intervention approaches also have specifically at the beneficial effects of this treat-
promise and deserve mention. ment on behavior at home and school are needed
to determine whether biofeedback “works” as a
Driving. Fabiano et al. (2011) have developed the treatment strategy for ADHD in adolescence.
STEER program as an intervention for adoles-
cents with ADHD who are learning to drive. This
program incorporates components of cognitive- What Doesn’t Work
behavior therapy (CBT) that have been shown to
be promising in the treatment of teens with Although no intervention has been sufficiently
ADHD, including negotiating, goal setting, con- studied with adolescents with ADHD to con-
tracting, monitoring of behavior, and contingency clude that it does not work for certain, ADHD
management. In a pilot study, Fabiano and col- treatment research with younger children sug-
leagues demonstrated that STEER is feasible to gests approaches that are not likely to work.
implement and promising for improving driving Specifically, treatments targeting youth that
performance. do not include behavioral management strate-
gies applied by parents and teachers have not
Working memory. Studies of working mem- been found to be effective for children with
ory training have included both children and ADHD. Consistent with this, Antshel et al. (2012)
adolescents, so it is not possible to pinpoint the studied the effectiveness of cognitive-behavioral
effects of such programs on adolescents with therapy combined with parental education (rather
ADHD. Working memory training programs than behavioral parent training) for adolescents
have found some intriguing initial results, pri- with ADHD and failed to find any significant
marily demonstrating that they can improve per- improvements as a result of the treatment (see
formance on working memory tasks in the lab. Table 9.1 for further information). Numerous
9 Attention-Deficit Hyperactivity Disorder 163

alternative treatments have been developed and is, unauthorized use of medication involving the
have proponents who claim that the approaches giving, selling, or trading of prescribed medication
are effective for treating ADHD. However, in by youth with ADHD to another youth (Wilens
general, these alternative treatments either have et al., 2008). This concern has led to recommenda-
not been researched sufficiently or research has tions that prescribing clinicians monitor carefully
failed to find beneficial results when the treatment refill requests and use medications that have low
was subjected to a double-blind study. For further abuse potential (AAP, 2011).
information regarding alternative treatments for
ADHD, see the review by Hurt, Lofthouse, and
Arhold (2011). Prevention for Youth with ADHD

Prevention for youth with ADHD refers to reduc-

Psychopharmacology and ADHD ing educational and social impairments and mini-
mizing risks associated with poor outcomes later
There is strong evidence that pharmacological in life. Research focused on the prevention of
treatment is effective with adolescents and adults impairments and risk among adolescents with
(Barkley, 2006; Wolraich, 2011) and equally ADHD is limited, but public health models have
effective with males and females. The most effec- been developed that have relevance and promise
tive class of medications for treating ADHD for youth with ADHD.
is the stimulants (AAP, 2011). There are two
broad classes of stimulants: methylphenidate and
amphetamine compounds. Both classes of medi- What Works
cation are essentially equally effective, although
some individuals respond more favorably to one Although research on adolescents with ADHD
class as opposed to the other. Experts generally has increased substantially over the past several
recommend that prescribing providers offer a years, no prevention programs for these individu-
trial of both types of stimulants before advanc- als have been demonstrated to be effective.
ing to non-stimulant alternatives (Wolraich, However, many prevention approaches are prom-
2011). Several additional medications have been ising and likely to be effective.
approved by the Food and Drug Administration
for the treatment of ADHD; these include atomox-
etine, extended release guanfacine, and extended What Might Work
release clonidine. In general, effect sizes achieved
by the stimulants are larger than those exhibited Schools are a logical venue for the delivery of
by these alternative drugs (AAP, 2011). prevention services, given that the mission of
A major concern with the pharmacological schools is to promote youth development and
treatment of ADHD is non-adherence (Molina given that they serve a very high percentage of
et al., 2009). Non-adherence is often related to youth. Since 2000, there has been a widespread
ambivalence on the part of adolescents about the effort to implement a public health, preven-
benefits and usefulness of medication, as well as tion framework in public schools throughout
concerns about unwanted side effects (e.g., seri- the USA. The most commonly used and most
ousness, lack of spontaneity). For this reason, widely studied approach is School-wide Positive
approaches to treatment planning that involve full Behavior Support (SWPBS; Sugai & Horner,
participation by adolescents as well as their parents 2006). This approach is characterized by the
and health providers are strongly recommended use of multi-tier models of prevention and inter-
(Power, Soffer, Cassano, Tresco, & Mautone, vention. Applying a public health approach to
2011). Another concern when treating adolescents programming for youth with ADHD has signifi-
with medicine is the potential for diversion, that cant utility and potential effectiveness (Evans
164 J. Nissley-Tsiopinis et al.

et al., 2014). Most multi-tier models developed communicating high and realistic expectations to
for schools have three or four levels. Recently, students and identifying useful websites.
Tresco, Lefler, and Power (2010) have described The second tier refers to selective strategies
a four-tier model that has applicability for youth for the subgroup of students who do not respond
with ADHD. sufficiently to universal approaches. Peer tutor-
ing is an approach that has received some
Multi-tier models. The first tier refers to univer- research attention for students with ADHD
sal strategies for all students that can be ben- (DuPaul, Ervin, Hook, & McGoey, 1998). Peer
eficial to the subset of youth with ADHD. These tutoring is typically provided by pairing students
approaches include instructional strategies that and requesting them to work in a reciprocal man-
maximize student attention and productivity. For ner (i.e., exchange of tutor/tutee roles). This
example, research indicates that instruction incor- strategy provides opportunities for students to
porating novel material and teaching methods receive individualized instruction using a pace
that provide students with frequent opportunities that matches the style of the learner. Also, peer
for active responding (e.g., participation in class, tutoring typically includes frequent prompts for
brief written assignments, opportunities to work attention and frequent positive reinforcement for
on educational computer games) can promote effort and accurate responding. In addition, peer
concentration and work productivity (DuPaul & coaching is a useful approach and has the poten-
Power, 2009). Further, instruction in organiza- tial to improve both academic and social perfor-
tional strategies, such as note taking, organization mance (Dawson & Guare, 1998). Peer coaching
of school work and homework, and time manage- typically incorporates goal-setting techniques
ment, can be useful in promoting school success and monitoring to evaluate goal attainment. The
for all children, especially those with ADHD. success of both peer tutoring and peer coaching
Universal strategies have also been developed requires careful planning with the teacher and
to promote adaptive behavior and social interac- ongoing adult supervision. Another Tier 2 strat-
tion. For example, it is important for teachers to egy is identifying a school-based mentor, who
identify a limited number of critical rules for stu- could be a teacher, counselor, or coach. The role
dents to follow, to post these rules in a prominent of the mentor is to provide support and guidance
location, and to provide frequent instruction and to the student, coordinate communications
reminders about the rules. In addition, it is impor- among teachers, and promote family–school col-
tant for teachers to observe students on a contin- laboration. Various models of school mentoring
ual basis with regard to how well they are have been developed. The Check and Connect
following the rules and provide frequent positive program, developed to promote school engage-
reinforcement for rule-governed behavior. ment and prevent dropout, uses an approach to
Corrective feedback can be offered to students in mentoring that is relatively intensive and more
the class, but the ratio of positive reinforcement consistent with a Tier 3 intervention (Sinclair
to corrective feedback to the class as a whole and et al., 2005), but components of this program can
to each student should be at least four to one be adapted for use at the Tier 2 level.
(DuPaul & Stoner, 2010). Promoting family Multi-tier models for youth with ADHD typi-
involvement in education is another important cally include two additional tiers that involve
universal strategy, given the clear link between intervention as opposed to prevention. Tier 3
family involvement and student outcomes includes interventions such as self-management,
(Christenson & Sheridan, 2001). Teachers can organizational skills training, and social skills
provide parents and youth with clear guidelines programming, which are described in the treat-
about how to address common homework chal- ment section. Tier 4 refers to highly intensive
lenges and how to seek help when problems intervention that might include placement in spe-
arise. In addition, teachers can educate parents cial education for most of the school day or par-
about other ways to support students, such as tial hospitalization programming.
9 Attention-Deficit Hyperactivity Disorder 165

Progress monitoring. A key component of pre- practice skills. Engagement can be measured by
vention programming is monitoring of progress clinician ratings of intervention involvement,
on critical outcome variables. There are two participant response to clinician attempts to
broad classes of outcome variables that are rele- contact, or permanent products generated by
vant for students with ADHD: academic and homework assigned to participants (Power
social-behavioral. A useful strategy for monitor- et al., 2005).
ing progress with regard to academic functioning
is curriculum-based measurement (CBM), which Response to intervention. A key feature of
involves the frequent, ongoing assessment of multi-tier models of prevention is that move-
materials directly linked to the curriculum using ment up and down the tiers is based on response
brief (1- or 2-min) probes (Shapiro & Gebhardt, to intervention, which is determined by prog-
2012). A noteworthy advantage of CBM methods ress monitoring of targeted outcome variables
is that they yield useful data about rate (slope) of and a consideration of integrity and engage-
progress in addition to level of functioning, ment (Glover & DiPerna, 2007). For example,
which is highly useful in assessing whether rate in the context of a public health or prevention
of progress is adequate. framework, all students with ADHD will receive
A highly useful strategy for monitoring social universal strategies of instruction and behavior
and behavioral functioning is direct behavior rat- management and their progress will be moni-
ings (DBRs). This method involves frequent tored based on empirical findings regarding
(daily or multiple times per day) ratings of stu- the student’s academic, behavioral, and social
dent behavior by a teacher on one or more tar- functioning. If the student is struggling based
geted behaviors (Gresham et al., 2010; Volpe & on progress monitoring data, then integrity and
Gadow, 2010). These methods demonstrate ade- engagement data should be reviewed to deter-
quate psychometric properties for progress moni- mine whether adjustments in implementation
toring and generally are sensitive to the effects of by the teacher are needed. If outcomes are inad-
evidence-based interventions. equate despite acceptable implementation, then
transitioning to Tier 2 prevention strategies likely
Assessment of integrity and engagement. is needed. Subsequent applications of prevention
Integrity refers to the extent to which interven- strategies and collection of outcome, integrity,
tions are delivered as intended, and engage- and engagement data are then used to determine
ment refers to the extent to which participants whether movement to higher tiers (Tier 3 and 4)
are actively involved in the process of interven- are required.
tion. The importance of assessing integrity and As a general rule, prevention programming for
engagement is highlighted by the reality that students begins with Tier 1 and proceeds in a
lack of intervention (or prevention) effectiveness gradual, step-by-step (one tier at time) manner.
could be due to use inadequate clinician imple- However, for some children with ADHD, data
mentation and/or participant engagement (Glover available at baseline may indicate that universal
& DiPerna, 2007). programming will not be adequate and more
Implementing intervention strategies with intensive strategies are needed. In these cases,
integrity means adhering to or following the starting treatment at Tier 2 or 3 may be war-
steps of the intervention and doing so compe- ranted. Also, the use of medication may have an
tently. Integrity is most accurately assessed by effect on the tier that is most appropriate for stu-
having external reviewers observe the interven- dents. For example, use of medication may
tion and code for adherence and competence. enable a student with ADHD to be treated effec-
Engagement is a multi-dimensional construct tively in the general education setting using Tier
that includes session attendance, active attend- 3 strategies, thereby averting the needed for
ing during sessions, and completion of between- intensive special education or partial hospitaliza-
session assignments to parents or youth to tion (Tresco et al., 2010).
166 J. Nissley-Tsiopinis et al.

What Doesn’t Work tional impairments in teenagers with ADHD is in

its infancy. As a result, no specific psychosocial
In general, elimination diets and vitamin and treatment has been shown to work in at least three
mineral supplementation are limited in their randomized controlled trials.
effectiveness. Elimination diets generally are However, research conducted to date with
not effective unless they target foods for which adolescents who have ADHD supports the fol-
an individual has been shown to have height- lowing practices:
ened sensitivity. However, these approaches • Interventions applied at home and school
can have adverse effects, such as parent–child should be based on principles of behavioral
conflict related to efforts to maintain adherence psychology and include youth, their parents
and nutrition imbalance associated with unin- and teachers in goal setting and contingency
tended elimination of important vitamins and management involving the frequent use of
minerals. Further, the application of elimina- positive reinforcement.
tion diets may result in delayed use of treat- • Training youth and their parents in communi-
ments that are much more likely to be effective cation and negotiation skills is critical in
(Arnold et al., 2011). strengthening parent–child relationships and
Diets involving nutritional supplementation developing strategies that are developmentally
have been examined in numerous studies (e.g., appropriate and acceptable to youth.
Hirayama et al., 2004; Raz et al., 2009; Voigt • Organizational skills training and peer rela-
et al., 2001) There is little support for amino acid tions training that involve youth as well as
supplementation but some evidence that essential their parents and teachers are promising
fatty acid supplementation may be a safe and sen- approaches to improving academic and social
sible approach for improving inattention (Arnold functioning.
et al., 2011; Chalon, 2009). Also, administering • Public health models incorporating multi-tier
recommended daily allowances of multivitamins models of prevention, ongoing monitoring of
may promote nutrition and general health, but integrity and outcomes, and adjustments in
there is essentially no evidence to support the use level of support based on response to interven-
of megadoses of vitamins (Arnold et al., 2011). tion are promising in preventing the emer-
Research generally supports the practice of pre- gence of serious impairments among youth
scribing mineral supplements when there are with ADHD.
identified deficiencies of these substances. • Pharmacological treatment, in particular the
Further, thyroid treatment may be indicated when stimulants, is an evidence-based treatment for
there is evidence of thyroid dysfunction (Arnold adolescents with ADHD. Medication can be
et al., 2011). effective when youth view this treatment as
acceptable and consistently adhere to the
regimen. Also, there is evidence to suggest
Recommended Best Practice that medication may facilitate response to psy-
chosocial interventions.
ADHD is a neurodevelopmental disorder that Research suggests that the response rate to
usually starts in early childhood and often contin- existing interventions is variable and lower than
ues through adolescence. Currently, there is no that for younger children. Therefore, additional
cure for the biopsychosocial underpinnings of treatment development research is needed to
ADHD. When working with adolescents with adapt current treatments to increase their effec-
ADHD, the goal is to help them develop strate- tiveness and to develop new methods of interven-
gies to manage the symptoms and address associ- tion. Working memory training and neurofeedback
ated functional challenges, as well as to prevent are promising approaches, but additional research
the emergence of additional problems. Research is needed to demonstrate their effectiveness and
regarding the treatment and prevention of func- determine the conditions under which they may
9 Attention-Deficit Hyperactivity Disorder 167

be beneficial in augmenting approaches that are Barkley, R. A., Guevremont, D. C., Anastopoulos, A. D.,
& Fletcher, K. E. (1992). A comparison of three fam-
more likely to be effective, that is, behavioral and
ily therapy programs for treating family conflicts in
cognitive-behavioral strategies applied at home adolescents with attention-deficit hyperactivity disor-
and school and medication, when indicated. der. Journal of Consulting and Clinical Psychology,
60, 450–462.
Betts, J. E., Appleton, J. J., Reschly, A. L., Christenson,
S. L., & Huebner, E. S. (2010). A study of the factorial
References invariance of the Student Engagement Instrument
(SEI): Results from middle and high school students.
American Academy of Pediatrics. (2011). ADHD clinical School Psychology Quarterly, 25(2), 84–93.
practice guidelines for the diagnosis, evaluation, and Biederman, J., & Faraone, S. V. (2002). Current concepts
treatment of attention-deficit/hyperactivity disorder in on the neurobiology of attention-deficit/hyperactivity
children and adolescents. Pediatrics, 128(5), 1–18. disorder. Journal of Attention Disorders, 6(Suppl 1),
American Psychiatric Association. (2000). Diagnostic S-7–S-16.
and statistical manual of mental disorders (4th ed.). Biederman, J., Faraone, S., Milberger, S., Curtis, S., Chen,
Washington, DC: Author. L., Marrs, A., et al. (1996). Predictors of persistence
Antshel, K. M., Faraone, S. V., & Gordon, M. (2012). and remission of ADHD into adolescence: results
Cognitive behavioral treatment outcomes in adoles- from a four-year prospective follow-up study. Journal
cent ADHD. Journal of Attention Disorders, 18(6), of the American Academy of Child and Adolescent
483–495. 10.77/1087054712443155. Psychiatry, 35(3), 343–351.
Arnold, L. E., Hurt, E. A., Mayes, T., & Lofthouse, N. Burke, J. D., Loeber, R., & Lahey, B. B. (2001). Which
(2011). Ingestible alternative and complementary aspects of ADHD are associated with tobacco use in
treatments for attention deficit hyperactivity disorder. early adolescence? Journal of Child Psychology and
In S. W. Evans & B. Hoza (Eds.), Treating attention Psychiatry, 42(4), 493–502.
deficit and hyperactivity disorder: Assessment and Burns, M. K. (2004). Using curriculum-based assessment
intervention in developmental context (pp. 14-1–14- in the consultative process: A review of three levels of
28). Kingston, NJ: Civic Research Institute. research. Journal of Educational and Psychological
Bakhshayesh, A. R., Esser, G., & Wyschkon, A. (2010). Consultation, 15, 63–78.
Effectiveness of EEG-biofeedback in the treatment of Castellanos, F. X., Lee, P. P., Sharp, W., Jeffries, N. O.,
attention deficit/hyperactivity disorder. Psychological Greenstein, D. K., Clasen, L. S., et al. (2002).
Research, 13(1), 7–29. Developmental trajectories of brain volume abnormal-
Barkley, R. A. (2004). Driving impairments in teens ities in children and adolescents with attention-deficit/
and adults with attention-deficit/hyperactivity disor- hyperactivity disorder. The Journal of the American
der. Psychiatric Clinics of North America, 27(2), Medical Association, 288(14), 1740–1748.
233–260. Castellanos, F. X., Sonuga-Barke, E. J. S., Milham, M. P.,
Barkley, R. A. (2006). Attention-deficit hyperactivity dis- & Tannock, R. (2006). Characterizing cognition in
order: A handbook for diagnosis and treatment (3rd ADHD: Beyond executive dysfunction. Trends in
ed.). New York: Guilford. Cognitive Sciences, 10(3), 117–123.
Barkley, R. A., & Cox, D. (2007). A review of driving Chalon, S. (2009). The role of fatty acids in the treatment
ricks and impairments associated with attention- of ADHD. Neuropharmacology, 57, 636–639.
deficit/hyperactivity disorder and the effects of stimu- Christenson, S. L., & Sheridan, S. M. (2001). Schools and
lant medication on driving performance. Journal of families: Creating essential connections for learning.
Safety Research, 38, 113–128. New York: Guilford.
Barkley, R. A., Edwards, G., Laneri, M., Fletcher, K., & Creel, C., Fore, C., Boon, R. T., & Bender, W. N. (2006).
Metevia, L. (2001). The efficacy of problem-solving Effects of self-monitoring on classroom preparedness
communication training alone, behavior management skills of middle school students with attention deficit
training alone, and their combination for parent- hyperactivity disorder. Learning Disabilities: A
adolescent conflict in teenagers with ADHD and Multidisciplinary Journal, 14, 105–113.
ODD. Journal of Consulting and Clinical Psychology, Currie, D., Lee, D. L., & Scheeler, M. C. (2005). Using
69, 926–941. PDAs to increase homework completion of students
Barkley, R. A., Edwards, G., & Robin, A. L. (1999). with ADHD. Journal of Evidence Based Practices for
Defiant teens: A clinician’s manual for assessment Schools, 6, 151–162.
and family intervention. New York: Guilford. Dawson, P., & Guare, R. (1998). Coaching the ADHD stu-
Barkley, R. A., & Gordon, M. (2002). Research on comor- dent. North Tonawanda, NY: Multi-Health Systems.
bidity, adaptive functioning, and cognitive impair- Deault, L. C. (2010). A systematic review of parenting in
ments in adults with ADHD: Implications for a clinical relation to the development of comorbidities and func-
practice. In A. T. E. S. Goldstein (Ed.), Clinicians’ tional impairments in children with attention deficit/
guide to adult ADHD: Assessment and intervention hyperactivity disorder (ADHD). Child Psychiatry and
(pp. 43–66). Oxford, UK: Elsevier. Human Development, 41(2), 168–192.
168 J. Nissley-Tsiopinis et al.

Diliberto, J. A., Beattie, J. R., Flowers, C. P., & Algozzine, course model of care for youth with ADHD. In N. A.
R. F. (2008). Effects of teaching syllable skills instruc- L. M. D. Weist, C. P. Bradshaw, & J. S. Owens (Eds.),
tion on reading achievement in struggling middle Handbook of school mental health (2nd ed.).
school readers. Literacy Research and Instruction, 48, New York, NY: Springer.
14–27. Evans, S. W., Schultz, B. K., DeMars, C., & Davis, H.
DuPaul, G., Ervin, R. A., Hook, C. L., & McGoey, K. E. (2011). Effectiveness of the challenging horizons
(1998). Peer tutoring for children with attention deficit after-school program for young adolescents with
hyperactivity disorder: Effects on classroom behavior ADHD. Behavior Therapy, 42, 462–474.
and academic performance. Journal of Applied Evans, S. W., Schultz, B. K., White, C., Brady, C., Sibley,
Behavior Analysis, 31, 579–592. M. H., & Van Eck, K. (2009). A school-based organi-
DuPaul, G., & Power, T. (2009). Attention-deficit disor- zation intervention for young adolescents with
ders (ADDs) in elementary school children. In T. E. attention-deficit/hyperactivity disorder. School Mental
Brown (Ed.), ADHD comorbidities: Handbook for Health, 1, 78–88.
ADHD complications in children and adults (2nd ed., Evans, S. W., Serpell, Z. N., Schultz, B. K., & Pastor,
pp. 55–68). Washington, DC: American Psychiatric D. A. (2007). Cumulative benefits of secondary
Publishing. school-based treatment of students with attention defi-
DuPaul, G. J., Power, T. J., Anastopoulos, A. D., & Reid, cit hyperactivity disorder. School Psychology Review,
R. (1998). ADHD rating Scale-IV: Checklists, norms, 36, 256–273.
and clinical interpretation. New York: Guilford. Fabiano, G. A., Hulme, K., Linke, S., Nelson-Tuttle, C.,
DuPaul, G. J., & Stoner, G. (2003). ADHD in the schools: Pariseau, M., Gangloff, B., et al. (2011). The support-
Assessment and intervention strategies. New York: ing a Teen’s Effective Entry to the Roadway (STEER)
Guilford Press. Program: Feasibility and preliminary support for a
DuPaul, G., & Stoner, G. (2010). Interventions for atten- psychosocial intervention for teenage drivers with
tion deficit hyperactivity disorder. In M. R. Shinn & ADHD. Cognitive and Behavioral Practice, 18,
H. M. Walker (Eds.), Interventions for achievement 267–280.
and behavior problems in a three-tier model including Fabiano, G. A., Pelham, W. E., Coles, E. K., Gnagy,
RTI (pp. 825–848). Bethesda, MD: National E. M., & Chronis-Tuscano, A. (2009). A meta-analysis
Association of School Psychologists. of behavioral treatments for attention-deficit/hyperac-
Edbom, T., Malmberg, K., Lichtenstein, P., Granlund, M., tivity disorder. Clinical Psychology Review, 29(2),
& Larsson, J.-O. (2010). High sense of coherence in 129–140.
adolescence is a protective factor in the longitudinal Faraone, S. V. (2000). Genetics of childhood disorders:
development of ADHD symptoms. Scandinavian XX. ADHD, part 4: Is ADHD genetically heteroge-
Journal of Caring Sciences, 24(3), 541–547. neous? Journal of the American Academy of Child &
Ehringer, M. A., Rhee, S. H., Young, S., Corley, R., & Hewitt, Adolescent Psychiatry, 39(11), 1455–1457.
J. K. (2006). Genetic and environmental contributions to Glover, T. A., & DiPerna, J. C. (2007). Service delivery
common psychopathologies of childhood and adoles- for response to intervention: Core components and
cence: A study of twins and their siblings. Journal of directions for future research. School Psychology
Abnormal Child Psychology, 34(1), 1–17. Review, 36(4), 526–540.
Elia, J., Gai, X., Xie, H. M., Perin, J. C., Geiger, E., Graham-Day, K. J., Gardner, R., & Hsin, Y. W. (2010).
Glessner, J. T., et al. (2010). Rare structural variants Increasing on-task behaviors of high school students
found in attention-deficit hyperactivity disorder are with attention deficit hyperactivity disorder: Is it
preferentially associated with neurodevelopmental enough? Education and Treatment of Children, 33,
genes. Molecular Psychiatry, 15(6), 637–646. 205–221.
Ervin, R. A., DuPaul, G. J., Kern, L., & Friman, P. C. Gresham, F. M., Cook, C. R., Collins, T., Dart, E.,
(1998). Classroom-based functional and adjunctive Rasetshwane, K., Truelson, E., et al. (2010).
assessments: Proactive approaches to intervention Developing a change-sensitive brief behavior rat-
selection for adolescents with attention deficit hyper- ing scale as a progress monitoring tool for social
activity disorder. Journal of Applied Behavior behavior: An example using the social skills rating
Analysis, 31, 65–78. system-teacher form. School Psychology Review,
Evans, S. W., Axelrod, J., & Langberg, J. M. (2004). 39(3), 364–379.
Efficacy of a school-based treatment program for mid- Grolnick, W. S., Kurowski, C. O., Dunlap, K. G., &
dle school youth with ADHD: Pilot data. Behavior Hevey, C. (2000). Parental resources and the transition
Modification, 28, 528–547. to junior high. Journal of Research on Adolescence,
Evans, S. W., Langberg, J., Raggi, V., Allen, J., & 10(4), 465–488.
Buvinger, E. C. (2005). Development of a school- Gureasko-Moore, S., DuPaul, G. J., & White, G. P.
based treatment program for middle school youth with (2006). The effects of self-management in general
ADHD. Journal of Attention Disorders, 9, 343–353. education classrooms on the organizational skills of
Evans, S. W., Owens, J. S., Mautone, J. A., DuPaul, G. J., adolescents with ADHD. Behavior Modification, 30,
& Power, T. J. (2014). Toward a comprehensive, life 159–183.
9 Attention-Deficit Hyperactivity Disorder 169

Hermens, D. F., Kohn, M. R., Clarke, S. D., Gordon, E., & American Academy of Child and Adolescent
Williams, L. M. (2005). Sex differences in adolescent Psychiatry, 43(10), 1267–1275.
ADHD: Findings from concurrent EEG and EDA. Lerner, R. M., & Benson, P. L. (2003). Developmental
Clinical Neurophysiology, 116(6), 1455–1463. assets and asset-building communities implications
Hirayama, S., Hamazaki, T., & Terasawa, K. (2004). Effect for research, policy, and practice. New York: Kluwer
of docosahexaenoic acid-containing food administra- Academic/Plenum.
tion on symptoms of attention-deficit/hyperactivity Majeika, C. E., Walder, J. P., Hubbard, J. P., Steeb, K. M.,
disorder—A placebo-controlled double-blind study. Ferris, G. J., Oakes, W. P., et al. (2011). Improving on-
European Journal of Clinical Nutrition, 58, 467–473. task behavior using a functional assessment-based
Hurt, E. A., Lofthouse, N., & Arhold, L. E. (2011). intervention in an inclusive high school setting.
Noningestible alternative and complementary treat- Beyond Behavior, 20, 55–66.
ments for attention deficit hyperactivity disorder. In McCleary, L., & Ridley, T. (1999). Parenting adolescents
S. W. Evans & B. Hoza (Eds.), Treating attention defi- with ADHD: Evaluation of a psychoeducation group.
cit hyperactivity disorder: Assessment and interven- Patient Education and Counseling, 38(1), 3–10.
tion in developmental context (pp. 15-1–15-26). Merriman, D. E., & Codding, R. S. (2008). The effects of
Kingston, NJ: Civic Research Institute. coaching on mathematics homework completion and
Hurtig, T., Ebelinge, H., Taanila, A., Miettunen, J., accuracy of high school students with attention-deficit/
Smalley, S. L., McGough, J. J., et al. (2007). ADHD hyperactivity disorder. Journal of Behavioral
symptoms and subtypes: Relationship between child- Education, 17, 339–355.
hood and adolescent symptoms. Journal of American Meyer, K., & Kelley, M. L. (2008). Improving homework
Academy of Child and Adolescent Psychiatry, 46(12), behavior in adolescents with attention-deficit/hyperac-
1605–1613. tivity disorder: Self vs. parent monitoring of home-
Iseman, J. S., & Naglieri, J. A. (2011). Cognitive strategy work behavior and study skills. Child and Family
instruction to improve math calculation for children Behavior Therapy, 29, 25–42.
with ADHD and LD: A randomized controlled study. Molina, B. S. G. (2011). Delinquency and substance use
Journal of Learning Disabilities, 44, 184–195. in attention deficit hyperactivity disorder: Adolescent
Johnson, J. W., Reid, R., & Mason, L. H. (2012). and young adult outcomes in developmental context.
Improving the reading recall of high school students In S. W. Evans & B. Hoza (Eds.), Treating attention
with ADHD. Remedial and Special Education, 33, deficit hyperactivity disorder: Assessment and inter-
258–268. vention in developmental context (pp. 19–42).
Jones, M., Boon, R. T., Fore, C., & Bender, W. N. (2008). Kingston, NJ: Civic Research Institute.
“Our Mystery Hero!” A group contingency interven- Molina, B. S. G., Flory, K., Bukstein, O. G., Greiner,
tion for reducing verbally disrespectful behaviors. A. R., Baker, J. L., Krug, V., et al. (2008). Feasibility
Learning Disabilities: A Multidisciplinary Journal, and preliminary efficacy of an after-school program
15, 61–69. for middle schoolers with ADHD: A randomized trial
Kohls, G., Herpertz-Dahlmann, B., & Konrad, K. (2009). in a large public middle school. Journal of Attention
Hyperresponsiveness to social rewards in children and Disorders, 12, 207–217.
adolescents with attention-deficit/hyperactivity disor- Molina, B. S. G., Hinshaw, S. P., Swanson, J. M., Arnold,
der (ADHD). Behavioral and Brain Functions, 5(20). L. E., Vitiello, B., Jensen, P. S., et al. (2009). The MTA
doi:10.1186/1744-9081-5-20 Published online ahead at 8 years: Prospective follow-up of children treated
of print. Retrieved September 13, 2013 from http:// for combined type ADHD in the multisite study.
www.behavioralandbrainfunctions.com/content/5/1/20 Journal of the American Academy of Child and
Konrad, K., & Eickhoff, S. B. (2010). Is the ADHD brain Adolescent Psychiatry, 68(7), 484–500.
wired differently? A review on structural and func- Monuteaux, M. C., Mick, E., Faraone, S. V., & Biederman,
tional connectivity in attention deficit hyperactivity J. (2010). The influence of sex on the course and psy-
disorder. Human Brain Mapping, 31(6), 904–916. chiatric correlates of ADHD from childhood to adoles-
Kuester, D. A., & Zentall, S. S. (2012). Social interaction cence: A longitudinal study. Journal of Child
rules in cooperative learning groups for students at Psychology and Psychiatry, 51(3), 233–241.
risk for ADHD. Journal of Experimental Education, National Research Council. (2001). Understanding drop-
80, 69–95. outs: Statistics, strategies, and high-stakes testing.
Langberg, J. M., Epstein, J. N., Urbanowicz, C. M., Washington, DC: National Academies Press.
Simon, J. O., & Graham, A. J. (2008). Efficacy of an National Research Council and Institute of Medicine.
organization skills intervention to improve the aca- (2004). Engaginge schools: Fostering high school stu-
demic functioning of students with attention-deficit/ dents’ motivation to learn. Washington, DC: National
hyperactivity disorder. School Psychology Quarterly, Academies Press.
23, 407–417. Pianta, R. C. (1999). Enhancing relationships between
Larsson, J. O., Larsson, H., & Lichtenstein, P. (2004). children and teachers. Washington, DC: American
Genetic and environmental contributions to stability Psychological Association.
and change of ADHD symptoms between 8 and 13 Pollatsek, A., Fisher, D. L., & Pradhan, A. (2006).
years of age: a longitudinal twin study. Journal of the Identifying and remedying failures of selective atten-
170 J. Nissley-Tsiopinis et al.

tion in younger drivers. Current Directions in receptor (DRD4) gene polymorphism. Neuroscience
Psychological Science, 15(5), 255–259. Letters, 366(3), 282–286.
Power, T., Blom-Hoffman, J., Clarke, A., Riley-Tillman, Shapiro, E. S., DuPaul, G. J., & Bradley-Klug, K. L.
C., Kelleher, C., & Manz, P. (2005). Reconceptualizing (1998). Self-management as a strategy to improve the
intervention integrity: A partnership-based framework classroom behavior of adolescents with ADHD.
for linking research with practice. Psychology in the Journal of Learning Disabilities, 31, 545–555.
Schools, 42, 495–507. Shapiro, E. S., & Gebhardt, S. N. (2012). Comparing
Power, T. J., Soffer, S. L., Cassano, M. C., Tresco, K. E., computer-adaptive and curriculum-based measure-
& Mautone, J. A. (2011). Integrating pharmacological ment methods of assessment. School Psychology
and psychosocial interventions for attention deficit Review, 41(3), 295–305.
hyperactivity disorder: An evidence-based, participa- Shimabukuro, S. M., Prater, M. A., Jenkins, A., & Edelen-
tory approach. In S. W. Evans & B. Hoza (Eds.), Smith, P. (1999). The effects of self-monitoring of aca-
Treating attention deficit hyperactivity disorder: demic performance on students with learning disabilities
Assessment and intervention in developmental context and ADD/ADHD. Education and Treatment of Children,
(pp. 13-1–13-19). Kingston, NJ: Civic Research 22, 397–414.
Institute. Shipstead, Z., Redick, T. S., & Engle, R. W. (2012). Is
Price, T. S., Simonoff, E., Asherson, P., Curran, S., Kuntsi, J., working memory training effective? Psychological
Waldman, I., et al. (2005). Continuity and change in Bulletin, 138(4), 628–654.
preschool ADHD symptoms: longitudinal genetic Sibley, M. H., Pelham, W. E., Evans, S. W., Gnagy, E. M.,
analysis with contrast effects. Behavior Genetics, Ross, M., & Greiner, A. R. (2011). An evaluation of a
35(2), 121–132. summer treatment program for adolescents with ADHD.
Raggi, V. L., Chronis-Tuscano, A., Fishbein, H., & Cognitive and Behavioral Practice, 18, 530–544.
Groomes, A. (2009). Development of a brief, behav- Sibley, M. H., Smith, B. H., Evans, S. W., Pelham, W. E., &
ioral homework intervention for middle school stu- Gnagy, E. M. (2012). Treatment response to an intensive
dents with attention-deficit/hyperactivity disorder. summer treatment program for adolescents with ADHD.
School Mental Health, 1, 61–77. Journal of Attention Disorders, 16, 443–448.
Raz, R., Carasso, R. L., & Yehuda, S. (2009). The influ- Sinclair, M. F., Christenson, S. L., & Thurlow, M. L.
ence of short-chain essential fatty acids on children (2005). Promoting school completion of urban sec-
with attention-deficit/hyperactivity disorder: A double- ondary youth with emotional or behavioral disabili-
blind placebo-controlled study. Journal of Child and ties. Exceptional Children, 71(4), 465–482.
Adolescent Psychopharmacology, 19, 167–177. Sprich, S., Biederman, J., Crawford, M. H., Mundy, E., &
Robin, A. L. (2009). ADHD in adolescents. In T. E. Brown Faraone, S. V. (2000). Adoptive and biological fami-
(Ed.), ADHD comorbidities: Handbook for ADHD com- lies of children and adolescents with ADHD. Journal
plications in children and adults (pp. 69–80). of the American Academy of Child and Adolescent
Washington, DC: American Psychiatric Publishing. Psychiatry, 39(11), 1432–1437.
Rogevich, M. E., & Perin, D. (2008). Effects on science Sugai, G., & Horner, R. R. (2006). A promising approach for
summarization of a reading comprehension interven- expanding and sustaining school-wide positive behavior
tion for adolescents with behavior and attention disor- support. School Psychology Review, 35(2), 245–259.
ders. Exceptional Children, 74, 135–154. Tresco, K. E., Lefler, E. K., & Power, T. J. (2010).
Sadler, J. M., Evans, S. W., Schultz, B. K., & Zoromski, Psychosocial interventions to improve the school per-
A. K. (2011). Potential mechanisms of action in the formance of students with attention-deficit/hyperac-
treatment of social impairment and disorganization in tivity disorder. Mind & Brain, The Journal of
adolescents with ADHD. School Mental Health, 3, Psychiatry, 1, 69–74.
156–168. Voigt, R. G., Llorente, A. M., Jensen, C. L., Fraley, J. K.,
Schulz, K. P., Newcorn, J., Fan, J., Tang, C. Y., & Halperin, Berretta, M. C., & Heird, W. C. (2001). A random-
J. M. (2005). Brain activation gradients in ventrolat- ized, double-blind, placebo-controlled trial of doco-
eral prefrontal cortex related to persistence of ADHD sahexaenoic acid supplementation in children with
in adolescent boys. Journal of the American Academy attention-deficit/hyperactivity disorder. Journal of
of Child and Adolescent Psychiatry, 44(1), 47–54. Pediatrics, 139, 189–196.
Schultz, M. R., Rabi, K., Faraone, S. V., Kremen, W., & Volpe, R. J., & Gadow, K. D. (2010). Creating abbreviated
Lyons, M. J. (2006). Efficacy of retrospective recall of rating scales to monitor classroom inattention-
attention-deficit hyperactivity disorder symptoms: A overactivity, aggression, and peer conflict: Reliability,
twin study. Twin Research and Human Genetics, 9(2), validity, and treatment sensitivity. School Psychology
220–232. Review, 39(3), 350–363.
Seeger, G., Schloss, P., Schmidt, M. H., Rüter-Jungfleisch, Wang, L., Zhu, C., He, Y., Zang, Y., Cao, Q., Zhang, H.,
A., & Henn, F. A. (2004). Gene-environment interac- et al. (2009). Altered small-world brain functional net-
tion in hyperkinetic conduct disorder (HD + CD) as works in children with attention-deficit/hyperactivity
indicated by season of birth variations in dopamine disorder. Human Brain Mapping, 30(2), 638–649.
9 Attention-Deficit Hyperactivity Disorder 171

Watkins, D. E., & Wentzel, K. R. (2008). Training boys Willcutt, E. G., Nigg, J. T., Pennington, B. F., Solanto,
with ADHD to work collaboratively: Social and learn- M. V., Rohde, L. A., Tannock, R., et al. (2012).
ing outcomes. Contemporary Educational Psychology, Validity of DSM-IV attention deficit/hyperactivity dis-
33, 625–646. order symptom dimensions and subtypes. Journal of
Wilens, T. W., Adler, L. A., Adams, J., Sgambati, S., Abnormal Psychology, 121(4), 991–1010.
Rotrosen, J., Sawtelle, R., et al. (2008). Misuse and Wolraich, M. L. (2011). Pharmacological interventions
diversion of stimulants prescribed for ADHD: A for individuals with attention deficit hyperactivity dis-
systematic review of the literature. Journal of order. In S. W. Evans & B. Hoza (Eds.), Treating
American Academy of Child and Adolescent attention deficit hyperactivity disorder (pp. 1–21).
Psychiatry, 4, 21–31. Kingston, NJ: Civic Research Institute.