Randomized Controlled Trial of a Peer-Delivered High School Preparatory Intervention for ADHD

Objective: The high school transition is a period of academic and socioemotional vulnerability for adolescents with ADHD. Standard high school interventions for ADHD typically demonstrate access and engagement challenges. Peer-delivered interventions may overcome staff time and resource shortages while increasing adolescent engagement. A previously tested peer-delivered model (STRIPES;16 weekly psychosocial sessions with a peer) showed promising effects but suboptimal engagement. Method: This development trial evaluates enhancements to STRIPES (STRIPES+) adding a 1-week peer-led school orientation and six parent training sessions. Ninth grade students meeting current ADHD symptom and impairment criteria (N = 72) were randomized to STRIPES+ versus school services as usual (SSU). Engagement metrics were evaluated and group × time 1-year outcome trajectories were compared using Linear Mixed Models. Results: Student and peer, but not parent, attendance was strong. STRIPES+ was feasible and acceptabled to students and peers. Compared to SSU, STRIPES+ demonstrated significant gains for school materials organization (b = 0.01, SE = 0.01, p = .040, d = 0.51), use of a daily planner (b = 0.64, SE = 0.31, p = .042, d = 0.38), self-reported sense of academic autonomy (b = 0.02, SE = 0.01, p = .018, d = .61), and reductions in parent academic assistance across three indices (b = −0.02, SE = 0.01, p = .014, d = 0.50; b = −0.01, SE = 0.04, p = .023, d = 0.50; b = −0.01, SE = 0.00, p = .021, d = 0.34). There was no acute impact on primary academic or ADHD symptom outcomes. Conclusions: Use of peer interventionists may be an effective engagement strategy for adolescents with ADHD. STRIPES+ engaged target mechanisms but students demonstrated similar 1-year school outcomes to SSU. A developmentally advantageous transfer of academic responsibility from parents to adolescents was noted in STRIPES+ relative to SSU. The long-term impact of STRIPES+ on promoting increasing academic autonomy through high school should be evaluated. Clinicaltrials.gov ID: NCT04571320.