Changing Academic Support in the Home for Adolescents With Attention-Deficit/Hyperactivity Disorder: A Family-Based Clinical Protocol for Improving School Performance

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Highlights

  • Therapists have few tools for addressing school problems in adolescents with ADHD

  • We introduce a model to increase home academic support for this group: CASH-AA

  • CASH-AA utilizes family ADHD psychoeducation and family motivational interventions

  • It focuses on training interventions for homework planning and organization skills

  • Two case examples with markedly different treatment profiles are presented

Abstract

Attention-deficit/hyperactivity disorder (ADHD) is highly prevalent among adolescent clinical populations and associated with myriad deficits in school functioning. Yet, behavior therapists have few developmentally appropriate tools for addressing school problems in this group. This article introduces a behavioral protocol designed to fill the gap: Changing Academic Support in the Home for Adolescents With ADHD (CASH-AA). CASH-AA is a family-based intervention that targets home environment, adolescent skills, and family-school partnership characteristics in order to improve school performance. Protocol components are derived from three evidence-based approaches for adolescent behavior problems: family psychoeducation, clinical family interventions to heighten adolescent and caregiver motivation to change, and training interventions for homework planning and organization skills. CASH-AA contains four treatment modules: (1) Psychoeducation: ADHD and Academic Functioning; (2) Motivation and Preparation: Home Academic Environment; (3) Behavior Change: School Attendance and Homework Plan; (4) Collaboration: Therapist-Family-School Partnership. The protocol can be implemented as a stand-alone intervention for ADHD or an adjunct to other behavioral interventions for co-occurring disorders. Two case examples with markedly different treatment profiles are presented to illustrate the utility and flexibility of the protocol.

Section snippets

ADHD Prevalence in General and Clinical Adolescent Populations

Knowledge about the prevalence of ADHD in adolescent populations has grown enormously over the past decade. There is now consensus that ADHD is a chronic childhood mental health condition that persists across the developmental span of adolescence and into young adulthood (Taylor, 2009). The newest national prevalence data on ADHD in adolescents gathered by the National Survey of Children’s Health (Visser et al., 2014) indicate that 14% of children aged 11 to 17 have received an ADHD diagnosis

Evidence Base for the Three Primary Components of the CASH-AA Protocol

CASH-AA integrates components from three evidence-based behavioral approaches: family psychoeducation in ADHD, family therapy models for adolescent conduct and substance use problems, and TIs for adolescents with ADHD. Figure 1 depicts a conceptual model of the CASH-AA protocol, including evidence-based intervention components, hypothesized mechanisms of change, and targeted clinical outcomes. As described below, the protocol is intended to (a) enhance clinician confidence and technical

CASH-AA Protocol: Treatment Modules and Interventions

CASH-AA (Hogue, Bobek, Evans, & Dendy, 2014) is a family-based clinical protocol intended for use with adolescents diagnosed with ADHD as either a primary or secondary disorder. It can be delivered in conjunction with family-based treatment or with individual-based treatment that can include caregivers in multiple sessions. It consists of four treatment modules, described briefly below, that can be initiated and completed at any point based on individualized treatment planning and case progress

Module 3—Behavior Change: School Attendance and Homework Plan

Module 3 in intended to implement family-centered interventions designed to boost school attendance (as needed) and homework quality. For adolescents with lateness or truancy issues, clinicians and families design a developmentally calibrated behavior contract featuring incentives for regular school attendance. For all cases, two training interventions adapted from CHP, Homework Management Plan and Bookbag Organization, are implemented to improve homework completion and organization habits over

Case Presentation

Michael was a 14-year-old African American male living with his mother, younger brother, and older sister. The family was referred for services by Michael’s high school guidance counselor based on concerns about his school performance, both academics and behavior. Michael was completing ninth grade and had passed few of his courses due to missing work and also attendance issues caused by chronic lateness.

Assessment

At intake Michael met diagnostic criteria for ADHD combined type (youth and caregiver

Case Presentation

Jenny was a 17-year-old Hispanic female of Puerto Rican descent living with her grandmother. She was referred by a school guidance counselor based on reports of inability to focus in class and difficulties in emotional regulation that compromised her capacity for schoolwork. Jenny was starting her senior year of high school and maintained a part-time job as well as extensive involvement in extracurricular activities, particularly music and theater.

Assessment

Jenny and her grandmother completed an intake

Implications for Practicing Behavioral Therapists

The CASH-AA protocol is designed to fill a troublesome gap in clinic-based psychosocial interventions for adolescents with ADHD. ADHD and its related school functioning deficits are highly prevalent in teens referred for outpatient behavioral services, yet few effective treatment options are available. Pharmacological interventions have demonstrated modest impact on school outcomes, and behavior management models are developmentally ill-suited for this age group. Whereas school-located training

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  • Cited by (0)

    Preparation of this article was supported by the National Institute on Drug Abuse (K02 DA026538). The authors would like to thank Chris A. Ziegler Dendy for her invaluable contributions to CASH-AA model development.

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