Evidence-based assessment of attention-deficit/hyperactivity disorder: measuring outcomes.
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Attention Deficit Disorder with Hyperactivity↗
Biomedical subjects
Steven W Evans
Publications and source records attributed to Steven W Evans.
Measuring symptoms and functioning of youth with ADHD in middle schools.
The identification of reliable and valid means for evaluating the effectiveness of school-based treatments and completing diagnostic evaluations of middle school aged students are needed. The present study examined the inter-rater agreement of teacher ratings and the relationship between ratings and observational data in a middle school setting. The data are interpreted in the context of differences between a secondary and elementary school setting. Teacher ratings and observational data were collected regularly over the course of two academic years for middle school students diagnosed with ADHD. The results indicate low rates of inter-rater agreement as well as low rates of agreement between teachers and observational data, and between observational data collected in different classrooms. Inter-rater agreement was lowest in late fall and gradually increased over the second half of the year. Implications for conducting treatment outcome evaluations of school-based treatment programs and diagnostic evaluations are discussed.
Adolescent↗
Development of a school-based treatment program for middle school youth with ADHD.
The authors conduct an evaluation of a middle school-based treatment program for youth with ADHD during early stages of treatment development. The studies focus on interpreting outcome trends in preliminary data and identifying assessment issues that will be important to consider when conducting a clinical trial. Parent reports indicate that the majority of students benefit from improvements in academic, social, and overall functioning. Although teachers report beneficial effects for the majority of the participants in the program, there is little agreement about individual students. Measurement problems are associated with understanding normal change during a school year, accounting for normal behavior changes in December and May, and considerable disagreement between teachers. Suggestions to guide future work in this area are provided.
Adolescent↗
Community participation in the treatment development process using community development teams.
Little literature exists about methods for adapting research-based treatments to typical practice settings. This report describes a 2-step process and associated methods used to adapt a school-based treatment program for middle-school youth with attention deficit hyperactivity disorder (ADHD) that operates in a controlled setting to one that can operate in a typical practice setting. Step 1 included a feasibility study that yielded important findings regarding potential obstacles to successful implementation. These data, along with original treatment manuals and literature on treatments for youth with ADHD, were utilized for Step 2--the Community Development Team (CDT) process. Data collected about the CDT process indicate that its strengths outweigh potential limitations. These methods are discussed in the context of successful collaborative procedures for developing and evaluating research-based treatments in practice settings.
Adolescent↗
Attention-deficit/hyperactivity disorder among adolescents: a review of the diagnosis, treatment, and clinical implications.
Attention-deficit/hyperactivity disorder (ADHD) is the most common mental disorder in childhood, and primary care clinicians provide a major component of the care for children with ADHD. However, because of limited available evidence, the American Academy of Pediatrics guidelines did not include adolescents and young adults. Contrary to previous beliefs, it has become clear that, in most cases, ADHD does not resolve once children enter puberty. This article reviews the current evidence about the diagnosis and treatment of adolescents and young adults with ADHD and describes how the information informs practice. It describes some of the unique characteristics observed among adolescents, as well as how the core symptoms change with maturity. The diagnostic process is discussed, as well as approaches to the care of adolescents to improve adherences. Both psychosocial and pharmacologic interventions are reviewed, and there is a discussion of these patients' transition into young adulthood. The article also indicates that research is needed to identify the unique adolescent characteristics of ADHD and effective psychosocial and pharmacologic treatments.
Adolescent↗
Implementing empirically supported treatments in the schools: what are we asking?
The research reported in this special issue addresses important areas for the continued development of empirically supported school-based treatments. Although advances in the development and evaluation of treatment services have occurred, there is little public demand for the widespread dissemination of these treatments. In this commentary, the authors draw data from historical examples, related research, and personal experience to demonstrate the need to create a societal mandate for change. They present specific implications for future areas of research and the type of public education and marketing campaign that will be needed to create a demand for empirically supported school-based treatments.
Adolescent↗
Efficacy of a school-based treatment program for middle school youth with ADHD: pilot data.
The effects of a set of behavioral and educational interventions provided in a middle-school-based mental health program on the behavior and academic performance of 7 students diagnosed with attention-deficit/hyperactivity disorder (ADHD) were studied. The treatments included educational, social skills and family interventions designed to target school functioning, peer relations, and family functioning. Dependent measures included parent and teacher ratings of ADHD symptoms, daily functioning, and academic grades. Large effect sizes were found on measures of inattention and school functioning. Grades and measures of family functioning and peer relations yielded small to moderate effect sizes. Description of the procedures is provided and implications for advancing school-based mental health care for adolescents with a diagnosis of ADHD are discussed.
Achievement↗
Funding a full continuum of mental health promotion and intervention programs in the schools.
PURPOSE: To assess the availability of public and private financing sources to support comprehensive school mental health programs. The paper focuses on "expanded school mental health" (ESMH) programs, which provide a full array of mental health promotion and intervention services to youth in general and special education through school-community partnerships. METHODS: A range of strategies to fund ESMH services are reviewed, including fee-for-service funding, as well as grants, contracts, and other mechanisms from federal, state, local, and private sources. RESULTS: An objective national study of the characteristics and financing of ESMH programs has yet to be conducted. Existing evidence suggests that funding for these programs is patchy and tenuous. Many programs are being funded through fee-for-service programs, which generally only support the provision of more intensive services (e.g., assessment, therapy) and are associated with significant bureaucracy and other concerns (e.g., the need to diagnose students). As programs move to enhance funding for preventive and mental health-promoting activities and services, there is an increasing need for grants, contracts, and other sources of support. CONCLUSION: Progress in the national movement toward ESMH will be promoted through an interconnected agenda of quality improvement, evaluation of program effectiveness, and the advancement of advocacy. These developments will facilitate policy improvements and increased funding for the full continuum of mental health promotion and intervention in the schools.
Adolescent↗