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The Impact of Social Determinants of Health on the Efficacy of School-Based Interventions for Adolescents with ADHD

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Abstract

Adolescents with Attention-deficit/hyperactivity disorder (ADHD) experience significant impairment in functioning. There are multiple clinic-based interventions that address these impairments (e.g., behavioral parent training). However, clinic-based interventions are often associated with barriers to care (e.g., transportation and financial resources), which can limit access based upon social determinants of health (e.g., parental income). School-based interventions have been developed to address the impairments adolescents with ADHD experience, with the goal of also improving access to care and limiting the impact social determinants of health. Despite this, to date, there has been almost no research evaluating the role of social determinants of health on the efficacy of school-based ADHD interventions. In a sample of 222 adolescents with ADHD randomly assigned to receive two different interventions, the present study evaluates the impact of income, maternal education, single-parent status, and race, on intervention efficacy. Single-parent status had the greatest impact on intervention efficacy, resulting in diminished improvements for two of the three outcomes. There was also a significant moderation effect for income, but only for parent-rated homework performance. In addition, main effects were found for single-parent status and race that represent disparities present at baseline that remained post-intervention. Overall, this study suggests that although school-based models of service delivery have the potential to significantly improve access to care, social determinants of health, and single-parent status, in particular, still need to be considered and addressed.

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Funding

The research reported here was supported by the Institute of Education Sciences, U.S. Department of Education, through Grant R305A130011 to Virginia Commonwealth University. The opinions expressed are those of the authors and do not represent views of the Institute or the U.S. Department of Education. We are grateful to the participating administrators, schools, teachers and families in the Chesterfield County School District for their collaboration and support of this project.

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  1. Department of Psychology, Virginia Commonwealth University, 806 West Franklin St., P.O. Box 842018, Richmond, VA, 23284-2018, USA

    Cathrin D. Green, Joshua M. Langberg, Heather A. Jones & Alfonso L. Floyd Jr.

  2. Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA

    Melissa R. Dvorsky

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  1. Cathrin D. Green
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Green, C.D., Dvorsky, M.R., Langberg, J.M. et al. The Impact of Social Determinants of Health on the Efficacy of School-Based Interventions for Adolescents with ADHD. School Mental Health 12, 580–594 (2020). https://doi.org/10.1007/s12310-020-09367-w

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