Patterns and Predictors of Adolescent Academic Achievement and Performance in a Sample of Children with Attention-Deficit/Hyperactivity Disorder

Abstract

The current study examined predictors of academic achievement, measured by standardized test scores, and performance, measured by school grades, in adolescents (Mn age = 16.8) who met diagnostic criteria for Attention-Deficit/Hyperactivity Disorder (ADHD)–Combined type in early childhood (Mn age = 8.5; N = 579). Several mediation models were also tested to determine whether ADHD medication use, receipt of special education services, classroom performance, homework completion, or homework management mediated the relationship between symptoms of ADHD and academic outcomes. Childhood predictors of adolescent achievement differed from those for performance. Classroom performance and homework management mediated the relationship between symptoms of inattention and academic outcomes.

Acknowledgments

The Multimodal Treatment Study of Children with ADHD (MTA) was a National Institute of Mental health (NIMH) cooperative agreement randomized clinical trial involving six clinical sites. Collaborators from the National Institute of Mental Health: Peter S. Jensen, M.D. (currently at Columbia University), L. Eugene Arnold, M.D., M.Ed. (currently at Ohio State University), Joanne B. Severe, M.S. (Clinical Trials Operations and Biostatistics Unit, Division of Services and Intervention Research), Benedetto Vitiello, M.D. (Child & Adolescent Treatment and Preventive Interventions Research Branch), Kimberly Hoagwood, Ph.D. (currently at Columbia); previous contributors from NIMH to the early phase: John Richters, Ph.D. (currently at National Institute of Nursing Research); Donald Vereen, M.D. (currently at National Institute on Drug Abuse). Principal investigators and coinvestigators from the clinical sites are University of California, Berkeley/San Francisco: Stephen P. Hinshaw, Ph.D. (Berkeley), Glen R. Elliott, Ph.D., M.D. (San Francisco); Duke University: C. Keith Conners, Ph.D., Karen C. Wells, Ph.D., John March, M.D., M.P.H., Jeffery Epstein, Ph.D.; University of California, Irvine/Los Angeles: James Swanson, Ph.D. (Irvine), Dennis P. Cantwell, M.D., (deceased, Los Angeles), Timothy Wigal, Ph.D. (Irvine); Long Island Jewish Medical Center/Montreal Children's Hospital: Howard B. Abikoff, Ph.D. (currently at New York University School of Medicine), Lily Hechtman, M.D. (McGill University); New York State Psychiatric Institute/Columbia University/Mount Sinai Medical Center: Laurence L. Greenhill, M.D. (Columbia), Jeffrey H. Newcorn, M.D. (Mount Sinai School of Medicine); University of Pittsburgh: William E. Pelham, Ph.D. (currently at State University of New York, Buffalo), Betsy Hoza, Ph.D. (currently at University of Vermont), Brooke Molina, Ph.D. Original statistical and trial design consultant: Helena C. Kraemer, Ph.D. (Stanford University). Follow-up phase statistical collaborators: Robert D. Gibbons, Ph.D. (University of Illinois, Chicago), Sue Marcus, Ph.D. (Mt. Sinai College of Medicine), Kwan Hur, Ph.D. (University of Illinois, Chicago). Collaborator from the Office of Special Education Programs/US Department of Education: Thomas Hanley, Ed.D. Collaborator from Office of Juvenile Justice and Delinquency Prevention/Department of Justice: Karen Stern, Ph.D.

The work reported was supported by cooperative agreement grants and contracts from the National Institute of Mental Health to the following: University of California, Berkeley: U01MH50461, N01MH12009, and HHSN271200800005-C; Duke University: U01 MH50477, N01MH12012, and HHSN271200800009-C ; University of California, Irvine: U01 MH50440, N01MH 12011, and HHSN271200800006-C; Research Foundation for Mental Hygiene (New York State Psychiatric Institute/Columbia University): U01 MH50467, N01 MH12007, and HHSN271200800007-C; Long Island-Jewish Medical Center U01 MH50453; New York University: N01MH 12004, and HHSN271200800004-C; University of Pittsburgh: U01 MH50467, N01 MH 12010, and HHSN 271200800008C; and McGill University N01MH12008, and HHSN271200800003-C. The Office of Special Education Programs of the U.S. Department of Education, the Office of Juvenile Justice and Delinquency Prevention of the Justice Department, and the National Institute on Drug Abuse also participated in funding.

The opinions and assertions contained in this report are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of Health and Human Services, the National Institutes of Health, or the National Institute of Mental Health.

Notes

Note: N = 436. Inattention and Hyper/Impulsive scores are item means scores from the SNAP rating scale where 0 = not at all, 1 = just a little, 2 = pretty much, and 3 = very much. Social Skills Rating Scale (SSRS) Classroom score is an item mean score with range of 1 to 5. Homework Problems Checklist (HPC) Completion and HPC Materials Management are the two factors generated from the Homework Problems Checklist. Special Education variable is the average hours per week of special education services received between the Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder (MTA) baseline and 8-year assessment. Medication use variable is the average percentage of days on Attention-Deficit/Hyperactivity Disorder medications between the MTA baseline and the 8-year assessment. WISC–III = Wechsler Intelligence Scale for Children–Third Edition; ODD = oppositional defiant disorder.

Note: Values in bold italics were significant at the p < .10 level and were entered into the multivariate model. Negative relationship for ethnicity indicates that minority status is associated with lower grades. Negative relationship for child sex indicates that female gender is associated with lower grades. Special Education variable is the average hours per week of special education services received between the Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder (MTA) baseline and 8-year assessment. Medication use variable is the average percentage of days on Attention-Deficit/Hyperactivity Disorder (ADHD) medications between the MTA baseline and the 8-year assessment. GPA = grade point average; ODD = oppositional defiant disorder; SSRS = Social Skills Rating System. HPC = Homework Problems Checklist.

Note: Values in bold italics were significant at the p < .10 level and were entered into the multivariate model. Negative relationship for ethnicity indicates that minority status is associated with lower grades. Negative relationship for child sex indicates that female gender is associated with lower grades. Special Education variable is the average hours per week of special education services received between the Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder (MTA) baseline and 8-year assessment. Medication use variable is the average percentage of days on Attention-Deficit/Hyperactivity Disorder (ADHD) medications between the MTA baseline and the 8-year assessment. ODD = oppositional defiant disorder; SSRS = Social Skills Rating System. HPC = Homework Problems Checklist.

Note: N = 436. Estimates in table are unstandardized regression coefficients. Negative coefficients for child ethnicity indicates that minority status is associated with lower grades. Negative coefficients for child sex indicates that female gender is associated with lower grades. Special Education variable is the average hours per week of special education services received between the Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder (MTA) baseline and 8-year assessment. Medication use variable is the average percentage of days on Attention-Deficit/Hyperactivity Disorder (ADHD) medications between the MTA baseline and the 8-year assessment. GPA = grade point average; NA = variables that were not significant at the p < .10 level in the correlation analyses and not entered into the multivariate model; ODD = oppositional defiant disorder; SSRS = Social Skills Rating System; HPC = Homework Problems Checklist.

*p < .05. **p < .01. ***p < .001.

Note: N = 436. Estimates in table are unstandardized regression coefficients. Negative coefficients for child ethnicity indicates that minority status is associated with lower grades. Special Education variable is the average hours per week of special education services received between the Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder (MTA) baseline and 8-year assessment. Medication use variable is the average percentage of days on Attention-Deficit/Hyperactivity Disorder (ADHD) medications between the MTA baseline and the 8-year assessment. NA = variables that were not significant at the p < .10 level in the correlation analyses and not entered into the multivariate model; ODD = oppositional defiant disorder; SSRS = Social Skills Rating System; HPC = Homework Problems Checklist.

*p < .05. **p < .01. ***p < .001.

Note. N = 436. Mediation effects were not significant for Wechsler Individual Achievement Test (WIAT) Reading or for English and Science grades. Mediation effects of the service use variables (special education services and medication use) were also examined but are not included in the table because no significant relationships were established. SSRS = Social Skills Rating System; HPC = Homework Problems Checklist.