Academic Achievement among High School Students with ADHD and Internalizing Symptoms and their Response to a Multicomponent Treatment Intervention

Abstract ADHD is a common disorder in youth, with core deficits that impair important areas of functioning, most notably academic achievement. Existing school-based interventions may not be as effective in improving long-term academic outcomes for adolescents with comorbid ADHD and internalizing disorders. The purpose of this study was to explore the association between ADHD and internalizing symptoms in adolescents and the impact of anxiety and depression symptom severity on their academic outcomes after engaging in a multicomponent school-based intervention (BEST Project). The BEST Project was implemented in several high schools, with 126 participants included in this study. All participants met DSM-5 criteria for ADHD, were 14-18 years old, and attended public high schools.A multiple multivariate regression analysis was conducted to investigate if internalizing symptom severity predicts pre-treatment academic performance. Female students were found to have more academic problems. To examine whether pre-treatment internalizing symptom severity predicts post-treatment academic performance and moderates the relationship between the effects of the BEST project and academic performance, a second multiple multivariate regression analysis was conducted. Graphed interactions and Johnson-Neyman results suggest that once student's internalizing symptom scores are above the median, treatment effects on homework problems are stronger for those with anxiety symptoms and weaker for youth with depression symptoms. These findings suggest anxiety may serve as a protective factor in the context of a structured intervention. Limitations and future directions for research and practice are discussed.