BackgroundThe ESCAschool study addresses the treatment of school-age children with attention-deficit/hyperactivity disorder (ADHD) in a large multicentre trial. It aims to investigate three interrelated topics: (i) Clinical guidelines often recommend a stepped care approach, including different treatment strategies for children with mild to moderate and severe ADHD symptoms, respectively. However, this approach has not yet been empirically validated. (ii) Behavioural interventions and neurofeedback have been shown to be effective, but the superiority of combined treatment approaches such as medication plus behaviour therapy or medication plus neurofeedback compared to medication alone remains questionable. (iii) Growing evidence indicates that telephone-assisted self-help interventions are effective in the treatment of ADHD. However, larger randomised controlled trials (RCTs) are lacking. This report presents the ESCAschool trial protocol. In an adaptive treatment design, two RCTs and additional observational treatment arms are considered.MethodsThe target sample size of ESCAschool is 521 children with ADHD. Based on their baseline ADHD symptom severity, the children will be assigned to one of two groups (mild to moderate symptom group and severe symptom group). The adaptive design includes two treatment phases (Step 1 and Step 2). According to clinical guidelines, different treatment protocols will be followed for the two severity groups. In the moderate group, the efficacy of telephone-assisted self-help for parents and teachers will be tested against waitlist control in Step 1 (RCT I). The severe group will receive pharmacotherapy combined with psychoeducation in Step 1. For both groups, treatment response will be determined after Step 1 treatment (no, partial or full response). In severe group children demonstrating partial response to medication, in Step 2, the efficacy of (1) counselling, (2) behaviour therapy and (3) neurofeedback will be tested (RCT II). All other treatment arms in Step 2 (severe group: no or full response; moderate group: no, partial or full response) are observational.DiscussionThe ESCAschool trial will provide evidence-based answers to several important questions for clinical practice following a stepped care approach. The adaptive study design will also provide new insights into the effects of additional treatments in children with partial response.Trial registrationGerman Clinical Trials Register (DRKS) DRKS00008973. Registered 18 December 2015.

The School Refusal Assessment Scale-Revised (SRAS-R) is a widely used measure of the functional conditions leading to school absenteeism. In the present study, we developed a German version of the SRAS-R and investigated its psychometric properties in a clinical sample (N = 62) of referred school absentees aged 11 to 17 years. Results of an exploratory factor analysis revealed a four-factor solution for the self-rated version and a three-factor solution for the parent-rated version. All four subscales of the final 22-item German SRAS-R were internally consistent. Convergent and discriminant validity were shown by significant correlations with other scales assessing internalizing and externalizing symptoms. Overall, the German SRAS-R is a valuable instrument for assessing school absenting behavior. The results should be interpreted conservatively due to the limited sample size.

Objective: ADHD treatment has positive effects on behavioral symptoms and psychosocial functioning, but studies that follow children treated for ADHD into adulthood are rare. Method: This follow-up study assessed symptom severity and functional outcomes of adults ( n = 70) who had received individualized ADHD treatment in the Cologne Adaptive Multimodal Treatment (CAMT) Study at ages 6 to 10 years. Results: Despite symptomatic improvement, participants reported poorer educational and occupational outcomes than expected (e.g., currently unemployed: 17%). They had also been in contact with the justice system more often than expected (e.g., lifetime convictions: 33%) and were impaired on health-related outcomes (e.g., substance use problems: 15%). Several social outcomes were favorable (e.g., long-term relationship/married: 63%). Conclusion: Compared to the general population or norm samples, CAMT participants had a higher relative risk ( RR) of functional impairments, demonstrating the need for continued support for a substantial proportion of the young adults.

Objective: Both genetic and environmental factors contribute to the development of ADHD, but associations between risk factors and ADHD symptom severity in affected children remain unclear. This systematic review and meta-analysis synthesizes evidence on the association between familial factors and symptom severity in children with ADHD (PROSPERO CRD42020076440). Method: PubMed and PsycINFO were searched for eligible studies. Results: Forty-three studies ( N = 11,123 participants) were meta-analyzed. Five additional studies ( N = 2,643 participants) were considered in the supplemental review. Parenting stress ( r = .25), negative parenting practices ( r = .19), broken parental partnership ( r = .19), critical life events ( r = .17), parental psychopathologies ( r = .14–.16), socioeconomic status ( r = −.10), and single-parent family ( r = .10) were significantly associated with ADHD symptom severity. Conclusion: These results suggest that psychosocial familial factors show small but significant associations with symptom severity in children with ADHD. Implications are discussed.