Reaching “The Other Half”: Teacher Referral Increases Inclusivity in Intervention Research for Neurodivergent School-Age Children

ABSTRACT

Objective

Researchers employed two recruitment strategies in a school-based comparative effectiveness trial for students with a diagnosis of attention-deficit/hyperactivity disorder (ADHD) or autism. This study assessed the: 1) effectiveness of school-based referrals for identifying students meeting diagnostic criteria and 2) impact of eliminating requirements for existing diagnoses on recruitment, sample characteristics, and intervention response.

Method

Autistic students and students with ADHD in schools serving underresourced communities were recruited for an executive functioning (EF) intervention trial over 2 years. In Year 1, school staff nominated students with previous diagnoses. In Year 2, school staff nominated students demonstrating EF challenges associated with ADHD or autism; previous diagnosis was not required. Study staff then confirmed diagnoses.

Results

More students were included in Year 2 (N = 106) than Year 1 (N = 37). In Year 2, 96% of students referred by school staff met diagnostic criteria for ADHD or autism, 53% of whom were not previously diagnosed. Newly identified students were less likely than previously diagnosed students to be receiving services and, for those with ADHD, were more likely to speak primarily Spanish at home. Previously diagnosed and newly identified students did not differ on other demographic variables or intervention response. Caregivers of previously diagnosed students reported more symptoms than caregivers of newly identified students for both diagnostic groups. Previously diagnosed students with ADHD had more researcher-rated symptoms than newly identified students.

Conclusions

Recruitment for an intervention study using behavior-based referrals from school staff enhanced enrollment without compromising the sample’s diagnostic integrity and engaged children who otherwise would have been excluded.

Disclosure Statement

Author L.K. is an author of the BRIEF, which was used in this study. L.K. receives royalties from PAR, Inc for the BRIEF, however, free author copies were used in this study. The authors have no other conflicts of interest to report.

Notes

¹ We use “autism” or “ADHD” when referring to the DSM diagnosis of each condition. We use identity-first language (i.e., autistic person) or “on the spectrum” when referring to autistic children (Bottema-Beutel et al., 2021). We use person-first language (i.e., person with ADHD) when referring to children with ADHD.

² The term “Hispanic” is used throughout this manuscript to mean “Hispanic, Latino/a or of Spanish origin,” as it is the term used by the majority of members of this community (Noe-Bustamanate et al., 2020).

³ Defined as reflective and inclusive of a group’s cultural values, beliefs, expectancies, norms and attitudes (Marín, 1993).

Additional information

Funding

The research reported in this article was funded through a Patient-Centered Outcomes Research Institute (PCORI) Award (AD-1304-7379). The statements in this article are solely the responsibility of the authors and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute (PCORI), its Board of Governors or Methodology Committee.