Exploring contextual secondary school influences on the mental health and wellbeing of adolescents with ADHD: A mixed methods study

Rowe, Abbey 2025. Exploring contextual secondary school influences on the mental health and wellbeing of adolescents with ADHD: A mixed methods study. PhD Thesis, Cardiff University. Item availability restricted.

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Abstract

Adolescents with attention deficit hyperactivity disorder (ADHD) are at an increased risk of developing co-occurring mental health problems, including depression and anxiety, that can result in disproportionately adverse long-term outcomes. Research has highlighted environmental factors as having the potential to influence the mental health of adolescents with ADHD. Yet the role of contextual secondary school influences on this group remains underexplored, providing a critical foundation for the mixed methods inquiry undertaken in this thesis. Firstly, multilevel modelling of secondary school survey data was conducted to understand the between school variation in mental health and wellbeing (MHW) outcomes for adolescents that self-reported increased ADHD symptoms. Secondly, the ability of this self-reported ADHD measure to distinguish between adolescents with and without a clinically recorded ADHD diagnosis was explored using discriminative performance statistics and linked healthcare data. Thirdly, interviews with students and staff (n=45) were conducted to explore the challenges and benefits that aspects of secondary school climate might pose for the MHW of adolescents with ADHD. Reflexive Thematic Analysis was used to code and organise this data into themes. Results indicated small but significant between school variation in a range of MHW outcomes for adolescents with increased self-reported symptoms of ADHD. The self-reported ADHD measure also demonstrated acceptable discriminative ability within a large community sample. The qualitative study reported evidence of both a perceived and experienced association between a range of contextual secondary school factors and multiple facets of MHW for students with ADHD. Three themes and subsequent subthemes detailed the contribution of school expectations, relational understanding and inclusive practices on such outcomes for this group. This thesis concludes that secondary schools have the potential to both positively and negatively impact the MHW of adolescents with ADHD and argues the need for an integrated and sustainable systems change to reduce such inequalities.

Item Type:	Thesis (PhD)
Date Type:	Completion
Status:	Unpublished
Schools:	Schools > Social Sciences (Includes Criminology and Education)
Subjects:	H Social Sciences > H Social Sciences (General)
Funders:	ESRC
Date of First Compliant Deposit:	25 March 2026
Last Modified:	26 Mar 2026 10:57
URI:	https://orca.cardiff.ac.uk/id/eprint/186014

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