Three-Year Effects of Motivational Interviewing-Enhanced Behavior Therapy for Adolescents With ADHD: A Randomized Community-Based Trial.

IF 9.2 1区医学 Q1 PEDIATRICS Journal of the American Academy of Child and Adolescent Psychiatry Pub Date : 2024-10-17 DOI:10.1016/j.jaac.2024.10.009

Margaret H Sibley,Paulo A Graziano,Stefany Coxe,Timothy F Page,Pablo Martin

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Abstract

OBJECTIVE This study reports three-year effects of a parent-teen cognitive/behavioral treatment for adolescent ADHD, blended with Motivational Interviewing (Supporting Teens' Autonomy Daily; STAND), versus Usual Care (UC) in four community clinics. METHOD A randomized clinical trial with double randomization of adolescents and therapists to STAND vs. UC. Participants were 278 culturally-diverse adolescents diagnosed with DSM-5 ADHD and 82 community therapists. Long-term effects on outcomes and theorized mechanisms were assessed ∼3 years post-baseline (M age=16.94, SD=1.69): ADHD severity (parent-rated), parent-teen conflict (parent/adolescent-rated), organization, time management, and planning skills (OTP; parent-rated), treatment and school enrollment (parent/adolescent-reported), and ADHD diagnostic persistence (clinician-determined). Therapist licensure was examined as a treatment moderator. Intent-to-treat (ITT) and per protocol analyses (n=225; participants initiating treatment after agency intake) were conducted. RESULTS As in the original trial, ITT analyses indicated no long-term group x time effects. However, STAND (versus UC) led to superior long-term outcomes when therapists were licensed (22% of sample) vs. unlicensed for parent-rated hyperactivity/impulsivity: d=.39; adolescent-rated parent-teen conflict: d=.27, and parent-rated OTP skills: d=.79. Previously-reported post-treatment group differences on medication engagement were non-significant at three-year follow-up. CONCLUSION Although STAND did not outperform UC overall, group x licensure interactions indicate specific long-term impacts on ADHD symptoms, executive function skills such as OTP, and parent-teen conflict, extending this trial's acute effects and replicating previous findings. Clinicians in community settings might recommend adjunctive cognitive/behavioral treatment to adolescents with ADHD to maximize long-term outcomes. However, additional efforts are needed to facilitate effective implementation by unlicensed clinicians.

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动机访谈-强化行为疗法对多动症青少年的三年疗效：基于社区的随机试验。

目的：本研究报告了在四个社区诊所开展的针对青少年多动症的家长-青少年认知/行为治疗（与动机访谈相结合）（每日支持青少年自主性；STAND）与常规护理（UC）的三年效果。方法：随机临床试验，对青少年和治疗师进行双随机分组，让他们分别接受 STAND 与 UC 治疗。参与者包括 278 名被诊断患有 DSM-5 多动症（ADHD）的不同文化背景的青少年和 82 名社区治疗师。对基线后3年（M年龄=16.94，SD=1.69）的结果和理论机制的长期影响进行了评估：ADHD严重程度（家长评分）、家长与青少年冲突（家长/青少年评分）、组织、时间管理和计划技能（OTP；家长评分）、治疗和入学率（家长/青少年报告）以及ADHD诊断持续性（临床医生确定）。治疗师执照被视为治疗调节因素。进行了意向治疗（ITT）和按协议分析（n=225；参与者在机构接纳后开始治疗）。结果在最初的试验中，ITT分析表明没有长期的组x时间效应。然而，当治疗师有执照（占样本的 22%）与无执照相比，STAND（与 UC 相比）在家长评定的多动/冲动性：d=.39；青少年评定的家长与青少年冲突：d=.27，以及家长评定的 OTP 技能：d=.79 等方面的长期效果更优。结论虽然 STAND 的总体表现并不优于 UC，但组别 x 许可的相互作用表明，STAND 对多动症症状、执行功能技能（如 OTP）和家长与青少年冲突有特定的长期影响，从而扩展了该试验的急性效应，并复制了之前的研究结果。社区环境中的临床医生可能会向患有多动症的青少年推荐辅助认知/行为治疗，以最大限度地提高长期疗效。不过，还需要做出更多努力，以促进无证临床医生的有效实施。

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来源期刊

Journal of the American Academy of Child and Adolescent Psychiatry 医学-精神病学

CiteScore

21.00

自引率

1.50%

发文量

1383

审稿时长

53 days

期刊介绍： The Journal of the American Academy of Child & Adolescent Psychiatry (JAACAP) is dedicated to advancing the field of child and adolescent psychiatry through the publication of original research and papers of theoretical, scientific, and clinical significance. Our primary focus is on the mental health of children, adolescents, and families. We welcome unpublished manuscripts that explore various perspectives, ranging from genetic, epidemiological, neurobiological, and psychopathological research, to cognitive, behavioral, psychodynamic, and other psychotherapeutic investigations. We also encourage submissions that delve into parent-child, interpersonal, and family research, as well as clinical and empirical studies conducted in inpatient, outpatient, consultation-liaison, and school-based settings. In addition to publishing research, we aim to promote the well-being of children and families by featuring scholarly papers on topics such as health policy, legislation, advocacy, culture, society, and service provision in relation to mental health. At JAACAP, we strive to foster collaboration and dialogue among researchers, clinicians, and policy-makers in order to enhance our understanding and approach to child and adolescent mental health.

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