Megan Kelley, Margaret H Sibley, Stefany J Coxe, Hana Basu, Samantha M Margherio, Steven W Evans, Frances L Wang
{"title":"为患有多动症的青少年提供高强度行为疗法与低强度行为疗法:对药物使用结果的潜在长期不利影响》。","authors":"Megan Kelley, Margaret H Sibley, Stefany J Coxe, Hana Basu, Samantha M Margherio, Steven W Evans, Frances L Wang","doi":"10.1007/s10802-024-01254-1","DOIUrl":null,"url":null,"abstract":"<p><p>Individuals with ADHD are at risk for substance use initiation in adolescence and escalation to problematic use in adulthood. Little is known about the impact of psychosocial ADHD treatment on substance use. Based on existing theory, both therapeutic (i.e., through reducing symptoms and impairments) and iatrogenic effects (i.e., through improved social functioning) of psychosocial treatment for ADHD on adolescent substance use initiation are plausible. A primarily ethnic/racial minority sample (~ 95% Latinx or Black) of rising ninth grade students with ADHD (n = 106) were randomly assigned to receive high intensity (i.e., Summer Treatment Program-Adolescent, parent training, and school consultation) or lower intensity (parent training, organization skills training, and school consultation) intervention the summer before entering high school. Participants were followed four-years post-baseline and substance use was documented. Analyses tested treatment effects on substance use initiation (alcohol and/or marijuana) and mediators of main effects. After controlling for covariates, participants assigned to HI (37.5%) were significantly more likely than LI (18.6%) to initiate substance use by end of high school, indicating an iatrogenic effect of HI treatment. No significant mediators were detected. Post-hoc exploration of moderators suggested that youth with elevated Posttraumatic Stress Disorder (PTSD) symptoms may have experienced a benefit of HI treatment on substance use whereas youth without elevated PTSD symptoms experienced iatrogenic effects. Large, well-powered, samples should examine moderated mediational models to better understand who is most risk for iatrogenic effects of ADHD psychosocial treatment and why. Clinicians delivering psychosocial treatment to adolescents with ADHD should monitor for potential iatrogenic effects.</p>","PeriodicalId":36218,"journal":{"name":"Research on Child and Adolescent Psychopathology","volume":null,"pages":null},"PeriodicalIF":2.9000,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"High vs. Low Intensity Behavior Therapy Delivered to Adolescents with ADHD: Potential Adverse Long-Term Effects on Substance Use Outcomes.\",\"authors\":\"Megan Kelley, Margaret H Sibley, Stefany J Coxe, Hana Basu, Samantha M Margherio, Steven W Evans, Frances L Wang\",\"doi\":\"10.1007/s10802-024-01254-1\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>Individuals with ADHD are at risk for substance use initiation in adolescence and escalation to problematic use in adulthood. 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After controlling for covariates, participants assigned to HI (37.5%) were significantly more likely than LI (18.6%) to initiate substance use by end of high school, indicating an iatrogenic effect of HI treatment. No significant mediators were detected. Post-hoc exploration of moderators suggested that youth with elevated Posttraumatic Stress Disorder (PTSD) symptoms may have experienced a benefit of HI treatment on substance use whereas youth without elevated PTSD symptoms experienced iatrogenic effects. Large, well-powered, samples should examine moderated mediational models to better understand who is most risk for iatrogenic effects of ADHD psychosocial treatment and why. 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引用次数: 0
摘要
多动症患者有可能在青春期开始使用药物,并在成年后升级为有问题的药物使用。人们对多动症的社会心理治疗对药物使用的影响知之甚少。根据现有理论,ADHD 的社会心理治疗对青少年开始使用药物的治疗性影响(即通过减少症状和损伤)和先天性影响(即通过改善社会功能)都是合理的。在进入高中前的一个暑假,一个主要由少数族裔/种族(约 95% 为拉丁裔或黑人)组成的九年级多动症学生样本(n = 106)被随机分配到接受高强度(即青少年暑期治疗计划、家长培训和学校咨询)或低强度(家长培训、组织技能培训和学校咨询)干预的学校。在基线后四年对参与者进行跟踪调查,并记录药物使用情况。分析检验了治疗对开始使用药物(酒精和/或大麻)的效果以及主要效果的中介作用。在控制了协变量后,被分配到 HI(37.5%)的参与者在高中毕业时开始使用药物的可能性明显高于 LI(18.6%),这表明 HI 治疗产生了先天效应。没有发现明显的调节因素。对调节因素的事后分析表明,创伤后应激障碍(PTSD)症状升高的青少年可能会从 HI 治疗的药物使用中获益,而 PTSD 症状未升高的青少年则会受到先天性影响。应该对大型、有效的样本进行调节中介模型研究,以更好地了解哪些人最有可能受到 ADHD 心理社会治疗的先天性影响,以及为什么。为患有多动症的青少年提供心理治疗的临床医生应监测潜在的先天效应。
High vs. Low Intensity Behavior Therapy Delivered to Adolescents with ADHD: Potential Adverse Long-Term Effects on Substance Use Outcomes.
Individuals with ADHD are at risk for substance use initiation in adolescence and escalation to problematic use in adulthood. Little is known about the impact of psychosocial ADHD treatment on substance use. Based on existing theory, both therapeutic (i.e., through reducing symptoms and impairments) and iatrogenic effects (i.e., through improved social functioning) of psychosocial treatment for ADHD on adolescent substance use initiation are plausible. A primarily ethnic/racial minority sample (~ 95% Latinx or Black) of rising ninth grade students with ADHD (n = 106) were randomly assigned to receive high intensity (i.e., Summer Treatment Program-Adolescent, parent training, and school consultation) or lower intensity (parent training, organization skills training, and school consultation) intervention the summer before entering high school. Participants were followed four-years post-baseline and substance use was documented. Analyses tested treatment effects on substance use initiation (alcohol and/or marijuana) and mediators of main effects. After controlling for covariates, participants assigned to HI (37.5%) were significantly more likely than LI (18.6%) to initiate substance use by end of high school, indicating an iatrogenic effect of HI treatment. No significant mediators were detected. Post-hoc exploration of moderators suggested that youth with elevated Posttraumatic Stress Disorder (PTSD) symptoms may have experienced a benefit of HI treatment on substance use whereas youth without elevated PTSD symptoms experienced iatrogenic effects. Large, well-powered, samples should examine moderated mediational models to better understand who is most risk for iatrogenic effects of ADHD psychosocial treatment and why. Clinicians delivering psychosocial treatment to adolescents with ADHD should monitor for potential iatrogenic effects.