Mechanisms of Skill Uptake and Maintenance in Psychosocial Treatment for Adolescent ADHD

青少年多动症心理社会治疗中技能获取和维持的机制

• 批准号: 9510019
• 负责人: Margaret Harper Sibley
• 金额: $ 21.98万
• 依托单位: FLORIDA INTERNATIONAL UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-06-19 至 2019-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9510019
• 关键词: Acute; Address; Adolescence; Adolescent; Aftercare; Age; Attention deficit hyperactivity disorder; Audiotape; Characteristics; Client; Code; Development; Disease remission; Educational process of instructing; Executive Dysfunction; Family; Foundations; Funding; Generations; Goals; Hispanics; Home environment; Hour; Impairment; Intervention; Interview; Lead; Life; Maintenance; Manuals; Measures; Mediating; Mind; Monitor; Motivation; National Institute of Mental Health; Oppositional Defiant Disorder; Outcome; Parents; Participant; Perception; Pharmaceutical Preparations; Population; Preparation; Process; Psychometrics; Race; Randomized Controlled Trials; Recommendation; Research; Resources; Sampling; Single Parent; Speech; Speech Therapist; Symptoms; Techniques; Teenagers; Testing; Therapeutic; Training; Transferable Skills; Universities; Volition; Work; barrier to care; base; behavior influence; contingency management; critical period; design; ethnic minority population; experience; follow-up; improved; male; motivational enhancement therapy; novel; parental influence; psychosocial; racial and ethnic; response; reward processing; skills; skills training; therapy outcome; treatment as usual; trial comparing; uptake; young adult

Project Summary. Supporting Teens’ Autonomy Daily is an intervention for adolescents with ADHD that teaches compensatory skills to offset the effects of “cool” executive functioning deficits, while teaching parents contingency management strategies to mitigate the effects of “hot” deficits in rewards processing (Castellanos, 2006). STAND combines skills-based therapy with Motivational Interviewing (MI), designed to overcome population-specific motivational and volitional barriers to treatment uptake. Our pilot work identifies skill practice at home between session as a key malleable factor that promotes maintenance of therapeutic gains. The purpose of the current study is to empirically test the extent to which hypothesized motivational and volitional barriers interfere with treatment and whether certain therapeutic strategies can influence parent and teen barriers, and in turn, improve skill practice and long-term therapy outcome. As a result, the study aims to identify key strategies that therapists may use to improve the long-term trajectory of illness for ADHD. From 2011-2016, our team completed two RCTs of STAND—an R34 funded by NIMH that compared STAND to Treatment as Usual (R34MH092466; N=128; Sibley et al., 2016) and a Klingenstein Third Generation Foundation funded trial that compared STAND to group parent training and teen organization skills training (KTGF; N=122; Sibley et al., in preparation). In the R34 and KTGF trials, a combined total of 128 participants were assigned to receive STAND. Therapists were instructed to audio record all STAND sessions, leading to the availability of 921 recorded sessions for coding in the proposed project (M=7.1 sessions per participant). In Y01, we will work with our consultants, Dr. Ernst and Dr. Houck, to adapt a therapy coding system (Sequential Code for Observing Process Exchanges; SCOPE; Moyers & Martin, 2008) utilized in Project MATCH (Project MATCH Research Group, 1998). In adapting these MI coding systems, we will incorporate key codes relevant to the hypothesized client motivational/volitional barriers and therapist strategic responses for adolescents with ADHD and their parents. We will undergo initial psychometric testing for the adapted coding system with a randomly selected subset of tapes prior to applying it to the 921 tapes. In addition, we will thematically code audiotapes of each family’s final STAND session, as well as newly collected in-depth interviews with past participants (N=20) and their parents (N=20) to develop new hypotheses about mechanisms of long-term outcome that are yet-to-be detected. In Y02, we will continue coding and conduct analyses of coded tapes. This proposal is novel in that it: (1) represents a first effort to develop a therapy tape coding system to detect parent and teen motivational and volitional barriers in ADHD treatment, (2) will provide a first empirical test of how therapist behaviors influence parent and teen motivational and volitional factors and by extension, transfer of skills to daily life contexts and long-term ADHD symptom remission, and (3) will explore yet-to-be-identified factors that may influence long-term outcome in adolescent ADHD treatment.

项目摘要。 《支持青少年自主日报》是针对多动症青少年的一项干预措施 教授补偿技能以抵消“冷”执行功能缺陷的影响，同时教授 家长应急管理策略，以减轻奖励处理中“热”赤字的影响 （卡斯特拉诺斯，2006）。 STAND 将基于技能的治疗与动机访谈 (MI) 相结合，旨在 克服特定人群接受治疗的动机和意志障碍。我们的试点工作确定了 治疗期间在家进行技能练习是促进维持治疗的关键可塑性因素 收益。本研究的目的是通过实证检验假设的动机和动机的程度 意志障碍会干扰治疗以及某些治疗策略是否会影响父母和 青少年的障碍，进而提高技能实践和长期治疗效果。因此，该研究旨在 确定治疗师可以用来改善多动症长期疾病轨迹的关键策略。从 2011-2016年，我们的团队完成了两项STAND的RCT——一项由NIMH资助的R34，将STAND与 常规治疗（R34MH092466；N=128；Sibley 等人，2016）和 Klingenstein 第三代 基金会资助的试验将 STAND 与团体家长培训和青少年组织技能培训进行比较 （KTGF；N=122；Sibley 等人，正在准备中）。在 R34 和 KTGF 试验中，共有 128 名参与者 被分配接收 STAND。治疗师被要求对所有 STAND 疗程进行录音，从而导致 在拟议项目中可用于编码的 921 个录制会话（M=每个参与者 7.1 个会话）。在 Y01，我们将与我们的顾问 Ernst 博士和 Houck 博士合作，调整治疗编码系统（顺序 观察进程交换的代码；范围; Moyers & Martin, 2008）在 Project MATCH（项目 MATCH 研究小组，1998）。在调整这些 MI 编码系统时，我们将合并相关的关键代码 假设的来访者动机/意志障碍和治疗师对青少年的战略反应 多动症和他们的父母。我们将对改编后的编码系统进行初步心理测试 在将其应用于 921 个磁带之前随机选择磁带子集。此外，我们还将按主题编写代码 每个家庭最后一次 STAND 会议的录音带，以及新收集的过去的深度访谈 参与者（N = 20）及其父母（N = 20）提出有关长期机制的新假设 尚未检测到的结果。 Y02，我们将继续编码并对编码磁带进行分析。 该提案的新颖之处在于：（1）代表了开发治疗胶带编码系统以检测 父母和青少年在多动症治疗中的动机和意志障碍，（2）将提供第一个实证检验 治疗师的行为如何影响父母和青少年的动机和意志因素以及延伸、转移 日常生活环境和长期多动症症状缓解的技能，以及（3）将探索尚未确定的 可能影响青少年多动症治疗长期结果的因素。