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: 9988143
• 负责人: Margaret Harper Sibley
• 金额: $ 19.33万
• 依托单位: SEATTLE CHILDREN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-01 至 2021-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9988143
• 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对青少年ADHD的干预 这教会了补偿技能，以抵消在教学过程中“冷酷的”执行功能缺陷的影响 父母权变管理策略，以减轻奖励处理过程中“热”缺陷的影响 (Castellanos，2006)。Stand将基于技能的治疗与动机访谈(MI)相结合，旨在 克服特定人群对治疗吸收的动机和意志障碍。我们的试点工作确定了 在治疗间歇期在家进行技能练习是促进治疗维持的关键可塑性因素 收获。目前这项研究的目的是经验性地检验假设的动机和 意志障碍干扰治疗，以及某些治疗策略是否会影响父母和 青少年障碍，反过来，改善技能练习和长期治疗结果。因此，这项研究旨在 确定治疗师可以用来改善ADHD疾病长期发展轨迹的关键策略。从… 2011-2016年，我们团队完成了两个STAND RCT-由NIMH资助的R34，与STAND进行了比较 照常治疗(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 (可转化生长因子；N=122；Sibley等人，正在准备中)。在R34和KTGF试验中，总共有128名参与者 被分配到接待台上。治疗师被指示对所有站立会议进行录音，导致 在拟议项目中提供921次录音会议以供编码(M=每名参与者7.1次会议)。在……里面 Y01，我们将与我们的顾问Ernst博士和Houck博士合作，以适应治疗编码系统(Sequential 观察过程交换的代码；范围；Moyers和Martin，2008)在项目匹配(Project)中使用 Match Research Group，1998)。在适应这些MI编码系统时，我们将纳入相关的关键代码 假想的客户动机/意志障碍和治疗师对青少年的策略反应 ADHD和他们的父母。我们将对调整后的编码系统进行初步的心理测试， 在将其应用于921磁带之前随机选择的磁带子集。此外，我们还将按主题编写代码 每个家庭的最后一次会议的录音带，以及新收集的对过去的深入采访 参与者(N=20)和他们的父母(N=20)提出关于长期记忆机制的新假说 尚未检测到的结果。在Y02年，我们将继续对编码磁带进行编码和分析。 这一建议是新颖的，因为它：(1)代表了开发治疗胶带编码系统以检测 父母和青少年在ADHD治疗中的动机和意志障碍，(2)将提供关于 治疗师的行为如何影响父母和青少年的动机和意志因素，进而影响迁移 对日常生活环境和长期ADHD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ADHD治疗长期结果的因素。

项目成果

Building a Theoretical Model for Supporting Teens' Autonomy Daily (STAND): A Network Analysis of Family-Perceived Changes.

建立支持青少年自主日报（STAND）的理论模型：家庭感知变化的网络分析。

• DOI: 10.1016/j.beth.2021.05.009
• 发表时间: 2022-01
• 期刊: Behavior therapy
• 影响因子: 3.7
• 作者: Sibley MH;Johansson M;Monroy JM;Hill D;LaCount P;Barney S;Molina N;Delgado A
• 通讯作者: Delgado A