School-Based Depression Prevention for Adolescents with ADHD

摘要/项目摘要 患有ADHD的儿童在青春期和青春期患抑郁症的风险增加，这一点 与任何一种疾病相比，共病与更大的损害有关，包括更高的 住院率和自杀意念和行为风险增加。尽管如此 不良结果，现有的基于证据的ADHD干预措施在 减少抑郁症状也不是既定的抑郁症预防计划对 患有多动症的青少年。奖励响应性(RR)和情绪调节(ER)是两个关键因素 证实了ADHD和抑郁症之间的联系，因此是治疗的关键目标 预防。为了解决获得和利用精神卫生保健之间的差距， 这在患有ADHD的青少年中尤为明显，我们的目标是开发和测试一种改进的 行为激活预防计划[在学校提高青少年的行为情绪 (BEAM-S)]它包含了直接针对这些据称的机制的模块。符合 以部署为中心的干预开发和测试模式，我们将开发一个计划， 可以在高中环境中轻松实施并可持续，由学校心理传授 卫生工作人员，通过以下方式减少抑郁并改善患有ADHD的青少年的整体功能 提高RR和ER的方法。作为第一步，我们将与社区一起开展焦点小组 利益相关者(例如，学校心理健康提供者、学校行政部门、青少年、家长、 教师)制定可接受的、可持续的、有选择和有指示的预防计划 学校教职员工可以利用。然后，我们将首先培训学校工作人员，通过联合- 治疗培训模式，为他们独立实施预防做好准备 由两个小组(两所高中各一组)组成的案例系列项目进行评估 初步可行性。然后，我们将使用混合类型1实施进行阶段1 RCT- 有效性设计，将四所高中随机分为BEAM-S条件(n =2)或按常规治疗(n=2)。最后，将使用目标1-3中的定性和定量数据 为未来的大规模有效性试验R01(目标4)准备最终程序。

ABSTRACT/PROJECT SUMMARY Children with ADHD are at elevated risk for depression in adolescence and young adulthood, and this comorbidity is associated with far greater impairment than either disorder alone, including higher rates of inpatient hospitalization and increased risk for suicidal ideation and behavior. Despite these adverse outcomes, existing evidence-based interventions for ADHD have not demonstrated effects in reducing depressive symptoms nor do established depression prevention programs work as well for adolescents with ADHD. Reward responsivity (RR) and emotion regulation (ER) are two key factors demonstrated to mediate the association between ADHD and depression and are thus key targets for prevention. In an effort to address the gap between access and utilization of mental health care, which is especially stark among adolescents with ADHD, we aim to develop and test a modified behavioral activation prevention program [Behaviorally Enhancing Adolescents’ Mood in Schools (BEAM-S)] that incorporates modules to directly target these purported mechanisms. In line with the Deployment-Focused Model of Intervention Development and Testing, we will develop a program that can be easily implemented and sustainable in the high school setting as delivered by school mental health staff that reduces depression and improves overall functioning in adolescents with ADHD, by way of improving RR and ER. As a first step, we will conduct focus groups with community stakeholders (e.g., school mental health providers, school administration, adolescents, parents, teachers) to develop an acceptable and sustainable selected and indicated prevention program for school staff to utilize. We will then initially train school staff to deliver this prevention program via a co- therapy training model to prepare them for their independent implementation of the prevention program in a case series consisting of two groups (one in each of two high schools) to evaluate preliminary feasibility. We will then conduct a stage 1 RCT with a hybrid-type 1 implementation- effectiveness design in which four high schools will be randomized to either the BEAM-S condition (n = 2) or treatment as usual (n = 2). Finally, qualitative and quantitative data from aims 1-3 will be used to prepare final procedures for a future large-scale effectiveness trial R01 (aim 4).