School-Based Depression Prevention for Adolescents with ADHD

摘要/项目总结 患有ADHD的儿童在青春期和成年初期患抑郁症的风险较高， 合并症与比单独的任何一种疾病更大的损害相关，包括更高的 住院率和自杀意念和行为的风险增加。尽管有这些 不良后果，现有的ADHD循证干预措施尚未显示出对 减少抑郁症状，也没有建立抑郁症预防计划的工作，以及 ADHD青少年奖赏反应性和情绪调节是影响个体行为的两个关键因素 证明了在ADHD和抑郁症之间起着中介作用，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的青少年中尤其明显，我们的目标是开发和测试一种改良的 行为激活预防计划〔在学校以行为方式提升青少年情绪 （BEAM-S）]，其包含直接针对这些声称的机制的模块。为配合 干预开发和测试的部署为重点的模型，我们将制定一个计划， 可以很容易地在高中环境中实施和可持续的，因为学校精神 卫生工作人员，减少抑郁症和改善整体功能的青少年多动症， 改善RR和ER的方法。作为第一步，我们将与社区 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， 制定一个可接受的和可持续的选择和指示的预防方案， 学校的工作人员使用。然后，我们将首先培训学校工作人员，通过共同提供这一预防计划， 治疗培训模式，为他们独立实施预防做好准备 一个案例系列中的程序，包括两个组（两所高中各一个），以评估 初步可行性。然后，我们将使用混合型1实施进行第1阶段RCT- 有效性设计，其中四所高中将被随机分配到BEAM-S条件（n = 2）或常规治疗（n = 2）。最后，将使用目标1-3的定性和定量数据 为未来的大规模有效性试验R 01（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).