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

项目摘要。每日支持青少年自主是对ADHD青少年的干预 这是一种教授补偿技能以抵消“冷静”执行功能缺陷的影响的方法， 父母的权变管理策略，以减轻奖励加工中“热”赤字的影响 （Castellanos，2006年）。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 作为促进治疗维持关键可塑性因素， 收益.本研究的目的是实证检验在多大程度上假设的动机和 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，并反过来，提高技能的做法和长期的治疗结果。因此，本研究旨在 确定治疗师可能用于改善ADHD疾病长期轨迹的关键策略。从 2011-2016年，我们的团队完成了两项STAND的RCT-由NIMH资助的R34，将STAND与 治疗为单克隆抗体（R34 MH 092466; N=128; Sibley et al.，2016年）和克林根斯坦第三代 基金会资助的试验，比较STAND与团体家长培训和青少年组织技能培训 (KTGF; N=122; Sibley等人，正在筹备中）。在R34和KTGF试验中，总共有128名参与者 被分配接受STAND。治疗师被指示录音所有STAND会话，导致 在拟议的项目中，有921个录制的会议可供编码（M=每个参与者7.1个会议）。在 Y 01，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 用于观察过程交换的代码; SCOPE; Moyers & Martin，2008年），用于项目MATCH（项目 MATCH研究小组，1998年）。在调整这些MI编码系统时，我们将纳入相关的关键代码 假设的客户动机/意志障碍和治疗师的策略反应的青少年与 ADHD和父母我们将对适应性编码系统进行初步的心理测试， 在将其应用于921个磁带之前，随机选择磁带的子集。此外，我们将按主题编码 每个家庭的最后一次STAND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）开发新的假说的机制，长期 这些结果尚未被发现。在2002年，我们将继续编码，并对编码磁带进行分析。 该建议是新颖的，因为它：（1）代表了开发治疗带编码系统以检测 父母和青少年的动机和意志障碍多动症治疗，（2）将提供第一个实证检验， 治疗师行为如何影响父母和青少年的动机和意志因素，并通过扩展，转移 的技能，以日常生活环境和长期ADHD症状缓解，和（3）将探讨尚未确定的 可能影响青少年ADHD治疗长期结果的因素。

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.