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。支持青少年每天的自治是对ADHD的青少年的干预 教导补偿技巧以抵消“酷”执行功能防御的影响，同时教学 父母应急管理策略减轻“热”的影响在奖励处理中定义 （Castelanos，2006年）。立场结合基于技能的疗法与旨在的动机访谈（MI） 克服特定人群的动机和意志障碍，以攻击治疗的吸收。我们的飞行员工作确定 在会议之间在家中的技能练习是促进治疗维持的关键可延展因素 收益。当前研究的目的是凭经验检验假设动机和 自愿性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，然后改善技能实践和长期治疗结果。结果，该研究的目的是 确定治疗师可能用来改善多动症疾病长期轨迹的关键策略。从 2011 - 2016年，我们的团队完成了两个RCT，这是由NIMH资助的R34，将立场与 像往常 基金会资助的试验将立场与小组父母培训和青少年组织技能培训进行了比较 （KTGF; n = 122; Sibley等人，在制备中）。在R34和KTGF试验中，总共有128名参与者 被指派接受立场。指示治疗师记录所有表演会议，从而 在拟议的项目中记录了921次编码的921个会话（M = 7.1个会话）。 Y01，我们将与我们的顾问Ernst和Houck博士合作，以适应治疗编码系统（顺序） 观察过程交换的代码；范围; Moyers＆Martin，2008年）在项目比赛中使用（项目 比赛研究小组，1998年）。在调整这些MI编码系统时，我们将合并关键代码相关 对假设客户的动机/自愿性障碍和治疗师的战略反应 多动症和他们的父母。我们将对改编的编码系统进行初始心理测试测试 将磁带的随机选择子集应用于921磁带之前。此外，我们将以主题编码 每个家庭的最后一场演出的录音带，以及与过去的新近收集的深入访谈 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。在Y02中，我们将继续对编码磁带进行编码和进行分析。 该提议是新颖的：（1）代表开发用于检测治疗胶带编码系统的第一项努力 父母和青少年动机和自愿性障碍（2）将提供第一个经验检验 治疗师的行为如何影响父母和青少年的动机和意志因素，并通过扩展，转移 日常生活环境和长期ADHD症状缓解的技能，（3）将探索尚未确定的 可能影响青少年多动症治疗中长期预后的因素。