Community-Delivered Evidence-Based Practice and Usual Care for Adolescent Attention-Deficit/Hyperactivity Disorder:
Paulo A Graziano1, Margaret H Sibley2, Stefany J Coxe1
1Florida International University.
Behavior Therapy
|February 28, 2024
Summary
Usual care (UC) improved executive functioning in adolescents with ADHD more than the Supporting Teens' Autonomy Daily (STAND) intervention. STAND improved teen motivation but only when delivered by licensed therapists.
Area of Science:
- Child and Adolescent Psychiatry
- Behavioral Psychology
- Clinical Psychology
Background:
- Psychosocial care for adolescent ADHD often lacks robust evidence.
- Existing treatments are a mix of diluted evidence-based practices (EBPs) and low-value approaches.
- Community-based interventions require evaluation for efficacy and mechanisms.
Purpose of the Study:
- To compare a community-delivered EBP (STAND) with usual care (UC) for adolescents with ADHD.
- To examine differential changes in behavioral, psychological, and cognitive mechanisms.
- To assess the impact of therapist licensure on intervention effectiveness.
Main Methods:
- A randomized community-based trial with 278 adolescents (ages 11-17) with ADHD.
- Double randomization of adolescents and therapists to STAND or UC.
- Measurement of mechanistic outcomes via parent-rated, observational, and task-based assessments at baseline, post-treatment, and follow-up.
Main Results:
- UC showed superior effects on executive functioning compared to STAND.
- STAND improved adolescent motivation and reduced parental intrusiveness when delivered by licensed therapists.
- STAND did not demonstrate proposed mechanisms when delivered by unlicensed therapists.
Conclusions:
- Community-delivered UC may enhance executive functioning in ADHD.
- STAND's effectiveness is linked to therapist licensure and may improve motivation.
- Future EBP adaptations need enhanced support for unlicensed community therapists.
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