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Three-Year Effects of Motivational Interviewing-Enhanced Behavior Therapy for Adolescents With
Margaret H Sibley1, Paulo A Graziano2, Stefany Coxe3
1University of Washington School of Medicine and Seattle Children's Research Institute in Seattle, WA; Florida International University Herbert Wertheim College of Medicine in Miami, FL.
Journal of the American Academy of Child and Adolescent Psychiatry
|October 23, 2024
Summary
The Supporting Teens' Autonomy Daily (STAND) intervention showed long-term benefits for adolescent ADHD when delivered by licensed therapists. Unlicensed therapists require further training for optimal outcomes in community mental health settings.
Area of Science:
- Child and Adolescent Psychiatry
- Behavioral Therapy
- Clinical Psychology
Background:
- Attention-deficit/hyperactivity disorder (ADHD) significantly impacts adolescents.
- Parent-teen cognitive/behavioral treatments aim to improve ADHD symptoms and related challenges.
- Motivational Interviewing (MI) integrated into interventions may enhance treatment engagement and outcomes.
Purpose of the Study:
- To evaluate the 3-year effects of the Supporting Teens' Autonomy Daily (STAND) intervention compared to Usual Care (UC) for adolescent ADHD.
- To assess the impact of STAND on ADHD severity, parent-teen conflict, and executive functioning.
- To examine the moderating role of therapist licensure on long-term treatment outcomes.
Main Methods:
- A randomized clinical trial involving 278 adolescents with ADHD and 82 community therapists.
- Double randomization of adolescents and therapists to STAND or UC.
- Long-term outcomes assessed at 3 years, including ADHD severity, parent-teen conflict, organization, time management, planning skills (OTP), treatment/school enrollment, and diagnostic persistence.
Main Results:
- No overall long-term group differences between STAND and UC were found in intent-to-treat analyses.
- However, STAND demonstrated superior long-term outcomes for licensed therapists in reducing hyperactivity/impulsivity, parent-teen conflict, and improving OTP skills.
- Previously observed post-treatment effects on medication engagement were not significant at the 3-year follow-up.
Conclusions:
- While STAND did not universally outperform UC, therapist licensure significantly moderated long-term effects on ADHD symptoms, executive functions, and parent-teen conflict.
- These findings suggest adjunctive cognitive/behavioral treatments like STAND can maximize long-term outcomes for adolescents with ADHD in community settings.
- Further efforts are needed to ensure effective implementation of STAND by unlicensed clinicians to achieve consistent long-term benefits.
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