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Randomized Controlled Trial
. 2023 Sep;54(5):839-851.
doi: 10.1016/j.beth.2023.03.001. Epub 2023 Mar 16.

A Randomized Community-Based Trial of Behavior Therapy vs. Usual Care for Adolescent ADHD: Secondary Outcomes and Effects on Comorbidity

Margaret H Sibley  1 , Paulo A Graziano  2 , Stefany J Coxe  2 , Leonard Bickman  3 , Pablo Martin  2 , Sabrina Flores  4
Affiliations
Randomized Controlled Trial

A Randomized Community-Based Trial of Behavior Therapy vs. Usual Care for Adolescent ADHD: Secondary Outcomes and Effects on Comorbidity

Margaret H Sibley et al. Behav Ther. 2023 Sep.

Abstract

Though behavior therapy (BT) for ADHD in adolescence is evidence-based, almost no work examines its implementation and effectiveness in community settings. A recent randomized community-based trial of an evidence-based BT for adolescent ADHD (Supporting Teens' Autonomy Daily; STAND; N = 278) reported high clinician, parent, and youth acceptability but variable implementation fidelity. Primary outcome analyses suggested no significant differences between STAND and usual care (UC) unless the clinician delivering STAND was licensed. The present study reports secondary outcomes for this trial on indices of comorbidity (anxiety, depression, oppositional defiant disorder, conduct disorder) and ADHD outcomes not targeted by the active treatment (social skills, sluggish cognitive tempo). We also examine whether therapist licensure moderated treatment effects (as in primary outcome analyses). Using intent-to-treat and per protocol linear mixed models, patients randomized to STAND were compared to those randomized to UC over approximately 10 months of follow-up. Group × Time effects revealed that, overall, STAND did not outperform usual care when implemented by community clinicians. However, a Group × Time × Licensure interaction revealed a significant effect on conduct problems when STAND was delivered by licensed clinicians (d = .19-.47). When delivered in community settings, behavior therapy for adolescent ADHD can outperform UC with respect to conduct problems reduction. Community mental health clinics should consider: (1) assigning adolescent ADHD cases to licensed professionals to maximize impact and (2) choosing psychosocial approaches when ADHD presents with comorbid conduct problems. There is also a need to reduce implementation barriers for unlicensed clinicians in community settings.

Keywords: ADHD; community-based treatment; randomized controlled trial.

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Conflict of interest statement

Conflict of Interest: Dr. Sibley receives royalties from Guilford Press for a book describing the treatment evaluated in this research. No other authors report conflicts of interest.

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References

    1. Achenbach TM (2009). The Achenbach System of Empirically Based Assessment (ASEBA): Development, findings, theory, and applications. University of Vermont Research Center for Children, Youth, & Families.
    1. Achenbach TM, & Rescorla LA (2001). Manual for the ASEBA school-age forms & profiles. University of Vermont, Research Center for Children, Youth, & Families.
    1. Bangs ME, Emslie GJ, Spencer TJ, Ramsey JL, Carlson C, Bartky EJ, et al. (2007). Efficacy and safety of atomoxetine in adolescents with attention-deficit/hyperactivity disorder and major depression. Journal of Child and Adolescent Psychopharmacology, 17, 407–419. 10.1089/cap.2007.0066 - DOI - PubMed
    1. Brinkman WB, Simon JO, & Epstein JN (2018). Reasons why children and adolescents with attention-deficit/hyperactivity disorder stop and restart taking medicine. Academic Pediatrics, 18(3), 273–280. 10.1016/j.acap.2017.09.005 - DOI - PMC - PubMed
    1. Chan E, Fogler JM, & Hammerness PG (2016). Treatment of attention-deficit/hyperactivity disorder in adolescents: A systematic review. JAMA, 315(18), 1997–2008. 10.1001/jama.2016.5453 - DOI - PubMed

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