Margaret H Sibley1, Kara Link2, Gissell Torres Antunez2, Lydia Greenwood2. 1. University of Washington School of Medicine, Seattle Children's Research Institute. 2. University of Washington Department of Psychology, Seattle Children's Research Institute.
Abstract
OBJECTIVE: To identify barriers to behavior therapy for adolescent ADHD (Supporting Teens' Autonomy Daily; STAND) and understand the relationship between barriers and treatment engagement. METHOD: A mixed-method design with qualitative coding of 822 audio-recorded therapy sessions attended by 121 adolescents with ADHD (ages 11-16; 72.7% male, 77.7% Latinx, 7.4% African-American, 11.6% White, non-Latinx) and parents. Grounded theory methodology identified barriers articulated by parents and adolescents in session. Barriers were sorted by subtype (cognitive/attitudinal, behavioral, logistical) and subject (parent, teen, dyad). Frequency and variety of barriers were calculated by treatment phase (engagement, skills, planning). Generalized linear models and generalized estimating equations examined between-phase differences in frequency of each barrier and relationships between barriers frequency, subtype, subject, and phase on engagement (attendance and homework completion). RESULTS: Coding revealed twenty-five engagement barriers (ten cognitive/attitudinal, eleven behavioral, four logistical). Common barriers were: low adolescent desire (72.5%), parent failure to monitor skill application (69.4%), adolescent forgetfulness (60.3%), and adolescent belief that no change is needed (56.2%). Barriers were most commonly cognitive/attitudinal, teen-related, and occurring in STAND's planning phase. Poorer engagement was associated with cognitive/attitudinal, engagement phase, and dyadic barriers. Higher engagement in treatment was predicted by more frequent behavioral, logistical, parent, and skills/planning phase barriers. CONCLUSIONS: Baseline assessment of barriers may promote individualized engagement strategies for adolescent ADHD treatment. Cognitive/attitudinal barriers should be targeted at treatment outset using evidence-based engagement strategies (e.g., Motivational Interviewing). Behavioral and logistical barriers should be addressed when planning and reviewing application of skills.
OBJECTIVE: To identify barriers to behavior therapy for adolescent ADHD (Supporting Teens' Autonomy Daily; STAND) and understand the relationship between barriers and treatment engagement. METHOD: A mixed-method design with qualitative coding of 822 audio-recorded therapy sessions attended by 121 adolescents with ADHD (ages 11-16; 72.7% male, 77.7% Latinx, 7.4% African-American, 11.6% White, non-Latinx) and parents. Grounded theory methodology identified barriers articulated by parents and adolescents in session. Barriers were sorted by subtype (cognitive/attitudinal, behavioral, logistical) and subject (parent, teen, dyad). Frequency and variety of barriers were calculated by treatment phase (engagement, skills, planning). Generalized linear models and generalized estimating equations examined between-phase differences in frequency of each barrier and relationships between barriers frequency, subtype, subject, and phase on engagement (attendance and homework completion). RESULTS: Coding revealed twenty-five engagement barriers (ten cognitive/attitudinal, eleven behavioral, four logistical). Common barriers were: low adolescent desire (72.5%), parent failure to monitor skill application (69.4%), adolescent forgetfulness (60.3%), and adolescent belief that no change is needed (56.2%). Barriers were most commonly cognitive/attitudinal, teen-related, and occurring in STAND's planning phase. Poorer engagement was associated with cognitive/attitudinal, engagement phase, and dyadic barriers. Higher engagement in treatment was predicted by more frequent behavioral, logistical, parent, and skills/planning phase barriers. CONCLUSIONS: Baseline assessment of barriers may promote individualized engagement strategies for adolescent ADHD treatment. Cognitive/attitudinal barriers should be targeted at treatment outset using evidence-based engagement strategies (e.g., Motivational Interviewing). Behavioral and logistical barriers should be addressed when planning and reviewing application of skills.
Authors: Melissa L Danielson; Rebecca H Bitsko; Reem M Ghandour; Joseph R Holbrook; Michael D Kogan; Stephen J Blumberg Journal: J Clin Child Adolesc Psychol Date: 2018-01-24
Authors: Michael A Lindsey; Nicole E Brandt; Kimberly D Becker; Bethany R Lee; Richard P Barth; Eric L Daleiden; Bruce F Chorpita Journal: Clin Child Fam Psychol Rev Date: 2014-09
Authors: Margaret H Sibley; Paulo A Graziano; Aparajita B Kuriyan; Stefany Coxe; William E Pelham; Lourdes Rodriguez; Frances Sanchez; Karen Derefinko; Sarah Helseth; Anthony Ward Journal: J Consult Clin Psychol Date: 2016-04-14
Authors: Margaret H Sibley; Stefany J Coxe; Mark A Stein; Michael C Meinzer; Matthew J Valente Journal: J Am Acad Child Adolesc Psychiatry Date: 2021-06-05 Impact factor: 13.113
Authors: Margaret H Sibley; Paulo A Graziano; Stefany Coxe; Leonard Bickman; Pablo Martin Journal: J Am Acad Child Adolesc Psychiatry Date: 2020-08-28 Impact factor: 13.113