Search

This study tested whether early and developmentally atypical substance use mediates risk for adult substance use among children with attention-deficit/hyperactivity disorder (ADHD), and whether that risk is substance-specific. Participants were children with ADHD previously enrolled in a randomized controlled trial (RCT), and a demographically similar non-ADHD group, assessed at 2 through 16 years after the original RCT baseline. Self-reports of heavy drinking, marijuana use, daily smoking, and other illicit drug use were collected at follow-ups to establish atypically early and frequent use. Models estimated statistically mediated effects of childhood ADHD on adult substance use via early substance involvement, with planned comparisons to evaluate substance specificity. Results supported the mediation hypothesis, showing that childhood ADHD was associated with more frequent adult substance use via early substance involvement for marijuana, cigarettes, illicit drugs, and to a lesser extent, alcohol. Mediation was not escalated by comorbid childhood conduct disorder or oppositional defiant disorder except for early use of nonmarijuana illicit drugs. Substance-specificity in the mediational pathway was largely absent except for cigarette use, where ADHD-related early smoking most strongly predicted adult daily smoking. Findings from this study provide new evidence that atypically early substance use associated with childhood ADHD signals important cross-drug vulnerability by early adulthood, but cigarette use at a young age is especially associated with increased risk for habitual (daily) smoking specifically. Efforts to prevent, delay, or reduce substance experimentation should occur early and focus on factors relevant to multiple drugs of abuse in this at-risk population. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Childhood attention-deficit/hyperactivity disorder (ADHD) is prospectively linked to substance use and disorder. Depression emerging in adolescence is an understudied risk factor that may explain some of this risk. In the present study, we considered mediating and moderating roles of adolescent depression in explaining this association by using longitudinal data from the prospective 16-year follow-up of the Multimodal Treatment Study of ADHD (MTA). Participants were 547 children diagnosed with DSM-IV ADHD Combined Type, and 258 age- and sex-matched comparison children. In adolescence, depressive symptoms did not exacerbate effects of childhood ADHD on any substance use. For both groups, time-varying and average depressive symptoms were associated with more frequent use of all substances. Prospectively, we found no evidence of depression mediation to adult substance use. However, adolescent depression moderated the association between childhood ADHD and adult marijuana use. Although adults without ADHD histories used marijuana more frequently if they had elevated depressive symptoms in adolescence, marijuana use by adults with ADHD histories was independent of their adolescent depression. In adulthood, depression diagnoses and ADHD persistence continued to operate as independent, additive correlates of substance use risk. Our findings suggest a circumscribed role for depression in substance use risk that adds to, but does not alter or explain, ADHD-related risk.

Background Method Results Conclusions Attention Deficit/Hyperactivity Disorder (ADHD) demonstrates unique developmental manifestations in adolescence with implications for optimized, age‐appropriate treatment. This 10‐year update is the third in a series of systematic reviews examining the efficacy and safety of adolescent ADHD treatments. We broadly examined efficacy on ADHD symptoms, impairments, and other reported outcomes. Acute and long‐term efficacy, and treatment moderators, were considered.We performed PubMed, EMBASE, and PsycINFO searches for articles published or in press from 2013 to 2024, integrated with hand search and randomized controlled trials (RCTs) identified in this series' earlier reviews. RCTs examining the safety or efficacy of interventions delivered to adolescents (ages 10.0–19.9) with a diagnosis of ADHD were included. Study characteristics were extracted and reviewed, quality of evidence was assessed using GRADE, and effect sizes were calculated for individual studies and illustrated using forest plots.Sixty‐three RCTs were identified. Quality of evidence ranged from high (medication; k = 29) to very low (nutrient supplementation, neurofeedback, occupational therapy; k = 1 each). Medications demonstrated consistent strong impact on ADHD symptoms and inconsistent impact on impairment. Diverse cognitive/behavioral treatments (C/BTs) demonstrated inconsistent impact on ADHD symptoms but strong and consistent impact on impairment and executive function skills, plus moderate benefits on internalizing symptoms. No interventions demonstrated significant safety concerns. Long‐term maintenance (up to 3 years post‐treatment) was demonstrated for C/BTs, though moderate quality of evidence was noted because participants cannot be fully blinded to receipt of treatment.The effects of C/BTs and medication appear complementary, not duplicative. Combining medication and C/BT is advised at treatment outset to maximize engagement, maintenance, and response breadth (i.e. improving both ADHD symptoms/cognitive performance and coping skills/functional impairments). Engagement strategies (e.g. motivational interviewing) may facilitate uptake. Novel treatments do not yet demonstrate effects on ADHD symptoms or impairments in adolescents but remain a promising area for research. [ABSTRACT FROM AUTHOR]

Background: Attention-deficit/hyperactivity disorder (ADHD) treatment utilization among adolescents is highly variable. This article describes pharmacological and nonpharmacological treatment utilization in a community sample of primarily Latinx and/or Black adolescents with ADHD (N = 218), followed longitudinally for 4 years, from early adolescence until approximately age 17 (M = 16.80, standard deviation = 1.65). Methods: Electronic surveys administered between 2012 and 2019 queried parent and youth reports of medication initiation, persistence, diversion, and misuse, as well as reasons for desistence. Nonpharmacological treatment utilization (including complementary and alternative treatments) was also measured. Results: Results indicated that: (1) the majority of the sample sought treatment for ADHD in their community, (2) rates of psychosocial treatment utilization were higher than medication utilization, (3) approximately half of the medicated sample discontinued community-administered ADHD medication during the follow-up period, most frequently citing tolerability issues and concerns that they were "tired of taking" medication, and (4) medication misuse consisted of youth diversion and parent utilization of teen medication, but both were reported at low rates. Race/ethnicity did not predict treatment utilization patterns, but lower family adversity and psychiatric comorbidity predicted persistence of medication use over time. Conclusions: ADHD treatment engagement efforts for Latinx and/or Black adolescents might link treatment to goals valued by the youth, address concerns related to medication tolerability, and promote secure monitoring of medication. Nonpharmacological treatments for ADHD may be more palatable to Latinx and Black youth with ADHD, and efforts to engage youth with ADHD in treatment should consider offering medication and psychosocial treatment options. [ABSTRACT FROM AUTHOR]

We utilized qualitative methodology to characterize potential long-term effects (therapeutic and iatrogenic) of behavior therapy for adolescents with ADHD. Forty-two in-depth interviews were conducted with adolescents with ADHD and parents, 4 years post-treatment. Grounded theory methods identified and reported prevalence of themes. All reported long-term effects were classified as benefits; no iatrogenic effects were noted. Long-term impact themes reported for a majority of participants included: development of organization skills (81.0%), enhanced motivation (57.1%), improved self-awareness (57.1%), improved parental knowledge of ADHD (76.2%), increased parent autonomy granting (61.9%), enhanced parental engagement with the youth (52.4%), and improved parent-teen relationships (52.4%). Fourteen themes were present for smaller subsamples, including reduced need for medication (3 of 9 medicated participants). Experimental studies of behavior therapy for adolescent ADHD should measure themes detected herein and directly test the possibility of long-term treatment effects. [ABSTRACT FROM AUTHOR]

Behavior therapy is identified as an evidence-based treatment for adolescents with ADHD. To date, there is no literature comparing and contrasting the content of existing behavior therapy packages. This review explores the heterogeneity of evidence-based behavior therapies for adolescents with ADHD by identifying the differences and commonalities amongst them. We conducted a systematic review of the literature and identified six treatment packages that met our inclusion criteria. Qualitative coding of practice elements employed a distillation approach based on review of treatment materials from each identified package. Practice elements were sorted into categories of common, shared, or unique elements. We identified 22 practice elements in total: 5 common elements, 11 shared, and 6 unique. Common elements represented skills training (organization and time management skills) and behavior management (skill application assignments, progress monitoring, use of rewards) elements. The list of shared elements primarily comprised varying engagement and skill generalization components designed to support the success of common elements. Unique elements were primarily skills-based: social skills training and peer-based recreation activities (Challenging Horizons Program), parent-teen communication training (Supporting Teens' Autonomy Daily), and distractibility reduction training and cognitive restructuring (Cognitive-Behavioral Therapy), but also included behavior modification (Challenging Horizons Program). Evidence-based psychosocial treatments for adolescents with ADHD overlap substantially and include more common and shared than unique elements. In adolescence, ADHD psychosocial therapies represent hybrid training and behavior management interventions. Community-based adaptations of evidence-based treatments should retain common elements and consider modular implementation of shared and unique elements. Highlights: Four interventions demonstrated a significant impact on ADHD symptoms in randomized controlled trials: Massachusetts General Hospital's cognitive-behavioral therapy protocol, the Homework, Organization, and Planning Skills (HOPS) program, the Challenging Horizon's Program (CHP), and Supporting Teens' Autonomy Daily (STAND). There are five common elements of evidence-based treatments for adolescent ADHD: organization and time management skills training, skill application assignments, progress monitoring, and use of rewards. In adolescence, ADHD psychosocial therapies represent hybrid training and behavior management interventions. [ABSTRACT FROM AUTHOR]

The Summer Treatment Program (STP) is one of the most widely studied psychosocial treatments for children with ADHD and has been adapted for adolescent populations (STP-A). However, there is a discrepancy between small effect sizes of improvement in outcomes and high perceived improvement by parents and adolescents, suggesting that we are not capturing some treatment-related improvements with quantitative pre-post assessments. This study examines parent and young adult perceptions of the impact of participating in the STP-A. Using qualitative interviewing, 22 in-depth interviews were conducted with young adults with ADHD (ages 18–21) and their parents. Informants offered their perspectives of what outcomes they perceived as changing as a result of participating in the STP-A and (2) how (i.e., by what mechanisms) the STP-A produced changes in these outcomes. Self-concept, motivation, executive functioning, parenting practices, and connectedness (e.g., positive interactions with peers and mentors who could provide social support, and encouragement) were reported as key mechanisms to improving functional outcomes with respect to academic, social, and family functioning. Findings highlight that parents and young adults reported improvements in many outcomes and mechanisms that have not been thoroughly measured in past clinical trials of the STP-A or the children's STP. Implications for improving assessment of intervention effects and intervention development are discussed. Highlights: Examined perspectives of the impact of a summer program for adolescents with ADHD. Informants reported benefits that have not been measured in past clinical trials. Novel improvements included self-concept, connectedness, and parental optimism. [ABSTRACT FROM AUTHOR]

Objective: Almost no studies identify mediators of psychosocial interventions for attention deficit/hyperactivity disorder (ADHD)—largely due to design limitations. Understanding mediators can promote streamlined interventions in usual care (UC) settings. When individual studies are insufficient to pursue complex questions, integrative data analysis (IDA) allows researchers to pool raw data from multiple studies to produce cumulative scientific knowledge. Method: We leveraged IDA to pool and harmonize data from four randomized controlled trials of ADHD psychosocial treatment (N = 854) with three time points. Linear growth curve analyses examined the impact of four psychosocial treatment conditions on ADHD symptom outcomes and five candidate mediators (compared to no treatment). To test mediation, we examined whether treatment condition predicted linear growth in the mediator at posttreatment, and if the mediator predicted linear growth in the outcome at follow-up. Results: Compared to no treatment, engagement-focused parent–teen treatment (d =.43–.72; Supporting Teens' Autonomy Daily [STAND]) and community-based usual care (d =.54–.99) led to greatest reductions in parent-rated ADHD symptoms, followed by the Summer Treatment Program–Adolescent (d =.29–.30; STP-A) and standard behavioral parent training + organization skills training (d =.26–.31; BPT/OST). Improvements in organization, time management, and planning skills mediated outcome for all treatments. BPT/OST and STP-A prevented deterioration of social skills, in turn mitigating escalation of ADHD symptoms. Improvements in parent–teen communication skills mediated outcome for STAND, BPT/OST, and the STP-A. Parent contingency management and disruptive classroom behavior were not treatment mediators. Conclusions: Psychosocial treatments for adolescent ADHD primarily improve ADHD symptoms through development of teen organization, time management (OTP), and parent–teen communication skills, as well as slowing deterioration of social skills. What is the public health significance of this article?: Community-based treatments for adolescent ADHD should include evidence-based treatment components that target these outcomes. [ABSTRACT FROM AUTHOR]

Adolescents with attention-deficit/hyperactivity disorder (ADHD) experience academic difficulties, but there are limitations to current methods of measuring these problems. The parent-rated Adolescent Academic Problems Checklist (AAPC) is a particularly promising measure, as the items were derived from concerns of parents and teachers of adolescents with ADHD and the scale demonstrates good concurrent validity and treatment sensitivity (Sibley et al. in School Psychology Quarterly, 29(4), 422, 2014; Sibley et al. Journal of Consulting and Clinical Psychology, 84(8), 699, 2016b). Because parents do not observe some academic behaviors queried on the AAPC, they may provide inaccurate responses to some items, leading to measurement error. In the current study, we sought to (1) determine the extent to which parents of adolescents with ADHD possess knowledge of the academic behaviors assessed on the AAPC, (2) determine if the scale maintains the two-factor structure (academic skills and disruptive behavior) and continues to relate to indicators of academic functioning after removing items associated with low parent knowledge, and (3) validate findings with the revised scale in a separate sample of adolescents with ADHD. Results identified five items for which the majority of parents reported little to no knowledge. When removing items with low parental knowledge, the AAPC's model fit was maintained and the two-factor model remained a better fit than the one-factor model. The relationships between the revised subscales and measures of academic functioning remained significant and largely equivalent to the original version. The revised model demonstrated similar fit in the second sample and was also related to indicators of academic functioning. Implications for clinical practice are discussed. [ABSTRACT FROM AUTHOR]

Objective: To identify patient- and treatment-level factors that predict intervention engagement and outcome for adolescents with attention-deficit/hyperactivity disorder (ADHD), guiding efforts to enhance care.Method: Integrative data analysis was used to pool data from 4 randomized controlled trials of adolescent ADHD treatment with participants (N = 854) receiving various evidence-based behavioral therapy packages in 5 treatment arms (standard [STANDARD], comprehensive [COMP], engagement-focused [ENGAGE]), community-based usual care (UC), or no treatment (NOTX). Participants also displayed varying medication use patterns (negligible, inconsistent, consistent) during the trial. Regression and latent growth curve analyses examined treatment- and patient-level predictors of engagement and outcome.Results: Compared with COMP, ENGAGE was associated with higher parent engagement in behavioral therapy (d = 1.35-1.73) when delivered in university, but not community, clinics. Under some conditions, ENGAGE also predicted youth engagement in behavioral therapy (d = 1.21) and lower likelihood of negligible medication use (odds ratio = 0.49 compared with NOTX). UC was associated with poorer parent engagement compared with COMP (d = -0.59) and negligible medication use (odds ratio = 2.29) compared with NOTX. Compared with COMP, ENGAGE (in university settings) was consistently associated with larger ADHD symptom improvements (d = 0.41-0.83) at 6-month follow-up and sometimes associated with larger grade point average (d = 0.68) and parent-teen conflict (d = 0.41) improvements. Consistent medication use during behavioral therapy was associated with larger improvements in ADHD symptoms (d = 0.28) and parent-teen conflict (d = 0.25-0.36). An ADHD+internalizing clinical profile predicted larger improvements in grade point average (d = 0.45). Family adversity predicted poorer parent and youth engagement (rate ratio = 0.90-0.95), negligible medication use (odds ratio = 1.22), and smaller improvements in grade point average (d = -0.23). African American race predicted smaller improvements in parent-teen conflict (d = -0.49).Conclusion: Engagement-focused behavioral therapy and consistent medication use most frequently predicted stronger clinical engagement and outcomes for adolescents with ADHD. Youths who are African American or who experience family adversity may demonstrate treatment-related disparities for certain outcomes; youths with ADHD+internalizing symptoms may demonstrate excellent academic outcomes following behavioral therapy.Data Sharing: The full ADHD TIDAL dataset is publicly available through the National Data Archive (https://nda.nih.gov), including a data dictionary. The study protocol is also publicly available: https://doi.org/10.1186/s12888-020-02734-6. [ABSTRACT FROM AUTHOR]

Background: Adolescents with attention‐deficit/hyperactivity disorder (ADHD) experience developmentally distinct challenges from children and adults with ADHD. Yet no work in this age group identifies treatment‐related phenotypes that can inform treatment matching, development of tailored treatments, and screening efforts. Method: This study uses Latent Profile Analysis to detect unique presenting problem profiles among adolescents with ADHD and to test whether these profiles differ by key individual characteristics (age, sex, race, family adversity level). Participants were 854 ethnically diverse adolescents (ages 10–17) from the ADHD Teen Integrative Data Analysis Longitudinal (TIDAL) dataset who were assessed at clinical referral. Parent, adolescent, and teacher ratings, educational testing, and school records measured eight key presenting problems at intake. Results: A three‐profile solution emerged. ADHD simplex (63.7%) was characterized by a mix of the ADHD‐Inattentive and ADHD‐Combined subtypes, moderate impairment levels, and infrequent comorbidities. ADHD + internalizing (11.4%) was characterized by higher likelihood of comorbid anxiety and/or depression. The disruptive/disorganized ADHD (24.9%) profile was characterized by severe organization, time management, and planning (OTP) problems, the ADHD‐Combined subtype, and frequent disruptive behavior at school. Age did not vary across these phenotypes. More females were present in the ADHD + internalizing phenotype; males were more likely to be found in the disruptive/disorganized ADHD phenotype. Higher family adversity and African American race were associated with the disruptive/disorganized ADHD phenotype. Conclusions: Adolescents with ADHD demonstrate varying presenting problem phenotypes that vary by sex, family adversity, and race/ethnicity. Consideration of these phenotypes may inform treatment matching and efforts to improve screening among under‐diagnosed groups. [ABSTRACT FROM AUTHOR]

Objective: This study tests the effectiveness of parent-teen psychotherapy for adolescent attention-deficit/hyperactivity disorder (ADHD) (Supporting Teens' Autonomy Daily [STAND]) versus usual care (UC) in 4 community clinics.Method: A randomized clinical trial was conducted with double randomization of adolescents and therapists to STAND versus UC. Participants were 278 culturally diverse adolescents diagnosed with DSM-5 ADHD at baseline and 82 community therapists. Seven primary outcomes were assessed at baseline (BL), posttreatment (PT; mean = 5.11 months post-BL, SD = 2.26), and follow-up (FU; mean = 9.81 months post-BL, SD = 2.50): inattention (IN; parent/teacher-rated), academics (parent-rated/official records), family functioning (parent/adolescent-rated), and disciplinary records. Treatment engagement indicated consumer fit (eg, number or sessions received, percentage of sessions attended by parent, satisfaction). The impact of treatment on concurrent medication use was also examined. Service delivery features were examined as moderators of outcome.Results: Intent-to-treat (N = 278) analyses indicated no significant group × time effects. STAND only led to superior outcomes when therapists were licensed (22% of sample) versus unlicensed (parent-rated IN: p < .001, d = 1.08; parent-rated academic impairment: p = .010, d = 1.17). Compared to UC, STAND was associated with greater parent participation (p < .001, d = 0.88) and higher scores on certain indices of parent satisfaction. STAND also was associated with superior medication engagement over time compared to UC (odds ratio = 7.18).Conclusion: Evidence-based psychosocial treatment for adolescent ADHD did not outperform UC on outcome trajectories despite improving some indices of treatment engagement. STAND requires additional adaptation for community contexts.Clinical Trial Registration Information: STAND Community Trial (STAND); https://clinicaltrials.gov/; NCT02694939. [ABSTRACT FROM AUTHOR]

ADHD symptom severity appears to be exacerbated during the COVID-19 pandemic. The present study surveyed top problems experienced by adolescents and young adults (A/YAs) with ADHD during the COVID-19 pandemic to identify possible reasons for symptom escalation and potential targets for intervention. We also explored perceived benefits of the pandemic for A/YAs with ADHD. At the outbreak of the COVID-19 pandemic (April–June 2020), we administered self and parent ratings about current and pre-pandemic top problem severity and benefits of the pandemic to a sample of convenience (N = 134 A/YAs with ADHD participating in a prospective longitudinal study). The most common top problems reported in the sample were social isolation (parent-report: 26.7%; self-report: 41.5%), difficulties engaging in online learning (parent-report: 23.3%, self-report: 20.3%), motivation problems (parent-report: 27.9%), and boredom (self-report: 21.3%). According to parent (d = 0.98) and self-report (d = 1.33), these top problems were more severe during the pandemic than in prior months. Contrary to previous speculation, there was no evidence that pandemic-related changes mitigated ADHD severity. Multi-level models indicated that A/YAs with higher IQs experienced severer top problems exacerbations at the transition to the COVID-19 pandemic. For A/YAs with ADHD, several risk factors for depression and school dropout were incurred during the early months of the COVID-19 pandemic. A/YAs with ADHD should be monitored for school disengagement and depressive symptoms during the COVID-19 pandemic. Recommended interventions attend to reducing risk factors such as increasing social interaction, academic motivation, and behavioral activation among A/YAs with ADHD. [ABSTRACT FROM AUTHOR]

Objectives: Little is known about factors that contribute to conflict between parents and adolescents with ADHD. The current study examines the frequency and intensity of arguments between adolescents with ADHD and their parents with attention to situational triggers and adolescent and parent characteristics that predict conflict. Method: Adolescents and parents (N = 128) completed a battery of rating scales at baseline intake into a randomized clinical trial. Results: The most frequent and clinically significant argument topics identified by parent were homework problems, personal hygiene, and bedtime. Similarly, homework problems were rated by parents as the most intense sources of arguments. Adolescents with ADHD who displayed higher comorbid depressive or aggressive symptoms had the most frequent arguments with their parents. Conclusions: Intervention and prevention programs targeting conflict between teens with ADHD and their parents might consider concurrent treatment of argument sources (i.e., disorganization, homework problems). Comorbid mood and behavior problems should also be addressed. [ABSTRACT FROM AUTHOR]

Individuals with attention deficit hyperactivity disorder (ADHD) underreport symptoms compared with informants and objective measures. This study applied enhanced statistical methodology (polynomial regression) to the study of ADHD self-reporting to clarify what contributes to symptom underreporting by adolescents with ADHD (N = 107; ages = 11-15 years). Polynomial regression models were conducted to test competing hypotheses about the nature of self-reporting problems. Traditional difference score models were nested within polynomial regression models to examine how modeling strategy influences results. Sixty-six percent of the sample substantially underreported symptoms compared with parents and 23.6% denied all symptoms. Polynomial regression models provided no evidence that the size of the discrepancy between parent and adolescent symptom reports possessed meaningful linear associations with any of the hypothesized predictors. Nested models indicated that the difference score approach led to very poor model fit and increased risk for Type I errors when examining underreporting among youth with ADHD. This finding suggests that past evaluations using a difference score approach should be replicated using polynomial regression to ensure that significant effects do not represent statistical artifact. [ABSTRACT FROM AUTHOR]

Background Academic impairment is among the most troubling domains of impairment for adolescents with Attention Deficit/Hyperactivity Disorder ( ADHD). Method This investigation presents results of a yearlong academic intervention delivered to adolescents with ADHD (N = 218) by engaging school staff as interventionists through behavioral consultation with an outside mental health professional. Results The intervention was coordinated successfully in some cases, but not in others. The principal challenge to intervention coordination was sustaining monthly contact between consultants and interventionists (38.5% success rate) and scheduling in-person consultation meetings with interventionists (40.0% success rate). Implementation of the intervention was enhanced when the student (a) attended a public (vs. private) school, (b) had an IEP or Section 504 plan in place, (c) was in middle school (vs. high school), (d) had a parent who communicated regularly with the school, and (e) had a special education support staff member or counselor (vs. teacher or administrator) as a school interventionist. Conclusions Considering these data, recommendations are provided for effective coordination of academic interventions for adolescents with ADHD. [ABSTRACT FROM AUTHOR]

This study evaluates the impact of the DSM-5 ADHD symptom wording changes on symptom endorsement among adolescents with ADHD. Parents of adolescents with systematically diagnosed DSM-IV-TR ADHD ( N= 78) completed counterbalanced DSM-IV-TR and DSM-5 ADHD symptom checklists in a single sitting. General linear models were conducted to evaluate whether the new DSM-5 symptom descriptors influenced the total number of ADHD symptoms and overall ADHD symptom severity endorsed by parents, how demographic factors were associated with noted changes in symptom endorsement when moving to the DSM-5, and which DSM ADHD items displayed notable changes in endorsement rates under the new wording. On average, parents identified 1.15 additional symptoms of ADHD in adolescents when moving from the DSM-IV-TR to the DSM-5. Increased symptom identification was not specific to age, sex, ethnicity, race, or socioeconomic status. Over half of the sample experienced increased symptom endorsement when changing texts (59.0%). Under the new DSM-5 wording, four symptoms had statistically significant endorsement increases (range: 11.2–16.7%): difficulty sustaining attention, easily distracted, difficulty organizing tasks and activities, and does not seem to listen. [ABSTRACT FROM AUTHOR]

Objective: This study evaluates a parent-teen skills-based therapy for attention deficit/hyperactivity disorder (ADHD) blended with motivational interviewing (MI) to enhance family engagement. Supporting Teens' Autonomy Daily (STAND) is an adolescent-specific treatment for ADHD that targets empirically identified adolescent (i.e., organization, time management, and planning, or OTP skills) and parent-based (i.e., monitoring and contingency management) mechanisms of long-term outcome through individual parent-teen sessions. Method: The current randomized trial (N = 128) evaluates efficacy at posttreatment and 6-month follow-up. Participants were ethnically diverse teens (7.7% non-Hispanic White, 10.8% African American, 78.5% Hispanic, 3.0% other) randomly assigned to STAND or Treatment As Usual (TAU). Results: Primary findings were that (1) STAND was delivered in an Mi-adherent fashion and most families fully engaged in treatment (85% completed); (2) STAND produced a range of significant acute effects on ADHD symptoms, OTP skills, homework behavior, parent-teen contracting, implementation of home privileges, parenting stress, and daily homework recording; and (3) 6 months after treatment ceased, effects on ADHD symptom severity, OTP skills, and parenting stress maintained, while parent use of contracting and privilege implementation strategies, as well as teen daily homework recording and homework behavior gains, were not maintained. Conclusion: Skills-based behavior therapy blended with MI is an acutely efficacious treatment for adolescents with ADHD although more work is needed to establish the nature of long-term effects. [ABSTRACT FROM AUTHOR]

Abstract: Smith, Waschbusch, Willoughby, and Evans (2000) reviewed a small treatment literature on ADHD in adolescents and concluded that methylphenidate stimulant medication was a well-established treatment and behavior therapy (BT) demonstrated preliminary efficacy. This review extends and updates the findings of the prior one based on the previous 15years of research. Studies published since 1999 were identified and coded using standard criteria and effect sizes were calculated where appropriate. Highlights of the last 15years of research include an expansion of pharmacological treatment options and developmentally appropriate psychosocial treatment packages for adolescents with ADHD. Additionally, nonstimulant medications (e.g., atomoxetine) are now approved for the treatment of ADHD in adolescence. The review concludes that medication and BT produce a similar range of therapeutic effects on the symptoms of adolescents with ADHD. However, results suggest that BT may produce greater overall benefits on measures of impairment. There was no evidence that cognitive enhancement trainings, such as working memory training or neurofeedback improved the functioning of adolescents with ADHD. Whether to use medication, BT, or their combination to treat an adolescent with ADHD is complicated and we provide evidence-informed guidelines for treatment selection. The reviewed evidence does not support current American Academy of Pediatrics and American Academy of Child and Adolescent Psychiatry professional guidelines, which state that stimulant medication is the preferred treatment for adolescents with ADHD. Recommendations for assessment, practice guidelines, and future research are discussed. [Copyright &y& Elsevier]

Objective: This study examines adolescent-specific practical problems associated with current practice parameters for diagnosing attention-deficit/hyperactivity disorder (ADHD) to inform recommendations for the diagnosis of ADHD in adolescents. Specifically, issues surrounding the use of self- versus informant ratings, diagnostic threshold, and retrospective reporting of childhood symptoms were addressed. Method: Using data from the Pittsburgh ADHD Longitudinal Study (PALS), parent, teacher, and self-reports of symptoms and impairment were examined for 164 adolescents with a childhood diagnosis of ADHD (age M = 14.74 years) and 119 demographically similar non-ADHD controls (total N = 283). Results: Results indicated that 70% of the well-diagnosed childhood ADHD group continued to meet Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; American Psychiatric Association, 2000) diagnostic criteria for ADHD in adolescence; however, an additional 17% possessed clinically significant impairment in adolescence but did not qualify for a current ADHD diagnosis. The optimal source of information was combined reports from the parent and a core academic teacher. Adolescents with ADHD met criteria for very few symptoms of hyperactivity/impulsivity, suggesting a need to revisit the diagnostic threshold for these items. Additionally, emphasis on impairment, rather than symptom threshold, improved identification of adolescents with a gold-standard childhood diagnosis of ADHD and persistent ADHD symptoms. Parent retrospective reports of baseline functioning, but not adolescent self-reports, were significantly correlated with reports collected at baseline in childhood. Conclusions: Recommendations are offered for diagnosing ADHD in adolescence based on these findings. [ABSTRACT FROM AUTHOR]

Comorbid depression has received little attention as a mechanism linking childhood ADHD to later substance use and substance use disorder. Childhood ADHD predicted worse depressive symptoms in adolescence, but symptoms in turn predicted adult cannabis use only for LNCG. Screening for depression in adolescence may be clinically important but not as a means of preventing ADHD-related risk of adult substance use. [Extracted from the article]