Project SummaryADHD children are at risk for a variety of negative outcomes as adolescents and young adults,including high school failure, delinquency, and substance abuse (Barkley et al, 2007; Lee et al,2011; Molina et al, 2009; Sibley et al, 2011). Stimulant medication is the most widely usedintervention for ADHD and has documented acute benefits for adolescents (Evans et al, 2000;Findling et al., 2011; Smith et al, 1998). However, long-term benefits have not beendocumented (Molina et al, 2009). By the end of adolescence, 80-90% of teens with ADHD arenoncompliant with stimulant medication use, arguably the primary cause of the lack of long-termbenefit (Biswas et al., 209; Molina et al, 2009). We propose to evaluate a dual componentfamily-based intervention for adolescents with ADHD to improve medication adherence(Supporting Teen Adherence and Responsibility; STAR). STAR pairs Motivational Interviewing(MI; Miller and Rollnick, 2013) with parent-teen behavioral contracting (PTBC; Barkley,Edwards, Robin, 1999) to address the unique needs of ethnically diverse, primarily Hispanic,adolescents with ADHD. In the proposed study, 200 adolescents with ADHD and a history ofchronic NA to their ADHD medication will be randomly assigned to medication alone(medication as usual: MAU) or MAU+STAR. As most ADHD youth are treated in primary caresettings (Rushton, Kant & Clark, 2004), all participants will receive ADHD medication from theirown primary care provider (PCC) for the duration of the study, and all visits will be held in theoffices of their PCC. To test the intervention's acute and long-term efficacy, the study willexamine treatment effects on adherence (MEMS cap pill count, monthly phone diaries) acrosssix months of active intervention, one year of maintenance intervention, and a final year ofnaturalistic follow-up. In addition to monthly MEMS cap and phone diary assessments ofadherence, participants' functioning will be assessed at intake, 6 months, 18 months, and 30months in order to detect group differences in DBD symptomatology, academic functioning,family conflict, and substance use. The specific aims are to examine (1) the impact of STAR onmedication adherence, (2) moderators of intervention effects on adherence, (3) if theintervention improves the functioning of adolescents with ADHD in four key domains:ADHD/ODD symptom severity, academics, family conflict, and substance use. Despite thealarmingly high rates of medication NA in ADHD, this proposal is the first randomized trial of anintervention specifically designed to improve medication adherence in adolescents with ADHD.
