Project Summary. Supporting Teens’ Autonomy Daily is an intervention for adolescents with ADHDthat teaches compensatory skills to offset the effects of “cool” executive functioning deficits, while teachingparents contingency management strategies to mitigate the effects of “hot” deficits in rewards processing(Castellanos, 2006). STAND combines skills-based therapy with Motivational Interviewing (MI), designed toovercome population-specific motivational and volitional barriers to treatment uptake. Our pilot work identifiesskill practice at home between session as a key malleable factor that promotes maintenance of therapeuticgains. The purpose of the current study is to empirically test the extent to which hypothesized motivational andvolitional barriers interfere with treatment and whether certain therapeutic strategies can influence parent andteen barriers, and in turn, improve skill practice and long-term therapy outcome. As a result, the study aims toidentify key strategies that therapists may use to improve the long-term trajectory of illness for ADHD. From2011-2016, our team completed two RCTs of STAND—an R34 funded by NIMH that compared STAND toTreatment as Usual (R34MH092466; N=128; Sibley et al., 2016) and a Klingenstein Third GenerationFoundation funded trial that compared STAND to group parent training and teen organization skills training(KTGF; N=122; Sibley et al., in preparation). In the R34 and KTGF trials, a combined total of 128 participantswere assigned to receive STAND. Therapists were instructed to audio record all STAND sessions, leading tothe availability of 921 recorded sessions for coding in the proposed project (M=7.1 sessions per participant). InY01, we will work with our consultants, Dr. Ernst and Dr. Houck, to adapt a therapy coding system (SequentialCode for Observing Process Exchanges; SCOPE; Moyers & Martin, 2008) utilized in Project MATCH (ProjectMATCH Research Group, 1998). In adapting these MI coding systems, we will incorporate key codes relevantto the hypothesized client motivational/volitional barriers and therapist strategic responses for adolescents withADHD and their parents. We will undergo initial psychometric testing for the adapted coding system with arandomly selected subset of tapes prior to applying it to the 921 tapes. In addition, we will thematically codeaudiotapes of each family’s final STAND session, as well as newly collected in-depth interviews with pastparticipants (N=20) and their parents (N=20) to develop new hypotheses about mechanisms of long-termoutcome that are yet-to-be detected. In Y02, we will continue coding and conduct analyses of coded tapes.This proposal is novel in that it: (1) represents a first effort to develop a therapy tape coding system to detectparent and teen motivational and volitional barriers in ADHD treatment, (2) will provide a first empirical test ofhow therapist behaviors influence parent and teen motivational and volitional factors and by extension, transferof skills to daily life contexts and long-term ADHD symptom remission, and (3) will explore yet-to-be-identifiedfactors that may influence long-term outcome in adolescent ADHD treatment.
