Abstract
Adolescents with ADHD have planning problems, often affecting school- and social functioning. Evidence-based treatments for adolescents with ADHD are scarce and treatment drop-out rates are substantial. The effectiveness of two new, individual, short-term cognitive behavioral therapies (CBT) was investigated: One with an aim on improving planning skills and one solution-focused treatment (SFT) without such an aim. Motivational Interviewing elements were added to both treatments to enhance treatment compliance. In a multi-center randomized clinical trial, 159 adolescents (12–17 years) with ADHD were randomly assigned to one of both treatments. Pre-, post- and 3-month follow-up data were gathered on five domains: Parent-rated ADHD, planning problems and executive functioning (primary outcomes), neuropsychological measures of planning, comorbid symptoms, general functioning, and teacher measures. Attrition was low in both treatments (5 %). Adolescents improved significantly between pre- and post-test with large effect sizes on all domains. Improvements remained stable or continued to improve from post-test to follow-up, also when controlling for medication use. Marginally significant differences were found in favor of the planning-focused treatment: parents and therapists evaluated this treatment more positively than SFT and the planning-focused treatment showed more reduction of parent-rated planning problems. Two new CBTs with integrated motivational components were feasible and attrition was low. ADHD symptoms and co-existing problems of the adolescents improved from pre-test to 3 months after treatment. As the planning-focused treatment was evaluated more positive and had marginal additional beneficial effects to SFT, especially planning-focused CBT seems promising to fill the gap in available treatments for adolescents with ADHD.
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Notes
Because some adolescents only use MPH during the school-week, school-week average dose is calculated.
Please note that this is the maximum adherence score.
Due to Bonferroni correction alpha = .0125, thus these p values are considered a trend.
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Acknowledgments
We thank ZonMw for a research grant. We are grateful to the participating families, students and mental healthcare institutions Lucertis Kinder-en Jeugdpsychiatrie, Bosman GGZ, Jeugdriagg, GGZ Noord-Holland Noord, UvA-Minds, Symphora-groep RCKJP and Riagg for their collaboration. We thank Rietta Oberink, from the UvA, for advice on Motivational Interviewing, Saskia Nyst for her help coordinating the project, and Lisa Doove, from KU Leuven, for advice on statistical analyses.
Conflict of interest
Bianca E. Boyer is co-developer and author of the manuals ‘Plan My Life’ and ‘Solution Focused Treatment’. She receives royalties for the sales of both interventions. Saskia van der Oord has been a paid consultant for Janssen Pharmaceuticals in the development of a serious game “Healseeker”, aimed at training cognitive functions. Also, she is co-developer and author of the manuals ‘Plan My Life’ and ‘Solution Focused Treatment’. However, she has no financial interest in the sales of the interventions. Other authors declare no conflict of interest.
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“Training adolescents with ADHD to plan and organize: Investigating short- and longterm effects of treatment”, http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2142, NTR2142.
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Boyer, B.E., Geurts, H.M., Prins, P.J.M. et al. Two novel CBTs for adolescents with ADHD: the value of planning skills. Eur Child Adolesc Psychiatry 24, 1075–1090 (2015). https://doi.org/10.1007/s00787-014-0661-5
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DOI: https://doi.org/10.1007/s00787-014-0661-5