青少年注意力缺陷多动障碍行为治疗的参与障碍。
Engagement Barriers to Behavior Therapy for Adolescent ADHD.
机构信息
University of Washington School of Medicine, Seattle Children's Research Institute.
University of Washington Department of Psychology, Seattle Children's Research Institute.
出版信息
J Clin Child Adolesc Psychol. 2023 Nov-Dec;52(6):834-849. doi: 10.1080/15374416.2022.2025597. Epub 2022 Jan 27.
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.
目的
识别青少年 ADHD 行为治疗的障碍（支持青少年日常自主；STAND），并了解障碍与治疗参与之间的关系。
方法
采用混合方法设计，对 121 名患有 ADHD 的青少年（年龄 11-16 岁；72.7%为男性，77.7%为拉丁裔，7.4%为非裔美国人，11.6%为白人，非拉丁裔）及其父母参加的 822 次音频记录治疗会议进行定性编码。扎根理论方法确定了父母和青少年在会议中表达的障碍。障碍按亚型（认知/态度、行为、后勤）和主体（父母、青少年、对偶）进行分类。按治疗阶段（参与、技能、计划）计算障碍的频率和种类。广义线性模型和广义估计方程检验了各障碍在参与阶段（出勤率和作业完成情况）的频率之间的阶段差异，以及障碍频率、亚型、主体和阶段之间的关系。
结果
编码揭示了 25 个参与障碍（10 个认知/态度，11 个行为，4 个后勤）。常见的障碍包括：青少年需求低（72.5%）、父母未能监测技能应用（69.4%）、青少年健忘（60.3%）和青少年认为无需改变（56.2%）。障碍最常见的是认知/态度、青少年相关，并且发生在 STAND 的计划阶段。较差的参与与认知/态度、参与阶段和对偶障碍有关。更频繁的行为、后勤、父母和技能/计划阶段障碍与更高的治疗参与度相关。
结论
对障碍的基线评估可能会促进青少年 ADHD 治疗的个体化参与策略。在治疗开始时应使用基于证据的参与策略（例如，动机访谈）针对认知/态度障碍进行干预。应在计划和审查技能应用时解决行为和后勤障碍。
Zotero 插件