比较两种 ADHD 青少年团体干预措施的长期治疗结果的调节因素：谁从基于 DBT 的技能训练中获益更多？
Moderators of long-term treatment outcome when comparing two group interventions for adolescents with ADHD: who benefits more from DBT-based skills training?
机构信息
Department of Medical Sciences, Child and Adolescent Psychiatry Unit, Uppsala University, Uppsala, Sweden.
Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
出版信息
BMC Psychiatry. 2022 Dec 6;22(1):767. doi: 10.1186/s12888-022-04435-8.
BACKGROUND
Psychosocial interventions for adolescents with attention-deficit/hyperactivity disorder (ADHD), targeting emotional dysregulation and impulsive behaviors, have been requested, but the heterogeneity within this group makes it unlikely that there is one treatment that fits all. The aim of this study was to identify which adolescents with ADHD might have an effect from a structured skills training group (SSTG) based on dialectical behavioral therapy, by exploring pre-treatment characteristics as potential moderators of long-term treatment outcome.
METHODS
This study was based on follow-up data from a randomized controlled trial comparing the SSTG (n = 71) to a psychoeducational control intervention (n = 57) for adolescents with ADHD (15-18 years old). Clinical characteristics (sex, age, medication status, ADHD presentation, severity of ADHD symptom, psychiatric comorbidity, impairment of emotional dysregulation and functional impairment) were explored as potential moderators of pre-treatment to follow-up change in ADHD symptoms and functional impairment. Moderation analyses were performed using the PROCESS macro for SPSS.
RESULTS
Three moderators (severity of hyperactivity/impulsivity, conduct problems and impairment of emotional dysregulation) were identified in regard to the outcome self-rated change in ADHD symptoms. Participants with elevated pre-scores on these variables had a better effect of the SSTG than of the psychoeducational control intervention. No moderators were found in regard to the parental-rated outcomes.
CONCLUSIONS
The SSTG seems to be beneficial for adolescents with ADHD who perceive pronounced symptoms of hyperactivity/impulsivity, conduct problems and emotional dysregulation. Our findings need to be confirmed in future trials evaluating dialectical behavioral therapy-based skills training for adolescents with ADHD, where these moderators could be used as criteria for inclusion or stratification.
TRIAL REGISTRATION
https://doi.org/10.1186/ISRCTN17366720 , retrospectively registered.
背景
针对注意力缺陷多动障碍（ADHD）青少年的情绪调节和冲动行为的心理社会干预措施已被提出，但该人群的异质性使得不太可能有一种治疗方法适合所有人。本研究的目的是通过探索潜在的治疗前特征作为长期治疗结果的潜在调节因素，来确定哪些 ADHD 青少年可能会从基于辩证行为治疗的结构化技能训练组（SSTG）中受益。
方法
本研究基于一项随机对照试验的随访数据，该试验比较了 SSTG（n=71）与 ADHD 青少年（15-18 岁）的心理教育对照干预（n=57）。探讨了临床特征（性别、年龄、用药状况、ADHD 表现、ADHD 症状严重程度、精神共病、情绪调节障碍和功能障碍的严重程度）作为 ADHD 症状和功能障碍从治疗前到随访变化的潜在调节因素。使用 SPSS 的 PROCESS 宏进行调节分析。
结果
在 ADHD 症状自评变化的结果中，确定了三个调节因素（多动/冲动症状、品行问题和情绪调节障碍的严重程度）。这些变量的预评分较高的参与者，SSTG 的效果优于心理教育对照干预。在父母评定的结果中未发现调节因素。
结论
SSTG 似乎对感知到明显多动/冲动症状、品行问题和情绪调节障碍的 ADHD 青少年有益。我们的研究结果需要在未来的临床试验中进一步证实，这些临床试验将评估基于辩证行为治疗的技能训练对 ADHD 青少年的疗效，其中这些调节因素可以作为纳入或分层的标准。
试验注册
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