The purpose of this study was to understand patient characteristics that predict engagement barriers during behavior therapy for ADHD.
Method:
Participants were 121 adolescents with ADHD and parents who received evidence-based behavior therapy for ADHD. Multiple regression examined relationships between six independent variables and frequency of barriers.
Results:
ODD comorbidity and parental ADHD predicted higher frequency of overall barriers. With respect to barriers subtypes, these variables also predicted higher frequencies of cognitive, teen, early-treatment and mid-treatment barriers. Late-treatment, ODD predicted higher frequency of barriers, while minority status predicted lower barriers.
Conclusions:
Adolescents diagnosed with ADHD and comorbid ODD, or who have parents that are also diagnosed with ADHD, are at greatest risk for engagement barriers during behavior therapy. During all phases of treatment, this patient subgroup would benefit from enhancements to standard behavior therapy that focus on therapeutic engagement—particularly targeting teen beliefs about treatment.
AdlerL. A.SpencerT.FaraoneS. V.KesslerR. C.HowesM. J.BiedermanJ.SecnikK. (2006). Validity of pilot Adult ADHD Self- Report Scale (ASRS) to Rate Adult ADHD symptoms. Annals of Clinical Psychiatry, 18(3), 145–148. https://doi.org/10.1080/10401230600801077
2.
AghaS. S.ZammitS.ThaparA.LangleyK. (2013). Are parental ADHD problems associated with a more severe clinical presentation and greater family adversity in children with ADHD?European Child & Adolescent Psychiatry, 22, 369–377. https://doi.org/10.1007/s00787-013-0378-x
3.
BirdH. R.GouldM. S.StaghezzaB. (1992). Aggregating data from multiple informants in child psychiatry epidemiological research. Journal of the American Academy of Child & Adolescent Psychiatry, 31(1), 78–85. https://doi.org/10.1097/00004583-199201000-00012
4.
BreauxR. P.BrownH. R.HarveyE. A. (2016). Mediators and moderators of the relation between parental ADHD symptomatology and the early development of child ADHD and ODD symptoms. Journal of Abnormal Child Psychology, 45(3), 443–456. https://doi.org/10.1007/s10802-016-0213-1
5.
BuckinghamS.BrandtN.BeckerK.GordonD.CammackN. (2016). Collaboration, empowerment, and advocacy: Consumer perspectives about treatment engagement. Journal of Child and Family Studies, 25(12), 3702–3715. https://doi.org/10.1007/s10826-016-0507-5
6.
BussingR.ZimaB.GaryF.GarvanC. (2003). Barriers to detection, help-seeking, and service use for children with ADHD symptoms. The Journal of Behavioral Health Services & Research, 30(2), 176–189. https://doi.org/10.1007/BF02289806
7.
ChackoA.WymbsB.RajwanE.WymbsF.FeirsenN. (2017). Characteristics of parents of children with ADHD who never attend, drop out, and complete behavioral parent training. Journal of Child and Family Studies, 26(3), 950–960. https://doi.org/10.1007/s10826-016-0618-z
8.
Chronis-TuscanoA.WangC. H.WoodsK. E.StricklandJ.SteinM. A. (2017). Parent ADHD and evidence-based treatment for their children: Review and directions for future research. Journal of Abnormal Child Psychology, 45(3), 501–517. https://doi.org/10.1007/s10802-016-0238-5
9.
CicchettiD.V. (1994). Guidelines, criteria, and rules of thumb for evaluating normed and standardized assessment instruments in psychology. Psychological Assessment, 6(4), 284–290. https://doi.org/10.1037/1040-3590.6.4.284
10.
CoxeS.SibleyM. H.BeckerS. P. (2021). Presenting problem profiles for adolescents with ADHD: Differences by sex, age, race, and family adversity. Child and Adolescent Mental Health, 26(3), 228–237.
11.
DanielsonM.L.BitskoR. H.GhandourR. M.HolbrookJ. R.KoganM.D.BlumbergS. J. (2018). Prevalence of parent-reported ADHD diagnosis and associated treatment among U.S. children and adolescents, 2016. Journal of Clinical Child and Adolescent Psychology, 47(2), 199–212. https://doi.org/10.1080/15374416.2017.1417860
12.
DankoC.GarbaczL.BuddK. (2016). Outcomes of parent–child interaction therapy in an urban community clinic: A comparison of treatment completers and dropouts. Children and Youth Services Review, 60, 42–51. https://doi.org/10.1016/j.childyouth.2015.11.007
13.
DawsonA. E.WymbsB. T.MarshallS. A.MautoneJ. A.PowerT. J. (2016). The role of parental ADHD in sustaining the effects of a family-school intervention for ADHD. Journal of Clinical Child & Adolescent Psychology, 45(3), 305–319. https://doi.org/10.1080/15374416.2014.963858
14.
DvorskyM.FriedmanL.SpiessM.PfiffnerL. (2021). Patterns of parental adherence and the association to child and parenting outcomes following a multicomponent school-home intervention for youth with ADHD. Behavior Therapy, 52(3), 745–760. https://doi.org/10.1016/j.beth.2020.09.007
15.
FabianoG. A.PelhamW. E.JrWaschbuschD. A.GnagyE. M.LaheyB. B.ChronisA. M.OnyangoA. N.KippH.Lopez-WilliamsA.Burrows-MacLeanL. (2006). A practical measure of impairment: Psychometric properties of the impairment rating scale in samples of children with attention deficit hyperactivity disorder and two school-based samples. Journal of Clinical Child and Adolescent Psychology, 35(3), 369–385. https://doi.org/10.1207/s15374424jccp3503_3
16.
FriedmanL.DvorskyM.McBurnettK.PfiffnerL. (2020). Do parents’ ADHD symptoms affect treatment for their children? The impact of parental ADHD on adherence to behavioral parent training for childhood ADHD. Journal of Abnormal Child Psychology, 48(11), 1425–1437. DOI: 10.1007/s10802-020-00672-1
17.
GlynnL. H.HallgrenK. A.HouckJ. M.MoyersT. B. (2012) CACTI: Free, open-source software for the sequential coding of behavioral interactions. PLoS One, 7(7), e39740. https://doi.org/10.1371/journal.pone.0039740
18.
Haine-SchlagelR.MartinezJ.RoeschS.BustosC.JanickiC. (2018). Randomized trial of the parent and caregiver active participation toolkit for child mental health treatment. Journal of Clinical Child and Adolescent Psychology, 47(1), S150–S160. https://doi.org/10.1080/15374416.2016.1183497
19.
Haine-SchlagelR.WalshN. (2015). A review of parent participation engagement in child and family mental health treatment. Clinical Child and Family Psychology Review, 18(2), 133–150. https://doi.org/10.1007/s10567-015-0182-x
20.
JensenP. S.HinshawS. P.KraemerH. C.LenoraN.NewcornJ. H.AbikoffH. B.MarchJ. S.ArnoldL. E.CantwellD. P.ConnersC. K.ElliottG. R.GreenhillL. L.HechtmanL.HozaB.PelhamW. E.SevereJ. B.SwansonJ. M.WellsK. C.WigalT.VitielloB. (2001). ADHD comorbidity findings from the MTA study: Comparing comorbid subgroups. Journal of the American Academy of Child & Adolescent Psychiatry, 40(2), 147–158. https://doi.org/10.1097/00004583-200102000-00009.
21.
JohnsonE.MellorD.BrannP. (2008). Differences in dropout between diagnoses in child and adolescent mental health services. Clinical Child Psychology and Psychiatry, 13(4), 515–530. https://doi.org/10.1177/1359104508096767
22.
JohnstonC.MashE. J.MillerN.NinowskiJ. E. (2012). Parenting in adults with attention-deficit/hyperactivity disorder (ADHD). Clinical Psychology Review, 32(4), 215–228. https://doi.org/10.1016/j.cpr.2012.01.007
23.
KazdinA.HollandL.CrowleyM. (1997). Family experience of barriers to treatment and premature termination from child therapy. Journal of Consulting and Clinical Psychology, 65(3), 453–463. https://doi.org/10.1037/0022-006X.65.3.453
24.
KazdinA.WassellG. (1999). Barriers to treatment participation and therapeutic change among children referred for conduct disorder. Journal of Clinical Child Psychology, 28(2), 160–172. https://doi.org/10.1207/s15374424jccp2802_4
25.
LangbergJ. M.BeckerS. P.EpsteinJ. N.VaughnA. J.Girio-HerreraE. (2012). Predictors of response and mechanisms of change in an organizational skills intervention for students with ADHD. Journal of child and family studies, 22(7), 1000–1012. https://doi.org/10.1007/s10826-012-9662-5
26.
MillerL.Southam-GerowM.AllinR. (2008). Who stays in treatment? Child and family predictors of youth client retention in a public mental health agency. Child & Youth Care Forum, 37(4), 153–170. https://doi.org/10.1007/s10566-008-9058-2
27.
MillerW. R.RollnickS. (2013). Motivational interviewing. Help the person initiate the change (Vol. 2). Guilford press.
28.
OwensP. L.HoagwoodK.HorwitzS. M.LeafP. J.PoduskaJ. M.KellamS. G.IalongoN. S. (2002). Barriers to children’s mental health services. Journal of American Academy of Child and Adolescent Psychiatry, 41(6), 731–738. https://doi.org/10.1097/00004583-200206000-00013
29.
PellerinK.CostaN.WeemsC.DaltonR. (2010). An examination of treatment completers and non-completers at a child and adolescent community mental health clinic. Community Mental Health Journal, 46(3), 273–281. https://doi.org/10.1007/s10597-009-9285-5
30.
QianShuai, L.CaoQ.ChanR. C. K.WangY. (2010). Do executive function deficits differentiate between children with Attention Deficit Hyperactivity Disorder (ADHD) and ADHD comorbid with oppositional defiant disorder? A cross-cultural study using performance-based tests and the behavior rating inventory of executive function. Clinical Neuropsychologist, 24(5), 793–810. https://doi.org/10.1080/13854041003749342
31.
RealeL.BartoliB.CartabiaM.ZanettiM.CostantinoM.CaneviniM.TermineC.BonatiM. (2017). Comorbidity prevalence and treatment outcome in children and adolescents with ADHD. European Child & Adolescent Psychiatry, 26(12), 1443–1457. https://doi.org/10.1007/s00787-017-1005-z
32.
ReardonT.HarveyK.BaranowskaM.O’BrienD.SmithL.CreswellC. (2017). What do parents perceive are the barriers and facilitators to accessing psychological treatment for mental health problems in children and adolescents? A systematic review of qualitative and quantitative studies. European Child & Adolescent Psychiatry, 26(6), 623–647. https://doi.org/10.1007/s00787-016-0930-6
33.
Rios-DavisA.SibleyM. H.DelgadoA.Zulauf-McCurdyC. A. (2022). Identifying common, shared, and unique elements of evidence-based treatments for adolescent ADHD. Journal of Child and Family Studies. Advance online publication. https://doi.org/10.1007/s10826-022-02475-y
34.
RutterCox, A.TuplingC.BergerM.YuleW. (1975). Attainment and adjustment in two geographical areas: I–The prevalence of psychiatric disorder. British Journal of Psychiatry, 126(6), 493–509. https://doi.org/10.1192/bjp.126.6.493
35.
SalloumA.JohncoC.LewinA.McBrideN.StorchE. (2016). Barriers to access and participation in community mental health treatment for anxious children. Journal of Affective Disorders, 196, 54–61. https://doi.org/10.1016/j.jad.2016.02.026
36.
SchneiderB.GerdesA.HaackL.LawtonK. (2013). Predicting treatment dropout in parent training interventions for families of school-aged children with ADHD. Child & Family Behavior Therapy, 35(2), 144–169. https://doi.org/10.1080/07317107.2013.789365
37.
ShafferD.FisherP.LucasC. P.DulcanM. K.Schwab-StoneM. E. (2000). NIMH diagnostic interview schedule for children version IV (NIMH DISC-IV): Description, differences from previous versions, and reliability of some common diagnoses. Journal of the American Academy of Child & Adolescent Psychiatry, 39(1), 28–38. https://doi.org/10.1097/00004583-200001000-00014
38.
SibleyM. H. (2016). Parent-teen therapy for executive function deficits and ADHD: Building skills and motivation. Guilford.
39.
SibleyM. H.CoxeS. J.SteinM. A.MeinzerM. C.ValenteM. J. (2022). Predictors of treatment engagement and outcome among adolescents with attention-deficit/hyperactivity disorder: An integrative data analysis. Journal of the American Academy of Child & Adolescent Psychiatry, 61(1), 66–79.
40.
SibleyM. H.GrazianoP. A.KuriyanA. B.CoxeS.PelhamW. E.RodriguezL.SanchezF.DerefinkoK.HelsethS.WardA. (2016). Parent-teen behavior therapy motivational interviewing for adolescents with ADHD. Journal of Consulting and Clinical Psychology, 84(8), 699–712. https://doi.org/10.1037/ccp0000106
41.
SibleyM. H.KuriyanA. B. (2016). DSM-5 changes enhance parent identification of symptoms in adolescents with ADHD. Psychiatry Research, 242, 180–185. https://doi.org/10.1016/j.psychres.2016.05.036
42.
SibleyM. H.LinkK.Torres AntunezG.GreenwoodL. (2022). Engagement barriers to behavior therapy for adolescent ADHD. Journal of Clinical Child and Adolescent Psychology. Advance online publication. https://doi.org/10.1080/15374416.2022.2025597
43.
SibleyM. H.RodriguezL.CoxeS.PageT.EspinalK. (2020). Parent–teen group versus dyadic treatment for adolescent ADHD: What works for whom?. Journal of Clinical Child & Adolescent Psychology, 49(4), 476–492.
44.
StevensJ.KelleherK.Ward-EstesJ.HayesJ. (2006). Perceived barriers to treatment and psychotherapy attendance in child community mental health centers. Community Mental Health Journal, 42(5), 449–458. https://doi.org/10.1007/s10597-006-9048-5
45.
TorrenteF.LópezP.Alvarez PradoD.KichicR.Cetkovich-BakmasM.LischinskyA.ManesF. (2014). Dysfunctional cognitions and their emotional, behavioral, and functional correlates in adults with attention deficit hyperactivity disorder (ADHD). Journal of Attention Disorders, 18(5), 412–424. https://doi.org/10.1177/1087054712443153
WangC. H.Mazursky-HorowitzH.Chronis-TuscanoA. (2014). Delivering evidence-based treatments for child attention-deficit/hyperactivity disorder (ADHD) in the context of parental ADHD. Current Psychiatry Reports, 16(10), 474. https://doi.org/10.1007/s11920-014-0474-8
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
