(PS11-A12) Clinical Characteristics and Sociodemographic Factors Predicting Engagement Barriers for Adolescent ADHD Treatment

Background/

Objective: Engagement barriers may prevent adolescents with Attention Deficit Hyperactivity Disorder (ADHD) from actively participating in treatment (Brinkman et al., 2017; Sibley et al., 2022), but what patient characteristics predict frequency of barriers is largely unknown. Barriers can be either cognitive, logistical, or behavioral, and a previous study by our team found that cognitive barriers were associated with poor treatment engagement among adolescents with ADHD participating in behavior therapy (Sibley et al., 2022). Our purpose for this study was to ascertain and understand any relationships between engagement barriers in behavioral therapy and clinical characteristics/sociodemographic factors.

Method: Participants were 121 adolescents with ADHD (ages 11-16; 72.7% male, 77.7% Latinx, 7.4% African-American, 11.6% White, non-Latinx) and parents who received a course of Supporting Teens’ Autonomy Daily (STAND) as part of their participation in a previously reported randomized controlled trial (Sibley et al., 2016, 2020). Audio recordings of 822 therapy sessions were coded to quantify overall frequency of treatment barriers articulated by parents and adolescents in session, as well as several barriers subtypes. Minority status, gender, ADHD medication status, family adversity, Oppositional Defiant Disorder (ODD) comorbidity, and parental ADHD served as independent variables. Multiple regression models examined relationships between each independent variable and barriers frequency and subtypes.

Results: ODD comorbidity and parental ADHD each significantly predicted a primary outcome of an overall higher barrier frequency. In addition, ODD comorbidity and parental ADHD each significantly predicted higher cognitive barriers, teen barriers, engagement phase, and skills phase barriers frequencies. ODD also predicted significantly higher planning phase barriers frequencies, while minority status significantly predicted lower planning phase barriers frequencies.

Conclusions: These results demonstrate that populations of adolescents diagnosed with ADHD and comorbid ODD or who have parents that are also diagnosed with ADHD are at greatest risk for engagement barriers. This patient subgroup would greatly benefit from evidence-based engagement strategies (e.g., Motivational Interviewing). These tools will help therapists better serve adolescents with comorbid ADHD and ODD, and parents with ADHD.