Symposia
ADHD - Child
Melissa R. Dvorsky, Ph.D.
Assistant Professor
Children’s National Health System
Washington, District of Columbia
Randi Streisand, PhD
Professor and Endowed Chair of Division of Psychology and Behavioral Health
Children's National/George Washington University School of Medicine & Health Sciences
Washington, District of Columbia
Amanda H. Steinberg, B.S.
Research Coordinator
Children's National Hospital
Washington, District of Columbia
Andrea M. Chronis-Tuscano, Ph.D
Professor
UMD
College Park, MD
Linda J. Pfiffner, Ph.D.
Professor
University of California San Francisco
San Francisco, California
Introduction: Despite evidence demonstrating the effectiveness of psychosocial interventions for adolescents with ADHD, 41-60% of adolescents have difficulty engaging in treatment (Langberg et al., 2016). Low motivation, inadequate between-session skills use, poor reward saliency, and low family involvement are key contributors to limited engagement (Bussing et al., 2003; Breaux et al., 2018). Current practices fail to adequately address these mechanisms, resulting in poor generalization and maintenance of skills. This study takes a theory-driven, empirical approach for optimizing treatment for ADHD by engaging modifiable targets (reward sensitivity, motivation, executive functioning, social support) to target skills acquisition and utilization using technology. We describe the development and testing of ATOM (Advanced Tools for Organization Management), a digital tool to augment treatment for ADHD.
Method: ATOM was developed facilitating a user-centered design with iterative stakeholder input collected via focus groups, qualitative interviews, and formative usage evaluation with adolescents (N=26; Mage=12.4 years 50% female), parents (N=16), teachers (N=8), and providers (N=8). Mixed method results including analyses of focus group themes (transcribed from video recordings and coded using rapid qualitative analysis) will be presented to share how they informed design and refinement. Results from extended usability testing and predictors of engagement during an open feasibility trial of ATOM (N=20) will be presented.
Results: Key themes identified from focus group and qualitative interviews emphasized adolescent, family, and provider preferences for features and design of ATOM, including immediate points, in-vivo prompts for skills, and interactive rewards. Iterative development entailed enhanced features and revised design to address stakeholders’ feedback. ATOM was continuously revised until it met key stakeholders’ needs, and ratings suggest high usability (System Usability Scale scores > 80). Adolescents’ motivation, executive functioning, and adults’ use of rewards significantly predicted adolescent skill use (Bs=.19-.31, ps< .05). Additional pre-post treatment outcomes will be presented from the open trial.
Conclusion: Results highlight the importance of reducing barriers and promoting facilitators of adolescents’ engagement in treatment. Our findings provide initial support for leveraging technology to increase engagement in evidence-based intervention for adolescents with ADHD.