Refinement and Testing of Interventions to Enhance and Sustain ADHD Treatment Effects Across Settings and Developmental Transitions

Presenter:

Mary Rooney, Ph.D.
Division of Services and Intervention Research

Goal:

The goal of this FOA is to support research that evaluates the effectiveness of augmented or modified interventions designed to promote enhanced and sustained improvement in attention-deficit/hyperactivity disorder (ADHD) symptoms and functional impairments across settings and transitions throughout childhood, adolescence, and young adulthood.

Rationale:

ADHD is an impairing and costly chronic condition that profoundly affects all domains of functioning (e.g., academic, social, occupational) and health-related quality of life. The clinical trajectory of ADHD is often devastating, with outcomes of academic and occupational underachievement, substance abuse and dependence, self-injurious behavior, accident-related injury, obesity and other physical health problems, strained marital and parent-child relationships, and financial problems. Comorbid conditions frequently accompany ADHD and amplify negative long-term outcomes. Approximately 6.4 million children and adolescents (9.4%) in the US have received an ADHD diagnosis.

While research supports the short-term efficacy of evidence-based treatments (EBTs) for ADHD, the majority are focused exclusively on elementary school-aged children and are associated with intervention effects that dissipate over time. The sustained use of interventions and the maintenance of treatment gains is hampered, in part, by a lack of interventions optimized for delivery across settings (e.g., home, academic, childcare, extracurricular, occupational) and key developmental transitions (e.g., elementary school to middle school, middle school to high school, high school to post-secondary education or employment). Modifiable factors associated with the sustained impact of ADHD interventions and the long-term trajectory of ADHD symptoms and impairments have been identified in the literature, yet few evidence-supported strategies exist for tailoring interventions across development based on these targets. Refinements and augmentations to existing EBTs are needed to promote service-ready interventions capable of sustaining treatment effects across settings and developmental transitions.

Theory-driven, developmentally-informed projects might develop and test service-ready strategies that: (1) remediate residual problems related to functional impairment, or problems otherwise associated with a negative developmental course; (2) overcome generalization challenges across settings, developmental transitions, and intervention agents (e.g., teachers, parents, etc.); (3) address sustained adherence to psychosocial and pharmacological interventions; (4) incorporate empirically informed approaches that anticipate or intervene early with predictable downstream comorbidities and health-related consequences (e.g., anxiety disorders, depressive disorders, eating disorders, personality disorders, substance misuse and abuse, obesity).