Objective This study evaluates a parent-teen skills-based therapy for ADHD blended with motivational interviewing (MI) to enhance family engagement. Supporting Teens’ Academic Needs Daily (STAND) is an adolescent-specific treatment for ADHD that targets empirically identified adolescent (i.e., organization, time management, and planning; OTP skills) and parent-based (i.e., monitoring and contingency management) mechanisms of long-term outcome through individual parent-teen sessions. Method The current randomized trial (N=128) evaluates efficacy at post-treatment and six-month follow-up. Participants were ethnically diverse teens (7.7% non-Hispanic White, 10.8% African-American, 78.5% Hispanic, 3.0% other) randomly assigned to STAND or Treatment As Usual (TAU). Results Primary findings were that: (1) STAND was delivered in an MI-adherent fashion and most families fully engaged in treatment (85% completed), (2) STAND produced a range of significant acute effects on ADHD symptoms, OTP skills, homework behavior, parent-teen contracting, implementation of home privileges, parenting stress, and daily homework recording, and (3) six months after treatment ceased, effects on ADHD symptom severity, OTP skills, and parenting stress maintained, while parent use of contracting and privilege implementation strategies, as well as teen daily homework recording and homework behavior gains, were not maintained. Conclusions Skills-based behavior therapy blended with MI is an acutely efficacious treatment for adolescents with ADHD although more work is needed to establish the nature of long-term effects. Public Health Significance A skills-based parent-teen behavior therapy blended with MI successfully engages families and leads to long-term improvement in parent-reported ADHD symptoms, organization skills, and parenting stress. Effects on school setting variables were less robust, requiring continued work to enhance these outcomes.

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Attention-deficit/hyperactivity disorder (ADHD) is associated with deficits in response inhibition, response execution, and emotion regulation. However, the nature of the associations among these deficits remains unclear. Thus, this study examines these associations using a multi-method design. One hundred sixty-six children (aged 5-13 years; 66.3% male; 75 with ADHD) completed two conditions (i.e., neutral and fear) of an emotional go/no-go task. Parasympathetic-based regulation was indexed via respiratory sinus arrhythmia (RSA), and sympathetic-based reactivity was indexed via cardiac pre-ejection period (PEP). Overall, children exhibited more difficulty with response execution (i.e., more omission errors, fewer correct go responses) and less difficulty with response inhibition (i.e., fewer commission errors, more correct no-go responses) during the fear condition than the neutral condition. Children with ADHD displayed more difficulty with response execution during the fear condition compared to typically developing youth. Additionally, children with ADHD displayed parasympathetic-based dysregulation (i.e., RSA increase from baseline) and reduced sympathetic-based reactivity (i.e., PEP lengthening) compared to typically developing youth across task conditions. In sum, children with ADHD demonstrate greater difficulty with response execution during emotionally salient contexts, as well as parasympathetic-based emotion dysregulation. Future work should examine these associations longitudinally with the aim of predicting impairment and treatment response in youth with ADHD.