Community Implementation of MI-Enhanced Behavior Therapy for Adolescent ADHD: Linking Fidelity to Effectiveness

Community-Delivered Evidence-Based Practice and Usual Care for Adolescent Attention-Deficit/Hyperactivity Disorder: Examining Mechanistic Outcomes

“…It may also be the case that licensed therapists are more professionally engaged, relative to unlicensed therapists, which may impact the quality of implementation. A recent STAND paper showed how lower content fidelity related to poorer treatment outcomes within the academic impairment domain (Sibley et al, 2021a), yet such content fidelity and MI quality did not differ among licensed and unlicensed therapists. More work is clearly needed in measuring quality of treatment implementation and unpacking why unlicensed individuals have less success implementing STAND.…”

“…Detailed information about therapist recruitment can be found in Sibley et al (2021a). All therapists were randomly assigned to STAND or UC at baseline.…”

“…UC therapists were offered STAND training at study conclusion. Fidelity and differentiation data are presented elsewhere (Sibley et al, 2021a).…”

“…Usual care (UC) psychosocial treatment for adolescents with ADHD typically involves a mix of non-evidence-based and evidence-based practices (EBPs), delivered at low intensities by master's-level therapists. While community providers find evidence-based treatments for ADHD to be highly acceptable and engaging to deliver, they often struggle to maintain strong fidelity across the course of treatment and incorporate low-value practices (Sibley et al, 2021a(Sibley et al, , 2021b. Thus, EBP dilution may undermine effectiveness.…”

“…For example, in earlier work from the present randomized community-based trial (N = 278), a community-delivered EBP for ADHD (Supporting Teens' Autonomy Daily [STAND]) was compared to UC. Treatment was delivered with suboptimal fidelity, EBP effect sizes were smaller than lab-based trials (Sibley et al, 2021a), and effects failed to separate from UC in both primary (ADHD symptoms and impairments; Sibley et al, 2021c) and secondary analyses (impact on comorbidities and nontargeted ADHDrelated outcomes like social skills and sluggish cognitive tempo; Sibley et al, 2023). However, in both primary and secondary analyses STAND demonstrated superiority to UC when therapists were licensed (ADHD symptoms, OTP skills, conduct problems; Sibley et al, 2021cSibley et al, , 2023.…”