Mediation and Moderation of Outcome in a Training Intervention for Adolescents With Attention-Deficit/Hyperactivity Disorder

Abstract

Objective: A training intervention that aims to improve the problem-solving and organization skills of adolescents with attention-deficit/hyperactivity disorder (ADHD) has been investigated. Aim of this study was to examine the mechanisms of change that occurred during the intervention in an empirical trial. Method: Forty-nine adolescents with ADHD aged 12–17 years took part in the intervention. The primary outcome of the intervention was the reduction of ADHD symptoms. To understand how the intervention facilitated the improvement of the outcome, we conducted mediation and moderation analyses. As potential mediators, improvement in academic enablers and meta- and neurocognitive functioning were investigated. Age, gender, and medication status were analyzed as potential moderators of the outcome. Results: An improvement in academic enablers partially mediated symptom reductions. There were no effects of moderation. Conclusions: Enhancing academic skills can reduce ADHD symptom severity. The training intervention examined in this study is a promising treatment for adolescents with ADHD.

Cross-Informant Disagreement on Behavioral Symptoms in Adolescent Attention-Deficit/Hyperactivity Disorder and Its Impact on Treatment Effects

“…The German intervention LeJA (Linderkamp, Hennig, & Schramm, 2011) aims to improve academic skills and to enable adolescents with ADHD to cope with actual developmental tasks such as preparing for employment. It is comprised of psychoeducation about ADHD and learning problems, problem-solving training, self-instruction training, and coaching (for a more detailed description, see Hennig, Schramm, Linderkamp, & Koglin, 2016). The intervention is carried out in 16–20 sessions in a one-on-one setting.…”

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

“…The current study examined the impacts of an EBP for adolescents with ADHD (STAND) and UC on well-established, ADHD-related cognitive, psychological, and behavioral processes. Known mechanisms by which psychosocial treatment improves ADHD symptoms are largely behavioral and include parenting behaviors (e.g., disciplinary practices, parent-child relationship quality; Haack et al, 2017;Hinshaw et al, 2000) and youth skills development (Breaux et al, 2019;Hennig et al, 2016;Sibley et al, 2022a). This study attempts to replicate these existing findings in a community context, while examining novel cognitive (i.e., executive functioning, rewards processing) and psychological (i.e., parent and youth motivational attitudes) processes that are central to prevailing models of ADHD (Sonuga-Barke, 2002).…”

Mediators of psychosocial treatment for adolescent ADHD.

“…However, there is almost no work examining youth skill development variables as mechanisms of child and adolescent ADHD treatments. No formal tests of these mediators appear to be published, though some research demonstrates that youth with ADHD who receive interventions with skills training components show meaningful skill improvements that predict improved outcomes (Breaux et al, 2019; Hennig et al, 2016; Pfiffner et al, 2013). For example, two studies demonstrate that improvement in organization skills predicted improvements in academics among students with ADHD receiving school-based intervention (Breaux et al, 2019; Pfiffner et al, 2013).…”