2 - (SYM 55) Long-term Effectiveness of Parent-teen Psychotherapy for Adolescent ADHD: The Moderating Impact of Therapist Licensure Status

Abstract Body
Attention-Deficit/Hyperactivity Disorder (ADHD) related executive dysfunction & motivation deficits link to poor organizational, time management, and planning (OTMP) skills and academic problems. Multiple RCTs document the efficacy of psychosocial treatments for ADHD in adolescence via youth directed OTMP skills training along with contingency management. More recently, a hybrid implementation-effectiveness trial of Supporting Teens’ Autonomy Daily (STAND; Sibley et al., 2021) was completed in which practitioners in four community mental health agencies delivered STAND or usual care (UC). Several STAND papers show that the benefits of STAND over UC on several outcomes 9-months post treatment (e.g., reduction of inattention, academic and conduct problems, OTMP parental oversight and increased teen motivation) tend to only occur when the intervention is delivered by a licensed therapist vs. unlicensed (Graziano et al., 2023; Sibley et al., 2023). The current paper examines long-term (3-years after study baseline) effects of STAND vs. UC and whether licensed therapist status continues to be a significant moderator in such outcomes.  
Participants were 278 adolescents (ages 11-17; 70% male, 82% Hispanic) with ADHD who were randomly assigned to STAND (n=138) or UC (n=140) using a stratified randomization procedure within agency. Two-hundred twenty-six participants participated in the long-term follow-up assessment (LTFU) which took place 2.99 years after baseline. Outcome measures collected included ADHD severity (parent rated), parent-teen conflict (parent/adolescent rated), and OTMP skills (parent rated). As in the original trial, intent to treat growth curve analyses indicated no significant long-term group (STAND vs. UC) x time effects. However, per protocol analyses showed that the group x licensure effects were extended from the acute trial with STAND leading to superior long-term outcomes when therapists were licensed (22% of sample) vs. unlicensed for parent-rated hyperactivity/impulsivity: d=.39; adolescent-rated parent-teen conflict: d=.27), and parent-rated OTMP skills (d=.79). Although STAND did not have a long-term impact on all tested outcomes, this study suggests that a single-dose of engagement-focused cognitive/behavioral treatment delivered by a licensed practitioner in community mental health contexts has an immediate moderate effect on several important outcomes, including OTMP skills, which may continue to have downstream impacts on functioning as adolescents transition to adulthood.