Skip to main content

Advertisement

Log in

Integrating Tobacco Prevention Skills into an Evidence-Based Intervention for Adolescents with ADHD: Results from a Pilot Efficacy Randomized Controlled Trial

  • Published:
Journal of Abnormal Child Psychology Aims and scope Submit manuscript

Abstract

Adolescents with attention-deficit/hyperactivity disorder (ADHD) are at high risk for tobacco use, but tobacco use prevention strategies are not regularly incorporated into evidence-based ADHD interventions. We conducted a pilot randomized-controlled trial to determine the feasibility of integrating tobacco use prevention skills into a behavioral treatment for ADHD and to provide preliminary efficacy data comparing a combined (ADHD + tobacco) intervention (N = 40) to an ADHD only intervention (N = 23) on tobacco risk outcomes. Sixty-three adolescents (72% male; 13–17 years) with ADHD and their caregivers were randomly assigned to condition and families were masked to condition. Parent and adolescent ratings were collected at baseline, immediate post-intervention, and at 3- and 9-month follow-up assessments. The combined intervention was (1) implemented with high fidelity (94%), (2) well received by parents and adolescents as evidenced by high levels of treatment attendance (82%) and satisfaction with the intervention, and (3) associated with parent- and adolescent-reported reductions in tobacco use risk. Relative to the ADHD intervention, the combined intervention buffered against increases in tobacco risk, including reduced intentions to smoke and maladaptive social normative beliefs, and increased parental control, family cohesion, and family communication about substance use. Effect sizes at post-treatment were in the small to moderate range. Overall, this study provides preliminary support for a parent-adolescent behavioral treatment supplemented with family-based tobacco prevention strategies. This approach targets families already in treatment for ADHD, reducing barriers that occur when families attend multi-session prevention programs in addition to ADHD treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  • Barkley, R. A., Edwards, G., Laneri, M., Fletcher, K., & Metevia, L. (2001). The efficacy of problem-solving communication training alone, behavior management training alone, and their combination for parent–adolescent conflict in teenagers with ADHD and ODD. Journal of Consulting and Clinical Psychology, 69(6), 926–941.

    PubMed  Google Scholar 

  • Benjamini, Y., & Hochberg, Y. (1995). Controlling the false discovery rate: A practical and powerful approach to multiple testing. Journal of the Royal Statistical Society, Series B: Methodological, 57, 289–300.

    Google Scholar 

  • Coatsworth, J. D., Duncan, L. G., Greenberg, M. T., & Nix, R. L. (2010). Changing parent’s mindfulness, child management skills and relationship quality with their youth: Results from a randomized pilot intervention trial. Journal of Child and Family Studies, 19(2), 203–217.

    PubMed  Google Scholar 

  • Cohen, J. (1988). Statistical power analysis for the behavioral sciences. Hillsdale: Erlbaum.

    Google Scholar 

  • Dunne, E. M., Hearn, L. E., Rose, J. J., & Latimer, W. W. (2014). ADHD as a risk factor for early onset and heightened adult problem severity of illicit substance use: An accelerated gateway model. Addictive Behaviors, 39(12), 1755–1758.

    PubMed  PubMed Central  Google Scholar 

  • DuPaul, G.J. & Langberg, J.M. (2014). Educational impairments in children with ADHD: In R.a. Barkley (Ed.) Attention-Deficit/Hyperactivity Disorder: A Handbook for Diagnosis and Treatment, 4thEdition, New York, NY: Guilford publications.

  • Dvorsky, M. R., & Langberg, J. M. (2019). Cigarette and e-cigarette use and social perceptions over the transition to college: The role of ADHD symptoms. Psychology of Addictive Behaviors, 33(3), 318–330.

    PubMed  PubMed Central  Google Scholar 

  • Ennett, S. T., Bauman, K. E., Foshee, V. A., Pemberton, M., & Hicks, K. A. (2001). Parent-child communication about adolescent tobacco and alcohol use: What do parents say and does it affect youth behavior? Journal of Marriage and Family, 63(1), 48–62.

    Google Scholar 

  • Evans, S. W., Owens, J. S., Wymbs, B. T., & Ray, A. R. (2018). Evidence-based psychosocial treatments for children and adolescents with attention deficit/hyperactivity disorder. Journal of Clinical Child & Adolescent Psychology, 47(2), 157–198.

    Google Scholar 

  • Fabiano, G. A., Pelham, W. E., Coles, E. K., Gnagy, E. M., Chronis-Tuscano, A., & O'Connor, B. C. (2009). A meta-analysis of behavioral treatments for attention-deficit/hyperactivity disorder. Clinical Psychology Review, 29(2), 129–140.

    PubMed  Google Scholar 

  • Glass, K., & Flory, K. (2010). Why does ADHD confer risk for cigarette smoking? A review of psychosocial mechanisms. Clinical Child and Family Psychology Review, 13(3), 291–313.

    PubMed  Google Scholar 

  • Gibson, L. A., Creamer, M. R., Breland, A. B., Giachello, A. L., Kaufman, A., Kong, G., Pechacek, T. F., Pepper, J. K., Soule, E. K., & Halpern-Felsher, B. (2018). Measuring perceptions related to e-cigarettes: Important principles and next steps to enhance study validity. Addictive Behaviors, 79, 219–225.

    PubMed  Google Scholar 

  • Groenman, A., Oosterlaan, J., Rommelse, N., Franke, B., Greven, C. U., Hoekstra, P., et al. (2013). Stimulant treatment for attention-deficit hyperactivity disorder and risk of developing substance use disorder. The British Journal of Psychiatry: Mental Science, 203(2), 112–119.

    Google Scholar 

  • Humphreys, K. L., Eng, T., & Lee, S. S. (2013). Stimulant medication and substance use outcomes: A meta-analysis. JAMA Psychiatry, 70(7), 740–749.

    PubMed  PubMed Central  Google Scholar 

  • Johnston, L. D., O'Malley, P. M., Miech, R. A., Bachman, J. G., & Schulenberg, J. E. (2015). Monitoring the future national results on adolescent drug use: Overview of key findings, 2014. Ann Arbor: Institute for Social Research, the University of Michigan.

    Google Scholar 

  • Kerr, M., & Stattin, H. (2000). What parents know, how they know it, and several forms of adolescent adjustment: Further support for a reinterpretation of monitoring. Developmental Psychology, 36(3), 366–380.

    PubMed  Google Scholar 

  • Kline, R. B. (2004). Beyond significance testing. Washington, DC: American Psychological Association.

    Google Scholar 

  • Kumpfer, K. L., Whiteside, H. O., Greene, J. A., & Allen, K. C. (2010). Effectiveness outcomes of four age versions of the strengthening families program in statewide field sites. Group Dynamics: Theory, Research, and Practice, 14(3), 211–229.

    Google Scholar 

  • Lee, S. S., Humphreys, K. L., Flory, K., Liu, R., & Glass, K. (2011). Prospective association of childhood attention-deficit/hyperactivity disorder (ADHD) and substance use and abuse/dependence: A meta-analytic review. Clinical Psychology Review, 31(3), 328–341.

    PubMed  PubMed Central  Google Scholar 

  • Loren, R., Vaughn, A., Langberg, J., Cyran, J., Proano-Raps, T., et al. (2015). Effects of an 8-session behavioral parent training group for parents of children with ADHD on child impairment and parenting confidence. Journal of Attention Disorders, 19(2), 158–166.

    PubMed  Google Scholar 

  • Mahabee-Gittens, E. M., Huang, B., Chen, C., Dorn, L. D., Ammerman, R. T., & Gordon, J. S. (2011). The association of parental self-efficacy and parent-youth connectedness with youth smoking intentions. Journal of Prevention & Intervention in the Community, 39, 194–208.

    Google Scholar 

  • McLeod, B. D., Southam-Gerow, M. A., Tully, C. B., Rodríguez, A., & Smith, M. M. (2013). Making a case for treatment integrity as a psychosocial treatment quality indicator for youth mental health care. Clinical Psychology: Science and Practice, 20(1), 14–32.

    Google Scholar 

  • Mitchell, J., Howard, A., Belendiuk, K., Kennedy, T., Stehli, A., et al. (2018). Cigarette smoking progression among young adults diagnosed with ADHD in childhood: A 16-year longitudinal study of children with and without ADHD. Nicotine & Tobacco Research, 1, 1–10.

    Google Scholar 

  • Molina, B. S., Flory, K., Hinshaw, S. P., Greiner, A. R., Arnold, L. E., et al. (2007). Delinquent behavior and emerging substance use in the MTA at 36 months: Prevalence, course, and treatment effects. Journal of the American Acad of Child & Adolescent Psychiatry, 46(8), 1028–1040.

    Google Scholar 

  • Molina, B. S., Hinshaw, S. P., Arnold, L., Swanson, J., Pelham, W., et al. (2013). Adolescent substance use in the multimodal treatment study of attention-deficit/hyperactivity disorder (MTA) as a function of childhood ADHD, random assignment to childhood treatments, and subsequent medication. Journal of the American Acad of Child & Adolescent Psychiatry, 52(3), 250–263.

    Google Scholar 

  • Molina, B. S., & Pelham, W. E. (2003). Childhood predictors of adolescent substance use in a longitudinal study of children with ADHD. Journal of Abnormal Psychology, 112(3), 497.

  • Molina, B. S., & Pelham, W. E. (2014). Attention-deficit/hyperactivity disorder and risk of substance use disorder: Developmental considerations, potential pathways, and opportunities for research. Annual Review of Clinical Psychology, 10, 607–639.

    PubMed  PubMed Central  Google Scholar 

  • Morris, S. B. (2008). Estimating effect sizes from pretest-posttest-control group designs. Organizational Research Methods, 11(2), 364–386.

    Google Scholar 

  • NCI Working Group Report (2016). Tobacco control research priorities for the next decade: Working group recommendations for 2016-2025. Retrieved on September 26, 2019 from https://www.cancer.gov/news-events/cancer-currents-blog/2016/tobacco-control-plan

  • Olson, D. H. (1986). Circumplex model VII: Validation studies and FACES III. Family Process, 25(3), 337–351.

    PubMed  Google Scholar 

  • Olson, D. H., Portner, J., & Lavee, Y. (1985). Family adaptability and cohesion evaluation scales (FACES III). St.Paul: University of Minnesota, Family Social Science.

    Google Scholar 

  • Pepper, J., Reiter, P., McRee, A., Cameron, L., Gilkey, M., & Brewer, N. (2013). Adolescent males' awareness of and willingness to try electronic cigarettes. Adolescent Health, 52(2), 144–150.

    Google Scholar 

  • Pliszka, S. R. (2007). Pharmacologic treatment of attention-deficit/hyperactivity disorder: Efficacy, safety and mechanisms of action. Neuropsychology Review, 17(1), 61–72.

    PubMed  Google Scholar 

  • Power, T. J., Werba, B. E., Watkins, M. W., Angelucci, J. G., & Eiraldi, R. B. (2006). Patterns of parent-reported homework problems among ADHD-referred and non-referred children. School Psychology Quarterly, 21(1), 13–33.

  • Redmond, C., Spoth, R., Shin, C., Schainker, L., Greenberg, M., & Feinberg, M. (2009). Long-term protective factor outcomes of evidence-based interventions implemented by community teams through a community–university partnership. The Journal of Primary Prevention, 30(5), 513–530.

    PubMed  PubMed Central  Google Scholar 

  • Robin, A.L. & Foster, S.L. (1989). Negotiating parent-adolescent conflict: A behavioral-family systems approach. New York: Guilford.

  • Schoenfelder, E. N., & Kollins, S. H. (2014). Prevention of health risk behaviors in ADHD youth: Is ADHD treatment enough? The ADHD Report, 22(4), 1–8.

    Google Scholar 

  • Schoenfelder, E. N., Faraone, S. V., & Kollins, S. H. (2014). Stimulant treatment of ADHD and cigarette smoking: A meta-analysis. Pediatrics, 133(6), 1070–1080.

    PubMed  PubMed Central  Google Scholar 

  • Sibley, M. H., Pelham, W., Derefinko, K., Kuriyan, A., Sanchez, F., & Graziano, P. (2013). A pilot trial of supporting teens’ academic needs daily (STAND): A parent-adolescent collaborative intervention for ADHD. Journal of Psychopathology and Behavioral Assessment, 35(4), 436–449.

    Google Scholar 

  • Sibley, M. H., Altszuler, A. R., Ross, J. M., Sanchez, F., Pelham Jr., W. E., & Gnagy, E. M. (2014a). A parent-teen collaborative treatment model for academically impaired high school students with ADHD. Cognitive and Behavioral Practice, 21(1), 32–42.

    Google Scholar 

  • Sibley, M. H., Pelham, W., Molina, B. S., Coxe, S., Kipp, H., Gnagy, E. M., et al. (2014b). The role of early childhood ADHD and subsequent CD in the initiation and escalation of adolescent cigarette, alcohol, and marijuana use. Journal of Abnormal Psychology, 123(2), 362–374.

    PubMed  PubMed Central  Google Scholar 

  • Sibley, M. H., Graziano, P. A., Kuriyan, A. B., Coxe, S., Pelham, W. E., Rodriguez, L., Sanchez, F., Derefinko, K., Helseth, S., & Ward, A. (2016). Parent–teen behavior therapy+ motivational interviewing for adolescents with ADHD. Journal of Consulting and Clinical Psychology, 84(8), 699–712.

    PubMed  PubMed Central  Google Scholar 

  • Sonuga-Barke, E., Brandeis, D., Cortese, S., Daley, D., Ferrin, M., Holtmann, M., et al. (2013). Nonpharmacological interventions for ADHD: Systematic review and meta-analyses of randomized controlled trials of dietary and psychological treatments. American Journal of Psychiatry, 170(3), 275–289.

    PubMed  Google Scholar 

  • Spoth, R., Redmond, C., Mason, W. A., Schainker, L., & Borduin, L. (2015). Research on the strengthening families program for parents and youth 10-14: Long-term effects, mechanisms, translation to public health, PROSPER partnership scale up. In L. M. Scheier (Ed.), Handbook of drug prevention. DC. American Psychological Association: Washington.

    Google Scholar 

  • Spoth, R., Shin, C., Guyll, M., Redmond, C., & Azevedo, K. (2006). Universality of effects: An examination of the comparability of long-term family intervention effects on substance use across risk-related subgroups. Prevention Science, 7, 209–224.

    PubMed  Google Scholar 

  • U.S. Department of Health and Human Services. The Health Consequences of Smoking: 50 Years of Progress. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.

  • Visser, S. N., Danielson, M. L., Bitsko, R. H., Holbrook, J. R., Kogan, M. D., Ghandour, R. M., et al. (2014). Trends in the parent-report of health care provider-diagnosed and medicated Attention-Deficit/Hyperactivity Disorder: United States, 2003–2011. Journal of the American Academy of Child & Adolescent Psychiatry, 53(1), 34–46 e2.

    Google Scholar 

  • Weller, E. B., Weller, R., Fristad, M., Rooney, M. T., & Schecter, J. (2000). Children's interview for psychiatric syndromes (ChIPS). Journal of the American Academy of Child & Adolescent Psychiatry, 39(1), 76–84.

    Google Scholar 

  • Wechsler, D. (1999). Wechsler abbreviated scale of intelligence-II. San Antonio: Psych Corp.

    Google Scholar 

  • Wechsler, D. (2009). Wechsler individual achievement test-III. San Antonio: Psych Corp.

    Google Scholar 

  • Wilens, T., Vitulano, M., Upadhyaya, H., Adamson, J., Sawtelle, R., Utzinger, L., et al. (2008). Cigarette smoking associated with attention deficit hyperactivity disorder. The Journal of Pediatrics, 153(3), 414–419.

    PubMed  PubMed Central  Google Scholar 

  • Wilens, T. E., Martelon, M., Joshi, G., Bateman, C., Fried, R., Petty, C., & Biederman, J. (2011). Does ADHD predict substance-use disorders? A 10-year follow-up study of young adults with ADHD. Journal of the American Academy of Child & Adolescent Psychiatry, 50(6), 543–553.

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Rosalie Corona.

Ethics declarations

Conflicts of Interest

The authors declare that they have no conflict of interest.

Human Participants and/or Animals

Ethical clearance was obtained by Virginia Commonwealth University. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research ethics committee (BSSERC #2015000875) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Written informed consent was obtained from parents and informed assent from adolescents after their parent had granted permission for them to participate.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

ESM 1

(DOCX 27.2 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Corona, R., Dvorsky, M.R., Romo, S. et al. Integrating Tobacco Prevention Skills into an Evidence-Based Intervention for Adolescents with ADHD: Results from a Pilot Efficacy Randomized Controlled Trial. J Abnorm Child Psychol 48, 1439–1453 (2020). https://doi.org/10.1007/s10802-020-00689-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10802-020-00689-6

Keywords

Navigation