Abstract
The Summer Treatment Program (STP) is one of the most widely studied psychosocial treatments for children with ADHD and has been adapted for adolescent populations (STP-A). However, there is a discrepancy between small effect sizes of improvement in outcomes and high perceived improvement by parents and adolescents, suggesting that we are not capturing some treatment-related improvements with quantitative pre-post assessments. This study examines parent and young adult perceptions of the impact of participating in the STP-A. Using qualitative interviewing, 22 in-depth interviews were conducted with young adults with ADHD (ages 18–21) and their parents. Informants offered their perspectives of what outcomes they perceived as changing as a result of participating in the STP-A and (2) how (i.e., by what mechanisms) the STP-A produced changes in these outcomes. Self-concept, motivation, executive functioning, parenting practices, and connectedness (e.g., positive interactions with peers and mentors who could provide social support, and encouragement) were reported as key mechanisms to improving functional outcomes with respect to academic, social, and family functioning. Findings highlight that parents and young adults reported improvements in many outcomes and mechanisms that have not been thoroughly measured in past clinical trials of the STP-A or the children’s STP. Implications for improving assessment of intervention effects and intervention development are discussed.
Highlights
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Examined perspectives of the impact of a summer program for adolescents with ADHD.
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Informants reported benefits that have not been measured in past clinical trials.
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Novel improvements included self-concept, connectedness, and parental optimism.
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References
Abba, N., Chadwick, P., & Stevenson, C. (2008). Responding mindfully to distressing psychosis: a grounded theory analysis. Psychotherapy Research, 18(1), 77–87.
Altszuler, A. R., Page, T. F., Gnagy, E. M., Coxe, S., Arrieta, A., Molina, B. S., & Pelham, W. E. (2016). Financial dependence of young adults with childhood ADHD. Journal of Abnormal Child Psychology, 44(6), 1217–1229.
American Psychiatric Association, DSM-5 Task Force. (2013). Diagnostic and statistical manual of mental disorders: DSM-5™ (5th ed.). Arlington, VA, US: American Psychiatric Publishing, Inc.
Arango, A., Cole-Lewis, Y., Lindsay, R., Yeguez, C. E., Clark, M., & King, C. (2019). The protective role of connectedness on depression and suicidal ideation among bully victimized youth. Journal of Clinical Child & Adolescent Psychology, 48(5), 728–739.
Arnold, L. E., Hodgkins, P., Kahle, J., Madhoo, M., & Kewley, G. (2020). Long-term outcomes of ADHD: academic achievement and performance. Journal of Attention Disorders, 24(1), 73–85.
Barkley, R. A., Murphy, K. R., & Fischer, M. (2008). ADHD in adults: What the science says. New York, NY: Guilford.
Becker, S. P., Langberg, J. M., Evans, S. W., Girio-Herrera, E., & Vaughn, A. J. (2015). Differentiating anxiety and depression in relation to the social functioning of young adolescents with ADHD. Journal of Clinical Child & Adolescent Psychology, 44(6), 1015–1029.
Bendelin, N., Hesser, H., Dahl, J., Carlbring, P., Nelson, K. Z., & Andersson, G. (2011). Experiences of guided Internet-based cognitive-behavioural treatment for depression: a qualitative study. BMC Psychiatry, 11(1), 107.
Blanton, H., & Jaccard, J. (2006). Arbitrary metrics in psychology. American Psychologist, 61(1), 27–41.
Botvin, G. J., & Griffin, K. W. (2004). Life skills training: empirical findings and future directions. The Journal of Primary Prevention, 25, 211–232.
Breaux, R. P., Langberg, J. M., Molitor, S. J., Dvorsky, M. R., Bourchtein, E., Smith, Z. R., & Green, C. D. (2019). Predictors and trajectories of response to the Homework, Organization, and Planning Skills (HOPS) intervention for adolescents with ADHD. Behavior Therapy, 50(1), 140–154.
Burlingame, G. M., McClendon, D. T., & Yang, C. (2018). Cohesion in group therapy: a meta-analysis. Psychotherapy, 55(4), 384–398.
Butler, J., Gregg, L., Calam, R., & Wittkowski, A. (2020). Parents’ perceptions and experiences of parenting programmes: a systematic review and metasynthesis of the qualitative literature. Clinical Child and Family Psychology Review, 23, 176–204.
Centers for Disease Control and Prevention. (2013). Mental health surveillance among children—United States, 2005–2011. MMWR, 62, 1–35.
Chan, E., Fogler, J. M., & Hammerness, P. G. (2016). Treatment of attention-deficit/hyperactivity disorder in adolescents: a systematic review. JAMA, 315, 1997–2008.
Charmaz, K. (2014). Constructing grounded theory. Thousand Oaks, CA: Sage.
Creswell, J. W. (1998). Qualitative inquiry and research design: choosing among five traditions. Thousand Oaks, CA: Sage.
Cunningham, C. E. (2006). COPE: Large-group, community-based, family- centered parent training. In R. A. Barkley (Ed.), Attention-deficit hyper- activity disorder: a handbook for diagnosis and treatment (pp. 480–498). New York, NY: Guilford Press.
Dahl, R. E., Allen, N. B., Wilbrecht, L., & Suleiman, A. B. (2018). Importance of investing in adolescence from a developmental science perspective. Nature, 554, 441–450.
Daniels, B., Volpe, R. J., Briesch, A. M., & Fabiano, G. A. (2014). Development of a problem-focused behavioral screener linked to evidence-based intervention. School Psychology Quarterly, 29(4), 438–451.
Dryburgh, N. S., Khullar, T. H., Sandre, A., Persram, R. J., Bukowski, W. M., & Dirks, M. A. (2020). Evidence base update for measures of social skills and social competence in clinical samples of youth. Journal of Clinical Child & Adolescent Psychology, 49(5), 573–594.
Edwards, G., Barkley, R. A., Laneri, M., Fletcher, K., & Metevia, L. (2001). Parent–adolescent conflict in teenagers with ADHD and ODD. Journal of Abnormal Child Psychology, 29(6), 557–572.
Evans, S. W., Owens, J. S., & Bunford, N. (2014). Evidence-based psychosocial treatments for children and adolescents with attention-deficit/hyperactivity disorder. Journal of Clinical Child & Adolescent Psychology, 43(4), 527–551.
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.
Fabiano, G. A., Pelham, W., Waschbusch, D., Gnagy, E., Lahey, B. B., & Chronis, A., et al. (2006). A practical measure of impairment: psychometric properties of the impairment rating scale in samples of children with attention deficit hyperactivity disorder and two school-based samples. Journal of Clinical Child and Adolescent Psychology, 35, 369–385.
Fabiano, G. A., Schatz, N. K., & Pelham, W. E. (2014). Summer treatment programs for youth with ADHD. Child and Adolescent Psychiatric Clinics, 23(4), 757–773.
Fabiano, G. A., Schatz, N. K., Aloe, A. M., Chacko, A., & Chronis-Tuscano, A. (2015). A systematic review of meta-analyses of psychosocial treatment for attention-deficit/hyperactivity disorder. Clinical Child and Family Psychology Review, 18(1), 77–97.
Garcia, A. M., Medina, D., & Sibley, M. H. (2019). Conflict between Parents and Adolescents with ADHD: Situational Triggers and the Role of Comorbidity. Journal of Child and Family Studies, 28(12), 3338–334.
Glaser, B. G., (1978). Theoretical sensitivity. Mill Valley, CA: Sociology Press.
Harpin, V., Mazzone, L., Raynaud, J. P., Kahle, J., & Hodgkins, P. (2016). Long-term outcomes of ADHD: a systematic review of self-esteem and social function. Journal of Attention Disorders, 20(4), 295–305.
Hill, R. M., Hunt, Q., Oosterhoff, B., Yeguez, C. E., & Pettit, J. W. (2019). Perceived burdensomeness among adolescents: a mixed-methods analysis of the contexts in which perceptions of burdensomeness occur. Journal of Social and Clinical Psychology, 38(7), 585–604.
Johnston, C., & Freeman, W. (2002). Parents’ beliefs about ADHD: implications for assessment and treatment. The ADHD Report, 10(1), 6–9.
Karver, M. S., De Nadai, A. S., Monahan, M., & Shirk, S. R. (2018). Meta-analysis of the prospective relation between alliance and outcome in child and adolescent psychotherapy. Psychotherapy, 55(4), 341–355.
Kashdan, T. B., Pelham, W. E., Lang, A. R., Hoza, B., Jacob, R. G., Jennings, J. R., & Gnagy, E. M. (2002). Hope and optimism as human strengths in parents of children with externalizing disorders: stress is in the eye of the beholder. Journal of Social and Clinical Psychology, 21(4), 441–468.
Kazdin, A. E. (2006). Arbitrary metrics: implications for identifying evidence-based treatments. American Psychologist, 61(1), 42–49.
Kuriyan, A. B., Pelham, W. E., Molina, B. S., Waschbusch, D. A., Gnagy, E. M., Sibley, M. H., & Kent, K. M. (2013). Young adult educational and vocational outcomes of children diagnosed with ADHD. Journal of Abnormal Child Psychology, 41(1), 27–41.
Langberg, J. M., Becker, S. P., Epstein, J. N., Vaughn, A. J., & Girio-Herrera, E. (2013). Predictors of response and mechanisms of change in an organizational skills intervention for students with ADHD. Journal of child and family studies, 22(7), 1000–1012.
Lerner, M. D., Mikami, A. Y., & McLeod, B. D. (2011). The alliance in a friendship coaching intervention for parents of children with ADHD. Behavior Therapy, 42(3), 449–461.
Molina, B. S., Marshal, M. P., Pelham, Jr, W. E., & Wirth, R. J. (2005). Coping skills and parent support mediate the association between childhood attention-deficit/hyperactivity disorder and adolescent cigarette use. Journal of Pediatric Psychology, 30(4), 345–357.
Molina, B. S., Hinshaw, S. P., Swanson, J. M., Arnold, L. E., Vitiello, B., Jensen, P. S., & Elliott, G. R. (2009). The MTA at 8 years: prospective follow-up of children treated for combined-type ADHD in a multisite study. Journal of the American Academy of Child & Adolescent Psychiatry, 48(5), 484–500.
Molina, B. S., Pelham, Jr, W. E., Cheong, J., Marshal, M. P., Gnagy, E. M., & Curran, P. J. (2012). Childhood attention-deficit/hyperactivity disorder (ADHD) and growth in adolescent alcohol use: The roles of functional impairments, ADHD symptom persistence, and parental knowledge. Journal of Abnormal Psychology, 121(4), 922.
Morsink, S., Sonuga-Barke, E., Mies, G., Glorie, N., Lemiere, J., & Van der Oord, S., et al. (2017). What motivates individuals with ADHD? A qualitative analysis from the adolescent’s point of view. European Child & Adolescent Psychiatry, 26(8), 923–932.
MTA Cooperative Group. (1999). Multimodal Treatment Study of Children with ADHD. A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. Archives of General Psychiatry, 56(12), 1073–1086.
Ogle, R. R., Frazier, S. L., Nichols-Lopez, K., & Cappella, E. (2016). Non-academic self-concept among urban youth: associations with academic success. School Mental Health, 8(2), 278–291.
Pelham, W. E., Foster, E. M., & Robb, J. A. (2007). The economic impact of attention-deficit/hyperactivity disorder in children and adolescents. Journal of Pediatric Psychology, 32(6), 711–727.
Pelham, W., Gnagy, E., Greenslade, K., & Milich, R. (1992). Teacher ratings of DSM-III-R symptoms for the disruptive behavior disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 31, 210–218.
Pelham, W. E., Gnagy, E. M., Greiner, A. R., Hoza, B., Hinshaw, S. P., Swanson, J. M., & McBurnett, K. (2000). Behavioral versus behavioral and pharmacological treatment in ADHD children attending a summer treatment program. Journal of Abnormal Child Psychology, 28(6), 507–525.
Pelham, W. E., Gnagy, E. M., Greiner, A. R., Waschbusch, D. A., Fabiano, G. A. & Burrows-Maclean, L. (2010). Summer treatment programs for attention-deficit/hyperactivity disorder. In: Evidence-based psychotherapies for children and adolescents, (2nd ed., pp. 277–292). Guilford Press.
Shaffer, D., Fisher, P., Lucas, C. P., Dulcan, M., & Schwab-Stone, M. (2000). NIMH diagnostic interview schedule for children version IV (NIMH DISC-IV): Description, differences from previous versions, and reliability of some common diagnoses. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 28–38.
Schraw, G., Wadkins, T., & Olafson, L. (2007). Doing the things we do: a grounded theory of academic procrastination. Journal of Educational Psychology, 99(1), 12–25.
Searle, A., Calnan, M., Lewis, G., Campbell, J., Taylor, A., & Turner, K. (2011). Patients’ views of physical activity as treatment for depression: a qualitative study. British Journal of General Practice, 61(585), e149–e156.
Sibley, M. H., Pelham, W. E., Evans, S. W., Gnagy, E. M., Ross, J. M., & Greiner, A. R. (2011). An evaluation of a summer treatment program for adolescents with ADHD. Cognitive and Behavioral Practice, 18(4), 530–544.
Sibley, M. H., Smith, B. H., Evans, S. W., Pelham, W. E., & Gnagy, E. M. (2012a). Treatment response to an intensive summer treatment program for adolescents with ADHD. Journal of Attention Disorders, 16(6), 443–448.
Sibley, M. H., Pelham, Jr, W. E., Molina, B. S., Gnagy, E. M., Waxmonsky, J. G., Waschbusch, D. A., & Kuriyan, A. B. (2012b). When diagnosing ADHD in young adults emphasize informant reports, DSM items, and impairment. Journal of Consulting and Clinical Psychology, 80(6), 1052–1061.
Sibley, M. H., Ross, J. M., Gnagy, E. M., Dixon, L. J., Conn, B., & Pelham, W. E. (2013). An intensive summer treatment program for ADHD reduces parent–adolescent conflict. Journal of Psychopathology and Behavioral Assessment, 35(1), 10–19.
Sibley, M. H., Pelham, Jr, W. E., Molina, B. S., Coxe, S., Kipp, H., Gnagy, E. M., & Lahey, B. B. (2014a). 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.
Sibley, M. H., Kuriyan, A. B., Evans, S. W., Waxmonsky, J. G., & Smith, B. H. (2014b). Pharmacological and psychosocial treatments for adolescents with ADHD: an updated systematic review of the literature. Clinical Psychology Review, 34(3), 218–232.
Sibley, M. H., Altszuler, A. R., Ross, J. M., Sanchez, F., Pelham, Jr, W. E., & Gnagy, E. M. (2014c). A parent-teen collaborative treatment model for academically impaired high school students with ADHD. Cognitive and Behavioral Practice, 21(1), 32–42.
Sibley, M. H., Altszuler, A. R., Morrow, A. S., & Merrill, B. M. (2014d). Mapping the academic problem behaviors of adolescents with ADHD. School Psychology Quarterly, 29(4), 422–437.
Sibley, M. H., & Kuriyan, A. B. (2016). DSM-5 changes enhance parent identification of symptoms in adolescents with ADHD. Psychiatry Research, 242, 180–185.
Sibley, M. H., Mitchell, J. T., & Becker, S. P. (2016). Method of adult diagnosis influences estimated persistence of childhood ADHD: a systematic review of longitudinal studies. The Lancet Psychiatry, 3(12), 1157–1165.
Sibley, M. H., Campez, M., Perez, A., Morrow, A. S., Merrill, B. M., Altszuler, A. R., & Yeguez, C. E. (2016). Parent management of organization, time management, and planning deficits among adolescents with ADHD. Journal of Psychopathology and Behavioral Assessment, 38(2), 216–228.
Sibley, M. H. (2017). Supporting autonomy development in teens with ADHD: how professionals can help. The ADHD Report, 25(1), 1–7.
Sibley, M. H., Swanson, J. M., Arnold, L. E., Hechtman, L. T., & Owens, L. E., The MTA Cooperative Group. (2017). Defining ADHD symptom persistence in adulthood: optimizing sensitivity and specificity. Journal of Child Psychology and Psychiatry, 58, 655–662.
Sibley, M. H., Coxe, S. J., Campez, M., Morley, C., Olson, S., Hidalgo-Gato, N., & Pelham, W. E. (2018). High versus low intensity summer treatment for ADHD delivered at secondary school transitions. Journal of Clinical Child & Adolescent Psychology, 47(2), 248–265.
Sibley, M. H., & Yeguez, C. E. (2018a). Managing ADHD at the post-secondary transition: a qualitative study of parent and young adult perspectives. School Mental Health, 10(4), 352–371.
Sibley, M. H., & Yeguez, C. E. (2018b). The impact of DSM-5 A-criteria changes on parent ratings of ADHD in adolescents. Journal of Attention Disorders, 22(1), 83–91.
Sibley, M. H., Coxe, S. J., Page, T. P., Pelham, W. E., Yeguez, C. E., LaCount, P. A., & Barney, S. (2022). Four-year follow-up of high versus low intensity summer treatment for adolescents with ADHD. Journal of Clinical Child and Adolescent Psychology, 51(5), 750–763.
Smith, Z. R., Langberg, J. M., Cusick, C. N., Green, C. D., & Becker, S. P. (2020). Academic motivation deficits in adolescents with ADHD and associations with academic functioning. Journal of Abnormal Child Psychology, 48(2), 237–249.
Steinberg, L., & Morris, A. S. (2001). Adolescent development. Journal of Cognitive Education and Psychology, 2(1), 55–87.
Swift, K. D., Hall, C. L., Marimuttu, V., Redstone, L., Sayal, K., & Hollis, C. (2013). Transition to adult mental health services for young people with Attention Deficit/Hyperactivity Disorder (ADHD): a qualitative analysis of their experiences. BMC Psychiatry, 13, 74.
Ward, A. R., Sibley, M. H., Musser, E. D., Campez, M., Bubnik-Harrison, M. G., Meinzer, M. C., & Yeguez, C. E. (2019). Relational impairments, sluggish cognitive tempo, and severe inattention are associated with elevated self-rated depressive symptoms in adolescents with ADHD. ADHD Attention Deficit and Hyperactivity Disorders, 11(3), 289–298.
Wechsler, D. (2011). Wechsler Abbreviated Scale of Intelligence–Second edition manual. Bloomington, MN: Pearson.
Wigfield, A., & Eccles, J. (2002). Students’ motivation during the middle school years. In Improving academic achievement: Impact of psychological factors on education. San Diego, CA: Academic Press.
Yeguez, C. E., Hill, R. M., Buitron, V., & Pettit, J. W. (2018). Stress accounts for the association between ADHD symptoms and suicide ideation when stress-reactive rumination is high. Cognitive Therapy and Research, 42(4), 461–467.
Zhao, X., Page, T. F., Altszuler, A. R., Pelham, W. E., Kipp, H., Gnagy, E. M., & Macphee, F. L. (2019). Family burden of raising a child with ADHD. Journal of Abnormal Child Psychology, 47(8), 1327–1338.
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Yeguez, C.E., Ogle, R.R., Jusko, M.L. et al. The Impact of an Intensive Summer Treatment Program for Adolescents with ADHD: A Qualitative Study of Parent and Young Adult Perspectives. J Child Fam Stud 31, 3281–3301 (2022). https://doi.org/10.1007/s10826-022-02384-0
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DOI: https://doi.org/10.1007/s10826-022-02384-0