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ADHD Institute Register

16 Apr 2018

Geissler J et al. Trials 2018; 19: 254

Since adolescence represents a crucial period for determining an individuals’ life trajectory, there is a great need for effective, feasible treatment strategies with well-tolerated safety profiles for adolescents with ADHD. Current treatment strategies with well-tolerated safety profiles consist of pharmacotherapy in combination with psychoeducation; however, current evidence of individual psychotherapy in adolescents is limited to a small number of mostly uncontrolled studies. This paucity may be due to the low adherence to treatment in adolescents with ADHD and the increased complexity surrounding comorbidities, in addition to shifts in core ADHD symptoms, psychosocial adversity and family dysfunction (including poor parenting skills and parental mental health problems). Therefore, individualised treatment plans for adolescents with ADHD should be developed which take these considerations into account.

This article describes the study protocol for the ESCAadol study,* which represents a randomised controlled trial designed to address the needs of adolescents with ADHD and investigate the benefits of an innovative short-term cognitive behavioural therapy programme based on established interventions, compared with parent-based telephone-assisted self-help (TASH).

The experimental plan for the ESCAadol study is as follows:

  • A total of 160 adolescents (aged 12–17 years) with severe ADHD (Clinical Global Impression-Severity scale score ≥4) and insufficient improvement in symptoms following at least 1 year of routine clinical care will undergo an observational, treatment-as-usual (TAU) phase for 4 weeks, in order to assess changes in ADHD symptoms during routine care.
  • Adolescents with ADHD for whom routine care has proved insufficient and who still present with severe ADHD will be randomised into one of two study arms (expected N=140).
    • In the experimental arm, adolescents with ADHD will undertake 12 weeks of an individualised modular treatment programme (IMTP) consisting of 10 hour-long sessions, involving 4 mandatory and 3 individualised modules selected based on core problem areas identified at screening and baseline visits as well as physician and individual goal-setting in the introductory treatment sessions
      • Individualised modules will aim to target organisational skills and planning, distractibility and procrastination, dysfunctional thinking, emotion regulation, problem solving, stress management, medication management, harmful substance (ab)use, dysfunctional communication, parental competence and parental mental health.
    • As an active control treatment, TASH will be implemented for 12 weeks and will comprise parent behavioural training applied through the use of 8 brochures and 10 half-hour telephone counselling sessions.
  • For both treatment arms, measurements will be taken at baseline, after the TAU phase, following the treatment phase, and at 12 weeks post-treatment. Clinical assessment of ADHD symptoms and comorbidities will be carried out by experienced clinicians, blinded to the treatment arm but not to the time point. To account for this, all interviews will be recorded and a subsample will be validated by a fully blinded expert.

Recruitment for the ESCAadol study is currently ongoing and it is hoped that these results will be used to determine if an IMTP represents a feasible and cost-effective treatment option for implementation into routine clinical practice. Further to this, the authors suggested that the ESCAadol study will also assist in addressing the paucity of information that exists in the treatment of adolescents with ADHD who do not benefit from routine clinical care.

Read more about the ESCAadol study here

 

*Evidence-based stepped care of ADHD: individualised short-term therapy for adolescents impaired by ADHD despite previous routine care treatment (ESCAadol). This study includes adolescents aged 12–17 years diagnosed with ADHD according to Diagnostic and Statistical Manual of Mental Disorders – 5th Edition criteria, assessed with a structured clinical interview. The individual must have received routine care for >6 months and shown no sufficient benefit from previous ADHD interventions
The IMTP was established by adapting elements of dialectical behaviour therapy for adolescents in general, and specifically for ADHD in adults, as well as interventions from the German treatment manuals for externalising disorders, performance problems in adolescents, family interventions and social skills training

Geissler J, Jans T, Banaschewski T, et al. Individualised short-term therapy for adolescents impaired by attention-deficit/hyperactivity disorder despite previous routine care treatment (ESCAadol) — Study protocol of a randomised controlled trial within the consortium ESCAlife. Trials 2018; 19: 254.

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