Objective: The purpose of this study was to understand patient characteristics that predict engagement barriers during behavior therapy for ADHD.
Method: Participants were 121 adolescents with ADHD and parents who received evidence-based behavior therapy for ADHD. Multiple regression examined relationships between six independent variables and frequency of barriers.
Results: ODD comorbidity and parental ADHD predicted higher frequency of overall barriers. With respect to barriers subtypes, these variables also predicted higher frequencies of cognitive, teen, early-treatment and mid-treatment barriers. Late-treatment, ODD predicted higher frequency of barriers, while minority status predicted lower barriers.
Conclusions: Adolescents diagnosed with ADHD and comorbid ODD, or who have parents that are also diagnosed with ADHD, are at greatest risk for engagement barriers during behavior therapy. During all phases of treatment, this patient subgroup would benefit from enhancements to standard behavior therapy that focus on therapeutic engagement-particularly targeting teen beliefs about treatment.
Keywords: adolescent ADHD; behavior therapy; engagement.