School-Based Depression Prevention for Adolescents With ADHD
Condition: Attention Deficit Hyperactivity Disorder; Depressive Symptoms
MeSH terms: Depression; Attention Deficit Disorder with Hyperactivity
Study type: Interventional

Summary: 
      The purpose of this study is to develop a modified behavioral activation program in
      adolescents with ADHD to be implemented by school mental health providers in an urban,
      low-income school district. Subsequently the investigators will examine its effectiveness in
      reducing depressive symptoms and improving emotion regulation and reward responsivity,
      compared to usual care.
    

Detailed description: 
      Children with ADHD are at elevated risk for depression in adolescence and young adulthood,
      and this comorbidity is associated with far greater impairment than either disorder alone,
      including higher rates of inpatient hospitalization and increased risk for suicidal ideation
      and behavior. Despite these adverse outcomes, existing evidence-based interventions for ADHD
      have not demonstrated effects in reducing depressive symptoms nor do established depression
      prevention programs work as well for adolescents with ADHD. Reward responsivity (RR) and
      emotion regulation (ER) are two key factors demonstrated to mediate the association between
      ADHD and depression and are thus key targets for prevention. In an effort to address the gap
      between access and utilization of mental health care, which is especially stark among
      adolescents with ADHD, the investigators aim to develop and test a modified behavioral
      activation prevention program [Behaviorally Enhancing Adolescents' Mood in Schools (BEAM-S)]
      that incorporates modules to directly target these purported mechanisms. In line with the
      Deployment-Focused Model of Intervention Development and Testing, the investigators will
      develop a program that can be easily implemented and sustainable in the high school setting
      as delivered by school mental health staff that reduces depression and improves overall
      functioning in adolescents with ADHD, by way of improving RR and ER. As a first step, the
      investigators will conduct focus groups with community stakeholders (e.g., school mental
      health providers, school administration, adolescents, parents, teachers) to develop an
      acceptable and sustainable selected and indicated prevention program for school staff to
      utilize. The investigators will then initially train school staff to deliver this prevention
      program via to pilot the intervention for implementation of the prevention program in a case
      series to evaluate preliminary feasibility. The investigators will then conduct a stage 1 RCT
      with a hybrid-type 1 implementation effectiveness design in three high schools where
      adolescents will be randomized to either the BEAM-S condition (n= 54) or treatment as usual
      (n = 54). Finally, qualitative and quantitative data from aims 1-3 will be used to prepare
      final procedures for a future large-scale effectiveness trial R01 (aim 4).
    

Intervention name(s): Behaviorally Enhancing Adolescents' Mood in Schools; Usual Care
Intervention type(s): Behavioral; Behavioral
Intervention description(s): 8-session modified behavioral activation intervention; Referral to school mental health provider, social worker, or community care.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention