Can a Structured Skills Training Group Help Adolescents with ADHD?

What you need to know

• This study compared a 14-week structured skills training group based on dialectical behavior therapy to a 3-week psychoeducation group for adolescents with ADHD.
• The skills training group did not show greater improvements than psychoeducation in ADHD symptoms, functioning, or other outcomes.
• Both interventions were viewed positively by participants, with most reporting increased knowledge about ADHD and improved ability to manage related problems.
• More research is needed to determine if structured skills training may benefit specific subgroups of adolescents with ADHD.

The challenges of ADHD in adolescence

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by persistent difficulties with attention, hyperactivity, and impulsivity that interfere with daily functioning. For adolescents with ADHD, these core symptoms can create significant challenges across many areas of life.

Academically, teens with ADHD often struggle with completing schoolwork, staying organized, and performing up to their potential. The transition to high school, with its increased demands for independence and self-management, can be especially difficult.

Socially, adolescents with ADHD may have trouble picking up on social cues, taking turns in conversations, or regulating their emotions and behaviors in peer interactions. This can lead to difficulties forming and maintaining friendships.

Emotionally, many teens with ADHD experience mood swings, irritability, low frustration tolerance, and poor self-esteem. They may also be at higher risk for anxiety, depression, and other mental health issues.

At home, conflicts with parents and siblings are common as teens with ADHD push back against rules and expectations. Forgetfulness, disorganization, and impulsive behaviors can strain family relationships.

Given these wide-ranging impacts, there is a need for treatments that can help adolescents with ADHD develop better coping skills and strategies across multiple domains of functioning. While medication can be helpful for managing core ADHD symptoms, psychosocial interventions may provide additional benefits for addressing the broader life challenges associated with ADHD.

Evaluating a structured skills training program

This study set out to evaluate the effectiveness of a structured skills training group program for adolescents with ADHD. The program was adapted from an intervention originally developed for adults with ADHD, based on principles of dialectical behavior therapy (DBT).

DBT is a type of cognitive-behavioral therapy that focuses on helping people develop skills in four key areas:

1. Mindfulness - Being aware and present in the moment
2. Distress tolerance - Coping with difficult situations and emotions
3. Emotion regulation - Understanding and managing emotions effectively
4. Interpersonal effectiveness - Communicating assertively and maintaining relationships

The structured skills training group (SSTG) for adolescents consisted of 14 weekly 2-hour sessions. Each session focused on teaching and practicing specific skills related to managing ADHD and associated difficulties. Some of the topics covered included:

• Understanding ADHD and its impacts
• Mindfulness and focusing attention
• Organizing and planning
• Managing distractions
• Regulating emotions
• Interpersonal skills and communication
• Problem-solving
• Building self-esteem

The researchers wanted to know if this more intensive skills-based approach would lead to greater improvements for teens with ADHD compared to a brief psychoeducational intervention. Psychoeducation involves providing information about a condition to help people better understand and manage it.

How the study was conducted

The study recruited 184 adolescents ages 15-18 who had been diagnosed with ADHD at child and adolescent psychiatric clinics in Sweden. Participants were randomly assigned to either:

1. The 14-week structured skills training group (SSTG)
2. A 3-week psychoeducational control group

The psychoeducational group covered general information about ADHD, its symptoms and challenges, and some basic coping strategies. Both interventions were delivered in a group format by trained clinicians.

Participants and their parents completed questionnaires assessing ADHD symptoms, functional impairment, quality of life, emotional/behavioral problems, and other outcomes at three time points:

• Two weeks before the intervention (baseline)
• Two weeks after the intervention ended
• Six months after the intervention

The researchers then compared the outcomes between the two groups to see if the skills training led to greater improvements than psychoeducation.

What the study found

Contrary to the researchers’ hypothesis, the structured skills training group did not show significantly greater improvements than the psychoeducational group on any of the main outcome measures. Specifically:

• There were no significant differences between groups in changes in ADHD symptoms, either self-reported or parent-reported.

• Functional impairment, quality of life, and mindfulness skills did not improve more in the skills training group compared to psychoeducation.

• Other outcomes like emotional/behavioral problems, anxiety/depression symptoms, perceived stress, and sleep problems also showed no significant differences between groups.

The one exception was that the psychoeducation group reported greater improvement in sleep problems immediately after the intervention compared to the skills training group. However, this difference was not maintained at the 6-month follow-up.

When looking at changes within each group over time, both interventions showed some improvements:

• Parents in both groups reported decreases in their child’s ADHD symptoms and functional impairment at both the post-intervention and 6-month follow-up time points.

• Adolescents in the skills training group (but not the psychoeducation group) self-reported decreases in ADHD symptoms and functional impairment at the 6-month follow-up.

• Both groups showed reductions in emotional and behavioral problems based on parent and self-reports.

Importantly, a majority of participants in both groups viewed the interventions positively:

• Over 90% in each group said their knowledge about ADHD had increased.
• Around 90% said they were more able to manage problems related to ADHD.
• Over 85% said they would recommend the group to others.
• Most reported the intervention had moderate to great benefit for them.

There were no significant differences between groups in these acceptability ratings.

Interpreting the results

The lack of clear superiority for the more intensive skills training program was somewhat surprising to the researchers. There are a few potential explanations to consider:

1. The psychoeducational intervention may have been more impactful than expected. Even brief education about ADHD could help teens better understand and manage their symptoms.

2. The skills training program may have been too broad, trying to cover too many topics in a limited time. More focused practice on fewer skills might be needed to see bigger changes.

3. Attendance and engagement was relatively low in the skills group, with participants attending an average of 62% of sessions. The full “dose” of the intervention may not have been received.

4. The study sample was heterogeneous in terms of ADHD severity, comorbidities, and impairment levels. The skills training may be more beneficial for certain subgroups.

5. Involvement of parents/teachers to reinforce skills practice in daily life may be needed to achieve greater improvements.

6. The outcome measures used may not have captured all relevant changes. More sensitive or targeted assessments could potentially detect differences between interventions.

It’s also worth noting that both interventions led to some improvements over time, particularly in parent-reported outcomes. This suggests that even relatively brief group interventions may provide some benefits for adolescents with ADHD.

Conclusions and future directions

While this study did not find the structured skills training to be superior to psychoeducation, both interventions were viewed positively by participants. For clinicians and families, this suggests that even short-term group interventions focused on ADHD education and coping strategies may be helpful and acceptable to adolescents.

More research is still needed to determine how to optimize psychosocial treatments for teens with ADHD. Some potential future directions include:

• Evaluating if certain subgroups of adolescents (e.g. those with more severe emotional dysregulation) may benefit more from intensive skills training.

• Exploring ways to improve engagement and skills practice, such as involving parents or using digital tools for reminders/tracking.

• Comparing skills training to other active treatments like cognitive-behavioral therapy.

• Assessing a wider range of outcomes, including objective measures of functioning.

• Examining longer-term impacts of different intervention approaches.

Ultimately, adolescents with ADHD may benefit from a stepped care approach - starting with psychoeducation and basic strategies, then moving to more intensive interventions if needed. Treatments likely need to be tailored to each individual’s specific symptom profile, strengths, and challenges.

While medication remains a key evidence-based treatment for ADHD, continued research on psychosocial interventions is crucial. Developing and refining effective non-pharmacological options can help address the complex needs of adolescents with ADHD as they navigate the transition to adulthood.