Enhancing Motivation in Adolescents With ADHD: Long-Term Insights From the STAND Trial

ADHD is a long-term condition that often continues into adulthood, bringing academic, social, and health challenges. A new community trial tested Supporting Teens’ Autonomy Daily (STAND), a programme that combines motivational interviewing with parent–teen collaboration and training in organisation, time management, and planning skills. The study found that STAND improved outcomes when delivered by licensed therapists, highlighting both promise and implementation challenges.

Introduction

Adolescence presents unique challenges for young people with attention-deficit/hyperactivity disorder (ADHD), as developmental demands for autonomy, organisation, and family negotiation intensify. While psychosocial treatments are well-established for children, fewer interventions have been adapted and rigorously tested for adolescents, particularly within routine community settings (Evans et al., 2014; Sibley et al., 2016).

One programme designed specifically for this age group is Supporting Teens’ Autonomy Daily (STAND). STAND integrates behavioural therapy with motivational interviewing strategies to engage adolescents more actively in their treatment. The model combines joint sessions with parents and adolescents alongside separate work for each, focusing on improving organisation, time management, and planning (OTP) skills, while also addressing parent–teen conflict (Sibley et al., 2014). Motivational interviewing is used throughout to increase readiness for change and sustain behavioural improvements during this developmental stage.

The present study followed adolescents and their families for three years, comparing STAND with Usual Care (UC) across a range of functional and clinical outcomes. By examining both the efficacy of the model and the contextual factors that influence its impact, the study contributes valuable evidence to the field of adolescent ADHD treatment.

How the Study Was Set Up

The trial enrolled 278 culturally diverse adolescents with ADHD and their parents across four community mental health clinics. Families were randomly assigned to STAND or UC, with treatment delivered by 82 therapists reflecting the realities of community mental health staffing. Outcomes were tracked over three years using multi-informant assessments, including ADHD symptom ratings, measures of family functioning, adolescent reports of conflict, parent ratings of organisational skills, and indices of treatment engagement and school enrolment (Sibley et al., 2024).

STAND is implemented through joint sessions with parents and teens, alongside separate modules for each. The programme works on core ADHD difficulties—organisation, time management, and planning—while also addressing parent–teen conflict. Motivational interviewing is used to enhance adolescents’ readiness for change, a factor that helps maintain behavioural improvements during the teenage years (Sibley et al., 2014).

What the Researchers Found After Three Years

The intent-to-treat analyses showed no significant differences between STAND and UC across most outcomes at the three-year follow-up. This indicates that, in community settings, STAND was broadly comparable to the services typically available through UC (Sibley et al., 2024).

When therapist licensure was considered, however, a more nuanced picture emerged. STAND delivered by licensed therapists was linked to more favourable outcomes than UC in three important areas. Parents reported greater reductions in hyperactivity and impulsivity, adolescents described less parent–teen conflict, and parents also observed improvements in their children’s organisation, time management, and planning (OTP) skills.These improvements were not observed when STAND was delivered by unlicensed therapists, suggesting that professional training and experience may influence the effectiveness of the intervention (Sibley et al., 2024).

Across other domains—including inattention, persistence of ADHD diagnosis, medication use, psychosocial treatment engagement, and school enrolment—STAND and UC demonstrated similar long-term outcomes (Sibley et al., 2024).

Understanding the Results

The findings highlight both the potential of STAND and the challenges of implementation in community settings. The improvements involved areas often regarded as the most impairing aspects of ADHD during adolescence—hyperactivity/impulsivity, OTP skills, and parent–teen conflict (Evans et al., 2014). These effects were observed only when the programme was delivered by licensed therapists, pointing to the role of clinician expertise and training in sustaining outcomes.

At the same time, the absence of broad superiority to UC in the full sample indicates that translating structured, manualised treatments into heterogeneous community environments is complex. Many families in routine care encounter clinicians without formal licensure, and the study’s results suggest that additional training and supervision may be needed to maintain fidelity and effectiveness in such contexts (Sibley et al., 2024).

These findings also resonate with broader discussions in implementation science, which stress that the success of evidence-based treatments depends not only on the intervention itself but also on the systems and workforce responsible for delivering it (Weisz et al., 2013).

Implications for Research and Practice

This trial adds to the literature with three-year follow-up data on an adolescent ADHD intervention. As most studies stop at short-term outcomes, it offers a longer view that expands what is known about intervention effects (Evans et al., 2014; Sibley et al., 2016).

For researchers, these findings open the door to thinking about how interventions like STAND could be adapted for delivery by unlicensed or less experienced providers. It would be interesting to explore whether tailored training, ongoing supervision, or implementation supports might help extend the benefits seen with licensed clinicians into broader practice. For clinicians, the results may offer an opportunity to reflect on the role of family involvement and motivational strategies in adolescent ADHD care, especially when addressing challenges such as impulsivity and organisational skills.

The study also highlights adolescence as a potentially meaningful developmental window for psychosocial intervention. This stage may represent an opportunity to support autonomy, strengthen daily skills, and foster more constructive family relationships. At the same time, the modest differences observed between STAND and UC suggest that it may be useful to view interventions in context, recognising that benefits are unlikely to be broad or uniform across all outcomes (Sibley et al., 2024).

Conclusion

Sibley and colleagues (2024) provide one of the most rigorous examinations to date of a parent–teen intervention for ADHD in adolescence, testing the long-term effects of STAND over three years in community clinics. While overall outcomes were similar to Usual Care, licensed therapists delivering STAND achieved meaningful improvements in hyperactivity/impulsivity, organisational skills, and parent–teen conflict. These findings demonstrate both the potential of motivational interviewing–enhanced behavioural therapy and the practical challenges of scaling it within diverse service systems.

As such, the study underscores the need for ongoing research into workforce development, training, and implementation support, ensuring that interventions like STAND can fulfil their promise for adolescents with ADHD and their families.

NB this blog has been peer reviewed

Where next?

This webinar, led by Professor Dr. Margaret Sibley is a Professor of Psychiatry and Behavioral Sciences at the University of Washington School of Medicine and an attending clinical psychologist at Seattle Children’s Hospital. She has authored over 100 scholarly publications on ADHD. She is Secretary of the American Professional Society for ADHD and Related Disorders (APSARD) and a Professional Advisory Board Member for Children and Adults with Attention Deficit Hyperactivity Disorder (CHADD). She is the author of Parent-Teen Therapy for Executive Function Deficits and ADHD: Building Skills and Motivation and a member of the Motivational Interviewing Network of Trainers (MINT).

This presentation will be aimed at providing specialized training in the delivery of Motivational Interviewing to professionals and trainees working with clients who have ADHD and their families. Individuals with attention, executive functioning, and motivation difficulties often struggle to engage in interventions such as medication, educational interventions, cognitive-behavioral therapy, and ADHD coaching. Motivational Interviewing is an empirically supported technique that builds patient (and parent) engagement in treatment by targeting relational aspects of the provider-patient relationships as well as consideration of the change process during treatment.

Use the interactive programme below to gain an overview of the topic, meet the speaker, test your knowledge, and a whole lot more!