1 - (SYM 74) Leveraging a Digital Augmentation to Enhance Treatment Engagement: Predictors of Engagement and Differential Effects in School-based Intervention for Youth with ADHD

Half of youth who receive behavioral intervention for ADHD experience little improvement (Langberg et al., 2016), possibly due to low treatment engagement (Sibley et al., 2023). ATOM, a digital organization skills training (OST) augmentation, was designed to enhance treatment engagement. In this study, we evaluated ATOM’s effects on engagement relative to standard OST by examining differences in, predictors of, and conditional effects of ATOM on engagement.

Adolescents (47% White, 47% Black, 3% Asian, 3% Other/Unknown, 11% Hispanic/Latiné) with attention problems (N=39) were randomized to ATOM (n=22) or standard OST (n=17). Youth and teachers completed baseline measures of academic engagement, motivation, and impairment. Coders rated session engagement on a scale from 1 (low) to 7 (high) and tracked attendance. Independent samples t-tests were used to compare group differences in average session engagement. Associations between baseline variables and engagement were tested in linear regression models. Interactions between condition and baseline variables were modeled using PROCESS to probe significant interactions (Hayes, 2022).

There was no difference between observer-coded engagement for adolescents by condition. Adolescents in ATOM (M=8.64, SD=5.54) attended fewer sessions than those in the standard OST (M=12.42, SD=5.80), t(37)=2.07, p=.046. There was a significant interaction effect between student-teacher relationship and condition (B=-2.82, p=.003) in the association with coder-rated engagement. For adolescents in the standard condition, having more positive student-teacher relationships was associated with higher engagement (B=1.37, p< .001). There was a significant interaction effect between academic engagement and condition (B=-3.24, p=.002) in the association with coder-rated engagement. For adolescents in the standard condition, having higher academic engagement was associated with higher intervention engagement (B=1.51, p=.002).

Adolescents in standard OST attended more sessions than youth in ATOM. Baseline facilitators were critical to facilitating engagement for youth in standard OST, but less important for those in ATOM. Thus, for adolescents who did not receive the digital augmentation, the presence of protective factors may be crucial to maintain similar engagement to those who receive ATOM. Findings are important for illuminating novel strategies to effectively engage diverse youth in behavioral intervention.