ADHD Adolescence

Intervention spotlight: INSPIRE

Applying a novel behavior change system to reduce alcohol use in teens with ADHD

Overview of the intervention:

INSPIRE is a digital game-based narrative environment developed at the University of California, San Francisco (UCSF) in collaboration with North Carolina State University (Ozer and colleagues) with funding from the National Science Foundation and the National Cancer Institute. Grounded in Social Cognitive Theory, the goal of the INSPIRE intervention is to increase self-efficacy skills and promote competence in adolescent decision-making to reduce alcohol use in a teenage social gathering scenario.

The LCIRN-funded pilot study led by UCSF postdoctoral fellow Marianne Pugatch, PhD, LICSW examines the feasibility and acceptability of applying this innovative virtual behavior change system to the prevention of alcohol use in youth with attention deficit hyperactivity disorder (ADHD), a group known to be at risk for alcohol and substance misuse with major life course health consequences. As a first step, this pilot studied whether youth with ADHD could be engaged with the INSPIRE platform, and whether engagement promotes adolescent-initiated conversations with parents about alcohol use. Preliminary data show that adolescents with ADHD were engaged in the intervention. 

What makes this a life course intervention?

INSPIRE is designed to impact teen alcohol use at a sensitive period of 14-16 years and interrupt the risk trajectory of teen alcohol use. Further, it is designed to be vertically integrated into primary care settings and has been developed through a human-centered design process. As part of our evaluation of INSPIRE’s performance in this applied setting, we examined its potential impact on the parent-child ecosystem, including assessing the frequency of parent-teen communication regarding alcohol use in teens with ADHD. This intervention may be particularly well suited for youth with ADHD as it generates personalized interactive narratives addressing developmental characteristics of impulsivity and dysregulation through reinforcement learning, goal setting, and problem-solving.  

What are the benefits of collaborating across networks and institutions?

Applying this innovative behavior change system in a real-world setting was made possible through the collaboration of multiple individuals, disciplines, institutions and networks. The opportunity to leverage the current INSPIRE study to conduct this pilot project capitalized on prior federally funded research of the investigator team across institutions. It also enabled us to work collaboratively across three Maternal and Child Health research networks (Developmental -Behavioral Pediatrics Research Network; LCIRN; Adolescent and Young Adult Health Research Network), each bringing different resources and expertise. We collected data for the pilot through Developmental Pediatric Clinics. We worked with a senior investigator team that supported adding questions about ADHD to the survey and served as mentors on the project. We included an examination of parent-teen communication around alcohol use as a result of a discussion with the LCIRN team.

What are the next steps?

Future research will examine the effects of INSPIRE on self-efficacy, knowledge, and alcohol use among adolescents with ADHD.  We will potentially pursue additional funding to develop a parent component to INSPIRE. 

Adolescence Research Approaches

Youth-Led Participatory Action Research

By Emily J. Ozer, UC Berkeley School of Public Health

What is Youth-Led Participatory Action Research (YPAR)?

YPAR is a social justice-focused approach for promoting social change and positive youth development in which youth conduct systematic research and actions to improve their schools, communities, and other systems (e.g. health, juvenile justice). YPAR entails an iterative process of research and action led by youth and guided by adult allies.  YPAR is an approach that transforms the power and process of research; it is not a specific research method YPAR studies can use quantitative and/or qualitative methods.

YPAR differs from forms of adult-led research that gather diverse forms of data from youth (or by youth) because in YPAR it is the youth who formulate the research questions and lead the process. Topics taken up by young people in YPAR projects range widely and include reforming school cultures, promoting environmental justice regarding pollution and pesticides, access to healthy foods, reduction in liquor stores, city planning, policing, and cyber-bullying (see links below for case examples).

YPAR is a form of Community-Based Participatory Research (CBPR), as it called in public health, with “global North” roots in social psychology (Kurt Lewin’s action research for organizational improvement) and “global South” roots in political movements for liberation and empowerment (e.g. Paulo Freire’s popular education models). 

Why does YPAR matter for life course intervention research?

When conducted with integrity, YPAR can:

(a) promote positive development for youth who participate in multiple key domains,

(b) help address inequities in youth-serving systems and organizations,

(c) strengthen the relevance of developmental science questions and validity of methods, and

(d) inform intervention design and evaluation.

One way that YPAR can enhance the validity and impact of life course research is by bringing the insider expertise of young people on sensitive topics to shaping the questions we ask, our sampling approaches, our methods, and our sharing-out of findings for impact on policies and systems.  It can also help transform traditional and highly problematic deficit-focused lenses for understanding the development of non-white young people, including the role of racism and other structural inequalities and forms of marginalization (and resistance) for youth of color, immigrant, and LGBTQ+ youth. 

Practitioners and families can also be engaged in forms of partnered or participatory research to bring their expertise. Fundamentally, YPAR raises key questions about who can create developmental science evidence. What is the potential role of young people in creating the evidence base for further research on themselves? 

Learn more (including case examples and curricula for online implementation):