From the Clinic to Schools: Iterative Development of a Depression Prevention Program for Adolescents With ADHD Within an Urban School System

• Imipramine plus CBT shown to be superior to CBT alone but there are concerns about the safety of this drug for youth. • Two RCTs failed to show the superiority of fluoxetine combined with CBT compared to CBT alone. • Limited support for adjunctive antidepressants and empirical support for CBT suggest CBT is the first-line treatment. • Additional studies needed to evaluate benefits of combined CBT and antidepressant medication for school refusal. • Recommendations are provided for clinicians considering antidepressants in treatment of school refusal. Attention-deficit/hyperactivity disorder (ADHD) is a prevalent disorder, particularly among Black youth and youth in urban settings. In addition to well-documented academic and social dysfunction, ADHD is associated with increased risk for depression and suicide. However, there is a stark mismatch between services available and need among adolescents with ADHD, especially those from low-income backgrounds. Implementation of services in schools is one promising way to overcome barriers to care, decrease stigma associated with mental health care, and offer the ability to practice mental health skills in a more natural environment. As such, the current study aims to (a) describe the iterative development of a school-based depression prevention program (i.e., Behaviorally Enhancing Adolescents’ Mood in Schools [BEAMS]) for adolescents with ADHD in an underresourced, urban school district using stakeholder feedback; and (b) evaluate the preliminary effectiveness of an open trial of BEAMS. Raw data for all participants ( n = 6; 83% Black, 17% biracial; 83% male) with indications for significant Reliable Change Indices are presented in addition to two case vignettes to illustrate treatment components and exemplify participant response. Pre- and posttreatment focus group data are presented to depict the development of the BEAMS program, lessons learned, and modifications made to BEAMS, in preparation for a larger randomized trial. Future directions are discussed.