Uncovering Key Elements of an Executive Functioning Intervention in Adolescents: Epilepsy Journey.

Objective: The extent to which tailored executive functioning (EF) interventions lead to improvements in other areas of functioning in adolescents with epilepsy is unknown. The types of problems that youth select to practice EF skills during tailored interventions has not been documented. This study aimed to systematically evaluate: 1) the EF problems and strategies selected during a tailored EF intervention for youth with epilepsy, and 2) impact of a tailored intervention on specific problems for subgroups who choose to practice EF skills in those areas. Method: We conducted secondary data analyses of a proof-of-concept clinical trial of a tailored web-based EF intervention for youth with epilepsy. Baseline and 2-months post-intervention questionnaire data were included. A coding system was developed to identify the problem domains that adolescents targeted during treatment. Descriptive statistics and paired sample t-tests were used to examine whether adolescents who identified specific EF problems improved on specific domains. Results: Coding revealed eight domains: Academics, Activities of Daily Living, Family, Social, Adherence, Healthy Habits/Self-care, Sleep, and Emotion/Stress. Significant improvements were noted on "Academics," "Emotion/Stress," and "Sleep" domains for those who applied EF skills to those domains. Conclusions: Tailored EF interventions such as Epilepsy Journey are related not only to improvements in broad EF skills, but also to improvements across areas of functioning that adolescents identify as important. Clinically, EF skills may be more effectively learned when adolescents directly apply EF skills to the problems they identify as most salient. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02925663.