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Baweja R, Mattison RE, Waxmonsky JG. Impact of Attention-Deficit Hyperactivity Disorder on School Performance: What are the Effects of Medication? Paediatr Drugs 2015; 17:459-77. [PMID: 26259966 DOI: 10.1007/s40272-015-0144-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Attention-deficit hyperactivity disorder (ADHD) affects an estimated 5-7 % of schoolchildren worldwide. School functioning and academic achievement are frequently impaired by ADHD and represent one of the main reasons children start ADHD medication. Multiple potential causal pathways exist between ADHD and impaired school performance. In this review, we decompose school performance into three components and assess the impact of ADHD and its treatments on academic performance (assessed by grade point average [GPA], time on-task, percentage of work completed as well as percent completed correctly), academic skills (as measured by achievement tests and cognitive measures), and academic enablers (such as study skills, motivation, engagement, classroom behavior and interpersonal skills). Most studies examined only the short-term effects of medication on school performance. In these, ADHD medications have been observed to improve some aspects of school performance, with the largest impact on measures of academic performance such as seatwork productivity and on-task performance. In a subset of children, these benefits may translate into detectable improvements in GPA and achievement testing. However, limited data exists to support whether these changes are sustained over years. Optimizing medication effects requires periodic reassessment of school performance, necessitating a collaborative effort involving patients, parents, school staff and prescribers. Even with systematic reassessment, behavioral-based treatments and additional school-based services may be needed to maximize academic performance for the many youth with ADHD and prominent impairments in school performance.
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Affiliation(s)
- Raman Baweja
- Department of Psychiatry, Penn State University College of Medicine, 500 University Drive, H073, Hershey, PA, 17033-0850, USA.
| | - Richard E Mattison
- Department of Psychiatry, Penn State University College of Medicine, 500 University Drive, H073, Hershey, PA, 17033-0850, USA
| | - James G Waxmonsky
- Department of Psychiatry, Penn State University College of Medicine, 500 University Drive, H073, Hershey, PA, 17033-0850, USA
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Sahakian BJ, Bruhl AB, Cook J, Killikelly C, Savulich G, Piercy T, Hafizi S, Perez J, Fernandez-Egea E, Suckling J, Jones PB. The impact of neuroscience on society: cognitive enhancement in neuropsychiatric disorders and in healthy people. Philos Trans R Soc Lond B Biol Sci 2015; 370:20140214. [PMID: 26240429 PMCID: PMC4528826 DOI: 10.1098/rstb.2014.0214] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2015] [Indexed: 01/23/2023] Open
Abstract
In addition to causing distress and disability to the individual, neuropsychiatric disorders are also extremely expensive to society and governments. These disorders are both common and debilitating and impact on cognition, functionality and wellbeing. Cognitive enhancing drugs, such as cholinesterase inhibitors and methylphenidate, are used to treat cognitive dysfunction in Alzheimer's disease and attention deficit hyperactivity disorder, respectively. Other cognitive enhancers include specific computerized cognitive training and devices. An example of a novel form of cognitive enhancement using the technological advancement of a game on an iPad that also acts to increase motivation is presented. Cognitive enhancing drugs, such as methylphenidate and modafinil, which were developed as treatments, are increasingly being used by healthy people. Modafinil not only affects 'cold' cognition, but also improves 'hot' cognition, such as emotion recognition and task-related motivation. The lifestyle use of 'smart drugs' raises both safety concerns as well as ethical issues, including coercion and increasing disparity in society. As a society, we need to consider which forms of cognitive enhancement (e.g. pharmacological, exercise, lifelong learning) are acceptable and for which groups (e.g. military, doctors) under what conditions (e.g. war, shift work) and by what methods we would wish to improve and flourish.
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Affiliation(s)
- Barbara J Sahakian
- Department of Psychiatry, University of Cambridge, Herchel Smith Building for Brain and Mind Sciences, Forvie Site, Robinson Way, Cambridge CB2 0SZ, UK MRC/Wellcome Trust Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge CB2 3EB, UK
| | - Annette B Bruhl
- Department of Psychiatry, University of Cambridge, Herchel Smith Building for Brain and Mind Sciences, Forvie Site, Robinson Way, Cambridge CB2 0SZ, UK MRC/Wellcome Trust Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge CB2 3EB, UK Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Lenggstrasse 31, 8032 Zurich, Switzerland
| | - Jennifer Cook
- Department of Psychiatry, University of Cambridge, Herchel Smith Building for Brain and Mind Sciences, Forvie Site, Robinson Way, Cambridge CB2 0SZ, UK
| | - Clare Killikelly
- Department of Psychiatry, University of Cambridge, Herchel Smith Building for Brain and Mind Sciences, Forvie Site, Robinson Way, Cambridge CB2 0SZ, UK
| | - George Savulich
- Department of Psychiatry, University of Cambridge, Herchel Smith Building for Brain and Mind Sciences, Forvie Site, Robinson Way, Cambridge CB2 0SZ, UK
| | - Thomas Piercy
- Department of Psychiatry, University of Cambridge, Herchel Smith Building for Brain and Mind Sciences, Forvie Site, Robinson Way, Cambridge CB2 0SZ, UK
| | - Sepehr Hafizi
- Department of Psychiatry, University of Cambridge, Herchel Smith Building for Brain and Mind Sciences, Forvie Site, Robinson Way, Cambridge CB2 0SZ, UK CAMEO North Team, 3 Thorpe Road, Peterborough PE3 6AN, UK
| | - Jesus Perez
- Department of Psychiatry, University of Cambridge, Herchel Smith Building for Brain and Mind Sciences, Forvie Site, Robinson Way, Cambridge CB2 0SZ, UK CAMEO South Team, Block 7, Ida Darwin Site, Fulbourn, Cambridge CB21 5EE, UK
| | - Emilio Fernandez-Egea
- Department of Psychiatry, University of Cambridge, Herchel Smith Building for Brain and Mind Sciences, Forvie Site, Robinson Way, Cambridge CB2 0SZ, UK MRC/Wellcome Trust Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge CB2 3EB, UK
| | - John Suckling
- Department of Psychiatry, University of Cambridge, Herchel Smith Building for Brain and Mind Sciences, Forvie Site, Robinson Way, Cambridge CB2 0SZ, UK MRC/Wellcome Trust Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge CB2 3EB, UK
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Herchel Smith Building for Brain and Mind Sciences, Forvie Site, Robinson Way, Cambridge CB2 0SZ, UK MRC/Wellcome Trust Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge CB2 3EB, UK
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Faraone SV, Asherson P, Banaschewski T, Biederman J, Buitelaar JK, Ramos-Quiroga JA, Rohde LA, Sonuga-Barke EJS, Tannock R, Franke B. Attention-deficit/hyperactivity disorder. Nat Rev Dis Primers 2015; 1:15020. [PMID: 27189265 DOI: 10.1038/nrdp.2015.20] [Citation(s) in RCA: 800] [Impact Index Per Article: 88.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a persistent neurodevelopmental disorder that affects 5% of children and adolescents and 2.5% of adults worldwide. Throughout an individual's lifetime, ADHD can increase the risk of other psychiatric disorders, educational and occupational failure, accidents, criminality, social disability and addictions. No single risk factor is necessary or sufficient to cause ADHD. In most cases ADHD arises from several genetic and environmental risk factors that each have a small individual effect and act together to increase susceptibility. The multifactorial causation of ADHD is consistent with the heterogeneity of the disorder, which is shown by its extensive psychiatric co-morbidity, its multiple domains of neurocognitive impairment and the wide range of structural and functional brain anomalies associated with it. The diagnosis of ADHD is reliable and valid when evaluated with standard criteria for psychiatric disorders. Rating scales and clinical interviews facilitate diagnosis and aid screening. The expression of symptoms varies as a function of patient developmental stage and social and academic contexts. Although there are no curative treatments for ADHD, evidenced-based treatments can markedly reduce its symptoms and associated impairments. For example, medications are efficacious and normally well tolerated, and various non-pharmacological approaches are also valuable. Ongoing clinical and neurobiological research holds the promise of advancing diagnostic and therapeutic approaches to ADHD. For an illustrated summary of this Primer, visit: http://go.nature.com/J6jiwl.
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Affiliation(s)
- Stephen V Faraone
- Departments of Psychiatry and of Neuroscience and Physiology, State University of New York (SUNY) Upstate Medical University, Syracuse, New York 13210, USA
- K.G. Jebsen Centre for Psychiatric Disorders, Department of Biomedicine, University of Bergen, 5020 Bergen, Norway
| | - Philip Asherson
- Social Genetic and Developmental Psychiatry, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Joseph Biederman
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Pediatric Psychopharmacology Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jan K Buitelaar
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Cognitive Neuroscience and Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands
| | - Josep Antoni Ramos-Quiroga
- ADHD Program, Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Spain
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Luis Augusto Rohde
- ADHD Outpatient Program, Hospital de Clinicas de Porto Alegre, Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
- National Institute of Developmental Psychiatry for Children and Adolescents, Sao Paulo, Brazil
| | - Edmund J S Sonuga-Barke
- Department of Psychology, University of Southampton, Southampton, UK
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Rosemary Tannock
- Neuroscience and Mental Health Research Program, Research Institute of The Hospital for Sick Children, Toronto, Canada
- Department of Applied Psychology and Human Development, Ontario Institute for Studies in Education, University of Toronto, Toronto, Ontario, Canada
| | - Barbara Franke
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Departments of Human Genetics and Psychiatry, Nijmegen, The Netherlands
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Lambert MC, Reid R, Prosser B, Bussing R. A Survival Analysis of Psychostimulant Prescriptions in New South Wales from 1990 to 2010. J Child Adolesc Psychopharmacol 2015. [PMID: 26218772 DOI: 10.1089/cap.2014.0151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Psychostimulant medication is considered a mainstay in the treatment of attention-deficit/hyperactivity disorder (ADHD); however, research suggests that the typical duration of medication treatment for children and youth may be <3 years. The purpose of this study was to evaluate the psychostimulant treatment persistence for children and adolescents in New South Wales, Australia. METHODS This study used survival analysis to assess duration of medication treatment on a large administrative database of children and youth from New South Wales, Australia. Several models were fit to evaluate differences in survival rates among decades (1990-1999 vs. 2000-2010), gender, and age. RESULTS Results showed that: 1) Overall median treatment time (i.e., median survival time) was 1.96 years (99% CI=1.93, 1.99); 2) there were small, but significant changes over time in duration of treatment; 3) females had shorter treatment duration than males; and 4) there were relatively large differences in treatment duration across age groups. CONCLUSIONS These results indicate that the majority of children and youth receive medication treatment for only a small portion of childhood/adolescence, and that there are differential patterns in treatment duration across age groups.
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Affiliation(s)
- Matthew C Lambert
- 1 Department of Special Education and Communication Disorders, University of Nebraska , Lincoln, Nebraska
| | - Robert Reid
- 1 Department of Special Education and Communication Disorders, University of Nebraska , Lincoln, Nebraska
| | - Brenton Prosser
- 2 Faculty of Health, University of Canberra , Canberra, Australian Capital Territory, Australia
| | - Regina Bussing
- 3 Department of Psychiatry, University of Florida , Gainesville, Florida
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Abstract
PURPOSE OF REVIEW This article provides an overview of current controversies in attention-deficit/hyperactivity disorder (ADHD) research, with an emphasis on recent findings that are directly relevant to clinical practice. RECENT FINDINGS Over the past few years, a number of studies have added key evidence to ongoing debates about the epidemiology, nosology, and treatment of ADHD. Although the causes of the rising prevalence of ADHD in the USA are still not fully understood, recent research suggests that environmental factors and changes to the diagnostic criteria may have played a role. In addition, there continues to be controversy surrounding the clinical diagnosis of ADHD and newly recognized, related conditions such as sluggish cognitive tempo. Recent studies have also challenged previous assumptions about the long-term effects of stimulant treatment on growth, academic achievement, and substance use. Moreover, although most complementary and alternative therapies for ADHD appear to be ineffective, there is emerging evidence supporting the value of fatty acid supplementation. Although these findings are promising, more research is needed on all fronts. SUMMARY Although research has shed light on unanswered questions about the epidemiology, nosology, and treatment of ADHD, much is still not known. An understanding of the most important current controversies in ADHD research may aid pediatricians in clinical decision making and allow them to counsel patients more effectively.
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Berl MM, Terwilliger V, Scheller A, Sepeta L, Walkowiak J, Gaillard WD. Speed and complexity characterize attention problems in children with localization-related epilepsy. Epilepsia 2015; 56:833-40. [PMID: 25940056 DOI: 10.1111/epi.12985] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Children with epilepsy (EPI) have a higher rate of attention-deficit/hyperactivity disorder (ADHD; 28-70%) than typically developing (TD) children (5-10%); however, attention is multidimensional. Thus, we aimed to characterize the profile of attention difficulties in children with epilepsy. METHODS Seventy-five children with localization-related epilepsy ages 6-16 years and 75 age-matched controls were evaluated using multimodal, multidimensional measures of attention including direct performance and parent ratings of attention as well as intelligence testing. We assessed group differences across attention measures, determined if parent rating predicted performance on attention measures, and examined if epilepsy characteristics were associated with attention skills. RESULTS The EPI group performed worse than the TD group on timed and complex attention aspects of attention (p < 0.05), whereas performance on simple visual and simple auditory attention tasks was comparable. Children with EPI were 12 times as likely as TD children to have clinically elevated symptoms of inattention as rated by parents, but ratings were a weak predictor of attention performance. Earlier age of onset was associated with slower motor speed (p < 0.01), but no other epilepsy-related clinical characteristics were associated with attention skills. SIGNIFICANCE This study clarifies the nature of the attention problems in pediatric epilepsy, which may be under-recognized. Children with EPI had difficulty with complex attention and rapid response, not simple attention. As such, they may not exhibit difficulty until later in primary school when demands increase. Parent report with standard ADHD screening tools may under-detect these higher-order attention difficulties. Thus, monitoring through direct neuropsychological performance is recommended.
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Affiliation(s)
- Madison M Berl
- Children's National Health System (CNHS), Washington, District of Columbia, U.S.A.,George Washington University, Washington, District of Columbia, U.S.A
| | - Virginia Terwilliger
- Children's National Health System (CNHS), Washington, District of Columbia, U.S.A
| | - Alexandra Scheller
- Children's National Health System (CNHS), Washington, District of Columbia, U.S.A
| | - Leigh Sepeta
- Children's National Health System (CNHS), Washington, District of Columbia, U.S.A
| | | | - William D Gaillard
- Children's National Health System (CNHS), Washington, District of Columbia, U.S.A.,George Washington University, Washington, District of Columbia, U.S.A
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Sayal K, Washbrook E, Propper C. Childhood behavior problems and academic outcomes in adolescence: longitudinal population-based study. J Am Acad Child Adolesc Psychiatry 2015; 54:360-8.e2. [PMID: 25901772 DOI: 10.1016/j.jaac.2015.02.007] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 02/13/2015] [Accepted: 02/24/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate the impact of increasing levels of inattention, hyperactivity/impulsivity, and oppositional/defiant behaviors at age 7 years on academic achievement at age 16 years. METHOD In a population-based sample of 7-year-old children in England, information was obtained about inattention, hyperactivity/impulsivity, and oppositional/defiant behaviors (using parent and teacher ratings) and the presence of attention-deficit/hyperactivity disorder (ADHD) and disruptive behavior disorders (DBDs). After adjusting for confounder variables, their associations with academic achievement in national General Certificate of Secondary Education (GCSE) examinations (using scores and minimum expected school-leaving qualification level [5 "good" GCSEs]) at age 16 years were investigated (N = 11,640). RESULTS In adjusted analyses, there was a linear association between each 1-point increase in inattention symptoms and worse outcomes (2- to 3-point reduction in GCSE scores and 6% to 7% (10%-12% with teacher ratings) increased likelihood of not achieving 5 good GCSEs). ADHD was associated with a 27- to 32-point reduction in GCSE scores and, in boys, a more than 2-fold increased likelihood of not achieving 5 good GCSEs. In boys, oppositional/defiant behaviors were also independently associated with worse outcomes, and DBDs were associated with a 19-point reduction in GCSE scores and a 1.83-increased likelihood of not achieving 5 good GCSEs. CONCLUSION Across the full range of scores at a population level, each 1-point increase in inattention at age 7 years is associated with worse academic outcomes at age 16. The findings highlight long-term academic risk associated with ADHD, particularly inattentive symptoms. After adjusting for inattention and ADHD respectively, oppositional/defiant behaviors and DBDs are also independently associated with worse academic outcomes.
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Affiliation(s)
- Kapil Sayal
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, UK and the Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan (CANDAL), Institute of Mental Health, Nottingham.
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Oxidative and nitrosative stress in ADHD: possible causes and the potential of antioxidant-targeted therapies. ACTA ACUST UNITED AC 2015; 7:237-47. [DOI: 10.1007/s12402-015-0170-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 04/07/2015] [Indexed: 12/22/2022]
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Antel J, Albayrak Ö, Heusch G, Banaschewski T, Hebebrand J. Assessment of potential cardiovascular risks of methylphenidate in comparison with sibutramine: do we need a SCOUT (trial)? Eur Arch Psychiatry Clin Neurosci 2015; 265:233-47. [PMID: 25149468 DOI: 10.1007/s00406-014-0522-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 08/01/2014] [Indexed: 12/20/2022]
Abstract
With the recent approval of methylphenidate (MPH) for treating attention-deficit/hyperactivity disorder (ADHD) in adults, the number of patients exposed will increase tremendously. The ongoing debate on the cardiovascular safety of MPH has triggered two large retrospective cohort studies in children and adolescents as well as in young to middle-aged adults. These studies looked into serious cardiovascular events (sudden cardiac death, acute myocardial infarction and stroke) as primary endpoints and concluded that MPH was safe after a mean duration of 2.1 years of follow-up in children and adolescents and mean duration of 0.33 years of current use in adults. The results are encouraging with respect to the short- and medium-term use of MPH. Without the inherent limitations of retrospective cohort studies, a prospective randomized, double-blind, placebo-controlled, multicenter trial in individuals stratified for cardiovascular risk factors would allow for an optimized risk assessment. With many millions of patients treated per year and drawing parallels to the lately discovered risks of sibutramine, another sympathomimetic with an overlapping mode of action and similar side effects on heart rate and blood pressure, we hypothesize that such a trial might be a dedicated risk mitigation strategy for public health. A critical assessment of cardiovascular side effects of MPH appears particularly warranted, because ADHD is associated with obesity, smoking and poor health in general. We summarize recent findings with the focus on cardiovascular risks of MPH in humans; we additionally analyze the limited number of rodent studies that have addressed cardiovascular risks of MPH.
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Affiliation(s)
- Jochen Antel
- Research-Unit of the Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, LVR-Klinikum Essen, University of Duisburg-Essen, IG1 Virchowstr. 171, 45147, Essen, Germany,
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Arnold LE, Hodgkins P, Caci H, Kahle J, Young S. Effect of treatment modality on long-term outcomes in attention-deficit/hyperactivity disorder: a systematic review. PLoS One 2015; 10:e0116407. [PMID: 25714373 PMCID: PMC4340791 DOI: 10.1371/journal.pone.0116407] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 12/09/2014] [Indexed: 11/18/2022] Open
Abstract
Background Evaluation of treatments for attention-deficit/hyperactivity disorder (ADHD) previously focused on symptom control, but attention has shifted to functional outcomes. The effect of different ADHD treatment periods and modalities (pharmacological, non-pharmacological, and combination) on long-term outcomes needs to be more comprehensively understood. Methods A systematic search of 12 literature databases using Cochrane’s guidelines yielded 403 English-language peer-reviewed, primary studies reporting long-term outcomes (≥2 years). We evaluated relative effects of treatment modalities and durations and effect sizes of outcomes reported as statistically significantly improved with treatment. Results The highest proportion of improved outcomes was reported with combination treatment (83% of outcomes). Among significantly improved outcomes, the largest effect sizes were found for combination treatment. The greatest improvements were associated with academic, self-esteem, or social function outcomes. A majority of outcomes improved regardless of age of treatment initiation (60%–75%) or treatment duration (62%–72%). Studies with short treatment duration had shorter follow-up times (mean 3.2 years total study length) than those with longer treatment durations (mean 7.1 years total study length). Studies with follow-up times <3 years reported benefit with treatment for 93% of outcomes, whereas those with follow-up times ≥3 years reported treatment benefit for 57% of outcomes. Post-hoc analysis indicated that this result was related to the measurement of outcomes at longer periods (3.2 versus 0.4 years) after treatment cessation in studies with longer total study length. Conclusions While the majority of long-term outcomes of ADHD improve with all treatment modalities, the combination of pharmacological and non-pharmacological treatment was most consistently associated with improved long-term outcomes and large effect sizes. Older treatment initiation age or longer durations did not markedly affect proportion of improved outcomes reported, but measurement of outcomes long periods after treatment cessation may attenuate results.
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Affiliation(s)
- L. Eugene Arnold
- Research Unit on Pediatric Psychopharmacology, The Ohio State University, Columbus, Ohio, United States of America
| | - Paul Hodgkins
- Global Health Economics & Outcomes Research, Shire, Wayne, PA, United States of America
| | - Hervé Caci
- Hôpitaux Pédiatriques de Nice CHU Lenval, F-06200, Nice, France
| | - Jennifer Kahle
- BPS International, San Diego, CA, 92130, United States of America
- * E-mail:
| | - Susan Young
- Imperial College London, Centre for Mental Health, London, SW7 2AZ, United Kingdom
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Schuck SEB, Emmerson NA, Fine AH, Lakes KD. Canine-assisted therapy for children with ADHD: preliminary findings from the positive assertive cooperative kids study. J Atten Disord 2015; 19:125-37. [PMID: 24062278 PMCID: PMC4348044 DOI: 10.1177/1087054713502080] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The objective of this study was to provide preliminary findings from an ongoing randomized clinical trial using a canine-assisted intervention (CAI) for 24 children with ADHD. METHOD Project Positive Assertive Cooperative Kids (P.A.C.K.) was designed to study a 12-week cognitive-behavioral intervention delivered with or without CAI. Children were randomly assigned to group therapy with or without CAI. Parents of children in both groups simultaneously participated in weekly parent group therapy sessions. RESULTS Across both treatment groups, parents reported improvements in children's social skills, prosocial behaviors, and problematic behaviors. In both groups, the severity of ADHD symptoms declined during the course of treatment; however, children who received the CAI model exhibited greater reductions in the severity of ADHD symptoms than did children who received cognitive-behavioral therapy without CAI. CONCLUSION Results suggest that CAI offers a novel therapeutic strategy that may enhance cognitive-behavioral interventions for children with ADHD.
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Tarver J, Daley D, Sayal K. Beyond symptom control for attention-deficit hyperactivity disorder (ADHD): what can parents do to improve outcomes? Child Care Health Dev 2015; 41:1-14. [PMID: 24910021 DOI: 10.1111/cch.12159] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/30/2014] [Indexed: 01/08/2023]
Abstract
Attention-deficit hyperactivity disorder (ADHD) and its associated behavioural manifestations develop and progress as the result of complex gene-environment interactions. Parents exert a substantial influence and play a major role in their child's social environment. Despite this, recent evidence has suggested that adapting the child's environment via parenting interventions has minimal effects on child ADHD symptoms when analysing data from informants who are probably blind to treatment allocation. However, adverse parenting and family environments may act as a source of environmental risk for a number of child outcomes beyond ADHD symptoms. This is a narrative review that critically discusses whether parenting interventions are beneficial for alternative functioning outcomes in ADHD including neuropsychological, academic and social functioning and disruptive behaviour and how parenting and familial environments may be associated with these outcomes. In addition, the review explores how parental depression and parenting efficacy impact on capacity for optimal parenting and whether parenting interventions benefit parents too. A review of the evidence suggests that with modification, parenting interventions are beneficial for a number of outcomes other than ADHD symptom reduction. Improving the parent-child relationship may have indirect benefits for disruptive behaviour. Furthermore, parenting behaviours may directly benefit child neuropsychological, academic and social functioning. Parenting interventions can have therapeutic benefits for parents as well as children, which is important as parent and child well-being is likely to have a transactional relationship. Evaluation of the clinical success of parenting interventions should focus on a wider range of outcomes in order to aid understanding of the multifaceted benefits that they may be able to offer. Parenting interventions should not be seen as a redundant adjunct to medication in multi-modal treatment approaches for ADHD; they have the potential to target outcomes that, at present, medication seems less able to improve.
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Affiliation(s)
- J Tarver
- Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK; Centre for ADHD and Neuro-developmental Disorders across the Life Span (CANDAL), Institute of Mental Health, University of Nottingham, Nottingham, UK
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Chacko A, Kofler M, Jarrett M. Improving outcomes for youth with ADHD: a conceptual framework for combined neurocognitive and skill-based treatment approaches. Clin Child Fam Psychol Rev 2014; 17:368-84. [PMID: 25120200 PMCID: PMC4335705 DOI: 10.1007/s10567-014-0171-5] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a prevalent and chronic mental health condition that often results in substantial impairments throughout life. Although evidence-based pharmacological and psychosocial treatments exist for ADHD, effects of these treatments are acute, do not typically generalize into non-treated settings, rarely sustain over time, and insufficiently affect key areas of functional impairment (i.e., family, social, and academic functioning) and executive functioning. The limitations of current evidence-based treatments may be due to the inability of these treatments to address underlying neurocognitive deficits that are related to the symptoms of ADHD and associated areas of functional impairment. Although efforts have been made to directly target the underlying neurocognitive deficits of ADHD, extant neurocognitive interventions have shown limited efficacy, possibly due to misspecification of training targets and inadequate potency. We argue herein that despite these limitations, next-generation neurocognitive training programs that more precisely and potently target neurocognitive deficits may lead to optimal outcomes when used in combination with specific skill-based psychosocial treatments for ADHD. We discuss the rationale for such a combined treatment approach, prominent examples of this combined treatment approach for other mental health disorders, and potential combined treatment approaches for pediatric ADHD. Finally, we conclude with directions for future research necessary to develop a combined neurocognitive + skill-based treatment for youth with ADHD.
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Affiliation(s)
- Anil Chacko
- Department of Applied Psychology, New York University, New York, NY, USA,
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Derefinko KJ, Hayden A, Sibley MH, Duvall J, Milich R, Lorch EP. A Story Mapping Intervention to Improve Narrative Comprehension Deficits in Adolescents with ADHD. SCHOOL MENTAL HEALTH 2014; 6:251-263. [PMID: 25436018 PMCID: PMC4244711 DOI: 10.1007/s12310-014-9127-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The current study examined the effects of an 8-week Story Mapping Intervention (SMI) to improve narrative comprehension in adolescents with ADHD. Thirty 12 - 16 year-old adolescents with ADHD who were participating in a summer treatment program for adolescents with ADHD received the SMI instruction ten times and completed SMI homework ten times in a structured environment with teacher feedback. Recall of fables and story creation were assessed before and after the SMI. At post-test, fable recalls included more of the most important events, were more coherent, and included a greater number of plausible inferences than pre-test fable recalls. SMI homework scores accounted for increases in recall of important events and plausible inferences, suggesting that consistent practice and feedback with story mapping could contribute to important recall gains. In contrast, the inclusion of goal-based events and the rated coherence of created stories did not improve, suggesting that more explicit instruction in applying story mapping to story creation may be required.
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66
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Tarver J, Daley D, Sayal K. Attention-deficit hyperactivity disorder (ADHD): an updated review of the essential facts. Child Care Health Dev 2014; 40:762-74. [PMID: 24725022 DOI: 10.1111/cch.12139] [Citation(s) in RCA: 146] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/06/2014] [Indexed: 02/07/2023]
Abstract
Attention-deficit hyperactivity disorder (ADHD) is a complex disorder that can affect individuals across the lifespan. It is associated with substantial heterogeneity in terms of aetiology, clinical presentation and treatment outcome and is the subject of extensive research. Because of this, it can be difficult for clinicians to stay up to date with the most relevant findings and know how best to respond to parents' questions and concerns about the disorder and interventions. This is a narrative review that aims to summarize key findings from recent research into ADHD and its treatment that clinicians can share with families in order to increase their knowledge about ADHD and intervention options. ADHD develops as a result of complex interplay between interdependent genetic and non-genetic factors. The disorder is associated with substantial impairments in functioning and poor long-term outcomes. Pharmacological and non-pharmacological treatment options are available for symptom management and to improve function, but functioning outcomes often fail to normalize in children with ADHD. Despite extensive advances in understanding this complex disorder, it is clear that there is still a long way to go. In particular, we address the need for future non-pharmacological interventions to be more specifically targeted for ADHD symptoms and its commonly associated functioning deficits in order to ensure the best long-term outcomes for children with ADHD.
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Affiliation(s)
- J Tarver
- Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK; Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan (CANDAL), University of Nottingham, Nottingham, UK
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Evans SW, Langberg JM, Egan T, Molitor SJ. Middle and High School Based Interventions for Adolescents with ADHD. Child Adolesc Psychiatr Clin N Am 2014; 23:699-715. [PMID: 25220081 PMCID: PMC4167775 DOI: 10.1016/j.chc.2014.05.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The development and evaluation of psychosocial treatments for adolescents with attention-deficit/hyperactivity disorder has lagged behind the treatment development work conducted with children with the disorder. Two middle school-based and high school-based treatment programs have the most empirical work indicating beneficial effects. Treatment development research addressing many of the basic questions related to mediators, moderators, and sequencing of treatments is needed. Implications for future treatment development research are reviewed, including the potential benefits of combining treatments of a variety of modalities to address the large gaps in the literature.
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Affiliation(s)
- Steven W. Evans
- Department of Psychology, Center for Intervention Research in Schools, Ohio University, Athens, Ohio 45701
| | - Joshua M. Langberg
- Department of Psychology, Virginia Commonwealth University, 806 W. Franklin Street, P.O. Box 842018, Richmond, Virginia 23284-2018
| | - Theresa Egan
- Department of Psychology, Center for Intervention Research in Schools, Ohio University, Athens, Ohio 45701
| | - Stephen J. Molitor
- Department of Psychology, Virginia Commonwealth University, 806 W. Franklin street, P.O. Box 842018, Richmond, Virginia 23284-2018
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Hogue A, Bobek M, Tau GZ, Levin FR. Clinical Strategies for Integrating Medication Interventions Into Behavioral Treatment for Adolescent ADHD: The Medication Integration Protocol. CHILD & FAMILY BEHAVIOR THERAPY 2014; 36:280-304. [PMID: 25505817 PMCID: PMC4258514 DOI: 10.1080/07317107.2014.967631] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Attention-Deficit/Hyperactivity Disorder (ADHD) is highly prevalent among adolescents enrolled in behavioral health services but remains undertreated in this age group. Also the first-line treatment for adolescent ADHD, stimulant medication, is underutilized in routine practice. This article briefly describes three behavioral interventions designed to promote stronger integration of medication interventions into treatment planning for adolescent ADHD: family ADHD psychoeducation, family-based medication decision-making, and behavior therapist leadership in coordinating medication integration. It then introduces the Medication Integration Protocol (MIP), which incorporates all three interventions into a five-task protocol: ADHD Assessment and Medication Consult; ADHD Psychoeducation and Client Acceptance; ADHD Symptoms and Family Relations; ADHD Medication and Family Decision-Making; and Medication Management and Integration Planning. The article concludes by highlighting what behavior therapists should know about best practices for medication integration across diverse settings and populations: integrating medication interventions into primary care, managing medication priorities and polypharmacy issues for adolescents with multiple diagnoses, providing ADHD medications to adolescent substance users, and the compatibility of MIP intervention strategies with everyday practice conditions.
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Affiliation(s)
- Aaron Hogue
- The National Center on Addiction and Substance Abuse at Columbia University, New York, New York, USA
| | - Molly Bobek
- The National Center on Addiction and Substance Abuse at Columbia University, New York, New York, USA
| | - Gregory Z Tau
- Division of Child and Adolescent Psychiatry at Columbia University, New York, New York, USA and New York State Psychiatric Institute
| | - Frances R Levin
- Division on Substance Abuse at Columbia University, New York, New York, USA and New York State Psychiatric Institute
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Fienup DM, Reyes-Giordano K, Wolosik K, Aghjayan A, Chacko A. Brief Experimental Analysis of Reading Deficits for Children With Attention-Deficit/Hyperactivity Disorder. Behav Modif 2014; 39:191-214. [DOI: 10.1177/0145445514550393] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Reading difficulties are especially high among children with attention-deficit/hyperactivity disorder (ADHD). Although there are a number of empirically supported reading interventions for children with ADHD, there is little data to guide the selection of the most efficacious reading intervention for a specific child. Brief experimental analysis (BEA) is a procedure that directly compares the efficacy of various academic interventions with the goal of guiding the selection of the intervention that results in optimal efficacy. The current proof of concept study examined the efficacy of the BEA methodology for determining the relative effectiveness of seven reading interventions for children with ADHD. The seven interventions included empirically supported ADHD interventions as well as traditional interventions found in the BEA literature. Six children diagnosed with ADHD completed the proof of concept study. Results indicated that the BEA successfully determined an efficacious intervention for each participant. The efficacy of the interventions and the optimal intervention based on BEA procedures varied for each child, suggesting the importance of a BEA approach when comparing various interventions for reading in children with ADHD. Implications and future directions for selecting effective reading interventions for children with ADHD are discussed.
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Affiliation(s)
- Daniel M. Fienup
- Queens College, CUNY, Flushing, NY, USA
- The Graduate Center, CUNY, New York, NY, USA
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Hong M, Lee WH, Moon DS, Lee SM, Chung US, Bahn GH. A 36 month naturalistic retrospective study of clinic-treated youth with attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol 2014; 24:341-6. [PMID: 24955936 DOI: 10.1089/cap.2013.0090] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate factors for pharmacotherapy adherence in patients with attention-deficit/hyperactivity disorder (ADHD), with an emphasis on medication possession ratio (MPR). METHODS The medical records of 300 clinic-treated youth diagnosed with ADHD were retrospectively reviewed. Patients from March 2005 through January 2009 were diagnosed using the Diagnostic and Statistical Manual of Mental Disorders, 4(th) ed., Text Revision (DSM-IV-TR) and psychological tests. Patients were classified based on the time period from the initial visit to the last visit. We selectively compared the early dropout group within 6 months and the long-term medication group over 36 months (LMed) to identify long-term follow-up characteristics. The short-term follow-up group was divided into an early dropout group without pharmacotherapy commencement (EDO) and a short-term medication group (SMed). Sociodemographic data, psychological test scores, and average MPR of the EDO, SMed, and LMed groups were compared. RESULTS The number of EDO patients was 69 (23.0%) out of the 300 total patients who were studied, and there were 59 SMed patients (19.3%), and 60 LMed patients (20.0%). Compared with other groups, the EDO group included significantly more younger patients, younger parents, higher maternal education level, lower Short Form Korean-Conners' Parent Rating Scale (K-CPRS) score, and higher full scale and performance intelligence quotient (IQ). There was no significant correlation between the average MPR and the treatment duration. CONCLUSIONS Within the first 6 months of visiting the hospital, >40% of the patients dropped out of treatment regardless of methylphenidate (MPH) use. Twenty percent of the subjects showed adherence to MPH medication after 36 months.
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Affiliation(s)
- Minha Hong
- 1 Department of Neuropsychiatry, School of Medicine, Kyung Hee University , Seoul, Korea
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71
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Sciberras E, Mueller KL, Efron D, Bisset M, Anderson V, Schilpzand EJ, Jongeling B, Nicholson JM. Language problems in children with ADHD: a community-based study. Pediatrics 2014; 133:793-800. [PMID: 24753530 DOI: 10.1542/peds.2013-3355] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To examine the prevalence of language problems in children with attention-deficit/hyperactivity disorder (ADHD) versus non-ADHD controls, and the impact of language problems on the social and academic functioning of children with ADHD. METHODS Children (6 to 8 years) with ADHD (n = 179) and controls (n = 212) were recruited through 43 Melbourne schools. ADHD was assessed by using the Conners 3 ADHD Index and the Diagnostic Interview Schedule for Children IV. Oral language was assessed by using the Clinical Evaluation of Language Fundamentals, fourth edition, screener. Academic functioning was measured via direct assessment (Wide Range Achievement Test 4) and teacher report (Social Skills Improvement System). Social functioning was measured via parent and teacher report (Strengths and Difficulties Questionnaire; Social Skills Improvement System). Logistic and linear regression models were adjusted for sociodemographic factors and child comorbidities. RESULTS Children with ADHD had a higher prevalence of language problems than controls after adjustment for sociodemographic factors and comorbidities (odds ratio, 2.8; 95% confidence interval [CI], 1.5 to 5.1). Compared with children with ADHD alone, those with language problems had poorer word reading (mean difference [MD], -11.6; 95% CI, -16.4 to -6.9; effect size, -0.7), math computation (MD, -11.4; 95% CI, -15.0 to -7.7; effect size, -0.8), and academic competence (MD, -10.1; 95% CI, -14.0 to -6.1; effect size, -0.7). Language problems were not associated with poorer social functioning. CONCLUSIONS Children with ADHD had a higher prevalence of language problems than controls, and language problems in children with ADHD contributed to markedly poorer academic functioning.
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Affiliation(s)
- Emma Sciberras
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia; The Royal Children's Hospital, Parkville, Victoria, Australia;
| | - Kathryn L Mueller
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Daryl Efron
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia; The Royal Children's Hospital, Parkville, Victoria, Australia; The University of Melbourne, Parkville, Victoria, Australia
| | - Matthew Bisset
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Vicki Anderson
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia; The Royal Children's Hospital, Parkville, Victoria, Australia; The University of Melbourne, Parkville, Victoria, Australia
| | - Elizabeth J Schilpzand
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia; The University of Melbourne, Parkville, Victoria, Australia
| | - Brad Jongeling
- Child Development Service, Joondalup, Western Australia; The University of Western Australia, Perth, Western Australia; and
| | - Jan M Nicholson
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia; Parenting Research Centre, Melbourne, Victoria, Australia
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Becker SP, Paternite CE, Evans SW. Special Educators’ Conceptualizations of Emotional Disturbance and Educational Placement Decision Making for Middle and High School Students. SCHOOL MENTAL HEALTH 2014. [DOI: 10.1007/s12310-014-9119-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Mediators of methylphenidate effects on math performance in children with attention-deficit hyperactivity disorder. J Dev Behav Pediatr 2014; 35:100-7. [PMID: 24509055 PMCID: PMC3928797 DOI: 10.1097/dbp.0000000000000025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Stimulant medications, such as methylphenidate (MPH), improve the academic performance of children with attention-deficit hyperactivity disorder (ADHD). However, the mechanism by which MPH exerts an effect on academic performance is unclear. We examined MPH effects on math performance and investigated possible mediation of MPH effects by changes in time on-task, inhibitory control, selective attention, and reaction time variability. METHODS Children with ADHD aged 7 to 11 years (N = 93) completed a timed math worksheet (with problems tailored to each individual's level of proficiency) and 2 neuropsychological tasks (Go/No-Go and Child Attention Network Test) at baseline, then participated in a 4-week, randomized, controlled, titration trial of MPH. Children were then randomly assigned to their optimal MPH dose or placebo for 1 week (administered double-blind) and repeated the math and neuropsychological tasks (posttest). Baseline and posttest videorecordings of children performing the math task were coded to assess time on-task. RESULTS Children taking MPH completed 23 more math problems at posttest compared to baseline, whereas the placebo group completed 24 fewer problems on posttest versus baseline, but the effects on math accuracy (percent correct) did not differ. Path analyses revealed that only change in time on-task was a significant mediator of MPH's improvements in math productivity. CONCLUSIONS MPH-derived math productivity improvements may be explained in part by increased time spent on-task, rather than improvements in neurocognitive parameters, such as inhibitory control, selective attention, or reaction time variability.
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Becker SP, Fite PJ, Vitulano ML, Rubens SL, Evans SC, Cooley JL. Examining Anxiety and Depression as Moderators of the Associations Between ADHD Symptoms and Academic and Social Problems in Hispanic Adolescents. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2013. [DOI: 10.1007/s10862-013-9394-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Parker J, Wales G, Chalhoub N, Harpin V. The long-term outcomes of interventions for the management of attention-deficit hyperactivity disorder in children and adolescents: a systematic review of randomized controlled trials. Psychol Res Behav Manag 2013; 6:87-99. [PMID: 24082796 PMCID: PMC3785407 DOI: 10.2147/prbm.s49114] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To systematically identify and review the currently available evidence on the long-term outcomes of recommended attention-deficit hyperactivity disorder (ADHD) interventions following randomized controlled trials with children and young people. METHOD A systematic search was conducted to identify trials >1 year in length using the following databases: CINAHL (January 1982- July 2012), MEDLINE (Ovid and Cambridge Scientific Abstracts [CSA]), Psych info, Science Direct (Elsevier), and Cochrane Library. Hand searches of key journals in the subject, book chapters, and conference proceedings were also carried out. Relevant papers were critically appraised using the Cochrane risk of bias tool. RESULTS Eight controlled trials were identified as being relevant, of duration ranging from 1 year to 8 years (at follow up). The total number of participants in the studies was 1,057, of whom 579 (54.7%) were from one cohort and included 26 different outcome measures. Results suggest there is moderate-to-high-level evidence that combined pharmacological and behavioral interventions, and pharmacological interventions alone can be effective in managing the core ADHD symptoms and academic performance at 14 months. However, the effect size may decrease beyond this period. CONCLUSION This review has highlighted the paucity and limitations of the evidence investigating the long-term outcomes of recommended interventions for managing ADHD symptoms. There is little evidence to suggest that the effects observed over the relatively short term are maintained throughout longer periods of impairment. Furthermore, much of the existing evidence examining effectiveness beyond 12 months does not include newer medications currently available or consider significant contextual and cultural differences, such as UK/European and Asian populations. Longitudinal studies are required to examine the long-term outcomes for children and young people with ADHD managed with currently recommended service interventions. They should also include the whole spectrum of ADHD, with its full range of coexisting conditions, and cultural and contextual diversity.
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Affiliation(s)
- Jack Parker
- Child and Adolescent Mental Health Service, Sheffield Children’s NHS Foundation Trust, Sheffield, UK
| | - Gill Wales
- Paediatric Neurodisability, Ryegate Children’s Centre, Sheffield Children’s NHS Foundation Trust, Sheffield, UK
| | - Nevyne Chalhoub
- Child and Adolescent Mental Health Service, Sheffield Children’s NHS Foundation Trust, Sheffield, UK
| | - Val Harpin
- Paediatric Neurodisability, Ryegate Children’s Centre, Sheffield Children’s NHS Foundation Trust, Sheffield, UK
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Abstract
OBJECTIVE To better understand how heterogeneity in attention-deficit hyperactivity disorder (ADHD) symptoms relates to heterogeneity in functional impairment domains in children with ADHD after accounting for demographic variables and comorbidities, in particular oppositionality and internalizing symptoms. METHODS Parents and teachers (n = 5663) rated child/adolescent impairments across impairment domains in the International Classification of Functioning, Disability and Health as well as symptoms of ADHD and comorbidities. Hierarchical regressions were conducted to assess the relationship between parent and teacher ratings of ADHD symptom domains and functional impairments after accounting for personal factors and comorbid disorders. RESULTS Symptoms of inattention were the strongest predictors of ratings of academic (math, writing, and so on) functioning, while hyperactivity/impulsivity symptoms were the strongest predictor of classroom disruption even after accounting for the presence of learning disorders and oppositional symptoms. Symptoms of ADHD accounted for minimal variance in interpersonal functioning or participation in organized activities after controlling oppositional symptoms. CONCLUSION The ADHD symptom domains demonstrate domain-specific relations with various ADHD-related functional impairments. In addition, the results highlight the role of oppositionality in interpersonal relationship difficulties and participation in organized activities.
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Graves SL, Serpell Z. Racial Differences in Medication Use in a National Sample of Children with ADHD Enrolled in Special Education. SCHOOL MENTAL HEALTH 2013. [DOI: 10.1007/s12310-013-9105-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Advokat C, Scheithauer M. Attention-deficit hyperactivity disorder (ADHD) stimulant medications as cognitive enhancers. Front Neurosci 2013; 7:82. [PMID: 23754970 PMCID: PMC3666055 DOI: 10.3389/fnins.2013.00082] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 05/07/2013] [Indexed: 11/13/2022] Open
Abstract
Recent increases in attention deficit hyperactivity disorder (ADHD) diagnoses, and the escalation of stimulant prescriptions, has raised concern about diversion and abuse of stimulants, as well as the ethics of using these drugs as “cognitive enhancers.”Such concern appears misplaced in the face of substantial evidence that stimulant drugs do not improve the academic performance of ADHD-diagnosed students. Moreover, numerous studies have found little or no benefit of stimulants on neuropsychological tests of ADHD-diagnosed as well as normal, individuals. This paper examines the apparent paradox: why don't drugs that improve “attention,” produce better academic outcomes in ADHD-diagnosed students? We found that stimulant drugs significantly improved impairment of episodic memory in ADHD-diagnosed undergraduate students. Nevertheless, we also found consistent academic deficits between ADHD students and their non-ADHD counterparts, regardless of whether or not they used stimulant medications. We reviewed the current literature on the behavioral effects of stimulants, to try to find an explanation for these conflicting phenomena. Across a variety of behavioral tasks, stimulants have been shown to reduce emotional reactions to frustration, improve the ability to detect errors, and increase effortful behavior. However, all of these effects would presumably enhance academic performance. On the other hand, the drugs were also found to promote “risky behavior” and to increase susceptibility to environmental distraction. Such negative effects, including the use of drugs to promote wakefulness for last minute study, might explain the lack of academic benefit in the “real world,” despite their cognitive potential. Like many drugs, stimulants influence behavior in multiple ways, depending on the environmental contingencies. Depending on the circumstances, stimulants may, or may not, enhance cognition.
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Affiliation(s)
- Claire Advokat
- Department of Psychology, Louisiana State University Baton Rouge, LA, USA
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Sibley MH, Pelham WE, Derefinko KJ, Kuriyan AB, Sanchez F, Graziano PA. A Pilot Trial of Supporting teens’ Academic Needs Daily (STAND): A Parent-Adolescent Collaborative Intervention for ADHD. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2013. [DOI: 10.1007/s10862-013-9353-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Langberg JM, Becker SP, Dvorsky MR. The Association Between Sluggish Cognitive Tempo and Academic Functioning in Youth with Attention-Deficit/Hyperactivity Disorder (ADHD). JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2013; 42:91-103. [PMID: 23359145 DOI: 10.1007/s10802-013-9722-3] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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