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Paananen M, Husberg H, Katajamäki H, Aro T. School-based group intervention in attention and executive functions: Intervention response and moderators. Front Psychol 2022; 13:975856. [PMID: 36186366 PMCID: PMC9521625 DOI: 10.3389/fpsyg.2022.975856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 08/19/2022] [Indexed: 11/20/2022] Open
Abstract
Objective This study investigated the effects of a school-based skill-training intervention in attention control and executive functions for pupils with hyperactivity-impulsivity (H-I) and cognitive control (CC) deficits. The main aim was to examine whether the intervention differently influenced H-I and CC, and whether cognitive abilities or conduct problems moderated response to the intervention. Method Elementary school pupils from 41 schools participated the study and were divided into an intervention group (n = 71) and a waitlist control group (n = 77). Intervention outcomes were assessed with an inventory assessing executive function difficulties (including H-I and CC) completed by classroom teachers. Results Significant intervention effects and positive changes were detected in CC but not in H-I. Significant intervention effects were found mainly among pupils with low levels of conduct problems. Conclusions The results suggest that a skill-training intervention has specific positive effects on CC, but conduct problems may diminish response to intervention.
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Affiliation(s)
- Mika Paananen
- Niilo Mäki Institute, Jyväskylä, Finland
- Department of Psychology, University of Jyväskylä, Jyväskylä, Finland
- *Correspondence: Mika Paananen
| | - Henrik Husberg
- Niilo Mäki Institute, Jyväskylä, Finland
- Department of Education, University of Helsinki, Helsinki, Finland
| | | | - Tuija Aro
- Department of Psychology, University of Jyväskylä, Jyväskylä, Finland
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52
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Asgharian P, Quispe C, Herrera-Bravo J, Sabernavaei M, Hosseini K, Forouhandeh H, Ebrahimi T, Sharafi-Badr P, Tarhriz V, Soofiyani SR, Helon P, Rajkovic J, Durna Daştan S, Docea AO, Sharifi-Rad J, Calina D, Koch W, Cho WC. Pharmacological effects and therapeutic potential of natural compounds in neuropsychiatric disorders: An update. Front Pharmacol 2022; 13:926607. [PMID: 36188551 PMCID: PMC9521271 DOI: 10.3389/fphar.2022.926607] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 08/03/2022] [Indexed: 11/13/2022] Open
Abstract
Neuropsychiatric diseases are a group of disorders that cause significant morbidity and disability. The symptoms of psychiatric disorders include anxiety, depression, eating disorders, autism spectrum disorders (ASD), attention-deficit/hyperactivity disorder, and conduct disorder. Various medicinal plants are frequently used as therapeutics in traditional medicine in different parts of the world. Nowadays, using medicinal plants as an alternative medication has been considered due to their biological safety. Despite the wide range of medications, many patients are unable to tolerate the side effects and eventually lose their response. By considering the therapeutic advantages of medicinal plants in the case of side effects, patients may prefer to use them instead of chemical drugs. Today, the use of medicinal plants in traditional medicine is diverse and increasing, and these plants are a precious heritage for humanity. Investigation about traditional medicine continues, and several studies have indicated the basic pharmacology and clinical efficacy of herbal medicine. In this article, we discuss five of the most important and common psychiatric illnesses investigated in various studies along with conventional therapies and their pharmacological therapies. For this comprehensive review, data were obtained from electronic databases such as MedLine/PubMed, Science Direct, Web of Science, EMBASE, DynaMed Plus, ScienceDirect, and TRIP database. Preclinical pharmacology studies have confirmed that some bioactive compounds may have beneficial therapeutic effects in some common psychiatric disorders. The mechanisms of action of the analyzed biocompounds are presented in detail. The bioactive compounds analyzed in this review are promising phytochemicals for adjuvant and complementary drug candidates in the pharmacotherapy of neuropsychiatric diseases. Although comparative studies have been carefully reviewed in the preclinical pharmacology field, no clinical studies have been found to confirm the efficacy of herbal medicines compared to FDA-approved medicines for the treatment of mental disorders. Therefore, future clinical studies are needed to accelerate the potential use of natural compounds in the management of these diseases.
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Affiliation(s)
- Parina Asgharian
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Cristina Quispe
- Facultad de Ciencias de la Salud, Universidad Arturo Prat, Iquique, Chile
| | - Jesús Herrera-Bravo
- Departamento de Ciencias Básicas, Facultad de Ciencias, Universidad Santo Tomas, Santo Tomas, Chile
- Center of Molecular Biology and Pharmacogenetics, Scientific and Technological Bioresource Nucleus, Universidad de La Frontera, Temuco, Chile
| | - Mahsa Sabernavaei
- Department of Pharmacognosy and Pharmaceutical Biotechnology, School of Pharmacy, Iran University of Medical Sciences, Tehran, Iran
| | - Kamran Hosseini
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Molecular Medicine, Faculty of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Haleh Forouhandeh
- Infectious and Tropical Diseases Research Center, Biomedicine Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Tahereh Ebrahimi
- Infectious and Tropical Diseases Research Center, Biomedicine Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Paria Sharafi-Badr
- Department of Pharmacognosy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Vahideh Tarhriz
- Infectious and Tropical Diseases Research Center, Biomedicine Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saiedeh Razi Soofiyani
- Infectious and Tropical Diseases Research Center, Biomedicine Institute, Tabriz University of Medical Sciences, Tabriz, Iran
- Clinical Research Development Unit of Sina Educational, Research and Treatment Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Paweł Helon
- Branch in Sandomierz, Jan Kochanowski University of Kielce, Sandomierz, Poland
| | - Jovana Rajkovic
- Medical Faculty, Institute of Pharmacology, Clinical Pharmacology and Toxicology, University of Belgrade, Belgrade, Serbia
| | - Sevgi Durna Daştan
- Department of Biology, Faculty of Science, Sivas Cumhuriyet University, Sivas, Turkey
- Beekeeping Development Application and Research Center, Sivas Cumhuriyet University, Sivas, Turkey
| | - Anca Oana Docea
- Department of Toxicology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | | | - Daniela Calina
- Department of Clinical Pharmacy, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Wojciech Koch
- Department of Food and Nutrition, Medical University of Lublin, Lublin, Poland
| | - William C. Cho
- Department of Clinical Oncology, Queen Elizabeth Hospital, Kowloon, Hong Kong SAR, China
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53
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Intensive Behavior Therapy for Tics and Co-Occurring ADHD: A Case Report. COGNITIVE AND BEHAVIORAL PRACTICE 2022. [DOI: 10.1016/j.cbpra.2021.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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54
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A Review of Clinical Practice Guidelines in the Diagnosis and Treatment of Attention-Deficit/Hyperactivity Disorder. Child Adolesc Psychiatr Clin N Am 2022; 31:569-581. [PMID: 35697402 DOI: 10.1016/j.chc.2022.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Clinical practice guidelines (CPGs) are systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances. CPGs have evolved during the last 2 decades from general consensus statements by prominent practitioners in the field to highly structured instruments. The Institute of Medicine has laid out specific standards for selecting the experts who develop a CPG and the process by which CPGs are developed. Attention-deficit/hyperactivity disorder (ADHD) has been the focus of more than 20 CPGs created by governments and professional societies, both in the United States and internationally. There is a good deal of consensus across these CPGs regarding the principles of the diagnosis and treatment of ADHD. Drawing on the rich research base in ADHD, all CPGs emphasize the need for screening, a diagnosis based on history and standardized rating scales, as well as the use of evidence-based psychosocial and pharmacologic treatments. They vary in terms of their emphasis on the role of psychosocial treatment and the degree to which they address comorbid disorders in ADHD. Although limited research has shown ADHG CPGs do change provider practice, there is no research examining if the changes in practice brought about by CPGs impact patient outcomes.
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Haugan ALJ, Sund AM, Young S, Thomsen PH, Lydersen S, Nøvik TS. Cognitive behavioural group therapy as addition to psychoeducation and pharmacological treatment for adolescents with ADHD symptoms and related impairments: a randomised controlled trial. BMC Psychiatry 2022; 22:375. [PMID: 35655149 PMCID: PMC9164353 DOI: 10.1186/s12888-022-04019-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 05/25/2022] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Cognitive behavioural therapy (CBT) is recommended for attention-deficit/hyperactivity-disorder (ADHD) in adolescents. However, all CBTs are not created equal, and the guidelines do not specify which CBT interventions are the most effective for this patient group. This study examines the efficacy of a group CBT without parent involvement as follow-up treatment compared to no additional CBT in adolescents with persistent and impairing ADHD symptoms after a short psychoeducational intervention and medical treatment. METHODS The authors conducted a two-arm parallel randomized controlled trial in two child and adolescent mental health outpatient clinics in Norway. One hundred patients aged 14-18 years with a diagnosis of ADHD (66%) or subthreshold ADHD (34%) were randomized to either a 12-week group CBT program (N = 50) or a non-CBT control condition (N = 50). Assessments were made at admission to the clinic, two weeks before and two weeks after treatment. The primary outcomes were parent-, teacher- and self-ratings of ADHD symptoms (ADHD Rating Scale-IV), and the secondary outcomes were ratings of ADHD symptom severity, executive function, functional impairment, and emotional problems. Evaluators blinded to group allocation rated ADHD symptom severity with the Clinical Global Impression Scale for Severity (CGI-S) at baseline and post-treatment. RESULTS Analyses using mixed-effects models showed no difference between the treatment arms from baseline to post treatment in primary and secondary outcomes. CONCLUSIONS Contrary to our hypothesis, we found no incremental treatment effect on the part of a group CBT as follow-up to psychoeducation and pharmacological treatment on ADHD symptoms and accompanying impairments. Limitations with the CBT was the large number and low dosage of treatment components, causing restricted time for practice. Unlike evidence-based, individualized targeted CBTs with parent involvement, a group CBT directed solely at the adolescents with no parent involvement does not appear effective for treating ADHD. TRIAL REGISTRATION NCT02937142 , 18/10/2016.
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Affiliation(s)
- Anne-Lise Juul Haugan
- Department of Mental Health, Faculty of Medicine and Health Sciences, Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), NTNU- Norwegian University of Science and Technology, Trondheim, Norway.
| | - Anne Mari Sund
- Department of Mental Health, Faculty of Medicine and Health Sciences, Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), NTNU- Norwegian University of Science and Technology, Trondheim, Norway
- Department of Child and Adolescent Psychiatry, St. Olav University Hospital, Trondheim, Norway
| | - Susan Young
- Psychology Services Limited, London, UK
- Department of Psychology, University of Reykjavik, Reykjavik, Iceland
| | - Per Hove Thomsen
- Department of Mental Health, Faculty of Medicine and Health Sciences, Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), NTNU- Norwegian University of Science and Technology, Trondheim, Norway
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark
| | - Stian Lydersen
- Department of Mental Health, Faculty of Medicine and Health Sciences, Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), NTNU- Norwegian University of Science and Technology, Trondheim, Norway
| | - Torunn Stene Nøvik
- Department of Mental Health, Faculty of Medicine and Health Sciences, Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), NTNU- Norwegian University of Science and Technology, Trondheim, Norway
- Department of Child and Adolescent Psychiatry, St. Olav University Hospital, Trondheim, Norway
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Wang FH, Sun LY, Cui XM, Zhao HD, Yang LF, Wang Z, Shi TK. Comparative efficacy of targeted structural patterns of electroencephalography neurofeedback in children with inattentive or combined attention deficit hyperactivity disorder. Brain Behav 2022; 12:e2572. [PMID: 35462456 PMCID: PMC9226819 DOI: 10.1002/brb3.2572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/08/2022] [Accepted: 03/20/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate and compare the effects of three courses of different structural patterns of electroencephalography neurofeedback on predominantly inattentive attention deficit hyperactivity disorder (ADHD-PI) and combined ADHD (ADHD-CT). METHODS Thirty-eight ADHD-PI and ADHD-CT children were selected and completed three courses of different structural patterns of electroencephalography neurofeedback according to their ADHD type. Before and after each course, relative power value of electroencephalography, including θ, β, α, SMR and their ratios (θ/β, θ/α), and eighteen integrated visual and auditory continuous performance test (IVA/CPT) quotients were obtained and compared. Data were analyzed by SPSS software, and p < .05 was considered statistically significant. RESULTS After one course, θ, three IVA/CPT quotients in both types and two comprehensive quotients in ADHD-CT changed significantly (all p < .05). After two courses, θ/α, θ/β and five IVA/CPT quotients in both types, θ and α in ADHD-PI, four comprehensive quotients, and four respond control quotients in ADHD-CT varied significantly compared to before treatment and after one course (all p < .05). After three courses, α, β, θ, θ/α, θ/β and ten IVA/CPT quotients in both types changed significantly compared to before treatment and after one course (all p < .05). In addition, six IVA/CPT quotients in both types after three courses were significantly higher than those after two courses (all p < .05). CONCLUSION Different structural patterns of electroencephalography neurofeedback targeted for ADHD-CT and ADHD-PI were both effective and feasible. Three courses of EEG neurofeedback were most effective.
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Affiliation(s)
- Feng-Hua Wang
- School of Medicine, Jiaxing University, Jiaxing, China
| | - Li-Yan Sun
- School of Medicine, Jiaxing University, Jiaxing, China
| | - Xiao-Mei Cui
- Women's and Children's Hospital Affiliated to Jiaxing University, Jiaxing, China
| | | | - Ling-Fei Yang
- School of Medicine, Jiaxing University, Jiaxing, China
| | - Zheng Wang
- School of Medicine, Jiaxing University, Jiaxing, China
| | - Tong-Kun Shi
- School of Medicine, Jiaxing University, Jiaxing, China
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57
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Lawson GM, Owens JS, Mandell DS, Tavlin S, Rufe S, So A, Power TJ. Barriers and Facilitators to Teachers' Use of Behavioral Classroom Interventions. SCHOOL MENTAL HEALTH 2022; 14:844-862. [PMID: 35669254 PMCID: PMC9135387 DOI: 10.1007/s12310-022-09524-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2022] [Indexed: 11/30/2022]
Abstract
Multi-tiered behavioral classroom interventions are particularly important for students with or at risk for ADHD or other externalizing behaviors. Teachers often use these interventions infrequently or not as designed, and little is known about the barriers and facilitators to their use, especially from the teachers' perspective. Using an exploratory sequential approach, we first used semi-structured qualitative interviews to identify teacher-reported barriers and facilitators to using three Tier 1 and one Tier 2 behavioral classroom interventions with students with ADHD symptoms (Study 1). Then, we identified which barriers and facilitators were most frequently endorsed on a survey (Study 2). The types of barriers and facilitators that emerged from semi-structured interviews included teachers' beliefs about behavioral classroom interventions (i.e., about their effectiveness or the consequences of using them) that motivated teachers or reduced their motivation to use them, as well as factors that interfered or assisted with execution in the moment. The most frequently endorsed barriers were being distracted or forgetting due to competing demands, and feeling "stressed, frustrated, or burned out;" frequently endorsed facilitators included having a strong student-teacher relationship and having built the habit of using the intervention. Together, these results identify specific, malleable factors that can be targeted when supporting teachers in using Tier 1 and Tier 2 behavioral classroom interventions for students with ADHD symptoms. Supplementary Information The online version contains supplementary material available at 10.1007/s12310-022-09524-3.
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Affiliation(s)
- Gwendolyn M. Lawson
- Children’s Hospital of Philadelphia, Philadelphia, PA USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | | | - David S. Mandell
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | | | - Steven Rufe
- School District of Philadelphia, Philadelphia, PA USA
| | - Amy So
- Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - Thomas J. Power
- Children’s Hospital of Philadelphia, Philadelphia, PA USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
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58
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Trace ME, Feygin YB, Williams PG, Winders Davis D, Brothers KB, Sullivan JE, Calhoun AW. Attention-Deficit/Hyperactivity Disorder Practice Patterns: A Survey of Kentucky Pediatric Providers. J Dev Behav Pediatr 2022; 43:233-239. [PMID: 34799539 DOI: 10.1097/dbp.0000000000001037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 09/23/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Kentucky ranks among the highest in the nation for attention-deficit/hyperactivity disorder (ADHD) prevalence in children aged 4 to 17 years. In 2011, the American Academy of Pediatrics (AAP) released a clinical practice guideline based on the DSM-IV. A guideline revision based on the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) was released in October 2019. In this study, we assess and describe pediatric providers' ADHD practices using the 2011 guideline and DSM-5 diagnostic criteria. METHODS This was a cross-sectional, survey-based descriptive study. Kentucky Chapter of the AAP (KY AAP) members were anonymously surveyed. The results were examined for trends in routine practice. RESULTS Fifty-eight general pediatricians and pediatric residents responded to the survey, yielding a 38% (58/154) response rate. Among respondents performing routine diagnosis of ADHD (N = 51), 73% (37/51) used DSM-5 criteria. Most providers usually or always initially assessed for coexisting behavioral conditions (96%; 49/51), developmental conditions (78%; 39/51), and adverse childhood experiences (73%; 37/51). Among respondents performing routine management of ADHD (N = 55), only 11% (6/55) of respondents indicated that they titrated stimulant medications every 3 to 7 days. After initiation of medication, 78% of providers scheduled a follow-up visit within 2 to 4 weeks. During subsequent visits, only half indicated discussing behavioral interventions, screening for coexisting conditions, and reviewing follow-up teacher-rated ADHD scales. CONCLUSION Pediatricians in the KY AAP adhere to the DSM-5 criteria for diagnosing ADHD. Pediatric providers' practices would benefit from education in improvements in pharmacotherapy titration, surveillance of coexisting conditions associated with ADHD, discussion of psychosocial interventions, and school support strategies.
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Affiliation(s)
- Marie E Trace
- Center for Developmental Pediatrics, Cleveland Clinic Children's Hospital for Rehabilitation, Cleveland, OH
| | - Yana B Feygin
- Child and Adolescent Health Research Design and Support Unit, Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY
| | - Patricia G Williams
- Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY
| | - Deborah Winders Davis
- Child and Adolescent Health Research Design and Support Unit, Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY
| | - Kyle B Brothers
- Division of Pediatric Clinical and Translational Research, Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY
| | - Janice E Sullivan
- Divisions of Pediatric Clinical and Translational Research and Pediatric Critical Care, Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY
| | - Aaron W Calhoun
- Division of Pediatric Critical Care, Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY
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Yao A, Shimada K, Kasaba R, Tomoda A. Beneficial Effects of Behavioral Parent Training on Inhibitory Control in Children With Attention-Deficit/Hyperactivity Disorder: A Small-Scale Randomized Controlled Trial. Front Psychiatry 2022; 13:859249. [PMID: 35573335 PMCID: PMC9094443 DOI: 10.3389/fpsyt.2022.859249] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/17/2022] [Indexed: 11/28/2022] Open
Abstract
The purpose of this study was to examine whether the beneficial effects of behavioral parent training (BPT), as an indirect type of psychosocial treatment, are extended to cognitive manifestations beyond behavioral symptoms of attention-deficit/hyperactivity disorder (ADHD). Although previous studies of community families have shown an association between parenting quality and a child's cognitive functions, little is known about the effects of BPT on cognitive manifestations in children with ADHD. In this study, we focused on inhibitory control among cognitive domains, which is considered to be the most malleable to direct types of psychosocial treatment for ADHD. We hypothesized that inhibitory control is affected by BPT, which uses parents as the primary agents of change to help their children. Thirty school-age children (6-12 years old) with ADHD and their parents (mothers) participated and were randomly assigned to either the standard BPT or waitlist control group. Using two objective laboratory-based tasks of inhibitory control (i.e., go/no-go and single response selection tasks), we assessed baseline and post-treatment response inhibition to suppress task-irrelevant responses and response selection to select task-relevant responses. In addition to decreased ADHD symptoms and negative parenting, the BPT group exhibited significantly improved performance in the single response selection task, but not in the go/no-go task, compared with the waitlist control group. Although tentative, these findings partially support our hypothesis that BPT has beneficial effects on the cognitive inhibitory control of ADHD, highlighting the potential for supportive environmental modifications to advance cognitive development in children with ADHD.
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Affiliation(s)
- Akiko Yao
- Research Center for Child Mental Development, University of Fukui, Fukui, Japan
- Department of Child Development, United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University, and University of Fukui, Fukui, Japan
| | - Koji Shimada
- Research Center for Child Mental Development, University of Fukui, Fukui, Japan
- Department of Child Development, United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University, and University of Fukui, Fukui, Japan
- Biomedical Imaging Research Center, University of Fukui, Fukui, Japan
| | - Ryoko Kasaba
- Department of Child Development, United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University, and University of Fukui, Fukui, Japan
| | - Akemi Tomoda
- Research Center for Child Mental Development, University of Fukui, Fukui, Japan
- Department of Child Development, United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University, and University of Fukui, Fukui, Japan
- Department of Child and Adolescent Psychological Medicine, University of Fukui Hospital, Fukui, Japan
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Hornstra R, Groenman AP, van der Oord S, Luman M, Dekkers TJ, van der Veen-Mulders L, Hoekstra PJ, van den Hoofdakker BJ. Review: Which components of behavioral parent and teacher training work for children with ADHD? - a metaregression analysis on child behavioral outcomes. Child Adolesc Ment Health 2022; 28:258-268. [PMID: 35417075 DOI: 10.1111/camh.12561] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/13/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND This metaregression analysis examined which behavioral techniques that are commonly used in behavioral parent and teacher training programs for children with attention-deficit/hyperactivity disorder (ADHD) were related to program effectiveness on children's behavioral outcomes. METHODS We included 32 randomized controlled trials (N = 2594 children) investigating behavioral parent training, teacher training, or a combination, in children with ADHD under 18 years. Outcomes were symptom counts of total ADHD, inattention, and hyperactivity-impulsivity and behavioral problems. The dosage of techniques was extracted from the intervention manuals. Metaregression was used to assess which techniques and intervention characteristics (setting, delivery method, duration, and home-school collaboration) were associated with intervention effectiveness. RESULTS Higher dosage of psycho-education for parents was associated with smaller effects on behavioral problems and, only in case of parent training, also with smaller effects on ADHD symptoms. Higher dosage of teaching parents/teachers to use negative consequences was associated with larger effects on behavioral problems. Individual training compared with group training was associated with larger effects on ADHD and hyperactivity-impulsivity symptoms. CONCLUSIONS This study provides first insights into the specific techniques that are essential in behavioral parent and teacher training programs for children with ADHD. This knowledge can eventually be used to improve and tailor interventions.
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Affiliation(s)
- Rianne Hornstra
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Annabeth P Groenman
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Saskia van der Oord
- Clinical Psychology, KU Leuven, Leuven, Belgium.,Developmental Psychology, Faculty of Social and Behavioral Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Marjolein Luman
- Department of Clinical, Developmental and Neuropsychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Tycho J Dekkers
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Developmental Psychology, Faculty of Social and Behavioral Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Lianne van der Veen-Mulders
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Pieter J Hoekstra
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Barbara J van den Hoofdakker
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
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Meyer J, Alaie I, Ramklint M, Isaksson J. Associated predictors of functional impairment among adolescents with ADHD-a cross-sectional study. Child Adolesc Psychiatry Ment Health 2022; 16:29. [PMID: 35382854 PMCID: PMC8985377 DOI: 10.1186/s13034-022-00463-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/24/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) in adolescence is associated with functional impairment in several domains of life. To enable development of interventions that more effectively target functional impairment in this age group, the associations between clinical characteristics and impairment need to be clarified. The aim of this study was to investigate the associations between ADHD and functional impairment, if they varied by sex, and the potential impact of comorbid psychiatric symptoms on the associations. METHODS This was a cross-sectional study including adolescents with ADHD (n = 164) and a reference group of adolescents without ADHD (n = 106). Self-ratings and parental ratings of functional impairment in different life domains were used as outcomes in all analyses. Differences between groups were investigated with comparative analyses. General linear models (GLMs) were used to explore associations between ADHD symptoms and functional impairment in adolescents with ADHD, while adjusting for of comorbid symptoms, sex, and medication. RESULTS Adolescents with ADHD displayed higher levels of functional impairment than peers without ADHD, and girls with ADHD rated higher impairment than their male counterparts. The combined ADHD presentation was associated with the highest levels of self-reported impairment, while parental ratings indicated comparable levels of overall impairment across presentations. In the adjusted GLMs, symptoms of inattention were strongly associated with self- and parent-rated impairment in school, but symptoms of hyperactivity/impulsivity were not, whereas symptoms of both inattention and hyperactivity/impulsivity were modestly associated with self-rated impairment with friends. Further, both emotional and conduct problems were associated with impairment in daily life. CONCLUSIONS Our results suggest that attention difficulties, in particular, seem to impair academic functioning in adolescents with ADHD, and interventions targeting such difficulties are warranted. In addition, comorbid symptoms need to be assessed and treated, and self-reports of functioning should be included in research and clinical practice involving adolescents.
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Affiliation(s)
- Jenny Meyer
- Child and Adolescent Psychiatry Unit, Department of Medical Sciences, Uppsala University, 751 85, Uppsala, Uppsala, Sweden.
| | - Iman Alaie
- grid.8993.b0000 0004 1936 9457Child and Adolescent Psychiatry Unit, Department of Medical Sciences, Uppsala University, 751 85 Uppsala, Uppsala, Sweden ,grid.4714.60000 0004 1937 0626Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Mia Ramklint
- grid.8993.b0000 0004 1936 9457Child and Adolescent Psychiatry Unit, Department of Medical Sciences, Uppsala University, 751 85 Uppsala, Uppsala, Sweden
| | - Johan Isaksson
- grid.8993.b0000 0004 1936 9457Child and Adolescent Psychiatry Unit, Department of Medical Sciences, Uppsala University, 751 85 Uppsala, Uppsala, Sweden ,grid.4714.60000 0004 1937 0626Centre for Psychiatry Research, Department of Women’s and Children’s Health, Karolinska Institute Centre of Neurodevelopmental Disorders (KIND), Karolinska Institutet, Stockholm, Sweden
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Dekkers TJ, Hornstra R, van der Oord S, Luman M, Hoekstra PJ, Groenman AP, van den Hoofdakker BJ. Meta-analysis: Which Components of Parent Training Work for Children With Attention-Deficit/Hyperactivity Disorder? J Am Acad Child Adolesc Psychiatry 2022; 61:478-494. [PMID: 34224837 DOI: 10.1016/j.jaac.2021.06.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 06/02/2021] [Accepted: 06/25/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Behavioral parent training is an evidence-based intervention for children with attention-deficit/hyperactivity disorder (ADHD), but it is unknown which of its components are most effective. This meta-regression analysis investigated which specific behavioral techniques that parents learn in parent training are associated with effects on parental outcomes. METHOD A search was performed for randomized controlled trials on parent training for children with ADHD, with positive parenting, negative parenting, parenting sense of competence, parent-child relationship quality, and parental mental health as outcome measures. After screening 23,026 publications, 29 studies contributing 138 effect sizes were included (N = 2,345). For each study, the dosage of 39 behavioral techniques was derived from intervention manuals, and meta-regression determined which techniques were related to outcomes. RESULTS Parent training had robust small- to medium-sized positive effects on all parental outcomes relative to control conditions, both for unblinded and probably blinded measures. A higher dosage of techniques focusing on the manipulation of antecedents of behavior was associated with better outcomes on parenting sense of competence and parental mental health, and a higher dosage of techniques focusing on reinforcement of desired behaviors was related to larger decreases in negative parenting. Higher dosages of psychoeducation were negatively related to parental outcomes. CONCLUSION Although techniques were not investigated in isolation, the results suggested that manipulation of antecedents of behavior and reinforcement techniques are key components of parent training for children with ADHD in relation to parental outcomes. These exploratory findings may help to strengthen and tailor parent training interventions for children with ADHD.
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Affiliation(s)
- Tycho J Dekkers
- University of Groningen, the Netherlands; University of Amsterdam, the Netherlands; Levvel, Academic Center for Child- and Adolescent Psychiatry and Specialized Youthcare, Amsterdam, the Netherlands; Amsterdam University Medical Center, the Netherlands.
| | | | - Saskia van der Oord
- University of Amsterdam, the Netherlands; KU Leuven, Research Group Clinical Psychology, Belgium
| | - Marjolein Luman
- Levvel, Academic Center for Child- and Adolescent Psychiatry and Specialized Youthcare, Amsterdam, the Netherlands; Vrije Universiteit Amsterdam, the Netherlands
| | | | - Annabeth P Groenman
- University of Groningen, the Netherlands; University of Amsterdam, the Netherlands
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63
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Hornstra R, Dekkers TJ, Bosmans G, van den Hoofdakker B, van der Oord S. Attachment Representation Moderates the Effectiveness of Behavioral Parent Training Techniques for Children with ADHD: Evidence from a Randomized Controlled Microtrial. Res Child Adolesc Psychopathol 2022; 50:1151-1164. [PMID: 35362776 PMCID: PMC9525431 DOI: 10.1007/s10802-022-00921-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2022] [Indexed: 11/26/2022]
Abstract
Behavioral parent training is an evidence-based intervention for children with attention-deficit/hyperactivity disorder (ADHD), but knowledge on the differential effects of behavioral techniques for specific subgroups of children is very limited. Attachment representations of children with ADHD may affect how receptive children are to changes in parenting. In this study, we investigated whether specific behavioral techniques were more or less effective for children with ADHD in relation to their attachment representations. We included parents of 74 children with ADHD (4-11 years, M = 8.15) who took part in a larger randomized controlled microtrial in which they were randomized to a two session training in antecedent-based techniques (i.e., stimulus control techniques: rules, instructions; n = 26), a two session training in consequent-based techniques (i.e., contingency management techniques: praise, rewards, ignoring; n = 25) or a waitlist control condition (n = 23). We examined whether attachment representation moderated the effectiveness of a) training versus waitlist, and b) antecedent- versus consequent-based techniques. Attachment representations were measured with a story stem task, the intervention outcome was daily parent-rated problem behaviors of the children. Attachment representation did not moderate the effects of the training compared to the waitlist. However, compared to antecedent-based techniques, consequent-based techniques were less effective for more securely and less disorganized attached children, and particularly effective for more disorganized attached children. This was the first study examining attachment as a moderator of behavioral techniques for ADHD. If replicated, the findings of this study can be used for treatment development and tailoring.
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Affiliation(s)
- Rianne Hornstra
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
- Accare Child Study Center, Groningen, the Netherlands.
| | - Tycho J Dekkers
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Accare Child Study Center, Groningen, the Netherlands
- Academic Center for Child and Adolescent Psychiatry, Levvel, Amsterdam, the Netherlands
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
- Department of Child and Adolescent Psychiatry, Amsterdam University Medical Center (AUMC), Amsterdam, the Netherlands
| | - Guy Bosmans
- Department of Clinical Psychology, KU Leuven, Leuven, Belgium
| | - Barbara van den Hoofdakker
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Accare Child Study Center, Groningen, the Netherlands
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, the Netherlands
| | - Saskia van der Oord
- Department of Clinical Psychology, KU Leuven, Leuven, Belgium
- Leuven Brain Institute, Leuven, Belgium
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64
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Fabiano GA, Naylor J, Pelham WE, Gnagy EM, Burrows-MacLean L, Coles E, Chacko A, Wymbs BT, Walker KS, Wymbs F, Garefino A, Mazzant JR, Sastry AL, Tresco KE, Waschbusch DA, Massetti GM, Waxmonsky J. Special Education for Children with ADHD: Services Received and a Comparison to Children with ADHD in General Education. SCHOOL MENTAL HEALTH 2022. [DOI: 10.1007/s12310-022-09514-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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65
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Abstract
Attention-deficit/hyperactivity disorder (ADHD) is the most prevalent neurobehavioral disorder in childhood. The major components of this disorder are developmentally inappropriate levels of inattention and hyperactivity/impulsivity, which result in functional impairment in 1 or more areas of academic, social, and emotional function. In addition to the propensity for children to have some compromise of academic and emotional function, children with ADHD also have a higher frequency of co-occurring learning, cognitive, language, motor, and mental health disorders. Similarly, children with developmental disorders have a higher risk of co-occurring ADHD. The diagnosis of ADHD can be ascertained by a review of the risks for the condition, consideration of masquerading conditions, a careful history and physical examination, and the recognition of co-occurring disorders. The signs and symptoms of co-occurring disorders and the management of ADHD differ across early childhood, middle childhood, and adolescence. Management is largely limited to behavioral and pharmacologic interventions, and it favors behavioral strategies in early childhood, pharmacologic and behavioral strategies in middle childhood, and pharmacologic interventions in adolescence. This article offers an approach to the evaluation, presentation, and management of ADHD with a focus on guiding primary care pediatricians.
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Affiliation(s)
- Meghna Rajaprakash
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD.,Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mary L Leppert
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD.,Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
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66
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Condo JS, Chan ESM, Kofler MJ. Examining the effects of ADHD symptoms and parental involvement on children's academic achievement. RESEARCH IN DEVELOPMENTAL DISABILITIES 2022; 122:104156. [PMID: 35007980 PMCID: PMC8944944 DOI: 10.1016/j.ridd.2021.104156] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 11/23/2021] [Accepted: 12/20/2021] [Indexed: 05/17/2023]
Abstract
OBJECTIVE Our understanding of the role of parental involvement in academic outcomes for children with ADHD is limited, with mixed evidence suggesting a positive association between parental involvement and academic achievement for pediatric ADHD but limited evidence regarding how this varies based on ADHD symptom severity, ADHD symptom domains, or co-occurring ODD symptoms. In this context, the present study aimed to examine the effects of parental involvement, ADHD symptoms, and comorbid ODD on children's overall, reading, and math achievement. METHOD A well-characterized clinically-evaluated sample of 162 children recruited through a university-based children's learning/behavioral health clinic and community resources (ages 8-13; 50 girls; 69% Caucasian/Non-Hispanic) were administered standardized academic achievement tests, with parents and teachers completing measures of parental involvement and ADHD symptoms, respectively. RESULTS Inattention, but not hyperactivity-impulsivity, was associated with lower academic achievement in all tested models (β= -.16 to -.22, all p < .03). Surprisingly, parental involvement had significant negative associations with math and overall academic achievement (β= -.13 to -.26, both p< .05) and did not moderate the relations between ADHD symptoms and academic achievement in any tested model. Comorbid ODD symptoms did not significantly predict academic achievement or interact with parental involvement in any tested model. These findings were robust to control for child IQ, age, sex, SES, anxiety, and depression. CONCLUSION Parental involvement may not serve as a protective factor against academic underachievement for children with clinically elevated ADHD symptoms, and may predict lower rather than higher academic achievement for clinically evaluated children in general.
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Affiliation(s)
- Jaida S Condo
- Florida State University, Department of Psychology, United States
| | | | - Michael J Kofler
- Florida State University, Department of Psychology, United States.
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67
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van Hoorn J, de Water E, Dekkers TJ, Pollak Y, Popma A, Jansen BRJ, Huizenga HM, van Duijvenvoorde ACK. Peer feedback decreases impulsive choice in adolescents with and without attention-deficit/hyperactivity disorder. JCPP ADVANCES 2022; 2:e12065. [PMID: 37431500 PMCID: PMC10242953 DOI: 10.1002/jcv2.12065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 02/03/2022] [Indexed: 01/02/2023] Open
Abstract
Background Impulsivity is a core feature of attention-deficit/hyperactivity disorder (ADHD). Previous work using the delay discounting task to assess impulsivity reveals that adolescents with ADHD tend to prefer a smaller-immediate reward over a larger-delayed reward, and this relates to problematic choices in daily life. To gain a better understanding of daily decision-making in adolescence, it is important to examine the social context, as peers have a major influence on decisions. Peer influence often has a negative connotation, but also provides an opportunity to promote positive outcomes. To date, it is unclear if peers affect impulsive decision-making in adolescents with ADHD, for better or for worse. Methods The aim of this preregistered study was to examine the effect of peer feedback on impulsive choice in male adolescents with and without ADHD (ages 13-23; N = 113). We utilized an adapted delay discounting task that was administered alone, in a social condition, and alone again. In the social condition, adolescents received either (between-subjects) manipulated impulsive or non-impulsive peer feedback. Impulsive peer feedback consisted of likes for choosing the smaller immediate reward, whereas non-impulsive peers endorsed choosing the larger delayed reward. Results Preregistered analyses showed that non-impulsive peer feedback resulted in decreased impulsive choice, whereas impulsive peer feedback did not alter decision-making in adolescents with and without ADHD. Explorative analyses of inattention and hyperactivity-impulsivity symptoms in the total sample, irrespective of diagnosis, showed that lower hyperactivity-impulsivity and more inattention symptoms were associated with increased susceptibility to non-impulsive peer feedback. Conclusions Together, these findings indicate that peers may provide an opportunity to decrease impulsivity and emphasize individual differences in susceptibility to non-impulsive peer feedback related to inattention and hyperactivity-impulsivity. Therefore, peer feedback may be a promising component in behavioral peer-supported interventions in adolescents with ADHD.
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Affiliation(s)
- Jorien van Hoorn
- Institute of Psychology, Department of Developmental and Educational PsychologyLeiden UniversityLeidenThe Netherlands
- Leiden Institute for Brain and CognitionLeidenThe Netherlands
- LevvelAcademic Center for Child‐ and Adolescent PsychiatryAmsterdamThe Netherlands
| | | | - Tycho J. Dekkers
- LevvelAcademic Center for Child‐ and Adolescent PsychiatryAmsterdamThe Netherlands
- Department of PsychologyUniversity of AmsterdamAmsterdamThe Netherlands
- Department of Child‐ and Adolescent PsychiatryUniversity Medical Center GroningenGroningenThe Netherlands
- Department of Child‐ and Adolescent PsychiatryAmsterdam University Medical CentersAmsterdamThe Netherlands
| | - Yehuda Pollak
- Seymour Fox School of EducationHebrew University of JerusalemJerusalemIsrael
| | - Arne Popma
- LevvelAcademic Center for Child‐ and Adolescent PsychiatryAmsterdamThe Netherlands
- Department of Child‐ and Adolescent PsychiatryAmsterdam University Medical CentersAmsterdamThe Netherlands
| | - Brenda R. J. Jansen
- Department of PsychologyUniversity of AmsterdamAmsterdamThe Netherlands
- Amsterdam Brain and Cognition CenterAmsterdamThe Netherlands
- Research Priority Area YieldAmsterdamThe Netherlands
| | - Hilde M. Huizenga
- Department of PsychologyUniversity of AmsterdamAmsterdamThe Netherlands
- Amsterdam Brain and Cognition CenterAmsterdamThe Netherlands
- Research Priority Area YieldAmsterdamThe Netherlands
| | - Anna C. K. van Duijvenvoorde
- Institute of Psychology, Department of Developmental and Educational PsychologyLeiden UniversityLeidenThe Netherlands
- Leiden Institute for Brain and CognitionLeidenThe Netherlands
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68
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Abstract
OBJECTIVE The adverse outcomes associated with ADHD are well known, but less is known about the minority of children with ADHD who may be flourishing despite this neurodevelopmental risk. The present multi-informant study is an initial step in this direction with the basic but unanswered question: Are there resilient children with ADHD? METHOD Reliable change analysis of the BASC-3 Resiliency subscale for a clinically evaluated sample of 206 children with and without ADHD (ages 8-13; 81 girls; 66.5% White/Non-Hispanic). RESULTS Most children with ADHD are perceived by their parents and teachers as resilient (52.8%-59.2%), with rates that did not differ from the comorbidity-matched Non-ADHD sample. CONCLUSION Exploratory analyses highlighted the importance of identifying factors that promote resilience for children with ADHD specifically, such that some child characteristics were promotive (associated with resilience for both groups), some were protective (associated with resilience only for children with ADHD), and some were beneficial only for children without ADHD.
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Groenman AP, Hornstra R, Hoekstra PJ, Steenhuis L, Aghebati A, Boyer BE, Buitelaar JK, Chronis-Tuscano A, Daley D, Dehkordian P, Dvorsky M, Franke N, DuPaul GJ, Gershy N, Harvey E, Hennig T, Herbert S, Langberg J, Mautone JA, Mikami AY, Pfiffner LJ, Power TJ, Reijneveld SA, Schramm SA, Schweitzer JB, Sibley MH, Sonuga-Barke E, Thompson C, Thompson M, Webster-Stratton C, Xie Y, Luman M, van der Oord S, van den Hoofdakker BJ. An Individual Participant Data Meta-analysis: Behavioral Treatments for Children and Adolescents With Attention-Deficit/Hyperactivity Disorder. J Am Acad Child Adolesc Psychiatry 2022; 61:144-158. [PMID: 33932495 DOI: 10.1016/j.jaac.2021.02.024] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 02/03/2021] [Accepted: 02/19/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Behavioral interventions are well established treatments for children with attention-deficit/hyperactivity disorder (ADHD). However, insight into moderators of treatment outcome is limited. METHOD We conducted an individual participant data meta-analysis (IPDMA), including data of randomized controlled behavioral intervention trials for individuals with ADHD <18 years of age. Outcomes were symptoms of ADHD, oppositional defiant disorder (ODD), and conduct disorder (CD) and impairment. Moderators investigated were symptoms and impairment severity, medication use, age, IQ, sex, socioeconomic status, and single parenthood. RESULTS For raters most proximal to treatment, small- to medium-sized effects of behavioral interventions were found for symptoms of ADHD, inattention, hyperactivity/impulsivity (HI), ODD and CD, and impairment. Blinded outcomes were available only for small preschool subsamples and limited measures. CD symptoms and/or diagnosis moderated outcome on ADHD, HI, ODD, and CD symptoms. Single parenthood moderated ODD outcome, and ADHD severity moderated impairment outcome. Higher baseline CD or ADHD symptoms, a CD diagnosis, and single parenthood were related to worsening of symptoms in the untreated but not in the treated group, indicating a protective rather than an ameliorative effect of behavioral interventions for these children. CONCLUSION Behavioral treatments are effective for reducing ADHD symptoms, behavioral problems, and impairment as reported by raters most proximal to treatment. Those who have severe CD or ADHD symptoms, a CD diagnosis, or are single parents should be prioritized for treatment, as they may evidence worsening of symptoms in the absence of intervention.
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Effectiveness of Specific Techniques in Behavioral Teacher Training for Childhood ADHD Behaviors: Secondary Analyses of a Randomized Controlled Microtrial. Res Child Adolesc Psychopathol 2022; 50:867-880. [PMID: 35015187 PMCID: PMC9246781 DOI: 10.1007/s10802-021-00892-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2021] [Indexed: 12/04/2022]
Abstract
Behavioral teacher training is an effective intervention for children with attention-deficit/hyperactivity disorder (ADHD). Intervention effectiveness may be enhanced by including intervention components that carry the strongest evidence for their effectiveness. A previous article of this group showed that both antecedent- (i.e., stimulus-control) and consequent-based (i.e., contingency management) techniques were highly effective in reducing daily teacher-rated, individually selected problem behaviors in a specific situation of the child. Effects were observed up to three months post intervention. Here, we tested whether effects were also present in teacher-rated and masked DSM-based assessments that comprise the full range of ADHD and oppositional defiant disorder (ODD) symptoms, as well as on teacher-rated impairment. Teachers of 90 children with (subthreshold) ADHD (6–12 years) were randomly assigned to one of three conditions: a short (two sessions), individualized intervention consisting of either a) antecedent-based techniques or b) consequent-based techniques; or c) waitlist. Multilevel analyses showed that both sets of techniques were effective in reducing teacher-rated ADHD symptoms and impairment immediately after the intervention and up to three months later, as compared to waitlist. Masked observations of ADHD behavior were in line with teacher ratings, with effects being most pronounced for inattention. No effects on teacher-rated or masked ODD behavior were found. This study showed that antecedent- and consequent-based techniques were effective in improving classroom ADHD symptoms and impairment. Long-term changes in teacher-rated ADHD are promising. These results extend previous findings and show the potential of short individually tailored interventions in classroom settings as treatment of ADHD symptoms.
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71
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DuPaul GJ, Gormley MJ, Daffner-Deming M. School-Based Interventions for Elementary School Students with Attention-Deficit/Hyperactivity Disorder. Child Adolesc Psychiatr Clin N Am 2022; 31:149-166. [PMID: 34801152 DOI: 10.1016/j.chc.2021.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Children with attention-deficit/hyperactivity disorder experience significant academic, social, and behavioral impairments in elementary school settings. Although psychopharmacologic treatments can improve symptomatic behaviors, these rarely are sufficient for enhancing school performance. Thus, medication should be supplemented by one or more school interventions, including behavioral strategies, academic interventions, behavioral peer interventions, organizational skills training, and self-regulation strategies. Although all of these school interventions have been found effective, classroom behavioral strategies, organizational skills training, and self-regulation strategies have the strongest empirical support. Clinicians should collaborate with school mental health professionals to encourage implementation of effective school interventions across school years.
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Affiliation(s)
- George J DuPaul
- Department of Education and Human Services, Lehigh University, 111 Research Drive, Bethlehem, PA 18015, USA.
| | - Matthew J Gormley
- Department of Education and Human Services, Lehigh University, 111 Research Drive, Bethlehem, PA 18015, USA; University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Molly Daffner-Deming
- Department of Education and Human Services, Lehigh University, 111 Research Drive, Bethlehem, PA 18015, USA
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72
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Groves NB, Chan ESM, Marsh CL, Gaye F, Jaisle EM, Kofler MJ. Does central executive training and/or inhibitory control training improve emotion regulation for children with attention-deficit/hyperactivity disorder? A randomized controlled trial. Front Psychiatry 2022; 13:1034722. [PMID: 36561637 PMCID: PMC9763728 DOI: 10.3389/fpsyt.2022.1034722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Approximately 48-54% of children with attention-deficit/hyperactivity disorder (ADHD) have impairing difficulties with emotion regulation, and these difficulties are not ameliorated by first-line ADHD treatments. Working memory and inhibitory control represent promising intervention targets given their functional, if not causal, links with ADHD-related emotion dysregulation. METHODS This preregistered randomized controlled trial tested whether two digital therapeutic training protocols that have been previously shown to improve working memory (Central Executive Training [CET]) and inhibitory control (Inhibitory Control Training [ICT]) can improve emotion regulation in a sample of 94 children with ADHD aged 8-13 years (M = 10.22, SD = 1.43; 76% White/non-Hispanic; 29 girls). RESULTS Results of Bayesian mixed model ANOVAs indicated both treatment groups demonstrated significant decreases in emotion dysregulation relative to pre-treatment at immediate post-treatment (parent report; d = 1.25, BF10 = 8.04 × 1013, p < 0.001), at 1-2 months after completing treatment (teacher report; d = 0.99, BF10 = 1.22 × 106, p < 0.001), and at 2-4-months follow-up (parent report; d = 1.22, BF10 = 1.15 × 1014, p < 0.001). Contrary to our hypotheses, the CET and ICT groups demonstrated equivalent reductions in emotion dysregulation and maintenance of effects. Exploratory analyses revealed that results were robust to control for informant expectancies, ADHD medication status/changes, in-person vs. at-home treatment, child age, and time from treatment completion to post-treatment ratings. DISCUSSION To determine whether working memory and inhibitory control are causally linked with ADHD-related emotion dysregulation, future studies should include active control conditions that do not train executive functions prior to making decisions about the clinical utility of CET/ICT for the treatment of emotion dysregulation in ADHD. CLINICAL TRIAL REGISTRATION [https://clinicaltrials.gov/], identifier [NCT03324464].
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Affiliation(s)
- Nicole B Groves
- Department of Psychology, Florida State University, Tallahassee, FL, United States
| | - Elizabeth S M Chan
- Department of Psychology, Florida State University, Tallahassee, FL, United States
| | - Carolyn L Marsh
- Department of Psychology, Florida State University, Tallahassee, FL, United States
| | - Fatou Gaye
- Department of Psychology, Florida State University, Tallahassee, FL, United States
| | - Emma M Jaisle
- Department of Psychology, Florida International University, Miami, FL, United States
| | - Michael J Kofler
- Department of Psychology, Florida State University, Tallahassee, FL, United States
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73
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Sibley MH, Reyes Francisco JC, Rios-Davis A, Graziano PA. Investigating routine care non-pharmacological treatment for adolescents with ADHD. FRONTIERS IN HEALTH SERVICES 2022; 2:929521. [PMID: 36925828 PMCID: PMC10012638 DOI: 10.3389/frhs.2022.929521] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/26/2022] [Indexed: 11/13/2022]
Abstract
Objective To characterize routine non-pharmacological care for youth with ADHD. Methods 76 audio-recorded work-samples were collected from community mental health therapists in a large metropolitan area in the United States and were analyzed for operationally defined practice elements commonly included in evidence-based non-pharmacological treatment for ADHD. Analyses characterized community provider practices and examined predictors of using evidence-based (vs.low-value) practices. Results Individually delivered social skills training was the most commonly detected practice element (31.6% of practice samples). Parent involvement in routine care was uncommon (53.9% of sessions had no parental presence). Core elements of evidence-based practices were rarely delivered (e.g., organization skills training: 18.4% of tapes; operant reinforcement: 13.2%); when evidence-based content was introduced, it was typically implemented at a very low intensity. Patient and provider characteristics did not predict use of evidence-based practices. Conclusions Routine non-pharmacological care for adolescent ADHD primarily consisted of low value practices such as youth-directed treatment and social skills training with low parent involvement and only occasional therapy homework. To improve quality of care, efforts to de-implement low value practices should be coupled with efforts to implement evidence-based practices (i.e., parent involvement, measurement-based care, organization skills training, use of operant reinforcement).
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Affiliation(s)
- Margaret H Sibley
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States.,Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, United States
| | - Juan Carlos Reyes Francisco
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, United States
| | - Alexandria Rios-Davis
- Department of Psychology, Florida International University, Miami, FL, United States
| | - Paulo A Graziano
- Department of Psychology, Florida International University, Miami, FL, United States
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Sibley MH, Ortiz M, Rios-Davis A, Zulauf-McCurdy CA, Graziano PA, Bickman L. Stakeholder-Generated Implementation Strategies to Promote Evidence-Based ADHD Treatment in Community Mental Health. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2022; 49:44-58. [PMID: 33988847 DOI: 10.1007/s10488-021-01143-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2021] [Indexed: 10/21/2022]
Abstract
Community implementation of evidence-based practices (EBPs) for Attention Deficit/Hyperactivity Disorder (ADHD) is greatly lacking. A recent randomized community-based trial of an EBP for ADHD (Supporting Teens' Autonomy Daily; STAND) demonstrated suboptimal implementation and effectiveness outcomes. In the present study, we conducted an Innovation Tournament (IT) with agency staff stakeholders (N = 26) to identify barriers to successful implementation of STAND and implementation strategies for a revised service delivery model. We conducted member-checking of agency staff-generated ideas with parents (N = 226) and subsequent querying of additional parent (N = 226) and youth-generated (N = 205) strategies to improve care. Go-Zone plots were utilized to identify strategies with the highest feasibility and importance. Practical barriers (i.e., transportation, scheduling difficulties) and parent/youth engagement were the most commonly cited obstacles to successful implementation of STAND in community contexts. Eighteen "winning" implementation strategies were identified that survived member checking. These were classified as train and educate stakeholders (n = 5; e.g., train agency supervisors to deliver supervision, digitize treatment materials and trainings), engage consumers (n = 9; e.g., begin treatment with rapport building sessions, increase psychoeducation), provide interactive assistance (n = 2; e.g., add group supervision, increase roleplay in supervision), and use of evaluative/iterative strategies (n = 2; e.g., perform fidelity checks, supervisor review of session recordings). Parents and youth desired longer duration of treatment and increased focus on maintenance. Strategies will be developed and tested as part of a pilot effectiveness trial designed to refine STAND's service delivery model.Trial Registration NCT02694939 www.clinicaltrials.gov.
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Affiliation(s)
- Margaret H Sibley
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA.
- Seattle Children's Research Institute, Seattle, WA, USA.
| | | | | | - Courtney A Zulauf-McCurdy
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
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Nunes MEN, Zuanetti PA, Hamad APA. Attitudes and practices in the management of attention deficit hyperactivity disorder among Brazilian pediatric neurologists who responded to a national survey: a cross-sectional study. SAO PAULO MED J 2022; 141:e2021966. [PMID: 36541950 PMCID: PMC10065098 DOI: 10.1590/1516-3180.2021.0966.r1.20092022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 09/20/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) has a prevalence of 5.3% among children and adolescents. It is characterized by attention deficit, hyperactivity, and impulsivity. OBJECTIVE We aimed to conduct a survey involving pediatric neurologists in the management of ADHD and compare the results with the current literature and guidelines. DESIGN AND SETTING Descriptive analytical study of a virtual environment, was used Test of equality of proportions for comparison between two groups of pediatric neurologists (working as specialists for > 6 versus ≤ 6 years), with a significance level of P = 0.05. METHODS This cross-sectional study used a virtual questionnaire covering the steps in the diagnosis and treatment of children with ADHD. The inclusion criteria were professionals who had completed their residency/specialization in pediatric neurology and clinical neurologists working in pediatric neurology. RESULTS Among the 548 electronic invitations sent, 128 were considered valid. For all participants, the diagnosis was clinically based on the disease classification manuals. Combination treatment promotes improvement of symptoms (96.9%). Among psychostimulants, short-acting methylphenidate was the most commonly prescribed medication (85.2%). Headache was the most common side effect (77.3%). Altogether, 73.4% of the participants requested laboratory tests, 71.1% requested an electrocardiogram, and 42.2% requested an electroencephalogram. Pediatric neurologists working as specialists for ≤ 6 years had more frequent referrals to psycho-pedagogists for diagnosis (P = 0.03). CONCLUSIONS The participants complied with clinical guidelines, emphasizing the relevance of diagnostic manuals and treatment guidelines for an eminently clinical situation and enabling uniformity in quality treatment.
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Affiliation(s)
- Marina Estima Neiva Nunes
- MD. Child Neurologist, Department of Neurosciences and Behavioral Sciences, Faculdade de Medicina de Ribeirão Preto (FMRP), Universidade de São Paulo (USP), Ribeirão Preto (SP), Brazil
| | - Patricia Aparecida Zuanetti
- PhD. Speech and Hearing Therapist, Department Health Sciences, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto (HCFMRP), Universidade de São Paulo (USP), Ribeirão Preto (SP), Brazil
| | - Ana Paula Andrade Hamad
- MD, PhD. Child Neurologist, Department of Neurosciences and Behavioral Sciences, Faculdade de Medicina de Ribeirão Preto (FMRP), Universidade de São Paulo (USP), Ribeirão Preto (SP), Brazil
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76
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Which factors determine clinicians' policy and attitudes towards medication and parent training for children with Attention-Deficit/Hyperactivity Disorder? Eur Child Adolesc Psychiatry 2022; 31:483-493. [PMID: 33585968 PMCID: PMC8940866 DOI: 10.1007/s00787-021-01735-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 01/31/2021] [Indexed: 01/19/2023]
Abstract
Behavioral parent and teacher training and stimulant medication are recommended interventions for children with attention-deficit/hyperactivity disorder (ADHD). However, not all children with ADHD receive this evidence-based care, and the aim of the current study was to find out why. More specifically, we investigated clinicians' policy, guideline use, and attitudes towards medication and parent training when treating children with ADHD, as well as several factors that could affect this. A total of 219 Dutch clinicians (mainly psychologists, psychiatrists and educationalists) completed a survey. Clinicians were likely to recommend medication more often than parent training, and clinicians' policy to recommend medication and parent training was positively associated with their attitudes towards these interventions. Less experienced clinicians and those with a non-medical background reported lower rates of guideline use, whereas clinicians with a medical background reported less positive attitudes towards parent training. Furthermore, a substantial portion of the clinicians based their decision to recommend parent training on their clinical judgement (e.g., prior estimations of efficacy, perceived low abilities/motivation of parents), and many clinicians reported barriers for referral to parent training, such as waiting lists or a lack of skilled staff. To achieve better implementation of evidence-based care for children with ADHD, guidelines should be communicated better towards clinicians. Researchers and policy-makers should further focus on barriers that prevent implementation of parent training, which are suggested by the discrepancy between clinicians' overall positive attitude towards parent training and the relatively low extent to which clinicians actually advise parent training.
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Improving Adherence to Behavioral Parent Training for ADHD Using Digital Health Tools. JOURNAL OF PSYCHIATRY AND BRAIN SCIENCE 2022; 7:e220005. [PMID: 36110580 PMCID: PMC9473542 DOI: 10.20900/jpbs.20220005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Behavioral Parent Training (BPT) is a well-established treatment for school-age children with ADHD but lack of parent adherence to prescribed parenting strategies limits treatment gains. Digital Health (dHealth) tools can be leveraged to target barriers to parent adherence but existing tools for parenting interventions are limited. New efforts to develop a dHealth tool to target adherence barriers including limited skill competence, EF processes, and low motivation/negative attitudes, are presented and recommendations for future technology-enhanced treatments are provided.
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Evaluation of a structured skills training group for adolescents with attention-deficit/hyperactivity disorder: a randomised controlled trial. Eur Child Adolesc Psychiatry 2022; 31:1-13. [PMID: 33721085 PMCID: PMC9343260 DOI: 10.1007/s00787-021-01753-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 02/26/2021] [Indexed: 10/25/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) in adolescence is associated with behavioural, emotional and interpersonal problems, and non-pharmacological treatments targeting these difficulties have been requested. The objective of this study was to evaluate the effectiveness and acceptance of an age-adapted structured skills training group (SSTG) for adolescents with ADHD. Adolescents (n = 184, ages 15-18 years) with a diagnosis of ADHD were randomly assigned to either the SSTG, which is based on dialectical behavioural therapy, or an active control group based on psychoeducation. Symptoms of ADHD, behavioural and emotional problems, functional impairment, and health-related outcomes were assessed with self-ratings and parental ratings two weeks before, two weeks after, and six months after treatment. All participants who completed the pre-treatment measurements (n = 164) were included in the main analyses, which were conducted using a linear mixed model. Our results demonstrated no significant group differences in favour of the SSTG for any of the study outcomes. A majority of the participants in both groups reported that they had increased their knowledge about ADHD, improved their ability to manage problems related to the diagnosis, and would recommend the treatment to others. We conclude that the SSTG seems to be acceptable for adolescents with ADHD in a clinical context. However, the treatment was not proved to be more effective or more acceptable than the psychoeducational control intervention.Trial registration: http://www.isrctn.com/ISRCTN17366720,11/05/2016 , retrospectively registered.
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79
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Babinski DE, Sibley MH. Family-based treatments for attention-deficit/hyperactivity disorder: A review of family functioning outcomes in randomized controlled trials from 2010 to 2019. JOURNAL OF MARITAL AND FAMILY THERAPY 2022; 48:83-106. [PMID: 34779516 DOI: 10.1111/jmft.12572] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 10/31/2021] [Indexed: 06/13/2023]
Abstract
This review details advances in randomized controlled trials of family-based treatments for attention-deficit/hyperactivity disorder (ADHD) conducted in the United States from 2010 to 2019, and the impact of these treatments on the domain of family functioning. Twenty-two studies were included in the review and three types of family treatments, integrated parent-child treatments, parent-directed treatments, and youth treatments with adjunctive parent involvement, were identified for children and adolescents. Studies point to considerable advancements in consideration of understudied and diverse populations, and results of the review show all three types of family interventions for ADHD should be considered well-established interventions addressing family functioning. Practical guidelines are offered, and future directions for research are discussed.
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Affiliation(s)
- Dara E Babinski
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Margaret H Sibley
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle Children's Research Institute, Seattle, Washington, USA
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80
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Sampaio F, Feldman I, Lavelle TA, Skokauskas N. The cost-effectiveness of treatments for attention deficit-hyperactivity disorder and autism spectrum disorder in children and adolescents: a systematic review. Eur Child Adolesc Psychiatry 2022; 31:1655-1670. [PMID: 33751229 PMCID: PMC9666301 DOI: 10.1007/s00787-021-01748-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 02/17/2021] [Indexed: 12/24/2022]
Abstract
Economic evaluations can help decision makers identify what services for children with neurodevelopmental disorders provide best value-for-money. The aim of this paper is to review the best available economic evidence to support decision making for attention deficit-hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) in children and adolescents. We conducted a systematic review of economic evaluations of ADHD and ASD interventions including studies published 2010-2020, identified through Econlit, Medline, PsychINFO, and ERIC databases. Only full economic evaluations comparing two or more options, considering both costs and consequences were included. The quality of the studies was assessed using the Drummond checklist. We identified ten studies of moderate-to-good quality on the cost-effectiveness of treatments for ADHD and two studies of good quality of interventions for ASD. The majority of ADHD studies evaluated pharmacotherapy (n = 8), and two investigated the economic value of psychosocial/behavioral interventions. Both economic evaluations for ASD investigated early and communication interventions. Included studies support the cost-effectiveness of behavioral parenting interventions for younger children with ADHD. Among pharmacotherapies for ADHD, different combinations of stimulant/non-stimulant medications for children were cost-effective at willingness-to-pay thresholds reported in the original papers. Early intervention for children with suspected ASD was cost-effective, but communication-focused therapy for preschool children with ASD was not. Prioritizing more studies in this area would allow decision makers to promote cost-effective and clinically effective interventions for this target group.
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Affiliation(s)
- Filipa Sampaio
- Department of Public Health and Caring Sciences, Uppsala University, Husargatan 3, P.O Box 564, 751 22, Uppsala, Sweden.
| | - Inna Feldman
- grid.8993.b0000 0004 1936 9457Department of Public Health and Caring Sciences, Uppsala University, Husargatan 3, P.O Box 564, 751 22 Uppsala, Sweden ,grid.12650.300000 0001 1034 3451Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Tara A. Lavelle
- grid.67033.310000 0000 8934 4045Center for the Evaluation of Value and Risk, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA USA
| | - Norbert Skokauskas
- grid.5947.f0000 0001 1516 2393Regional Centre for Child and Youth Mental Health and Child Welfare, IPH, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway ,Child and Adolescent Mental Health Services, St. Olav Hospital, Trondheim, Norway
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81
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Dawson AE, Kallash M, Spencer JD, Wilson CS. The pressure's on: understanding neurocognitive and psychological associations with pediatric hypertension to inform comprehensive care. Pediatr Nephrol 2021; 36:3869-3883. [PMID: 33890179 DOI: 10.1007/s00467-021-05077-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 03/15/2021] [Accepted: 03/30/2021] [Indexed: 11/30/2022]
Abstract
The prevalence of hypertension is increasing in pediatric populations. While clinical data and practice guidelines identify the impact of hypertension on organ dysfunction and emphasize the importance for end-organ damage screening, the bidirectional effects of pediatric hypertension on neurocognitive and psychological outcomes are understudied. The objective of this review is to highlight the association between hypertension and cognition, attention, learning, and mental health in children and adolescents. In doing so, this review provides a framework and toolkit to integrate neuropsychology and psychology into the screening and management stages of pediatric hypertension. By recognizing the effects of hypertension on cognition, behavior, and mental health, screenings and interventions can be implemented to proactively and comprehensively improve the health outcomes for children with blood pressure concerns.
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Affiliation(s)
- Anne E Dawson
- Department of Pediatric Psychology and Neuropsychology, Department of Pediatrics, Nationwide Children's, 700 Children's Drive, Columbus, OH, 43205, USA.
| | - Mahmoud Kallash
- Division of Nephrology and Hypertension, Department of Pediatrics, Nationwide Children's, Columbus, OH, USA
| | - John D Spencer
- Division of Nephrology and Hypertension, Department of Pediatrics, Nationwide Children's, Columbus, OH, USA
| | - Camille S Wilson
- Department of Pediatric Psychology and Neuropsychology, Department of Pediatrics, Nationwide Children's, 700 Children's Drive, Columbus, OH, 43205, USA
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82
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Pérez-Gómez J, Amigo-Gamero H, Collado-Mateo D, Barrios-Fernandez S, Muñoz-Bermejo L, Garcia-Gordillo MÁ, Carlos-Vivas J, Adsuar JC. Equine-assisted activities and therapies in children with attention-deficit/hyperactivity disorder: A systematic review. J Psychiatr Ment Health Nurs 2021; 28:1079-1091. [PMID: 33171006 DOI: 10.1111/jpm.12710] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/03/2020] [Accepted: 10/19/2020] [Indexed: 12/26/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: Attention-deficit/hyperactivity disorder (ADHD) is characterized by problems of inattention and impulsive hyperactivity in children. Equine-assisted activities and therapies (EAATs) have been used as alternative non-pharmacological intervention option in patients with ADHD. WHAT DOES THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Nowadays, more studies of high methodological quality are needed to determine whether EAAT is an effective intervention for the treatment in children with ADHD. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Between 15 and 40 min of rising horses, 8-32 total sessions, for 4-32 weeks, seem to be beneficial to reduce the symptoms of ADHD. ABSTRACT INTRODUCTION: Attention-deficit/hyperactivity disorder (ADHD) is a disorder characterized by problems of inattention and impulsive hyperactivity. Equine-assisted activities and therapies (EAATs) have become an emerging non-pharmacological intervention option in patients with ADHD. AIM To perform a systematic review of updated literature about EAAT in children with ADHD. METHOD A systematic review was performed until 28 November 2019, in four electronic databases: PubMed, Web of Science, Embase and Google Scholar. The inclusion criteria were as follows: (a) intervention programme, with pre- and post-data, based on EAAT, (b) children with ADHD and (c) articles written in English. RESULTS A total of 9 articles were found that meet the inclusion criteria. The evidence level was C for 7 studies and B for 2 studies. The level of conclusion was 3. DISCUSSION There are few studies with high methodological quality, and there is a high heterogeneity in the variables included, what make that the level of evidence and conclusion are low. CONCLUSION There is no account with enough studies of high methodological quality to determine whether EAAT is an effective intervention for the treatment in children with ADHD.
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Affiliation(s)
- Jorge Pérez-Gómez
- Health, Economy, Motricity and Education (HEME) Research Group, University of Extremadura, Cáceres, Spain
| | - Helena Amigo-Gamero
- Health, Economy, Motricity and Education (HEME) Research Group, University of Extremadura, Cáceres, Spain
| | | | | | | | | | - Jorge Carlos-Vivas
- Health, Economy, Motricity and Education (HEME) Research Group, University of Extremadura, Cáceres, Spain
| | - José Carmelo Adsuar
- Health, Economy, Motricity and Education (HEME) Research Group, University of Extremadura, Cáceres, Spain
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83
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Reyes ADL, Talbott E, Power TJ, Michel JJ, Cook CR, Racz SJ, Fitzpatrick O. The needs-to-goals gap: How informant discrepancies in youth mental health assessments impact service delivery. Clin Psychol Rev 2021; 92:102114. [DOI: 10.1016/j.cpr.2021.102114] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 10/25/2021] [Accepted: 12/16/2021] [Indexed: 01/24/2023]
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84
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Döpfner M, Mandler J, Breuer D, Schürmann S, Dose C, Walter D, von Wirth E. Children with Attention-Deficit/Hyperactivity Disorder Grown Up: An 18-Year Follow-Up after Multimodal Treatment. J Atten Disord 2021; 25:1801-1817. [PMID: 32772881 DOI: 10.1177/1087054720948133] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE ADHD treatment has positive effects on behavioral symptoms and psychosocial functioning, but studies that follow children treated for ADHD into adulthood are rare. METHOD This follow-up study assessed symptom severity and functional outcomes of adults (n = 70) who had received individualized ADHD treatment in the Cologne Adaptive Multimodal Treatment (CAMT) Study at ages 6 to 10 years. RESULTS Despite symptomatic improvement, participants reported poorer educational and occupational outcomes than expected (e.g., currently unemployed: 17%). They had also been in contact with the justice system more often than expected (e.g., lifetime convictions: 33%) and were impaired on health-related outcomes (e.g., substance use problems: 15%). Several social outcomes were favorable (e.g., long-term relationship/married: 63%). CONCLUSION Compared to the general population or norm samples, CAMT participants had a higher relative risk (RR) of functional impairments, demonstrating the need for continued support for a substantial proportion of the young adults.
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Affiliation(s)
- Manfred Döpfner
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Faculty of Medicine and University Hospital Cologne, School for Child and Adolescent Cognitive Behavior Therapy (AKiP), University of Cologne, Cologne, Germany
| | - Janet Mandler
- Faculty of Medicine and University Hospital Cologne, School for Child and Adolescent Cognitive Behavior Therapy (AKiP), University of Cologne, Cologne, Germany
| | - Dieter Breuer
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Stephanie Schürmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Faculty of Medicine and University Hospital Cologne, School for Child and Adolescent Cognitive Behavior Therapy (AKiP), University of Cologne, Cologne, Germany
| | - Christina Dose
- Faculty of Medicine and University Hospital Cologne, School for Child and Adolescent Cognitive Behavior Therapy (AKiP), University of Cologne, Cologne, Germany
| | - Daniel Walter
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Faculty of Medicine and University Hospital Cologne, School for Child and Adolescent Cognitive Behavior Therapy (AKiP), University of Cologne, Cologne, Germany
| | - Elena von Wirth
- Faculty of Medicine and University Hospital Cologne, School for Child and Adolescent Cognitive Behavior Therapy (AKiP), University of Cologne, Cologne, Germany
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DuPaul GJ, Gormley MJ, Anastopoulos AD, Weyandt LL, Labban J, Sass AJ, Busch CZ, Franklin MK, Postler KB. Academic Trajectories of College Students with and without ADHD: Predictors of Four-Year Outcomes. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2021; 50:828-843. [PMID: 33529049 DOI: 10.1080/15374416.2020.1867990] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective: Completing a college degree is associated with success in employment, financial earnings, and life satisfaction. Mental health difficulties, including attention-deficit/hyperactivity disorder (ADHD), can compromise degree completion.Method: We examined 4-year academic performance trajectories of 201 college students with ADHD (97 receiving medication [ADHD-Med], 104 not receiving medication [ADHD-NoMed]) relative to 205 non-ADHD Comparison students. Demographic (e.g., sex, race/ethnicity), psychological (e.g., self-reported depression and anxiety symptoms), and service-related (e.g., receipt of academic support) variables were included as predictors of intercept (i.e., Year 1 performance) and slope (yearly change) of semester GPA, progress toward graduation, and self-reported study skill strategies.Results: College students with ADHD obtained significantly lower GPAs (Hedge's g = -0.46 and -0.63) and reported less frequent use of study skills strategies (Hedge's g range from -1.00 to -2.28) than Comparison students. Significantly more Comparison students (59.1%) persisted through eight semesters relative to ADHD-NoMed students (49%). Multiple variables predicted outcomes with parent education, fewer depressive symptoms, better executive functioning, and receipt of high school Section 504 accommodations and college academic support services among the strongest predictors.Conclusions: Findings suggest support services for students with ADHD should begin prior to college matriculation and focus on improving executive functioning skills and depressive symptoms to increase chances of academic success.
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Affiliation(s)
- George J DuPaul
- Department of Education and Human Services, Lehigh University
| | - Matthew J Gormley
- Department of Educational Psychology, University of Nebraska-Lincoln
| | - Arthur D Anastopoulos
- Department of Human Development and Family Studies, University of North Carolina-Greensboro
| | | | - Jeffrey Labban
- Department of Human Development and Family Studies, University of North Carolina-Greensboro
| | | | - Chelsea Z Busch
- Department of Education and Human Services, Lehigh University
| | | | - Kaicee B Postler
- Department of Human Development and Family Studies, University of North Carolina-Greensboro
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Hulsbosch AK, De Meyer H, Beckers T, Danckaerts M, Van Liefferinge D, Tripp G, Van der Oord S. Systematic Review: Attention-Deficit/Hyperactivity Disorder and Instrumental Learning. J Am Acad Child Adolesc Psychiatry 2021; 60:1367-1381. [PMID: 33862167 DOI: 10.1016/j.jaac.2021.03.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 02/10/2021] [Accepted: 03/16/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Although instrumental learning deficits are, among other deficits, assumed to contribute to attention-deficit/hyperactivity disorder (ADHD), no comprehensive systematic review of instrumental learning deficits in ADHD exists. This review examines differences between ADHD and typically developing (TD) children in basic instrumental learning and the effects of reinforcement form, magnitude, schedule, and complexity, as well as effects of medication, on instrumental learning in children with ADHD. METHOD A systematic search of PubMed, PsyINFO, CINAHL, EMBASE+EMBASE CLASSIC, ERIC, and Web of Science was conducted for articles up to March 16, 2020. Experimental studies comparing instrumental learning between groups (ADHD versus TD) or a manipulation of reinforcement/medication within an ADHD sample were included. Quality of studies was assessed with an adapted version of the Hombrados and Waddington criteria to assess risk of bias in (quasi-) experimental studies. RESULTS A total of 19 studies from among 3,384 non-duplicate screened articles were included. No difference in basic instrumental learning was found between children with ADHD and TD children, nor effects of form or magnitude of reinforcement. Results regarding reinforcement schedule and reversal learning were mixed, but children with ADHD seemed to show deficits in conditional discrimination learning compared to TD children. Methylphenidate improved instrumental learning in children with ADHD. Quality assessment showed poor quality of studies with respect to sample sizes and outcome and missing data reporting. CONCLUSION The review identified very few and highly heterogenous studies, with inconsistent findings. No clear deficit was found in instrumental learning under laboratory conditions. Children with ADHD do show deficits in complex forms of learning, that is, conditional discrimination learning. Clearly more research is needed, using more similar task designs and manipulations.
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Affiliation(s)
- An-Katrien Hulsbosch
- Mrs. Hulsbosch, Dr. De Meyer, and Prof. Drs. Beckers, Danckaerts, and Van der Oord are with KU Leuven, Belgium.
| | - Hasse De Meyer
- Mrs. Hulsbosch, Dr. De Meyer, and Prof. Drs. Beckers, Danckaerts, and Van der Oord are with KU Leuven, Belgium; Dr. De Meyer is also with the HELP University, Kuala Lumpur, Malaysia
| | - Tom Beckers
- Mrs. Hulsbosch, Dr. De Meyer, and Prof. Drs. Beckers, Danckaerts, and Van der Oord are with KU Leuven, Belgium
| | - Marina Danckaerts
- Mrs. Hulsbosch, Dr. De Meyer, and Prof. Drs. Beckers, Danckaerts, and Van der Oord are with KU Leuven, Belgium; Dr. Van Liefferinge and Prof. Dr. Danckaerts also are with the University Psychiatric Centre KU Leuven, Belgium
| | - Dagmar Van Liefferinge
- Dr. Van Liefferinge and Prof. Dr. Danckaerts also are with the University Psychiatric Centre KU Leuven, Belgium
| | - Gail Tripp
- Prof. Dr. Tripp is with the Okinawa Institute of Science and Technology (OIST) Graduate University, Japan
| | - Saskia Van der Oord
- Mrs. Hulsbosch, Dr. De Meyer, and Prof. Drs. Beckers, Danckaerts, and Van der Oord are with KU Leuven, Belgium; Prof. Dr. Van der Oord is with the University of Amsterdam, the Netherlands
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87
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Siebelink NM, Kaijadoe SPT, van Horssen FM, Holtland JNP, Bögels SM, Buitelaar JK, Speckens AEM, Greven CU. Mindfulness for Children With ADHD and Mindful Parenting (MindChamp): A Qualitative Study on Feasibility and Effects. J Atten Disord 2021; 25:1931-1942. [PMID: 32727260 PMCID: PMC8427809 DOI: 10.1177/1087054720945023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Objective: We describe qualitative results on facilitators and barriers to participating in a family mindfulness-based intervention (MBI) for youth with ADHD and their parents and perceived effects on child and parent. Method: Sixty-nine families started the 8-week protocolized group-based MBI called "MYmind." After the MBI, individual semi-structured interviews were conducted with a purposive sample of parents (n = 20), children (n = 17, ages 9-16 years), and mindfulness teachers (n = 3). Interviews were analyzed using Grounded Theory. Results: Facilitators and barriers regarding contextual factors (e.g., time investment), MBI characteristics (e.g., parallel parent-child training), and participant characteristics (e.g., ADHD-symptoms) are described. Perceived effects were heterogeneous: no/adverse effects, awareness/insight, acceptance, emotion regulation/reactivity, cognitive functioning, calmness/relaxation, relational changes, generalization. Conclusion: MYmind can lead to a variety of transferable positively perceived effects beyond child ADHD-symptom decrease. Recommendations on MYmind participant inclusion, program characteristics, mindfulness teachers, and evaluating treatment efficacy are provided.
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Affiliation(s)
- Nienke M. Siebelink
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands,Karakter Child and Adolescent Psychiatry University Center, Nijmegen, The Netherlands
| | | | - Fylis M. van Horssen
- Karakter Child and Adolescent Psychiatry University Center, Nijmegen, The Netherlands
| | | | - Susan M. Bögels
- Department of Developmental Psychology & Research Institute of Child Development and Education, University of Amsterdam, The Netherlands
| | - Jan K. Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands,Karakter Child and Adolescent Psychiatry University Center, Nijmegen, The Netherlands
| | - Anne E. M. Speckens
- Radboudumc Center for Mindfulness, Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Corina U. Greven
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands,Karakter Child and Adolescent Psychiatry University Center, Nijmegen, The Netherlands,Institute of Psychiatry, Psychology and Neuroscience, Social, Genetic and Developmental Psychiatry Centre, King’s College London, UK,Corina U. Greven, Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Kapittelweg 29, 6525 EN Nijmegen, The Netherlands.
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Psychosocial Interventions for Attention-Deficit/Hyperactivity Disorder: Systematic Review with Evidence and Gap Maps. J Dev Behav Pediatr 2021; 41 Suppl 2S:S77-S87. [PMID: 31996574 DOI: 10.1097/dbp.0000000000000778] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To inform the scope of future systematic reviews, meta-analyses, and treatment outcome studies, this review aims to describe the extent of the evidence for psychosocial interventions for children and adolescents with attention-deficit/hyperactivity disorder, with particular attention to specific types of interventions, targets of outcome assessment, and risk of bias. METHOD A comprehensive search of relevant databases (i.e., Medline, PsychInfo, Education Resources Information Center, and ProQuest Dissertation Database) was conducted. Detailed information related to treatment type, outcome assessment, study design, and risk of bias was extracted by trained coders. Evidence and gap maps were created to summarize evidence within types of treatments and targets of outcome assessment. Indicators of risk of bias were assessed for selected combinations of treatments and outcome assessment. RESULTS We identified 185 eligible individual studies and 3817 effect sizes. Behavioral parent training and cognitive training (COG) were the most commonly studied stand-alone interventions. Treatment versus control comparisons for stand-alone interventions (s = 70) were less common than for complex interventions involving combinations of psychosocial interventions (s = 100). Combinations of behavioral and child training (e.g., COG, organizational training) interventions were the most frequently studied. CONCLUSION There is a considerable variability within this literature regarding combinations of treatments across outcome assessment targets. To address gaps in existing evidence, more primary studies assessing direct comparisons of isolated and combined treatment effects of specific types of psychosocial treatments relative to control and other treatments are needed. Future meta-analyses should take into account the complexity and breadth of available evidence.
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89
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Developing the Evidence-Grading Tools and Process for the Complex Attention-Deficit/Hyperactivity Disorder Guideline. J Dev Behav Pediatr 2021; 41 Suppl 2S:S105-S110. [PMID: 31996576 DOI: 10.1097/dbp.0000000000000773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Clinical practice guidelines (CPGs) rely on a robust assessment of the quality of evidence supporting guideline recommendations. For the Society for Developmental and Behavioral Pediatrics (SDBP) CPG for the Assessment and Treatment of Children and Adolescents with Complex Attention-Deficit Hyperactivity Disorder (ADHD), the nature of the evidence and resource constraints led the guideline panel to develop an innovative, yet rigorous, approach to evidence grading. This study will (1) describe the challenges of evidence grading for the SDBP Complex ADHD Guideline; (2) discuss the rationale, process, and tools developed to conduct evidence grading; and (3) report on the experiences and readiness of the volunteer reviewers with diverse background in research methodology to conduct evidence grading. This evidence review process may serve as an example of approaches that can be used by other groups tasked with evaluating the evidence in support of new CPGs.
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90
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Supplementary Evidence Tables for Treatment of Complex Attention-Deficit/Hyperactivity Disorder. J Dev Behav Pediatr 2021; 41 Suppl 2S:s111-s148. [PMID: 31996573 DOI: 10.1097/dbp.0000000000000768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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91
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Society for Developmental and Behavioral Pediatrics Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents with Complex Attention-Deficit/Hyperactivity Disorder. J Dev Behav Pediatr 2021; 41 Suppl 2S:S35-S57. [PMID: 31996577 DOI: 10.1097/dbp.0000000000000770] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is the most common childhood neurodevelopmental disorder and is associated with an array of coexisting conditions that complicate diagnostic assessment and treatment. ADHD and its coexisting conditions may impact function across multiple settings (home, school, peers, community), placing the affected child or adolescent at risk for adverse health and psychosocial outcomes in adulthood. Current practice guidelines focus on the treatment of ADHD in the primary care setting. The Society for Developmental and Behavioral Pediatrics has developed this practice guideline to facilitate integrated, interprofessional assessment and treatment of children and adolescents with "complex ADHD" defined by age (<4 years or presentation at age >12 years), presence of coexisting conditions, moderate to severe functional impairment, diagnostic uncertainty, or inadequate response to treatment.
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92
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Outcomes of School-Home Intervention for Attention and Behavior Problems: Teacher Adherence Matters. SCHOOL MENTAL HEALTH 2021; 12:703-715. [PMID: 34589157 DOI: 10.1007/s12310-020-09378-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study evaluated the effects of teacher adherence to behavioral treatment on student outcomes. Eighty-four children (ages 7-11) completed a 12-week, collaborative school-home behavioral intervention designed for youth with significant attention-deficit/hyperactivity disorder symptoms and impairment. Teacher adherence was assessed via school mental health provider (SMHP) ratings and Daily Report Card (DRC) implementation. Pre- and post-treatment outcomes included parent and teacher ratings of organizational skills and problem behaviors, observational measures of classroom task engagement and off task behaviors and report card standard grades. Using multi-level models to account for clustering by school, teacher adherence rated by SMHPs predicted improvement across teacher- and parent-rated organizational skills, parent-rated problem behaviors, and classroom observations of task engagement and off-task behavior. Higher rates of DRC implementation only predicted improvements in parent-rated organizational skills; percentage of days parents signed the DRC only predicted teacher-rated improvement in organizational skills. Post-hoc analyses indicated that teacher adherence and child success with academic targets on the DRC during the first month predicted parent-rated improvement in organizational skills. These results suggest that teacher adherence, particularly when rated by SMHPs, is an important predictor of positive treatment outcomes across both school and home settings. Future research is needed to better understand methods for measuring and optimizing teacher adherence to classroom behavioral interventions.
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93
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Aviv TLM, Katz YJ, Berant E. The Contribution of Therapeutic Horseback Riding to the Improvement of Executive Functions and Self-Esteem Among Children With ADHD. J Atten Disord 2021; 25:1743-1753. [PMID: 32508191 DOI: 10.1177/1087054720925898] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Attention deficit hyperactive disorder (ADHD) is associated with difficulties in executive functions (EFs), (assessed by questionnaires) and self-esteem. Objective: To examine the contribution of therapeutic horseback riding to the EFs' improvement and self-esteem. Method: In total, 123 Israeli children diagnosed with ADHD participated in the study. The study group participated in 20 weeks of therapeutic horseback riding sessions in addition to receiving medication, whereas the control group received only medication. The children and their mothers filled out questionnaires before treatment, at the end of treatment, and 12 weeks after the treatment ended. To examine changes in the children's EFs and self-esteem, a series of latent growth models (LGMs) were conducted. Results: Therapeutic horseback riding contributed to the improvement of EFs and self-esteem. Improved self-esteem predicted subsequent improvement in EFs. Conclusion: Therapeutic horseback riding is an effective therapeutic method to improve EFs and self-esteem among children with ADHD.
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Affiliation(s)
| | | | - Ety Berant
- Interdisciplinary Center Herzliya, Israel
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94
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Staff AI, Oosterlaan J, van der Oord S, Königs M, van den Hoofdakker BJ, Luman M. Child neurocognitive functioning influences the effectiveness of specific techniques in behavioral teacher training for ADHD: Moderator analyses from a randomized controlled microtrial. JCPP ADVANCES 2021; 1:e12032. [PMID: 37431443 PMCID: PMC10242932 DOI: 10.1002/jcv2.12032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 09/02/2021] [Indexed: 11/08/2022] Open
Abstract
Background Childhood attention-deficit/hyperactivity disorder (ADHD) is associated with several neurocognitive impairments. Whether these impairments influence the effectiveness of techniques that are commonly used in behavioral teacher training for ADHD has not been investigated so far. Method In this microtrial, teachers of 90 children with ADHD symptoms (6-12 years) were randomly assigned to a short intervention consisting of either antecedent-based (stimulus-control) techniques or consequent-based (contingency management) techniques, or to a waitlist control condition. Primary outcome was the daily assessment of individually selected problem behavior, assessed pre- and post-intervention. Potential neurocognitive moderators of treatment effect included teacher ratings of cognitive control, reward, and punishment sensitivity, and measures derived from computerized neurocognitive tasks, including attentional lapses, interference control, visuospatial working memory, and emotional functioning. Intervention condition by moderator interactions were assessed in separate multilevel mixed models. Results Lapses of attention, working memory, and emotional functioning interacted with intervention effectiveness. Antecedent-based techniques were effective independent of these neurocognitive functions; consequent-based techniques were (more) effective when these functions were more impaired. The effectiveness of techniques was neither related to interference control nor to teacher-rated neurocognitive functioning. Conclusions This study showed that child neurocognitive functioning influences the effectiveness of behavioral teacher techniques for children with ADHD symptoms. Findings suggest that antecedent-based techniques may be effective for all children, while consequent-based techniques have added value particularly for children who suffer from low visuospatial working memory, low emotional functioning, and/or large numbers of attentional lapses.
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Affiliation(s)
- Anouck I. Staff
- Department of Clinical‐, Neuro‐, and Developmental PsychologyVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Jaap Oosterlaan
- Department of Clinical‐, Neuro‐, and Developmental PsychologyVrije Universiteit AmsterdamAmsterdamThe Netherlands
- Emma Neuroscience GroupDepartment of PediatricsAmsterdam Reproduction & DevelopmentEmma Children's HospitalAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Saskia van der Oord
- Faculty of Psychology and Educational SciencesKU LeuvenLeuvenBelgium
- Department of Developmental PsychologyUniversity of AmsterdamAmsterdamThe Netherlands
| | - Marsh Königs
- Emma Neuroscience GroupDepartment of PediatricsAmsterdam Reproduction & DevelopmentEmma Children's HospitalAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Barbara J. van den Hoofdakker
- Department of Child and Adolescent PsychiatryUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
- Department of Clinical Psychology and Experimental PsychopathologyUniversity of GroningenGroningenThe Netherlands
| | - Marjolein Luman
- Department of Clinical‐, Neuro‐, and Developmental PsychologyVrije Universiteit AmsterdamAmsterdamThe Netherlands
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95
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Green CD, Langberg JM. A Review of Predictors of Psychosocial Service Utilization in Youth with Attention-Deficit/Hyperactivity Disorder. Clin Child Fam Psychol Rev 2021; 25:356-375. [PMID: 34498154 DOI: 10.1007/s10567-021-00368-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2021] [Indexed: 11/29/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is one of the most common childhood disorders. Professional practice guidelines recommend combined treatment, psychopharmacological and psychosocial, for youth with ADHD. There have been multiple reviews of pharmacological prescription practices and utilization, however, less is known about predictors of ADHD psychosocial service utilization. Given the importance of accessing psychosocial treatment in relation to improving functional impairment, this review synthesizes evidence on predictors of ADHD psychosocial intervention utilization in clinic, community, and school settings. Eighteen studies were identified and included in the review. Findings are summarized across informant profile factors, predisposing characteristics, and barriers and facilitators. The most robust findings were for the impact of symptom severity/impairment, the presence of comorbidities, and age on ADHD psychosocial service utilization. Race/ethnicity, sex, parental knowledge of the disorder and insurance coverage were also identified as key factors. Future avenues of research are provided, and clinical and policy implications targeted at reducing psychosocial treatment disparities in youth with ADHD are discussed.
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Affiliation(s)
- Cathrin D Green
- Virginia Commonwealth University, 806 W. Franklin St, Box 842018, Richmond, VA, 23284, USA
| | - Joshua M Langberg
- Virginia Commonwealth University, 806 W. Franklin St, Box 842018, Richmond, VA, 23284, USA.
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96
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Hasslinger J, Bölte S, Jonsson U. Slow Cortical Potential Versus Live Z-score Neurofeedback in Children and Adolescents with ADHD: A Multi-arm Pragmatic Randomized Controlled Trial with Active and Passive Comparators. Res Child Adolesc Psychopathol 2021; 50:447-462. [PMID: 34478006 PMCID: PMC8940855 DOI: 10.1007/s10802-021-00858-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2021] [Indexed: 11/25/2022]
Abstract
Neurofeedback (NF) as a treatment for Attention Deficit Hyperactivity Disorder (ADHD) has been evaluated in several trials, but the specificity and generalizability of effects remain unclear. This four-arm randomized controlled trial evaluated the efficacy of Slow Cortical Potential (SCP; standard NF protocol) and Live Z-score (LZS; non-standard NF protocol) delivered in high-frequency format (five sessions per week during five weeks), compared to Working-memory training (WMT; active comparator) and Treatment-as-usual (TAU; passive comparator). N = 202 children/adolescents aged 9 to 17 years with ADHD participated. The primary outcome measure was multi-report (self-, teacher-, and parent-report) ADHD core symptoms on the Conners-3, assessed at baseline, posttreatment, and 6-months follow-up. Data were analyzed using a linear mixed model. Between-group differences were scarce and did not show a distinct pattern. Superiority of LZS over TAU at endpoint were observed for teacher-rated measures only, while significant differences between SCP and TAU were restricted to posttreatment measurements. Contrary to our expectations, LZS outperformed SCP at endpoint for teacher-rated hyperactivity (-5.37; 95% CI: -10.14 to -0.60; p = .028; d = -.36) and overall ADHD symptoms (-2.20; -4.18 to -0.22; p = .030; d = -.41). There was no indication that either form of NF was superior to WMT. No severe adverse events were reported during the trial, whereas transient stress-related problems were quite frequent. Overall, the results from this pragmatic trial do not provide convincing support for broad implementation of NF in child and adolescent psychiatric services. Future research should try to clarify for whom and under what circumstances NF might be a viable treatment option.
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Affiliation(s)
- John Hasslinger
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet & Child and Adolescent Psychiatry, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
- Child and Adolescent Psychiatry, Stockholm Health Services, Region Stockholm, Stockholm, Sweden.
| | - Sven Bölte
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet & Child and Adolescent Psychiatry, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Child and Adolescent Psychiatry, Stockholm Health Services, Region Stockholm, Stockholm, Sweden
- Curtin Autism Research Group, School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, WA, Australia
| | - Ulf Jonsson
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet & Child and Adolescent Psychiatry, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Child and Adolescent Psychiatry, Stockholm Health Services, Region Stockholm, Stockholm, Sweden
- Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden
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Popow C, Ohmann S, Plener P. Practitioner's review: medication for children and adolescents with autism spectrum disorder (ASD) and comorbid conditions. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2021; 35:113-134. [PMID: 34160787 PMCID: PMC8429404 DOI: 10.1007/s40211-021-00395-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/15/2021] [Indexed: 11/14/2022]
Abstract
Alleviating the multiple problems of children with autism spectrum disorder (ASD) and its comorbid conditions presents major challenges for the affected children, parents, and therapists. Because of a complex psychopathology, structured therapy and parent training are not always sufficient, especially for those patients with intellectual disability (ID) and multiple comorbidities. Moreover, structured therapy is not available for a large number of patients, and pharmacological support is often needed, especially in those children with additional attention deficit/hyperactivity and oppositional defiant, conduct, and sleep disorders.
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Affiliation(s)
- Christian Popow
- Dept. Child and Adolescent Psychiatry, Medical University of Vienna, Waehringer Guertel 18–20, 1090 Vienna, Austria
| | - Susanne Ohmann
- Dept. Child and Adolescent Psychiatry, Medical University of Vienna, Waehringer Guertel 18–20, 1090 Vienna, Austria
| | - Paul Plener
- Dept. Child and Adolescent Psychiatry, Medical University of Vienna, Waehringer Guertel 18–20, 1090 Vienna, Austria
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98
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Gregg DE, Hart KC, Vaquerano S, Cuervo S, Suarez M, Graziano PA. Multidisciplinary Early Intervention for Preschoolers with Externalizing Behavior Problems and Language Impairment: Results from an Open Trial. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2021. [DOI: 10.1007/s10862-020-09865-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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99
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Hornstra R, van der Oord S, Staff AI, Hoekstra PJ, Oosterlaan J, van der Veen-Mulders L, Luman M, van den Hoofdakker BJ. Which Techniques Work in Behavioral Parent Training for Children with ADHD? A Randomized Controlled Microtrial. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2021; 50:888-903. [PMID: 34424102 DOI: 10.1080/15374416.2021.1955368] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Behavioral parent training (BPT) is an evidence-based intervention for children with attention-deficit/hyperactivity disorder (ADHD), but little is known about the effects of separate techniques parents learn in BPT. METHOD In a three-armed randomized controlled microtrial including parents of 92 children (4-12 years) with ADHD, we examined the efficacy of two sessions parent training involving either stimulus control techniques (antecedent-based condition (AC)) or contingency management techniques (consequent-based condition (CC)), compared to a waitlist. Primary outcome was daily parent-rated problem behaviors, secondary outcomes were parent-rated symptoms of ADHD and oppositional defiant disorder (ODD), and mental health-care consumption. Measures were completed at baseline (T0), immediately after the training (T1), at two weeks (T2) and three months (T3) follow-up. We also explored whether child and parent characteristics moderated treatment effects. RESULTS Compared to the waitlist, in the AC, daily rated problem behaviors improved at T1 (d= .56) and T2 (d= .65); in the CC, these behaviors only improved at T2 (d= .53). Daily rated problem behaviors within both conditions remained stable between T2 and T3. In the AC compared to the other conditions, inattention symptoms decreased at T1 and T2. For both active conditions compared to waitlist, hyperactivity-impulsivity symptoms decreased only at T2 and ODD symptoms did not decrease. No moderators were identified. Mental health-care consumption after training was low and did not differ between the active conditions. CONCLUSIONS Brief training of parents in antecedent- or consequent-based techniques improves problem behaviors of children with ADHD. Antecedent-based techniques appear to be especially important to target inattention.
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Affiliation(s)
- Rianne Hornstra
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen
| | - Saskia van der Oord
- Clinical Psychology, KU Leuven.,Affiliated staff, Developmental Psychology, University of Amsterdam
| | - Anouck I Staff
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam
| | - Pieter J Hoekstra
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen
| | - Jaap Oosterlaan
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam.,Department of Pediatrics, Amsterdam Reproduction & Development, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Emma Neuroscience Group
| | | | - Marjolein Luman
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam.,Specialist in youth and family care, Levvel
| | - Barbara J van den Hoofdakker
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen.,Department of Clinical Psychology and Experimental Psychopathology, University of Groningen
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100
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Leveraging Machine Learning to Identify Predictors of Receiving Psychosocial Treatment for Attention Deficit/Hyperactivity Disorder. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 47:680-692. [PMID: 32405822 DOI: 10.1007/s10488-020-01045-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study aimed to identify factors associated with receiving psychosocial treatment for ADHD in a nationally representative sample. Participants were 6630 youth with a parent-reported diagnosis of ADHD from the 2016-2017 National Survey of Children's Health. Machine learning analyses were performed to identify factors associated with receipt of psychosocial treatment for ADHD. We examined potentially associated factors in the broad categories of variables hypothesized to affect problem recognition (e.g., severity, mental health comorbidities); the decision to seek treatment; service selection (e.g., insurance coverage) and service use. We found that three machine learning models unanimously identified parent-reported ADHD severity (mild vs. moderate/severe) as the factor that best distinguishes between children who receive psychosocial treatment for ADHD and those who do not. Receive operating characteristic curve analysis revealed the following model performance: classification and regression tree analysis (area under the curve; AUC = .68); an ensemble model (AUC = .71); and a deep, multi-layer neural network (AUC = .72), as well as comparison to a logistic regression model (AUC = .69). Further, insurance coverage of mental/behavioral health needs emerged as a salient factor associated with the receipt of psychosocial treatment. Machine learning models identified risk and protective factors that predicted the receipt of psychosocial treatment for ADHD, such as ADHD severity and health insurance coverage.
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