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Vacher C, Romo L, Dereure M, Soler M, Picot MC, Purper-Ouakil D. Efficacy of cognitive behavioral therapy on aggressive behavior in children with attention deficit hyperactivity disorder and emotion dysregulation: study protocol of a randomized controlled trial. Trials 2022; 23:124. [PMID: 35130934 PMCID: PMC8819925 DOI: 10.1186/s13063-022-05996-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is frequently associated with emotional dysregulation (ED). ED is characterized by excessive and inappropriate emotional reactions compared to social norms, uncontrolled and rapid shifts in emotion, and attention focused on emotional stimuli. Few studies have evaluated non-pharmacological interventions to improve ED in children with ADHD. The current randomized controlled trial assesses the efficacy of a cognitive behavioral therapy (CBT) intervention compared with a theater-based intervention (TBI) in children with ADHD and ED. METHODS Sixty-eight 7- to 13-year-old children with ADHD and ED will be recruited and randomly assigned to the CBT or TBI group. CBT aims to reduce ED by teaching anger management strategies. TBI seeks to reduce ED by improving emotion understanding and expression through mimics and movement. In both groups, children participate in 15 1-h sessions, and parents participate in 8 sessions of a parent management program. The primary outcome measure is the change in the "Aggression" sub-score of the Child Behavior Checklist (CBCL). Secondary outcome measures include overall impairment (Children's Global Assessment Scale, Strengths and Difficulties Questionnaire), personality profile (Hierarchical Personality Inventory for Children), executive function (Behavioral Rating Inventory of Executive Function), quality of life (Kidscreen-27), parental stress (Parenting Stress Index, 4th edition), parental depression (Beck Depression Inventory-II), and impact of child disorders on the quality of the family life (Parental Quality of Life and Developmental Disorder). DISCUSSION Children with ADHD and ED are at risk of functional impairment and poor outcomes and have specific therapeutic needs. This randomized controlled trial wants to assess non-pharmacological treatment options for this population. TRIAL REGISTRATION Clinicaltrials.gov. NCT03176108 . Registered on June 5, 2017.
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Affiliation(s)
- C Vacher
- Centre Hospitalo-Universitaire de Montpellier, Service Médecine Psychologique de l'Enfant et de l'Adolescent, Montpellier, Hérault, France. .,CLIPSYD EA-4430, UFR Sciences Psychologiques et Sciences de l'Education, Université de Nanterre, Nanterre, Hauts de Seine, France. .,INSERM U 1018, CESP, Psychiatrie du développement - Evaluer et traiter les troubles émotionnels et du neurodéveloppement (ETE-ND), Montpellier, France.
| | - L Romo
- CLIPSYD EA-4430, UFR Sciences Psychologiques et Sciences de l'Education, Université de Nanterre, Nanterre, Hauts de Seine, France.,Service de Pathologies professionnelles et de l'environnement, Assistance Publique des Hôpitaux de Paris, Hôpital Universitaire Raymond Poincaré, Garches, France
| | - M Dereure
- Unité de Recherche Clinique et Epidémiologie, Département de l'Information Médicale, Centre Hospitalo-Universitaire de Montpellier, Montpellier, Hérault, France
| | - M Soler
- Unité de Recherche Clinique et Epidémiologie, Département de l'Information Médicale, Centre Hospitalo-Universitaire de Montpellier, Montpellier, Hérault, France
| | - M C Picot
- Unité de Recherche Clinique et Epidémiologie, Département de l'Information Médicale, Centre Hospitalo-Universitaire de Montpellier, Montpellier, Hérault, France.,Centre d'Investigation Clinique, Hôpital Saint Eloi, Centre Hospitalo-Universitaire de Montpellier, Montpellier, Hérault, France
| | - D Purper-Ouakil
- Centre Hospitalo-Universitaire de Montpellier, Service Médecine Psychologique de l'Enfant et de l'Adolescent, Montpellier, Hérault, France.,INSERM U 1018, CESP, Psychiatrie du développement - Evaluer et traiter les troubles émotionnels et du neurodéveloppement (ETE-ND), Montpellier, France
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Vacher C, Goujon A, Romo L, Purper-Ouakil D. Efficacy of psychosocial interventions for children with ADHD and emotion dysregulation: a systematic review. Psychiatry Res 2020; 291:113151. [PMID: 32619822 DOI: 10.1016/j.psychres.2020.113151] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 03/09/2020] [Accepted: 05/26/2020] [Indexed: 12/22/2022]
Abstract
Attention-Deficit Hyperactivity Disorder (ADHD) is frequently associated with emotion dysregulation (ED) that is characterized by excessive and inappropriate emotional reactions. Children with ADHD and ED present significant social, academic and family functioning impairments. These findings indicate that ED should be regularly monitored in children with ADHD and should be managed with targeted therapeutic interventions. However, few studies have evaluated the efficacy of psychosocial interventions to manage ED in children with ADHD. The aim of this systematic review was to assess the effects of psychosocial interventions for children with ADHD and ED, particularly their benefits and limitations. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) model. A systematic literature search of different databases in February 2018 allowed the identification of five randomized controlled trials, one quasi-experimental study, and four open-label uncontrolled studies. Analysis of the results reported in these studies suggested that psychosocial interventions can improve severe irritability and aggressive behavior in children with ADHD and ED. However, the short trial duration, the lack of follow-up and of control group in several studies, and the heterogeneity of the outcome measures affected the result interpretation. Future studies should use standardized measures of ED and larger samples.
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Affiliation(s)
- Cécile Vacher
- Centre Hospitalo-Universitaire de Montpellier, Service Médecine Psychologique de l'Enfant et de l'Adolescent, Montpellier, Hérault, France; CLIPSYD EA-4430, UFR Sciences Psychologiques et Sciences de l'Education, Université de Nanterre, Nanterre, Hauts de Seine, France.
| | - Allison Goujon
- Centre Hospitalo-Universitaire de Montpellier, Service Médecine Psychologique de l'Enfant et de l'Adolescent, Montpellier, Hérault, France
| | - Lucia Romo
- CLIPSYD EA-4430, UFR Sciences Psychologiques et Sciences de l'Education, Université de Nanterre, Nanterre, Hauts de Seine, France; CMME, Hôpital Sainte-Anne, GHU Paris Psychiatrie et Neurosciences; INSERM UMR1266 Institute of Psychiatry and Neuroscience of Paris
| | - Diane Purper-Ouakil
- Centre Hospitalo-Universitaire de Montpellier, Service Médecine Psychologique de l'Enfant et de l'Adolescent, Montpellier, Hérault, France; INSERM U1018 CESP/Psychiatry, development and trajectories, Montpellier
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Abstract
Individuals with attention-deficit/hyperactivity disorder (ADHD) experience impairments in a number of functional domains. Although current evidence-based treatments for ADHD reduce symptoms and improve academic and behavioral functioning, they have minimal impact on social functioning or on risky behaviors (see Evans et al. in J Clin Child Adolesc Psychol, 43:527-551, 2014 for review). Preliminary evidence indicates that emotion dysregulation (ED) is associated with impairments across the developmental spectrum, such as social impairment and risky behaviors, and that its relative absence/presence is differentially associated with treatment response. It thus stands to reason that by incorporating a focus on ED in interventions targeting social impairment and risky behaviors, we may be able to increase the number of youth who respond to such interventions and decrease the prevalence or degree of these impairments and behaviors among youth and adults with ADHD. However, a number of questions remain unaddressed about the association between ADHD and ED, such as the portion of individuals with ADHD who experience ED, the extent to which ED is associated with the above impairments and behaviors, and whether or not ED is malleable. To begin addressing these questions, we summarize and critically evaluate the literature on the association between ADHD and ED and make recommendations for future basic, translational, and treatment outcome research.
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Social Skills Mediate the Association of ADHD and Depression in Preadolescents. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2016. [DOI: 10.1007/s10862-016-9569-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Intervention with students with ADHD: Analysis of the effects of a multi-component and multi-contextualized program on academic and socio-emotional adjustment. ACTA ACUST UNITED AC 2015. [DOI: 10.1108/s0735-004x(2009)0000022010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Godley SH, Smith JE, Passetti LL, Subramaniam G. The Adolescent Community Reinforcement Approach (A-CRA) as a Model Paradigm for the Management of Adolescents With Substance Use Disorders and Co-Occurring Psychiatric Disorders. Subst Abus 2014; 35:352-63. [DOI: 10.1080/08897077.2014.936993] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Villodas MT, McBurnett K, Kaiser N, Rooney M, Pfiffner LJ. Additive effects of parent adherence on social and behavioral outcomes of a collaborative school-home behavioral intervention for ADHD. Child Psychiatry Hum Dev 2014; 45:348-60. [PMID: 24043560 PMCID: PMC4808053 DOI: 10.1007/s10578-013-0405-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The present study evaluated the impact of the Collaborative Life Skills Program (CLS), a novel school-home psychosocial intervention, on social and behavioral impairments among children with attention and behavior problems. Fifty-seven ethnically/racially diverse children (70 % boys) with attention and/or behavior problems in the second through fifth grades participated in a pilot study. Ten school-based mental health professionals were trained and then implemented the intervention at their respective schools. Children significantly improved from pre- to post-treatment on parent, teacher, and report card ratings of children's social and behavioral functioning. Treatment improvements were consistent for children with and without co-occurring disruptive behavior problems. The impact of the intervention was enhanced when parents used the intervention strategies more regularly, according to both clinicians' and parents' reports. Findings support the emphasis of CLS on coordinating intervention strategies across contexts to facilitate the generalization of treatment-related improvements in social and behavioral functioning.
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Olivier MAJ, Gomes AM, Greyling AJ. Attention Deficit Hyperactivity Disorder (ADHD)—Dilemmas and Solutions. JOURNAL OF PSYCHOLOGY IN AFRICA 2014. [DOI: 10.1080/14330237.2009.10820285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Rowe DL, Hermens DF. Attention-deficit/hyperactivity disorder: neurophysiology, information processing, arousal and drug development. Expert Rev Neurother 2014; 6:1721-34. [PMID: 17144785 DOI: 10.1586/14737175.6.11.1721] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In this review, we draw on literature from both animal and human neurophysiological studies to consider the neurochemical mechanisms underlying attention-deficit/ hyperactivity disorder (ADHD). Psychophysiological and neuropsychological research is used to propose possible etiological endophenotypes of ADHD. These are conceptualized as patients with distinct cortical-arousal, information-processing or maturational abnormalities, or a combination thereof, and how the endophenotypes can be used to help drug development and optimize treatment and management. To illustrate, the paper focuses on neuro- and psychophysiological evidence that suggests cholinergic mechanisms may underlie specific information-processing abnormalities that occur in ADHD. The clinical implications for a cholinergic hypothesis of ADHD are considered, along with its possible implications for treatment and pharmacological development.
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Affiliation(s)
- Donald L Rowe
- The Brain Dynamics Centre and Department of Psychological Medicine, Westmead Hospital and University of Sydney, NSW, Australia.
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Hwang JH, Kwack YS. The Effect of Social Skills Training for Children with Attention-Deficit Hyperactivity Disorder and Asperger's Disorder : Preliminary Study. Soa Chongsonyon Chongsin Uihak 2013. [DOI: 10.5765/jkacap.2013.24.4.199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Miranda A, Presentación MJ, Siegenthaler R, Jara P. Effects of a psychosocial intervention on the executive functioning in children with ADHD. JOURNAL OF LEARNING DISABILITIES 2013; 46:363-376. [PMID: 22064952 DOI: 10.1177/0022219411427349] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The purpose of this study was to analyze the effects of an intensive psychosocial intervention on the executive functioning (EF) in children with ADHD. The treatment was carried out in a coordinated manner over a period of 10 weeks with 27 children with ADHD aged 7 to 10, their parents, and their teachers. A battery of neuropsychological tasks was applied to evaluate attention, interference control, verbal and visuospatial working memory, planning ability, and flexibility. The comparative analysis of the treated group of ADHD children and an untreated ADHD group showed significant differences that were especially important in visuospatial memory and planning in favor of the treated children, even when the scores in the pretreatment phase were included as covariables. Likewise, improvements were observed in the parents' and teachers' behavioral ratings of hyperactivity or impulsivity and inattention. The conclusion was drawn that psychosocial interventions with children with ADHD can have a positive effect on some executive functions.
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Affiliation(s)
- Ana Miranda
- Departamento de Psicología Evolutiva y de la Educación, University of Valencia, Valencia, Spain.
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Huang YH, Chung CY, Ou HY, Tzang RF, Huang KY, Liu HC, Sun FJ, Chen SC, Pan YJ, Liu SI. Treatment effects of combining social skill training and parent training in Taiwanese children with attention deficit hyperactivity disorder. J Formos Med Assoc 2013; 114:260-7. [PMID: 25777975 DOI: 10.1016/j.jfma.2012.10.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Revised: 08/14/2012] [Accepted: 10/30/2012] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND/PURPOSE Children with attention-deficit/hyperactivity disorder (ADHD) often have problems in social interactions. We investigated the social and behavioral effects of providing both social skill training and parent training to school-aged children with ADHD in Taiwan. METHODS Seven consecutive 8-week behavioral-based social skill training (SST) group sessions were held for 48 children with ADHD; parallel 8-week parent group sessions were provided simultaneously. Fifty-five children with ADHD were recruited as a control group. All children took medication as prescribed by their doctors. The effects were assessed using the teacher and parent version of the Chinese version of Swanson, Nolan, and Pelham, version IV scale (SNAP-IV), the Chinese version of the Child Behavior Check List (CBCL-C), child and teacher version of the modified Social Skill Rating System (SSRS-C and SSRS-T), at baseline, post-treatment, and 4 months from baseline. The doses of methylphenidate and drug compliance were controlled during the analysis. RESULTS The mixed-effects model demonstrated the main effect of group sessions on the Oppositional subscale of SNAP-P, the Anxious/Depressed subscale of CBCL-C, the Self Control subscale of SSRS-C, and the Active Participation subscale of SSRS-T, all in favor of the experimental group. However, the improvement on the Oppositional subscale of SNAP-P and the Self Control subscale of SSRS-C were noted only between baseline and post-treatment period and were not sustained at the end of the follow-up period. CONCLUSION Our study demonstrated that children with ADHD could benefit from this low intensity psychosocial program, although some improvements were not maintained at follow-up assessment.
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Affiliation(s)
- Yu-Hsin Huang
- Department of Medicine, Mackay Medical College, Taipei, Taiwan; Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Medicine, Nursing and Management College, Taipei, Taiwan; Suicide Prevention Center, Mackay Memorial Hospital, Taipei, Taiwan
| | - Chao-Ying Chung
- Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan
| | - Hsing-Yi Ou
- Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan
| | - Ruu-Fen Tzang
- Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Medicine, Nursing and Management College, Taipei, Taiwan
| | - Kuo-Yang Huang
- Department of Psychiatry, Taiwan Adventist Hospital, Taipei, Taiwan
| | - Hui-Ching Liu
- Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan; Suicide Prevention Center, Mackay Memorial Hospital, Taipei, Taiwan
| | - Fang-Ju Sun
- Mackay Medicine, Nursing and Management College, Taipei, Taiwan; Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan
| | - Shu-Chin Chen
- Suicide Prevention Center, Mackay Memorial Hospital, Taipei, Taiwan
| | - Yi-Ju Pan
- Department of Psychiatry, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - Shen-Ing Liu
- Department of Medicine, Mackay Medical College, Taipei, Taiwan; Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Medicine, Nursing and Management College, Taipei, Taiwan; Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan; Suicide Prevention Center, Mackay Memorial Hospital, Taipei, Taiwan.
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Van der Oord S, Prins PJM, Oosterlaan J, Emmelkamp PMG. Efficacy of methylphenidate, psychosocial treatments and their combination in school-aged children with ADHD: a meta-analysis. Clin Psychol Rev 2007; 28:783-800. [PMID: 18068284 DOI: 10.1016/j.cpr.2007.10.007] [Citation(s) in RCA: 194] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2006] [Revised: 07/31/2007] [Accepted: 10/26/2007] [Indexed: 01/18/2023]
Abstract
INTRODUCTION This meta-analysis compares effect-sizes of methylphenidate and psychosocial treatments and their combination on ADHD, concurrent oppositional, conduct symptoms, social behaviors and academic functioning. METHOD Several databases (PubMed, PsycInfo, ISI Web of Science) were searched for articles published between 1985 and September 2006. Inclusion criteria were: a diagnosis of ADHD; age from 6-12 years; a randomized controlled treatment design; efficacy established with parent and teacher rating scales; psychosocial treatments used were described as behavioral or cognitive-behavioral; the methylphenidate treatment was short-acting; and finally, treatment was conducted in a clinical setting. RESULTS ADHD outcomes showed large mean weighted effect-sizes for both methylphenidate and combined treatments, psychosocial treatments had a moderate mean weighted effect-size; a similar pattern emerged for oppositional and conducted behavior symptoms. Social behavior outcomes showed comparable moderate mean weighted effect-sizes for all treatments, while on academic functioning, all treatments had low mean weighted effect-sizes. There was no correlation between duration of psychosocial treatment and effect-size. CONCLUSIONS Both methylphenidate and psychosocial treatments are effective in reducing ADHD symptoms. However, psychosocial treatment yields smaller effects than both other treatment conditions. Psychosocial treatment has no additional value to methylphenidate for the reduction of ADHD and teacher rated ODD symptoms. However, for social behavior and parent rated ODD the three treatments were equally effective. For improvement of academic functioning no treatment was effective.
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Affiliation(s)
- S Van der Oord
- Department of Clinical Psychology, University of Amsterdam, Roeterstraat 15, 1018 WB Amsterdam, The Netherlands.
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Abstract
The purpose of this article is to discuss alternative treatments other than drug therapy for Attention-Deficit/Hyperactive Disorder (ADHD) in educational settings. There is an increasing body of knowledge that supports interventions for improving cognitive outcomes without the use of medication. The article explores the risks to ADHD children, shows the potential linkage between gifted children and ADHD, explores recent brain research, and examines various alternative treatment options. Information is presented on alternative treatments such as cognitive behavioral therapies, educational interventions, electroencephalograph (EEG) neuro-feedback, and diet.
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Miranda A, Presentación MJ, Soriano M. Effectiveness of a school-based multicomponent program for the treatment of children with ADHD. JOURNAL OF LEARNING DISABILITIES 2002; 35:546-562. [PMID: 15493252 DOI: 10.1177/00222194020350060601] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The objective of this study was to evaluate the efficacy of a multicomponent program for treating attention-deficit/hyperactivity disorder (ADHD) carried out by teachers in a classroom context. Dependent measures included neuropsychological tasks, behavioral rating scales for parents and teachers, direct observation of behavior in the classroom, and academic records of children with ADHD. Fifty children with ADHD participated in the study. The teachers of 29 of the 50 students were trained in the use of behavior modification techniques, cognitive behavior strategies, and instructional management strategies. The other 21 students formed the control group. Parents' and teachers'ratings detected improvements in primary symptoms (inattention-disorganization, hyperactivity-impulsivity) and in behavioral difficulties usually associated with ADHD (e.g., antisocial behavior, psychopathological disorders, anxiety). Furthermore, the results showed increased academic scores, enhanced classroom behavioral observations, and improved teachers' knowledge about the strategies directed toward responding to the children's educational needs.
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Affiliation(s)
- Ana Miranda
- Department of Developmental and Educational Psychology, University of Valencia, Spain.
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