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Schultz BK, Evans SW, Bowditch J, Carter K, Rogers EE, Donelan J, Dembowski A. Acceptability and playability of an organization training videogame for young adolescents with ADHD: The development of ATHEMOS. PLOS DIGITAL HEALTH 2023; 2:e0000374. [PMID: 37956184 PMCID: PMC10642850 DOI: 10.1371/journal.pdig.0000374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 09/22/2023] [Indexed: 11/15/2023]
Abstract
An estimated 8.7% to 9.8% of school-age children in the United States have attention deficit hyperactivity disorder (ADHD), affecting 4.3 to 4.9 million public school students. ADHD is a costly disorder that often goes untreated, especially among adolescents. Accessible computer-based programs have emerged to address the neurocognitive deficits of ADHD, but results to date have been disappointing. In this study, we tested the acceptability, playability, and user satisfaction of a novel planning/organization skills training game, called "ATHEMOS," based on an established psychosocial treatment package (i.e., Challenging Horizons Program). We conducted eight focus groups during a three-year development period, using feedback from 72 young adolescents with ADHD to iteratively improve the game. Then, during a pilot study in the fourth year, we collected data from 16 young adolescents who played the game as part of a 6- to 16-week school-based intervention. Our findings suggest that the serious game resulted in acceptability and playability ratings only moderately below that of recreational games (δ = -0.40). Critically, average perceptions remained positive when delivered within a school-based ADHD intervention over several weeks or months, with strong overall user satisfaction. Boys found the game more acceptable than girls, with ratings near that of recreational games (δ = -0.23). We conclude that computer-assisted behavior interventions appeal to adolescents with ADHD and offer a potentially promising treatment delivery method in schools.
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Affiliation(s)
- Brandon K. Schultz
- Department of Psychology, East Carolina University, Greenville, North Carolina, United States of America
| | - Steven W. Evans
- Department of Psychology, Ohio University, Athens, Ohio, United States of America
| | - John Bowditch
- Game Research and Immersive Design Laboratory, Ohio University, Athens, Ohio, United States of America
| | - Kaitlynn Carter
- Department of Psychology, East Carolina University, Greenville, North Carolina, United States of America
| | - Emma E. Rogers
- Department of Psychology, Ohio University, Athens, Ohio, United States of America
| | - Jennifer Donelan
- Department of Psychology, East Carolina University, Greenville, North Carolina, United States of America
| | - Allison Dembowski
- Department of Psychology, East Carolina University, Greenville, North Carolina, United States of America
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Fedewa A, Mayo MR, Ahn S, Erwin H. A School-Based Physical Activity Intervention for Young Children: Are There Effects on Attention and Behavior? JOURNAL OF APPLIED SCHOOL PSYCHOLOGY 2020. [DOI: 10.1080/15377903.2020.1858380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
| | | | - Soyeon Ahn
- University of Miami, Coral Gables, Florida, USA
| | - Heather Erwin
- Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, Kentucky, USA
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Zendarski N, Sciberras E, Mensah F, Hiscock H. Factors Associated With Educational Support in Young Adolescents With ADHD. J Atten Disord 2020; 24:750-757. [PMID: 30328744 DOI: 10.1177/1087054718804351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objective: This study aimed to examine patterns of use and factors associated with education support use in students with ADHD during early adolescence. Method: Participants were 130 adolescents (M = 13.7 years, SD = 1.1) with ADHD. Educational support use and the factors associated with use were collected by parent and teacher questionnaires and standardized academic tests during the 2014-2015 school years. Support rates and categories are described. Logistic regression models examine individual, family, and school variables associated with support versus no support. Results: About two thirds of students with ADHD (60%) had accessed education support in the current school year, which included social support (36%), Individualized Educational Plans (IEPs; 22%), Student Support Groups (SSGs; 18%), counseling (17%), mentoring (15%), and homework support (9%). Academic risk (adjusted odds ratio [OR] = 2.30, 95% confidence interval [CI] = [1.03, 5.14], p = .04), behavioral problems (adjusted OR = 1.47, 95% CI = [1.01, 2.14], p = .047), and attending a Catholic school (adjusted OR = 5.10, 95% CI = [1.59, 16.42], p = .006) were associated with receiving support independent of adolescent age, gender, ADHD medication use, and socioeconomic status. Conclusions: Future research needs to determine whether education support makes a difference to long-term outcomes for students with ADHD and to determine why some students at academic risk receive no support.
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Affiliation(s)
- Nardia Zendarski
- Murdoch Children's Research Institute, Melbourne, Australia.,University of Melbourne, Australia
| | - Emma Sciberras
- Murdoch Children's Research Institute, Melbourne, Australia.,University of Melbourne, Australia.,The Royal Children's Hospital, Melbourne, Victoria, Australia.,Deakin University, Burwood, Australia
| | - Fiona Mensah
- Murdoch Children's Research Institute, Melbourne, Australia.,University of Melbourne, Australia.,The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Harriet Hiscock
- Murdoch Children's Research Institute, Melbourne, Australia.,University of Melbourne, Australia.,The Royal Children's Hospital, Melbourne, Victoria, Australia
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Corkum P, Elik N, Blotnicky-Gallant PAC, McGonnell M, McGrath P. Web-Based Intervention for Teachers of Elementary Students With ADHD: Randomized Controlled Trial. J Atten Disord 2019; 23:257-269. [PMID: 26362259 DOI: 10.1177/1087054715603198] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To test the acceptability, satisfaction, and effectiveness of a web-based intervention for teachers of elementary school-aged children with ADHD. METHOD Elementary classroom teachers (N = 58), along with their students with ADHD, participated in a randomized controlled trial. The program consisted of six sessions that included evidence-based intervention strategies for reducing ADHD symptoms and impairment in the classroom setting. Teachers also had access to a moderated Discussion Board and an online ADHD coach. Questionnaire data were electronically collected from teachers and parents pre-intervention, post-intervention (6 weeks), and after an additional 6-week follow-up. RESULTS Intent-to-treat analyses found significant improvements based on teacher (but not parent) reports of core ADHD symptoms and impairment for the Teacher Help for ADHD treatment group. Teachers reported a high level of acceptability and satisfaction. CONCLUSION Web-based ADHD interventions have the potential to reduce the barriers to treatment utilization and implementation that are common problems for school-based ADHD interventions.
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Affiliation(s)
- Penny Corkum
- 1 Dalhousie University, Halifax, Nova Scotia, Canada.,3 IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Nezihe Elik
- 2 Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | | | | | - Patrick McGrath
- 1 Dalhousie University, Halifax, Nova Scotia, Canada.,3 IWK Health Centre, Halifax, Nova Scotia, Canada
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Veenman B, Luman M, Oosterlaan J. Efficacy of behavioral classroom programs in primary school. A meta-analysis focusing on randomized controlled trials. PLoS One 2018; 13:e0201779. [PMID: 30303966 PMCID: PMC6179198 DOI: 10.1371/journal.pone.0201779] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 07/23/2018] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE This meta-analysis evaluated the efficacy of behavioral classroom programs on symptoms of Attention-deficit Hyperactivity Disorder or Oppositional Defiant and/or Conduct Disorder in primary school children. METHOD Online database searches (in PubMed, Embase, Psycinfo, and Eric) yielded nineteen randomized controlled trials (N = 18,094), comparing behavioral classroom programs (including multimodal programs involving a classroom program) to no treatment/treatment as usual. Random-effects meta-analyses were conducted for teacher-rated and classroom-observed disruptive classroom behavior and for classroom-observed on-task behavior. Post-hoc analyses investigated whether effects depended on type and severity of problem behavior. Meta-regressions studied the moderating effects of age, gender, and intervention duration. RESULTS Small positive effects were found on teacher-rated disruptive behavior (d = -0.20) and classroom-observed on-task behavior (d = 0.39). Program effects on teacher-rated disruptive behavior were unrelated to age, gender, type and severity, but negatively associated with intervention duration (R2 = 0.43). CONCLUSION Behavioral classroom programs have small beneficial effects on disruptive behavior and on-task behavior. Results advocate universal programs for entire classrooms to prevent and reduce disruptive classroom behavior.
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Affiliation(s)
- Betty Veenman
- Clinical Neuropsychology section, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marjolein Luman
- Clinical Neuropsychology section, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jaap Oosterlaan
- Clinical Neuropsychology section, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Hogue A, Bobek M, Evans SW. Changing Academic Support in the Home for Adolescents with Attention-Deficit/Hyperactivity Disorder: A Family-Based Clinical Protocol for Improving School Performance. COGNITIVE AND BEHAVIORAL PRACTICE 2016; 23:14-30. [PMID: 34103882 DOI: 10.1016/j.cbpra.2014.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Attention-Deficit/Hyperactivity Disorder (ADHD) is highly prevalent among adolescent clinical populations and associated with myriad deficits in school functioning. Yet, behavior therapists have few developmentally appropriate tools for addressing school problems in this group. This article introduces a behavioral protocol designed to fill the gap: Changing Academic Support in the Home for Adolescents with ADHD (CASH-AA). CASH-AA is a family-based intervention that targets home environment, adolescent skills, and family-school partnership characteristics in order to improve school performance. Protocol components are derived from three evidence-based approaches for adolescent behavior problems: family psychoeducation, clinical family interventions to heighten adolescent and caregiver motivation to change, and training interventions for homework planning and organization skills. CASH-AA contains four treatment modules: (1) Psychoeducation: ADHD and Academic Functioning; (2) Motivation & Preparation: Home Academic Environment; (3) Behavior Change: School Attendance and Homework Plan; (4) Collaboration: Therapist-Family-School Partnership. The protocol can be implemented as a stand-alone intervention for ADHD or an adjunct to other behavioral interventions for co-occurring disorders. Two case examples with markedly different treatment profiles are presented to illustrate the utility and flexibility of the protocol.
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Affiliation(s)
- Aaron Hogue
- The National Center on Addiction and Substance Abuse at Columbia University
| | - Molly Bobek
- The National Center on Addiction and Substance Abuse at Columbia University
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Antshel KM. Psychosocial interventions in attention-deficit/hyperactivity disorder: update. Child Adolesc Psychiatr Clin N Am 2015; 24:79-97. [PMID: 25455577 DOI: 10.1016/j.chc.2014.08.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is the most common reason for referral to child and adolescent psychiatry clinics. Although stimulant medications represent an evidence-based approach to managing ADHD, psychosocial interventions for child/adolescent ADHD target functional impairments as the intervention goal, and rely heavily on behavioral therapy techniques and operant conditioning principles. Evidence-based psychosocial interventions for managing pediatric ADHD include behavioral parent training, school-based interventions relying on behavioral modification, teaching skills, and operant conditioning principles, and intensive summer treatment programs. The use of conjoint psychosocial treatments with ADHD medications may enable lower doses of each form of treatment.
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Affiliation(s)
- Kevin M Antshel
- Department of Psychology, Syracuse University, 802 University Avenue, Syracuse, NY 13244, USA.
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Richard S, Eichelberger I, Döpfner M, Hanisch C. Schulbasierte Interventionen bei ADHS und Aufmerksamkeitsproblemen: Ein Überblick. ZEITSCHRIFT FUR PADAGOGISCHE PSYCHOLOGIE 2015. [DOI: 10.1024/1010-0652/a000141] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Kinder mit einer Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) oder subklinischen Aufmerksamkeitsproblemen sind in ihrer schulischen Leistungsfähigkeit beeinträchtigt. Für Lehrkräfte stellen diese Beeinträchtigungen eine große Herausforderung dar. Im Zuge der Umsetzung der Behindertenrechtskonvention der Vereinten Nationen (UN) wird der Bedarf an effektiven Strategien zum Umgang mit diesen Verhaltensauffälligkeiten an allgemeinbildenden Schulen deutlich steigen. Ziel der vorliegenden Arbeit ist es, einen Überblick über effektive Klassen-, Lehrkraft- und Schüler-zentrierte Maßnahmen für Schüler mit Aufmerksamkeitsproblemen zu geben. Die aktuelle Studienlage zu Interventionen im Schulsetting bietet überwiegend Einzelfallstudien, die eine Generalisierung der Ergebnisse erschweren. Unter Berücksichtigung der Studienqualität können daher nur interdependente Gruppenverstärkerpläne (klassen-zentriert) als evidenzbasiert bezeichnet werden. Forschungsmethodische Einschränkungen und Forschungsperspektiven werden diskutiert.
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Affiliation(s)
- Stefanie Richard
- Fachbereich Sozial- und Kulturwissenschaften, Fachhochschule Düsseldorf
| | - Ilka Eichelberger
- Klinik für Psychiatrie und Psychotherapie des Kindes- und Jugendalters, Universität Köln
| | - Manfred Döpfner
- Klinik für Psychiatrie und Psychotherapie des Kindes- und Jugendalters, Universität Köln
| | - Charlotte Hanisch
- Fachbereich Sozial- und Kulturwissenschaften, Fachhochschule Düsseldorf
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Hogue A, Bobek M, Tau GZ, Levin FR. Clinical Strategies for Integrating Medication Interventions Into Behavioral Treatment for Adolescent ADHD: The Medication Integration Protocol. CHILD & FAMILY BEHAVIOR THERAPY 2014; 36:280-304. [PMID: 25505817 PMCID: PMC4258514 DOI: 10.1080/07317107.2014.967631] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Attention-Deficit/Hyperactivity Disorder (ADHD) is highly prevalent among adolescents enrolled in behavioral health services but remains undertreated in this age group. Also the first-line treatment for adolescent ADHD, stimulant medication, is underutilized in routine practice. This article briefly describes three behavioral interventions designed to promote stronger integration of medication interventions into treatment planning for adolescent ADHD: family ADHD psychoeducation, family-based medication decision-making, and behavior therapist leadership in coordinating medication integration. It then introduces the Medication Integration Protocol (MIP), which incorporates all three interventions into a five-task protocol: ADHD Assessment and Medication Consult; ADHD Psychoeducation and Client Acceptance; ADHD Symptoms and Family Relations; ADHD Medication and Family Decision-Making; and Medication Management and Integration Planning. The article concludes by highlighting what behavior therapists should know about best practices for medication integration across diverse settings and populations: integrating medication interventions into primary care, managing medication priorities and polypharmacy issues for adolescents with multiple diagnoses, providing ADHD medications to adolescent substance users, and the compatibility of MIP intervention strategies with everyday practice conditions.
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Affiliation(s)
- Aaron Hogue
- The National Center on Addiction and Substance Abuse at Columbia University, New York, New York, USA
| | - Molly Bobek
- The National Center on Addiction and Substance Abuse at Columbia University, New York, New York, USA
| | - Gregory Z Tau
- Division of Child and Adolescent Psychiatry at Columbia University, New York, New York, USA and New York State Psychiatric Institute
| | - Frances R Levin
- Division on Substance Abuse at Columbia University, New York, New York, USA and New York State Psychiatric Institute
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Prevalence and Characteristics of School Services for High School Students with Attention-Deficit/Hyperactivity Disorder. SCHOOL MENTAL HEALTH 2014; 6:264-278. [PMID: 25506403 DOI: 10.1007/s12310-014-9128-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study examines the prevalence and characteristics of services reported by school staff for 543 high school students participating in the 8 year follow-up of the multi-site Multimodal Treatment study of ADHD (MTA). Overall, 51.6% of students with a history of attention-deficit/hyperactivity disorder (ADHD) were receiving services through an Individualized Educational Plan (IEP) or a 504 plan, a rate higher than expected for this age group. Less than 5% of these had 504 plans; 35.5% attended special education classes. Very few services (except tutoring) were provided outside of an IEP or 504 plan. Almost all students with services received some type of academic intervention, whereas only half received any behavioral support or learning strategy. Less than one-fourth of interventions appear to be evidence-based. Students receiving services showed greater academic and behavioral needs than those not receiving services. Services varied based upon type of school, with the greatest number of interventions provided to students attending schools that only serve those with disabilities. Original MTA treatment randomization was unrelated to services, but cumulative stimulant medication and greater severity predicted more service receipt. Results highlight a need for accommodations with greater evidence of efficacy and for increased services for students who develop academic difficulties in high school.
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“Nothing works!” A case study using cognitive-behavioral interventions to engage parents, educators, and children in the management of attention-deficit/hyperactivity disorder. PSYCHOLOGY IN THE SCHOOLS 2011. [DOI: 10.1002/pits.20554] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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