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Cuber I, Goncalves De Souza JG, Jacobs I, Lowman C, Shepherd D, Fritz T, Langberg JM. Examining the Use of VR as a Study Aid for University Students with ADHD. PROCEEDINGS OF THE SIGCHI CONFERENCE ON HUMAN FACTORS IN COMPUTING SYSTEMS. CHI CONFERENCE 2024; 2024:65. [PMID: 38832086 PMCID: PMC11146098 DOI: 10.1145/3613904.3643021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition characterized by patterns of inattention and impulsivity, which lead to difficulties maintaining concentration and motivation while completing academic tasks. University settings, characterized by a high student-to-staff ratio, make treatments relying on human monitoring challenging. One potential replacement is Virtual Reality (VR) technology, which has shown potential to enhance learning outcomes and promote flow experience. In this study, we investigate the usage of VR with 27 university students with ADHD in an effort to improve their performance in ctableompleting homework, including an exploration of automated feedback via a technology probe. Quantitative results show significant increases in concentration, motivation, and effort levels during these VR sessions and qualitative data offers insight into considerations like comfort and deployment. Together, the results suggest that VR can be a valuable tool in leveling the playing field for university students with ADHD.
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Redmond SM, Ash AC, Zhang Y. A preliminary study of the effects of stimulant medications on estimates of psycholinguistic abilities for children with attention-deficit/hyperactivity disorder. CLINICAL LINGUISTICS & PHONETICS 2023:1-21. [PMID: 37906703 PMCID: PMC11058111 DOI: 10.1080/02699206.2023.2273750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 10/17/2023] [Indexed: 11/02/2023]
Abstract
Underlying deficits in inattention, hyperactivity, and/or impulsivity might contribute to suboptimal test-taking behaviours during language assessments that can lead to diagnostic errors. Considerations of potential medication effects on estimates of children's nonword repetition, sentence recall, tense-marking, and narrative abilities are warranted given long-standing enthusiasm for these indices to serve as clinical markers for developmental language disorder (DLD). A battery consisting of 1 nonverbal, 1 reading, and 6 verbal measures was administered twice to 26 children (6-9 years) with independently diagnosed combined-type attention-deficit/hyperactivity disorder (ADHD). All participants had been prescribed stimulant medications for the management of their ADHD symptoms and were assessed off- and on-medication, with order counter-balanced across participants. Half of the participants had concomitant DLD. Examiners were unaware of children's clinical status during assessments or when they were testing children who had received medication. Effect sizes were calculated for each measure. Significant score differences indicating a beneficial impact of stimulant medications on children's performances were observed on the recalling sentences subtest of the Clinical Evaluation of Language Fundamentals and the Picture Peabody Vocabulary Test. Adjustments may be needed when speech language pathologists use sentence recall or receptive vocabulary measures to make diagnostic decisions with children who have ADHD.
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Affiliation(s)
- Sean M Redmond
- Communication Sciences and Disorders,University of Utah Health, Salt Lake City, Utah, USA
| | - Andrea C Ash
- Communication Sciences and Disorders,University of Utah Health, Salt Lake City, Utah, USA
| | - Yue Zhang
- Communication Sciences and Disorders,University of Utah Health, Salt Lake City, Utah, USA
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Taylor A, Kong C, Zhang Z, Herold F, Ludyga S, Healy S, Gerber M, Cheval B, Pontifex M, Kramer AF, Chen S, Zhang Y, Müller NG, Tremblay MS, Zou L. Associations of meeting 24-h movement behavior guidelines with cognitive difficulty and social relationships in children and adolescents with attention deficit/hyperactive disorder. Child Adolesc Psychiatry Ment Health 2023; 17:42. [PMID: 36973804 PMCID: PMC10042421 DOI: 10.1186/s13034-023-00588-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/08/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Evidence-based 24-h movement behavior (24-HMB) guidelines have been developed to integrate recommendations for the time spent on physical activity, sedentary behavior, and sleep. For children and adolescents, these 24-HMB guidelines recommend a maximum of two hours of recreational screen time (as part of sedentary behavior), a minimum of 60 min per day of moderate to vigorous physical activity (MVPA), and an age-appropriate sleep duration (9-11 h for 5 to 13-year-olds; 8-10 h for 14 to 17-year-olds). Although adherence to the guidelines has been associated with positive health outcomes, the effects of adhering to the 24-HMB recommendations have not been fully examined in children and adolescents with attention eficit/hyperactive disorder (ADHD). Therefore, this study examined potential associations between meeting the 24-HMB guidelines and indicators of cognitive and social difficulties in children and adolescents with ADHD. METHODS Cross-sectional data on 3470 children and adolescents with ADHD aged between 6 and 17 years was extracted from the National Survey for Children's Health (NSCH 2020). Adherence to 24-HMB guidelines comprised screen time, physical activity, and sleep. ADHD-related outcomes included four indicators; one relating to cognitive difficulties (i.e., serious difficulties in concentrating, remembering, or making decisions) and three indicators of social difficulties (i.e., difficulties in making or keeping friends, bullying others, being bullied). Logistic regression was performed to determine the associations between adherence to 24-HMB guidelines and the cognitive and social outcomes described above, while adjusting for confounders. RESULTS In total, 44.8% of participants met at least one movement behavior guideline, while only 5.7% met all three. Adjusted logistic regressions further showed that meeting all three guidelines was associated with lower odds of cognitive difficulties in relation to none of the guidelines, but the strongest model included only screen time and physical activity as predictors (OR = 0.26, 95% CI 0.12-0.53, p < .001). For social relationships, meeting all three guidelines was associated with lower odds of difficulty keeping friends (OR = 0.46, 95% CI 0.21-0.97, p = .04) in relation to none of the guidelines. Meeting the guideline for screen time was associated with lower odds of being bullied (OR = 0.61, 95% CI 0.39-0.97, p = .04) in relation to none of the guidelines. While screen time only, sleep only and the combination of both were associated with lower odds of bullying others, sleep alone was the strongest predictor (OR = 0.44, 95% CI 0.26-0.76, p = .003) in relation to none of the guidelines. CONCLUSION Meeting 24-HMB guidelines was associated with reduced likelihood of cognitive and social difficulties in children and adolescents with ADHD. These findings highlight the importance of adhering to healthy lifestyle behaviors as outlined in the 24-HMB recommendations with regard to cognitive and social difficulties in children and adolescents with ADHD. These results need to be confirmed by longitudinal and interventional studies with a large sample size.
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Affiliation(s)
- Alyx Taylor
- School of Rehabilitation, Sport and Psychology, AECC University College, Bournemouth, BH5 2DF, UK
- Body-Brain-Mind Laboratory; The Shenzhen Humanities & Social Sciences Key Research Bases of the Center for Mental Health School of Psychology, Shenzhen University, Shenzhen, 518061, China
| | - Chuidan Kong
- Body-Brain-Mind Laboratory; The Shenzhen Humanities & Social Sciences Key Research Bases of the Center for Mental Health School of Psychology, Shenzhen University, Shenzhen, 518061, China
| | - Zhihao Zhang
- Body-Brain-Mind Laboratory; The Shenzhen Humanities & Social Sciences Key Research Bases of the Center for Mental Health School of Psychology, Shenzhen University, Shenzhen, 518061, China
| | - Fabian Herold
- Research Group Degenerative and Chronic Diseases, Movement, Faculty of Health Sciences Brandenburg, University of Potsdam, 14476, Potsdam, Germany
| | - Sebastian Ludyga
- Department of Sport, Exercise, and Health, University of Basel, 4052, Basel, Switzerland
| | - Sean Healy
- Community Health Academic Group, School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, 9, Ireland
| | - Markus Gerber
- Department of Sport, Exercise, and Health, University of Basel, 4052, Basel, Switzerland
| | - Boris Cheval
- Swiss Center for Affective Sciences, University of Geneva, Geneva, Switzerland
| | - Matthew Pontifex
- Departments of Kinesiology, Michigan State University, East Lansing, USA
| | - Arthur F Kramer
- Center for Cognitive and Brain Health, Northeastern University, Boston, MA, 02115, USA
- Beckman Institute, University of Illinois at Urbana-Champaign, Champaign, IL, 61820, USA
| | - Sitong Chen
- Institute for Health and Sport, Victoria University, Melbourne, 8001, Australia
| | - Yanjie Zhang
- Physical Education Unit, School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, 518172, China
| | - Notger G Müller
- Research Group Degenerative and Chronic Diseases, Movement, Faculty of Health Sciences Brandenburg, University of Potsdam, 14476, Potsdam, Germany
| | - Mark S Tremblay
- Healthy Active Living and Obesity Research Group, CHEO Research Institute, Ottawa, ON, K1H 8L1, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, ON, K1N 6N5, Canada
| | - Liye Zou
- Body-Brain-Mind Laboratory; The Shenzhen Humanities & Social Sciences Key Research Bases of the Center for Mental Health School of Psychology, Shenzhen University, Shenzhen, 518061, China.
- Research Group Degenerative and Chronic Diseases, Movement, Faculty of Health Sciences Brandenburg, University of Potsdam, 14476, Potsdam, Germany.
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Kosheleff AR, Mason O, Jain R, Koch J, Rubin J. Functional Impairments Associated With ADHD in Adulthood and the Impact of Pharmacological Treatment. J Atten Disord 2023; 27:669-697. [PMID: 36876491 PMCID: PMC10173356 DOI: 10.1177/10870547231158572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
OBJECTIVE Among untreated adults, functional impairments associated with ADHD are widespread and cumulative, and can include social, educational, and professional impairments, increased risk of accidents and mortality, and reduced quality of life. Here, we review the most prominent functional impairments in adults with ADHD and summarize evidence describing the potential role of medication in improving outcomes. METHOD Articles related to the search terms "ADHD," "adult," and functional impairments were identified through Google Scholar and PubMed and selected for inclusion based on four criteria: strength of evidence, relevance to current challenges in adult ADHD, impact on the field, and recency of the results. RESULTS We identified 179 papers to support the conclusions on the relationship between ADHD and functional impairments, and the impact of pharmacological therapy on functional impairments. CONCLUSION This narrative review provides evidence that pharmacological treatment can be effective in minimizing not only the symptoms of ADHD, but its functional consequences as well.
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Affiliation(s)
| | - Oren Mason
- Attention MD, Grand Rapids, MI, USA and Michigan State University College of Human Medicine, East Lansing, MI, USA
| | - Rakesh Jain
- Texas Tech University School of Medicine, Midland, TX, USA
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Lee YC, Chen CR, Lin KC. Effects of Mindfulness-Based Interventions in Children and Adolescents with ADHD: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15198. [PMID: 36429915 PMCID: PMC9690476 DOI: 10.3390/ijerph192215198] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 06/16/2023]
Abstract
(1) Objectives: Mindfulness-based interventions have been receiving more attention in research for children with attention deficit hyperactivity disorder (ADHD). This systematic review and meta-analysis was conducted to synthesize the findings of randomized controlled trials of mindfulness-based interventions for children with ADHD. (2) Methods: A systematic review and meta-analysis of studies published in PsycINFO, PubMed, and Google Scholar was completed from the earliest available date until August 2022. (3) Results: The systematic review included 12 studies that met the inclusion criteria, and the meta-analysis included 11 studies. The overall effect sizes were g = 0.77 for ADHD symptoms, g = 0.03 for externalizing behavior problem, g = 0.13 for internalizing behavior problem, g = 0.43 for mindfulness, and g = 0.40 for parental stress for children with ADHD. (4) Conclusion: The results of this systematic review highlight the possible benefits of mindfulness-based interventions for children with ADHD.
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Affiliation(s)
- Yi-Chen Lee
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Chyi-Rong Chen
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei 100, Taiwan
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
| | - Keh-Chung Lin
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei 100, Taiwan
- Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei 100, Taiwan
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Zendarski N, Guo S, Sciberras E, Efron D, Quach J, Winter L, Bisset M, Middeldorp CM, Coghill D. Examining the Educational Gap for Children with ADHD and Subthreshold ADHD. J Atten Disord 2022; 26:282-295. [PMID: 33317376 DOI: 10.1177/1087054720972790] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The present study examined the impact of Attention Deficit Hyperactivity Disorder (ADHD) on core educational outcomes in two large community cohorts of Australian school children. METHOD Academic (reading and numeracy) and non-academic (school engagement, attendance, peer victimization, and parental expectations) outcomes were compared between children with ADHD, subthreshold ADHD, and controls when children were in grade 5 (M age = 10.5). Data were drawn from the Longitudinal Study of Australian Children birth cohort (LSAC; N = 3,540) and the Children's Attention Project (CAP; N = 356). RESULTS Both subthreshold ADHD and ADHD groups had poorer outcomes on all measures, with medium effects sizes. Differences were not evident between subthreshold ADHD and ADHD groups. CONCLUSIONS Educational outcomes examined in this study highlight the educational risk for upperprimary school children with ADHD or subthreshold ADHD, in comparison to their peers. Monitoring these outcomes is necessary to inform policy, practice, and intervention.
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Affiliation(s)
- Nardia Zendarski
- The University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia
| | - Shuaijun Guo
- The University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia
| | - Emma Sciberras
- The University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia.,Deakin University, Geelong, Australia
| | - Daryl Efron
- The University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia.,Department General Medicine, Royal Children's Hospital, Melbourne Australia
| | - Jon Quach
- The University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia
| | | | - Matthew Bisset
- Murdoch Children's Research Institute, Melbourne, Australia.,Deakin University, Geelong, Australia
| | - Christel M Middeldorp
- The University of Queensland, Brisbane, Australia.,Children's Health Queensland Hospital and Health Service, Brisbane Australia
| | - David Coghill
- The University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia
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Ward RJ, Bristow SJ, Kovshoff H, Cortese S, Kreppner J. The Effects of ADHD Teacher Training Programs on Teachers and Pupils: A Systematic Review and Meta-Analysis. J Atten Disord 2022; 26:225-244. [PMID: 33331193 PMCID: PMC8679179 DOI: 10.1177/1087054720972801] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To synthesize the evidence on the efficacy of ADHD teacher training interventions for teachers' ADHD knowledge and reducing pupils' ADHD-type behaviors. METHOD Six electronic databases were systematically searched up to 14/04/20. Meta-analyses were performed to pool standardized mean differences (SMD). RESULTS 29 studies were included in the systematic review, and 22 meta-analyzed. SMD for teacher knowledge within subjects at post-test and follow-up was 1.96 (95% confidence interval = 1.48, 2.43) and ‒1.21 (-2.02, -0.41) respectively. Between subjects analyses at post-test showed SMD = 1.56 (0.52, 2.59), with insufficient data at follow-up. At post-test, SMD for pupils' behavior within and between subjects was 0.78 (0.37, 1.18), and 0.71 (-0.11, 1.52), respectively. Medium-to-high risk of bias was found in all but one study. CONCLUSION ADHD teacher training programs may be effective in initially improving ADHD teachers' knowledge. There is inconsistent evidence for their efficacy to reduce students' ADHD-type behaviors.
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Affiliation(s)
| | | | | | - Samuele Cortese
- University of Southampton, Southampton,
Hampshire, UK
- Solent NHS Trust, Southampton, UK
- New York University Child Study Center,
New York, NY, USA
- University of Nottingham, Nottingham,
UK
| | - Jana Kreppner
- University of Southampton, Southampton,
Hampshire, UK
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Schmengler H, Peeters M, Stevens GWJM, Kunst AE, Hartman CA, Oldehinkel AJ, Vollebergh WAM. Educational level, attention problems, and externalizing behaviour in adolescence and early adulthood: the role of social causation and health-related selection-the TRAILS study. Eur Child Adolesc Psychiatry 2021; 32:809-824. [PMID: 34797409 PMCID: PMC10147770 DOI: 10.1007/s00787-021-01913-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 11/09/2021] [Indexed: 10/19/2022]
Abstract
Social causation and health-related selection may contribute to educational differences in adolescents' attention problems and externalizing behaviour. The social causation hypothesis posits that the social environment influences adolescents' mental health. Conversely, the health-related selection hypothesis proposes that poor mental health predicts lower educational attainment. From past studies it is unclear which of these mechanisms predominates, as attention problems and externalizing behaviour have the potential to interfere with educational attainment, but may also be affected by differences in the educational context. Furthermore, educational gradients in mental health may reflect the impact of 'third variables' already present in childhood, such as parental socioeconomic status (SES), and IQ. We investigated both hypotheses in relation to educational differences in externalizing behaviour and attention problems throughout adolescence and young adulthood. We used data from a Dutch cohort (TRAILS Study; n = 2229), including five measurements of educational level, externalizing behaviour, and attention problems from around age 14-26 years. First, we evaluated the directionality in longitudinal associations between education, externalizing behaviour, and attention problems with and without adjusting for individual differences using fixed effects. Second, we assessed the role of IQ and parental SES in relation to attention problems, externalizing behaviour, and educational level. Attention problems predicted decreases in education throughout all of adolescence and young adulthood. Differences in parental SES contributed to increases in externalizing behaviour amongst the lower educational tracks in mid-adolescence. Childhood IQ and parental SES strongly predicted education around age 14. Parental SES, but not IQ, also predicted early adolescent attention problems and externalizing behaviour. Our results provide support for the health-related selection hypothesis in relation to attention problems and educational attainment. Further, our results highlight the role of social causation from parental SES in determining adolescent educational level, attention problems, and externalizing behaviour.
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Affiliation(s)
- Heiko Schmengler
- Department of Interdisciplinary Social Science, Utrecht Centre for Child and Adolescent Studies, Utrecht University, Padualaan 14, 3584 CH, Utrecht, The Netherlands.
| | - Margot Peeters
- Department of Interdisciplinary Social Science, Utrecht Centre for Child and Adolescent Studies, Utrecht University, Padualaan 14, 3584 CH, Utrecht, The Netherlands
| | - Gonneke W J M Stevens
- Department of Interdisciplinary Social Science, Utrecht Centre for Child and Adolescent Studies, Utrecht University, Padualaan 14, 3584 CH, Utrecht, The Netherlands
| | - Anton E Kunst
- Department of Public and Occupational Health, Center for Health Inequality Studies, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Catharina A Hartman
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation, University Medical Center of Groningen, University of Groningen, Groningen, The Netherlands
| | - Albertine J Oldehinkel
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation, University Medical Center of Groningen, University of Groningen, Groningen, The Netherlands
| | - Wilma A M Vollebergh
- Department of Interdisciplinary Social Science, Utrecht Centre for Child and Adolescent Studies, Utrecht University, Padualaan 14, 3584 CH, Utrecht, The Netherlands
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Glasofer A, Dingley C. Diagnostic and Medication Treatment Disparities in African American Children with ADHD: a Literature Review. J Racial Ethn Health Disparities 2021; 9:2027-2048. [PMID: 34520001 DOI: 10.1007/s40615-021-01142-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/28/2021] [Accepted: 08/30/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Despite a national focus on achieving health equity, limited attention has been paid to behavioral and pediatric health disparities. As the most common pediatric neurobehavioral disorder, attention-deficit/hyperactivity disorder (ADHD) provides an opportunity to assess the status of pediatric behavior health disparities. The purpose of this literature review is to provide a synthesis of existing research on ADHD diagnostic and treatment disparities between African American and White children. METHODS Studies were systematically identified through searches in PubMed, CINAHL, and APA PsycInfo using the terms attention-deficit/hyperactivity disorder, disparity, race, ethnicity, diagnosis, medication, and treatment. Summary calculations were conducted to report the proportions of studies with statistically significant differences in ADHD diagnosis and treatment between White and African American children, and to describe trends in disparities over time. RESULTS Forty-one studies were included in this review. The majority of studies identified significant disparities in ADHD diagnosis and medication treatment between African American and White children. While diagnostic disparities show a trend toward reduction over time, a similar trend was not observed in medication treatment disparities. This synthesis provides a critique of the existing literature and recommendations for practice and future research.
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Affiliation(s)
- Amy Glasofer
- School of Nursing, University of Nevada, Las Vegas, NV, USA.
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10
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Ward RJ, Kovshoff H, Kreppner J. School staff perspectives on ADHD and training: understanding the needs and views of UK primary staff. EMOTIONAL AND BEHAVIOURAL DIFFICULTIES 2021. [DOI: 10.1080/13632752.2021.1965342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Rebecca J Ward
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Hanna Kovshoff
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Jana Kreppner
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
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Zoromski AK, Epstein JN, Ciesielski HA. Unique Associations Between Specific Attention-Deficit Hyperactivity Disorder Symptoms and Related Functional Impairments. J Dev Behav Pediatr 2021; 42:343-354. [PMID: 33433140 DOI: 10.1097/dbp.0000000000000904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 11/10/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to explore the unique relationships between specific attention-deficit hyperactivity disorder (ADHD) symptoms and functional impairment in school-age children using parent and teacher ratings. METHODS Parents and teachers rated ADHD symptoms and comorbidities (internalizing and oppositional behaviors) as well as impairments (academic, relationship, and classroom behavior) for 8689 children using the Vanderbilt ADHD Diagnostic Rating Scales. Stepwise regression was used to determine which of the 18 ADHD symptom items were most associated with specific domains of impairment with relevant demographic and clinical characteristics used as covariates (e.g., sex, comorbidities, medication status, and age). RESULTS "Careless mistakes" and "avoids tasks" significantly predicted academic impairment across content areas and across parent- and teacher-rating models. ADHD symptoms accounted for limited variance in impairment in the family and peer relationship domains or in organized activities when oppositional symptoms were entered as a covariate. Regarding teacher-rated classroom behavior, the strongest predictor of impairment was "talks too much." CONCLUSION The findings indicate that the symptoms that were most predictive of impairment varied by domain of impairment.
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Affiliation(s)
- Allison K Zoromski
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Jeffery N Epstein
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Heather A Ciesielski
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Kazda L, Bell K, Thomas R, McGeechan K, Sims R, Barratt A. Overdiagnosis of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents: A Systematic Scoping Review. JAMA Netw Open 2021; 4:e215335. [PMID: 33843998 PMCID: PMC8042533 DOI: 10.1001/jamanetworkopen.2021.5335] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
IMPORTANCE Reported increases in attention-deficit/hyperactivity disorder (ADHD) diagnoses are accompanied by growing debate about the underlying factors. Although overdiagnosis is often suggested, no comprehensive evaluation of evidence for or against overdiagnosis has ever been undertaken and is urgently needed to enable evidence-based, patient-centered diagnosis and treatment of ADHD in contemporary health services. OBJECTIVE To systematically identify, appraise, and synthesize the evidence on overdiagnosis of ADHD in children and adolescents using a published 5-question framework for detecting overdiagnosis in noncancer conditions. EVIDENCE REVIEW This systematic scoping review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Extension for Scoping Reviews and Joanna Briggs Methodology, including the PRISMA-ScR Checklist. MEDLINE, Embase, PsychINFO, and the Cochrane Library databases were searched for studies published in English between January 1, 1979, and August 21, 2020. Studies of children and adolescents (aged ≤18 years) with ADHD that focused on overdiagnosis plus studies that could be mapped to 1 or more framework question were included. Two researchers independently reviewed all abstracts and full-text articles, and all included studies were assessed for quality. FINDINGS Of the 12 267 potentially relevant studies retrieved, 334 (2.7%) were included. Of the 334 studies, 61 (18.3%) were secondary and 273 (81.7%) were primary research articles. Substantial evidence of a reservoir of ADHD was found in 104 studies, providing a potential for diagnoses to increase (question 1). Evidence that actual ADHD diagnosis had increased was found in 45 studies (question 2). Twenty-five studies showed that these additional cases may be on the milder end of the ADHD spectrum (question 3), and 83 studies showed that pharmacological treatment of ADHD was increasing (question 4). A total of 151 studies reported on outcomes of diagnosis and pharmacological treatment (question 5). However, only 5 studies evaluated the critical issue of benefits and harms among the additional, milder cases. These studies supported a hypothesis of diminishing returns in which the harms may outweigh the benefits for youths with milder symptoms. CONCLUSIONS AND RELEVANCE This review found evidence of ADHD overdiagnosis and overtreatment in children and adolescents. Evidence gaps remain and future research is needed, in particular research on the long-term benefits and harms of diagnosing and treating ADHD in youths with milder symptoms; therefore, practitioners should be mindful of these knowledge gaps, especially when identifying these individuals and to ensure safe and equitable practice and policy.
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Affiliation(s)
- Luise Kazda
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Katy Bell
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Rae Thomas
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Kevin McGeechan
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Rebecca Sims
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Alexandra Barratt
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Effectiveness of a digital therapeutic as adjunct to treatment with medication in pediatric ADHD. NPJ Digit Med 2021; 4:58. [PMID: 33772095 PMCID: PMC7997870 DOI: 10.1038/s41746-021-00429-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 02/25/2021] [Indexed: 11/08/2022] Open
Abstract
STARS-Adjunct was a multicenter, open-label effectiveness study of AKL-T01, an app and video-game-based treatment for inattention, as an adjunct to pharmacotherapy in 8-14-year-old children with attention-deficit/hyperactivity disorder (ADHD) on stimulant medication (n = 130) or not on any ADHD medication (n = 76). Children used AKL-T01 for 4 weeks, followed by a 4-week pause and another 4-week treatment. The primary outcome was change in ADHD-related impairment (Impairment Rating Scale (IRS)) after 4 weeks. Secondary outcomes included changes in IRS, ADHD Rating Scale (ADHD-RS). and Clinical Global Impressions Scale-Improvement (CGI-I) on days 28, 56, and 84. IRS significantly improved in both cohorts (On Stimulants: -0.7, p < 0.001; No Stimulants: -0.5, p < 0.001) after 4 weeks. IRS, ADHD-RS, and CGI-I remained stable during the pause and improved with a second treatment period. The treatment was well-tolerated with no serious adverse events. STARS-Adjunct extends AKL-T01's body of evidence to a medication-treated pediatric ADHD population, and suggests additional treatment benefit.
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García T, Fernández E, Villalba M, Areces D, Rodríguez C. What Predicts Life Satisfaction in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD)? A Study from Parent and Child/Adolescent Perspectives. THE SPANISH JOURNAL OF PSYCHOLOGY 2021; 24:e12. [PMID: 33612131 DOI: 10.1017/sjp.2021.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The aim of this study was to analyze life satisfaction in a sample of 70 children and adolescents (M = 12.21, SD = 2.85) with Attention-Deficit/Hyperactivity Disorder (ADHD), according to parents' and children's/adolescents' reports. In addition, we examined the influence of a series of child/adolescent variables (ADHD presentation, and Conduct Disorder (CD) symptoms, age, gender, and pharmacological support status) on their levels of life satisfaction. Results indicated moderate correlations between children's/adolescents' and parents' perceptions of life satisfaction (r = .40; p < .01), with school being the area with the lowest levels of satisfaction. Also, 44.3% of the sample of parents reported that ADHD drastically interferes negatively in this context. Examining the effects of child/adolescent variables, only the variables age and CD symptoms generated statistically significant differences, showing that as children/adolescents grow up and/or present associate symptoms of CD, perceptions of life satisfaction tend to be more negative. These variables explained 34.5% of the variance of a composite score of life satisfaction, demonstrating a negative effect over the dependent variable. These results might have important implications for diagnosis and intervention in ADHD, as they highlight the relevance of considering life satisfaction as an important aspect to consider in both processes. Further studies must look more deeply into the mechanisms that explain these findings.
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15
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Kortekaas-Rijlaarsdam AF, Luman M, Sonuga-Barke E, Bet P, Oosterlaan J. Methylphenidate-Related Improvements in Math Performance Cannot Be Explained by Better Cognitive Functioning or Higher Academic Motivation: Evidence From a Randomized Controlled Trial. J Atten Disord 2020; 24:1824-1835. [PMID: 28608744 PMCID: PMC7543012 DOI: 10.1177/1087054717713640] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Objective: This study investigated whether improvements in working memory, reaction time, lapses of attention, interference control, academic motivation, and perceived competence mediated effects of methylphenidate on math performance. Method: Sixty-three children (ADHD diagnosis; methylphenidate treatment; age 8-13; IQ > 70) were randomly allocated to a 7-day methylphenidate or placebo treatment in this double-blind placebo-controlled crossover study and compared with 67 controls. Data were collected at schools and analyzed using mixed-model analysis. Methylphenidate was hypothesized to improve all measures; all measures were evaluated as potential mediators of methylphenidate-related math improvements. Results: Controls mostly outperformed the ADHD group. Methylphenidate did not affect measures of cognitive functioning (p = .082-.641) or academic motivation (p = .199-.865). Methylphenidate improved parent ratings of their child's self-perceived competence (p < .01), which mediated methylphenidate efficacy on math productivity. Conclusion: These results question the necessity of improvements in specific cognitive and motivational deficits associated with ADHD for medication-related academic improvement. They also stimulate further study of perceived competence as a mediator.
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Affiliation(s)
- Anne Fleur Kortekaas-Rijlaarsdam
- Vrije Universiteit Amsterdam, The Netherlands,Anne Fleur Kortekaas-Rijlaarsdam, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, Amsterdam 1081 BT, The Netherlands.
| | | | | | - Pierre Bet
- VU University Medical Centre, Amsterdam, The Netherlands
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16
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Parsley I, Zhang Z, Hausmann M, Lerdahl A, Vaughan B, Edwards R, Hwang S. Effectiveness of Stimulant Medications on Disruptive Behavior and Mood Problems in Young Children. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2020; 18:402-411. [PMID: 32702219 PMCID: PMC7383001 DOI: 10.9758/cpn.2020.18.3.402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/14/2020] [Accepted: 05/06/2020] [Indexed: 11/20/2022]
Abstract
Objective There are very few studies on the effectiveness of stimulant medications for the treatment of disruptive mood and behavior problems in young children (less than 7 years) with Disruptive Behavior Disorders (DBD). The current study aims to determine whether young children (ages 4−7) in a long-term, intensive outpatient behavioral treatment program who are receiving stimulant medications show greater improvement in mood and behavior problems compared to peers who did not. Methods A retrospective chart review was conducted for 97 participants diagnosed with DBD, aged 4−7 years old who were enrolled in an intensive outpatient behavioral intervention program. Pre- and post-intervention Child Behavior Checklist (CBCL) scores for disruptive behavior and mood problems were compared between the children who received stimulant medications and those who did not. Results Paired t tests showed a statistically significant improvement in CBCL outcomes between pre- and post-intervention scores of disruptive behavior and mood problems. ANCOVA analysis, however, showed no clear further improvement in those same CBCL scores in the participants who received stimulant medications compared to the participants who did not. CBCL scores for Conduct Disorder were marginally significant for less improvement for the participants who received stimulant medications. Conclusion This retrospective review suggests a possibility that stimulant medications may not provide additional benefit for the long-term treatment of disruptive behavior and mood problems in young children under age 7. Future study is warranted to evaluate the efficacy/effectiveness of stimulant medications in the treatment of disruptive behavior and mood problems in this population.
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Affiliation(s)
- Ian Parsley
- Department of Psychiatry, Washington University, St. Louis, MO, USA
| | - Zhuo Zhang
- China University of Political Science and Law, School of Psychology, Beijing, China
| | - Mark Hausmann
- Daybreak Mental and Behavioral Health, Papillion, NE, USA
| | - Arica Lerdahl
- Department of Psychiatry, University of Nebraska Medical Center, Omaha, NE, USA
| | - Brigette Vaughan
- Department of Psychiatry, University of Nebraska Medical Center, Omaha, NE, USA
| | - Ryan Edwards
- Department of Psychiatry, University of Nebraska Medical Center, Omaha, NE, USA
| | - Soonjo Hwang
- Department of Psychiatry, University of Nebraska Medical Center, Omaha, NE, USA
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17
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A review of measures used to examine medication adherence in people with ADHD at initiation, implementation and discontinuation of pharmacotherapy. Res Social Adm Pharm 2020; 16:277-289. [DOI: 10.1016/j.sapharm.2019.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 05/29/2019] [Accepted: 06/06/2019] [Indexed: 12/19/2022]
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18
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Langberg JM, Becker SP. ADHD Treatment and Long-Term Academic Outcomes: Response to Arnold and Colleagues. J Atten Disord 2020; 24:819-820. [PMID: 25903586 DOI: 10.1177/1087054715577138] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Stephen P Becker
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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19
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Arnold LE, Hodgkins P, Kahle J, Madhoo M, Kewley G. Long-Term Outcomes of ADHD: Academic Achievement and Performance. J Atten Disord 2020; 24:73-85. [PMID: 25583985 DOI: 10.1177/1087054714566076] [Citation(s) in RCA: 167] [Impact Index Per Article: 41.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Objective: The aim of this study was to synthesize published data regarding long-term effects of ADHD on information learned (measured via achievement tests) and success within the school environment (academic performance). Method: A systematic search identified 176 studies (1980-2012) of long-term (≥2 years) academic outcomes with ADHD. Results: Achievement test outcomes (79%) and academic performance outcomes (75%) were worse in individuals with untreated ADHD compared with non-ADHD controls, also when IQ difference was controlled (72% and 81%, respectively). Improvement in both outcome groups was associated with treatment, more often for achievement test scores (79%) than academic performance (42%), also when IQ was controlled (100% and 57%, respectively). More achievement test and academic performance outcomes improved with multimodal (100% and 67%, respectively) than pharmacological (75% and 33%) or non-pharmacological (75% and 50%) treatment alone. Conclusion: ADHD adversely affects long-term academic outcomes. A greater proportion of achievement test outcomes improved with treatment compared with academic performance. Both improved most consistently with multimodal treatment.
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Affiliation(s)
| | - Paul Hodgkins
- Global Health Economics & Outcomes Research, Shire, Wayne, PA, USA.,Vertex Pharmaceuticals, Boston, MA, USA
| | | | - Manisha Madhoo
- Behavioural Health Medical Strategy, Shire, Wayne, PA, USA
| | - Geoff Kewley
- Learning Assessment & Neurocare Centre, West Sussex, UK
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20
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Sayal K, Merrell C, Tymms P, Kasim A. Academic Outcomes Following a School-Based RCT for ADHD: 6-Year Follow-Up. J Atten Disord 2020; 24:66-72. [PMID: 25555626 DOI: 10.1177/1087054714562588] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: For children with high levels of ADHD symptoms, to investigate the impact of early school-based interventions on academic outcomes in mid-childhood. Method: A 6-year follow-up of 4- to 5-year-olds (N = 52,075) whose schools participated in a cluster randomized controlled trial for children at risk of ADHD. School-level interventions involved the provision of a booklet with evidence-based information (book) and/or feedback of names (identification) of children with high levels of ADHD symptoms. At ages 10 to 11 years, outcome measures were scores in English and mathematics tests. Results: For children with high levels of ADHD symptoms, the interventions had no impact on academic outcomes. When all children were analyzed, the book intervention had a positive impact on mathematics. Baseline inattention was associated with poorer academic outcomes, whereas impulsiveness was associated with better academic outcomes. Conclusion: The provision of evidence-based information about helping children with ADHD at school may have wider academic benefits.
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Affiliation(s)
- Kapil Sayal
- University of Nottingham, UK.,CANDAL (Centre for ADHD and Neuro-Developmental Disorders Across the Lifespan), Institute of Mental Health, Nottingham, UK
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21
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Langberg JM, Epstein JN, Becker SP, Girio-Herrera E, Vaughn AJ. Evaluation of the Homework, Organization, and Planning Skills (HOPS) Intervention for Middle School Students with Attention Deficit Hyperactivity Disorder as Implemented by School Mental Health Providers. SCHOOL PSYCHOLOGY REVIEW 2019. [DOI: 10.1080/02796015.2012.12087514] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Joshua M. Langberg
- Virginia Commonwealth University and Cincinnati Children's Hospital Medical Center
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22
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Foubister L, Rennie F, Williams J. Parents in Control: Parental perceptions of problem behaviors before and after attending an ADHD-specific parent-training program. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2019; 33:30-37. [PMID: 31763749 DOI: 10.1111/jcap.12261] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 10/24/2019] [Accepted: 11/17/2019] [Indexed: 11/29/2022]
Abstract
PROBLEM There is scant evidence to support the efficacy of attention deficit hyperactivity disorder (ADHD)-specific parent-training programs in the treatment of preadolescent children with ADHD. This study explores the effectiveness of the Parents in Control (PINC) parent-training program, designed specifically for children with ADHD. METHODS In this pragmatic uncontrolled pre-poststudy parents of preadolescent children with a diagnosis of ADHD were invited to attend the 6-week PINC course. Fifty-seven parent-report pre/postprogram questionnaires were completed. FINDINGS Parental ratings of the intensity and frequency of problem behaviors after completing PINC showed a significant reduction (p < .001) with a moderate effect size (0.6-0.7). CONCLUSIONS Our findings demonstrate the efficacy of PINC in reducing the parental perception of problem behaviors and support a need for further rigorous randomised controlled trial (RCT) evaluation of this ADHD-specific intervention.
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Affiliation(s)
- Louise Foubister
- CAMHS, Royal Aberdeen Children's Hospital, Aberdeen, United Kingdom
| | - Fiona Rennie
- CAMHS, Royal Aberdeen Children's Hospital, Aberdeen, United Kingdom
| | - Justin Williams
- CAMHS, Royal Aberdeen Children's Hospital, Aberdeen, United Kingdom
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23
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Sluiter MN, Wienen AW, Thoutenhoofd ED, Doornenbal JM, Batstra L. Teachers’ role and attitudes concerning ADHD medication: A qualitative analysis. PSYCHOLOGY IN THE SCHOOLS 2019. [DOI: 10.1002/pits.22270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Maruschka N. Sluiter
- Department of Developmental PsychologyUniversity of GroningenGroningen The Netherlands
- Professorship Youth, Education and SocietyHanze University of Applied Sciences GroningenGroningen The Netherlands
| | - Albert W. Wienen
- Department of Developmental PsychologyUniversity of GroningenGroningen The Netherlands
| | | | - Jeannette M. Doornenbal
- Professorship Youth, Education and SocietyHanze University of Applied Sciences GroningenGroningen The Netherlands
| | - Laura Batstra
- Department of Special Needs Education and Child CareUniversity of GroningenGroningen The Netherlands
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24
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Park Y, Seo DG, Park J, Kim B, Choi J. The influence of behavioral and emotional characteristics on academic achievement of middle school students: A growth modeling approach. SCHOOL PSYCHOLOGY INTERNATIONAL 2019. [DOI: 10.1177/0143034319853010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The purpose of this study was to examine the associations between behavioral and emotional characteristics and middle school student achievement across different grades based on a growth modeling approach. Using a total of 1,874 students, target predictor variables (i.e., attention, aggressiveness, behavioral control, social withdrawal, depression, self-esteem) and dependent variables (i.e., Korean language arts, mathematics) were extracted from a national and longitudinal data set, and four predictor models were formulated to examine the influence of behavioral/emotional characteristics on student growth trajectories. Results showed that (a) students' initial performance at seventh grade did not predict their over-time growth; and (b) self-esteem and behavioral control variables impacted on the seventh graders' achievement as well as their growth from the seventh to ninth grade. Based on the findings, practical implications and future research are discussed.
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25
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Gesser-Edelsburg A, Hamade Boukai R. Does the education system serve as a persuasion agent for recommending ADHD diagnosis and medication uptake? A qualitative case study to identify and characterize the persuasion strategies of Israeli teachers and school counselors. BMC Psychiatry 2019; 19:153. [PMID: 31101094 PMCID: PMC6525420 DOI: 10.1186/s12888-019-2120-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 04/16/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There has been a steady rise in the use of medication by Israeli school children to treat ADHD, partly due to what seems like school teachers' and counselors' tendency to express positive attitudes towards its use. Therfore it is important to examine the involvement of the school teachers and counselors in the parents' decision-making about giving their children medication. METHODS This study used a qualitative constructivist research method of semi-structured interviews. It included individual interviews with 36 teachers and school counselors and 11 parents of students ages 9-14 from the Jewish and Arab populations. RESULTS Teachers and school counselors use different strategies to encourage parents to have their children diagnosed for ADHD and medicated. First they suggest diagnosis as a necessary step in the best interest of the child, distinguishing between diagnosis and medication to mitigate parents' concerns. In the second stage, teachers normalize the use of medication, as well as framing it as a drug that provides not only a medical treatment but also emotional wellbeing. CONCLUSIONS Teachers and counselors are involved in parents' decision-making process about medicating their children to treat ADHD, which contradicts the education system's guidelines. It is necessary to set clear and explicit limits and guidelines for education system employees so that they do not cross professional and ethical limits.
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Affiliation(s)
- Anat Gesser-Edelsburg
- School of Public Health, University of Haifa, 199 Aba Khoushy Ave. Mount Carmel, 3498838, Haifa, Israel. .,The Health and Risk Communication Research Center, University of Haifa, 199 Aba Khoushy Ave. Mount Carmel, 3498838, Haifa, Israel.
| | - Rasha Hamade Boukai
- 0000 0004 1937 0562grid.18098.38School of Public Health, University of Haifa, 199 Aba Khoushy Ave. Mount Carmel, 3498838 Haifa, Israel
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26
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Jangmo A, Stålhandske A, Chang Z, Chen Q, Almqvist C, Feldman I, Bulik CM, Lichtenstein P, D'Onofrio B, Kuja-Halkola R, Larsson H. Attention-Deficit/Hyperactivity Disorder, School Performance, and Effect of Medication. J Am Acad Child Adolesc Psychiatry 2019; 58:423-432. [PMID: 30768391 PMCID: PMC6541488 DOI: 10.1016/j.jaac.2018.11.014] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 11/01/2018] [Accepted: 12/03/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Individuals with attention-deficit/hyperactivity disorder (ADHD) are at increased risk for poor school performance, and pharmacological treatment of ADHD may have beneficial effects on school performance. Conclusions from previous research have been limited by small sample sizes, outcome measures, and treatment follow-up. The current study analyzed school performance in students with ADHD compared to students without ADHD, and the association between pharmacological treatment of ADHD and school performance. METHOD A linkage of Swedish national registers covering 657,720 students graduating from year 9 of compulsory school provided measures of school performance, electronically recorded dispensations of ADHD medication, and potentially confounding background factors such as parental socioeconomic status. Primary measures of school performance included student eligibility to upper secondary school and grade point sum. RESULTS ADHD was associated with substantially lower school performance independent of socioeconomic background factors. Treatment with ADHD medication for 3 months was positively associated with all primary outcomes, including a decreased risk of no eligibility to upper secondary school, odds ratio = 0.80, 95% confidence interval (CI) = 0.76-0.84, and a higher grade point sum (range, 0.0-320.0) of 9.35 points, 95% CI = 7.88-10.82; standardized coefficient = 0.20. CONCLUSION ADHD has a substantial negative impact on school performance, whereas pharmacological treatment for ADHD is associated with higher levels in several measures of school performance. Our findings emphasize the importance of detection and treatment of ADHD at an early stage to reduce the negative impact on school performance.
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Affiliation(s)
| | - Amanda Stålhandske
- Karolinska Institutet, Stockholm, Sweden; Child and Adolescent Clinic, Stockholm County Council, Stockholm, Sweden
| | | | - Qi Chen
- Karolinska Institutet, Stockholm, Sweden
| | - Catarina Almqvist
- Karolinska Institutet, Stockholm, Sweden; Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | | | - Cynthia M Bulik
- Karolinska Institutet, Stockholm, Sweden; University of North Carolina at Chapel Hill, NC
| | | | - Brian D'Onofrio
- Karolinska Institutet, Stockholm, Sweden; Indiana University, Bloomington, IN
| | | | - Henrik Larsson
- Karolinska Institutet, Stockholm, Sweden; School of Medical Sciences, Örebro University, Örebro, Sweden
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27
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Kortekaas-Rijlaarsdam AF, Luman M, Sonuga-Barke E, Oosterlaan J. Does methylphenidate improve academic performance? A systematic review and meta-analysis. Eur Child Adolesc Psychiatry 2019; 28:155-164. [PMID: 29353323 DOI: 10.1007/s00787-018-1106-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 01/04/2018] [Indexed: 11/26/2022]
Abstract
Academic improvement is amongst the most common treatment targets when prescribing stimulants to children with ADHD. Previous reviews on stimulant-related academic improvements are inconclusive and focus on task engagement. Recent literature suggests outcome-domain-specific medication effects that are larger for productivity than for accuracy. The aims of this study are quantifying methylphenidate effects on academic productivity and accuracy for math, reading, spelling; exploring the mediating or moderating effects of symptom improvements, demographic-, design- and disorder-related variables. PubMed, EMBASE, ERIC and PsycINFO were searched for articles reporting methylphenidate effects on academic productivity and accuracy. Thirty-four studies met entry criteria. Methylphenidate improved math productivity (7.8% increase, p < .001); math accuracy (3.0% increase, p = .001); increased reading speed (SMD .47, p < .001) but not reading accuracy. None of the mediators or moderators tested affected methylphenidate efficacy. Academic improvements were small compared to symptom improvements; qualitative changes limited to math. Clinicians should take this discrepancy into account when prescribing medication for ADHD.
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Affiliation(s)
| | - Marjolein Luman
- Clinical Neuropsychology section, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands
| | - Edmund Sonuga-Barke
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England, UK
| | - Jaap Oosterlaan
- Clinical Neuropsychology section, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands
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28
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Fibert P, Peasgood T, Relton C. Rethinking ADHD intervention trials: feasibility testing of two treatments and a methodology. Eur J Pediatr 2019; 178:983-993. [PMID: 31020392 PMCID: PMC6565660 DOI: 10.1007/s00431-019-03374-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 03/25/2019] [Accepted: 03/26/2019] [Indexed: 01/22/2023]
Abstract
Attention deficit hyperactivity disorder (ADHD) is a lifelong condition associated with considerable costs. The long-term effectiveness and acceptability of treatments to improve outcomes remains in doubt. Long-term trials are needed comparing interventions with standard care and each other. The Sheffield Treatments for ADHD Research (STAR) project used the Trials within Cohorts (TwiCs) approach. A cohort of children with ADHD was recruited and outcomes collected from carers and teachers. A random selection was offered treatment by homoeopaths (hom) or nutritional therapists (NT). Their outcomes (Conners Global ADHD Index) were compared with those not offered interventions. The feasibility of the methods and interventions was assessed. The TwiCs approach was feasible with modifications. 144 participants were recruited to the cohort, 83 offered treatment, 72 accepted, and 50 attended 1+ appointments. Results according to carers assessments at 6 months were as follows: t = 1.08, p = .28 (- 1.48, 4.81) SMD .425 (hom); t = 1.71, p = .09 (- .347, 5.89), SMD = .388 (NT). Teachers' responses were too few and unstable. No serious treatment adverse events occurred.Conclusion: the STAR project demonstrated the feasibility of the TwiCs approach for testing interventions for children with ADHD. What is Known: • Attention deficit hyperactivity disorder (ADHD) is a lifelong condition associated with considerable costs to ADHD stakeholders. Children are at risk of negative outcomes and in need of pre-emptive strategies • The long-term effectiveness and acceptability of recommended treatments to improve outcomes remains in doubt What is New: • A small-scale test of the design demonstrated that the Trials within Cohorts (TwiCs) approach is feasible and can make a useful contribution regarding testing the effectiveness of interventions for children with ADHD to improve long-term negative outcomes • Treatment by homoeopaths and nutritional therapists may offer novel opportunities to improve outcomes.
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Affiliation(s)
- Philippa Fibert
- School of Health and Related Research, University of Sheffield, Regent Coutrt, 30 Regent Street, Sheffield, S1 4DA, UK.
| | - Tessa Peasgood
- 0000 0004 1936 9262grid.11835.3eSchool of Health and Related Research, University of Sheffield, Regent Coutrt, 30 Regent Street, Sheffield, S1 4DA UK ,Health Economics and Decision Science, West Court, Mappin Street, Sheffield, S1 4DP UK
| | - Clare Relton
- 0000 0004 1936 9262grid.11835.3eSchool of Health and Related Research, University of Sheffield, Regent Coutrt, 30 Regent Street, Sheffield, S1 4DA UK ,0000 0001 2171 1133grid.4868.2Pragmatic Clinical Trials Unit, Centre for Primary Care and Public Health, Queen Mary’s University, 58 Turner Street, London, UK
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29
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Orban SA, Karamchandani TA, Tamm L, Sidol CA, Peugh J, Froehlich TE, Brinkman WB, Estell N, Mii AE, Epstein JN. Attention-Deficit/Hyperactivity Disorder-Related Deficits and Psychostimulant Medication Effects on Comprehension of Audiovisually Presented Educational Material in Children. J Child Adolesc Psychopharmacol 2018; 28:727-738. [PMID: 30148660 PMCID: PMC6306678 DOI: 10.1089/cap.2018.0006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective: We aimed to (1) examine differences in observed visual attention and motor activity, as well as comprehension of a science video between children with and without attention-deficit/hyperactivity disorder (ADHD) and (2) explore if psychostimulant medication improves ADHD behaviors and comprehension of a science video in children with ADHD. Method: Children aged 7-11 with (n = 91) and without (n = 45) ADHD watched a science video and then completed a comprehension test. Then, children with ADHD began a 4-week within-subject, randomized, double-blind crossover trial of methylphenidate (MPH). At post-testing, children were randomized to receive placebo or their optimal dosage, watched another science film, and completed a comprehension test. Results: Children with ADHD exhibited higher rates of motor activity during, and worse comprehension of material discussed within, the science video. Mediation models revealed that increased motor activity suppressed between-group differences in comprehension. MPH improved comprehension and visual attention, but not motor activity during the science video. Conclusion: Children with ADHD may benefit from MPH to improve comprehension of and sustained attention during audiovisually presented learning material.
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Affiliation(s)
- Sarah A. Orban
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Center for ADHD, Cincinnati, Ohio.,Address correspondence to: Sarah A. Orban, PhD, Department of Psychology, University of Tampa, 401 W. Kennedy Blvd. SC 253, Tampa, FL, 33606
| | - Tanya A. Karamchandani
- Department of Rehabilitation Psychology/Neuropsychology, TIRR Memorial Hermann Rehabilitation Network, Houston, Texas.,Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Baylor University, Houston, Texas
| | - Leanne Tamm
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Center for ADHD, Cincinnati, Ohio.,College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Craig A. Sidol
- Department of Psychology, University of Cincinnati, Cincinnati, Ohio
| | - James Peugh
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Center for ADHD, Cincinnati, Ohio.,College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Tanya E. Froehlich
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Center for ADHD, Cincinnati, Ohio.,College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - William B. Brinkman
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Center for ADHD, Cincinnati, Ohio.,College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Nicole Estell
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Center for ADHD, Cincinnati, Ohio
| | - Akemi E. Mii
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Center for ADHD, Cincinnati, Ohio
| | - Jeffery N. Epstein
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Center for ADHD, Cincinnati, Ohio.,College of Medicine, University of Cincinnati, Cincinnati, Ohio
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Froehlich T, Fogler J, Barbaresi WJ, Elsayed NA, Evans SW, Chan E. Using ADHD Medications to Treat Coexisting ADHD and Reading Disorders: A Systematic Review. Clin Pharmacol Ther 2018; 104:619-637. [PMID: 30053315 PMCID: PMC6141313 DOI: 10.1002/cpt.1192] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 07/11/2018] [Indexed: 11/10/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD), the most common pediatric neurobehavioral disorder, frequently presents with coexisting reading disorders (RDs). Despite this, it is unclear whether medication improves symptoms and function in children with comorbid ADHD and RD. We present a systematic review of studies investigating the effects of ADHD medications on ADHD symptoms, academic outcomes, and neuropsychological measures in this important group.
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Affiliation(s)
- Tanya Froehlich
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics, University of Cincinnati College of Medicine
| | - Jason Fogler
- Division of Developmental Medicine, Boston Children’s Hospital, Boston MA
- Harvard Medical School, Boston, MA
| | - William J. Barbaresi
- Division of Developmental Medicine, Boston Children’s Hospital, Boston MA
- Harvard Medical School, Boston, MA
| | - Nada A. Elsayed
- Department of Pharmacology and Systems Physiology, University of Cincinnati College of Medicine
| | | | - Eugenia Chan
- Division of Developmental Medicine, Boston Children’s Hospital, Boston MA
- Harvard Medical School, Boston, MA
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31
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Age level vs grade level for the diagnosis of ADHD and neurodevelopmental disorders. Eur Child Adolesc Psychiatry 2018; 27:1171-1180. [PMID: 29876753 DOI: 10.1007/s00787-018-1180-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 06/04/2018] [Indexed: 12/19/2022]
Abstract
A number of worldwide studies have demonstrated that children born later in the school year are more likely to receive an ADHD diagnosis than their same school-year peers. There is, however, variation in findings between countries. We aimed to confirm whether relative age is associated with ADHD diagnosis, with or without comorbidities, and to investigate whether relative age is associated with ADHD type and severity, and if this age relationship is in common with other neurodevelopmental disorder. We used the Lombardy Region's ADHD registry. Data on children aged 6 years and older from September 1, 2011 to December 31, 2017 were considered. We calculated incidence ratios to assess the inter-relations between relative age within the school year, using age at diagnosis of ADHD or of other psychiatric disorder, year of diagnosis, and total number of children born in Lombardy during the corresponding timeframe. Data on ADHD type, severity of diagnosed disorder clinical global impressions-severity scale, and repetition of a school-grade were also considered. 4081 children, 2856 of whom with ADHD, were identified. We confirmed that the cumulative incidence of ADHD diagnosis was greatest for younger children, in particular for boys, for whom the prevalence is greater. The relative age effect was not accounted for by ADHD comorbid disorders, ADHD of combined type or severity. The relative age effect was also observed for children with other neurodevelopmental disorders (without ADHD), with a similar profile as ADHD children: the incidence ratio was 1.78 (95% CI 1.07-2.97; p < 0.0247) for boys diagnosed before age ten. The findings have a potential implication for diagnostic and therapeutic practice, educational advice, and policies, besides to better plan and organize service systems and appropriately inform parents, children, and citizens.
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32
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Chacko A, Bedard ACV, Marks D, Gopalan G, Feirsen N, Uderman J, Chimiklis A, Heber E, Cornwell M, Anderson L, Zwilling A, Ramon M. Sequenced neurocognitive and behavioral parent training for the treatment of ADHD in school-age children. Child Neuropsychol 2018; 24:427-450. [PMID: 28277151 PMCID: PMC6224162 DOI: 10.1080/09297049.2017.1282450] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The present study examines the potential of sequencing a neurocognitive intervention with behavioral parent training (BPT) to improve executive functions (EFs), psychiatric symptoms, and multiple indices of functional impairment in school-age children aged 7 to 11 years who have been diagnosed with attention-deficit/hyperactivity disorder (ADHD). Specifically, in a randomized controlled trial design, 85 children were assigned to either Cogmed Working Memory Training (CWMT) followed by an empirically supported, manualized BPT intervention, or to a placebo version of CWMT followed by the same BPT intervention. Working memory maintenance (i.e., attention control/short-term memory), working memory processing and manipulation, ADHD and oppositional defiant disorder (ODD) symptoms, impairment in parent-child dynamics, familial impairment, and overall functional compromise were evaluated as outcomes. The results suggest specific effects of the combined CWMT and BPT program on verbal and nonverbal working memory storage and nonverbal working memory processing and manipulation but no incremental benefits in regard to ADHD symptoms, ODD symptoms, and functional outcomes. The present findings do not support the hypothesis regarding the complementary and augmentative benefits of sequenced neurocognitive and BPT interventions for the treatment of ADHD. These results, the study's limitations, and future directions for research are further discussed.
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Affiliation(s)
- A Chacko
- a Department of Applied Psychology , New York University , NY , USA
| | - A-C V Bedard
- b Department of Applied Psychology and Human Development, Ontario Institute for Studies in Education , University of Toronto , Canada
| | - D Marks
- c Department of Child and Adolescent Psychiatry , New York University School of Medicine , NY , USA
| | - G Gopalan
- d Department of Social Work , University of Maryland at Baltimore , MD , USA
| | - N Feirsen
- e Department of Psychology , City University of New York , NY , USA
| | - J Uderman
- e Department of Psychology , City University of New York , NY , USA
| | - A Chimiklis
- e Department of Psychology , City University of New York , NY , USA
| | - E Heber
- e Department of Psychology , City University of New York , NY , USA
| | - M Cornwell
- e Department of Psychology , City University of New York , NY , USA
| | - L Anderson
- e Department of Psychology , City University of New York , NY , USA
| | - A Zwilling
- e Department of Psychology , City University of New York , NY , USA
| | - M Ramon
- e Department of Psychology , City University of New York , NY , USA
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Mulraney M, Schilpzand EJ, Anderson V, Nicholson JM, Efron D, Hazell P, Sciberras E. Correlates of Anxiety in 6- to 8-Year-Old Children With ADHD: A Community-Based Study. J Atten Disord 2018; 22:425-434. [PMID: 27020802 DOI: 10.1177/1087054716638510] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of this study was to identify the child and parent/family correlates of anxiety in a community-based sample of children with ADHD. METHOD Children (6-8 years) with ADHD ( n = 179) and controls ( n = 212) were assessed for ADHD and anxiety using the Diagnostic Interview Schedule for Children IV. Potential child and parent/family correlates were measured through direct assessments, and parent- and teacher-reported questionnaires. Associations were examined using univariate and multivariate logistic regression analyses. RESULTS One in four children with ADHD ( n = 44) met criteria for an anxiety disorder, compared with one in 20 controls ( n = 10). Anxiety was common in both boys and girls with ADHD. The strongest correlates of anxiety in multivariate analyses were ADHD subtype, primary caregiver psychosocial distress, and neighborhood socioeconomic disadvantage. CONCLUSION Anxiety is common in children with ADHD. This study provides insight into the potential parent/family stressors that may increase risk for anxiety in children with ADHD.
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Affiliation(s)
- Melissa Mulraney
- 1 Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,3 The University of Melbourne, Parkville, Victoria, Australia
| | - Elizabeth J Schilpzand
- 1 Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,3 The University of Melbourne, Parkville, Victoria, Australia
| | - Vicki Anderson
- 1 Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,2 The Royal Children's Hospital, Parkville, Victoria, Australia.,3 The University of Melbourne, Parkville, Victoria, Australia
| | - Jan M Nicholson
- 1 Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,4 La Trobe University, Melbourne, Victoria, Australia
| | - Daryl Efron
- 1 Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,2 The Royal Children's Hospital, Parkville, Victoria, Australia.,3 The University of Melbourne, Parkville, Victoria, Australia
| | | | - Emma Sciberras
- 1 Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,2 The Royal Children's Hospital, Parkville, Victoria, Australia.,3 The University of Melbourne, Parkville, Victoria, Australia.,6 Deakin University, Melbourne, Victoria, Australia
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L’entraînement de la mémoire de travail est-il bénéfique pour les enfants présentant un trouble déficit de l’attention/hyperactivité ? ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.neurenf.2017.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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35
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Evans S, Ling M, Hill B, Rinehart N, Austin D, Sciberras E. Systematic review of meditation-based interventions for children with ADHD. Eur Child Adolesc Psychiatry 2018; 27:9-27. [PMID: 28547119 DOI: 10.1007/s00787-017-1008-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 05/17/2017] [Indexed: 10/19/2022]
Abstract
Meditation-based interventions such as mindfulness and yoga are commonly practiced in the general community to improve mental and physical health. Parents, teachers and healthcare providers are also increasingly using such interventions with children. This review examines the use of meditation-based interventions in the treatment of children with Attention-Deficit Hyperactivity Disorder (ADHD). Electronic databases searched included PsycINFO, Medline, CINAHL, and AMED. Inclusion criteria involved children (aged to 18 years) diagnosed with ADHD, delivery of a meditation-based intervention to children and/or parents, and publication in a peer-reviewed journal. Studies were identified and coded using standard criteria, risk of bias was assessed using Risk of Bias in Non-randomised Studies- of interventions (ROBINS-I), and effect sizes were calculated. A total of 16 studies were identified (8 that included children in treatment, and 8 that included combined parent-child treatment). Results indicated that risk of bias was high across studies. At this stage, no definitive conclusions can be offered regarding the utility of meditation-based interventions for children with ADHD and/or their parents, since the methodological quality of the studies reviewed is low. Future well designed research is needed to establish the efficacy of meditation-based interventions, including commonly used practices such as mindfulness, before recommendations can be made for children with ADHD and their families.
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Affiliation(s)
- Subhadra Evans
- School of Psychology, Deakin University, Geelong, Australia.
| | - Mathew Ling
- School of Psychology, Deakin University, Geelong, Australia
| | - Briony Hill
- School of Psychology, Deakin University, Geelong, Australia
| | | | - David Austin
- School of Psychology, Deakin University, Geelong, Australia
| | - Emma Sciberras
- School of Psychology, Deakin University, Geelong, Australia
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Abstract
Although a broad array of neurocognitive dysfunctions are associated with ADHD, it is unknown whether these dysfunctions play a role in the course of ADHD symptoms. The present longitudinal study investigated whether neurocognitive functions assessed at study-entry (mean age = 11.5 years, SD = 2.7) predicted ADHD symptom severity and overall functioning 6 years later (mean age = 17.4 years, 82.6 % = male) in a carefully phenotyped large sample of 226 Caucasian participants from 182 families diagnosed with ADHD-combined type. Outcome measures were dimensional measures of ADHD symptom severity and the Kiddie-Global Assessment Scale (K-GAS) for overall functioning. Predictors were derived from component scores for 8 domains of neurocognitive functioning: working memory, motor inhibition, cognitive inhibition, reaction time variability, timing, information processing speed, motor control, intelligence. Effects of age, gender, and pharmacological treatment were considered. Results showed that better working memory predicted lower ADHD symptom severity (R2 = 3.0 %), and less reaction time variability predicted better overall functioning (higher K-GAS-score, R2 = 5.6 %). Predictors were still significant with baseline behavior included in the models. The role of neurocognitive functioning in the long term outcome of ADHD behavior is discussed.
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37
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Lu Y, Sjölander A, Cederlöf M, D'Onofrio BM, Almqvist C, Larsson H, Lichtenstein P. Association Between Medication Use and Performance on Higher Education Entrance Tests in Individuals With Attention-Deficit/Hyperactivity Disorder. JAMA Psychiatry 2017; 74:815-822. [PMID: 28658471 PMCID: PMC5710548 DOI: 10.1001/jamapsychiatry.2017.1472] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
IMPORTANCE Individuals with attention-deficit/hyperactivity disorder (ADHD) are at greater risk for academic problems. Pharmacologic treatment is effective in reducing the core symptoms of ADHD, but it is unclear whether it helps to improve academic outcomes. OBJECTIVE To investigate the association between the use of ADHD medication and performance on higher education entrance tests in individuals with ADHD. DESIGN, SETTING, AND PARTICIPANTS This cohort study observed 61 640 individuals with a diagnosis of ADHD from January 1, 2006, to December 31, 2013. Records of their pharmacologic treatment were extracted from Swedish national registers along with data from the Swedish Scholastic Aptitude Test. Using a within-patient design, test scores when patients were taking medication for ADHD were compared with scores when they were not taking such medication. Data analysis was performed from November 24, 2015, to November 4, 2016. EXPOSURES Periods with and without ADHD medication use. MAIN OUTCOMES AND MEASURES Scores from the higher education entrance examination (score range, 1-200 points). RESULTS Among 930 individuals (493 males and 437 females; mean [SD] age, 22.2 [3.2] years) who had taken multiple entrance tests (n = 2524) and used ADHD medications intermittently, the test scores were a mean of 4.80 points higher (95% CI, 2.26-7.34; P < .001) during periods they were taking medication vs nonmedicated periods, after adjusting for age and practice effects. Similar associations between ADHD medication use and test scores were detected in sensitivity analyses. CONCLUSIONS AND RELEVANCE Individuals with ADHD had higher scores on the higher education entrance tests during periods they were taking ADHD medication vs nonmedicated periods. These findings suggest that ADHD medications may help ameliorate educationally relevant outcomes in individuals with ADHD.
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Affiliation(s)
- Yi Lu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden2Statistical Genetics, Genetics, and Computational Biology Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Arvid Sjölander
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Martin Cederlöf
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Brian M D'Onofrio
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden3Department of Psychological and Brain Sciences, Indiana University, Bloomington
| | - Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden4Pediatric Allergy and Pulmonology Unit, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden5School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Adherence to Attention-Deficit/Hyperactivity Disorder Medication During the Transition to College. J Adolesc Health 2017; 60:706-713. [PMID: 28162841 DOI: 10.1016/j.jadohealth.2016.12.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 12/15/2016] [Accepted: 12/17/2016] [Indexed: 12/26/2022]
Abstract
PURPOSE The present study explores the medication self-management experiences of adolescents with attention-deficit/hyperactivity disorder (ADHD) during their transition to young adulthood in college. METHODS Participants were college freshmen with ADHD prescribed daily medication for their condition. Ten individual interviews were conducted using a semistructured interview script. Measures related to ADHD medication management were also completed. Qualitative data were analyzed via directed content analysis and quantitative data via descriptive statistics. RESULTS Five themes emerged from interviews: (1) transitions to independence are often abrupt, and many adolescents lack critical self-management skills; (2) volitional nonadherence is high due to inaccurate disease beliefs, perceived academic demands, and medication side effects; (3) poor self-management negatively impacts school performance; (4) peer pressure to share medication affects social functioning and adherence; and (5) social support is greatly needed. Common barriers to adherence included "don't feel like taking medication" (90%) and "difficulties in sticking to a fixed medication schedule" (80%). CONCLUSIONS Participants with ADHD were not prepared to manage their chronic illness independently in context of increased demands and newfound freedom, resulting in negative academic consequences. Social factors also play an influential role in ADHD self-management, particularly related to the isolation associated with sharing the medication and its side effects. Intervention programs targeting medication self-management during the transition to independence are greatly needed for young adults with ADHD as high academic performance in college is critical for future success.
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Hogue A, Evans SW, Levin FR. A Clinician's Guide to Co-occurring ADHD among Adolescent Substance Users: Comorbidity, Neurodevelopmental Risk, and Evidence-based Treatment Options. JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2017; 26:277-292. [PMID: 30828239 PMCID: PMC6392461 DOI: 10.1080/1067828x.2017.1305930] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
This article introduces neurodevelopmental and clinical considerations for treating adolescents with co-occurring Attention-Deficit/Hyperactivity Disorder (ADHD) and substance use (ASU) in outpatient settings. We first describe neurobiological impairments common to ADHD and ASU, including comorbidity with conduct disorder, that evoke a profile of multiplicative developmental risk. We then present two evidence-based options for targeting ADHD-related problems during ASU treatment. Medication integration interventions utilize family ADHD psychoeducation to prompt decision-making about ADHD medication and integrate medication management into behavioral services. Clinic-based academic training interventions utilize family interventions to improve the home academic environment and boost organization skills. We conclude with recommendations for ADHD assessment and intervention sequencing.
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Affiliation(s)
- Aaron Hogue
- National Center on Addiction and Substance Abuse, New York, NY, USA
| | | | - Frances R Levin
- Columbia University, New York, NY, USA, New York State Psychiatric Institute
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Short-Term Effects of Methylphenidate on Math Productivity in Children With Attention-Deficit/Hyperactivity Disorder are Mediated by Symptom Improvements: Evidence From a Placebo-Controlled Trial. J Clin Psychopharmacol 2017; 37:210-219. [PMID: 28145999 DOI: 10.1097/jcp.0000000000000671] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although numerous studies report positive effects of methylphenidate on academic performance, the mechanism behind these improvements remains unclear. This study investigates the effects of methylphenidate on academic performance in children with attention-deficit/hyperactivity disorder (ADHD) and the mediating and moderating influence of ADHD severity, academic performance, and ADHD symptom improvement. METHODS Sixty-three children with ADHD participated in a double-blind placebo-controlled crossover study comparing the effects of long-acting methylphenidate and placebo. Dependent variables were math, reading, and spelling performance. The ADHD group performance was compared with a group of 67 typically developing children. RESULTS Methylphenidate improved math productivity and accuracy in children with ADHD. The effect of methylphenidate on math productivity was partly explained by parent-rated symptom improvement, with greater efficacy for children showing more symptom improvement. Further, children showing below-average math performance while on placebo profited more from methylphenidate than children showing above-average math performance. CONCLUSIONS The results from this study indicate positive effects of methylphenidate on academic performance, although these were limited to math abilities. In light of these results, expectations of parents, teachers, and treating physicians about the immediate effects of methylphenidate on academic improvement should be tempered. Moreover, our results implicate that positive effects of methylphenidate on math performance are in part due directly to effects on math ability and in part due to reductions in ADHD symptoms.
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Merrill BM, Morrow AS, Altszuler AR, Macphee FL, Gnagy EM, Greiner AR, Coles EK, Raiker JS, Coxe S, Pelham WE. Improving homework performance among children with ADHD: A randomized clinical trial. J Consult Clin Psychol 2017; 85:111-122. [PMID: 27618639 PMCID: PMC5280087 DOI: 10.1037/ccp0000144] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Evidence indicates that children with Attention Deficit Hyperactivity Disorder (ADHD) experience acute and prolonged academic impairment and underachievement including marked difficulty with completing homework. This study is the first to examine the effects of behavioral, psychostimulant, and combined treatments on homework problems, which have been shown to predict academic performance longitudinally. METHOD Children with ADHD (ages 5-12, N = 75, 71% male, 83% Hispanic/Latino) and their families were randomly assigned to either behavioral treatment (homework-focused parent training and a daily report card; BPT + DRC) or a waitlist control group. Children also participated in a concurrent psychostimulant crossover trial conducted in a summer treatment program. Children's objective homework completion and accuracy were measured as well as parent-reported child homework behaviors and parenting skills. RESULTS BPT + DRC had large effects on objective measures of homework completion and accuracy (Cohen's ds from 1.40 to 2.21, ps < .001). Other findings, including unimodal medication and incremental combined treatment benefits, were not significant. CONCLUSIONS Behavioral treatment focused on homework problems results in clear benefits for children's homework completion and accuracy (the difference between passing and failing, on average), whereas long-acting stimulant medication resulted in limited and largely nonsignificant acute effects on homework performance. (PsycINFO Database Record
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Zendarski N, Sciberras E, Mensah F, Hiscock H. Early high school engagement in students with attention/deficit hyperactivity disorder. BRITISH JOURNAL OF EDUCATIONAL PSYCHOLOGY 2017; 87:127-145. [PMID: 28054712 DOI: 10.1111/bjep.12140] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 10/26/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Students with attention/deficit hyperactivity disorder (ADHD) continue to languish behind their peers with regard to academic achievement and education attainment. School engagement is potentially modifiable, and targeting engagement may be a means to improve education outcomes. AIMS To investigate school engagement for students with ADHD during the crucial high school transition period and to identify factors associated with low school engagement. SAMPLE Participants are adolescents (12-15 years) in the first and third year of high school with diagnosed ADHD (n = 130). Participants were recruited from 21 paediatric practices. METHODS Cross-sectional study assessing school engagement. Data were collected through direct assessment and child, parent, and teacher surveys. School engagement is measured as student attitudes to school (cognitive and emotional) and suspension rates (behavioural). Multivariable regression analyses examined student, family, and school factors affecting engagement. RESULTS In comparison with state data, students with ADHD in the first year of high school were less motivated (p < .01) and less connected to peers (p < .01). Overall, there was no discordance in third year attitudes. There were high rates of suspension in both years in comparison to state-wide suspensions (21% vs. 6%, p < .01). Explanatory factors for poor attitudes include adolescent depression, poor adolescent supervision, and devaluing education. Conduct problems and increased hyperactivity were related to increased likelihood of being suspended, whilst higher cognitive ability, family socio-economic status, and independent schools reduced risk. CONCLUSIONS Potentially modifiable individual and family factors including adolescent depression, behavioural problems, education values, and family supervision could be targeted to better manage the high school transition for students with ADHD.
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Affiliation(s)
- Nardia Zendarski
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Victoria, Australia
| | - Emma Sciberras
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,The Royal Children's Hospital, Parkville, Victoria, Australia.,Deakin University, Burwood, Victoria, Australia
| | - Fiona Mensah
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Victoria, Australia.,The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Harriet Hiscock
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Victoria, Australia.,The Royal Children's Hospital, Parkville, Victoria, Australia
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Advancing Evidence-Based Assessment in School Mental Health: Key Priorities for an Applied Research Agenda. Clin Child Fam Psychol Rev 2016; 19:271-284. [PMID: 27730441 DOI: 10.1007/s10567-016-0217-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Erler A. Using Stimulants to Tackle Social Disadvantages: Interesting in Theory, Problematic in Practice. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2016; 16:48-50. [PMID: 27216102 DOI: 10.1080/15265161.2016.1170234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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45
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Molitor SJ, Langberg JM, Evans SW. The written expression abilities of adolescents with Attention-Deficit/Hyperactivity Disorder. RESEARCH IN DEVELOPMENTAL DISABILITIES 2016; 51-52:49-59. [PMID: 26802631 PMCID: PMC5134244 DOI: 10.1016/j.ridd.2016.01.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 10/14/2015] [Accepted: 01/08/2016] [Indexed: 05/17/2023]
Abstract
Students with Attention-Deficit/Hyperactivity Disorder (ADHD) often experience deficits in academic achievement. Written expression abilities in this population have not been extensively studied but existing prevalence estimates suggest that rates of comorbid writing underachievement may be substantially higher than rates of comorbid reading and mathematics underachievement. The current study examined written expression abilities in a school-based sample of 326 middle school age students with ADHD. The prevalence of written expression impairment, the associations between written expression and academic outcomes, and specific patterns of written expression were investigated. Students with ADHD in this sample experienced written expression impairment (17.2-22.4%) at a similar rate to reading impairment (17.0-24.3%) and at a slightly lower rate than mathematics impairment (24.7-36.3%). Students' written expression abilities were significantly associated with school grades and parent ratings of academic functioning, above and beyond the influence of intelligence. Analyses of patterns suggest that students with ADHD exhibit greater deficits in written expression tasks requiring organization and attention to detail, especially in the context of a complex task.
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Affiliation(s)
- Stephen J Molitor
- Virginia Commonwealth University, 806 W. Franklin Street, P.O. Box 842018, Richmond, VA 23284-2018, United States.
| | - Joshua M Langberg
- Virginia Commonwealth University, 806 W. Franklin Street, P.O. Box 842018, Richmond, VA 23284-2018, United States.
| | - Steven W Evans
- Ohio University, 200 Porter Hall, Athens, OH 45701, United States.
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Gaastra GF, Groen Y, Tucha L, Tucha O. The Effects of Classroom Interventions on Off-Task and Disruptive Classroom Behavior in Children with Symptoms of Attention-Deficit/Hyperactivity Disorder: A Meta-Analytic Review. PLoS One 2016; 11:e0148841. [PMID: 26886218 PMCID: PMC4757442 DOI: 10.1371/journal.pone.0148841] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 01/25/2016] [Indexed: 11/19/2022] Open
Abstract
Children with attention-deficit/hyperactivity disorder (ADHD) often exhibit problem behavior in class, which teachers often struggle to manage due to a lack of knowledge and skills to use classroom management strategies. The aim of this meta-analytic review was to determine the effectiveness of several types of classroom interventions (antecedent-based, consequence-based, self-regulation, combined) that can be applied by teachers in order to decrease off-task and disruptive classroom behavior in children with symptoms of ADHD. A second aim was to identify potential moderators (classroom setting, type of measure, students’ age, gender, intelligence, and medication use). Finally, it was qualitatively explored whether the identified classroom interventions also directly or indirectly affected behavioral and academic outcomes of classmates. Separate meta-analyses were performed on standardized mean differences (SMDs) for 24 within-subjects design (WSD) and 76 single-subject design (SSD) studies. Results showed that classroom interventions reduce off-task and disruptive classroom behavior in children with symptoms of ADHD (WSDs: MSMD = 0.92; SSDs: MSMD = 3.08), with largest effects for consequence-based (WSDs: MSMD = 1.82) and self-regulation interventions (SSDs: MSMD = 3.61). Larger effects were obtained in general education classrooms than in other classroom settings. No reliable conclusions could be formulated about moderating effects of type of measure and students’ age, gender, intelligence, and medication use, mainly because of power problems. Finally, classroom interventions appeared to also benefit classmates’ behavioral and academic outcomes.
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Affiliation(s)
- Geraldina F. Gaastra
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
- * E-mail:
| | - Yvonne Groen
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
| | - Lara Tucha
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
| | - Oliver Tucha
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, 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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48
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Zendarski N, Sciberras E, Mensah F, Hiscock H. A longitudinal study of risk and protective factors associated with successful transition to secondary school in youth with ADHD: prospective cohort study protocol. BMC Pediatr 2016; 16:20. [PMID: 26822230 PMCID: PMC4730730 DOI: 10.1186/s12887-016-0555-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 01/21/2016] [Indexed: 11/25/2022] Open
Abstract
Background Attention-Deficit/Hyperactivity Disorder (ADHD) has a significant impact on child and adolescent development, especially in relation to school functioning and academic outcomes. Despite the transition to high school being a potentially critical period for children with ADHD, most research in this period has focused on academic outcomes. This study aims to extend previous research by describing academic, school engagement, behaviour and social-emotional outcomes for young people with ADHD in the first and third years of high school and to identify risk and protective factors predictive of differing outcomes across these four domains. Methods and design The Moving Up study is a longitudinal, prospective cohort study of children with ADHD as they transition and adjust to high school (age 12–15 years). Data are collected through direct assessment and child, parent and teacher surveys. The primary outcome is academic achievement, obtained by linking to standardised test results. Secondary outcomes include measures of behaviour, ADHD symptoms, school engagement (attitudes and attendance), and social and emotional functioning, including depressive symptoms. The mean performance of the study cohort on each outcome measure will be compared to the population mean for same aged children, using t-tests. Risk and protective factors to be examined using multiple regression include a child, family and school factors know to impact academic and school functioning. Discussion The Moving up study is the first Australian study prospectively designed to measure a broad range of student outcomes for children with ADHD during the high school transition period. Examining both current (cross sectional) and earlier childhood (longitudinal) factors gives us the potential to learn more about risk and protective factors associated with school functioning in young people with ADHD. The richness and depth of this information could lead to more targeted and effective interventions that may alter academic and wellbeing trajectories for young people at risk of poor outcomes. The study is approved by The Royal Children’s Hospital Melbourne Human Research Ethics Committee (33206). Findings will be disseminated through peer-reviewed journals and conference presentations.
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Affiliation(s)
- Nardia Zendarski
- Department of Paediatrics, University of Melbourne, Parkville, 3052, VIC, Australia. .,Community Health Services Research, Murdoch Childrens Research Institute, The Royal Children's Hospital, Flemington Rd, Parkville, 3052, VIC, Australia. .,Centre for Community Child Health, The Royal Children's Hospital, 5th floor Flemington Rd, Parkville, 3052, VIC, Australia.
| | - Emma Sciberras
- Department of Paediatrics, University of Melbourne, Parkville, 3052, VIC, Australia. .,Community Health Services Research, Murdoch Childrens Research Institute, The Royal Children's Hospital, Flemington Rd, Parkville, 3052, VIC, Australia. .,Centre for Community Child Health, The Royal Children's Hospital, 5th floor Flemington Rd, Parkville, 3052, VIC, Australia. .,School of Psychology, Deakin University, Burwood, 3125, VIC, Australia.
| | - Fiona Mensah
- Department of Paediatrics, University of Melbourne, Parkville, 3052, VIC, Australia. .,Community Health Services Research, Murdoch Childrens Research Institute, The Royal Children's Hospital, Flemington Rd, Parkville, 3052, VIC, Australia. .,Centre for Community Child Health, The Royal Children's Hospital, 5th floor Flemington Rd, Parkville, 3052, VIC, Australia.
| | - Harriet Hiscock
- Department of Paediatrics, University of Melbourne, Parkville, 3052, VIC, Australia. .,Community Health Services Research, Murdoch Childrens Research Institute, The Royal Children's Hospital, Flemington Rd, Parkville, 3052, VIC, Australia. .,Centre for Community Child Health, The Royal Children's Hospital, 5th floor Flemington Rd, Parkville, 3052, VIC, Australia.
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Molitor SJ, Langberg JM, Bourchtein E, Eddy LD, Dvorsky MR, Evans SW. Writing abilities longitudinally predict academic outcomes of adolescents with ADHD. ACTA ACUST UNITED AC 2016; 31:393-404. [PMID: 26783650 DOI: 10.1037/spq0000143] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Students with attention-deficit/hyperactivity disorder (ADHD) often experience a host of negative academic outcomes, and deficits in reading and mathematics abilities contribute to these academic impairments. Students with ADHD may also have difficulties with written expression, but there has been minimal research in this area and it is not clear whether written expression abilities uniquely contribute to the academic functioning of students with ADHD. The current study included a sample of 104 middle school students diagnosed with ADHD (Grades 6-8). Participants were followed longitudinally to evaluate whether written expression abilities at baseline predicted student grade point average (GPA) and parent ratings of academic impairment 18 months later, after controlling for reading ability and additional relevant covariates. Written expression abilities longitudinally predicted both academic outcomes above and beyond ADHD and oppositional defiant disorder symptoms, medication use, reading ability, and baseline values of GPA and parent-rated academic impairment. Follow-up analyses revealed that no single aspect of written expression was demonstrably more impactful on academic outcomes than the others, suggesting that writing as an entire process should be the focus of intervention. (PsycINFO Database Record
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Affiliation(s)
| | | | | | - Laura D Eddy
- Department of Psychology, Virginia Commonwealth University
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Treuer T, Méndez L, Montgomery W, Wu S. Factors affecting treatment adherence to atomoxetine in ADHD: a systematic review. Neuropsychiatr Dis Treat 2016; 12:1061-83. [PMID: 27217754 PMCID: PMC4862343 DOI: 10.2147/ndt.s97724] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The purpose of this paper was to systematically review the literature related to research about the factors affecting treatment adherence and discontinuation of atomoxetine in pediatric, adolescent, and adult patients with attention-deficit/hyperactivity disorder (ADHD). Medline was systematically searched using the following prespecified terms: "ADHD", "Adherence", "Compliance", "Discontinuation", and "Atomoxetine". We identified 31 articles that met all inclusion and exclusion criteria. The findings from this review indicate that persistence and adherence to atomoxetine treatment were generally high. Factors found to influence adherence and nonadherence to atomoxetine treatment in ADHD in this review include age, sex, the definition of response used, length of treatment, initial dose of treatment, comorbid conditions, and reimbursement. Tolerability was cited as an important reason for treatment discontinuation. More research is needed to understand those factors that can help to identify patients at risk for poor adherence and interventions that could improve treatment adherence early in the stage of this illness to secure a better long-term prognosis.
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Affiliation(s)
- Tamás Treuer
- Neuroscience Research, Eli Lilly and Company, Budapest, Hungary
| | | | - William Montgomery
- Global Patient Outcomes and Real World Evidence, Eli Lilly Australia Pty Ltd, West Ryde, NSW, Australia
| | - Shenghu Wu
- Neuroscience Research, Eli Lilly Asia, Inc, Shanghai, People's Republic of China
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