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Nadermohammadi Moghadam M, Bakhshi P, Azarkollah A, Moulai B, Molavi P. A Comparison of Effectiveness of Attention Process Training (APT) with Parenting Management Training (PMT) in Reducing Symptoms of Attention Deficit Hyperactivity Disorder. IRANIAN JOURNAL OF PSYCHIATRY 2024; 19:254-264. [PMID: 39055521 PMCID: PMC11267122 DOI: 10.18502/ijps.v19i3.15802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 03/09/2024] [Accepted: 05/26/2024] [Indexed: 07/27/2024]
Abstract
Objective: Child-oriented psychotherapies, such as Attention Process Training (APT), target ADHD symptoms directly, whereas family-oriented interventions, like Parent Management Training (PMT), address its functional impairments. The aim of this study was to compare the effectiveness of APT and PMT in treating ADHD symptoms. Method : This research was a randomized controlled trial in which 45 children (26 females and 19 males, with a mean age of 8.47 ± 1.66 years) with ADHD were selected conveniently and assigned randomly to one of three groups (PMT = 15, APT = 15, and CTRL = 15). The groups had no significant differences in ADHD severity. The PMT children were managed with parenting techniques. Children in the APT group practiced attention techniques, while children in the control group did not receive any intervention. Ritalin was prescribed to all the children in the three groups. The score on the Conners Parenting Rating Scale-Revised: Short form was the outcome variable. Results: Both interventions decreased ADHD symptoms severity more than the control group. Howver, the reduction in the APT group was more than in the PMT group (P-value < 0.001). The scores of 40% of the APT group and 80% of the PMT group did not fall below the cut-off point. In the APT group after the intervention, the inattention subscale was significantly lower than the hyperactivity subscale, while in the PMT group, the hyperactivity subscale was lower. The effect sizes of APT and PMT were 2.18 and 2.09, respectively. Conclusion: For ADHD, psychological interventions are crucial in addition to medication. According to the results of this study, APT is more effective for inattention symptoms, while PMT is more effective for hyperactivity symptoms. When selecting psychotherapy, the subtype of ADHD should be taken into account. Treatment sessions must also be completed according to intervention protocols.
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Affiliation(s)
- Mehriar Nadermohammadi Moghadam
- Social Determinants of Health Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
- Department of Psychiatry, Fatemi Hospital, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Parisa Bakhshi
- Department of Psychiatry, Fatemi Hospital, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Anita Azarkollah
- Department of Psychiatry, Fatemi Hospital, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Behnam Moulai
- Department of Psychiatry, Fatemi Hospital, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Parviz Molavi
- Department of Psychiatry, Fatemi Hospital, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
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Chacko A, Merrill BM, Kofler MJ, Fabiano GA. Improving the efficacy and effectiveness of evidence-based psychosocial interventions for attention-deficit/hyperactivity disorder (ADHD) in children and adolescents. Transl Psychiatry 2024; 14:244. [PMID: 38851829 PMCID: PMC11162428 DOI: 10.1038/s41398-024-02890-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/14/2024] [Accepted: 03/22/2024] [Indexed: 06/10/2024] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a prevalent, chronic, and impairing mental health disorder of childhood. Decades of empirical research has established a strong evidence-based intervention armamentarium for ADHD; however, limitations exist in regards to efficacy and effectiveness of these interventions. We provide an overview of select evidence-based interventions for children and adolescents, highlighting potential approaches to further improving the efficacy and effectiveness of these interventions. We conclude with broader recommendations for interventions, including considerations to moderators and under-explored intervention target areas as well as avenues to improve access and availability of evidence-based interventions through leveraging underutilized workforces and leveraging technology.
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van Doornik RS, van der Oord S, Luijckx J, Groenman AP, Leijten P, Luman M, Hoekstra PJ, van den Hoofdakker BJ, Dekkers TJ. The short- and longer-term effects of brief behavioral parent training versus care as usual in children with behavioral difficulties: study protocol for a randomized controlled trial. BMC Psychiatry 2024; 24:203. [PMID: 38475768 PMCID: PMC10936011 DOI: 10.1186/s12888-024-05649-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 03/01/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND The access to and uptake of evidence-based behavioral parent training for children with behavioral difficulties (i.e., oppositional, defiant, aggressive, hyperactive, impulsive, and inattentive behavior) are currently limited because of a scarcity of certified therapists and long waiting lists. These problems are in part due to the long and sometimes perceived as rigid nature of most evidence-based programs and result in few families starting behavioral parent training and high dropout rates. Brief and individually tailored parenting interventions may reduce these problems and make behavioral parent training more accessible. This protocol paper describes a two-arm, multi-center, randomized controlled trial on the short- and longer-term effectiveness and cost-effectiveness of a brief, individually tailored behavioral parent training program for children with behavioral difficulties. METHODS Parents of children aged 2-12 years referred to a child mental healthcare center are randomized to (i) three sessions of behavioral parent training with optional booster sessions or (ii) care as usual. To evaluate effectiveness, our primary outcome is the mean severity of five daily ratings by parents of four selected behavioral difficulties. Secondary outcomes include measures of parent and child behavior, well-being, and parent-child interaction. We explore whether child and parent characteristics moderate intervention effects. To evaluate cost-effectiveness, the use and costs of mental healthcare and utilities are measured. Finally, parents' and therapists' satisfaction with the brief program are explored. Measurements take place at baseline (T0), one week after the brief parent training, or eight weeks after baseline (in case of care as usual) (T1), and six months (T2) and twelve months (T3) after T1. DISCUSSION The results of this trial could have meaningful societal implications for children with behavioral difficulties and their parents. If we find the brief behavioral parent training to be more (cost-)effective than care as usual, it could be used in clinical practice to make parent training more accessible. TRIAL REGISTRATION The trial is prospectively registered at ClinicalTrials.gov (NCT05591820) on October 24th, 2022 and updated throughout the trial.
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Affiliation(s)
- Roos S van Doornik
- Accare Child Study Center, Groningen, The Netherlands.
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | | | - Joli Luijckx
- Balans, National Parent Association, Bunnik, The Netherlands
| | - Annabeth P Groenman
- Accare Child Study Center, Groningen, The Netherlands
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
| | - Patty Leijten
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
| | - Marjolein Luman
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Complex Behavioral Disorders and Forensic Youth Psychiatry, Levvel, Amsterdam, The Netherlands
| | - Pieter J Hoekstra
- Accare Child Study Center, Groningen, The Netherlands
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Barbara J van den Hoofdakker
- Accare Child Study Center, Groningen, The Netherlands
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
| | - Tycho J Dekkers
- Accare Child Study Center, Groningen, The Netherlands
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Complex Behavioral Disorders and Forensic Youth Psychiatry, Levvel, Amsterdam, The Netherlands
- Department of Child and Adolescent Psychiatry, Amsterdam University Medical Center (AUMC), Amsterdam, The Netherlands
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
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Oguchi M, Furukawa E, Nagahama N, Perera KD, Tripp G. Relationships between experimental task and questionnaire measures of reward/punishment sensitivity in attention-deficit/hyperactivity disorder (ADHD): protocol for a scoping review. BMJ Open 2024; 14:e078026. [PMID: 38355179 PMCID: PMC10868308 DOI: 10.1136/bmjopen-2023-078026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 01/18/2024] [Indexed: 02/16/2024] Open
Abstract
INTRODUCTION One of the purported underlying causal mechanisms of attention deficit hyperactivity disorder (ADHD) is altered motivational processes. Questionnaires have been used to identify the characteristics of reward and punishment sensitivity in individuals with ADHD. However, these questionnaires were initially developed to measure individual traits related to anxiety (inhibitory) and impulsivity (approach) tendencies or differences in pleasure-seeking. These reward and punishment sensitivity questionnaires are useful but might not capture all relevant aspects of altered motivational processes in ADHD. The proposed scoping review aims to: (1) examine which aspects of hypothesised altered reward and punishment sensitivity correspond to constructs measured by existing questionnaires, (2) characterise the relationships between ADHD symptomatology and reward and punishment sensitivity as measured by existing questionnaires and (3) evaluate the consistency between the altered reward and punishment sensitivity as measured by existing questionnaires and experimental task performance. METHODS AND ANALYSIS Reporting of the scoping review results will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews and the Joanna Briggs Methodology for Scoping Reviews. Published English-language literature was searched in three electronic databases (PubMed, Web of Science, APA PsycINFO) on 16 November 2023, with no restriction on the year of publication. Two researchers independently screened all identified titles/abstracts before proceeding to full-text review and additional handsearching of relevant studies. A narrative review and conclusions will be presented together with tables summarising the articles reviewed and the results organised by the three aims. ETHICS AND DISSEMINATION This study reviews existing publications with ethical approval in place. Therefore, ethical approval is not required. Review results will be disseminated through academic conferences and peer-reviewed manuscripts. Scoping review results will also inform future research to measure and identify altered motivational processes in ADHD.
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Affiliation(s)
- Mana Oguchi
- Human Developmental Neurobiology Unit, Okinawa Institute of Science and Technology Graduate University, Onna, Okinawa, Japan
- Research Fellowship for Young Scientists, Japan Society for the Promotion of Science, Chiyoda-ku, Tokyo, Japan
| | - Emi Furukawa
- Human Developmental Neurobiology Unit, Okinawa Institute of Science and Technology Graduate University, Onna, Okinawa, Japan
| | - Naano Nagahama
- Human Developmental Neurobiology Unit, Okinawa Institute of Science and Technology Graduate University, Onna, Okinawa, Japan
- Laboratory of Behavioral Neuroendocrinology, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Kokila Dilhani Perera
- Human Developmental Neurobiology Unit, Okinawa Institute of Science and Technology Graduate University, Onna, Okinawa, Japan
| | - Gail Tripp
- Human Developmental Neurobiology Unit, Okinawa Institute of Science and Technology Graduate University, Onna, Okinawa, Japan
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Rahali M, Fongaro E, Franc N, Nesensohn J, Purper-Ouakil D, Kerbage H. Expected changes in parenting after an online parent training for ADHD. L'ENCEPHALE 2024; 50:59-67. [PMID: 37005192 DOI: 10.1016/j.encep.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/26/2022] [Accepted: 01/10/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in children and adolescents. Treatments for this population should be multidisciplinary and must be initiated as early as possible. Non-pharmacological interventions for ADHD include psychoeducation, parent behavioural training programs and school interventions and accommodations. In response to the COVID-19 pandemic, we developed an online version of a combined psychoeducation and behavioural training program to facilitate access to mental health treatment and ensure continuity of care. OBJECTIVE The study assessed the acceptability of this online parent training program, among parents and caretakers of children and adolescents with ADHD. METHODS The program consisted of ten online sessions over the course of two consecutive days (five sessions a day). Satisfaction, usefulness and general comments about the program were assessed with open-ended questions and visual-analogous scales. Parents/caretakers' use of strategies to manage behavioural problems was assessed using the Parenting and Family Adjustment Scales. RESULTS A total of 206 parents participated in the online program 175 of whom completed the evaluation. Participants were satisfied with the content of the program. More than half of participants had already started using strategies included in the program. The engagement was high and no major obstacles were identified other than some internet connection issues. DISCUSSION In our survey, online delivery was described as more convenient, and participants were satisfied with the content of the program finding it beneficial for their child. Despite this, some difficulties in implementing new strategies were observed. Online BTP increased access to the BTP programs while being effective on ADHD symptoms and behavioural disturbances. CONCLUSIONS With these measures, we hope to improve engagement in online psychoeducation and behavioural therapy programs. Future research evaluating online behavioural training programs should focus on ways to make them more accessible and adaptable to families' obstacles.
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Affiliation(s)
- M Rahali
- Médecine Psychologique de l'Enfant et de l'Adolescent MPEA1, Hôpital Saint-Éloi, CHU de Montpellier, 80, avenue Augustin-Fliche, 34090 Montpellier, France
| | - E Fongaro
- Médecine Psychologique de l'Enfant et de l'Adolescent MPEA1, Hôpital Saint-Éloi, CHU de Montpellier, 80, avenue Augustin-Fliche, 34090 Montpellier, France; CESP, Inserm U 1018, UVSQ Psychiatry Development and Trajectories, Villejuif, France.
| | - N Franc
- Médecine Psychologique de l'Enfant et de l'Adolescent MPEA1, Hôpital Saint-Éloi, CHU de Montpellier, 80, avenue Augustin-Fliche, 34090 Montpellier, France
| | - J Nesensohn
- Médecine Psychologique de l'Enfant et de l'Adolescent MPEA1, Hôpital Saint-Éloi, CHU de Montpellier, 80, avenue Augustin-Fliche, 34090 Montpellier, France
| | - D Purper-Ouakil
- Médecine Psychologique de l'Enfant et de l'Adolescent MPEA1, Hôpital Saint-Éloi, CHU de Montpellier, 80, avenue Augustin-Fliche, 34090 Montpellier, France; CESP, Inserm U 1018, UVSQ Psychiatry Development and Trajectories, Villejuif, France
| | - H Kerbage
- Médecine Psychologique de l'Enfant et de l'Adolescent MPEA1, Hôpital Saint-Éloi, CHU de Montpellier, 80, avenue Augustin-Fliche, 34090 Montpellier, France; CESP, Inserm U 1018, UVSQ Psychiatry Development and Trajectories, Villejuif, France
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Marquet-Doléac J, Biotteau M, Chaix Y. Behavioral Parent Training for School-Aged Children With ADHD: A Systematic Review of Randomized Control Trials. J Atten Disord 2024; 28:377-393. [PMID: 38083879 DOI: 10.1177/10870547231211595] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
BACKGROUND All guidelines for the treatment of ADHD in children include behavioral parent training in combination with other strategies. In the past, several systematic reviews have been carried out that were either outdated or not sufficiently specific to ADHD. We wanted to conduct a new review focusing on a specific ADHD population of school age (4-12 years) and on behavioral and cognitive programs. We aimed to test our hypothesis that behavioral parent training would improve parents' difficulties, children's symptomatology, and the quality of life of families with ADHD. METHODS PUBMED, PsychInfo, Web of Science, ERIC, and Cochrane databases were searched for original articles on randomized control trials on behavioral parent training group for children with ADHD aged from 4 to 12 years until July 2023. RESULTS A total of 20 studies were included in the systematic review. The results were divided into four categories: parent data, child data collected by parents, teachers, or researchers. A qualitative analysis revealed for parents, effects on parental stress, feelings of parental efficacy, and negative parental educational behavior. As regard children, only effects are noted for parental assessment, on ADHD symptomatology, externalized disorders, and social skills. CONCLUSION Despite the heterogeneity or small number of studies in some categories, BPTs have positive effects on both parents and children. There are no convincing results to support the generalization of progress. This would seem to indicate that it remains essential to consider actions specific to each problematic environment for the child.
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Affiliation(s)
- Jerome Marquet-Doléac
- University of Toulouse, INSERM, UPS, France
- University of Toulouse 3 Paul Sabatier, France
| | - Maëlle Biotteau
- University of Toulouse, INSERM, UPS, France
- Purpan University Hospital, Toulouse, France
| | - Yves Chaix
- University of Toulouse, INSERM, UPS, France
- Purpan University Hospital, Toulouse, France
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Hulsbosch AK, Beckers T, De Meyer H, Danckaerts M, Van Liefferinge D, Tripp G, Van der Oord S. Instrumental learning and behavioral persistence in children with attention-deficit/hyperactivity-disorder: does reinforcement frequency matter? J Child Psychol Psychiatry 2023; 64:1631-1640. [PMID: 37040877 DOI: 10.1111/jcpp.13805] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/06/2023] [Indexed: 04/13/2023]
Abstract
BACKGROUND Prominent theoretical accounts of attention-deficit/hyperactivity-disorder (ADHD) hypothesize that reinforcement learning deficits underlie symptoms of ADHD. The Dynamic Developmental Theory and the Dopamine Transfer Deficit hypothesis assume impairments in both the acquisition and extinction of behavior, especially when learning occurs under partial (non-continuous) reinforcement, and subsequently the Partial Reinforcement Extinction Effect (PREE). Few studies have evaluated instrumental learning in ADHD and the results are inconsistent. The current study investigates instrumental learning under partial and continuous reinforcement schedules and subsequent behavioral persistence when reinforcement is withheld (extinction) in children with and without ADHD. METHODS Large well-defined samples of children with ADHD (n = 93) and typically developing (TD) children (n = 73) completed a simple instrumental learning task. The children completed acquisition under continuous (100%) or partial (20%) reinforcement, followed by a 4-min extinction phase. Two-way (diagnosis by condition) ANOVAs evaluated responses needed to reach the learning criterion during acquisition, and target and total responses during extinction. RESULTS Children with ADHD required more trials to reach criterion compared to TD children under both continuous and partial reinforcement. After partial reinforcement, children with ADHD executed fewer target responses during extinction than TD children. Children with ADHD executed more responses than TD children during extinction, irrespective of learning condition. CONCLUSIONS The findings demonstrate general difficulties in instrumental learning in ADHD, that is, slower learning irrespective of reinforcement schedule. They also show faster extinction following learning under partial reinforcement in those with ADHD, that is, a diminished PREE. Children with ADHD executed more responses during extinction. Results are theoretically important, with clinical implications for understanding and managing learning difficulties in those with ADHD, as they suggest poorer reinforcement learning and lower behavioral persistence.
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Affiliation(s)
- An-Katrien Hulsbosch
- Behavior, Health and Psychopathology, KU Leuven, Leuven, Belgium
- Child and Youth Institute, KU Leuven, Leuven, Belgium
| | - Tom Beckers
- Behavior, Health and Psychopathology, KU Leuven, Leuven, Belgium
- Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Hasse De Meyer
- Department of Psychology, National University of Singapore, Singapore City, Singapore
| | - Marina Danckaerts
- Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Center for Developmental Psychiatry, KU Leuven, Leuven, Belgium
- University Psychiatric Centre, KU Leuven, Leuven, Belgium
| | | | - Gail Tripp
- Human Developmental Neurobiology Unit, Okinawa Institute of Science and Technology Graduate University, Onna, Okinawa, Japan
| | - Saskia Van der Oord
- Behavior, Health and Psychopathology, KU Leuven, Leuven, Belgium
- Child and Youth Institute, KU Leuven, Leuven, Belgium
- Leuven Brain Institute, KU Leuven, Leuven, Belgium
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Sadr-Salek S, Costa AP, Steffgen G. Psychological Treatments for Hyperactivity and Impulsivity in Children with ADHD: A Narrative Review. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1613. [PMID: 37892276 PMCID: PMC10605405 DOI: 10.3390/children10101613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/18/2023] [Accepted: 09/25/2023] [Indexed: 10/29/2023]
Abstract
Treatment of the ADHD types (hyperactive-impulsive, inattentive, and combined) in children has rarely been studied separately, although their prognostic courses differ widely. In addition, data show that improvements in hyperactivity/impulsivity are hard to achieve. Thus, we focused on treatments tailored to hyperactivity/impulsivity. We examined meta-analyses and systematic reviews within the inter- and intra-individual treatments and found that psychoeducation and training for parents, school-based interventions, reinforcement strategies, and neurofeedback consistently showed small to moderate effect sizes in reducing hyperactivity/impulsivity in children. Conversely, emotional self-regulation, social skills, and cognitive trainings showed unsatisfactory results. In summary, we found that the quality of usual care can be surpassed when the designated interventions are purposefully combined into a multimodal treatment program.
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Affiliation(s)
- Shayan Sadr-Salek
- Service Psychologique, Solidarité Jeunes asbl—Haus 13, 48, rue Victor Hugo, L-4140 Esch-sur-Alzette, Luxembourg;
| | - Andreia P. Costa
- Institute for Health and Behaviour, Department of Behavioural and Cognitive Sciences, University of Luxembourg, Campus Belval, MSH, 11 Porte des Sciences, L-4366 Esch-sur-Alzette, Luxembourg;
| | - Georges Steffgen
- Institute for Health and Behaviour, Department of Behavioural and Cognitive Sciences, University of Luxembourg, Campus Belval, MSH, 11 Porte des Sciences, L-4366 Esch-sur-Alzette, Luxembourg;
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Kostyrka-Allchorne K, Chu P, Ballard C, Lean N, French B, Hedstrom E, Byford S, Cortese S, Daley D, Downs J, Glazebrook C, Goldsmith K, Hall CL, Kovshoff H, Kreppner J, Sayal K, Shearer J, Simonoff E, Thompson M, Sonuga-Barke EJS. Remote Recruitment Strategy and Structured E-Parenting Support (STEPS) App: Feasibility and Usability Study. JMIR Pediatr Parent 2023; 6:e47035. [PMID: 37695667 PMCID: PMC10520770 DOI: 10.2196/47035] [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] [Received: 03/14/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND The Structured E-Parenting Support (STEPS) app provides support for parents of children with elevated hyperactivity, impulsivity, inattention, and conduct problems who are awaiting clinical assessment. STEPS will be evaluated in a randomized controlled trial (RCT) within the Online Parent Training for the Initial Management of ADHD Referrals (OPTIMA) research program in the United Kingdom. Phase 1 of the OPTIMA tested the feasibility of participants' recruitment and the app's usability. OBJECTIVE This study aimed to adapt a digital routine clinical monitoring system, myHealthE, for research purposes to facilitate waitlist recruitment; test using remote methods to screen and identify participants quickly and systematically; pilot the acceptability of the recruitment and assessment protocol; and explore the usability of STEPS. METHODS myHealthE was adapted to screen patients' data. Parents' and clinicians' feedback on myHealthE was collected, and information governance reviews were conducted in clinical services planning to host the RCT. Potential participants for the observational feasibility study were identified from new referrals using myHealthE and non-myHealthE methods. Descriptive statistics were used to summarize the demographic and outcome variables. We estimated whether the recruitment rate would meet the planned RCT sample size requirement (n=352). In addition to the feasibility study participants, another group of parents was recruited to assess the STEPS usability. They completed the adapted System Usability Scale and responded to open-ended questions about the app, which were coded using the Enlight quality construct template. RESULTS Overall, 124 potential participants were identified as eligible: 121 (97.6%) via myHealthE and 3 (2.4%) via non-myHealthE methods. In total, 107 parents were contacted, and 48 (44.9%) consented and were asked if, hypothetically, they would be willing to participate in the OPTIMA RCT. Of the 28 feasibility study participants who provided demographic data, 21 (75%) identified as White. Their children had an average age of 8.4 (SD 1.7) years and 65% (31/48) were male. During the primary recruitment period (June to July 2021) when 45 participants had consented, 38 (84%) participants agreed hypothetically to take part in the RCT (rate of 19/mo, 95% CI 13.5-26.1), meeting the stop-go criterion of 18 participants per month to proceed with the RCT. All parents were satisfied or very satisfied with the study procedures. Parents (n=12) recruited to assess STEPS' usability described it as easy to navigate and use and as having an attractive combination of colors and visual design. They described the content as useful, pitched at the right level, and sensitively presented. Suggested improvements included adding captions to videos or making the recorded reflections editable. CONCLUSIONS Remote recruitment and study procedures for testing a parenting intervention app are feasible and acceptable for parents. The parents felt that STEPS was a useful and easy-to-use digital parenting support tool. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s40814-021-00959-0.
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Affiliation(s)
- Katarzyna Kostyrka-Allchorne
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Petrina Chu
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Claire Ballard
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Nancy Lean
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Blandine French
- Academic Unit of Mental Health & Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Ellen Hedstrom
- School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
| | - Sarah Byford
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Samuele Cortese
- School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
- Solent NHS Trust, Southampton, United Kingdom
- New York University Child Study Center, Hassenfeld Children's Hospital at NYU Langone, New York, NY, United States
| | - David Daley
- Nottingham Trent University Psychology, School of Social Science, Nottingham Trent University, Nottingham, United Kingdom
| | - Johnny Downs
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Cristine Glazebrook
- Academic Unit of Mental Health & Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Kimberley Goldsmith
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Charlotte L Hall
- Academic Unit of Mental Health & Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Hanna Kovshoff
- School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
| | - Jana Kreppner
- School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
| | - Kapil Sayal
- Academic Unit of Mental Health & Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - James Shearer
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Emily Simonoff
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Margaret Thompson
- School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
- Solent NHS Trust, Southampton, United Kingdom
| | - Edmund J S Sonuga-Barke
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
- Department of Child & Adolescent Psychiatry, Aarhus University, Aarhus, Denmark
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10
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Hornstra R, Onghena P, van den Hoofdakker BJ, van der Veen-Mulders L, Luman M, Staff AI, van der Oord S. Components of Behavioral Parent Training for Children With Attention-Deficit/Hyperactivity Disorder: A Series of Replicated Single-Case Experiments. Behav Modif 2023; 47:1042-1070. [PMID: 37056055 PMCID: PMC10403966 DOI: 10.1177/01454455231162003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
Behavioral parent training (BPT) is an evidence-based treatment for children with attention-deficit/hyperactivity disorder (ADHD). Stimulus control techniques (antecedent-based techniques, e.g., clear rules, instructions) and contingency management techniques (consequent-based techniques, e.g., praise, ignore) are the most common ones that are being taught to parents in BPT. However, research into the additive effects of these techniques is scarce. In this replicated single-case experimental ABC phase design, including six children on stable medication for ADHD (8-11 years) and their parents, the added efficacy of consequent-based techniques on top of antecedent-based techniques was evaluated. After a baseline period (phase A), we randomized the commencement time of two sessions parent training in antecedent-based techniques and two sessions parent training in consequent-based techniques for each child. Children's behaviors were assessed by daily parent ratings of selected problem behaviors and an overall behavior rating. Although visual inspection showed that behavior improved for most children in both phases, randomization tests did not demonstrate the added efficacy of the consequent-based techniques on top of the antecedent-based techniques. Limitations of the study and recommendations for future single-case experiments in this population are discussed.
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Affiliation(s)
- Rianne Hornstra
- University of Groningen, University Medical Center Groningen, The Netherlands
- Accare Child Study Center, Groningen, The Netherlands
- University of Groningen, The Netherlands
| | | | - Barbara J. van den Hoofdakker
- University of Groningen, University Medical Center Groningen, The Netherlands
- Accare Child Study Center, Groningen, The Netherlands
- University of Groningen, The Netherlands
| | - Lianne van der Veen-Mulders
- University of Groningen, University Medical Center Groningen, The Netherlands
- Accare Child Study Center, Groningen, The Netherlands
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11
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Bado P, da Costa R, Bernardes C, Tripp G, Mattos P, Furukawa E. Needs assessment for behavioral parent training for ADHD in Brazil. Front Psychiatry 2023; 14:1191289. [PMID: 37575579 PMCID: PMC10415012 DOI: 10.3389/fpsyt.2023.1191289] [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] [Received: 03/21/2023] [Accepted: 07/10/2023] [Indexed: 08/15/2023] Open
Abstract
Introduction Attention-Deficit/Hyperactivity Disorder (ADHD) is a debilitating condition affecting children and their families worldwide. Behavioral parent training is a recommended form of empirically supported non-pharmacological intervention for young children with mild to moderate ADHD. However, access to such treatment is limited in many countries. Here we identify the treatment needs of Brazilian families with children demonstrating symptoms of ADHD, and the barriers families face in accessing behavioral treatment. Methods A qualitative needs assessment was undertaken with parents (n = 23), educators (n = 15), and healthcare providers (n = 16). Semi-structured telephone interviews were conducted, and common themes were identified through inductive coding of participants' responses. Results Participants reported a lack of accessible behavioral treatment, and delays in accessing treatment when available. The majority of parents had not received behavioral parent training, despite it being a recommended form of treatment. Parents, educators and healthcare providers strongly endorsed a need for practical tools to manage the behavior of children with ADHD. Conclusion Existing services might not meet the needs of children with ADHD and their families in Brazil. Easily accessed behavioral parent training programs are recommended to address the identified treatment gap for Brazilian children with ADHD and their families.
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Affiliation(s)
- Patricia Bado
- D’Or Institute for Research and Education, Rio de Janeiro, Brazil
- Department of Psychology, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Raquel da Costa
- D’Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Camila Bernardes
- D’Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Gail Tripp
- Okinawa Institute of Science and Technology Graduate University, Okinawa, Japan
| | - Paulo Mattos
- D’Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Emi Furukawa
- Okinawa Institute of Science and Technology Graduate University, Okinawa, Japan
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12
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Furukawa E, Alsop B, Alves H, Vorderstrasse V, Carrasco KD, Chuang CC, Tripp G. Disrupted waiting behavior in ADHD: exploring the impact of reward availability and predictive cues. Child Neuropsychol 2023; 29:76-95. [PMID: 35532317 DOI: 10.1080/09297049.2022.2068518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Altered motivational processing is purported to contribute to ADHD symptoms. A stronger preference for immediate over delayed reward is well documented in ADHD. However, little attention has been paid to children's capacity to withhold responding until a "better" reward becomes available, and their actions while waiting. Using a novel computer task, we examine the ability of children with and without ADHD to wait to collect a large reward in the presence of a small available reward. The effects of a reward-predicting cue on response times and response choices are also explored. Data from 136 children (6-12 years), 90 with ADHD and 46 typically developing (TD) children, are included. The children could collect a small immediately available reward or wait to access a larger reward after a variable delay, its imminent availability sometimes signaled by a cue. Subsequent probe trials explored the effects of longer waiting times and disruption of the cue-reward association. As expected, children with ADHD collected the small immediately available reward more often than TD children. Importantly, they were more likely to terminate waiting once commenced, collecting the small reward or attempting to collect the large reward early. The cue decreased their response time but disrupted their waiting when it no longer consistently predicted reward. Children with ADHD were more likely to abandon efforts to wait, especially when wait times were extended and when expected rewards failed to appear. Behavioral interventions for ADHD should take into account reduced waiting capacity that extends beyond children's preference for immediate reward.
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Affiliation(s)
- Emi Furukawa
- Human Developmental Neurobiology Unit, Okinawa Institute of Science and Technology Graduate University, Okinawa, Japan
| | - Brent Alsop
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Heloisa Alves
- Department of Psychology, University of Massachusetts Dartmouth, Massachusetts, USA
| | - Valerie Vorderstrasse
- Human Developmental Neurobiology Unit, Okinawa Institute of Science and Technology Graduate University, Okinawa, Japan
| | - Kelly D Carrasco
- Wellington Faculty of Education, Victoria University of Wellington, Wellington, New Zealand
| | - Chi-Ching Chuang
- Department of Psychology and Counseling, University of Taipei, Taipei, Taiwan
| | - Gail Tripp
- Human Developmental Neurobiology Unit, Okinawa Institute of Science and Technology Graduate University, Okinawa, Japan
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13
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Lambek R, Sonuga-Barke EJS, Lange AM, Carroll DJ, Daley D, Thomsen PH. Parent Training for ADHD: No Generalization of Effects From Clinical to Neuropsychological Outcomes in a Randomized Controlled Trial. J Atten Disord 2023; 27:98-107. [PMID: 36314486 DOI: 10.1177/10870547221130108] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We examined whether neuropsychological function in ADHD can be improved by the New Forest Parenting Programme (NFPP), that combines standard parenting strategies with self-regulatory skills training, or predict ADHD and quality of life (QoL) treatment effects. METHOD Participants were 93 medication-naive preschool children with ADHD (3-7 years) randomized to either NFPP (n = 49) or treatment as usual (TAU; n = 44) in a recent randomized trial. Laboratory measures of executive function, reaction time variability, and delay of gratification were collected along with parent ratings of ADHD and QoL at baseline and post treatment. Ratings were collected again at 3-month follow-up. RESULTS NFPP did not improve neuropsychological function (compared to TAU), and baseline neuropsychological function did not predict treatment-related ADHD or QoL effects. CONCLUSION Although NFPP includes a neuropsychological training element and has been shown to improve several clinical outcomes, it did not improve the neuropsychological functions it targets.
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14
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Clinical Change Mechanisms in the Treatment of College Students with ADHD: Trajectories and Associations with Outcomes. Behav Ther 2022; 54:444-460. [PMID: 37088503 DOI: 10.1016/j.beth.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 11/10/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022]
Abstract
The purpose of this study was to evaluate trajectories of response for the three theorized mechanisms of clinical change (knowledge, behavioral strategies, and adaptive thinking) associated with the Accessing Campus Connections and Empowering Student Success (ACCESS) intervention for college students with attention-deficit/hyperactivity disorder (ADHD) and their association with treatment outcomes. Participants included 250 college students comprehensively diagnosed with ADHD randomly assigned to ACCESS or to a delayed-treatment control who completed ratings at baseline, end of active treatment, and end of the maintenance phase of treatment (after two semesters). Growth mixture models (GMMs) were used to evaluate trajectories. Participants in ACCESS made significant gains in the use of behavioral strategies and trajectories were associated with large effect size improvements in measures of symptoms and functioning. Participants also made improvements in ADHD knowledge. However, only the knowledge trajectory with rapid improvement displayed significantly better outcomes. Only one trajectory group showed improvement in adaptive thinking with most ACCESS participants remaining stable across time. However, adaptive thinking trajectories were strongly related to both symptom and functional outcomes. ACCESS is associated with large gains in two of the three theorized clinical mechanisms of change, behavioral strategies and ADHD knowledge. Rapid improvement in behavioral strategies was associated with robust improvement in symptoms and functioning. Although improvements in the third mechanism, adaptive thinking, were small, they were strongly associated with outcomes demonstrating the importance of a cognitive-behavioral approach in treating college students with ADHD.
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15
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Furukawa E, Bado P, da Costa RQM, Melo B, Erthal P, de Oliveira IP, Wickens JR, Moll J, Tripp G, Mattos P. Reward modality modulates striatal responses to reward anticipation in ADHD: Effects of affiliative and food stimuli. Psychiatry Res Neuroimaging 2022; 327:111561. [PMID: 36334392 DOI: 10.1016/j.pscychresns.2022.111561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 10/12/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022]
Abstract
Altered reward sensitivity has been proposed to underlie symptoms of attention deficit hyperactivity disorder (ADHD). Functional magnetic resonance imaging (fMRI) studies have reported hypoactivation to reward-predicting cues in the ventral striatum among individuals with ADHD, using experimental designs with and without behavioral response requirements. These studies have typically used monetary incentives as rewards; however, it is unclear if these findings extend to other reward types. The current study examined striatal responses to anticipation and delivery of both affiliative and food reward images using a classical conditioning paradigm. Data from 20 typically developing young adults, and 20 individuals diagnosed with ADHD were included in a region-of-interest analysis for a priori striatal regions. Consistent with findings from studies using monetary rewards, individuals with ADHD showed decreased activation to cues predicting affiliative rewards in the bilateral ventral and dorsal striatum and increased activation to the delivery of affiliative rewards in the ventral striatum. No group differences were found in striatal responses to food reward cues or images. These results suggest hyposensitivity to reward-predicting cues in ADHD extends to affiliative rewards, with important implications for understanding and managing the learning and social functioning of those with ADHD.
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Affiliation(s)
- Emi Furukawa
- Okinawa Institute of Science and Technology Graduate University (OIST), Okinawa, Japan.
| | - Patricia Bado
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
| | | | - Bruno Melo
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
| | - Pilar Erthal
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
| | | | - Jeff R Wickens
- Okinawa Institute of Science and Technology Graduate University (OIST), Okinawa, Japan
| | - Jorge Moll
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
| | - Gail Tripp
- Okinawa Institute of Science and Technology Graduate University (OIST), Okinawa, Japan
| | - Paulo Mattos
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
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16
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Fan X, Ma Y, Cai J, Zhu G, Gao W, Zhang Y, Lin N, Rao Y, Mao S, Li R, Yang R. Do Parents of Children with ADHD Know the Disease? Results from a Cross-Sectional Survey in Zhejiang, China. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1775. [PMID: 36421224 PMCID: PMC9689420 DOI: 10.3390/children9111775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/03/2022] [Accepted: 11/17/2022] [Indexed: 12/01/2023]
Abstract
Parents' knowledge, attitudes, and beliefs about attention-deficit/hyperactivity disorder (ADHD) are crucial in the selection of the treatment strategy and how to care for children with ADHD. However, little is known about parents' conception in mainland China. A semi-structured questionnaire was used to assess this information with 25 true/false questions regarding ADHD, and other questions investigating the methods of acquiring ADHD-related information, treatment preference, and concerns about ADHD treatment strategy. We found that the average score of all the participants was 17.42 ± 2.69 (total of 25 points) for the questionnaire on knowledge, attitudes, and beliefs about ADHD. This indicated that the parents had insufficient knowledge of this disease profile. They always accessed specialized information through mobile internet. For the treatment options, the investigated parents chose psychotherapy treatment rather than medications, in that they worried about the side effects of medication and expected to find alternative treatment strategies. The present investigation demonstrated that most parents lack knowledge about ADHD in treatment decision making in China. Medical professionals should provide parents with evidence-based ADHD-related information to help them understand this disease.
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Affiliation(s)
- Xiaoli Fan
- Department of Child Psychology, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Ye Ma
- Department of Child Psychology, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Jingjing Cai
- Department of Child Psychology, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Guochun Zhu
- Department of Child Psychology, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Weijia Gao
- Department of Child Psychology, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Yanyi Zhang
- Department of Child Psychology, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Nannan Lin
- Department of Child Psychology, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Yanxiao Rao
- Department of Child Psychology, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Shujiong Mao
- Department of Pediatrics, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China
| | - Rong Li
- Department of Child Psychology, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Rongwang Yang
- Department of Child Psychology, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
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17
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Kim SC, Lee H, Lee HS, Kim G, Song JH. Adjuvant Therapy for Attention in Children with ADHD Using Game-Type Digital Therapy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14982. [PMID: 36429699 PMCID: PMC9690113 DOI: 10.3390/ijerph192214982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/07/2022] [Accepted: 11/09/2022] [Indexed: 06/16/2023]
Abstract
Children diagnosed with attention deficit hyperactivity disorder (ADHD) require early intervention and sustained treatment. This study used a game-based digital treatment planning NeuroWorld DTx to analyze the impact on attention and cognitive function in children with ADHD. Thirty children diagnosed with ADHD were recruited and subjected to a four-week NeuroWorld DTx digital treatment. To assess the impact of the digital therapeutic therapy on children's attention, we used the comprehension attention test (CAT) and Korean ADHD Rating Scale (K-ARS). Clinical global impression (CGI) and the Korean-child behavior checklist (K-CBCL 6-18) were used to examine the degree of improvement in ADHD. After four weeks, significant differences in the sensitivity and response style indices were noted, as compared with the baseline in the CAT test; in the case of K-ARS and CGI, a moderate decrease in ADHD was confirmed. The study achieved better results for the "total behavior problems" belonging to the K-CBCL assessment. Game-based digital therapy intervention can be a treatment method that elicits interest and satisfaction in children with ADHD and can be used as an adjunct to drug therapy to improve the quality of life and strengthen attention in children with symptoms of ADHD.
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Affiliation(s)
- Seon-Chil Kim
- Department of Biomedical Engineering, School of Medicine, Keimyung University, 1095 Dalgubeol-daero, Daegu 42601, Republic of Korea
| | - Hojun Lee
- Department of Psychiatry, Keimyung University Dongsan Medical Center, Daegu 42601, Republic of Korea
- Department of Psychiatry, School of Medicine, Keimyung University, Daegu 42601, Republic of Korea
| | - Hyun-Suk Lee
- Woori Children’s Development Clinic, Affiliated with Woori Soft, 175, Wolbae-ro, Dalseo-gu, Daegu 42781, Republic of Korea
| | - Gaeun Kim
- College of Nursing, Keimyung University, Daegu 42601, Republic of Korea
| | - Jeong-Heon Song
- Woorisoft Inc., 175, Wolbae-ro, Dalseo-gu, Daegu 42781, Republic of Korea
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18
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Toates F. A motivation model of sex addiction - Relevance to the controversy over the concept. Neurosci Biobehav Rev 2022; 142:104872. [PMID: 36113783 DOI: 10.1016/j.neubiorev.2022.104872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/05/2022] [Accepted: 09/12/2022] [Indexed: 10/31/2022]
Abstract
An integrative model of sexual addiction is presented, involving a combination of models based upon (i) incentive motivation theory and (ii) the dual organisation of the control of behavior. The model is related to ongoing arguments about the validity of the notion of addiction when applied to sexual behavior. It is suggested that the evidence strongly favors the viability of an addiction model of sex. Strong similarities to the classical addiction to hard drugs are observed and features can be better understood with the help of the model. These include tolerance, escalation and withdrawal symptoms. It is argued that other candidates for accounting for the phenomena, such as obsessive-compulsive behavior, faulty impulse control, high drive and hypersexuality do not fit the evidence. The role of dopamine is central to the model. The model's relevance to stress, abuse, development, psychopathy, fantasy, sex differences, evolutionary psychology and the interaction with drug-taking is shown.
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19
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Furukawa E, Uchida R, Tatsuki MO, Fitts M, Tripp G. Wishes of Children With ADHD. Front Psychiatry 2022; 13:885496. [PMID: 35586408 PMCID: PMC9108194 DOI: 10.3389/fpsyt.2022.885496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 04/12/2022] [Indexed: 11/28/2022] Open
Abstract
Understanding the desires and motivations of children with ADHD is important in helping them thrive. Their inner worlds, however, have not been well captured. The Three Wishes task provides minimal cues and structure to elicit their desires and hopes in an unbiased manner. The wishes of 299 school-aged children with ADHD (193 boys, aged 6-12) were elicited during a research diagnostic assessment. We developed a coding scheme to characterize different aspects of their wishes, including beneficiary, valence, and immediacy. Maslow's hierarchy of needs, adapted to take account of the participants' ages, was used to identify the motivations underlying the children's wishes. As expected, many of the wishes reported were for immediate fulfillment, with many reflecting material desires. Affiliative wishes, highlighting the children's desire for positive interpersonal relationships, were also common. There was some evidence for self-actualization/self-betterment goals and a small number of altruistic wishes. A word cloud presents the content of the children's wishes grouped according to this hierarchy. This study highlights the diversity and typicality of the self-reported needs, desires and hopes of children with ADHD. It also serves as a timely reminder of the value of seeking such information directly from children themselves.
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Affiliation(s)
- Emi Furukawa
- Human Developmental Neurobiology Unit and Children's Research Center, Okinawa Institute of Science and Technology Graduate University, Okinawa, Japan
| | - Ryoko Uchida
- Human Developmental Neurobiology Unit and Children's Research Center, Okinawa Institute of Science and Technology Graduate University, Okinawa, Japan
| | - Miho Otomo Tatsuki
- Human Developmental Neurobiology Unit and Children's Research Center, Okinawa Institute of Science and Technology Graduate University, Okinawa, Japan
| | - Margaret Fitts
- Human Developmental Neurobiology Unit and Children's Research Center, Okinawa Institute of Science and Technology Graduate University, Okinawa, Japan
| | - Gail Tripp
- Human Developmental Neurobiology Unit and Children's Research Center, Okinawa Institute of Science and Technology Graduate University, Okinawa, Japan
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20
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Yao A, Shimada K, Kasaba R, Tomoda A. Beneficial Effects of Behavioral Parent Training on Inhibitory Control in Children With Attention-Deficit/Hyperactivity Disorder: A Small-Scale Randomized Controlled Trial. Front Psychiatry 2022; 13:859249. [PMID: 35573335 PMCID: PMC9094443 DOI: 10.3389/fpsyt.2022.859249] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/17/2022] [Indexed: 11/28/2022] Open
Abstract
The purpose of this study was to examine whether the beneficial effects of behavioral parent training (BPT), as an indirect type of psychosocial treatment, are extended to cognitive manifestations beyond behavioral symptoms of attention-deficit/hyperactivity disorder (ADHD). Although previous studies of community families have shown an association between parenting quality and a child's cognitive functions, little is known about the effects of BPT on cognitive manifestations in children with ADHD. In this study, we focused on inhibitory control among cognitive domains, which is considered to be the most malleable to direct types of psychosocial treatment for ADHD. We hypothesized that inhibitory control is affected by BPT, which uses parents as the primary agents of change to help their children. Thirty school-age children (6-12 years old) with ADHD and their parents (mothers) participated and were randomly assigned to either the standard BPT or waitlist control group. Using two objective laboratory-based tasks of inhibitory control (i.e., go/no-go and single response selection tasks), we assessed baseline and post-treatment response inhibition to suppress task-irrelevant responses and response selection to select task-relevant responses. In addition to decreased ADHD symptoms and negative parenting, the BPT group exhibited significantly improved performance in the single response selection task, but not in the go/no-go task, compared with the waitlist control group. Although tentative, these findings partially support our hypothesis that BPT has beneficial effects on the cognitive inhibitory control of ADHD, highlighting the potential for supportive environmental modifications to advance cognitive development in children with ADHD.
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Affiliation(s)
- Akiko Yao
- Research Center for Child Mental Development, University of Fukui, Fukui, Japan
- Department of Child Development, United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University, and University of Fukui, Fukui, Japan
| | - Koji Shimada
- Research Center for Child Mental Development, University of Fukui, Fukui, Japan
- Department of Child Development, United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University, and University of Fukui, Fukui, Japan
- Biomedical Imaging Research Center, University of Fukui, Fukui, Japan
| | - Ryoko Kasaba
- Department of Child Development, United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University, and University of Fukui, Fukui, Japan
| | - Akemi Tomoda
- Research Center for Child Mental Development, University of Fukui, Fukui, Japan
- Department of Child Development, United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University, and University of Fukui, Fukui, Japan
- Department of Child and Adolescent Psychological Medicine, University of Fukui Hospital, Fukui, Japan
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21
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Hornstra R, Groenman AP, van der Oord S, Luman M, Dekkers TJ, van der Veen-Mulders L, Hoekstra PJ, van den Hoofdakker BJ. Review: Which components of behavioral parent and teacher training work for children with ADHD? - a metaregression analysis on child behavioral outcomes. Child Adolesc Ment Health 2022; 28:258-268. [PMID: 35417075 DOI: 10.1111/camh.12561] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/13/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND This metaregression analysis examined which behavioral techniques that are commonly used in behavioral parent and teacher training programs for children with attention-deficit/hyperactivity disorder (ADHD) were related to program effectiveness on children's behavioral outcomes. METHODS We included 32 randomized controlled trials (N = 2594 children) investigating behavioral parent training, teacher training, or a combination, in children with ADHD under 18 years. Outcomes were symptom counts of total ADHD, inattention, and hyperactivity-impulsivity and behavioral problems. The dosage of techniques was extracted from the intervention manuals. Metaregression was used to assess which techniques and intervention characteristics (setting, delivery method, duration, and home-school collaboration) were associated with intervention effectiveness. RESULTS Higher dosage of psycho-education for parents was associated with smaller effects on behavioral problems and, only in case of parent training, also with smaller effects on ADHD symptoms. Higher dosage of teaching parents/teachers to use negative consequences was associated with larger effects on behavioral problems. Individual training compared with group training was associated with larger effects on ADHD and hyperactivity-impulsivity symptoms. CONCLUSIONS This study provides first insights into the specific techniques that are essential in behavioral parent and teacher training programs for children with ADHD. This knowledge can eventually be used to improve and tailor interventions.
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Affiliation(s)
- Rianne Hornstra
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Annabeth P Groenman
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Saskia van der Oord
- Clinical Psychology, KU Leuven, Leuven, Belgium.,Developmental Psychology, Faculty of Social and Behavioral Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Marjolein Luman
- Department of Clinical, Developmental and Neuropsychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Tycho J Dekkers
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Developmental Psychology, Faculty of Social and Behavioral Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Lianne van der Veen-Mulders
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Pieter J Hoekstra
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Barbara J van den Hoofdakker
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
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22
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Dekkers TJ, Hornstra R, van der Oord S, Luman M, Hoekstra PJ, Groenman AP, van den Hoofdakker BJ. Meta-analysis: Which Components of Parent Training Work for Children With Attention-Deficit/Hyperactivity Disorder? J Am Acad Child Adolesc Psychiatry 2022; 61:478-494. [PMID: 34224837 DOI: 10.1016/j.jaac.2021.06.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 06/02/2021] [Accepted: 06/25/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Behavioral parent training is an evidence-based intervention for children with attention-deficit/hyperactivity disorder (ADHD), but it is unknown which of its components are most effective. This meta-regression analysis investigated which specific behavioral techniques that parents learn in parent training are associated with effects on parental outcomes. METHOD A search was performed for randomized controlled trials on parent training for children with ADHD, with positive parenting, negative parenting, parenting sense of competence, parent-child relationship quality, and parental mental health as outcome measures. After screening 23,026 publications, 29 studies contributing 138 effect sizes were included (N = 2,345). For each study, the dosage of 39 behavioral techniques was derived from intervention manuals, and meta-regression determined which techniques were related to outcomes. RESULTS Parent training had robust small- to medium-sized positive effects on all parental outcomes relative to control conditions, both for unblinded and probably blinded measures. A higher dosage of techniques focusing on the manipulation of antecedents of behavior was associated with better outcomes on parenting sense of competence and parental mental health, and a higher dosage of techniques focusing on reinforcement of desired behaviors was related to larger decreases in negative parenting. Higher dosages of psychoeducation were negatively related to parental outcomes. CONCLUSION Although techniques were not investigated in isolation, the results suggested that manipulation of antecedents of behavior and reinforcement techniques are key components of parent training for children with ADHD in relation to parental outcomes. These exploratory findings may help to strengthen and tailor parent training interventions for children with ADHD.
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Affiliation(s)
- Tycho J Dekkers
- University of Groningen, the Netherlands; University of Amsterdam, the Netherlands; Levvel, Academic Center for Child- and Adolescent Psychiatry and Specialized Youthcare, Amsterdam, the Netherlands; Amsterdam University Medical Center, the Netherlands.
| | | | - Saskia van der Oord
- University of Amsterdam, the Netherlands; KU Leuven, Research Group Clinical Psychology, Belgium
| | - Marjolein Luman
- Levvel, Academic Center for Child- and Adolescent Psychiatry and Specialized Youthcare, Amsterdam, the Netherlands; Vrije Universiteit Amsterdam, the Netherlands
| | | | - Annabeth P Groenman
- University of Groningen, the Netherlands; University of Amsterdam, the Netherlands
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23
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Hornstra R, Dekkers TJ, Bosmans G, van den Hoofdakker B, van der Oord S. Attachment Representation Moderates the Effectiveness of Behavioral Parent Training Techniques for Children with ADHD: Evidence from a Randomized Controlled Microtrial. Res Child Adolesc Psychopathol 2022; 50:1151-1164. [PMID: 35362776 PMCID: PMC9525431 DOI: 10.1007/s10802-022-00921-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2022] [Indexed: 11/26/2022]
Abstract
Behavioral parent training is an evidence-based intervention for children with attention-deficit/hyperactivity disorder (ADHD), but knowledge on the differential effects of behavioral techniques for specific subgroups of children is very limited. Attachment representations of children with ADHD may affect how receptive children are to changes in parenting. In this study, we investigated whether specific behavioral techniques were more or less effective for children with ADHD in relation to their attachment representations. We included parents of 74 children with ADHD (4-11 years, M = 8.15) who took part in a larger randomized controlled microtrial in which they were randomized to a two session training in antecedent-based techniques (i.e., stimulus control techniques: rules, instructions; n = 26), a two session training in consequent-based techniques (i.e., contingency management techniques: praise, rewards, ignoring; n = 25) or a waitlist control condition (n = 23). We examined whether attachment representation moderated the effectiveness of a) training versus waitlist, and b) antecedent- versus consequent-based techniques. Attachment representations were measured with a story stem task, the intervention outcome was daily parent-rated problem behaviors of the children. Attachment representation did not moderate the effects of the training compared to the waitlist. However, compared to antecedent-based techniques, consequent-based techniques were less effective for more securely and less disorganized attached children, and particularly effective for more disorganized attached children. This was the first study examining attachment as a moderator of behavioral techniques for ADHD. If replicated, the findings of this study can be used for treatment development and tailoring.
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Affiliation(s)
- Rianne Hornstra
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
- Accare Child Study Center, Groningen, the Netherlands.
| | - Tycho J Dekkers
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Accare Child Study Center, Groningen, the Netherlands
- Academic Center for Child and Adolescent Psychiatry, Levvel, Amsterdam, the Netherlands
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
- Department of Child and Adolescent Psychiatry, Amsterdam University Medical Center (AUMC), Amsterdam, the Netherlands
| | - Guy Bosmans
- Department of Clinical Psychology, KU Leuven, Leuven, Belgium
| | - Barbara van den Hoofdakker
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Accare Child Study Center, Groningen, the Netherlands
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, the Netherlands
| | - Saskia van der Oord
- Department of Clinical Psychology, KU Leuven, Leuven, Belgium
- Leuven Brain Institute, Leuven, Belgium
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24
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Effective but Not Feasible—What Support Staff in All-Day Primary Schools Think of Pedagogical Interventions with Regard to Children with ADHD. SUSTAINABILITY 2022. [DOI: 10.3390/su14031393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Children with attention deficit/hyperactivity disorder (ADHD) are faced with multiple challenges both in the classroom and in the homework situation. While there are many studies on pedagogical interventions by teachers in the classroom, this is hardly the case when it comes to support staff in after-school homework supervision. In this study, 196 support staff with different qualifications were asked not only about their knowledge of ADHD, their subjective level of stress, and whether they felt trained enough to work with children with ADHD, but also to assess the effectiveness and feasibility of 25 interventions in homework supervision. Overall, the respondents rated effectiveness higher than feasibility. Higher qualifications, greater knowledge, and better preparation went hand in hand with higher ratings of effectiveness. The more stressed the support staff feel themselves to be, the less feasible they rate the measures. The results underline the necessity of employing well-trained pedagogical staff to supervise children with ADHD. A number of interventions can be identified that the support staff deem to be both effective and feasible, and that promise a high level of implementation in practice. At the same time, more attention should be given to potential obstacles to using recommended measures in training and further education.
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25
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Effectiveness of Specific Techniques in Behavioral Teacher Training for Childhood ADHD Behaviors: Secondary Analyses of a Randomized Controlled Microtrial. Res Child Adolesc Psychopathol 2022; 50:867-880. [PMID: 35015187 PMCID: PMC9246781 DOI: 10.1007/s10802-021-00892-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2021] [Indexed: 12/04/2022]
Abstract
Behavioral teacher training is an effective intervention for children with attention-deficit/hyperactivity disorder (ADHD). Intervention effectiveness may be enhanced by including intervention components that carry the strongest evidence for their effectiveness. A previous article of this group showed that both antecedent- (i.e., stimulus-control) and consequent-based (i.e., contingency management) techniques were highly effective in reducing daily teacher-rated, individually selected problem behaviors in a specific situation of the child. Effects were observed up to three months post intervention. Here, we tested whether effects were also present in teacher-rated and masked DSM-based assessments that comprise the full range of ADHD and oppositional defiant disorder (ODD) symptoms, as well as on teacher-rated impairment. Teachers of 90 children with (subthreshold) ADHD (6–12 years) were randomly assigned to one of three conditions: a short (two sessions), individualized intervention consisting of either a) antecedent-based techniques or b) consequent-based techniques; or c) waitlist. Multilevel analyses showed that both sets of techniques were effective in reducing teacher-rated ADHD symptoms and impairment immediately after the intervention and up to three months later, as compared to waitlist. Masked observations of ADHD behavior were in line with teacher ratings, with effects being most pronounced for inattention. No effects on teacher-rated or masked ODD behavior were found. This study showed that antecedent- and consequent-based techniques were effective in improving classroom ADHD symptoms and impairment. Long-term changes in teacher-rated ADHD are promising. These results extend previous findings and show the potential of short individually tailored interventions in classroom settings as treatment of ADHD symptoms.
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26
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Bosmans G, Van Vlierberghe L, Bakermans-Kranenburg MJ, Kobak R, Hermans D, van IJzendoorn MH. A Learning Theory Approach to Attachment Theory: Exploring Clinical Applications. Clin Child Fam Psychol Rev 2022; 25:591-612. [PMID: 35098428 PMCID: PMC8801239 DOI: 10.1007/s10567-021-00377-x] [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] [Subscribe] [Scholar Register] [Accepted: 12/28/2021] [Indexed: 02/05/2023]
Abstract
Although clinicians typically acknowledge the importance of insecure attachment as one factor that can contribute to children's psychopathology, translating attachment theory into clinical practice has proved a challenge. By specifying some of the mechanisms through which the child's attachment develops and changes, learning theory can enhance attachment based approaches to therapy. Specifically, interventions building on operant (parent management training) and classical (exposure therapy) learning can be used to stimulate new learning that increases the child's security and confidence in the parent's availability and responsiveness. To explore the clinical application and utility of a Learning Theory of Attachment (LTA), we focus on two attachment-focused interventions: Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD) and Middle Childhood Attachment-based Family Therapy (MCAT). VIPP-SD is an evidence-based parent management training designed to promote sensitive parenting and secure attachment in early childhood. MCAT is a recently developed intervention that uses exposure to stimulate secure attachment in middle childhood. LTA sheds light on the mechanisms set in train by VIPP-SD and MCAT facilitating the induction of professionals in clinical applications.
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Affiliation(s)
- Guy Bosmans
- Clinical Psychology, KU Leuven, Leuven, Belgium.
| | | | | | - Roger Kobak
- Department of Psychological and Brain Sciences, University of Delaware, Newark, USA
| | - Dirk Hermans
- Centre for Psychology of Learning and Experimental Psychopathology, KU Leuven, Leuven, Belgium
| | - Marinus H van IJzendoorn
- Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Research Department of Clinical, Education and Health Psychology, Faculty of Brain Sciences, UCL, London, UK
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27
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Attachment Representations in Children with and without Attention-Deficit/Hyperactivity Disorder (ADHD). Brain Sci 2021; 11:brainsci11111516. [PMID: 34827515 PMCID: PMC8615467 DOI: 10.3390/brainsci11111516] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 11/10/2021] [Indexed: 11/16/2022] Open
Abstract
Attention-Deficit/Hyperactivity Disorder (ADHD) in children is associated with several adverse family characteristics, such as higher parenting stress, more conflicted parent–child relationships, lower parental competence, and higher levels of parental psychopathology. Hence, children with ADHD more often grow up under suboptimal circumstances, which may impact the development of their attachment representations. Here, we investigated whether children with ADHD have more insecure and disorganized attachment representations than their typically developing peers, and which factors could explain this association. We included 104 children between 4 and 11 years old, 74 with ADHD (without Conduct Disorder) and 30 typically developing control children. Children completed a state-of-the-art story stem task to assess their attachment representation, and we measured parents’ expressed emotion (as an index of parent–child relationship quality), parents’ perceived sense of competence, parental education levels, and parent-rated ODD symptoms of the child. We found that, after controlling for multiple comparisons, children with ADHD had less secure and more ambivalent and disorganized attachment representations relative to their typically developing peers. These group differences were independent of comorbid ODD and parental education levels. There were no group differences on avoidant attachment representations. Explorative analyses within the ADHD group showed that attachment representations were not related to parent–child relationship quality, perceived parenting competence, parental education levels, and comorbid ODD symptoms. We conclude that children with ADHD disproportionately often have attachment problems. Although this conclusion is important, treatment implications of this co-occurrence are yet unclear as research on ADHD and attachment is still in its infancy.
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28
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Raiker JS. Editorial: Instrumental Learning in Children With Attention-Deficit/Hyperactivity Disorder: A Rewarding Review Incentivizing Future Research. J Am Acad Child Adolesc Psychiatry 2021; 60:1342-1344. [PMID: 33992749 DOI: 10.1016/j.jaac.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 05/05/2021] [Indexed: 10/21/2022]
Abstract
The mechanisms underlying attention-deficit/hyperactivity disorder (ADHD) continue to elude researchers, hindering efforts to improve diagnosis and treatment of the disorder.1 Notably, mechanisms such as operant conditioning, or instrumental learning, have been surprisingly underemphasized in the ADHD literature. This is curious given that behavioral interventions, which rely on the principles of operant conditioning, are one of only a few well-established interventions for ADHD.2 In this issue of the Journal, Hulsbosch et al.3 sought to answer critical questions regarding instrumental learning in children with ADHD through a systematic review that updates and extends prior reviews.4.
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29
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Hulsbosch AK, De Meyer H, Beckers T, Danckaerts M, Van Liefferinge D, Tripp G, Van der Oord S. Systematic Review: Attention-Deficit/Hyperactivity Disorder and Instrumental Learning. J Am Acad Child Adolesc Psychiatry 2021; 60:1367-1381. [PMID: 33862167 DOI: 10.1016/j.jaac.2021.03.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 02/10/2021] [Accepted: 03/16/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Although instrumental learning deficits are, among other deficits, assumed to contribute to attention-deficit/hyperactivity disorder (ADHD), no comprehensive systematic review of instrumental learning deficits in ADHD exists. This review examines differences between ADHD and typically developing (TD) children in basic instrumental learning and the effects of reinforcement form, magnitude, schedule, and complexity, as well as effects of medication, on instrumental learning in children with ADHD. METHOD A systematic search of PubMed, PsyINFO, CINAHL, EMBASE+EMBASE CLASSIC, ERIC, and Web of Science was conducted for articles up to March 16, 2020. Experimental studies comparing instrumental learning between groups (ADHD versus TD) or a manipulation of reinforcement/medication within an ADHD sample were included. Quality of studies was assessed with an adapted version of the Hombrados and Waddington criteria to assess risk of bias in (quasi-) experimental studies. RESULTS A total of 19 studies from among 3,384 non-duplicate screened articles were included. No difference in basic instrumental learning was found between children with ADHD and TD children, nor effects of form or magnitude of reinforcement. Results regarding reinforcement schedule and reversal learning were mixed, but children with ADHD seemed to show deficits in conditional discrimination learning compared to TD children. Methylphenidate improved instrumental learning in children with ADHD. Quality assessment showed poor quality of studies with respect to sample sizes and outcome and missing data reporting. CONCLUSION The review identified very few and highly heterogenous studies, with inconsistent findings. No clear deficit was found in instrumental learning under laboratory conditions. Children with ADHD do show deficits in complex forms of learning, that is, conditional discrimination learning. Clearly more research is needed, using more similar task designs and manipulations.
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Affiliation(s)
- An-Katrien Hulsbosch
- Mrs. Hulsbosch, Dr. De Meyer, and Prof. Drs. Beckers, Danckaerts, and Van der Oord are with KU Leuven, Belgium.
| | - Hasse De Meyer
- Mrs. Hulsbosch, Dr. De Meyer, and Prof. Drs. Beckers, Danckaerts, and Van der Oord are with KU Leuven, Belgium; Dr. De Meyer is also with the HELP University, Kuala Lumpur, Malaysia
| | - Tom Beckers
- Mrs. Hulsbosch, Dr. De Meyer, and Prof. Drs. Beckers, Danckaerts, and Van der Oord are with KU Leuven, Belgium
| | - Marina Danckaerts
- Mrs. Hulsbosch, Dr. De Meyer, and Prof. Drs. Beckers, Danckaerts, and Van der Oord are with KU Leuven, Belgium; Dr. Van Liefferinge and Prof. Dr. Danckaerts also are with the University Psychiatric Centre KU Leuven, Belgium
| | - Dagmar Van Liefferinge
- Dr. Van Liefferinge and Prof. Dr. Danckaerts also are with the University Psychiatric Centre KU Leuven, Belgium
| | - Gail Tripp
- Prof. Dr. Tripp is with the Okinawa Institute of Science and Technology (OIST) Graduate University, Japan
| | - Saskia Van der Oord
- Mrs. Hulsbosch, Dr. De Meyer, and Prof. Drs. Beckers, Danckaerts, and Van der Oord are with KU Leuven, Belgium; Prof. Dr. Van der Oord is with the University of Amsterdam, the Netherlands
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30
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Van Dessel J, Sonuga-Barke EJS, Moerkerke M, Van der Oord S, Morsink S, Lemiere J, Danckaerts M. The Limits of Motivational Influence in ADHD: No Evidence for an Altered Reaction to Negative Reinforcement. Soc Cogn Affect Neurosci 2021; 17:482-492. [PMID: 34643738 PMCID: PMC9071417 DOI: 10.1093/scan/nsab111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 09/14/2021] [Accepted: 10/12/2021] [Indexed: 11/24/2022] Open
Abstract
Functional magnetic resonance imaging studies have reported a diminished response in the brain’s reward circuits to contingent cues predicting future monetary gain in adolescents with attention-deficit/hyperactivity disorder (ADHD). The situation with regard to monetary loss is less clear, despite recognition that both positive and negative consequences impact ADHD behaviour. Here, we employ a new Escape Monetary Loss Incentive task in an MRI scanner, which allows the differentiation of contingency and valence effects during loss avoidance, to examine ADHD-related alterations in monetary loss processing. There was no evidence of atypical processing of contingent or non-contingent monetary loss cues in ADHD — either in terms of ratings of emotional and motivational significance or brain responses. This suggests that the ability to process contingencies between performance and negative outcomes is intact in ADHD and that individuals with ADHD are no more (or less) sensitive to negative outcomes than controls. This latter finding stands in stark contrast to recent evidence from a similar task of atypical emotion network recruitment (e.g. amygdala) in ADHD individuals to cues predicting another negative event, the imposition of delay, suggesting marked specificity in the way they respond to negative events.
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Affiliation(s)
- Jeroen Van Dessel
- Center for Developmental Psychiatry, Department of Neurosciences, UPC, KU Leuven, Leuven, Belgium
| | - Edmund J S Sonuga-Barke
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK.,Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Matthijs Moerkerke
- Center for Developmental Psychiatry, Department of Neurosciences, UPC, KU Leuven, Leuven, Belgium
| | - Saskia Van der Oord
- Clinical Psychology, KU Leuven, Leuven, Belgium.,Developmental Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - Sarah Morsink
- Center for Developmental Psychiatry, Department of Neurosciences, UPC, KU Leuven, Leuven, Belgium
| | - Jurgen Lemiere
- Center for Developmental Psychiatry, Department of Neurosciences, UPC, KU Leuven, Leuven, Belgium
| | - Marina Danckaerts
- Center for Developmental Psychiatry, Department of Neurosciences, UPC, KU Leuven, Leuven, Belgium
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31
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Hornstra R, van der Oord S, Staff AI, Hoekstra PJ, Oosterlaan J, van der Veen-Mulders L, Luman M, van den Hoofdakker BJ. Which Techniques Work in Behavioral Parent Training for Children with ADHD? A Randomized Controlled Microtrial. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2021; 50:888-903. [PMID: 34424102 DOI: 10.1080/15374416.2021.1955368] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Behavioral parent training (BPT) is an evidence-based intervention for children with attention-deficit/hyperactivity disorder (ADHD), but little is known about the effects of separate techniques parents learn in BPT. METHOD In a three-armed randomized controlled microtrial including parents of 92 children (4-12 years) with ADHD, we examined the efficacy of two sessions parent training involving either stimulus control techniques (antecedent-based condition (AC)) or contingency management techniques (consequent-based condition (CC)), compared to a waitlist. Primary outcome was daily parent-rated problem behaviors, secondary outcomes were parent-rated symptoms of ADHD and oppositional defiant disorder (ODD), and mental health-care consumption. Measures were completed at baseline (T0), immediately after the training (T1), at two weeks (T2) and three months (T3) follow-up. We also explored whether child and parent characteristics moderated treatment effects. RESULTS Compared to the waitlist, in the AC, daily rated problem behaviors improved at T1 (d= .56) and T2 (d= .65); in the CC, these behaviors only improved at T2 (d= .53). Daily rated problem behaviors within both conditions remained stable between T2 and T3. In the AC compared to the other conditions, inattention symptoms decreased at T1 and T2. For both active conditions compared to waitlist, hyperactivity-impulsivity symptoms decreased only at T2 and ODD symptoms did not decrease. No moderators were identified. Mental health-care consumption after training was low and did not differ between the active conditions. CONCLUSIONS Brief training of parents in antecedent- or consequent-based techniques improves problem behaviors of children with ADHD. Antecedent-based techniques appear to be especially important to target inattention.
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Affiliation(s)
- Rianne Hornstra
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen
| | - Saskia van der Oord
- Clinical Psychology, KU Leuven.,Affiliated staff, Developmental Psychology, University of Amsterdam
| | - Anouck I Staff
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam
| | - Pieter J Hoekstra
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen
| | - Jaap Oosterlaan
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam.,Department of Pediatrics, Amsterdam Reproduction & Development, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Emma Neuroscience Group
| | | | - Marjolein Luman
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam.,Specialist in youth and family care, Levvel
| | - Barbara J van den Hoofdakker
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen.,Department of Clinical Psychology and Experimental Psychopathology, University of Groningen
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32
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Do Childhood Emotional Lability and ADHD Symptoms Have Shared Neuropsychological Roots? JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2021. [DOI: 10.1007/s10862-020-09859-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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