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Yngve M, Lidström H. Implementation of information and communication technology to facilitate participation in high school occupations for students with neurodevelopmental disorders. Disabil Rehabil Assist Technol 2024; 19:2017-2025. [PMID: 37589426 DOI: 10.1080/17483107.2023.2244978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 07/31/2023] [Indexed: 08/18/2023]
Abstract
PURPOSE Information and communication technology (ICT) has been proposed to enable an inclusive learning environment and increased participation for students with special educational needs. The aim of this study was to investigate the perceived need for ICT before and after an individualized ICT intervention among high school students with neurodevelopmental disorders and describe how the ICT was used to improve participation in school activities. MATERIALS AND METHODS This mixed-method study, with a one-group pre- and post-test design, included 99 high school students with neurodevelopmental disorders. Data from questionnaires and assessments using the School Setting Interview (SSI) were analyzed using descriptive statistics and the Wilcoxon signed-rank test. Deductive content analysis was performed on written notes in the SSI assessment. RESULTS The results showed that students' median number of perceived needs for ICT in school activities had decreased from six needs at baseline to one need at follow-up (t16.5 df(98), p<.001). There were five SSI items for which over 50% of the students perceived a need for ICT, with most students (95%) needing support in the item Remember things. Students received a laptop, tablet or smartphone (95%), software for planning or structure (84%) and ICT for writing and reading (66%). The ICT facilitated participation in multiple school activities, providing reminders and structure, facilitating notetaking and improving spelling. After the ICT intervention, students (61%) experienced improved study results and improved ability to manage difficult school situations (68%). CONCLUSION To conclude, an individualized ICT intervention as support to increase school participation is promising among high school students with neurodevelopmental disorders.
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Affiliation(s)
- Moa Yngve
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Helene Lidström
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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2
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Hawkey EJ, Williams AI, Chung S, Owens EB, Pfiffner LJ. Emotion Regulation and Organizational Skills in Children With ADHD Symptoms Are Associated With Behavioral Parent Training Adherence. J Atten Disord 2024; 28:1320-1330. [PMID: 38726593 DOI: 10.1177/10870547241251725] [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] [Indexed: 06/12/2024]
Abstract
OBJECTIVE Behavioral parent training (BPT) is a well-established treatment for ADHD; however, treatment response is variable. Consistency in parent skill use during BPT is known to influence child outcomes post-treatment, while less research has focused on specific child factors that may be impacting parent skill utilization during treatment. The current study examined associations between child organizational skills and emotion dysregulation (ED) with parent treatment adherence during BPT and post-treatment child impairment. METHOD Parents of 72 children (Mage = 8.31) with ADHD symptoms and impairment participated in BPT which was embedded in a 12-week, multicomponent, school-based intervention for children delivered by school mental health clinicians. Outcomes included parent treatment adherence and child improvements in global impairment post-treatment. RESULTS Greater pre-treatment child organizational problems were associated with less parent treatment adherence regardless of ADHD symptom severity. Worse pre-treatment child ED was associated with more impairment post-treatment regardless of ADHD symptom severity whereas the effects of child ED on parent treatment adherence were moderated by child ADHD symptom severity. CONCLUSION The current study suggests that pre-treatment child ED and organizational difficulties impact parent treatment adherence to behavioral interventions targeting ADHD symptoms, potentially in unique ways, and should be considered in future BPT treatment studies.
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Affiliation(s)
| | | | - Sara Chung
- University of California, San Francisco, CA, USA
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3
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Mautone JA, Holdaway A, Chan W, Michel JJ, Guevara JP, Davis A, Desrochers C, Evans E, Gajary Z, Leavy S, Rios D, Tremont KL, Cacia J, Schwartz BS, Jawad AF, Power TJ. Reducing disparities in behavioral health treatment in pediatric primary care: a randomized controlled trial comparing Partnering to Achieve School Success (PASS) to usual ADHD care for children ages 5 to 11 - study protocol. BMC PRIMARY CARE 2024; 25:225. [PMID: 38909215 PMCID: PMC11193903 DOI: 10.1186/s12875-024-02473-7] [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: 04/25/2024] [Accepted: 06/10/2024] [Indexed: 06/24/2024]
Abstract
BACKGROUND Integrating behavioral health services into pediatric primary care can improve access to care, especially for children marginalized by poverty and racial/ethnic minority status. In primary care, a common presenting concern is attention-deficit/hyperactivity disorder (ADHD). Services in primary care for marginalized children with ADHD typically include medication alone; therapy to improve skills and build relationships is less available. This study evaluates the effectiveness of a behavioral intervention offered through primary care for marginalized families coping with ADHD (Partnering to Achieve School Success, PASS) compared to treatment as usual (TAU). METHOD Three hundred participants will be randomly assigned to PASS or TAU. Participants include children ages 5 to 11 who have ADHD and are from economically marginalized families. PASS is a personalized, enhanced behavioral intervention that includes evidence-based behavior therapy strategies and enhancements to promote family engagement, increase caregiver distress tolerance, and provide team-based care to improve academic and behavioral functioning. TAU includes services offered by primary care providers and referral for integrated behavioral health or community mental health services. Outcomes will be assessed at mid-treatment (8 weeks after baseline), post-treatment (16 weeks), and follow-up (32 weeks) using parent- and teacher-report measures of service use, child academic, behavioral, and social functioning, parenting practices, family empowerment, and team-based care. Mixed effects models will examine between-group differences at post-treatment and follow-up. Analyses will examine the mediating role of parenting practices, family empowerment, and team-based care. Subgroup analyses will examine differential effects of intervention by child clinical characteristics and socioeconomic factors. DISCUSSION This study is unique in targeting a population of children with ADHD marginalized by low socioeconomic resources and examining an intervention designed to address the challenges of families coping with chronic stress related to poverty. TRIAL REGISTRATION This study was registered on clinicaltrials.gov (NCT04082234) on September 5, 2019, prior to enrollment of the first participant. The current version of the protocol and IRB approval date is October 4, 2023. Results will be submitted to ClinicalTrials.gov no later than 30 days prior to the due date for the submission of the draft of the final research report to the Patient-Centered Outcomes Research Institute.
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Affiliation(s)
- Jennifer A Mautone
- Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Philadelphia, PA, 19146, USA.
- Perelman School of Medicine at, University of Pennsylvania, Philadelphia, PA, USA.
| | - Alex Holdaway
- Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Philadelphia, PA, 19146, USA
| | - Wendy Chan
- Graduate School of Education at University of Pennsylvania, Philadelphia, PA, USA
| | - Jeremy J Michel
- Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Philadelphia, PA, 19146, USA
- Perelman School of Medicine at, University of Pennsylvania, Philadelphia, PA, USA
| | - James P Guevara
- Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Philadelphia, PA, 19146, USA
- Perelman School of Medicine at, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Colette Desrochers
- Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Philadelphia, PA, 19146, USA
- Perelman School of Medicine at, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Zia Gajary
- Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Philadelphia, PA, 19146, USA
- Perelman School of Medicine at, University of Pennsylvania, Philadelphia, PA, USA
| | - Siobhan Leavy
- Chester County Intermediate Unit, Downingtown Philadelphia, PA, USA
| | - Danah Rios
- Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Philadelphia, PA, 19146, USA
- Perelman School of Medicine at, University of Pennsylvania, Philadelphia, PA, USA
| | - Katie L Tremont
- Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Philadelphia, PA, 19146, USA
| | - Jaclyn Cacia
- Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Philadelphia, PA, 19146, USA
| | - Billie S Schwartz
- Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Philadelphia, PA, 19146, USA
- Perelman School of Medicine at, University of Pennsylvania, Philadelphia, PA, USA
| | - Abbas F Jawad
- Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Philadelphia, PA, 19146, USA
- Perelman School of Medicine at, University of Pennsylvania, Philadelphia, PA, USA
| | - Thomas J Power
- Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Philadelphia, PA, 19146, USA
- Perelman School of Medicine at, University of Pennsylvania, Philadelphia, PA, USA
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4
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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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Tamm L, Hamik E, Yeung TS, Zoromski AK, Mara CA, Duncan A. Achieving Independence and Mastery in School: A School-Based Executive Function Group Intervention for Autistic Middle Schoolers. J Autism Dev Disord 2023:10.1007/s10803-023-06164-7. [PMID: 37991661 DOI: 10.1007/s10803-023-06164-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2023] [Indexed: 11/23/2023]
Abstract
Executive functioning (EF) deficits, such as challenges with planning, organization, and materials management, negatively impact academic performance, particularly for middle-school students with autism spectrum disorder (ASD) without intellectual disability (ID). The aim was to assess the initial efficacy of the school-based version of the Achieving Independence and Mastery in School (AIMS) intervention in a pilot randomized clinical trial. 47 autistic middle-schoolers without ID attending nine different schools were randomized to participate in AIMS or to wait to receive AIMS the following semester (waitlist control = WLC). Youth, caregivers, and teachers rated academic EFs and academic functioning, and youth completed an objective EF measure, at baseline and outcome (post). Effect sizes were computed comparing baseline and post measures within each group. Individuals randomized to AIMS improved from baseline to post on academic EF outcome measures with small to moderate effect sizes, compared to WLC, who made some improvements but with generally smaller effect sizes. Analyses with academic functioning measures showed a similar pattern of results. These promising results suggest that AIMS delivered in the school by school-based personnel to small groups of students with ASD without ID can improve academic EF skills.
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Affiliation(s)
- Leanne Tamm
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
- Department of Pediatrics, Center for ADHD, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 10006, Cincinnati, OH, 45229-3039, USA.
| | - Elizabeth Hamik
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Eastern Michigan University, Ypsilanti, MI, USA
| | - Tat Shing Yeung
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Oregon Health & Science University, Portland, OR, USA
| | - Allison K Zoromski
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Constance A Mara
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Amie Duncan
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Chan ES, Gaye F, Cole AM, Singh LJ, Kofler MJ. Central executive training for ADHD: Impact on organizational skills at home and school. A randomized controlled trial. Neuropsychology 2023; 37:859-871. [PMID: 37439737 PMCID: PMC10615842 DOI: 10.1037/neu0000918] [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: 07/14/2023] Open
Abstract
OBJECTIVE The current randomized controlled trial (RCT) was the first to examine the benefits of central executive training (CET, which trains the working components of working memory [WM]) for reducing organizational skills difficulties relative to a carefully matched neurocognitive training intervention (inhibitory control training [ICT]). METHOD A carefully phenotyped sample of 73 children with attention-deficit/hyperactivity-impulsivity disorder (ADHD; ages 8-13, M = 10.15, SD = 1.43; 20 girls; 73% White/Non-Hispanic) participated in a preregistered RCT of CET versus ICT (both 10-week treatments). Parent-rated task planning, organized actions, and memory/materials management data were collected at pretreatment, posttreatment, and 2-4 month follow-up; teacher ratings were obtained at pretreatment and 1-2 month follow-up. RESULTS CET was superior to ICT for improving organizational skills based on teacher report (Treatment × Time interaction: d = 0.61, p = .01, BF₁₀ = 31.61). The CET group also improved significantly based on parent report, but this improvement was equivalent in both groups (main effect of time: d = 0.48, p < .001, BF₁₀ = 3.13 × 10⁷; Treatment × Time interaction: d = 0.29, p = .25, BF₀₁ = 3.73). Post hocs/preregistered planned contrasts indicated that CET produced significant and clinically meaningful (number needed to treat = 3-8) pre/post gains on all three parent (d = 0.50 -0.62) and all three teacher (d = 0.46 -0.95) subscales, with gains that were maintained at 1-2 month (teacher report) and 2-4 month follow-up (parent report) for five of six outcomes. CONCLUSIONS Results provide strong initial evidence that CET produces robust and lasting downstream improvements in school-based organizational skills for children with ADHD based on teacher report. These findings are generally consistent with model-driven predictions that ADHD-related organizational problems are secondary outcomes caused, at least in part, by underdeveloped working memory abilities. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
| | - Fatou Gaye
- Florida State University, Department of Psychology
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7
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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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Frisch C, Tirosh E, Rosenblum S. Children with ADHD Symptomatology: Does POET Improve Their Daily Routine Management? CHILDREN (BASEL, SWITZERLAND) 2023; 10:1083. [PMID: 37371314 DOI: 10.3390/children10061083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/17/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023]
Abstract
Children with attention-deficit/hyperactivity disorder (ADHD) struggle with executive delays while managing their daily tasks. This is a secondary analysis of existing data from open-label research examining the efficacy of Parental Occupational Executive Training (POET). It further examines POET's efficacy in increasing young children's (3.83 to 7.08 years) executive control over daily routines, and in decreasing their ADHD symptoms. Additionally, the second analysis investigates which of the children's increased capabilities is better associated with the change in their daily routine management following the intervention. Parents of children with ADHD symptomatology (N = 72, 55 boys) received eight POET sessions. They completed standardised ADHD symptomatology, executive management of daily routines, and executive functions (EF) questionnaires at pretest, post-test, and 3-month follow-up. Children's ADHD symptoms and their management of daily routines significantly improved following the POET intervention. The children's score changes in EF accounted for 37% of the variance in their improved routine management. These findings suggest that interventions aiming to increase children's executive control over their daily routines should improve their broader array of EF besides decreasing core ADHD symptoms.
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Affiliation(s)
- Carmit Frisch
- The Laboratory of Complex Human Activity and Participation (CHAP), Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa 3498838, Israel
| | - Emanuel Tirosh
- The Hannah Khoushy Child Development Center, Bnai Zion Medical Center, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 69094, Israel
| | - Sara Rosenblum
- The Laboratory of Complex Human Activity and Participation (CHAP), Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa 3498838, Israel
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Kucera A, Koehlmoos T, Grunwald L, Banaag A, Schvey NA, Quinlan J, Tanofsky-Kraff M. Prescriptions of Psychotropic Medications by Providers Treating Children of Military Service Members. Mil Med 2023; 188:615-620. [PMID: 35257165 DOI: 10.1093/milmed/usac048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 01/14/2022] [Accepted: 02/14/2022] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION There are approximately 1.5 million U.S. military-dependent children. However, little is known about mental health referrals for these youths. This study sought to examine the type of mental health treatment referrals made by primary care providers for child military-dependent beneficiaries receiving care in the direct (within Military Treatment Facilities) and private care (civilian-fee-for service facilities) sectors of the Military Health System. MATERIALS AND METHODS A between-subjects, cross-sectional study was performed on children aged 5-18 years old in fiscal years 2011-2015 and enrolled in TRICARE Prime. Study analyses examined specialty ("talk therapy") mental health care and psychotropic medication referrals from TRICARE Prime (the Defense Health Agency-managed health care program) providers for beneficiary children diagnosed with attention-, mood-, anxiety-, or behavior-related disorders in direct versus private sector care. RESULTS Of 1,533,630 children enrolled in TRICARE Prime (50.03% female), 8.6% (n = 131,393) were diagnosed with a psychological disorder during FY 2011-2015. Most were attention-related (5.2%, n = 79,770), followed by mood (1.7%, n = 25,314), anxiety (1.1%, n = 16,155), and conduct-related diagnoses (0.7%, n = 10,154). Adjusting for age, sex, and sponsor rank, children within direct care diagnosed with attention-related disorders were 1.7 times more likely to receive a prescription for psychotropic medication than those in private sector care, odds ratio (OR) = 1.72, 95% confidence interval (CI): [1.66, 1.77]. Children diagnosed with mood-related disorders in direct care were 2.1 times more likely to receive a prescription for psychotropic medication than those in private sector care, OR = 2.08, 95% CI: [1.96, 2.21]. Across disorders, children who received private sector care were more likely to have a referral specialty mental health ("talk therapy") follow-up (ps < 0.0001). CONCLUSIONS For attention- and mood-related disorders, but not anxiety- or conduct-related disorders, direct care providers were more likely than private sector care providers to prescribe psychotropic medications. Inconsistencies of provider referrals within and outside of the Military Health System should be elucidated to determine the impact on outcomes.
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Affiliation(s)
- Alexandria Kucera
- Department of Medical and Clinical Psychology, USU, Bethesda, MD 20814, USA
| | - Tracey Koehlmoos
- Health Services Research Program, Department of Preventive Medicine and Biostatistics, USU, Bethesda, MD 20814, USA
| | - Lindsay Grunwald
- Health Services Research Program, Department of Preventive Medicine and Biostatistics, USU, Bethesda, MD 20814, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
| | - Amanda Banaag
- Health Services Research Program, Department of Preventive Medicine and Biostatistics, USU, Bethesda, MD 20814, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
| | - Natasha A Schvey
- Department of Medical and Clinical Psychology, USU, Bethesda, MD 20814, USA
| | - Jeffrey Quinlan
- Department of Family Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52317, USA
| | - Marian Tanofsky-Kraff
- Department of Medical and Clinical Psychology, USU, Bethesda, MD 20814, USA
- Military Cardiovascular Outcomes Research (MiCOR) Program, Department of Medicine, USU, Bethesda, MD 20814, USA
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10
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Schena A, Garotti R, D’Alise D, Giugliano S, Polizzi M, Trabucco V, Riccio MP, Bravaccio C. IAmHero: Preliminary Findings of an Experimental Study to Evaluate the Statistical Significance of an Intervention for ADHD Conducted through the Use of Serious Games in Virtual Reality. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3414. [PMID: 36834109 PMCID: PMC9966139 DOI: 10.3390/ijerph20043414] [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: 01/09/2023] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 06/18/2023]
Abstract
The use of new technologies, such as virtual reality (VR), represents a promising strategy in the rehabilitation of subjects with attention-deficit/hyperactivity disorder (ADHD). We present the results obtained by administering the IAmHero tool through VR to a cohort of subjects with ADHD between 5 and 12 years of age. The trial time was approximately 6 months. In order to assess the beneficial effects of the treatment, standardised tests assessing both ADHD symptoms and executive functions (e.g., Conners-3 scales) were administered both before and at the end of the sessions. Improvements were observed at the end of treatment in both ADHD symptoms (especially in the hyperactivity/impulsivity domain) and executive functions. One of the strengths of the VR approach is related above all to the acceptability of this tool and its flexibility. Unfortunately, to date, there are still few studies on this topic; therefore, future studies are essential to expand our knowledge on the utility and benefits of these technologies in the rehabilitation field.
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Affiliation(s)
- Annamaria Schena
- Villa delle Ginestre s.r.l. Rehabilitation and FKT Centre, 80040 Volla, Italy
| | - Raffaele Garotti
- Unità Operativa Semplice Dipartimentale of Child Neuropsychiatry, Department of Translational Medical Sciences, 80131 Naples, Italy
| | - Dario D’Alise
- Villa delle Ginestre s.r.l. Rehabilitation and FKT Centre, 80040 Volla, Italy
| | - Salvatore Giugliano
- Villa delle Ginestre s.r.l. Rehabilitation and FKT Centre, 80040 Volla, Italy
| | - Miriam Polizzi
- Unità Operativa Semplice Dipartimentale of Child Neuropsychiatry, Department of Translational Medical Sciences, 80131 Naples, Italy
| | - Virgilio Trabucco
- Villa delle Ginestre s.r.l. Rehabilitation and FKT Centre, 80040 Volla, Italy
| | - Maria Pia Riccio
- Unità Operativa Semplice Dipartimentale of Child Neuropsychiatry, Department of Translational Medical Sciences, 80131 Naples, Italy
| | - Carmela Bravaccio
- Unità Operativa Semplice Dipartimentale of Child Neuropsychiatry, Department of Translational Medical Sciences, 80131 Naples, Italy
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11
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Hatch B, Kadlaskar G, Miller M. Diagnosis and treatment children and adolescents with autism and ADHD. PSYCHOLOGY IN THE SCHOOLS 2022; 60:295-311. [PMID: 37065905 PMCID: PMC10092654 DOI: 10.1002/pits.22808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/11/2022] [Accepted: 09/11/2022] [Indexed: 11/12/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) and autism are neurodevelopmental disorders that emerge in childhood. There is increasing recognition that ADHD and autism frequently co-occur. Yet, questions remain among clinicians regarding the best ways to evaluate and treat co-occurring autism and ADHD. This review outlines issues relevant to providing evidence-based practice to individuals and families who may be experiencing difficulties associated with co-occurring autism and ADHD. After describing the complexities of the co-occurrence of autism and ADHD, we present practical considerations for best practice assessment and treatment of co-occurring autism and ADHD. Regarding assessment, this includes considerations for interviewing parents/caregivers and youth, using validated parent and teacher rating scales, conducting cognitive assessments, and conducting behavior observations. Regarding treatment, consideration is given to behavioral management, school-based interventions, social skills development, and the use of medications. Throughout, we note the quality of evidence that supports a particular component of assessment or treatment, highlighting when evidence is most relevant to those with co-occurring autism and ADHD across stages of development. In light of the current evidence for assessment and treatment of co-occurring autism and ADHD, we conclude by outlining practical implications for clinical and educational practice.
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Affiliation(s)
- Burt Hatch
- School of Psychology Victoria University of Wellington Wellington New Zealand
| | - Girija Kadlaskar
- Department of Psychiatry & Behavioral Sciences and MIND Institute University of California Davis California USA
| | - Meghan Miller
- Department of Psychiatry & Behavioral Sciences and MIND Institute University of California Davis California USA
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12
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Paananen M, Husberg H, Katajamäki H, Aro T. School-based group intervention in attention and executive functions: Intervention response and moderators. Front Psychol 2022; 13:975856. [PMID: 36186366 PMCID: PMC9521625 DOI: 10.3389/fpsyg.2022.975856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 08/19/2022] [Indexed: 11/20/2022] Open
Abstract
Objective This study investigated the effects of a school-based skill-training intervention in attention control and executive functions for pupils with hyperactivity-impulsivity (H-I) and cognitive control (CC) deficits. The main aim was to examine whether the intervention differently influenced H-I and CC, and whether cognitive abilities or conduct problems moderated response to the intervention. Method Elementary school pupils from 41 schools participated the study and were divided into an intervention group (n = 71) and a waitlist control group (n = 77). Intervention outcomes were assessed with an inventory assessing executive function difficulties (including H-I and CC) completed by classroom teachers. Results Significant intervention effects and positive changes were detected in CC but not in H-I. Significant intervention effects were found mainly among pupils with low levels of conduct problems. Conclusions The results suggest that a skill-training intervention has specific positive effects on CC, but conduct problems may diminish response to intervention.
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Affiliation(s)
- Mika Paananen
- Niilo Mäki Institute, Jyväskylä, Finland
- Department of Psychology, University of Jyväskylä, Jyväskylä, Finland
- *Correspondence: Mika Paananen
| | - Henrik Husberg
- Niilo Mäki Institute, Jyväskylä, Finland
- Department of Education, University of Helsinki, Helsinki, Finland
| | | | - Tuija Aro
- Department of Psychology, University of Jyväskylä, Jyväskylä, Finland
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13
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Weiss MD. A Paradigm for Targeting Functional Impairment as an Outcome in Attention-Deficit/Hyperactivity Disorder. Brain Sci 2022; 12:brainsci12081014. [PMID: 36009077 PMCID: PMC9405930 DOI: 10.3390/brainsci12081014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 02/03/2023] Open
Abstract
Although functional impairment is required for a diagnosis in the DSM 5, the time frame and definition of functional impairment is ambiguous. We present a conceptual review clarifying the difference between functional impairment as a stable trait representing strength or disability in various domains, and functional impairment as secondary to emotional or behavior problems, which is a state sensitive to change with treatment intervention. Functional impairment as a measure of treatment outcome includes both change from baseline and status at the endpoint of treatment. When using a validated measure of function, functional improvement can be defined as the percentage of patients who achieve the Minimal Important Clinical Difference (MCID) and functional remission as the percentage of patients who normalize at treatment endpoint. True treatment remission should be defined as both symptomatic and functional remission.
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14
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Tamm L, Risley SM, Hamik E, Combs A, Jones LB, Patronick J, Yeung TS, Zoromski AK, Duncan A. Improving academic performance through a school-based intervention targeting academic executive functions - a pilot study. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2022; 70:549-557. [PMID: 38699503 PMCID: PMC11062275 DOI: 10.1080/20473869.2022.2095690] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/22/2022] [Indexed: 05/05/2024]
Abstract
Background Academic challenges such as losing/not turning in assignments, misplacing materials, and inefficient studying are common in middle-school students with autism spectrum disorder (ASD) without intellectual disability. Deficits in organization, planning, prioritizing, memory/materials management, and studying skills [i.e. academic executive functioning (EF) deficits] contribute to these challenges. Objectives To assess the feasibility, satisfaction, and initial efficacy of the school-based version of the Achieving Independence and Mastery in School (AIMS) intervention in a proof-of-concept trial with 6 students with ASD. Methods 6 middle-schoolers with ASD without ID participated in AIMS. Parents and teachers rated academic EFs and functioning. Results Results suggest high feasibility, youth satisfaction, and improved EF skills and academic behaviors by parent and teacher report. Conclusion These promising results support further intervention development and suggest that academic EF skills are malleable in students with ASD.
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Affiliation(s)
- Leanne Tamm
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | - Elizabeth Hamik
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Angela Combs
- College of Arts and Sciences, University of Cincinnati, Cincinnati, OH, USA
| | | | - Jamie Patronick
- College of Arts and Sciences, University of Cincinnati, Cincinnati, OH, USA
| | - Tat Shing Yeung
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Allison K. Zoromski
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Amie Duncan
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
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15
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Singh LJ, Gaye F, Cole AM, Chan ES, Kofler MJ. Central executive training for ADHD: Effects on academic achievement, productivity, and success in the classroom. Neuropsychology 2022; 36:330-345. [PMID: 35343732 PMCID: PMC9035079 DOI: 10.1037/neu0000798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Central executive training (CET) is a "Level 2" evidence-based treatment for improving ADHD-related executive dysfunction and behavioral symptoms, but the extent to which these gains extend to the disorder's well-documented academic difficulties is unknown. METHOD Across two clinical trials, 108 children with attention-deficit/hyperactivity disorder (ADHD) 8-13 years old (M = 10.29, SD = 1.50; 32 girls; 75% White/Non-Hispanic) were treated with CET (n = 52), inhibitory control training (ICT; n = 29), or gold-standard behavioral parent training (BPT; n = 27). RESULTS CET was superior to BPT and ICT (d = 0.62-0.88) for improving masked teacher perceptions of academic success, impulse control, and academic productivity at 1-2 months posttreatment. At 2-4-month follow-up, CET (d = 0.76) and ICT (d = 0.54) were superior to BPT for improving objectively-tested academic achievement overall (reading comprehension, math problem-solving, language comprehension), and CET was superior to ICT (d = 0.56) for improving math problem-solving. The significant benefits of CET on academic success, academic productivity, reading comprehension, and math problem-solving replicated across both trials and were clinically significant as evidenced by low number needed to treat estimates (Needed to Treat; NNT = 3-7) and significantly higher proportions of individual cases demonstrating reliable improvements in academic success/productivity (33%-36% vs. 0%-18%) and achievement (38%-72% vs. 18%-54%) across outcomes (all p ≤ .01). CONCLUSIONS Results across the two trials provide strong support for the efficacy of CET for ADHD, and are consistent with model-driven hypotheses that academic difficulties in ADHD are due, in part, to these children's underdeveloped executive functioning abilities. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
| | - Fatou Gaye
- Florida State University, Department of
Psychology
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16
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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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17
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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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18
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Rothschild LB, Ratto AB, Kenworthy L, Hardy KK, Verbalis A, Pugliese C, Strang JF, Safer-Lichtenstein J, Anthony BJ, Anthony LG, Guter MM, Haaga DAF. Parents matter: Parent acceptance of school-based executive functions interventions relates to improved child outcomes. J Clin Psychol 2022; 78:1388-1406. [PMID: 34997971 DOI: 10.1002/jclp.23309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES School-based interventions with parent-training components might improve access among lower-income families to effective help for children with neurodevelopmental disorders. This potential might be realized, however, only if parents perceive the interventions as acceptable and therefore engage with treatment. METHODS Parents (N = 124) of 3rd-5th grade students diagnosed with Autism Spectrum Disorder or Attention-Deficit/Hyperactivity Disorder rated the acceptability of their child's treatment (one of two culturally responsive behavioral interventions). Parent engagement was measured through attendance at parent training sessions and the extent to which they read a corresponding workbook. RESULTS Education and income correlated inversely with parent perceptions of treatment acceptability. Acceptability correlated positively with engagement, more strongly among lower-income families. Acceptability had an indirect effect on treatment outcome, mediated by parent engagement. CONCLUSIONS Treatment providers should focus on strategies to increase parent acceptability, with particular attention to improving access for lower-income families.
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Affiliation(s)
- Leah B Rothschild
- Department of Psychology, Asbury Building, American University, Washington, District of Columbia, USA
| | - Allison B Ratto
- Center for Autism Spectrum Disorders, Children's National Hospital, Rockville, Maryland, USA.,Division of Pediatric Neuropsychology, Children's National Health System, Department of Psychiatry, The George Washington University School of Medicine
| | - Lauren Kenworthy
- Center for Autism Spectrum Disorders, Children's National Hospital, Rockville, Maryland, USA.,Division of Pediatric Neuropsychology, Children's National Health System, Department of Psychiatry, The George Washington University School of Medicine
| | - Kristina K Hardy
- Center for Autism Spectrum Disorders, Children's National Hospital, Rockville, Maryland, USA.,Division of Pediatric Neuropsychology, Children's National Health System, Department of Psychiatry, The George Washington University School of Medicine
| | - Alyssa Verbalis
- Center for Autism Spectrum Disorders, Children's National Hospital, Rockville, Maryland, USA.,Division of Pediatric Neuropsychology, Children's National Health System, Department of Psychiatry, The George Washington University School of Medicine
| | - Cara Pugliese
- Center for Autism Spectrum Disorders, Children's National Hospital, Rockville, Maryland, USA.,Division of Pediatric Neuropsychology, Children's National Health System, Department of Psychiatry, The George Washington University School of Medicine
| | - John F Strang
- Center for Autism Spectrum Disorders, Children's National Hospital, Rockville, Maryland, USA.,Division of Pediatric Neuropsychology, Children's National Health System, Department of Psychiatry, The George Washington University School of Medicine
| | | | - Bruno J Anthony
- Department of Psychiatry, CU Anschutz Medical Campus, Children's Hospital Colorado, Aurora, Colorado, USA.,University of Colorado School of Medicine and the Children's Hospital of Colorado, Aurora, Colorado, USA
| | - Laura G Anthony
- Department of Psychiatry, CU Anschutz Medical Campus, Children's Hospital Colorado, Aurora, Colorado, USA.,University of Colorado School of Medicine and the Children's Hospital of Colorado, Aurora, Colorado, USA
| | - Madison M Guter
- Department of Psychology, Asbury Building, American University, Washington, District of Columbia, USA
| | - David A F Haaga
- Department of Psychology, Asbury Building, American University, Washington, District of Columbia, USA
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19
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DuPaul GJ, Gormley MJ, Daffner-Deming M. School-Based Interventions for Elementary School Students with Attention-Deficit/Hyperactivity Disorder. Child Adolesc Psychiatr Clin N Am 2022; 31:149-166. [PMID: 34801152 DOI: 10.1016/j.chc.2021.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Children with attention-deficit/hyperactivity disorder experience significant academic, social, and behavioral impairments in elementary school settings. Although psychopharmacologic treatments can improve symptomatic behaviors, these rarely are sufficient for enhancing school performance. Thus, medication should be supplemented by one or more school interventions, including behavioral strategies, academic interventions, behavioral peer interventions, organizational skills training, and self-regulation strategies. Although all of these school interventions have been found effective, classroom behavioral strategies, organizational skills training, and self-regulation strategies have the strongest empirical support. Clinicians should collaborate with school mental health professionals to encourage implementation of effective school interventions across school years.
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Affiliation(s)
- George J DuPaul
- Department of Education and Human Services, Lehigh University, 111 Research Drive, Bethlehem, PA 18015, USA.
| | - Matthew J Gormley
- Department of Education and Human Services, Lehigh University, 111 Research Drive, Bethlehem, PA 18015, USA; University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Molly Daffner-Deming
- Department of Education and Human Services, Lehigh University, 111 Research Drive, Bethlehem, PA 18015, USA
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20
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Zheng Q, Wang X, Chiu KY, Shum KKM. Time Perception Deficits in Children and Adolescents with ADHD: A Meta-analysis. J Atten Disord 2022; 26:267-281. [PMID: 33302769 DOI: 10.1177/1087054720978557] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Prior studies have reported time perception impairment in children and adolescents with ADHD but the results were inconsistent. METHOD The current meta-analysis reviews 27 empirical studies published in English after year 2000 that compared time perception competence among children and adolescents with and without ADHD. RESULTS Results from 1620 participants with ADHD and 1249 healthy controls showed significant timing deficits in ADHD. Children/adolescents with ADHD perceived time less accurately (Hedges' g > 0.40), less precisely (Hedges' g = 0.66) and had higher tendency to overestimate time than their healthy counterparts. Moderator analyses indicated that the discrepancy of time perception between groups was not affected by the type of timing tasks nor the modality of stimuli used in the tasks. Nonetheless, results were moderated by age and gender. CONCLUSION These findings may update current understanding of the underlying neuropsychological deficits in ADHD and provide insight for future research in clinical assessments and treatments for ADHD.
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Affiliation(s)
- Que Zheng
- The University of Hong Kong, Hong Kong
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21
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Improving Adherence to Behavioral Parent Training for ADHD Using Digital Health Tools. JOURNAL OF PSYCHIATRY AND BRAIN SCIENCE 2022; 7:e220005. [PMID: 36110580 PMCID: PMC9473542 DOI: 10.20900/jpbs.20220005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Behavioral Parent Training (BPT) is a well-established treatment for school-age children with ADHD but lack of parent adherence to prescribed parenting strategies limits treatment gains. Digital Health (dHealth) tools can be leveraged to target barriers to parent adherence but existing tools for parenting interventions are limited. New efforts to develop a dHealth tool to target adherence barriers including limited skill competence, EF processes, and low motivation/negative attitudes, are presented and recommendations for future technology-enhanced treatments are provided.
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22
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Babinski DE, Sibley MH. Family-based treatments for attention-deficit/hyperactivity disorder: A review of family functioning outcomes in randomized controlled trials from 2010 to 2019. JOURNAL OF MARITAL AND FAMILY THERAPY 2022; 48:83-106. [PMID: 34779516 DOI: 10.1111/jmft.12572] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 10/31/2021] [Indexed: 06/13/2023]
Abstract
This review details advances in randomized controlled trials of family-based treatments for attention-deficit/hyperactivity disorder (ADHD) conducted in the United States from 2010 to 2019, and the impact of these treatments on the domain of family functioning. Twenty-two studies were included in the review and three types of family treatments, integrated parent-child treatments, parent-directed treatments, and youth treatments with adjunctive parent involvement, were identified for children and adolescents. Studies point to considerable advancements in consideration of understudied and diverse populations, and results of the review show all three types of family interventions for ADHD should be considered well-established interventions addressing family functioning. Practical guidelines are offered, and future directions for research are discussed.
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Affiliation(s)
- Dara E Babinski
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Margaret H Sibley
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle Children's Research Institute, Seattle, Washington, USA
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23
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Bikic A, Dalsgaard S, Olsen KD, Sukhodolsky DG. Organizational skills training for children with ADHD: study protocol for a randomized, controlled trial. Trials 2021; 22:752. [PMID: 34715906 PMCID: PMC8556963 DOI: 10.1186/s13063-021-05499-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 07/29/2021] [Indexed: 11/21/2022] Open
Abstract
Background Problems with sustained attention, impulsivity, and hyperactivity are the most prominent symptoms of attention-deficit hyperactivity disorder (ADHD), but many children with this diagnosis also present with poor organizational skills that are important in relation to school. These problems tend to increase from childhood to adolescence and are often not well managed by medication. Organizational skills training (OST) is a range of behavioral interventions that specifically target organizational skills deficits. Evidence supports the effect of OST on improving organizational skills, inattention, and academic performance in children with ADHD. Because previous clinical trials included mostly children above the age of 8 years, this trial includes children in the age range 6–13 years to expand the knowledge on the effects of OST in younger children. Previous OST research has also shown improvement on inattention in parent ratings; we will investigate if a change in inattention can be confirmed with neurocognitive tests. Finally, little is known about predictors of treatment response in OST. Objectives The primary objective is to investigate if OST has positive effects on organizational skills in children with ADHD. The primary outcome measurement is the parent-rated Children’s Organizational Skills Scale (COSS), collected before and at the end of the 10 week intervention. Secondary and exploratory outcomes include inattention ratings, family and school functioning, and cognitive functions measured before the intervention period, immediately after, and at a 6 month follow-up. Additional objectives are to investigate both neurocognitive outcomes and age as predictors of treatment response. Methods This is a randomized clinical superiority trial investigating the effect of OST vs a treatment-as-usual (TAU) control group for children with ADHD in the age range of 6–13 years. All participants (n = 142) receive TAU. OST is administered in a group format of 10 weekly sessions. Adverse events are monitored by study clinicians during weekly therapy sessions and all assessments. Data analyses will be conducted using mixed linear regression models with random intercepts for patients, adjusted for the stratification variables and the baseline value. Perspectives This study will provide important new knowledge and expand on existing research in the field of non-pharmacological treatment of children with ADHD. OST can potentially have a significant impact on the lives of children with ADHD by helping them learn how to cope with their present deficits and to become more independent and self-reliant. It is also important to investigate predictors of treatment response in order to optimize OST. Trial registration ClinicalTrials.gov NCT03160378. Registered on May 19, 2017. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05499-9.
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Affiliation(s)
- Aida Bikic
- Child and Adolescent Mental Health Services Southern Jutland, Kresten Phillipsens Vej 15, Aabenraa, Region of Southern Denmark, Denmark. .,Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Winsløwparken 19, 3, Odense C, Denmark.
| | - Søren Dalsgaard
- National Centre of Register-based research, Department of Economics and Business, Aarhus University, Fuglesangs Allé 4, Aarhus, Denmark
| | - Kristoffer Dalsgaard Olsen
- Child and Adolescent Mental Health Services Southern Jutland, Kresten Phillipsens Vej 15, Aabenraa, Region of Southern Denmark, Denmark
| | - Denis G Sukhodolsky
- Child Study Centre, Yale University School of Medicine, 230 South Frontage Road, New Haven, CT, USA
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24
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Society for Developmental and Behavioral Pediatrics Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents with Complex Attention-Deficit/Hyperactivity Disorder. J Dev Behav Pediatr 2021; 41 Suppl 2S:S35-S57. [PMID: 31996577 DOI: 10.1097/dbp.0000000000000770] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is the most common childhood neurodevelopmental disorder and is associated with an array of coexisting conditions that complicate diagnostic assessment and treatment. ADHD and its coexisting conditions may impact function across multiple settings (home, school, peers, community), placing the affected child or adolescent at risk for adverse health and psychosocial outcomes in adulthood. Current practice guidelines focus on the treatment of ADHD in the primary care setting. The Society for Developmental and Behavioral Pediatrics has developed this practice guideline to facilitate integrated, interprofessional assessment and treatment of children and adolescents with "complex ADHD" defined by age (<4 years or presentation at age >12 years), presence of coexisting conditions, moderate to severe functional impairment, diagnostic uncertainty, or inadequate response to treatment.
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25
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Wallin Ahlström S, Janeslätt G, Almqvist L. Feasibility of an intervention to facilitate time and everyday functioning in preschoolers. Scand J Occup Ther 2021; 29:337-352. [PMID: 34618656 DOI: 10.1080/11038128.2021.1981434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Children in need of special support (INS) often display delays in time-processing ability (TPA) affecting everyday functioning. Typically developing (TD) children are not yet mature to use the information of a clock. AIM To investigate the feasibility of an intervention program, MyTime, to facilitate TPA and everyday functioning in pre-school children, including the subjective experiences of pre-school staff and the children. MATERIALS AND METHODS The intervention sample consisted of 20 children: 4 INS and 16 TD. Intervention was given daily in 8 weeks with MyTime in the pre-school environment. Data collection procedures were evaluated and children were assessed for TPA pre- and post intervention. Everyday functioning were assessed by teachers, parents and children. Experiences of the intervention were assessed by a group interview with teachers and a Talking Mats© evaluation with children. RESULTS MyTime worked well in pre-school and indicated an increase in the children's TPA and everyday functioning. The program was perceived simple to use by teachers and children highlighted the importance to understand the duration of time. CONCLUSION The program MyTime was found to be feasible in the pre-school environment. Significance: The assessment and program design can be used to investigate intervention effectiveness in a randomised study.
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Affiliation(s)
- Sara Wallin Ahlström
- School of Health, Care and Social Welfare (HVV), Mälardalen University, Västerås, Sweden.,Center for Clinical Research Dalarna, Falun, Sweden.,Habilitation Services in Dalarna, Sweden
| | - Gunnel Janeslätt
- Center for Clinical Research Dalarna, Falun, Sweden.,Habilitation Services in Dalarna, Sweden.,Department of Public Health and Caring Sciences, Disability and Habilitation, Uppsala University, Uppsala, Sweden
| | - Lena Almqvist
- School of Health, Care and Social Welfare (HVV), Mälardalen University, Västerås, Sweden
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Holmefur M, Roshanay A, White S, Janeslätt G, Vimefall E, Lidström-Holmqvist K. Evaluation of the "Let's Get Organized" group intervention to improve time management: protocol for a multi-centre randomised controlled trial. Trials 2021; 22:640. [PMID: 34538253 PMCID: PMC8449991 DOI: 10.1186/s13063-021-05578-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 08/30/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Time management skills are essential for living in modern society. People with mental or neurodevelopmental disorders typically have cognitive limitations, including affected time management, which might lead to poor occupational balance, low self-efficacy, and poor parental sense of competence. "Let's Get Organized" (LGO) is a recently developed manual-based group intervention to train time management skills. The aim of this trial is to evaluate the efficiency of the Swedish version of LGO (LGO-S) compared to treatment as usual (individual occupational therapy) to improve time management for adults with impaired time management skills due to mental or neurodevelopmental disorders. Furthermore, to evaluate if the intervention is a cost-effective way to improve the quality of life and time management skills of these individuals, we will conduct a health economic evaluation. METHODS The trial will have a multi-centre, open, parallel randomised controlled design. A total of 104 adults with cognitive limitations due to mental or neurodevelopmental disorders will be recruited from open psychiatric or habilitation care units. Outcomes will be measured before and after a 10-week intervention, with a follow-up 3 months after completing the intervention. The primary outcome will be self-assessed time management skills. Secondary outcomes will be e.g. self-assessed skills in organisation and planning, regulation of emotions, satisfaction with daily occupations, occupational balance, self-efficacy, and quality-adjusted life years. DISCUSSION A recent feasibility study has shown promising results for LGO-S, and a randomised trial will provide robust evidence for the possible efficacy of LGO-S in comparison to treatment as usual. TRIAL REGISTRATION ClinicalTrials.gov NCT03654248 . Registered on 20 August 2018.
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Affiliation(s)
- Marie Holmefur
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Afsaneh Roshanay
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Suzanne White
- State University of New York, Downstate Medical Center, Brooklyn, New York, USA
| | - Gunnel Janeslätt
- Department of Public Health and Caring Sciences, Uppsala University and Centre for Clinical Research in Dalarna, Uppsala University, Falun, Sweden
| | - Elin Vimefall
- Örebro University School of Business, Faculty of Business, Science and Engineering, Örebro University, Örebro, Sweden
| | - Kajsa Lidström-Holmqvist
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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27
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Keller T, Szakál P. Not just words! Effects of a light-touch randomized encouragement intervention on students' exam grades, self-efficacy, motivation, and test anxiety. PLoS One 2021; 16:e0256960. [PMID: 34525100 PMCID: PMC8443032 DOI: 10.1371/journal.pone.0256960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 08/19/2021] [Indexed: 11/18/2022] Open
Abstract
Motivated by the self-determination theory of psychology, we investigate how simple school practices can forge students’ engagement with the academic aspect of school life. We carried out a large-scale preregistered randomized field experiment with a crossover design, involving all the students of the University of Szeged in Hungary. Our intervention consisted of an automated encouragement message that praised students’ past achievements and signaled trust in their success. The treated students received encouragement messages before their exam via two channels: e-mail and SMS message. The control students did not receive any encouragement. Our primary analysis compared the treated and control students’ end-of-semester exam grades, obtained from the university’s registry. Our secondary analysis explored the difference between the treated and control students’ self-efficacy, motivation, and test anxiety, obtained from an online survey before students’ exams. We did not find an average treatment effect on students’ exam grades. However, in the subsample of those who answered the endline survey, the treated students reported higher self-efficacy than the control students. The treatment affected students’ motivation before their first exam—but not before their second—and did not affect students’ test anxiety. Our results indicate that automated encouragement messages sent shortly before exams do not boost students’ exam grades, but they do increase self-efficacy. These results contribute to understanding the self-efficacy mechanism through which future encouragement campaigns might exert their effect. We conclude that encouraging students and raising their self-efficacy might create a school climate that better engages students with the academic aspect of school life.
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Affiliation(s)
- Tamás Keller
- Centre for Social Sciences: Research Center for Educational and Network Studies, Budapest, Huangary
- Research Center for Economic and Regional Studies: Institute of Economics, Budapest, Huangary
- TÁRKI Social Research Institute, Budapest, Huangary
- * E-mail:
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28
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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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29
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Evans SW, Allan D, Xiang J, Margherio SM, Owens JS, Langberg JM. Organization interventions as a mediator of change in grades in the Challenging Horizons Program. J Sch Psychol 2021; 87:18-27. [PMID: 34303445 DOI: 10.1016/j.jsp.2021.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 02/28/2021] [Accepted: 05/14/2021] [Indexed: 12/28/2022]
Abstract
This study evaluated whether an organization intervention was a mediator of change for grade point average (GPA) in a randomized clinical trial of a school-based treatment program for adolescents with attention deficit hyperactivity disorder (ADHD). A demographically diverse sample of 148 participants (105 males) with a diagnosis of ADHD were recruited from nine middle schools. Comprehensive diagnostic evaluations were completed and participants were randomized into one of three conditions (two active treatment conditions, one control condition) for a randomized clinical trial that lasted an entire school year. The results of the trial are reported elsewhere (Evans et al., 2016; Schultz et al., 2017); in this study we evaluated four of the criteria for determining mediation as reported by Kazdin (2007) to determine whether response to the organization intervention in this school-based treatment program mediated the relationship between dosage and GPA beyond previous GPA. The results provided evidence that response to the organization intervention mediated the relationship between intervention dosage and change in GPA.
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Affiliation(s)
- Steven W Evans
- Ohio University, Department of Psychology, Athens, OH 45701, United States.
| | - Darcey Allan
- Ohio University, Department of Psychology, Athens, OH 45701, United States.
| | - Joe Xiang
- Ohio University, Department of Psychology, Athens, OH 45701, United States.
| | | | - Julie Sarno Owens
- Ohio University, Department of Psychology, Athens, OH 45701, United States.
| | - Joshua M Langberg
- Virginia Commonwealth University, Department of Psychology, Richmond, VA 23284, United States.
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30
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Exploration of Clinician Adherence and Competency as Predictors of Treatment Outcomes in a School-Based Homework and Organization Intervention for Students with ADHD. SCHOOL MENTAL HEALTH 2021. [DOI: 10.1007/s12310-021-09430-0] [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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31
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Döpfner M, Dose C, Breuer D, Heintz S, Schiffhauer S, Banaschewski T. Efficacy of Omega-3/Omega-6 Fatty Acids in Preschool Children at Risk of ADHD: A Randomized Placebo-Controlled Trial. J Atten Disord 2021; 25:1096-1106. [PMID: 31680604 DOI: 10.1177/1087054719883023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To evaluate the efficacy of an Omega-3/Omega-6 fatty acid supplement in preschool children at risk for ADHD. Method: Forty preschool children with elevated levels of ADHD symptoms were randomly assigned to either a verum or a placebo group. Children in the verum group received a 4-month treatment with Omega-3/Omega-6 fatty acids. Outcome measures comprised parent- and teacher-rated ADHD symptoms, which were the primary outcome variables, internalizing and externalizing problems, and intellectual abilities. Results: Intention-to-treat analyses of covariance, controlling for age and baseline data, revealed effects on parent- and teacher-rated ADHD symptoms (primary outcomes; parent ratings: F = 4.51, df = 1, p = .04, d = 0.63; teacher ratings: F = 4.67, df = 1, p = .04, d = 0.70), parent-rated internalizing symptoms (F = 8.47, df = 1, p < .01, d = 0.63), and parent- and teacher-rated externalizing symptoms (parent ratings: F = 4.58, df = 1, p = .04, d = 0.54; teacher ratings: F = 5.99, df = 1, p = .02, d = 0.79). Analyses involving only cases with available data yielded significant moderate effects on teacher-rated inattention symptoms (F = 4.60, df = 1, p = .04, d = 0.79) and parent-rated internalizing problems (F = 6.04, df = 1, p = .02, d = 0.57). Conclusion: The intention-to-treat analyses provide some evidence for positive effects of Omega-3/Omega-6 fatty acids. However, the results require replication in larger samples to allow for firm conclusions for practice.
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Affiliation(s)
- Manfred Döpfner
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty, University of Cologne, Germany.,School for Child and Adolescent Cognitive Behavior Therapy (AKiP), Medical Faculty, University of Cologne, Germany
| | - Christina Dose
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty, University of Cologne, Germany.,School for Child and Adolescent Cognitive Behavior Therapy (AKiP), Medical Faculty, University of Cologne, Germany
| | - Dieter Breuer
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty, University of Cologne, Germany.,School for Child and Adolescent Cognitive Behavior Therapy (AKiP), Medical Faculty, University of Cologne, Germany
| | - Stefan Heintz
- Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Stefanie Schiffhauer
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty, University of Cologne, Germany.,School for Child and Adolescent Cognitive Behavior Therapy (AKiP), Medical Faculty, University of Cologne, Germany
| | - Tobias Banaschewski
- Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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32
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Britton-Rumohr DJ, Lannie AL. Adapting an Evidence Based Tier 3 Organizational Skill Intervention to Improve Classwide Organizational Skills. JOURNAL OF APPLIED SCHOOL PSYCHOLOGY 2021. [DOI: 10.1080/15377903.2021.1911898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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33
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Di Bartolo CA, Abikoff H, McDonald M, Gallagher R. Adapting an empirical clinic‐based organizational skills training program for use in schools: Iterative development and pilot assessment. PSYCHOLOGY IN THE SCHOOLS 2021. [DOI: 10.1002/pits.22530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Christina A. Di Bartolo
- Department of Child and Adolescent Psychiatry and Behavioral Science Children's Hospital of Philadelphia USA
| | - Howard Abikoff
- Department of Child and Adolescent Psychiatry NYU Langone Health New York New York USA
| | - Margaret McDonald
- Department of Child and Adolescent Psychiatry NYU Langone Health New York New York USA
| | - Richard Gallagher
- Department of Child and Adolescent Psychiatry NYU Langone Health New York New York USA
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34
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Knowledge and Feelings of Competence with Regard to ADHD Among Support Staff in All-Day Primary Schools. SUSTAINABILITY 2021. [DOI: 10.3390/su13073696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
(1) Background: Schools report a high number of schoolchildren with poor attention and hyperactive behavior, with 5% being diagnosed with attention deficit/hyperactivity disorder (ADHD). This causes specific problems during homework and classroom times, and the extension of all-day schooling in German primary schools makes this a challenge for support staff working in the after-school programs. Such staff have a very wide variety of qualifications, ranging from no formal teacher training to full teaching qualifications. (2) Methods: This study documents the knowledge of 196 support staff working in all-day primary schools about ADHD, and their subjective view of whether they feel competent with regard to homework situations in general and ADHD in particular. (3) Results: Those with an educational background have significantly more knowledge than those without such a background, staff feel less prepared to supervise children with ADHD, and there is a small but significant correlation here with knowledge about ADHD. (4) Conclusions: The importance of trained pedagogical staff in the supervision of children with concentration problems is emphasized.
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35
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Staff AI, van den Hoofdakker BJ, van der Oord S, Hornstra R, Hoekstra PJ, Twisk JWR, Oosterlaan J, Luman M. Effectiveness of Specific Techniques in Behavioral Teacher Training for Childhood ADHD: A Randomized Controlled Microtrial. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2021; 50:763-779. [PMID: 33471581 PMCID: PMC8802898 DOI: 10.1080/15374416.2020.1846542] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Objective: Behavioral teacher training is the most effective classroom-based intervention for children with attention-deficit/hyperactivity disorder (ADHD). However, it is currently unknown which components of this intervention add to its effectiveness and for whom these are effective. Method: In this microtrial, teachers of 90 children with impairing levels of ADHD symptoms (6–12 years) were randomly assigned to one of three conditions: a short (2 sessions), individualized intervention consisting of either (A) antecedent-based techniques (stimulus control), (B) consequent-based techniques (contingency management) or (C) waitlist. Primary outcome was the average of five daily assessments of four individualized problem behaviors, assessed pre and post intervention and three months later. Moderation analyses were conducted to generate hypotheses on child, teacher and classroom factors that may contribute to technique effectiveness. Results: Multilevel analyses showed that both antecedent- and consequent-based techniques were equally and highly effective in reducing problem behaviors compared to the control condition (Cohen’s d =.9); effects remained stable up to three months later. Child’s age and class size were moderators of technique effectiveness. For younger children, consequent-based techniques were more effective than antecedent-based techniques, whereas for older children the effect was in the opposite direction. Further, beneficial effects of antecedent-based techniques increased when the number of students per class decreased, whilst effectiveness of consequent-based techniques did not depend on class size. Conclusions: This study shows that both antecedent- and consequent-based techniques are highly effective in reducing problem behavior of children with ADHD. Interventions may be adapted to the child’s age and class size.
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Affiliation(s)
- Anouck I Staff
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam
| | - 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
| | - Saskia van der Oord
- Faculty of Psychology and Educational Sciences, KU Leuven.,Developmental Psychology, University of Amsterdam
| | - Rianne Hornstra
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen
| | - Pieter J Hoekstra
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen
| | - Jos W R Twisk
- Department of Epidemiology and Biostatistics, Vrije Universiteit Amsterdam
| | - 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
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36
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Abstract
Youth with autism spectrum disorders (ASD) without intellectual disability frequently experience academic problems, in part due to executive functioning (EF) deficits. There are currently no evidence-based interventions targeting academic EF skills for middle school youth with ASD. An intervention is currently in development. This paper reports on a "proof of concept" uncontrolled trial of the intervention, and focus groups with parents and youth to inform tailoring and adaptation of the intervention. Results of the trial suggest high feasibility/satisfaction, but a need for further adaptation to promote uptake by youth with ASD. Results from the focus groups confirmed the need for an intervention targeting academic EF skills, successful strategies in use, and the need to promote increased youth independence.
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37
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Au A, Lau K, Wong AH, Lam C, Leung C, Lau J, Lee YK. The Efficacy of a Group Triple P (Positive Parenting Program) for Chinese Parents with a Child Diagnosed with ADHD in Hong Kong: A Pilot Randomised Controlled Study. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12053] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Alma Au
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, and
| | - Kam‐mei Lau
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, and
| | - Ada Hsu‐chong Wong
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, and
| | - Candy Lam
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, and
| | - Cynthia Leung
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, and
| | - Joseph Lau
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, and
| | - Yiu Ki Lee
- Department of Psychiatry, United Christian Hospital
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38
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Wennberg B, Janeslätt G, Gustafsson PA, Kjellberg A. Occupational performance goals and outcomes of time-related interventions for children with ADHD. Scand J Occup Ther 2020; 28:158-170. [PMID: 32955952 DOI: 10.1080/11038128.2020.1820570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Children with attention deficit hyperactivity disorder (ADHD) have difficulties with occupational performance, related to difficulties with time-processing ability. AIMS To examine the outcome of a multimodal time-related intervention designed to support children aged 9-15 years with ADHD, to achieve their occupational performance goals and improve satisfaction with occupational performance. A further aim was to compare the children's ratings of outcome with their parents' ratings and to analyse the occupational performance goals. MATERIAL AND METHODS A pre-post design was used. Participants were 27 children, aged 9-15 years. Children and parents rated occupational performance and satisfaction at baseline and follow-up, after 24 weeks, using the Canadian Occupational Performance Measure (COPM). The intervention consisted of time-skills training and time-assistive devices (TADs). Descriptive and non-parametric statistics were used. RESULTS Significant improvements were found in reported performance and satisfaction. Children's were higher than those of their parents. Most goals were about carrying out daily routines, knowing the duration of an activity and knowing what will happen in the near future. CONCLUSION AND SIGNIFICANCE The study contributes to knowledge about suitable interventions for children with ADHD who have time-related difficulties. Occupational therapy interventions, including TADs and time-skills training, resulted in significantly improved occupational performance.
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Affiliation(s)
- Birgitta Wennberg
- Child and Adolescent Psychiatry, Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Gunnel Janeslätt
- Department of Public Health and Caring Sciences, Disability and Habilitation, Uppsala University, Uppsala, Sweden.,Centre for Clinical Research Dalarna, Falun, Sweden
| | - Per A Gustafsson
- Child and Adolescent Psychiatry, Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Anette Kjellberg
- Department of Health, Medicine and Caring Sciences, Linköping University, Norrkoping, Sweden
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39
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Tamm L, Zoromski AK, Kneeskern EE, Patel M, Lacey HM, Vaughn AJ, Ciesielski HA, Weadick HK, Duncan AW. Achieving Independence and Mastery in School: An Open Trial in the Outpatient Setting. J Autism Dev Disord 2020; 51:1705-1718. [PMID: 32809169 DOI: 10.1007/s10803-020-04652-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Youth with autism spectrum disorders (ASD) without intellectual disability frequently experience academic problems, in part due to executive functioning (EF) deficits. There are currently no evidence-based interventions targeting academic EF skills (e.g., organization, prioritization, etc.) for middle school youth with ASD. The need is critical given increasing demands on these skills during the transition from elementary to middle school. An intervention targeting academic EF skills, Achieving Independence and Mastery in School (AIMS), was recently developed. This paper reports on an open trial of the AIMS-Outpatient intervention with 21 middle schoolers with ASD. Results suggest high feasibility/satisfaction, and improved EF, particularly in the domains of organization and materials management. These promising results support further intervention development work and suggest that academic EF skills are malleable in youth with ASD.
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Affiliation(s)
- Leanne Tamm
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, USA.
- University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Allison K Zoromski
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, USA
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ellen E Kneeskern
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, USA
| | - Meera Patel
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, USA
| | - Heather M Lacey
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, USA
| | - Aaron J Vaughn
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, USA
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Heather A Ciesielski
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, USA
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Hannah K Weadick
- University of Cincinnati College of Arts and Sciences, 155 B McMicken Hall, Cincinnati, OH, 45221, USA
| | - Amie W Duncan
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, USA
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
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40
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Kofler MJ, Sarver DE, Wells EL. Working Memory and Increased Activity Level (Hyperactivity) in ADHD: Experimental Evidence for a Functional Relation. J Atten Disord 2020; 24:1330-1344. [PMID: 26494505 DOI: 10.1177/1087054715608439] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Converging evidence indicates large magnitude deficits in the "working" component of working memory for children with ADHD. However, our understanding of the relation between these central executive deficits and ADHD behavioral symptoms remains limited due to problems with several commonly used working memory tests. METHOD Children with ADHD (n = 25) completed a counterbalanced series of working memory tasks that differed only in memory set predictability. RESULTS Results indicated that central executive demands increased when memory set was unpredictable, as evidenced by moderate performance decreases (d = 0.22-0.56) and large changes in performance variability (d = 0.93-3.16) and response times (d = 1.74-4.16). Activity level remained relatively stable when memory set was unpredictable but decreased significantly over time when memory set was predictable. CONCLUSION Results suggest that altering memory set predictability is a feasible method for increasing/maintaining central executive demands over time, and suggest a positive association between working memory demands and gross motor activity for children with ADHD.
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41
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[ADHD in the transition to adulthood: prevalence, symptoms, risks, and care]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020; 63:910-915. [PMID: 32588062 DOI: 10.1007/s00103-020-03175-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder. In contrast to earlier assumptions, ADHD at least partially persists into adulthood in 50-80% of the patients.This narrative review article highlights the risks, treatment options, and care requirements associated with the transition to adulthood. Available epidemiological and routine care data and guidelines are reviewed and screened for indications and recommendations to improve the health-care of adolescents with ADHD.Epidemiological and routine care data point to a care gap for adolescents with ADHD in the sensitive phase of transition from adolescence to adulthood. Specific transition concepts should be expanded and their effectiveness scientifically investigated.
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Booster GD, Mautone JA, Nissley-Tsiopinis J, Van Dyke D, Power TJ. Reductions in Negative Parenting Practices Mediate the Effect of a Family–School Intervention for Children With Attention Deficit Hyperactivity Disorder. SCHOOL PSYCHOLOGY REVIEW 2019. [DOI: 10.17105/spr45-2.192-208] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Jennifer A. Mautone
- Children's Hospital of Philadelphia/Perelman School of Medicine at University of Pennsylvania
| | | | | | - Thomas J. Power
- Children's Hospital of Philadelphia/Perelman School of Medicine at University of Pennsylvania
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DuPaul GJ, Evans SW, Mautone JA, Owens JS, Power TJ. Future Directions for Psychosocial Interventions for Children and Adolescents with ADHD. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2019; 49:134-145. [DOI: 10.1080/15374416.2019.1689825] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
| | | | - Jennifer A. Mautone
- Department of Pediatrics, Children’s Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania
| | | | - Thomas J. Power
- Department of Pediatrics, Children’s Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania
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Phillips JM, Longoria JN. [Formula: see text] Addressing the neurodevelopmental needs of children and adolescents with congenital heart disease: A review of the existing intervention literature. Child Neuropsychol 2019; 26:433-459. [PMID: 31672097 DOI: 10.1080/09297049.2019.1682131] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Congenital heart disease (CHD) is among the most prevalent birth defects in the United States. Given that children with CHD are at risk for differences with development, learning, and psychosocial functioning, effective intervention becomes a central tenant of recommendations following neuropsychological consultation and evaluation. The primary focus of this review is to summarize available interventions for children and adolescents with CHD. The existing CHD literature has concentrated on early developmental services, psychopharmacological treatment, and need for academic supports. The literature is limited with regard to intervention studies that target cognitive deficits and psychosocial difficulties. To address this discrepancy, efficacious interventions that have been used to mitigate these concerns within other medical groups are also discussed in an effort to provide options for alternative recommendations and services. The current paper is intended to facilitate comprehensive care for cardiac patients by providing clinicians with a review of the available intervention literature, as well as potential interventions that may serve as supplemental strategies in the interim.
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Affiliation(s)
- Jannel M Phillips
- Department of Behavioral Health, Henry Ford Health System, Detroit, MI, USA
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Storebø OJ, Elmose Andersen M, Skoog M, Joost Hansen S, Simonsen E, Pedersen N, Tendal B, Callesen HE, Faltinsen E, Gluud C. Social skills training for attention deficit hyperactivity disorder (ADHD) in children aged 5 to 18 years. Cochrane Database Syst Rev 2019; 6:CD008223. [PMID: 31222721 PMCID: PMC6587063 DOI: 10.1002/14651858.cd008223.pub3] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) in children is associated with hyperactivity and impulsivity, attention problems, and difficulties with social interactions. Pharmacological treatment may alleviate the symptoms of ADHD but this rarely solves difficulties with social interactions. Children with ADHD may benefit from interventions designed to improve their social skills. We examined the benefits and harms of social skills training on social skills, emotional competencies, general behaviour, ADHD symptoms, performance in school of children with ADHD, and adverse events. OBJECTIVES To assess the beneficial and harmful effects of social skills training in children and adolescents with ADHD. SEARCH METHODS In July 2018, we searched CENTRAL, MEDLINE, Embase, PsycINFO, 4 other databases and two trials registers.We also searched online conference abstracts, and contacted experts in the field for information about unpublished or ongoing randomised clinical trials. We did not limit our searches by language, year of publication, or type or status of publication, and we sought translation of the relevant sections of non-English language articles. SELECTION CRITERIA Randomised clinical trials investigating social skills training versus either no intervention or waiting-list control, with or without pharmacological treatment of both comparison groups of children and adolescents with ADHD. DATA COLLECTION AND ANALYSIS We conducted the review in accordance with the Cochrane Handbook for Systematic Reviews of Intervention. We performed the analyses using Review Manager 5 software and Trial Sequential Analysis. We assessed bias according to domains for systematic errors. We assessed the certainty of the evidence with the GRADE approach. MAIN RESULTS We included 25 randomised clinical trials described in 45 reports. The trials included a total of 2690 participants aged between five and 17 years. In 17 trials, participants were also diagnosed with various comorbidities.The social skills interventions were described as: 1) social skills training, 2) cognitive behavioural therapy, 3) multimodal behavioural/psychosocial therapy, 4) child life and attention skills treatment, 5) life skills training, 6) the "challenging horizon programme", 7) verbal self-instruction, 8) meta-cognitive training, 9) behavioural therapy, 10) behavioural and social skills treatment, and 11) psychosocial treatment. The control interventions were no intervention or waiting list.The duration of the interventions ranged from five weeks to two years. We considered the content of the social skills interventions to be comparable and based on a cognitive-behavioural model. Most of the trials compared child social skills training or parent training combined with medication versus medication alone. Some of the experimental interventions also included teacher consultations.More than half of the trials were at high risk of bias for generation of the allocation sequence and allocation concealment. No trial reported on blinding of participants and personnel. Most of the trials did not report on differences between groups in medication for comorbid disorders. We used all eligible trials in the meta-analyses, but downgraded the certainty of the evidence to low or very low.We found no clinically relevant treatment effect of social skills interventions on the primary outcome measures: teacher-rated social skills at end of treatment (standardised mean difference (SMD) 0.11, 95% confidence interval (CI) 0.00 to 0.22; 11 trials, 1271 participants; I2 = 0%; P = 0.05); teacher-rated emotional competencies at end of treatment (SMD -0.02, 95% CI -0.72 to 0.68; two trials, 129 participants; I2 = 74%; P = 0.96); or on teacher-rated general behaviour (SMD -0.06 (negative value better), 95% CI -0.19 to 0.06; eight trials, 1002 participants; I2 = 0%; P = 0.33). The effect on the primary outcome, teacher-rated social skills at end of treatment, corresponds to a MD of 1.22 points on the social skills rating system (SSRS) scale (95% CI 0.09 to 2.36). The minimal clinical relevant difference (10%) on the SSRS is 10.0 points (range 0 to 102 points on SSRS).We found evidence in favour of social skills training on teacher-rated core ADHD symptoms at end of treatment for all eligible trials (SMD -0.26, 95% CI -0.47 to -0.05; 14 trials, 1379 participants; I2= 69%; P = 0.02), but the finding is questionable due to lack of support from sensitivity analyses, high risk of bias, lack of clinical significance, high heterogeneity, and low certainty.The studies did not report any serious or non-serious adverse events. AUTHORS' CONCLUSIONS The review suggests that there is little evidence to support or refute social skills training for children and adolescents with ADHD. We may need more trials that are at low risk of bias and a sufficient number of participants to determine the efficacy of social skills training versus no training for ADHD. The evidence base regarding adolescents is especially weak.
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Affiliation(s)
- Ole Jakob Storebø
- Region ZealandChild and Adolescent Psychiatric DepartmentBirkevaenget 3RoskildeDenmark4300
- Region Zealand PsychiatryPsychiatric Research UnitSlagelseDenmark4000
- University of Southern DenmarkDepartment of PsychologyCampusvej 55OdenseDenmark5230
| | | | - Maria Skoog
- Clinical Studies Sweden ‐ Forum SouthClinical Study SupportLundSweden
| | - Signe Joost Hansen
- Region Zealand PsychiatryPsychiatric Research UnitSlagelseDenmark4000
- University of Southern DenmarkDepartment of PsychologyCampusvej 55OdenseDenmark5230
| | - Erik Simonsen
- Region Zealand PsychiatryPsychiatric Research UnitSlagelseDenmark4000
- University of CopenhagenInstitute of Clinical Medicine, Faculty of Health and Medical SciencesCopenhagenDenmark
| | - Nadia Pedersen
- Region Zealand PsychiatryPsychiatric Research UnitSlagelseDenmark4000
| | - Britta Tendal
- RigshospitaletThe Nordic Cochrane Centre9 Blegdamsvej, 3343CopenhagenDenmark2100
- Danish Health AuthorityIslands Brygge 67CopenhagenDenmark
| | | | - Erlend Faltinsen
- Region Zealand PsychiatryPsychiatric Research UnitSlagelseDenmark4000
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University HospitalCochrane Hepato‐Biliary GroupBlegdamsvej 9CopenhagenDenmarkDK‐2100
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Görtz-Dorten A, Hanisch C, Hautmann C, Döpfner M. [The prevention of externalizing disturbances]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2019; 48:459-468. [PMID: 30882267 DOI: 10.1024/1422-4917/a000650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The prevention of externalizing disturbances Abstract. Objectives: Externalizing disturbances (attention deficit-hyperactivity disorders, oppositional defiant disorders, conduct disorders) in children and adolescents have a high prevalence, are stable over time, and precipitate a high individual and economic burden. Method: This review article presents the state of research based on selected current meta-analyzes and systematic reviews. Additionally, evidenced-based German-language prevention programs are discussed. Results: As in treatment, a multimodal approach to prevention is recommended which aims at reducing externalizing symptoms in specific settings. Interventions that focus on the specific environment in the family and the (pre-)school are preferable. Child-focused interventions are especially important in the context of peer-related problematic behavior because parent-based or teacher-based interventions may be less able to affect peer interactions. Conclusions: Comprehensive parent-based and (pre-)school-based preventive interventions of externalizing disturbances should be implemented. These should also include child-based approaches and additional parent-based group interventions. The effects of these interventions should be tested in large-scale studies.
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Affiliation(s)
- Anja Görtz-Dorten
- AKiP Köln, Ausbildungsinstitut für
Kinder- und Jugendlichenpsychotherapie, Uniklinik, Köln.,Institut für Klinische Kinderpsychologie der Christoph-Dornier-Stiftung an der Universität, Köln
| | | | - Christopher Hautmann
- AKiP Köln, Ausbildungsinstitut für
Kinder- und Jugendlichenpsychotherapie, Uniklinik, Köln
| | - Manfred Döpfner
- Klinik und Poliklinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters der Universität, Köln.,AKiP Köln, Ausbildungsinstitut für
Kinder- und Jugendlichenpsychotherapie, Uniklinik, Köln.,Institut für Klinische Kinderpsychologie der Christoph-Dornier-Stiftung an der Universität, Köln
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Janeslätt G, Ahlström SW, Granlund M. Intervention in time-processing ability, daily time management and autonomy in children with intellectual disabilities aged 10-17 years - A cluster randomised trial. Aust Occup Ther J 2019; 66:110-120. [PMID: 30548268 DOI: 10.1111/1440-1630.12547] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND/AIM Difficulties with management of time are frequently observed in children and youth with intellectual disabilities (IDs). The aim of this study was to evaluate a new intervention programme 'My Time' to improve time-processing ability (TPA) in children with IDs aged 10-17 years (n = 61). METHODS Cluster randomised and waiting-list control group design was used. Data collection included the Kit for assessment of TPA, the Time-Parent scale and a self-rating of autonomy to assess occupational performance in daily life. The method was implemented over an 8-week period. Effect size (ES) was calculated and an analysis of covariance on the individual level and a two-stage process on the cluster level. RESULTS The estimated mean improvement in the KaTid-Child score from baseline (t1) to t2 was significantly higher in the intervention group compared to the waiting-list group, ES Cohen's d = 0.64. CONCLUSION The results present first evidence of the effectiveness of a new occupational therapy intervention programme ('My Time') to facilitate TPA in children with mild to moderate IDs. Children with IDs aged 10-17 years could improve their TPA at a measurable pace when given intervention. The method could complement interventions using time-assistive devices. Children with IDs should be identified to guide intervention. Further research is necessary to establish whether using the intervention programme can facilitate the development of TPA in younger children.
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Affiliation(s)
- Gunnel Janeslätt
- Department of Public Health and Caring Sciences, Disability and Habilitation, Uppsala University, Uppsala, Sweden
- Center for Clinical Research Dalarna, Falun, Sweden
| | - Sara Wallin Ahlström
- Center for Clinical Research Dalarna, Falun, Sweden
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Mats Granlund
- CHILD, School of Health Sciences, Jönköping University, Jönköping, Sweden
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Ciesielski H, Tamm L, Vaughn A, Cyran J, Epstein J. Academic Skills Groups for Middle School Children With ADHD in the Outpatient Mental Health Setting: An Open Trial. J Atten Disord 2019; 23:409-417. [PMID: 25926629 PMCID: PMC4626438 DOI: 10.1177/1087054715584055] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To conduct an open trial assessing the initial efficacy of an intervention focusing on increasing skills related to academic performance (planning, organization, studying, and homework behaviors) for middle school children diagnosed with ADHD. The intervention is modeled on evidence-based interventions but designed for administration in the outpatient setting. METHOD Parents and their children diagnosed with ADHD attended seven weekly group sessions targeting academic, organizational, and homework skills. Parents completed the Homework Problem Checklist and Impairment Rating Scale pre- and post-treatment. RESULTS Following intervention, significant improvements in homework completion and management, as well as reductions in academic impairment and improvements in parent confidence and family relations, were reported. CONCLUSION Despite limitations including small sample size and lack of a control group, our results demonstrate initial efficacy of an academic skills intervention designed for use in the outpatient setting with middle school children diagnosed with ADHD on clinically relevant outcome measures.
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Affiliation(s)
| | - Leanne Tamm
- Cincinnati Children’s Hospital Medical Center
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Self-regulatory efficacy and sources of efficacy in elementary school pupils: Self-regulatory experiences in a population sample and pupils with attention and executive function difficulties. LEARNING AND INDIVIDUAL DIFFERENCES 2019. [DOI: 10.1016/j.lindif.2019.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Brigden A, Parslow RM, Linney C, Higson-Sweeney N, Read R, Loades M, Davies A, Stoll S, Beasant L, Morris R, Ye S, Crawley E. How are behavioural interventions delivered to children (5-11 years old): a systematic mapping review. BMJ Paediatr Open 2019; 3:e000543. [PMID: 31909219 PMCID: PMC6937047 DOI: 10.1136/bmjpo-2019-000543] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 10/11/2019] [Accepted: 10/18/2019] [Indexed: 01/19/2023] Open
Abstract
CONTEXT Behavioural interventions are used to prevent, manage and treat a wide variety of conditions including obesity, diabetes, chronic pain, asthma and emotional difficulties. There has been inadequate attention to the delivery of behavioural interventions to younger children (5-11 years old). OBJECTIVE Our objectives were to describe the characteristics of behavioural interventions for children aged 5-11 years. DATA SOURCES We searched five databases: CINAHL, EMBASE, PsycINFO, MEDLINE and Cochrane Library, from January 2005 to August 2019. STUDY SELECTION The inclusion criteria were (1) children aged 5-11, (2) cognitive and/or behavioural interventions, (3) randomised controlled trials and (4) 2005 onward. Two researchers independently identified studies for inclusion. DATA EXTRACTION Two researchers independently extracted data from eligible papers. RESULTS The search identified 10 541 papers. We extracted information on 117 interventions (from 152 papers). Many of the interventions were categorised as complex. This was particularly true for clinical populations; 78.7% were delivered to both the child and parent, and 33.9% took place across multiple settings, typically health and school settings. Most (70.9%) were 'First Wave' (behavioural) interventions, and few (4.3%) were 'Third Wave' (characterised by metacognition, acceptance and mindfulness). Thirty-nine per cent used interactive techniques (play, arts, story and/or games). Purely digital and paper-based interventions were rare, but around a third used these tools as supplements to face-face delivery. There were differences in interventions for younger (5-7 years) and older (8-11 years) children. CONCLUSIONS Interventions designed and delivered to children should be developmentally sensitive. This review highlights characteristics of interventions delivered to children 5-11 years old: the involvement of the child's parent, using behavioural (rather than cognitive) modalities, using interactive techniques and some interventions were delivered across multiple settings.
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Affiliation(s)
- Amberly Brigden
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - Roxanne Morin Parslow
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - Catherine Linney
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Rebecca Read
- Department of Psychology, University of Bath, Bath, Somerset, UK
| | - Maria Loades
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, UK.,Department of Psychology, University of Bath, Bath, Somerset, UK
| | - Anna Davies
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sarah Stoll
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - Lucy Beasant
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - Richard Morris
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Siyan Ye
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - Esther Crawley
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, UK
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