Improving homework performance among children with ADHD: A randomized clinical trial

The Emotional Impact of Family Involvement during Homework in Children with Neurodevelopmental Disorders: A Systematic Review

Neurodevelopmental disorders can be studied from two distinct perspectives: an internal approach, which examines the causes and consequences of these disorders; and a contextual approach, which considers the role of the family in the lives of children and adolescents. Research has demonstrated that the most significant form of family involvement in families raising a child with NDD is through homework. This involvement has been shown to have an emotional impact on children with neurodevelopmental disorders such as ADHD or dyslexia. The objective of this study is to review published articles on homework and neurodevelopmental disorders, with particular attention to the role of the family and the emotional health of children and families.

METHOD

The review followed the PRISMA guidelines. The final sample consisted of 11 articles, with samples ranging from less than 30 participants to more than 100 at the international level.

RESULTS

The results demonstrate the complex methodological and bibliometric picture of the final sample, as well as the many emotional and contextual variables that influence the relationship between homework and neurodevelopmental disorders.

CONCLUSIONS

Future research should consider how emotional health affects the engagement of families with children with neurodevelopmental disorders.

Single and Combined Effects of Multiple Intensities of Behavioral Modification and Methylphenidate for Children with ADHD in the Home Setting

Behavioral treatment, stimulants, and their combination are the recommended treatments for childhood attention-deficit/hyperactivity disorder (ADHD). The current study utilizes within-subjects manipulations of multiple doses of methylphenidate (placebo, 0.15, 0.30, and 0.60 mg/kg/dose t.i.d.) and intensities of behavioral modification (no, low, and high intensity) in the summer treatment program (STP) and home settings. Outcomes are evaluated in the home setting. Participants were 153 children (ages 5-12) diagnosed with ADHD. In alignment with experimental conditions implemented during the STP day, parents implemented behavioral modification levels in three-week intervals, child medication status varied daily, and the orders were randomized. Parents provided daily reports of child behavior, impairment, and symptoms and self-reported parenting stress and self-efficacy. At the end of the study, parents reported treatment preferences. Stimulant medication led to significant improvements across all outcome variables with higher doses resulting in greater improvement. Behavioral treatment significantly improved child individualized goal attainment, symptoms, and impairment in the home setting and parenting stress and self-efficacy. Effect sizes indicate that behavioral treatment combined with a low-medium dose (0.15 or 0.30 mg/kg/dose) of medication results in equivalent or superior outcomes compared to a higher dose (0.60 mg/kg/dose) of medication alone. This pattern was seen across outcomes. Parents overwhelmingly reported preferring treatment with a behavioral component as a first-choice treatment (99%). Results underscore the need to consider dosing as well as parent preference when utilizing combined treatment approaches. This study provides further evidence that combining behavioral treatment and stimulant medication may reduce the stimulant dose needed for beneficial effects.

Supporting Parents of Children with ADHD During COVID-19 School Closures: A Multiple-Baseline Trial of Behavioral Parent Training for Home Learning

During the COVID-19 pandemic, schools rapidly changed from in-class instruction to remote learning. Parent involvement and management of the home learning situation was greatly emphasized, and this presented challenges and opportunities for parents of children with attention-deficit/hyperactivity disorder (ADHD). There was an urgent need for effective parent support in the home learning situation, particularly for parents of youth with ADHD. The current study implemented a behavioral parent training (BPT) program, an evidence-based intervention for childhood ADHD, modified to target home learning and be delivered via telehealth. The intervention was evaluated in a multiple baseline trial across families of youth with ADHD (n = 3). The primary outcome was daily, parent-reported academic engagement during home learning. Parents also completed daily ratings of their child's respectful and disruptive behavior, and remote, home observations of academic tasks were recorded at baseline and post-treatment. Based on visual analysis of baseline, treatment and post-treatment daily ratings, two of the three participants had a positive response to treatment indicated by improved academic engagement. These findings provide preliminary support for the home-learning, telehealth-delivered BPT program in supporting families during the COVID pandemic.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12310-023-09569-y.

Diagnosis and treatment children and adolescents with autism and ADHD

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.

Effective but Not Feasible—What Support Staff in All-Day Primary Schools Think of Pedagogical Interventions with Regard to Children with ADHD

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.

Family-based treatments for attention-deficit/hyperactivity disorder: A review of family functioning outcomes in randomized controlled trials from 2010 to 2019

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.

Combined Treatment for Children with Attention-Deficit/Hyperactivity Disorder: Brief History, the Multimodal Treatment for Attention-Deficit/Hyperactivity Disorder Study, and the Past 20 Years of Research

Decades of research support 3 interventions for youth with attention-deficit/hyperactivity disorder (ADHD): behavioral intervention, stimulant medication, and their combination. However, professional organizations have long disagreed regarding the best approach for implementing evidence-based interventions for ADHD in practice. The accompanying Society of Developmental and Behavioral Pediatrics guidelines for complex ADHD provide a framework for initiating treatment with behavioral intervention and adding stimulant medication as necessary, resulting in combined/multimodal treatment for many, if not most, children. In this special article, we review the extant literature on combined treatment, with special emphasis on the past 15 years of research that have led to the recommendation for this approach. Specifically, we review the literature on dosing and sequencing of multimodal treatment for youth with ADHD and the impact of multimodal interventions on areas of functional impairment. The extant research provides clear support for a psychosocial-first approach in treating youth with complex ADHD.

A school-based parenting program for children with attention-deficit/hyperactivity disorder: Impact on paternal caregivers

Engaging male caregivers within school settings is a major need within the educational field. Paternal engagement may be particularly important for children with attention-deficit/hyperactivity disorder (ADHD). Children with ADHD have increased risk for a number of poor educational outcomes, which may be attenuated by the benefits of positive male caregiver involvement. The Coaching Our Acting Out Children: Heightening Essential Skills (COACHES) program has been illustrated to be an effective approach for engaging, retaining, and improving the parenting of male caregivers of children with ADHD in clinical settings. The present study reports on the efficacy of the COACHES in Schools program, an adaptation intended for deployment in elementary school settings. Sixty-one male caregivers were randomly assigned to COACHES in Schools or a waitlist control. Results indicated that male caregivers in COACHES in Schools used significantly more praise and less negative talk in a parent-child activity relative to male caregivers in the waitlist control at post-treatment and one-month follow-up. Distal outcomes related to child behavior at home and at school were not significantly different. Implications of the results for future studies and continued efforts to engage male caregivers within school settings are discussed.

Knowledge and Feelings of Competence with Regard to ADHD Among Support Staff in All-Day Primary Schools

(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.

Z-Score Neurofeedback and Heart Rate Variability Training for Adults and Children with Symptoms of Attention-Deficit/Hyperactivity Disorder: A Retrospective Study

ADHD is a common condition that causes suffering for those affected and economic loss for society at large. The current standard treatment for ADHD includes stimulant medications, which are not effective for all patients, may include side effects, and can be non-medically misused. Z-score neurofeedback (NFB) and heart rate variability (HRV) biofeedback are alternative treatment strategies that have been associated with Attention-Deficit/Hyperactivity Disorder (ADHD) symptom improvement. We utilized a retrospective pre-post study design to quantify the change in clients' ADHD symptoms after combined NFB + HRV treatment (which included simultaneous z-score training at four sites). We also assessed whether relevant physiological measures changed in accordance with the protocol, which would be consistent with effective NFB + HRV training. Adults (n = 39) and children (n = 100) with Borderline or Clinical ADHD classifications by the Achenbach System of Empirically Based Assessment (ASEBA) received 30 sessions of NFB + HRV training. Measures were compared before and after treatment for the ASEBA, the Integrated Visual and Auditory Continuous Performance Test (IVA), ADHD medication use, HRV and breathing parameters, and quantitative electroencephalogram (QEEG) parameters. Average ASEBA Attention-Deficit/Hyperactive Problems score improved after treatment for adults and children (p < 0.0001), with Cohen effect sizes (dz) of -1.21 and -1.17, respectively. 87.2% of adults and 80.0% of children experienced improvements of a magnitude greater than or equal to the Minimal Clinically Important Difference. After treatment, 70.8% of adults and 52.8% of children who began in the ASEBA Clinical range, and 80.0% of adults and 63.8% of children who began in the ASEBA Borderline range, were classified in the Normal range. IVA scores also improved after treatment. Changes in HRV and breathing pattern after treatment were consistent with the protocol. QEEG parameters after treatment were closer to the age-based normative mean, which is consistent with effective z-score NFB training.

Randomized Trial of First-Line Behavioral Intervention to Reduce Need for Medication in Children with ADHD

A study conducted in an analogue summer treatment setting showed that when concurrently receiving behavioral intervention, many children with Attention-Deficit Hyperactivity Disorder (ADHD) did not need medication or maximized responsiveness at very low doses. The present study followed participants in that summer study into the subsequent school year to investigate whether the same pattern would extend to the natural school and home settings. There were 127 unmedicated children with ADHD between the ages of 5 and 13 who were randomly assigned to receive or not receive behavioral consultation (BC) at the start of the school year. Children were evaluated by teachers and parents each week to determine if central nervous system stimulant treatment was needed. Children who received BC were approximately half as likely those who did not (NoBC) to initiate medication use each week at school or home and used lower doses when medicated at school. This produced a 40% reduction in total methylphenidate exposure over the course of the school year. BC and NoBC groups did not significantly differ on end-of-year teacher or parent ratings of behavior, which were positive. Moreover, BC and NoBC groups did not significantly differ in cost of treatment; although children in the BC condition accrued additional costs via the BC, these costs were offset by the associated delay and reduction in medication use. Results add to a growing literature suggesting that the use of low-intensity behavioral intervention as a first-line treatment reduces or eliminates the need for medication in children with ADHD.