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Al-Saoud S, Nichols ES, Brossard-Racine M, Wild CJ, Norton L, Duerden EG. A transdiagnostic examination of cognitive heterogeneity in children and adolescents with neurodevelopmental disorders. Child Neuropsychol 2024:1-19. [PMID: 38863216 DOI: 10.1080/09297049.2024.2364957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 06/02/2024] [Indexed: 06/13/2024]
Abstract
Children and adolescents with neurodevelopmental disorders demonstrate extensive cognitive heterogeneity that is not adequately captured by traditional diagnostic systems, emphasizing the need for alternative assessment and classification techniques. Using a transdiagnostic approach, a retrospective cohort study of cognitive functioning was conducted using a large heterogenous sample (n = 1529) of children and adolescents 7 to 18 years of age with neurodevelopmental disorders. Measures of short-term memory, verbal ability, and reasoning were administered to participants with attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), comorbid ADHD/ASD, and participants without neurodevelopmental disorders (non-NDD) using a 12-task, web-based neurocognitive testing battery. Unsupervised machine learning techniques were used to create a self-organizing map, an artificial neural network, in conjunction with k-means clustering to identify data-driven subgroups. The study aims were to: 1) identify cognitive profiles in the sample using a data-driven approach, and 2) determine their correspondence with traditional diagnostic statuses. Six clusters representing different cognitive profiles were identified, including participants with varying forms of cognitive impairment. Diagnostic status did not correspond with cluster-membership, providing evidence for the application of transdiagnostic approaches to understanding cognitive heterogeneity in children and adolescents with neurodevelopmental disorders. Additionally, the findings suggest that many typically developing participants may have undiagnosed learning difficulties, emphasizing the need for accessible cognitive assessment tools in school-based settings.
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Affiliation(s)
- Sarah Al-Saoud
- Applied Psychology, Faculty of Education, Western University, London, Ontario, Canada
| | - Emily S Nichols
- Applied Psychology, Faculty of Education, Western University, London, Ontario, Canada
- Western Institute for Neuroscience, Western University, London, Ontario, Canada
| | - Marie Brossard-Racine
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Conor J Wild
- Western Institute for Neuroscience, Western University, London, Ontario, Canada
- Physiology and Pharmacology, Western University, London, Ontario, Canada
| | - Loretta Norton
- Psychology, King's University College, Western University, London, Ontario, Canada
| | - Emma G Duerden
- Applied Psychology, Faculty of Education, Western University, London, Ontario, Canada
- Western Institute for Neuroscience, Western University, London, Ontario, Canada
- Neuroscience, Schulich School of Medicine and Dentistry, Western University, London, Canada
- Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, Canada
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Bassi D, Moro C, Orrù L, Turchi GP. Pupils' inclusion as a process of narrative interactions: tackling ADHD typification through MADIT methodology. BMC Psychol 2024; 12:281. [PMID: 38773668 PMCID: PMC11106906 DOI: 10.1186/s40359-024-01767-w] [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] [Received: 11/27/2023] [Accepted: 05/05/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND ADHD is the most common childhood neurodevelopmental disorder. The symptomatology makes the management of ADHD particularly demanding in school, so teachers' training programs have been widely implemented. Nevertheless, these interventions could lead teachers to concentrate on the dysfunctional elements of these students, exposing them to the risk of stigmatisation. Conceptualising stigma and inclusion as narrative processes, the present study observed how teacher ADHD training texts, endorsed by the Italian government, impact on the inclusion process of students. METHODS The research analysed a corpus of N = 31,261 text occurrences and focused on three areas: (1) ADHD as a clinical condition; (2) the impact of ADHD characteristics in the scholastic setting; (3) interventions to manage ADHD criticalities in school settings. To observe the interactive processes fostered by the narratives under scrutiny, we used Dialogic Science and MADIT methodology, since they allow us to measure the language use modalities through an index: the Dialogical Weight (dW). The value of dW ranges between 0.1 (min) and 0.9 (max) and is linked to the potential outcomes of inclusion for students with ADHD. A low dW accounts for narratives entrenched in personal beliefs presented as absolute truths, undermining inclusion of students with ADHD. In contrast, high dW signals language interaction relying on sharable elements, able to foster social unity and diminish stigma. RESULTS The results yielded a critical discursive configuration, both in general and for the three distinct areas. We measured an overall Dialogical Weight of 0.4dW and, for the three areas (1) = 0.3dW; (2) = 0.3dW; (3) = 0.4dW. The analysed text does not maximise the triggering of inclusive interactions, as they rely on individual references and present one's narrative as the sole plausible perspective: reinforcing already existing positions and exposing to the risk of stereotyping of the pupils. CONCLUSIONS The study highlighted how the ADHD training materials analysed, focusing on a purely informational and clinical approach, lose in effectiveness with respect to generating inclusive school settings. Finally, to promote the inclusion of these pupils, elements are offered for outlining an approach based on fostering active participation by all roles involved.
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Affiliation(s)
- Davide Bassi
- Centro Singular de Investigación en Tecnoloxías Intelixentes (CiTIUS), Universidade de Santiago de Compostela, Santiago de Compostela, Spain
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Dekkers TJ, Luman M. Editorial: The need for more effective school-based youth mental health interventions. Child Adolesc Ment Health 2024; 29:1-3. [PMID: 38140899 DOI: 10.1111/camh.12688] [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] [Accepted: 11/30/2023] [Indexed: 12/24/2023]
Abstract
An important setting to detect youth mental health problems and provide interventions is the school context, but effective and affordable school-based interventions are scarce and implementation of the available evidence-based interventions is limited. In this editorial, we highlight three issues and propose a research agenda. First, we emphasize that many of the mental health interventions currently used in school settings lack a solid evidence base. Second, we outline that high-quality studies are needed to determine what works, for whom it works and under which circumstances. This includes insight into the most effective intervention elements, subgroups of students who profit more or less from these interventions, and the most effective modes of delivery. These questions should drive our research agenda on school-based mental health interventions. Finally, while answering these pivotal questions, a collaborative multidisciplinary effort should be made to implement school-based interventions with a solid evidence base, which involves, among others, studying how this can be done most effectively.
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Affiliation(s)
- Tycho J Dekkers
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Accare Child Study Center, Groningen, The Netherlands
- Levvel, Academic Center for Child and Adolescent Psychiatry, Amsterdam, The Netherlands
- Department of Child and Adolescent Psychiatry, Amsterdam University Medical Centers (AUMC), Amsterdam, The Netherlands
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Marjolein Luman
- Levvel, Academic Center for Child and Adolescent Psychiatry, Amsterdam, The Netherlands
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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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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Lawson GM, Owens JS, Mandell DS, Tavlin S, Rufe S, Lyon AR, Eiraldi R, Power TJ. Implementation resources to support teachers' use of behavioral classroom interventions: protocol of a randomized pilot trial. Pilot Feasibility Stud 2023; 9:151. [PMID: 37626422 PMCID: PMC10463490 DOI: 10.1186/s40814-023-01381-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 07/19/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Teacher-delivered behavioral classroom management interventions are effective for students with or at-risk for attention-deficit/hyperactivity disorder (ADHD) or other disruptive behavior challenges, but they can be difficult for teachers to use in the classroom. In this study, we will pilot test a package of implementation strategies to support teachers in using behavioral classroom interventions for students with ADHD symptoms. METHODS We will use a 2-group, randomized controlled trial to compare outcomes for teachers who receive Positive Behavior Management Implementation Resources (PBMIR), a theory and data-driven implementation resource package designed to increase teacher implementation of behavioral classroom management interventions, with those who do not receive this additional implementation support. We will measure teacher implementation outcomes (e.g., observed fidelity to behavioral classroom interventions) and student clinical outcomes (e.g., ADHD-related impairment, ADHD symptoms, student-teacher relationship, academic performance) before and after an 8-week intervention period for both groups; we will also measure teacher-reported acceptability, appropriateness, and feasibility for the PBMIR group following the intervention period. DISCUSSION If there is preliminary evidence of feasibility and effectiveness, this pilot study will provide the foundation for evaluation the PBMIR at a larger scale and the potential to improve outcomes for students with or at risk for ADHD. TRIAL REGISTRATION This clinical trial was registered at ClinicalTrials.gov. ( https://clinicaltrials.gov/ ) on 8/5/2022 which was prior to the time of first participant enrollment. The registration number is: NCT05489081.
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Affiliation(s)
- Gwendolyn M Lawson
- Children's Hospital of Philadelphia, Philadelphia, USA.
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.
| | | | - David S Mandell
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | | | - Steven Rufe
- Rufe Educational Consulting, LLC, Schwenksville, PA, USA
| | - Aaron R Lyon
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
| | - Ricardo Eiraldi
- Children's Hospital of Philadelphia, Philadelphia, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Thomas J Power
- Children's Hospital of Philadelphia, Philadelphia, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
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Kim SC, Lee H, Lee HS, Kim G, Song JH. Adjuvant Therapy for Attention in Children with ADHD Using Game-Type Digital Therapy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14982. [PMID: 36429699 PMCID: PMC9690113 DOI: 10.3390/ijerph192214982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/07/2022] [Accepted: 11/09/2022] [Indexed: 06/16/2023]
Abstract
Children diagnosed with attention deficit hyperactivity disorder (ADHD) require early intervention and sustained treatment. This study used a game-based digital treatment planning NeuroWorld DTx to analyze the impact on attention and cognitive function in children with ADHD. Thirty children diagnosed with ADHD were recruited and subjected to a four-week NeuroWorld DTx digital treatment. To assess the impact of the digital therapeutic therapy on children's attention, we used the comprehension attention test (CAT) and Korean ADHD Rating Scale (K-ARS). Clinical global impression (CGI) and the Korean-child behavior checklist (K-CBCL 6-18) were used to examine the degree of improvement in ADHD. After four weeks, significant differences in the sensitivity and response style indices were noted, as compared with the baseline in the CAT test; in the case of K-ARS and CGI, a moderate decrease in ADHD was confirmed. The study achieved better results for the "total behavior problems" belonging to the K-CBCL assessment. Game-based digital therapy intervention can be a treatment method that elicits interest and satisfaction in children with ADHD and can be used as an adjunct to drug therapy to improve the quality of life and strengthen attention in children with symptoms of ADHD.
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Affiliation(s)
- Seon-Chil Kim
- Department of Biomedical Engineering, School of Medicine, Keimyung University, 1095 Dalgubeol-daero, Daegu 42601, Republic of Korea
| | - Hojun Lee
- Department of Psychiatry, Keimyung University Dongsan Medical Center, Daegu 42601, Republic of Korea
- Department of Psychiatry, School of Medicine, Keimyung University, Daegu 42601, Republic of Korea
| | - Hyun-Suk Lee
- Woori Children’s Development Clinic, Affiliated with Woori Soft, 175, Wolbae-ro, Dalseo-gu, Daegu 42781, Republic of Korea
| | - Gaeun Kim
- College of Nursing, Keimyung University, Daegu 42601, Republic of Korea
| | - Jeong-Heon Song
- Woorisoft Inc., 175, Wolbae-ro, Dalseo-gu, Daegu 42781, Republic of Korea
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Staff AI, Oosterlaan J, van der Oord S, de Swart F, Imeraj L, van den Hoofdakker BJ, Luman M. Teacher Feedback, Student ADHD Behavior, and the Teacher–Student Relationship: Are These Related? SCHOOL MENTAL HEALTH 2022. [DOI: 10.1007/s12310-022-09550-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractThis cross-sectional study aimed to compare positive and corrective teacher feedback toward children with attention-deficit/hyperactivity disorder (ADHD) and typically developing children, and to examine whether the quality of the teacher–student relationship moderated associations between child behavior and teacher feedback. We observed and coded classroom ADHD behaviors of 55 children with ADHD and 34 typically developing children (TDC; 6–12 years), as well as the levels of positive and corrective teacher feedback they received. Teachers rated closeness and conflict using the Student–Teacher Relationship Scale in the ADHD group. Multilevel analyses revealed that teachers provided significantly more corrective feedback to children in the ADHD compared to the TDC group. Children in the ADHD group received more corrective than positive feedback, but this pattern was reversed for the TDC group. Multiple regression analyses in the ADHD group indicated that lower levels of positive feedback were related to higher levels of motor hyperactivity. Higher levels of corrective feedback were associated with higher levels of verbal hyperactivity. Closeness moderated this association: Corrective feedback was related to levels of verbal hyperactivity only if teachers experienced less closeness in the relationship with the child. None of the other moderation effects were significant. Teachers provided more corrective feedback to children with ADHD than to typically developing children, and teacher feedback toward children with ADHD was associated with levels of hyperactivity. A close teacher–student relationship may serve as protective factor for the receipt of corrective feedback in this group, but experimental studies are needed to confirm this hypothesis.
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Hornstra R, Groenman AP, van der Oord S, Luman M, Dekkers TJ, van der Veen-Mulders L, Hoekstra PJ, van den Hoofdakker BJ. Review: Which components of behavioral parent and teacher training work for children with ADHD? - a metaregression analysis on child behavioral outcomes. Child Adolesc Ment Health 2022; 28:258-268. [PMID: 35417075 DOI: 10.1111/camh.12561] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/13/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND This metaregression analysis examined which behavioral techniques that are commonly used in behavioral parent and teacher training programs for children with attention-deficit/hyperactivity disorder (ADHD) were related to program effectiveness on children's behavioral outcomes. METHODS We included 32 randomized controlled trials (N = 2594 children) investigating behavioral parent training, teacher training, or a combination, in children with ADHD under 18 years. Outcomes were symptom counts of total ADHD, inattention, and hyperactivity-impulsivity and behavioral problems. The dosage of techniques was extracted from the intervention manuals. Metaregression was used to assess which techniques and intervention characteristics (setting, delivery method, duration, and home-school collaboration) were associated with intervention effectiveness. RESULTS Higher dosage of psycho-education for parents was associated with smaller effects on behavioral problems and, only in case of parent training, also with smaller effects on ADHD symptoms. Higher dosage of teaching parents/teachers to use negative consequences was associated with larger effects on behavioral problems. Individual training compared with group training was associated with larger effects on ADHD and hyperactivity-impulsivity symptoms. CONCLUSIONS This study provides first insights into the specific techniques that are essential in behavioral parent and teacher training programs for children with ADHD. This knowledge can eventually be used to improve and tailor interventions.
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Affiliation(s)
- Rianne Hornstra
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Annabeth P Groenman
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Saskia van der Oord
- Clinical Psychology, KU Leuven, Leuven, Belgium.,Developmental Psychology, Faculty of Social and Behavioral Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Marjolein Luman
- Department of Clinical, Developmental and Neuropsychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Tycho J Dekkers
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Developmental Psychology, Faculty of Social and Behavioral Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Lianne van der Veen-Mulders
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Pieter J Hoekstra
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Barbara J van den Hoofdakker
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
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Dekkers TJ, Hornstra R, van der Oord S, Luman M, Hoekstra PJ, Groenman AP, van den Hoofdakker BJ. Meta-analysis: Which Components of Parent Training Work for Children With Attention-Deficit/Hyperactivity Disorder? J Am Acad Child Adolesc Psychiatry 2022; 61:478-494. [PMID: 34224837 DOI: 10.1016/j.jaac.2021.06.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 06/02/2021] [Accepted: 06/25/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Behavioral parent training is an evidence-based intervention for children with attention-deficit/hyperactivity disorder (ADHD), but it is unknown which of its components are most effective. This meta-regression analysis investigated which specific behavioral techniques that parents learn in parent training are associated with effects on parental outcomes. METHOD A search was performed for randomized controlled trials on parent training for children with ADHD, with positive parenting, negative parenting, parenting sense of competence, parent-child relationship quality, and parental mental health as outcome measures. After screening 23,026 publications, 29 studies contributing 138 effect sizes were included (N = 2,345). For each study, the dosage of 39 behavioral techniques was derived from intervention manuals, and meta-regression determined which techniques were related to outcomes. RESULTS Parent training had robust small- to medium-sized positive effects on all parental outcomes relative to control conditions, both for unblinded and probably blinded measures. A higher dosage of techniques focusing on the manipulation of antecedents of behavior was associated with better outcomes on parenting sense of competence and parental mental health, and a higher dosage of techniques focusing on reinforcement of desired behaviors was related to larger decreases in negative parenting. Higher dosages of psychoeducation were negatively related to parental outcomes. CONCLUSION Although techniques were not investigated in isolation, the results suggested that manipulation of antecedents of behavior and reinforcement techniques are key components of parent training for children with ADHD in relation to parental outcomes. These exploratory findings may help to strengthen and tailor parent training interventions for children with ADHD.
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Affiliation(s)
- Tycho J Dekkers
- University of Groningen, the Netherlands; University of Amsterdam, the Netherlands; Levvel, Academic Center for Child- and Adolescent Psychiatry and Specialized Youthcare, Amsterdam, the Netherlands; Amsterdam University Medical Center, the Netherlands.
| | | | - Saskia van der Oord
- University of Amsterdam, the Netherlands; KU Leuven, Research Group Clinical Psychology, Belgium
| | - Marjolein Luman
- Levvel, Academic Center for Child- and Adolescent Psychiatry and Specialized Youthcare, Amsterdam, the Netherlands; Vrije Universiteit Amsterdam, the Netherlands
| | | | - Annabeth P Groenman
- University of Groningen, the Netherlands; University of Amsterdam, the Netherlands
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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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Staff AI, Oosterlaan J, Oord S, Königs M, Hoofdakker BJ, Luman M. Child neurocognitive functioning influences the effectiveness of specific techniques in behavioral teacher training for ADHD: Moderator analyses from a randomized controlled microtrial. JCPP ADVANCES 2021. [DOI: 10.1002/jcv2.12032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Anouck I. Staff
- Department of Clinical‐, Neuro‐, and Developmental Psychology Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Jaap Oosterlaan
- Department of Clinical‐, Neuro‐, and Developmental Psychology Vrije Universiteit Amsterdam Amsterdam The Netherlands
- Emma Neuroscience Group Department of Pediatrics Amsterdam Reproduction & Development Emma Children's Hospital Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
| | - Saskia Oord
- Faculty of Psychology and Educational Sciences KU Leuven Leuven Belgium
- Department of Developmental Psychology University of Amsterdam Amsterdam The Netherlands
| | - Marsh Königs
- Emma Neuroscience Group Department of Pediatrics Amsterdam Reproduction & Development Emma Children's Hospital Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
| | - Barbara J. Hoofdakker
- Department of Child and Adolescent Psychiatry University Medical Center Groningen University of Groningen Groningen The Netherlands
- Department of Clinical Psychology and Experimental Psychopathology University of Groningen Groningen The Netherlands
| | - Marjolein Luman
- Department of Clinical‐, Neuro‐, and Developmental Psychology Vrije Universiteit Amsterdam Amsterdam The Netherlands
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Conditional Learning Deficits in Children with ADHD can be Reduced Through Reward Optimization and Response-Specific Reinforcement. Res Child Adolesc Psychopathol 2021; 49:1165-1178. [PMID: 33792820 PMCID: PMC8322018 DOI: 10.1007/s10802-021-00781-5] [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] [Accepted: 01/31/2021] [Indexed: 12/04/2022]
Abstract
When children with ADHD are presented with behavioral choices, they struggle more than Typically Developing [TD] children to take into account contextual information necessary for making adaptive choices. The challenge presented by this type of behavioral decision making can be operationalized as a Conditional Discrimination Learning [CDL] task. We previously showed that CDL is impaired in children with ADHD. The present study explores whether this impairment can be remediated by increasing reward for correct responding or by reinforcing correct conditional choice behavior with situationally specific outcomes (Differential Outcomes). An arbitrary Delayed Matching-To-Sample [aDMTS] procedure was used, in which children had to learn to select the correct response given the sample stimulus presented (CDL). We compared children with ADHD (N = 45) and TD children (N = 49) on a baseline aDMTS task and sequentially adapted the aDMTS task so that correct choice behavior was rewarded with a more potent reinforcer (reward manipulation) or with sample-specific (and hence response-specific) reinforcers (Differential Outcomes manipulation). At baseline, children with ADHD performed significantly worse than TD children. Both manipulations (reward optimization and Differential Outcomes) improved performance in the ADHD group, resulting in a similar level of performance to the TD group. Increasing the reward value or the response-specificity of reinforcement enhances Conditional Discrimination Learning in children with ADHD. These behavioral techniques may be effective in promoting the learning of adaptive behavioral choices in children with ADHD.
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