Organizational skills training for children with ADHD: study protocol for a randomized, controlled trial

A Randomized Controlled Trial of the Effects of Organizational Skills Training on Children With Attention Deficit Hyperactivity Disorder in China

BACKGROUND

In addition to attention and hyperactivity problems, children with attention deficit hyperactivity disorder (ADHD) have poorer organizational skills needed to manage time and materials. This study examines the improvement of organizational skills in children with ADHD by studying organizational skills training (OST).

METHODS

This was a prospective, randomized controlled trial. Between September 2023 and January 2024, 70 children with a diagnosis of ADHD and at least one domain of executive dysfunction (EF) were divided into two groups. The conventional group was treated with medication, biofeedback, and behavioral interventions based on the children's actual condition. The OST group received OST in addition to the conventional group.

RESULTS

The mean age of the children was 8.33 ± 1.62 years. A total of 66 children completed the intervention and follow-up, 32 in the conventional group and 34 in the OST group. There were no differences between the two groups of children in terms of their preintervention scores on the BRIEF, SNAP-IV, or IVA-CPT. Postintervention scores on the behavioral scales decreased (p < .05), and IVA-CPT scores increased (p < .05) in both groups compared with those in the preintervention period. The OST group had a lower BRIEF (p = .019) and SNAP-IV Attention deficit subscale (p = .046) and a higher IVA-CPT Attention deficit Index (p = .032) than the conventional group after the intervention. The percentage of children with a normal BRIEF total score in the OST group was 79.41% (27/34) after the intervention, which was greater than the 37.50% (12/32) in the conventional group (p = .001). Compared with the OST group, children in the conventional group were at greater risk of having BRIEF scores that remained abnormal after the intervention. Analysis of covariance revealed a statistically significant effect of group (p = .008), preintervention BRIEF (p < .001), and participation score (p = .036) on postintervention BRIEF.

CONCLUSION

OST can further improve organizational skills in daily life in children with ADHD while improving core symptoms of attention deficit in addition to conventional treatment. The effect of OST on BRIEF is also influenced by the child's BRIEF status at the baseline level and the level of cooperation during the intervention.

TRIAL REGISTRATION

The randomized controlled trial registration number was ChiCTR2300075744.

Executive functioning in children with ADHD Investigating the cross-method correlations between performance tests and rating scales

Objective

Replicated evidence shows a weak or non-significant correlation between different methods of evaluating executive functions (EF). The current study investigates the association between rating scales and cognitive tests of EF in a sample of children with ADHD and executive dysfunction.

Method

The sample included 139 children (aged 6-13) diagnosed with ADHD and executive dysfunctions. The children completed subtests of the Cambridge Neuropsychological Test Automated Battery (CANTAB). Parents completed the Behavior Rating Inventory of Executive Function (BRIEF) and the Children's Organizational Skills Scale (COSS).

Analysis

Pairwise Spearman correlations were calculated between the composite and separate subscales of cognitive tests and rating scales. In secondary analyses, pairwise Spearman correlations were conducted between all composite scales and subscales, stratified by child sex and child ADHD subtype.

Results

The correlation analyses between composite scores yielded no significant correlations. The results when comparing CANTAB TO and BRIEF GE are r=-.095, p=.289, and r=.042, p=.643 when comparing CANTAB TO and COSS TO. The analyses between all composite scales and subscales found one significant negative correlation (r=-.25, p<.01). There are significant cross-method differences when stratified by the ADHD-Inattentive subtype, showing significant negative correlations (moderate) between CANTAB and BRIEF composite (r=-.355, p=.014) and subscales.

Discussion

It is possible that the different methods measure different underlying constructs of EF. It may be relevant to consider the effects of responder bias and differences in ecological validity in both measurement methods.

Conclusion

The results found no significant correlations. The expectation in research and clinical settings should not be to find the same results when comparing data from cognitive tests and rating scales. Future research might explore novel approaches to EF testing with a higher level of ecological validity, and designing EF rating scales that capture EF behaviors more so than EF cognition.

Identifying and removing ableism from Tier 1 school-wide positive behaviour support practices

Across Australia, almost one third of schools have been trained to implement school-wide positive behaviour support (SWPBS). As part of a Tier 1 approach, students are expected to demonstrate expected behaviours. By defining these behaviours in conjunction with students and families, and explicitly teaching these to students, schools implementing SWPBS can create climates where students can thrive both academically and behaviourally. However, many students with disability continue to be over-represented in discipline data in all schools, including those implementing SWPBS. We argue this is because defining the behaviours we want to see and celebrate is only part of the solution. Implementation is destined to fail if we do not, in tandem, address the conditions we created that act as barriers for students with disability. Further, through an analysis of Australian SWPBS matrices, we show that structural ableism exists in the way some expected behaviours are framed by requiring a greater response effort from students with disability if they are to meet the standard expected. We offer suggestions for schools to both recognise and remove ableism from Tier 1 SWPBS practices.

A Paradigm for Targeting Functional Impairment as an Outcome in Attention-Deficit/Hyperactivity Disorder

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.

Childhood ADHD, Going Beyond the Brain: A Meta-Analysis on Peripheral Physiological Markers of the Heart and the Gut

Attention-Deficit/Hyperactivity Disorder (ADHD) is the most common neurodevelopmental disorder diagnosed in children. Questions regarding its increased diagnostic rates and pharmacological treatments in developing children have led to a more holistic review of the multi-system pathophysiology observed in ADHD. The dopaminergic neurotransmitter system, known for its influence on reward-motivated behaviors and motor control, and the frontostriatal systems, that mediate motor, cognition, and behavior, are associated with ADHD's development. However, studies have shown that these neural systems do not wholly account for ADHD's multilayered and heterogeneous symptom presentation. For instance, the literature suggests that emotional dysregulation, the inability to regulate one's emotional responses to provoking stimuli, is associated with increased risk for social impairment in ADHD. A broader examination of physiological systems in children with ADHD has found potential markers in the heart-brain and gut-brain axes that correspond with certain behaviors associated with emotional dysregulation in recent studies. Hence, the purpose of this meta-analysis is to aggregate ten applicable published case studies and analyze task-related heart rate reactivity (HRR; n = 5 studies) and gut microbiota (n = 5 studies) data in children with and without ADHD. Data from a total of 531 youth with ADHD and 603 youth without ADHD revealed significant small and medium effect sizes for higher Chao1 levels and Actinobacteria levels in the ADHD group, respectively, but no evidence of altered task-related HRR. Thus, further research into multi-system psychophysiological measures of emotional dysregulation and ADHD is warranted. The clinical, empirical, and educational implications of these findings are discussed.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/prospero/, identifier PROSPERO (CRD42021236819).