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Merrill BM, Macphee FL, Burrows-MacLean L, Coles EK, Wymbs BT, Chacko A, Walker K, Wymbs F, Garefino A, Robb Mazzant J, Gnagy EM, Waxmonsky JG, Massetti GM, Waschbusch DA, Fabiano GA, Pelham WE. Single and Combined Effects of Multiple Intensities of Behavioral Modification and Methylphenidate for Children with ADHD in the Home Setting. Res Child Adolesc Psychopathol 2023; 51:1481-1495. [PMID: 37382748 PMCID: PMC11103974 DOI: 10.1007/s10802-023-01093-6] [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] [Accepted: 06/08/2023] [Indexed: 06/30/2023]
Abstract
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.
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Affiliation(s)
- Brittany M Merrill
- Center for Children and Families, Florida International University, Buffalo, NY, USA.
| | - Fiona L Macphee
- Center for Children and Families, Florida International University, Miami, FL, 33199, USA
| | | | - Erika K Coles
- Center for Children and Families, Florida International University, Miami, FL, 33199, USA
| | - Brian T Wymbs
- Department of Psychology, Ohio University, Athens, OH, USA
| | - Anil Chacko
- Department of Applied Psychology, Steinhardt School of Culture, Education and Human Development, New York University, New York, NY, USA
| | | | - Frances Wymbs
- Department of Primary Care, Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA
| | - Allison Garefino
- Department of Psychology, Kennesaw State University, Kennesaw, GA, USA
| | - Jessica Robb Mazzant
- Center for Children and Families, Florida International University, Miami, FL, 33199, USA
| | - Elizabeth M Gnagy
- Center for Children and Families, Florida International University, Miami, FL, 33199, USA
| | - James G Waxmonsky
- Department of Psychiatry, Pennsylvania State University Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Greta M Massetti
- State University of New York at Buffalo, Buffalo, NY, USA
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Daniel A Waschbusch
- Department of Psychiatry, Pennsylvania State University Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Gregory A Fabiano
- Center for Children and Families, Florida International University, Buffalo, NY, USA
| | - William E Pelham
- Center for Children and Families, Florida International University, Miami, FL, 33199, USA.
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Hudson JL, Minihan S, Chen W, Carl T, Fu M, Tully L, Kangas M, Rosewell L, McDermott EA, Wang Y, Stubbs T, Martiniuk A. Interventions for Young Children's Mental Health: A Review of Reviews. Clin Child Fam Psychol Rev 2023; 26:593-641. [PMID: 37488453 PMCID: PMC10465658 DOI: 10.1007/s10567-023-00443-6] [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] [Accepted: 06/25/2023] [Indexed: 07/26/2023]
Abstract
To determine the efficacy of intervention programs for young children (4-9 years) with emerging mental health needs, we conducted a review of meta-analytic and systematic reviews of the intervention literature. Of 41,061 abstracts identified and 15,076 screened, 152 review articles met the inclusion criteria. We reviewed interventions across multiple disciplines targeting: (1) general mental health concerns; (2) internalizing symptoms; (3) externalizing symptoms; (4) anxiety; (5) depression; (6) trauma; (7) symptoms of attention-deficit/hyperactivity disorder; and (8) mental health concerns associated with autism spectrum disorder. Substantial evidence was found for the efficacy of behavioral and cognitive behavioral interventions for general mental health concerns, externalizing symptoms (generally, as well as ADHD, conduct, and other behavioral symptoms) and internalizing symptoms (generally, as well as anxiety) aged 4-9 years. Emerging evidence was identified for interventions targeting trauma symptoms, depression symptoms, and social, emotional and behavioral symptoms in autism spectrum disorder in children aged 4-9 years. Currently there is only limited emerging evidence regarding non-behavioral or non-cognitive behavioral interventions for programs targeting children ages 4-9 years where the aim is to deliver an evidence-based program to improve child social, emotional and/or behavioral functioning. Given the recent rises in mental health needs reported in children, targeted behavioral-and/or cognitive behavior therapy-based interventions should be made widely available to children (and their families) who experience elevated symptoms.
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Affiliation(s)
- Jennifer L Hudson
- Black Dog Institute, University of New South Wales, Sydney, Australia.
| | - Savannah Minihan
- Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Wenting Chen
- Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Talia Carl
- Black Dog Institute, University of New South Wales, Sydney, Australia
- School of Psychology, University of Sydney, Sydney, Australia
| | - Michele Fu
- Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Lucy Tully
- School of Psychology, University of Sydney, Sydney, Australia
| | - Maria Kangas
- School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Linda Rosewell
- School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Emma A McDermott
- Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Yiwen Wang
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Thomas Stubbs
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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3
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Doffer DPA, Dekkers TJ, Hornstra R, van der Oord S, Luman M, Leijten P, Hoekstra PJ, van den Hoofdakker BJ, Groenman AP. Sustained improvements by behavioural parent training for children with attention-deficit/hyperactivity disorder: A meta-analytic review of longer-term child and parental outcomes. JCPP ADVANCES 2023; 3:e12196. [PMID: 37720584 PMCID: PMC10501699 DOI: 10.1002/jcv2.12196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 08/02/2023] [Indexed: 09/19/2023] Open
Abstract
Background Behavioural parent training is an evidence-based intervention for children with attention-deficit/hyperactivity disorder (ADHD), but little is known about the extent to which initial benefits are maintained. Aims This meta-analytic review investigated longer-term (i.e., more than 2 months post-intervention) child and parental outcomes of behavioural parent training for children with ADHD. Materials & Methods We searched for randomized controlled trials and examined ADHD symptoms, behavioural problems, positive parenting, negative parenting, parenting sense of competence, parent-child relationship quality, and parental mental health as outcomes. We included 27 studies (31 interventions; 217 effect sizes), used multilevel random-effects meta-analyses for between- and within-group comparisons (pre-intervention to follow-up and post-intervention to follow-up), and explored twelve predictors of change. Results Between pre-intervention and follow-up (M = 5.3 months), we found significant small-to-moderate between-group effects of the intervention on ADHD symptoms, behavioural problems, positive parenting, parenting sense of competence and parent-child relationship quality. Within-group findings show sustained improvements in the intervention conditions for all outcome domains. There were few significant changes from post-intervention to follow-up. Additionally, the large majority of the individual effect sizes indicated sustained outcomes from post-intervention to follow-up. There were seven significant predictors of change in child outcomes, including stronger reductions in ADHD symptoms of girls and behaviour problems of younger children. In contrast with some meta-analyses on short-term effects, we found no differences between masked and unmasked outcomes on ADHD symptoms at follow-up. Discussion & Conclusion We conclude that behavioural parent training has longer-term benefits for children's ADHD symptoms and behavioural problems, and for positive parenting behaviours, parenting sense of competence and quality of the parent-child relationship.
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Affiliation(s)
- Dominique P. A. Doffer
- Department of Child and Adolescent PsychiatryUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
- Accare Child Study CenterGroningenThe Netherlands
| | - Tycho J. Dekkers
- Department of Child and Adolescent PsychiatryUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
- Accare Child Study CenterGroningenThe Netherlands
- Levvel, Academic Center for Child and Adolescent PsychiatryAmsterdamThe Netherlands
- Department of PsychologyUniversity of AmsterdamAmsterdamThe Netherlands
- Department of Child and Adolescent PsychiatryAmsterdam University Medical Centers (AUMC)AmsterdamThe Netherlands
| | - Rianne Hornstra
- Department of Child and Adolescent PsychiatryUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
- Accare Child Study CenterGroningenThe Netherlands
| | - Saskia van der Oord
- KU LeuvenClinical PsychologyFaculty of Psychology and Educational SciencesLeuvenBelgium
| | - Marjolein Luman
- Levvel, Academic Center for Child and Adolescent PsychiatryAmsterdamThe Netherlands
- Department of Clinical, Neuro, and Developmental PsychologyVrije Universiteit AmsterdamAmsterdam Public Health Research InstituteAmsterdamThe Netherlands
| | - Patty Leijten
- University of AmsterdamResearch Institute of Child Development and EducationAmsterdamThe Netherlands
| | - Pieter J. Hoekstra
- Department of Child and Adolescent PsychiatryUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
- Accare Child Study CenterGroningenThe Netherlands
| | - Barbara J. van den Hoofdakker
- Department of Child and Adolescent PsychiatryUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
- Accare Child Study CenterGroningenThe Netherlands
- Department of Clinical Psychology and Experimental PsychopathologyUniversity of GroningenGroningenThe Netherlands
| | - Annabeth P. Groenman
- Department of Child and Adolescent PsychiatryUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
- Accare Child Study CenterGroningenThe Netherlands
- University of AmsterdamResearch Institute of Child Development and EducationAmsterdamThe Netherlands
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Pachiti I, Milienos FS, Dimitropoulou P. Child ViReal Support Program: A Randomized Controlled Trial Study for Effective Support of Parents Raising Children with Attention Deficits. Behav Sci (Basel) 2023; 13:691. [PMID: 37622831 PMCID: PMC10451949 DOI: 10.3390/bs13080691] [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] [Received: 06/30/2023] [Revised: 07/25/2023] [Accepted: 08/16/2023] [Indexed: 08/26/2023] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) results in various functioning impairments in children's lives and families. Parents of children with ADHD report high levels of parenting stress, low levels of parental self-efficacy, and use of more authoritarian and/or permissive parenting practices than parents of typically developing children. Intervention programs need to address both children's and parents' needs and multimodal intervention programs could cover this demand. The aim of this study was to examine the efficacy of "Child ViReal Support Program"-a multi-level evidence-based comprehensive program-on parenting stress, parental self-efficacy, parenting practices, and the core symptoms of children's ADHD. Families with a child diagnosed with ADHD (n = 16) were randomly allocated to two groups (PC and CP; P = parent training, C = child training), and a cross-over design was utilized. Participating parents completed, in four different times during the study, the Parenting Stress Index-Short Form, the Parenting Sense of Competence Scale, the Parenting Styles and Dimensions Questionnaire-Short Version, and the parent form of the ADHD Rating Scale-IV. Parents from both groups, after their participation in the parent training, demonstrated reduced parenting stress, enhanced parental self-efficacy, and increased the employ of democratic parenting practices. More than that, they reported decreased levels of inattention and impulsivity/hyperactivity for their children. Evidence-based multi-level intervention programs could produce positive effects on parents and children by incorporating effective methods and tools in accordance with the needs and the demands of the family context.
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Affiliation(s)
- Iouliani Pachiti
- Department of Psychology, University of Crete, 74150 Rethymno, Greece;
- Applied Psychology Laboratory, Center for Research and Studies, University of Crete, 74150 Rethymno, Greece
| | - Fotios S. Milienos
- Department of Sociology, Panteion University of Social and Political Sciences, 17671 Athens, Greece;
| | - Panagiota Dimitropoulou
- Department of Psychology, University of Crete, 74150 Rethymno, Greece;
- Applied Psychology Laboratory, Center for Research and Studies, University of Crete, 74150 Rethymno, Greece
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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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Doyle FL, Morawska A, Higgins DJ, Havighurst SS, Mazzucchelli TG, Toumbourou JW, Middeldorp CM, Chainey C, Cobham VE, Harnett P, Sanders MR. Policies are Needed to Increase the Reach and Impact of Evidence-Based Parenting Supports: A Call for a Population-Based Approach to Supporting Parents, Children, and Families. Child Psychiatry Hum Dev 2023; 54:891-904. [PMID: 34989941 PMCID: PMC8733919 DOI: 10.1007/s10578-021-01309-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/14/2021] [Indexed: 01/23/2023]
Abstract
Parents can be essential change-agents in their children's lives. To support parents in their parenting role, a range of programs have been developed and evaluated. In this paper, we provide an overview of the evidence for the effectiveness of parenting interventions for parents and children across a range of outcomes, including child and adolescent mental and physical health, child and adolescent competencies and academic outcomes, parental skills and competencies, parental wellbeing and mental health, and prevention of child maltreatment and family violence. Although there is extensive research showing the effectiveness of evidence-based parenting programs, these are not yet widely available at a population level and many parents are unable to access support. We outline how to achieve increased reach of evidence-based parenting supports, highlighting the policy imperative to adequately support the use of these supports as a way to address high priority mental health, physical health, and social problems.
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Affiliation(s)
- Frances L. Doyle
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW Australia
- School of Psychology, The MARCS Institute for Brain Behaviour and Development, Transforming Early Education and Child Health (TeEACH) Research Centre, Translational Health Research Institute, Western Sydney University, Sydney, NSW Australia
| | - Alina Morawska
- Parenting and Family Support Centre, School of Psychology, The University of Queensland, Brisbane, QLD Australia
| | - Daryl J. Higgins
- Institute of Child Protection Studies, Australian Catholic University, Melbourne, VIC, Australia
| | - Sophie S. Havighurst
- Mindful: Centre for Training and Research in Developmental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Trevor G. Mazzucchelli
- School of Psychology, Curtin University, Perth, WA Australia
- School of Psychology, The University of Queensland, Brisbane, QLD Australia
| | - John W. Toumbourou
- Centre for Social and Early Emotional Development, Deakin University, Geelong, VIC, Australia
| | - Christel M. Middeldorp
- Child Health Research Centre, The University of Queensland, Brisbane, QLD Australia
- Child and Youth Mental Health Service, Children’s Health Queensland Hospital and Health Service, Brisbane, QLD Australia
| | - Carys Chainey
- Parenting and Family Support Centre, School of Psychology, The University of Queensland, Brisbane, QLD Australia
| | - Vanessa E. Cobham
- School of Psychology, The University of Queensland, Brisbane, QLD Australia
- Child and Youth Mental Health Service, Children’s Health Queensland Hospital and Health Service, Brisbane, QLD Australia
| | - Paul Harnett
- School of Criminology and Criminal Justice, Griffith University, Brisbane, QLD, Australia
| | - Matthew R. Sanders
- Parenting and Family Support Centre, School of Psychology, The University of Queensland, Brisbane, QLD Australia
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Lawrence-Sidebottom D, Huffman LG, Huberty J, Beatty C, Roots M, Roots K, Parikh A, Guerra R, Weiser J. Using digital measurement-based care to address symptoms of inattention, hyperactivity, and opposition in youth: A retrospective analysis of Bend Health (Preprint). JMIR Form Res 2023; 7:e46578. [PMID: 37099379 PMCID: PMC10173032 DOI: 10.2196/46578] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/28/2023] [Accepted: 04/03/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) and associated behavioral disorders are highly prevalent in children and adolescents, yet many of them do not receive the care they need. Digital mental health interventions (DMHIs) may address this need by providing accessible and high-quality care. Given the necessity for high levels of caregiver and primary care practitioner involvement in addressing ADHD symptoms and behavioral problems, collaborative care interventions that adopt a whole-family approach may be particularly well suited to reduce symptoms of inattention, hyperactivity, and opposition in children and adolescents. OBJECTIVE The purpose of this study is to use member (ie, child and adolescent) data from Bend Health, Inc, a collaborative care DMHI that uses a whole-family approach to address child and adolescent mental health concerns, to (1) determine the effects of a collaborative care DMHI on inattention, hyperactivity, and oppositional symptoms in children and adolescents and (2) assess whether the effects of a collaborative care DMHI vary across ADHD subtypes and demographic factors. METHODS Caregivers of children and adolescents with elevated symptoms of inattention, hyperactivity, or opposition assessed their children's symptom severity approximately every 30 days while participating in Bend Health, Inc. Data from 107 children and adolescents aged 6-17 years who exhibited clinically elevated symptoms at baseline were used to assess symptom severity across monthly assessments (inattention symptom group: n=91, 85.0%; hyperactivity symptom group: n=48, 44.9%; oppositional symptom group: n=70, 65.4%). The majority of the sample exhibited elevated symptoms of at least 2 symptom types at baseline (n=67, 62.6%). RESULTS Members received care for up to 5.52 months and attended between 0 and 10 coaching, therapy, or psychiatry sessions through Bend Health, Inc. For those with at least 2 assessments, 71.0% (n=22) showed improvements in inattention symptoms, 60.0% (n=9) showed improvements in hyperactivity symptoms, and 60.0% (n=12) showed improvements in oppositional symptoms. When considering group-level change over time, symptom severity decreased over the course of treatment with Bend Health, Inc, for inattention (average decrease=3.51 points, P=.001) and hyperactivity (average decrease=3.07 points, P=.049) but not for oppositional symptoms (average decrease=0.70 points, P=.26). There was a main effect of the duration of care on symptom severity (P<.001) such that each additional month of care was associated with lower symptom scores. CONCLUSIONS This study offers promising early evidence that collaborative care DHMIs may facilitate improvements in ADHD symptoms among children and adolescents, addressing the growing need for accessible and high-quality care for behavioral health problems in the United States. However, additional follow-up studies bolstered by larger samples and control groups are necessary to further establish the robustness of these findings.
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Affiliation(s)
| | | | - Jennifer Huberty
- Bend Health, Inc., Madison, WI, United States
- FitMinded, Inc. LLC, Phoenix, AZ, United States
| | | | | | - Kurt Roots
- Bend Health, Inc., Madison, WI, United States
| | - Amit Parikh
- Bend Health, Inc., Madison, WI, United States
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Lussier-Desrochers D, Massé L, Simonato I, Lachapelle Y, Godin-Tremblay V, Lemieux A. Evaluation of the Effect of a Serious Game on the Performance of Daily Routines by Autistic and ADHD Children. ADVANCES IN NEURODEVELOPMENTAL DISORDERS 2023; 7:1-13. [PMID: 36777795 PMCID: PMC9896450 DOI: 10.1007/s41252-023-00319-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/22/2023] [Indexed: 06/18/2023]
Abstract
Objectives Learning and performing new routines are difficult for children with neurodevelopmental disorders. Studies have shown that consistency in child reinforcement and parental support are effective. For example, digital solutions such as serious games can be used to support parents and children in developing these life skills. The objective of this study was to evaluate the effect of a serious game on the performance of daily routines by autistic and ADHD children. Methods A total of 201 families (parents and children) participated in the study. The study used a combined 3 (intervention) × 3 (diagnosis) × 3 (time) research design with repeated measures. Participants were randomly assigned to three intervention groups (serious game, parental support, and a combination of serious game and parental support) based on their diagnosis (ASD, ADHD, neurotypical). Latent growth modeling and repeated ANOVAS were performed to analyze routine scores collected at three moments (baseline, midpoint, persistence) over an 8-week period. Results Results show a moderating effect of diagnosis on child routine trajectory. For ADHD participants, we observed a very important significant clinical effect for two interventions (parental support alone and combination of serious game and parental support) where for ASD children, this effect is observed for only one treatment (combination of serious game and parental support). For neurotypical children, results indicate a very important and significant clinical effect when they use the serious game alone. Conclusions Results show that the serious game can improve children's routines. However, for some neurodevelopmental profiles (ASD or ADHD), the addition of parental support produces greater clinical improvements.
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Affiliation(s)
- Dany Lussier-Desrochers
- Department of Psychoeducation, Université du Québec à Trois-Rivières, 3351 boulevard des Forges, Trois-Rivières, Québec, G8Z 4M3 Canada
| | - Line Massé
- Department of Psychoeducation, Université du Québec à Trois-Rivières, 3351 boulevard des Forges, Trois-Rivières, Québec, G8Z 4M3 Canada
| | - Isabelle Simonato
- Department of Psychoeducation, Université du Québec à Trois-Rivières, 3351 boulevard des Forges, Trois-Rivières, Québec, G8Z 4M3 Canada
| | - Yves Lachapelle
- Department of Psychoeducation, Université du Québec à Trois-Rivières, 3351 boulevard des Forges, Trois-Rivières, Québec, G8Z 4M3 Canada
| | - Valérie Godin-Tremblay
- Centre on Psychosocial Intervention at the Integrated University Health and Social Services Centre (CIUSSS) in Saguenay–Lac-Saint-Jean, Québec, Canada
| | - Annie Lemieux
- Department of Psychoeducation, Université du Québec à Trois-Rivières, 3351 boulevard des Forges, Trois-Rivières, Québec, G8Z 4M3 Canada
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9
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Lee YC, Chen CR, Lin KC. Effects of Mindfulness-Based Interventions in Children and Adolescents with ADHD: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15198. [PMID: 36429915 PMCID: PMC9690476 DOI: 10.3390/ijerph192215198] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 06/16/2023]
Abstract
(1) Objectives: Mindfulness-based interventions have been receiving more attention in research for children with attention deficit hyperactivity disorder (ADHD). This systematic review and meta-analysis was conducted to synthesize the findings of randomized controlled trials of mindfulness-based interventions for children with ADHD. (2) Methods: A systematic review and meta-analysis of studies published in PsycINFO, PubMed, and Google Scholar was completed from the earliest available date until August 2022. (3) Results: The systematic review included 12 studies that met the inclusion criteria, and the meta-analysis included 11 studies. The overall effect sizes were g = 0.77 for ADHD symptoms, g = 0.03 for externalizing behavior problem, g = 0.13 for internalizing behavior problem, g = 0.43 for mindfulness, and g = 0.40 for parental stress for children with ADHD. (4) Conclusion: The results of this systematic review highlight the possible benefits of mindfulness-based interventions for children with ADHD.
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Affiliation(s)
- Yi-Chen Lee
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Chyi-Rong Chen
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei 100, Taiwan
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
| | - Keh-Chung Lin
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei 100, Taiwan
- Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei 100, Taiwan
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10
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Recommendations for Diversifying Racial and Ethnic Representation in Autism Intervention Research: A Crossover Review of Recruitment and Retention Practices in Pediatric Mental Health. J Clin Med 2022; 11:jcm11216468. [PMID: 36362698 PMCID: PMC9654487 DOI: 10.3390/jcm11216468] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/20/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022] Open
Abstract
Disparities in diagnosis and access to healthcare and therapeutic services are well-documented for children with autism spectrum disorder (ASD) from minoritized races and ethnicities, but there is little empirical research to guide the selection and implementation of interventions and practices that will effectively support racially/ethnically diverse children with ASD and their families. This cross-over systematic review summarizes parent-mediated intervention research of children with or at risk for mental health disorders to identify potentially effective recruitment and retention strategies for diverse participants in parent-mediated intervention research for children with autism. Electronic database keyword, lead author name searches in PyschNet, MEDLINE, and ancestral searches were conducted to identify 68 relevant articles that used experimental designs to evaluate the effects of parent-mediated interventions on children with or at risk for mental health disorders. Articles were coded for participant demographics; intervention setting and type, recruitment and retention strategies, cultural adaptation of intervention, and reported attrition. Findings are discussed and applied to practices in autism parent-mediated intervention research. Suggestions for future research and limitations are discussed.
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Berger U, Lebowitz E. Parent training for dependent, yet abled, young adults. Bull Menninger Clin 2022; 86:249-281. [PMID: 36047938 DOI: 10.1521/bumc.2022.86.3.249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The term Failure to launch (FTL) has been used to describe abled adults who do not work, do not attend school, and live with- and at the expense of-their parents. FTL can be beneficially addressed through parent training, a treatment method that is rarely used with adults (i.e., individuals past the age of majority). The authors first review the goals of parent training programs offered to parents of adults. The review demonstrates that these goals dovetail with key aspects of FTL. The authors then describe a new parent training approach for parents of individuals with FTL, based on SPACE (Supportive Parenting for Anxious Childhood Emotions). They highlight five key components of SPACE-FTL: Psychoeducation, Reducing Parental Accommodation, Increasing Parental Support, De-Escalation, and Engaging Supporters. The authors conclude by discussing SPACE-FTL in relation and comparison to other parent training programs and their components.
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Affiliation(s)
- Uri Berger
- Anxiety and Mood Disorders Program, Child Study Center, Yale University, New Haven, Connecticut
| | - Eli Lebowitz
- Anxiety and Mood Disorders Program, Child Study Center, Yale University, New Haven, Connecticut
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12
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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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13
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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: 23] [Impact Index Per Article: 11.5] [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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14
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Hornstra R, Dekkers TJ, Bosmans G, van den Hoofdakker B, van der Oord S. Attachment Representation Moderates the Effectiveness of Behavioral Parent Training Techniques for Children with ADHD: Evidence from a Randomized Controlled Microtrial. Res Child Adolesc Psychopathol 2022; 50:1151-1164. [PMID: 35362776 PMCID: PMC9525431 DOI: 10.1007/s10802-022-00921-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2022] [Indexed: 11/26/2022]
Abstract
Behavioral parent training is an evidence-based intervention for children with attention-deficit/hyperactivity disorder (ADHD), but knowledge on the differential effects of behavioral techniques for specific subgroups of children is very limited. Attachment representations of children with ADHD may affect how receptive children are to changes in parenting. In this study, we investigated whether specific behavioral techniques were more or less effective for children with ADHD in relation to their attachment representations. We included parents of 74 children with ADHD (4-11 years, M = 8.15) who took part in a larger randomized controlled microtrial in which they were randomized to a two session training in antecedent-based techniques (i.e., stimulus control techniques: rules, instructions; n = 26), a two session training in consequent-based techniques (i.e., contingency management techniques: praise, rewards, ignoring; n = 25) or a waitlist control condition (n = 23). We examined whether attachment representation moderated the effectiveness of a) training versus waitlist, and b) antecedent- versus consequent-based techniques. Attachment representations were measured with a story stem task, the intervention outcome was daily parent-rated problem behaviors of the children. Attachment representation did not moderate the effects of the training compared to the waitlist. However, compared to antecedent-based techniques, consequent-based techniques were less effective for more securely and less disorganized attached children, and particularly effective for more disorganized attached children. This was the first study examining attachment as a moderator of behavioral techniques for ADHD. If replicated, the findings of this study can be used for treatment development and tailoring.
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Affiliation(s)
- Rianne Hornstra
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
- Accare Child Study Center, Groningen, the Netherlands.
| | - Tycho J Dekkers
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Accare Child Study Center, Groningen, the Netherlands
- Academic Center for Child and Adolescent Psychiatry, Levvel, Amsterdam, the Netherlands
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
- Department of Child and Adolescent Psychiatry, Amsterdam University Medical Center (AUMC), Amsterdam, the Netherlands
| | - Guy Bosmans
- Department of Clinical Psychology, KU Leuven, Leuven, Belgium
| | - Barbara van den Hoofdakker
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Accare Child Study Center, Groningen, the Netherlands
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, the Netherlands
| | - Saskia van der Oord
- Department of Clinical Psychology, KU Leuven, Leuven, Belgium
- Leuven Brain Institute, Leuven, Belgium
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15
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Ghim S, Ku B. The prevalence of health problems and their association with physical activity in caregivers of children with disabilities: 2018 National Health Interview Survey. Child Care Health Dev 2022; 48:347-357. [PMID: 34850443 DOI: 10.1111/cch.12934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 10/22/2021] [Accepted: 11/22/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Caregivers of children with disabilities often experience poor health. One way for caregivers to promote their own health may be to participate in physical activity (PA). AIMS The purpose of this study was to examine the association between PA and psychological and physical health problems in caregivers of children with disabilities. METHODS The 2018 National Health Interview Survey (NHIS) data were used, and 890 household representatives were identified as caregivers of children with disabilities. Based on the national PA guidelines, caregivers were classified into three groups: inactive (IA), aerobically active (AA), and aerobically and muscularly active (AMA). RESULTS Multivariable logistic regression indicated that the AMA group had a lower likelihood of reporting depression compared to the IA group (OR: 0.73 [95% confidence interval: 0.54, 0.98]). The AMA group also had a lower likelihood of reporting back pain and obesity compared to the IA group (OR:0.69 [95% confidence interval: 0.56, 0.84] and OR:0.63 [95% confidence interval: 0.52, 0.76], respectively). CONCLUSIONS The results of the current study suggest that caregivers of children with disabilities may benefit from PA, especially from the combination of aerobic and muscle-strengthening PA.
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Affiliation(s)
- Seungbeen Ghim
- Health Management and Policy, College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, USA
| | - Byungmo Ku
- Physical Education and Sports Science Academic Group, National Institute of Education, Nanyang Technological University, Singapore, Singapore
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16
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Groenman AP, Hornstra R, Hoekstra PJ, Steenhuis L, Aghebati A, Boyer BE, Buitelaar JK, Chronis-Tuscano A, Daley D, Dehkordian P, Dvorsky M, Franke N, DuPaul GJ, Gershy N, Harvey E, Hennig T, Herbert S, Langberg J, Mautone JA, Mikami AY, Pfiffner LJ, Power TJ, Reijneveld SA, Schramm SA, Schweitzer JB, Sibley MH, Sonuga-Barke E, Thompson C, Thompson M, Webster-Stratton C, Xie Y, Luman M, van der Oord S, van den Hoofdakker BJ. An Individual Participant Data Meta-analysis: Behavioral Treatments for Children and Adolescents With Attention-Deficit/Hyperactivity Disorder. J Am Acad Child Adolesc Psychiatry 2022; 61:144-158. [PMID: 33932495 DOI: 10.1016/j.jaac.2021.02.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 02/03/2021] [Accepted: 02/19/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Behavioral interventions are well established treatments for children with attention-deficit/hyperactivity disorder (ADHD). However, insight into moderators of treatment outcome is limited. METHOD We conducted an individual participant data meta-analysis (IPDMA), including data of randomized controlled behavioral intervention trials for individuals with ADHD <18 years of age. Outcomes were symptoms of ADHD, oppositional defiant disorder (ODD), and conduct disorder (CD) and impairment. Moderators investigated were symptoms and impairment severity, medication use, age, IQ, sex, socioeconomic status, and single parenthood. RESULTS For raters most proximal to treatment, small- to medium-sized effects of behavioral interventions were found for symptoms of ADHD, inattention, hyperactivity/impulsivity (HI), ODD and CD, and impairment. Blinded outcomes were available only for small preschool subsamples and limited measures. CD symptoms and/or diagnosis moderated outcome on ADHD, HI, ODD, and CD symptoms. Single parenthood moderated ODD outcome, and ADHD severity moderated impairment outcome. Higher baseline CD or ADHD symptoms, a CD diagnosis, and single parenthood were related to worsening of symptoms in the untreated but not in the treated group, indicating a protective rather than an ameliorative effect of behavioral interventions for these children. CONCLUSION Behavioral treatments are effective for reducing ADHD symptoms, behavioral problems, and impairment as reported by raters most proximal to treatment. Those who have severe CD or ADHD symptoms, a CD diagnosis, or are single parents should be prioritized for treatment, as they may evidence worsening of symptoms in the absence of intervention.
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17
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Powell LA, Parker J, Weighall A, Harpin V. Psychoeducation Intervention Effectiveness to Improve Social Skills in Young People with ADHD: A Meta-Analysis. J Atten Disord 2022; 26:340-357. [PMID: 33666104 PMCID: PMC8785297 DOI: 10.1177/1087054721997553] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Attention Deficit Hyperactivity Disorder (ADHD) can be associated with limited understanding of the condition and poor social skills. Some evidence favors a psychoeducational approach, but little is known about the effectiveness of psychoeducation. METHODS Systematic review and meta-analysis of studies assessing psychoeducational interventions that aim to improve social skills of young people with ADHD. RESULTS Ten studies, including 943 participants, reported across 13 papers met the inclusion criteria. Although effect sizes were small, findings suggest the included interventions significantly improved social skills in young people with ADHD. CONCLUSIONS Results show promise for psychoeducational behavioral interventions . However, the recommendations that can be developed from existing evidence are somewhat limited by the low quality of studies. Further rigorous trials are needed. In addition, future research should consider the long-term outcomes for these interventions, they should be iteratively co-designed and research should consider the context they intend to be delivered in.
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Affiliation(s)
- Lauren Amy Powell
- University of Sheffield, Sheffield, UK,Lauren Amy Powell, School of Education, University of Sheffield, Edgar Allen House, Sheffield, S10 2GW, UK.
| | | | | | - Valerie Harpin
- Ryegate Children’s Centre, Sheffield Children’s NHS Foundation Trust, Sheffield, UK
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18
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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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Which factors determine clinicians' policy and attitudes towards medication and parent training for children with Attention-Deficit/Hyperactivity Disorder? Eur Child Adolesc Psychiatry 2022; 31:483-493. [PMID: 33585968 PMCID: PMC8940866 DOI: 10.1007/s00787-021-01735-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 01/31/2021] [Indexed: 01/19/2023]
Abstract
Behavioral parent and teacher training and stimulant medication are recommended interventions for children with attention-deficit/hyperactivity disorder (ADHD). However, not all children with ADHD receive this evidence-based care, and the aim of the current study was to find out why. More specifically, we investigated clinicians' policy, guideline use, and attitudes towards medication and parent training when treating children with ADHD, as well as several factors that could affect this. A total of 219 Dutch clinicians (mainly psychologists, psychiatrists and educationalists) completed a survey. Clinicians were likely to recommend medication more often than parent training, and clinicians' policy to recommend medication and parent training was positively associated with their attitudes towards these interventions. Less experienced clinicians and those with a non-medical background reported lower rates of guideline use, whereas clinicians with a medical background reported less positive attitudes towards parent training. Furthermore, a substantial portion of the clinicians based their decision to recommend parent training on their clinical judgement (e.g., prior estimations of efficacy, perceived low abilities/motivation of parents), and many clinicians reported barriers for referral to parent training, such as waiting lists or a lack of skilled staff. To achieve better implementation of evidence-based care for children with ADHD, guidelines should be communicated better towards clinicians. Researchers and policy-makers should further focus on barriers that prevent implementation of parent training, which are suggested by the discrepancy between clinicians' overall positive attitude towards parent training and the relatively low extent to which clinicians actually advise parent training.
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Hulsbosch AK, De Meyer H, Beckers T, Danckaerts M, Van Liefferinge D, Tripp G, Van der Oord S. Systematic Review: Attention-Deficit/Hyperactivity Disorder and Instrumental Learning. J Am Acad Child Adolesc Psychiatry 2021; 60:1367-1381. [PMID: 33862167 DOI: 10.1016/j.jaac.2021.03.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 02/10/2021] [Accepted: 03/16/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Although instrumental learning deficits are, among other deficits, assumed to contribute to attention-deficit/hyperactivity disorder (ADHD), no comprehensive systematic review of instrumental learning deficits in ADHD exists. This review examines differences between ADHD and typically developing (TD) children in basic instrumental learning and the effects of reinforcement form, magnitude, schedule, and complexity, as well as effects of medication, on instrumental learning in children with ADHD. METHOD A systematic search of PubMed, PsyINFO, CINAHL, EMBASE+EMBASE CLASSIC, ERIC, and Web of Science was conducted for articles up to March 16, 2020. Experimental studies comparing instrumental learning between groups (ADHD versus TD) or a manipulation of reinforcement/medication within an ADHD sample were included. Quality of studies was assessed with an adapted version of the Hombrados and Waddington criteria to assess risk of bias in (quasi-) experimental studies. RESULTS A total of 19 studies from among 3,384 non-duplicate screened articles were included. No difference in basic instrumental learning was found between children with ADHD and TD children, nor effects of form or magnitude of reinforcement. Results regarding reinforcement schedule and reversal learning were mixed, but children with ADHD seemed to show deficits in conditional discrimination learning compared to TD children. Methylphenidate improved instrumental learning in children with ADHD. Quality assessment showed poor quality of studies with respect to sample sizes and outcome and missing data reporting. CONCLUSION The review identified very few and highly heterogenous studies, with inconsistent findings. No clear deficit was found in instrumental learning under laboratory conditions. Children with ADHD do show deficits in complex forms of learning, that is, conditional discrimination learning. Clearly more research is needed, using more similar task designs and manipulations.
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Affiliation(s)
- An-Katrien Hulsbosch
- Mrs. Hulsbosch, Dr. De Meyer, and Prof. Drs. Beckers, Danckaerts, and Van der Oord are with KU Leuven, Belgium.
| | - Hasse De Meyer
- Mrs. Hulsbosch, Dr. De Meyer, and Prof. Drs. Beckers, Danckaerts, and Van der Oord are with KU Leuven, Belgium; Dr. De Meyer is also with the HELP University, Kuala Lumpur, Malaysia
| | - Tom Beckers
- Mrs. Hulsbosch, Dr. De Meyer, and Prof. Drs. Beckers, Danckaerts, and Van der Oord are with KU Leuven, Belgium
| | - Marina Danckaerts
- Mrs. Hulsbosch, Dr. De Meyer, and Prof. Drs. Beckers, Danckaerts, and Van der Oord are with KU Leuven, Belgium; Dr. Van Liefferinge and Prof. Dr. Danckaerts also are with the University Psychiatric Centre KU Leuven, Belgium
| | - Dagmar Van Liefferinge
- Dr. Van Liefferinge and Prof. Dr. Danckaerts also are with the University Psychiatric Centre KU Leuven, Belgium
| | - Gail Tripp
- Prof. Dr. Tripp is with the Okinawa Institute of Science and Technology (OIST) Graduate University, Japan
| | - Saskia Van der Oord
- Mrs. Hulsbosch, Dr. De Meyer, and Prof. Drs. Beckers, Danckaerts, and Van der Oord are with KU Leuven, Belgium; Prof. Dr. Van der Oord is with the University of Amsterdam, the Netherlands
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Tiwawatpakorn N, Worachotekamjorn J, Tassanakijpanich N. Effectiveness of Parenting Training on Emotional and Behavioral Problems in First through Fourth Grade Thai Children with ADHD: A Randomized Controlled Study. Psychol Rep 2021; 125:2470-2484. [PMID: 34154470 DOI: 10.1177/00332941211026846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of parenting training on emotional and behavioral problems of first through fourth grade Thai children with ADHD compared with routine clinical care in a university hospital in southern Thailand. MATERIAL AND METHODS Caregivers of the children were invited and assessed for eligibility. Eighty children with ADHD were randomly assigned to either a parenting training group or a routine clinical care group. The primary caregivers of the parenting training group participated in 6 120-minute weekly sessions in addition to routine clinical care. Caregiver and teacher ADHD ratings and oppositional-defiant disorder ratings were collected at the time of enrollment and after the 6 weeks of training in both groups. The differences in scores in both groups were analyzed using a mixed model ANOVA. RESULTS Each arm had 40 participants. The mean (SD) age of the children was 8.3 (1.1) years and their mean (SD) age at the first diagnosis of ADHD was 6.8 (1.3) years. Most of them were receiving methylphenidate for treatment of their ADHD. The mother was the primary caregiver for 83.5% of the children. The ADHD symptoms and oppositional-defiant symptoms showed significant improvement after receiving the treatment in both groups; however, no significant differences were found between groups. CONCLUSION Adding parenting training to the routine clinical care for children with uncomplicated ADHD who are being medicated was not more effective than the routine clinical care alone. However, the power of this study is limited, and follow-up is needed to evaluate the long-term effectiveness.
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Yang KH, Lane HY, Chang YC, Tzang RF. Exploring the Effects of Pharmacological, Psychosocial, and Alternative/Complementary Interventions in Children and Adolescents With Attention-Deficit/Hyperactivity Disorder: Meta-Regression Approach. Int J Neuropsychopharmacol 2021; 24:776-786. [PMID: 34086891 PMCID: PMC8538900 DOI: 10.1093/ijnp/pyab034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 05/23/2021] [Accepted: 06/03/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND There have been various therapies for attention-deficit/hyperactivity disorder (ADHD), but the previous meta-analysis of ADHD efficacy remains unclear. This study aims to systemically meta-regress the effect sizes (ES) of psychostimulant pharmacotherapy (methylphenidate and lisdexamfetamine), non-stimulant pharmacotherapy (atomoxetine and alpha-2 agonists), psychosocial therapy (parental behavioral therapy [PBT]), combination therapy (psychostimulant plus PBT), and alternative/complementary interventions to determine the right treatment for ADHD. METHODS We searched various ADHD interventions from the MEDLINE and PubMed databases (National Center for Biotechnology Information) between January 1, 1980, and July 30, 2018. Following the meta-analysis of random effects, the meta-regression analyses were used to explore factors potentially influencing treatment efficacy. The confounding variables included type of treatment, type of study, age, type of symptom scale used, and year of publication. RESULTS A total of 107 trials (n = 9883 participants) were included. After adjustment, compared with the psychostimulant therapy (28 trial, 2134 participants), non-stimulant pharmacotherapy (28 trials, 4991 participants) and alternative/complement intervention (25 trials, 1195 participants) were less effective by the ES of -0.384 (P = .004) and -0.419 (P = .028), respectively. However, compared with psychostimulant, PBT (19 trials, 1122 participants; ES = -0.308, P = .095) and the combination of psychostimulant and PBT (7 trials, 441participants; ES = -0.196, P = .209) did not differ significantly. CONCLUSIONS Psychostimulant therapy surpassed non-stimulant pharmacotherapy and alternative/complement intervention. Psychostimulant therapy, PBT, and the combination of psychostimulant therapy and PBT appear to be similar in efficacy according to this meta-regression.
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Affiliation(s)
- Kung-Han Yang
- Department of Applied Mathematics, Chinese Culture University, Taipei, Taiwan
| | - Hsien-Yuan Lane
- Department of Psychiatry, China Medical University Hospital, Taichung, Taiwan,Graduate Institute of Biomedical Sciences, China Medical University Medical College, Taichung, Taiwan,Department of Psychology, College of Medical and Health Sciences, Asia University, Taichung, Taiwan
| | - Yue-Cune Chang
- Department of Mathematics, Tamkang University, Taipei, Taiwan
| | - Ruu-Fen Tzang
- Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan,Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan,Correspondence: Ruu-Fen Tzang, MD, Department of Psychiatry, Mackay Memorial Hospital, Number 92, Sec. 2, Zhong Shan N Road, Taipei 104, Taiwan ()
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Eşkisu M, Kapçı EGÜ. Efficacy of the parenting support program on child behavior problems. Scand J Psychol 2021; 62:449-459. [PMID: 33938582 DOI: 10.1111/sjop.12726] [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: 04/13/2020] [Revised: 12/26/2020] [Accepted: 02/16/2021] [Indexed: 11/26/2022]
Abstract
The study aimed to examine the efficacy of the Parenting Support Program (PSP) for reducing problem behaviors and increasing adaptive behaviors in young children aged 3 to 6. The PSP focuses on effective parenting skills and building positive interactions between parents and their children. Parents of children (n = 18 mothers and 11 fathers) were randomly assigned to an experiment group (EG) and a wait-list (WL) group. The EG attended a total of 12 individually delivered sessions. Data was gathered via parent and teacher report measures, observation and semi-structured interviews. The PSP was effective in increasing adaptive behaviors and decreasing behavior problems in children. The change in the children's score which fulfills the Reliable Change Index criteria in the EG was found to be higher than the WL group. However, fathers reported fewer improvements than mothers in the EG. Qualitative data supported the experimental study results demonstrating the efficacy of the PSP, and met the expectations of parents. Consequently, the PSP could be used as an intervention tool to decrease behavior problems and increase adaptive behaviors in young children.
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Affiliation(s)
- Mustafa Eşkisu
- Faculty of Education, Erzincan Binali Yıldırım University, Erzincan, Turkey
| | - Emine GÜl Kapçı
- Faculty of Educational Sciences, Ankara University, Ankara, Turkey
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Brehm B, Schill J, Rauh R, Fleischhaker C, Biscaldi M. Preliminary Evaluation of the FETASS Training for Parents of Children With Autism Spectrum Disorder: A Pilot Study. Front Psychol 2021; 12:604851. [PMID: 33995174 PMCID: PMC8120893 DOI: 10.3389/fpsyg.2021.604851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 03/31/2021] [Indexed: 12/03/2022] Open
Abstract
While several recent evaluation studies have shown the efficacy of parent training programs for children with neurodevelopmental disorders, manual-based training in German is still scarce. To address this gap, we developed a specific modularized training program for parents of children from preschool to pre-adolescent age with Autism Spectrum Disorder (FETASS). The overarching purpose of the FETASS intervention is to enhance social communication behavior and quality of life of the child by coaching parents. As a proximal target, the FETASS training aims to provide families with behavior management and communication strategies. The development of the training was influenced by published behavioral parent trainings and autism-specific interventions. The training comprises eight weekly sessions and targets families whose children have a diagnosis of Autism Spectrum Disorder (ASD) without intellectual and language impairments. As a preliminary pilot study, the purpose was to evaluate the acceptability of the training. Furthermore, the study aimed at initially evaluating social communication behavior, quality of life of the child, parental stress level, and parenting after training in comparison to a treatment as usual (TAU) group. Exploratively, long-term effects were investigated after 6 months of training as well. In total, 57 families participated (n[TAU] = 29, n[FETASS] = 28). Questionnaires about social communication behavior and quality of life of the child, parental stress, and parenting were administered at three time points (t1: baseline TAU/FETASS, t2: post TAU/FETASS; and t3: 6-month follow-up after FETASS). Primary outcome measures were the social communication behavior of the child and the parent's proxy report on quality of life of the child. Secondary outcome measures were changes in parental stress and parenting behavior. Acceptability of the training was very high and we had almost no dropouts during training. Results for the primary outcome measure of social communication behavior, overall quality of life of the child, and long-term effects on social communication behavior were not significant. While long-term findings for parent stress reduction and for the quality of life of the child are promising, further research has to be done in a future randomized controlled trial.
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Affiliation(s)
| | | | | | | | - Monica Biscaldi
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Murray AL, Hall HA, Speyer LG, Carter L, Mirman D, Caye A, Rohde L. Developmental trajectories of ADHD symptoms in a large population-representative longitudinal study. Psychol Med 2021; 52:1-7. [PMID: 33769236 DOI: 10.1017/s0033291721000349] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Previous research has suggested that there is substantial heterogeneity in the developmental trajectories of attention-deficit/hyperactivity disorder (ADHD) symptoms. Sometimes, qualitative distinctions between trajectories with different ages of onset and/or patterns of remission are made; however, little is known about the predictors and broader clinical meaningfulness of these candidate 'developmental subtypes' of ADHD symptoms. METHODS We applied latent class growth analysis to data from the UK Millennium Cohort Study (MCS; N = 11 316; ages 3, 5, 7, 11 and 14) to evaluate whether developmental trajectories of ADHD symptoms differing in early life predictors could be identified. Our optimal model included six trajectory groups, labelled unaffected (34.9% of the sample), mildly affected (24.1%), subclinical remitting (12.8%), pre-school onset partially remitting (14.1%), developmentally increasing (7.6%) and pre-school onset persistent (6.4%). RESULTS Factors such as gender, conduct problems, cognitive ability, maternal education, premature birth, peer problems and school readiness scores differentiated between specific ADHD symptom trajectories. CONCLUSIONS Taken together, our findings provide preliminary evidence that distinguishing different trajectories of ADHD symptoms could be clinically informative.
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Affiliation(s)
| | | | | | - Lara Carter
- Department of Psychology, University of Edinburgh, UK
| | - Daniel Mirman
- Department of Psychology, University of Edinburgh, UK
| | - Arthur Caye
- Department of Psychiatry, Federal University of Rio Grande do Sul, Brazil
| | - Luis Rohde
- Department of Psychiatry, Federal University of Rio Grande do Sul, Brazil
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26
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Acar S, Chen CI, Xie H. Parental involvement in developmental disabilities across three cultures: A systematic review. RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 110:103861. [PMID: 33482560 DOI: 10.1016/j.ridd.2021.103861] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 12/23/2020] [Accepted: 01/12/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Parents play a critical role in the early intervention/early childhood special education (EI/ECSE) services provided to young children (birth-6 years) with developmental disabilities. AIM The aim of this systematic review was to explore parental involvement in developmental disabilities across three cultures: Mainland China, Taiwan, and Turkey. METHOD According to PRISMA guidelines, we searched for articles indexed in EBSCOhost, PsycINFO, and PubMed published within the last decade for one culture (i.e., Mainland China, Taiwan, and Turkey), using the following keywords: family/parent involvement/engagement, developmental disability/disabilities, young child/children, EI/ECSE, and culture. RESULTS Twenty-four empirical studies were identified as relevant to our research. A majority of articles reported maternal involvement in EI/ECSE, and only a few studies included parents as intervention agents. CONCLUSIONS This review highlights the need for future research to investigate effects of culture on parental involvement and develop culturally responsive methodical approaches to underpin meaningful parental involvement in EI/ECSE.
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Affiliation(s)
- Serra Acar
- Department of Curriculum and Instruction, College of Education and Human Development, University of Massachusetts, Boston, MA, 02125-3393, United States.
| | | | - Huichao Xie
- National Institute of Education, Nanyang Technological University, Singapore.
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Maternal Parenting and Toddler Temperament: Predictors of Early School Age Attention-Deficit/Hyperactivity Disorder-Related Behaviors. Res Child Adolesc Psychopathol 2021; 49:763-773. [PMID: 33544276 DOI: 10.1007/s10802-021-00778-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2021] [Indexed: 01/20/2023]
Abstract
Detection of early risk for developing childhood attention-deficit/hyperactive disorder (ADHD) symptoms, inattention and hyperactivity, may be critical for prevention and early intervention. Temperament and parenting are two promising areas of risk, representing potential targets for preventive intervention; however, studies have rarely tested these factors longitudinally using multiple methods and reporters. In a longitudinal sample of 312 low-income boys, this study tested the hypothesis that negative emotionality (NE) and effortful control (EC) in toddlerhood (1.5-3.5 years old) would predict mother- and teacher-reported ADHD-related behaviors at school age (5-7 years old). Direct effects of observed warm, supportive and harsh maternal parenting were tested in relation to ADHD-related behaviors and as moderators of associations between NE and EC and ADHD-related behaviors. Several predictions were supported: 1) Greater maternal-reported toddler NE positively predicted mother-reported ADHD behaviors; 2) Greater observed EC was associated with fewer mother- and teacher-reported ADHD-related behaviors; 3) Warm, supportive parenting predicted fewer teacher-reported ADHD-related behaviors, and harsh parenting predicted more ADHD-related behaviors as reported by parents and teachers; 4) Harsh parenting moderated the association between observed EC and mother-reported ADHD-related behaviors. Together, the findings suggest that lower child EC, lower warm/supportive parenting, and greater harsh parenting in toddlerhood independently signal increased risk for later ADHD-related behaviors; further, the association between low EC and ADHD-related behaviors was amplified in the context of high levels of harsh parenting.
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28
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Dose C, Hautmann C, Bürger M, Schürmann S, Döpfner M. Negative parenting behaviour as a mediator of the effects of telephone-assisted self-help for parents of pharmacologically treated children with attention-deficit/hyperactivity disorder. Eur Child Adolesc Psychiatry 2021; 30:861-875. [PMID: 32488456 PMCID: PMC8140965 DOI: 10.1007/s00787-020-01565-w] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 05/21/2020] [Indexed: 11/30/2022]
Abstract
A previous randomised controlled trial demonstrated the effects of a telephone-assisted self-help (TASH) intervention for parents of pharmacologically treated children with attention-deficit/hyperactivity disorder (ADHD) on ADHD symptoms, oppositional symptoms, functional impairment, and negative parenting behaviour (per-protocol analyses). In the current study, we examined whether changes in positive and negative parenting behaviour mediated the effects on symptoms and impairment. Parents in an enhancement group (n = 51) participated in a 12-month TASH intervention (eight booklets plus up to 14 telephone consultations) as an adjunct to routine clinical care, whereas parents in a waitlist control group (n = 52) received routine clinical care only. Parents completed measures of child symptoms, child functional impairment, and parenting behaviour at baseline, at 6 months, and at 12 months. The mediating effects of parenting behaviour were examined using regression analyses. Per-protocol analyses (n = 74) revealed a significant indirect intervention effect on functional impairment through negative parenting behaviour at 6 months as well as indirect intervention effects on oppositional symptoms and functional impairment through negative parenting behaviour at 12 months. The indirect effect on ADHD symptoms through negative parenting behaviour at 12 months just failed to reach significance. The analyses yielded no indirect intervention effects through positive parenting behaviour. The study provides some, albeit limited, support for the importance of changes in negative parenting behaviour to achieve changes in symptoms and functional impairment during parent training. In consideration of the inconsistent results of previous studies concerning the mediating role of positive and negative parenting behaviour, further research is required to better understand the mechanisms of change during parent training, also including other possible mediators like parenting stress and parental self-efficacy.
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Affiliation(s)
- Christina Dose
- School for Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Pohligstr. 9, 50969, Cologne, Germany.
| | - Christopher Hautmann
- School for Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Pohligstr. 9, 50969 Cologne, Germany
| | - Mareike Bürger
- School for Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Pohligstr. 9, 50969 Cologne, Germany
| | - Stephanie Schürmann
- School for Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Pohligstr. 9, 50969 Cologne, Germany ,Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Robert-Koch-Str. 10, 50931 Cologne, Germany
| | - Manfred Döpfner
- School for Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Pohligstr. 9, 50969 Cologne, Germany ,Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Robert-Koch-Str. 10, 50931 Cologne, Germany
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29
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Riise EN, Wergeland GJH, Njardvik U, Öst LG. Cognitive behavior therapy for externalizing disorders in children and adolescents in routine clinical care: A systematic review and meta-analysis. Clin Psychol Rev 2020; 83:101954. [PMID: 33418192 DOI: 10.1016/j.cpr.2020.101954] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/09/2020] [Accepted: 11/23/2020] [Indexed: 12/11/2022]
Abstract
Various Cognitive Behavioral Therapy (CBT) programs for externalizing disorders in children and adolescents are supported by a substantial body of empirical evidence. Most of the research evidence comes from efficacy studies conducted in university settings, but there is less knowledge about the effect of these treatments in routine clinical care. The purpose of this meta-analysis was to investigate the effectiveness of CBT in non-university settings for Attention Deficit Hyperactivity Disorder (ADHD), Conduct Disorder (CD) and Oppositional Defiant Disorder (ODD). Embase OVID, Ovid MEDLINE and PsycINFO were systematically searched for eligible studies published up to May 2020. In total, 51 treatment effectiveness studies involving 5295 patients were included. The average within-group effect size at post-treatment was significant (g = 0.91), and there were large effect sizes for both ADHD (g = 0.80) and CD/ODD (g = 0.98). At post treatment, remission rates were 38% for ADHD and 48% for CD/ODD, and the overall attrition rate was 14%. Benchmarking against efficacy studies showed that CBT in routine clinical care yields remission rates, within-group effect sizes and attrition rates that are very similar to those found in university settings. The findings support the transportability of CBT for externalizing disorders from university settings to routine clinical care. PROSPERO registration: CRD42020147524.
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Affiliation(s)
- Eili N Riise
- Department of Child and Adolescent Psychiatry, District General Hospital of Førde, Førde, Norway.
| | - Gro Janne H Wergeland
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Norway
| | - Urdur Njardvik
- Department of Psychology, University of Iceland, Reykjavik, Iceland
| | - Lars-Göran Öst
- Department of Psychology, Stockholm University, Stockholm, Sweden; Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
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30
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van der Oord S, Tripp G. How to Improve Behavioral Parent and Teacher Training for Children with ADHD: Integrating Empirical Research on Learning and Motivation into Treatment. Clin Child Fam Psychol Rev 2020; 23:577-604. [PMID: 32968886 PMCID: PMC7585566 DOI: 10.1007/s10567-020-00327-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2020] [Indexed: 12/17/2022]
Abstract
Attention deficit hyperactivity disorder [ADHD] is one of the most common psychiatric disorders of childhood with poor prognosis if not treated effectively. Recommended psychosocial evidence-based treatment for preschool and school-aged children is behavioral parent and teacher training [BPT]. The core elements of BPT are instrumental learning principles, i.e., reinforcement of adaptive and the ignoring or punishment of non-adaptive behaviors together with stimulus control techniques. BPT is moderately effective in reducing oppositional behavior and improving parenting practices; however, it does not reduce blinded ratings of ADHD symptoms. Also after training effects dissipate. This practitioner review proposes steps that can be taken to improve BPT outcomes for ADHD, based on purported causal processes underlying ADHD. The focus is on altered motivational processes (reward and punishment sensitivity), as they closely link to the instrumental processes used in BPT. Following a critical analysis of current behavioral treatments for ADHD, we selectively review motivational reinforcement-based theories of ADHD, including the empirical evidence for the behavioral predictions arising from these theories. This includes consideration of children's emotional reactions to expected and unexpected outcomes. Next we translate this evidence into potential ADHD-specific adjustments designed to enhance the immediate and long-term effectiveness of BPT programs in addressing the needs of children with ADHD. This includes the use of remediation strategies for proposed deficits in learning not commonly used in BPT programs and cautions regarding the use of punishment. Finally, we address how these recommendations can be effectively transferred to clinical practice.
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Affiliation(s)
- Saskia van der Oord
- Behavior, Health and Psychopathology, KU Leuven, Tiensestraat 102, 3000, Leuven, Belgium.
- Developmental Psychology, University of Amsterdam, Nieuwe Achtergracht 129, 1018 WS, Amsterdam, The Netherlands.
| | - Gail Tripp
- Human Developmental Neurobiology Unit, Okinawa Institute of Science and Technology Graduate University, 1919-1 Tancha, Onna, Kunigami District, Okinawa Prefecture, 904-0495, Japan.
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De Meyer H, Beckers T, Tripp G, van der Oord S. Reinforcement Contingency Learning in Children with ADHD: Back to the Basics of Behavior Therapy. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 47:1889-1902. [PMID: 31292806 PMCID: PMC6842356 DOI: 10.1007/s10802-019-00572-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Reinforcement deficits in ADHD may affect basic operant learning processes relevant for Behavioral Treatment. Behavior acquired under partial reinforcement extinguishes less readily after the discontinuation of reinforcement than behavior acquired under continuous reinforcement, a phenomenon known as the Partial Reinforcement Extinction Effect [PREE], which has great relevance for the emergence of behavioral persistence. The present study examined acquisition and extinction of operant responding under partial and continuous reinforcement in children with and without ADHD. In addition, we evaluated the effectiveness of gradual stretching the reinforcement rate during acquisition for remedying potential acquisition or extinction deficits under partial reinforcement in ADHD. In an operant learning task designed to mimic the task confronted by an animal in a Skinner box, 62 typically developing and 49 children with ADHD (age: 8–12) were presented with a continuous, partial or gradually stretching reinforcement scheme followed by extinction. Both groups of children acquired the instrumental response more slowly and exhibited more behavioral persistence (reduced extinction) when responding was initially reinforced under partial relative to continuous reinforcement, with no differences between groups. Progressive ratio stretching resulted in faster acquisition than partial reinforcement yet promoted equal behavioral persistence, again without differences between ADHD and TD groups. Unlike suggested by previous research, children with ADHD exhibit neither an acquisition deficit under partial reinforcement nor a deficit in PREE. Of relevance for Behavioral Treatment, gradual reinforcement stretching can be used to facilitate response acquisition over purely partial reinforcement while maintaining equal behavioral persistence upon reward discontinuation.
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Affiliation(s)
- Hasse De Meyer
- Research Unit Behavior, Health and Psychopathology, KU Leuven, Tiensestraat 102 box 3720, 3000, Leuven, Belgium
| | - Tom Beckers
- Research Unit Behavior, Health and Psychopathology, KU Leuven, Tiensestraat 102 box 3720, 3000, Leuven, Belgium.,Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Gail Tripp
- Human Developmental Neurobiology Unit, Okinawa Institute of Science and Technology Graduate University, 1919-1 Tancha, Onna, Kunigami District, Okinawa, Prefecture, 904-0412, Japan
| | - Saskia van der Oord
- Research Unit Behavior, Health and Psychopathology, KU Leuven, Tiensestraat 102 box 3720, 3000, Leuven, Belgium. .,Developmental Psychology, University of Amsterdam, Nieuwe Achtergracht 129, Amsterdam, 1018 WS, The Netherlands.
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32
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Al-Yagon M, Lachmi M, Danino M. Manual-Based Personalized Intervention for Mothers of Children With SLD/ADHD: Effects on Maternal and Family Resources and Children's Internalizing/Externalizing Behaviors. J Atten Disord 2020; 24:720-736. [PMID: 31328607 DOI: 10.1177/1087054719864648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: This study explored manual-based personalized intervention for mothers of children with SLD and/or ADHD, as possibly contributing to (a) mothers' parenting-related emotional/coping resources, (b) family functioning, and (c) child adjustment, compared with a control group of mothers. Method: Participants were 73 mothers of a child formally diagnosed with SLD and/or ADHD ages 7-17. Mothers were assigned to an experimental (n=40) or control (n=33) group. Short-term intervention utilized a three-stage emotion-cognition-behavior model. Pre-post assessments included maternal affective resources (positive/negative affect, parenting stress), maternal coping resources (general coping strategies, coping specifically with diagnosed child's negative emotions), family cohesion/adaptability, and diagnosed child's externalizing/internalizing syndromes. Results: Significant interactions emerged between group (experimental/control) and time (pre/post) for most study variables. Conclusion: Findings clearly revealed the intervention's significant impact. Only the trained mothers demonstrated significant gains over time for most of the maternal, family, and child indices, whereas the untrained mothers did not.
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Affiliation(s)
| | | | - Maly Danino
- Nitzan Israeli Association for Children and Adults With Learning Disabilities, Tel Aviv, Israel
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33
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Lambez B, Harwood-Gross A, Golumbic EZ, Rassovsky Y. Non-pharmacological interventions for cognitive difficulties in ADHD: A systematic review and meta-analysis. J Psychiatr Res 2020; 120:40-55. [PMID: 31629998 DOI: 10.1016/j.jpsychires.2019.10.007] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 09/15/2019] [Accepted: 10/09/2019] [Indexed: 12/12/2022]
Abstract
Attention deficit hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder in children and is associated with significant risk of educational failure, interpersonal problems, mental illness, and delinquency. Despite a number of comparative and comprehensive reviews on the effects of ADHD treatments on ADHD core symptoms, evidence synthesizing the effects of ADHD interventions on cognitive difficulties is limited. In this meta-analysis, the neuropsychological effects of non-pharmacological interventions for ADHD were examined across studies published between 1980 and 2017. Data were extracted from studies that used objective cognitive measures (either computerized or pencil-and-paper), and multiple meta-analyses were conducted to compare the effectiveness across these interventions. Publication bias was assessed, as well as quality of the evidence, using Cochrane risk of bias tool for randomized control trials studies. Our final meta-analysis included 18 studies with interventions that were categorized into four categories: neurofeedback, cognitive-behavioral therapy, cognitive training, and physical exercises. Physical exercises demonstrated the highest average effect size (Morris d = 0.93). A further evaluation of cognitive functions yielded 49 effect sizes for the five categories, including attention, inhibition, flexibility, and working memory. Analyses demonstrated a homogenous, medium to large, effect size of improvement across interventions, with inhibition demonstrating the largest average effect size (Morris d = 0.685). This study highlights the positive effect of psychological interventions on ADHD cognitive symptomology and supports the inclusion of non-pharmacological interventions in conjunction with the commonly used pharmacological treatments.
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Affiliation(s)
- Bar Lambez
- Department of Psychology, Bar Ilan University, Ramat-Gan, Israel
| | - Anna Harwood-Gross
- Department of Psychology, Bar Ilan University, Ramat-Gan, Israel; Herman Dana Division of Child and Adolescent Psychiatry, Hadassah Hospital, Jerusalem, Israel
| | - Elana Zion Golumbic
- Leslie and Susan Gonda (Goldschmied) Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat-Gan, Israel
| | - Yuri Rassovsky
- Department of Psychology, Bar Ilan University, Ramat-Gan, Israel; Leslie and Susan Gonda (Goldschmied) Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat-Gan, Israel; Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA), California, USA.
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34
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Schorr-Sapir I, Apter A. Evidence for efficacy of parent-based interventions on parental characteristics. Eur Child Adolesc Psychiatry 2019; 28:1023-1024. [PMID: 31332525 DOI: 10.1007/s00787-019-01377-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | - Alan Apter
- Schneider Children's Medical Center of Israel, Petah-Tikva, Israel. .,Interdisciplinary Center, Herzliya, Israel. .,Ruppin Academic Center, Emek-Hefer, Israel.
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Graziano PA, Ros R, Hart KC, Slavec J. Summer Treatment Program for Preschoolers with Externalizing Behavior Problems: a Preliminary Examination of Parenting Outcomes. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2019; 46:1253-1265. [PMID: 29116424 DOI: 10.1007/s10802-017-0358-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Within an at-risk sample of preschoolers with externalizing behavior problems (EBP), the current study examined the initial promise of a multimodal intervention, the Summer Treatment Program for Pre-Kindergarteners (STP-PreK), in improving parenting outcomes. Using an open trial design, 154 parents and their preschool children (73% male; M age = 5.06 years; 82% Hispanic/Latino background) with at-risk or clinically elevated levels of EBP (57% of which were referred by schools or mental health/medical professionals) completed a baseline and post-treatment assessment. A subsample of 90 families completed a follow-up assessment approximately 6 to 9 months after treatment completion. Parental measures of parenting stress and discipline strategies were collected across all three assessments. Observational data were also collected across all assessments during a 5-min standardized child-led play situation and a 5-min parent-led clean up task. The parenting component of the STP-PreK included a School Readiness Parenting Program (SRPP) of which the behavioral management component was implemented via a Parent-Child Interaction Therapy (PCIT) adaptation (8 weekly group sessions with 15-20 parents in each group, lack of requirement of "mastery" criteria). All parenting outcomes (both ratings and observed) significantly improved after the intervention (Cohen's d mean effect size across measures 0.89) with all effects being maintained at the 6-9 month follow-up. These findings highlight the initial promise of our SRPP's PCIT adaptation in targeting multiple aspects of parenting while yielding comparable parenting skills acquisition compared to traditional individual PCIT.
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Burgdorf V, Szabó M, Abbott MJ. The Effect of Mindfulness Interventions for Parents on Parenting Stress and Youth Psychological Outcomes: A Systematic Review and Meta-Analysis. Front Psychol 2019; 10:1336. [PMID: 31244732 PMCID: PMC6562566 DOI: 10.3389/fpsyg.2019.01336] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 05/22/2019] [Indexed: 12/29/2022] Open
Abstract
Background: The psychological well-being of parents and children is compromised in families characterized by greater parenting stress. As parental mindfulness is associated with lower parenting stress, a growing number of studies have investigated whether mindfulness interventions can improve outcomes for families. This systematic review and meta-analysis evaluates the effectiveness of mindfulness interventions for parents, in reducing parenting stress and improving youth psychological outcomes. Methods: A literature search for peer-reviewed articles and dissertations was conducted in accordance with PRISMA guidelines in the PsycInfo, Medline, PubMed, CINAHL, Web of Science, Cochrane Central Register of Controlled Trials, and ProQuest Dissertations & Theses databases. Studies were included if they reported on a mindfulness-based intervention delivered in person to parents with the primary aim of reducing parenting stress or improving youth psychological outcomes. Results: Twenty-five independent studies were included in the review. Eighteen studies used a single group design and six were randomized controlled trials. Within-groups, meta-analysis indicated a small, post-intervention reduction in parenting stress (g = 0.34), growing to a moderate reduction at 2 month follow-up (g = 0.53). Overall, there was a small improvement in youth outcomes (g = 0.27). Neither youth age or clinical status, nor time in mindfulness training, moderated parenting stress or overall youth outcome effects. Youth outcomes were not moderated by intervention group attendees. Change in parenting stress predicted change in youth externalizing and cognitive effects, but not internalizing effects. In controlled studies, parenting stress reduced more in mindfulness groups than control groups (g = 0.44). Overall, risk of bias was assessed as serious. Conclusions: Mindfulness interventions for parents may reduce parenting stress and improve youth psychological functioning. While improvements in youth externalizing and cognitive outcomes may be explained by reductions in parenting stress, it appears that other parenting factors may contribute to improvements in youth internalizing outcomes. Methodological weaknesses in the reviewed literature prevent firm conclusions from being drawn regarding effectiveness. Future research should address these methodological issues before mindfulness interventions for parents are recommended as an effective treatment option for parents or their children.
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Affiliation(s)
- Virginia Burgdorf
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
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37
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Hahn-Markowitz J, Berger I, Manor I, Maeir A. Cognitive-Functional (Cog-Fun) Dyadic Intervention for Children with ADHD and Their Parents: Impact on Parenting Self-Efficacy. Phys Occup Ther Pediatr 2018; 38:444-456. [PMID: 29494784 DOI: 10.1080/01942638.2018.1441939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
AIM The family context of children with ADHD plays a role in intervention outcomes, especially when parents are involved in treatment. Parental participation in evidence-based treatment for ADHD may play a role in improving their own parenting self-efficacy (PSE) as well as child outcomes. This study examined the impact of Cognitive-Functional (Cog-Fun) intervention in occupational therapy (OT) for school-aged children with ADHD, on PSE. METHODS In this randomized controlled trial with crossover design, 107 children were allocated to intervention and waitlist control groups. Intervention participants (n = 50) received Cog-Fun after baseline assessment and waitlist controls (n = 49) received treatment 3 months later. Intervention participants received 3-month follow-up assessment. Treatment included 10 parent-child Cog-Fun weekly sessions. PSE was assessed with the Tool to measure Parenting Self-Efficacy (TOPSE). RESULTS All children who began treatment completed it. Mixed ANOVA revealed significant Time x Group interaction effects on TOPSE scales of Play and Enjoyment, Control, Self-Acceptance, Knowledge and Learning and Total score, which showed significant improvement with moderate treatment effects for the intervention group. Results were replicated in the control group after crossover. CONCLUSION The findings of this study suggest that Cog-Fun OT intervention may be effective for improving aspects of PSE among parents of children with ADHD.
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Affiliation(s)
- Jeri Hahn-Markowitz
- a School of Occupational Therapy , Hadassah-Hebrew University , Jerusalem , Israel.,b Neuro-Cognitive Center, Paediatric Neurology Unit , Hadassah-Hebrew University Medical School , Jerusalem , Israel
| | - Itai Berger
- b Neuro-Cognitive Center, Paediatric Neurology Unit , Hadassah-Hebrew University Medical School , Jerusalem , Israel
| | - Iris Manor
- c Attention Deficit Hyperactivity Disorder Clinic , Geha Medical Center , Petah Tikva , Israel.,d School of Occupational Therapy , Sackler Medical School, Tel Aviv University , Tel Aviv , Israel
| | - Adina Maeir
- a School of Occupational Therapy , Hadassah-Hebrew University , Jerusalem , Israel.,b Neuro-Cognitive Center, Paediatric Neurology Unit , Hadassah-Hebrew University Medical School , Jerusalem , Israel
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Charbonnier E, Caparos S, Trémolière B. The role of mothers’ affiliate stigma and child’s symptoms on the distress of mothers with ADHD children. J Ment Health 2018; 28:282-288. [DOI: 10.1080/09638237.2018.1521944] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Elodie Charbonnier
- Laboratoire de Psychologie Sociale (LPS), Aix-en-Provence, France
- Université de Nîmes, Nîmes, France
| | - Serge Caparos
- Université de Nîmes, Nîmes, France
- Laboratoire CHROME, Nîmes, France
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Daley D, Van Der Oord S, Ferrin M, Cortese S, Danckaerts M, Doepfner M, Van den Hoofdakker BJ, Coghill D, Thompson M, Asherson P, Banaschewski T, Brandeis D, Buitelaar J, Dittmann RW, Hollis C, Holtmann M, Konofal E, Lecendreux M, Rothenberger A, Santosh P, Simonoff E, Soutullo C, Steinhausen HC, Stringaris A, Taylor E, Wong ICK, Zuddas A, Sonuga-Barke EJ. Practitioner Review: Current best practice in the use of parent training and other behavioural interventions in the treatment of children and adolescents with attention deficit hyperactivity disorder. J Child Psychol Psychiatry 2018; 59:932-947. [PMID: 29083042 DOI: 10.1111/jcpp.12825] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Behavioural interventions are recommended for use with children and young people with attention deficit hyperactivity disorder (ADHD); however, specific guidance for their implementation based on the best available evidence is currently lacking. METHODS This review used an explicit question and answer format to address issues of clinical concern, based on expert interpretation of the evidence with precedence given to meta-analyses of randomised controlled trials. RESULTS On the basis of current evidence that takes into account whether outcomes are blinded, behavioural intervention cannot be supported as a front-line treatment for core ADHD symptoms. There is, however, evidence from measures that are probably blinded that these interventions benefit parenting practices and improve conduct problems which commonly co-occur with ADHD, and are often the main reason for referral. Initial positive results have also been found in relation to parental knowledge, children's emotional, social and academic functioning - although most studies have not used blinded outcomes. Generic and specialised ADHD parent training approaches - delivered either individually or in groups - have reported beneficial effects. High-quality training, supervision of therapists and practice with the child, may improve outcomes but further evidence is required. Evidence for who benefits the most from behavioural interventions is scant. There is no evidence to limit behavioural treatments to parents with parenting difficulties or children with conduct problems. There are positive effects of additive school-based intervention for the inattentive subtype. Targeting parental depression may enhance the effects of behavioural interventions. CONCLUSIONS Parent training is an important part of the multimodal treatment of children with ADHD, which improves parenting, reduces levels of oppositional and noncompliant behaviours and may improve other aspects of functioning. However, blinded evidence does not support it as a specific treatment for core ADHD symptoms. More research is required to understand how to optimise treatment effectiveness either in general or for individual patients and explore potential barriers to treatment uptake and engagement. In terms of selecting which intervention formats to use, it seems important to acknowledge and respond to parental treatment preferences.
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Affiliation(s)
- David Daley
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK.,NIHR MindTech Healthcare Technology Cooperative & Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan CANDAL, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Saskia Van Der Oord
- Department of Psychology, KU Leuven, Leuven, Belgium.,University of Amsterdam, Amsterdam, The Netherlands
| | - Maite Ferrin
- Academic Unit of Psychology, Developmental Brain-Behaviour Laboratory, University of Southampton, Southampton, UK.,Huntercombe Hospital Maidenhead, Maidenhead, UK
| | - Samuele Cortese
- Academic Unit of Psychology, Developmental Brain-Behaviour Laboratory, University of Southampton, Southampton, UK.,Langone Medical Center, Child Study Center, New York University, New York, NY, USA
| | - Marina Danckaerts
- Department of Child and Adolescent Psychiatry, KU Leuven, Leuven, Belgium
| | - Manfred Doepfner
- Department for Child and Adolescent Psychiatry, University of Cologne, Cologne, Germany
| | - Barbara J Van den 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
| | - David Coghill
- The Royal Children's Hospital, University of Melbourne, Melbourne, Vic., Australia.,School of Medicine, University of Dundee, Dundee, UK
| | - Margaret Thompson
- Academic Unit of Psychology, Developmental Brain-Behaviour Laboratory, University of Southampton, Southampton, UK
| | - Philip Asherson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Daniel Brandeis
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.,Department of Child and Adolescent Psychiatry & Psychotherapy, University Hospital of Psychiatry, Zürich, Switzerland
| | - Jan Buitelaar
- Department of Cognitive Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Ralf W Dittmann
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Chris Hollis
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK.,NIHR MindTech Healthcare Technology Cooperative & Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan CANDAL, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Martin Holtmann
- Department of Child and Adolescent Psychiatry and Psychotherapy, LWL-University Hospital Hamm, Ruhr University Bochum, Bochum, Germany
| | - Eric Konofal
- Pediatric Sleep Disorders Center, Hospital Robert Debré, Paris, France
| | - Michel Lecendreux
- Pediatric Sleep Disorders Center, Hospital Robert Debré, Paris, France
| | | | - Paramala Santosh
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Emily Simonoff
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Cesar Soutullo
- Child and Adolescent Psychiatry Unit, Department of Psychiatry and Medical Psychology, University of Navarra Clinic, Pamplona, Spain
| | - Hans Christoph Steinhausen
- Department of Psychology, University of Basel, Basel, Switzerland.,Department of Child and Adolescent Psychiatry, University of Zurich, Zurich, Switzerland.,Child and Adolescent Mental Health Centre, Capital Region Psychiatry, Copenhagen, Denmark
| | | | - Eric Taylor
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ian C K Wong
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
| | - Alessandro Zuddas
- Child & Adolescent Neuropsychiatry Unit, Department of Biomedical Sciences, University of Cagliari & "A.Cao" Paediatric Hospital, Cagliari, Italy
| | - Edmund J Sonuga-Barke
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,University of Ghent, Ghent, Belgium.,University of Aarhus, Aarhus, Denmark
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Jaite C, van Noort BM, Vloet TD, Graf E, Kappel V, Geissler J, Warnke A, Jacob C, Groß-Lesch S, Hennighausen K, Haack-Dees B, Schneider-Momm K, Philipsen A, Matthies S, Rösler M, Retz W, Hänig S, von Gontard A, Sobanski E, Alm B, Hohmann S, Häge A, Poustka L, Colla M, Gentschow L, Freitag CM, Becker K, Jans T. A multicentre randomized controlled trial on trans-generational attention deficit/hyperactivity disorder (ADHD) in mothers and children (AIMAC): an exploratory analysis of predictors and moderators of treatment outcome. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2018; 47:49-65. [PMID: 30084719 DOI: 10.1024/1422-4917/a000602] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE We examined predictors and moderators of treatment outcome in mothers and children diagnosed with ADHD in a large multicentre RCT. METHOD In total, 144 mother-child dyads with ADHD were randomly assigned to either a maternal ADHD treatment (group psychotherapy and open methylphenidate medication, TG) or to a control treatment (individual counselling without psycho- or pharmacotherapy, CG). After maternal ADHD treatment, parent-child training (PCT) for all mother-child dyads was added. The final analysis set was based on 123 dyads with completed primary outcome assessments (TG: n = 67, CG: n = 56). The primary outcome was the change in each child's externalizing symptoms. Multiple linear regression analyses were performed. RESULTS The severity of the child's externalizing problem behaviour in the family at baseline predicted more externalizing symptoms in the child after PCT, independent of maternal treatment. When mothers had a comorbid depression, TG children showed more externalizing symptoms after PCT than CG children of depressive mothers. No differences between the treatment arms were seen in the mothers without comorbid depression. CONCLUSIONS Severely impaired mothers with ADHD and depressive disorder are likely to need additional disorder-specific treatment for their comorbid psychiatric disorders to effectively transfer the contents of the PCT to the home situation (CCTISRCTN73911400).
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Affiliation(s)
- Charlotte Jaite
- 1a aa) Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy
| | - Betteke Maria van Noort
- 1a aa) Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy
| | - Timo D Vloet
- 2b bb) Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy
| | - Erika Graf
- 3 University of Freiburg, Medical Faculty and Medical Center, Freiburg, Germany
| | - Viola Kappel
- 1a aa) Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy
| | - Julia Geissler
- 2b bb) Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy
| | - Andreas Warnke
- 2b bb) Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy
| | - Christian Jacob
- 2a aa) Department of Psychiatry, Psychosomatics and Psychotherapy.,8 Hospital of Nürtingen, Nürtingen, Germany, Department of Psychiatry and Psychotherapy
| | - Silke Groß-Lesch
- 2a aa) Department of Psychiatry, Psychosomatics and Psychotherapy.,12 Schloss Werneck, Werneck, Germany, Department of Psychiatry, Psychotherapy and Psychosomatics
| | - Klaus Hennighausen
- 3b bb) Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics
| | - Barbara Haack-Dees
- 3b bb) Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics
| | - Katja Schneider-Momm
- 3b bb) Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics
| | - Alexandra Philipsen
- 3a aa) Department of Psychiatry and Psychotherapy.,9 University Hospital Bonn, Department of Psychiatry and Psychotherapy
| | | | | | - Wolfgang Retz
- 4a aa) Institute for Forensic Psychology and Psychiatry.,10 University Medical Center Mainz, Mainz, Germany, Department of Psychiatry and Psychotherapy, Germany
| | - Susann Hänig
- 4b bb) Saarland University Hospital, Department of Child and Adolescent Psychiatry and Psychotherapy
| | - Alexander von Gontard
- 4b bb) Saarland University Hospital, Department of Child and Adolescent Psychiatry and Psychotherapy
| | - Esther Sobanski
- 5a aa) Clinic for Psychiatry and Psychotherapy.,13 Johannes Gutenberg University Mainz, Mainz, Germany, Department of Child and Adolescent Psychiatry and Psychotherapy
| | - Barbara Alm
- 5a aa) Clinic for Psychiatry and Psychotherapy
| | - Sarah Hohmann
- 5b bb) Clinic for Child and Adolescent Psychiatry and Psychotherapy
| | - Alexander Häge
- 5b bb) Clinic for Child and Adolescent Psychiatry and Psychotherapy
| | - Luise Poustka
- 5b bb) Clinic for Child and Adolescent Psychiatry and Psychotherapy.,11 Universitätsmedizin Göttingen, Department of Child and Adolescent Psychiatry and Psychotherapy, Germany
| | - Michael Colla
- 14 Universitätsmedizin Rostock, Rostock, Germany, Department of Psychiatry and Psychotherapy
| | - Laura Gentschow
- 1b bb) Campus Benjamin Franklin, Department of Psychiatry and Psychotherapy
| | - Christine M Freitag
- 4b bb) Saarland University Hospital, Department of Child and Adolescent Psychiatry and Psychotherapy.,7 Frankfurt University Hospital, Frankfurt, Germany, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy
| | - Katja Becker
- 5b bb) Clinic for Child and Adolescent Psychiatry and Psychotherapy.,6 Philipps University Marburg, Marburg, Germany, Department of Child and Adolescent Psychiatry and Psychotherapy
| | - Thomas Jans
- 2b bb) Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy
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Arnold LE, Ober N, Aman MG, Handen B, Smith T, Pan X, Hyman SL, Hollway J, Lecavalier L, Page K, Rice R. A 1.5-Year Follow-Up of Parent Training and Atomoxetine for Attention-Deficit/Hyperactivity Disorder Symptoms and Noncompliant/Disruptive Behavior in Autism. J Child Adolesc Psychopharmacol 2018; 28:322-330. [PMID: 29694241 PMCID: PMC5994674 DOI: 10.1089/cap.2017.0134] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To examine status of children with autism spectrum disorder (ASD) 10 months after a 34-week clinical trial of atomoxetine (ATX) and parent training (PT). METHODS In a 2 × 2 design, 128 children with ASD and attention-deficit/hyperactivity disorder (ADHD) were randomly assigned ATX, PT+placebo, PT+ATX, or placebo alone. PT was weekly for 10 weeks, and then monthly. ATX/placebo was titrated over 6 weeks [≤1.8 mg/kg/d], and then maintained until week 10. Responders continued to week 34 or nonresponse. Placebo nonresponders had a 10-week ATX open trial; ATX nonresponders were treated clinically. All continued to week 34. With no further treatment from the study, all were invited to follow-up (FU) at 1.5 years postbaseline; 94 (73%) participated. Changes from Week 34 to FU and from baseline to FU were tested by one-way analysis of variance or chi-squared test. PT versus no PT was tested by chi-squared test, Fisher's exact test, Welch's t-test, Student's t-test, and Mann-Whitney's U test. RESULTS For the whole sample, the primary outcomes (parent-rated ADHD on the Swanson, Nolan, and Pelham [SNAP] scale and noncompliance on the Home Situations Questionnaire [HSQ]) deteriorated mildly from week 34 to FU, but were still substantially better than baseline (SNAP: t = 12.177, df = 93, p < 0.001; HSQ: t = 8.999, df = 93, p < 0.001). On the SNAP, 61% improved ≥30% from baseline (67% did at week 34); on noncompliance, 56% improved ≥30% from baseline (77% did at week 34). Outcomes with PT were not significantly better than without PT (SNAP p = 0.30; HSQ p = 0.27). Originally assigned treatment groups did not differ significantly. Only 34% still took ATX; 27% were taking stimulants; and 25% took no medication. CONCLUSIONS The majority retained their 34-week end-of-study improvement 10 months later, even though most participants stopped ATX. For some children, ATX continuation may not be necessary for continued benefit or other drugs may be necessary. Cautious individual clinical experimentation may be justified. Twelve sessions of PT made little long-term difference. ClinicalTrials.gov Identifier: Atomoxetine, Placebo and Parent Management Training in Autism (Strattera) (NCT00844753).
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Affiliation(s)
- L. Eugene Arnold
- Nisonger Center UCEDD, The Ohio State University, Columbus, Ohio
| | - Nicole Ober
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michael G. Aman
- Nisonger Center UCEDD, The Ohio State University, Columbus, Ohio
| | - Benjamin Handen
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Tristram Smith
- Department of Pediatrics, Division of Developmental and Behavioral Pediatrics, University of Rochester, Rochester, New York
| | - Xueliang Pan
- Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University, Columbus, Ohio
| | - Susan L. Hyman
- Department of Pediatrics, Division of Developmental and Behavioral Pediatrics, University of Rochester, Rochester, New York
| | - Jill Hollway
- Nisonger Center UCEDD, The Ohio State University, Columbus, Ohio
| | - Luc Lecavalier
- Nisonger Center UCEDD, The Ohio State University, Columbus, Ohio
| | - Kristin Page
- Nisonger Center UCEDD, The Ohio State University, Columbus, Ohio
| | - Robert Rice
- Nisonger Center UCEDD, The Ohio State University, Columbus, Ohio
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Chacko A, Bedard ACV, Marks D, Gopalan G, Feirsen N, Uderman J, Chimiklis A, Heber E, Cornwell M, Anderson L, Zwilling A, Ramon M. Sequenced neurocognitive and behavioral parent training for the treatment of ADHD in school-age children. Child Neuropsychol 2018; 24:427-450. [PMID: 28277151 PMCID: PMC6224162 DOI: 10.1080/09297049.2017.1282450] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The present study examines the potential of sequencing a neurocognitive intervention with behavioral parent training (BPT) to improve executive functions (EFs), psychiatric symptoms, and multiple indices of functional impairment in school-age children aged 7 to 11 years who have been diagnosed with attention-deficit/hyperactivity disorder (ADHD). Specifically, in a randomized controlled trial design, 85 children were assigned to either Cogmed Working Memory Training (CWMT) followed by an empirically supported, manualized BPT intervention, or to a placebo version of CWMT followed by the same BPT intervention. Working memory maintenance (i.e., attention control/short-term memory), working memory processing and manipulation, ADHD and oppositional defiant disorder (ODD) symptoms, impairment in parent-child dynamics, familial impairment, and overall functional compromise were evaluated as outcomes. The results suggest specific effects of the combined CWMT and BPT program on verbal and nonverbal working memory storage and nonverbal working memory processing and manipulation but no incremental benefits in regard to ADHD symptoms, ODD symptoms, and functional outcomes. The present findings do not support the hypothesis regarding the complementary and augmentative benefits of sequenced neurocognitive and BPT interventions for the treatment of ADHD. These results, the study's limitations, and future directions for research are further discussed.
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Affiliation(s)
- A Chacko
- a Department of Applied Psychology , New York University , NY , USA
| | - A-C V Bedard
- b Department of Applied Psychology and Human Development, Ontario Institute for Studies in Education , University of Toronto , Canada
| | - D Marks
- c Department of Child and Adolescent Psychiatry , New York University School of Medicine , NY , USA
| | - G Gopalan
- d Department of Social Work , University of Maryland at Baltimore , MD , USA
| | - N Feirsen
- e Department of Psychology , City University of New York , NY , USA
| | - J Uderman
- e Department of Psychology , City University of New York , NY , USA
| | - A Chimiklis
- e Department of Psychology , City University of New York , NY , USA
| | - E Heber
- e Department of Psychology , City University of New York , NY , USA
| | - M Cornwell
- e Department of Psychology , City University of New York , NY , USA
| | - L Anderson
- e Department of Psychology , City University of New York , NY , USA
| | - A Zwilling
- e Department of Psychology , City University of New York , NY , USA
| | - M Ramon
- e Department of Psychology , City University of New York , NY , USA
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Miller-Kuhaneck H, Watling R. Parental or Teacher Education and Coaching to Support Function and Participation of Children and Youth With Sensory Processing and Sensory Integration Challenges: A Systematic Review. Am J Occup Ther 2018; 72:7201190030p1-7201190030p11. [PMID: 29280713 DOI: 10.5014/ajot.2018.029017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This systematic review examines the literature published from January 2007 through May 2015 related to the effectiveness of occupational therapy interventions using parental or teacher education and coaching with children with challenges in sensory processing and sensory integration (SP-SI). Of more than 11,000 abstracts and 86 articles that were considered, only 4 met the criteria and were included in this review. Studies of parental training and coaching for children with challenges in SP-SI and comorbid autism spectrum disorder have suggested that educational or coaching programs could result in positive outcomes for both parents and children, often in a relatively short time period. Recommendations include a greater focus on providing educational interventions for parents and teachers and including specific assessment of SP-SI before implementing interventions meant to address those issues. Specific recommendations for future research are provided.
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Affiliation(s)
- Heather Miller-Kuhaneck
- Heather Miller-Kuhaneck, PhD, OTR/L, FAOTA, is Associate Professor, Department of Occupational Therapy, Sacred Heart University, Fairfield, CT
| | - Renee Watling
- Renee Watling, PhD, OTR/L, FAOTA, is Visiting Assistant Professor, School of Occupational Therapy, University of Puget Sound, Tacoma, WA, and Clinical Assistant Professor, Division of Occupational Therapy, University of Washington, Seattle;
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44
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Barnes G, Wilkes-Gillan S, Bundy A, Cordier R. The social play, social skills and parent-child relationships of children with ADHD 12 months following a RCT of a play-based intervention. Aust Occup Ther J 2017; 64:457-465. [DOI: 10.1111/1440-1630.12417] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Gabrielle Barnes
- Faculty of Health Science; The University of Sydney; Lidcombe Australia
| | | | - Anita Bundy
- Faculty of Health Science; The University of Sydney; Lidcombe Australia
| | - Reinie Cordier
- School of Occupational Therapy and Social Work; Curtin University; Perth Western Australia Australia
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45
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Lecavalier L, Smith T, Johnson C, Bearss K, Swiezy N, Aman MG, Sukhodolsky DG, Deng Y, Dziura J, Scahill L. Moderators of Parent Training for Disruptive Behaviors in Young Children with Autism Spectrum Disorder. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2017; 45:1235-1245. [PMID: 27917460 PMCID: PMC5459681 DOI: 10.1007/s10802-016-0233-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We conducted a 6 month, randomized trial of parent training (PT) versus a parent education program (PEP) in 180 young children (158 boys, 22 girls), ages 3-7 years, with autism spectrum disorder (ASD). PT was superior to PEP in decreasing disruptive and noncompliant behaviors. In the current study, we assess moderators of treatment response in this trial. Thirteen clinical and demographic variables were evaluated as potential moderators of three outcome variables: the Aberrant Behavior Checklist-Irritability subscale (ABC-I), Home Situations Questionnaire (HSQ), and Clinical Global Impressions-Improvement Scale (CGI-I). We used an intent-to-treat model and random effects regression. Neither IQ nor ASD severity moderated outcome on the selected outcome measures. Severity of Attention Deficit Hyperactivity Disorder (ADHD) and anxiety moderated outcomes on the ABC-I and HSQ. For instance, there was a 6.6 point difference on the ABC-I between high and low ADHD groups (p = .05) and a 5.3 point difference between high and low Anxiety groups (p = .04). Oppositional defiant disorder symptoms and household income moderated outcomes on the HSQ. None of the baseline variables moderated outcome on the CGI-I. That IQ and ASD symptom severity did not moderate outcome suggests that PT is likely to benefit a wide range of children with ASD and disruptive behavior.
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Affiliation(s)
- Luc Lecavalier
- Nisonger Center and Department of Psychology, Ohio State University, 371D McCampbell Hall, 1581 Dodd Dr., Columbus, OH, 43210, USA.
| | - Tristram Smith
- University of Rochester Medical Center School of Medicine and Dentistry, 601 Elmwood Ave, Box 671, Rochester, NY, 14642, USA
| | - Cynthia Johnson
- Department of Clinical and Health Psychology, 1225 Center Dr., Room 3130, PO Box 100165, Gainesville, FL, 32610-0165, USA
| | - Karen Bearss
- Department of Psychiatry and Behavioral Sciences, 4909 25th Ave NE, Seattle, WA, 98105, USA
| | - Naomi Swiezy
- Indiana University Riley Hospital for Children, 705 Riley Hospital Drive, Indianapolis, IN, 46202, USA
| | - Michael G Aman
- Ohio State University, 1581 Dodd Dr., Columbus, OH, 43210, USA
| | - Denis G Sukhodolsky
- Yale Child Study Center, 230 South Frontage Road, PO Box 207900, New Haven, CT, 06520-7900, USA
| | - Yanhong Deng
- Yale Center for Analytical Sciences, 300 George Street Suite 555, New Haven, CT, 06511, USA
| | - James Dziura
- Yale Center for Analytical Sciences, 300 George Street Suite 555, New Haven, CT, 06511, USA
| | - Lawrence Scahill
- Marcus Autism Center, 1920 Briarcliff Road, Atlanta, GA, 30329-4010, USA
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Randomized Clinical Trial of Mindfulness Skills Augmentation in Parent Training. CHILD & YOUTH CARE FORUM 2017. [DOI: 10.1007/s10566-017-9411-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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The relationship between aggression, empathy skills and serum oxytocin levels in male children and adolescents with attention deficit and hyperactivity disorder. Behav Pharmacol 2016; 27:681-688. [DOI: 10.1097/fbp.0000000000000234] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Smith T, Aman MG, Arnold LE, Silverman LB, Lecavalier L, Hollway J, Tumuluru R, Hyman SL, Buchan-Page KA, Hellings J, Rice RR, Brown NV, Pan X, Handen BL. Atomoxetine and Parent Training for Children With Autism and Attention-Deficit/Hyperactivity Disorder: A 24-Week Extension Study. J Am Acad Child Adolesc Psychiatry 2016; 55:868-876.e2. [PMID: 27663942 PMCID: PMC5108566 DOI: 10.1016/j.jaac.2016.06.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 05/31/2016] [Accepted: 07/27/2016] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The authors previously reported on a 2-by-2 randomized clinical trial of individual and combined treatment with atomoxetine (ATX) and parent training (PT) for attention-deficit/hyperactivity disorder (ADHD) symptoms and behavioral noncompliance in 128 5- to 14-year-old children with autism spectrum disorder. In the present report, they describe a 24-week extension of treatment responders and nonresponders. METHOD One-hundred seventeen participants from the acute trial (91%) entered the extension; 84 of these were in 2 subgroups: "treatment responders" (n = 43) from all 4 groups in the acute trial, seen monthly for 24 weeks, and "placebo nonresponders" (n = 41), treated with open-label ATX for 10 weeks. Participants originally assigned to PT continued PT during the extension; the remainder served as controls. Primary outcome measurements were the parent-rated Swanson, Nolan and Pelham ADHD scale and the Home Situations Questionnaire. RESULTS Sixty percent (26 of 43) of treatment responders in the acute trial, including 68% of responders originally assigned to ATX, still met the response criteria at the end of the extension. The response rate of placebo nonresponders treated with 10-week open-label ATX was 37% (15 of 41), similar to the acute trial. Children receiving open-label ATX + PT were significantly more likely to be ADHD responders (53% versus 23%) and noncompliance responders (58% versus 14%) than those receiving open-label ATX alone. CONCLUSION Most ATX responders maintained their responses during the extension. PT combined with ATX in the open-label trial appeared to improve ADHD and noncompliance outcomes more than ATX alone. Clinical trial registration information-Atomoxetine, Placebo and Parent Management Training in Autism (Strattera); http://clinicaltrials.gov; NCT00844753.
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Affiliation(s)
- Tristram Smith
- Division of Neurodevelopmental and Behavioral Pediatrics at the University of Rochester, Rochester, NY.
| | - Michael G Aman
- Nisonger Center UCEDD, The Ohio State University, Columbus
| | | | - Laura B Silverman
- Division of Neurodevelopmental and Behavioral Pediatrics at the University of Rochester, Rochester, NY
| | - Luc Lecavalier
- Nisonger Center UCEDD, The Ohio State University, Columbus
| | - Jill Hollway
- Nisonger Center UCEDD, The Ohio State University, Columbus
| | | | - Susan L Hyman
- Division of Neurodevelopmental and Behavioral Pediatrics at the University of Rochester, Rochester, NY
| | | | | | | | | | - Xueliang Pan
- Center for Biostatistics, The Ohio State University
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Incredible Years parent training: What changes, for whom, how, for how long? JOURNAL OF APPLIED DEVELOPMENTAL PSYCHOLOGY 2016. [DOI: 10.1016/j.appdev.2016.04.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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50
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Impact of implementing a parental training program in the treatment of a sample of ADHD children. MIDDLE EAST CURRENT PSYCHIATRY 2016. [DOI: 10.1097/01.xme.0000475431.46273.79] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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