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Chung S, Lai J, Hawkey EJ, Dvorsky MR, Owens E, Huston E, Pfiffner LJ. Feasibility study of a telehealth school-based behavioral parent training group program for attention-deficit/hyperactivity disorder. J Pediatr Psychol 2024:jsae060. [PMID: 39186568 DOI: 10.1093/jpepsy/jsae060] [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: 12/06/2023] [Revised: 06/26/2024] [Accepted: 07/04/2024] [Indexed: 08/28/2024] Open
Abstract
OBJECTIVE To evaluate the feasibility and preliminary efficacy of Telehealth Behavioral Parent Training (T-BPT), a school telehealth group intervention for attention-deficit/hyperactivity disorder (ADHD) with a companion training program for school clinicians. METHODS T-BPT was developed in an iterative three-phase design in partnership with community stakeholders during the COVID-19 pandemic. School clinicians (N = 4) delivered T-BPT over 8 weeks to parents (N = 21, groups of 5-6 per school) of children (Grades 2-5) with ADHD while simultaneously receiving training and consultation from PhD-level study trainers. A single-arm open trial was used to assess feasibility, engagement, and preliminary efficacy. RESULTS Parents and school clinicians endorsed high feasibility, acceptability, and usability of T-BPT. Parent attendance was high (M = 94.6%) and a majority of parents (66.7%) attended all eight sessions. Preliminary outcomes indicate moderate to large reductions in parent-reported ADHD symptoms (ω2 = .36), functional and clinical global impairment (ω2s= .21 and .19, respectively), and distance learning challenges (ω2 = .22). CONCLUSIONS Results were in line with in-person delivery, indicating promising feasibility of school telehealth BPT groups. This study also provided further support for the feasibility of the remote training model for school clinicians. Implications of the commonly endorsed barriers and benefits beyond COVID-19 and relevance to under resourced communities are also discussed.
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Affiliation(s)
- Sara Chung
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, United States
| | - Jasmine Lai
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, United States
| | - Elizabeth J Hawkey
- Mental Health/Substance Use Disorder Group, Providence Hood River Memorial Hospital, Hood River, OR, United States
| | - Melissa R Dvorsky
- Department of Psychiatry and Behavioral Sciences, Children's National Hospital, George Washington University, Washington, DC, United States
| | - Elizabeth Owens
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, United States
| | - Emma Huston
- Department of Psychology and Counseling, PGSP Stanford PsyD Consortium, Palo Alto University, Palo Alto, CA, United States
| | - Linda J Pfiffner
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, United States
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Wilkes-Gillan S, Parsons L, Parsons D, Mahoney N, Hancock N, Cordier R, Lincoln M, Chen YWR, Bundy A. An evaluation of intervention appropriateness from the perspective of parents: A peer-mediated, play-based intervention for children with ADHD. Aust Occup Ther J 2024. [PMID: 39032070 DOI: 10.1111/1440-1630.12981] [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: 12/03/2023] [Revised: 07/03/2024] [Accepted: 07/04/2024] [Indexed: 07/22/2024]
Abstract
INTRODUCTION A peer-mediated, play-based intervention has been developed to address social participation challenges experienced by children with ADHD. To facilitate implementation into clinical practice, interventions should be evaluated for appropriateness to the end-user, as well as effectiveness. Previous research demonstrated the approach is effective for improving children's social play skills. This study aimed to evaluate the appropriateness of the intervention for children with ADHD and their families. METHODS Parents of children with ADHD who participated in the play-based intervention were interviewed 1 month after completion. Parents were asked about their perspective of parent and children's experiences of the intervention, the perceived benefits for children and parents, the logistics of participating, and recommended adaptations to the intervention. Interviews were analysed thematically, and themes were mapped to the elements of the adopted definition of appropriateness to understand whether parents supported the appropriateness of the intervention for their families. CONSUMER AND COMMUNITY INVOLVEMENT Consumers were not directly involved in the decisions made about this study. FINDINGS One core theme, 'collaborative efforts', emerged from the data. Major themes comprising the core theme were 'on the same page', 'therapeutic relationship', and 'getting the job done'. Three sub-themes of 'engagement and motivation', 'the effort was worth it for the reward', and 'Rome wasn't built in a day' were nested within the major themes. CONCLUSION Parents largely supported the appropriateness of the intervention, indicating it addressed an important goal for their child, participation was a positive experience, and they perceived the intervention to be beneficial. Future adaptions of the intervention are needed to increase its ecological validity and to generalise the strategies to other social environments and playmates, such as peers at school. PLAIN LANGUAGE SUMMARY This study looked at an intervention that uses play with peers to help children with ADHD develop their play skills. The researchers wanted to know if parents thought the intervention was a good fit for their families and if it helped their children. Parents gave an interview a month after the intervention ended. They were asked about their thoughts on the intervention, how it helped their children and themselves, how easy it was to take part, and what changes could be made to make the intervention better. After analysing parents' answers, the researchers found parents mostly agreed that the intervention was a good fit. They said it helped their children to play with their peers, and they had a good time doing it. Parents thought the intervention was helpful, they liked that it was a joint effort between them and the occupational therapist, and they felt it was worth the effort. However, they also suggested some changes. They wanted the intervention to fit into other real-life social situations, such as school, so their children could use the skills they learned in other places. Overall, parents thought the intervention was helpful and suitable for their children and themselves, but some changes might make it more helpful.
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Affiliation(s)
- Sarah Wilkes-Gillan
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Lauren Parsons
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Dave Parsons
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Natasha Mahoney
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Nicola Hancock
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Reinie Cordier
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- Department of Social Work, Education and Community Wellbeing, Faculty of Health and Life Sciences, University of North Umbria, Newcastle upon Tyne, UK
| | - Michelle Lincoln
- Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Yu-Wei Ryan Chen
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Anita Bundy
- Department of Occupational Therapy, College of Health and Human Sciences, Colorado State University, Fort Collins, Colorado, USA
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Chacko A, Merrill BM, Kofler MJ, Fabiano GA. Improving the efficacy and effectiveness of evidence-based psychosocial interventions for attention-deficit/hyperactivity disorder (ADHD) in children and adolescents. Transl Psychiatry 2024; 14:244. [PMID: 38851829 PMCID: PMC11162428 DOI: 10.1038/s41398-024-02890-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/14/2024] [Accepted: 03/22/2024] [Indexed: 06/10/2024] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a prevalent, chronic, and impairing mental health disorder of childhood. Decades of empirical research has established a strong evidence-based intervention armamentarium for ADHD; however, limitations exist in regards to efficacy and effectiveness of these interventions. We provide an overview of select evidence-based interventions for children and adolescents, highlighting potential approaches to further improving the efficacy and effectiveness of these interventions. We conclude with broader recommendations for interventions, including considerations to moderators and under-explored intervention target areas as well as avenues to improve access and availability of evidence-based interventions through leveraging underutilized workforces and leveraging technology.
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Fabiano GA, Lupas K, Merrill BM, Schatz NK, Piscitello J, Robertson EL, Pelham WE. Reconceptualizing the approach to supporting students with attention-deficit/hyperactivity disorder in school settings. J Sch Psychol 2024; 104:101309. [PMID: 38871418 PMCID: PMC11331420 DOI: 10.1016/j.jsp.2024.101309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 09/19/2023] [Accepted: 03/16/2024] [Indexed: 06/15/2024]
Abstract
The long-term academic outcomes for many students with attention-deficit/hyperactivity disorder (ADHD) are strikingly poor. It has been decades since students with ADHD were specifically recognized as eligible for special education through the Other Health Impaired category under the Education for all Handicapped Children Act of 1975, and similarly, eligible for academic accommodations through Section 504 of the 1973 Rehabilitation Act. It is time to acknowledge that these school-policies have been insufficient for supporting the academic, social, and behavioral outcomes for students with ADHD. Numerous reasons for the unsuccessful outcomes include a lack of evidence-based interventions embedded into school approaches, minimizing the importance of the general education setting for promoting effective behavioral supports, and an over-reliance on assessment and classification at the expense of intervention. Contemporary behavioral support approaches in schools are situated in multi-tiered systems of support (MTSS); within this article we argue that forward-looking school policies should situate ADHD screening, intervention, and maintenance of interventions within MTSS in general education settings and reserve special education eligibility solely for students who require more intensive intervention. An initial model of intervention is presented for addressing ADHD within schools in a manner that should provide stronger interventions, more quickly, and therefore more effectively.
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Evans SW, DuPaul GJ, Benson K, Owens JS, Fu Q, Cleminshaw C, Kipperman K, Margherio S. Social Functioning Outcomes of a High School-Based Treatment Program for Adolescents with ADHD. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2024; 53:413-428. [PMID: 37494306 DOI: 10.1080/15374416.2023.2235693] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
OBJECTIVE We evaluated the extent to which receiving the multi-component treatment of the Challenging Horizons Program (CHP) would lead to significant improvements in social functioning, as well as in inattention, internalizing symptoms, parent stress, and emotion dysregulation for high-school-aged adolescents with attention-deficit hyperactivity disorder (ADHD). METHOD Participants were 186 high-school-aged adolescents (74% White) with a diagnosis of ADHD who were randomly assigned to either CHP (n = 92; 80% boys; M age = 15.0; SD = 0.8) or Community Care (CC; n = 94; 78% boys; M age = 15.1; SD = 0.9) within each of 12 participating schools. Parent and adolescent reports of social functioning were the primary outcome measures. Secondary outcomes included ratings of symptoms of ADHD and related disorders, parent stress, and emotion regulation. RESULTS Intent-to-treat analyses using hierarchical linear modeling revealed significant group-by-time interactions of medium magnitude (d range = .40 to .52) on parent-rated social skills. Significant group-by-time benefits were also identified for adolescent self-rated social skills as well as the secondary outcomes of parent-rated inattention symptoms, emotion regulation, and parenting stress. DISCUSSION CHP appears to benefit social skills along with related characteristics for adolescents with ADHD. Understanding these unique findings for this population informs additional research related to treatment mechanisms and effectiveness trials.
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Affiliation(s)
| | - George J DuPaul
- Department of Education and Human Services, Lehigh University
| | | | | | - Qiong Fu
- Department of Education and Human Services, Lehigh University
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Chronis-Tuscano A, Bounoua N. ADHD Prevalence Rose, Yet Disparities Remain: Commentary on the 2022 National Survey of Children's Health. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2024; 53:361-372. [PMID: 38905157 PMCID: PMC11193851 DOI: 10.1080/15374416.2024.2359075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/23/2024]
Abstract
This is a commentary on Danielson and colleagues' report entitled "ADHD Prevalence Among U.S. Children and Adolescents in 2022: Diagnosis, Severity, Co-Occurring Disorders, and Treatment," which provides updated prevalence rates related to ADHD diagnosis and treatment utilization using data from the 2022 National Survey of Children's Health (NSCH). This timely article is among the first to report on ADHD prevalence rates since the COVID-19 pandemic, and highlights important patterns related to ADHD diagnosis and treatment utilization. In this commentary, we contextualize these findings with consideration to the COVID-19 pandemic and within the existing literature on health disparities among youth with ADHD and their families. We end with recommendations for future work involving researchers, clinicians, and policymakers with the intention of reducing disparities in ADHD diagnosis and treatment in the U.S.
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van Doornik RS, van der Oord S, Luijckx J, Groenman AP, Leijten P, Luman M, Hoekstra PJ, van den Hoofdakker BJ, Dekkers TJ. The short- and longer-term effects of brief behavioral parent training versus care as usual in children with behavioral difficulties: study protocol for a randomized controlled trial. BMC Psychiatry 2024; 24:203. [PMID: 38475768 PMCID: PMC10936011 DOI: 10.1186/s12888-024-05649-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 03/01/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND The access to and uptake of evidence-based behavioral parent training for children with behavioral difficulties (i.e., oppositional, defiant, aggressive, hyperactive, impulsive, and inattentive behavior) are currently limited because of a scarcity of certified therapists and long waiting lists. These problems are in part due to the long and sometimes perceived as rigid nature of most evidence-based programs and result in few families starting behavioral parent training and high dropout rates. Brief and individually tailored parenting interventions may reduce these problems and make behavioral parent training more accessible. This protocol paper describes a two-arm, multi-center, randomized controlled trial on the short- and longer-term effectiveness and cost-effectiveness of a brief, individually tailored behavioral parent training program for children with behavioral difficulties. METHODS Parents of children aged 2-12 years referred to a child mental healthcare center are randomized to (i) three sessions of behavioral parent training with optional booster sessions or (ii) care as usual. To evaluate effectiveness, our primary outcome is the mean severity of five daily ratings by parents of four selected behavioral difficulties. Secondary outcomes include measures of parent and child behavior, well-being, and parent-child interaction. We explore whether child and parent characteristics moderate intervention effects. To evaluate cost-effectiveness, the use and costs of mental healthcare and utilities are measured. Finally, parents' and therapists' satisfaction with the brief program are explored. Measurements take place at baseline (T0), one week after the brief parent training, or eight weeks after baseline (in case of care as usual) (T1), and six months (T2) and twelve months (T3) after T1. DISCUSSION The results of this trial could have meaningful societal implications for children with behavioral difficulties and their parents. If we find the brief behavioral parent training to be more (cost-)effective than care as usual, it could be used in clinical practice to make parent training more accessible. TRIAL REGISTRATION The trial is prospectively registered at ClinicalTrials.gov (NCT05591820) on October 24th, 2022 and updated throughout the trial.
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Affiliation(s)
- Roos S van Doornik
- Accare Child Study Center, Groningen, The Netherlands.
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | | | - Joli Luijckx
- Balans, National Parent Association, Bunnik, The Netherlands
| | - Annabeth P Groenman
- Accare Child Study Center, Groningen, The Netherlands
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
| | - Patty Leijten
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
| | - Marjolein Luman
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Complex Behavioral Disorders and Forensic Youth Psychiatry, Levvel, Amsterdam, The Netherlands
| | - Pieter J Hoekstra
- Accare Child Study Center, Groningen, The Netherlands
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Barbara J van den Hoofdakker
- Accare Child Study Center, Groningen, The Netherlands
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
| | - Tycho J Dekkers
- Accare Child Study Center, Groningen, The Netherlands
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Complex Behavioral Disorders and Forensic Youth Psychiatry, Levvel, Amsterdam, The Netherlands
- Department of Child and Adolescent Psychiatry, Amsterdam University Medical Center (AUMC), Amsterdam, The Netherlands
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
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Rasmussen IL, Schei J, Ørjasæter KB. "A bit lost"-Living with attention deficit hyperactivity disorder in the transition between adolescence and adulthood: an exploratory qualitative study. BMC Psychol 2024; 12:20. [PMID: 38212821 PMCID: PMC10785427 DOI: 10.1186/s40359-024-01522-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/05/2024] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) begins in childhood and in many cases persists into adulthood. The transition from adolescence to adulthood for young people with ADHD is a vulnerable time and can be associated with comorbid conditions and unfavorable outcomes. Thus, further studies are needed to explore the characteristics of the transition period in emerging adulthood. The overall aim of this study was to gain increased knowledge of emerging adults' experience of living with ADHD in the transition from adolescence to adulthood. This is a follow-up from a previous qualitative study that examined how young people experience receiving and living with a diagnosis of ADHD. METHOD The study has a qualitative retrospective design. Seven participants were included in this study using a purposive sampling method. We re-invited the same participants who were interviewed in 2015-2016 and conducted in-depth interviews. The data were subjected to Malterud's systematic text condensation (STC). RESULTS Four crosscutting themes were identified from our analysis: (1) low level of knowledge about ADHD and treatment options; (2) barriers to seeking and accessing help; (3) developing self-help strategies; and (4) a preference to discontinued medication use. CONCLUSION The participants emphasized a need for more information about ADHD in transition phases and support, both from professionals and peers, about finding ways to live meaningful lives. The treatment they had been offered was particularly linked to symptom reduction and medication use. A more appropriate focus would have been linked to how they, as citizens, could gain knowledge and skills to live meaningful lives with ADHD.
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Affiliation(s)
| | - Jorun Schei
- NTNU, St. Olavs University Hospital, Trondheim, Norway
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Golson ME, Brunson McClain M, O'Dell SM, Gormley MJ, Roanhorse TT, Yang NJ, Kettlewell P, Shahidullah JD. Assessment and Management of Attention-Deficit/Hyperactivity Disorder: Pediatric Resident Perspectives on Training and Practice. Clin Pediatr (Phila) 2023; 62:1513-1522. [PMID: 36995005 DOI: 10.1177/00099228231163687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a common presenting concern in primary care. This study examined the relationship between pediatric residency training program characteristics and residents' ADHD knowledge, attitudes, and comfort in providing ADHD services. Given the familiarity that pediatric chief residents have with the training and experiences within their residency programs, a 30-item survey was mailed to pediatric chief residents. A total of 100 residents returned their surveys (response rate 49.5%) and were included in the descriptive quantitative and thematic qualitative analyses. The majority of participants rated their ADHD knowledge as at least average. However, approximately half of the participants were comfortable with screening, and less than half were comfortable with managing stimulant medication or behavioral treatments. Participants emphasized the importance of interprofessional collaboration, clinical experiences, and integrated ADHD education throughout training. These results emphasize the importance of improved training in screening, diagnosing, and managing ADHD to increase resident comfort regarding these practices.
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Affiliation(s)
- Megan E Golson
- Department of Psychology, Utah State University, Logan, UT, USA
| | | | | | | | | | - Nai-Jiin Yang
- Department of Psychology, Utah State University, Logan, UT, USA
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Karlsdóttir E, Gudmundsdottir BG, Sveinbjörnsdóttir B. Use of School-Based Interventions for ADHD, Professional Support, and Burnout Symptoms among Teachers in Iceland. J Atten Disord 2023; 27:1583-1595. [PMID: 37449377 DOI: 10.1177/10870547231187149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
OBJECTIVE Effective school-based interventions for youth with ADHD are critical to their success. We examined whether teacher application of such interventions and perceptions of professional support related to greater well-being, including fewer burnout symptoms. METHOD Teachers in primary schools in Iceland were invited to participate in an online survey, including questions about professional support and the Maslach Burnout Inventory (MBI). The sample comprised N = 592 (88.5% female) participants. RESULTS Regression analyses indicated that use of recommended ADHD interventions was positively associated with MBI-Personal Achievement (PA). Greater satisfaction with professional support related to lower MBI-Emotional Exhaustion and MBI-Depersonalization, and higher MBI-PA. Level of professional support was positively associated with use of recommended interventions. CONCLUSION Effective interventions and support for students with ADHD may enhance teacher well-being. Icelandic teachers require further training and professional support in best practices for ADHD, to help promote teacher and student success.
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Li S, Lu Y, Wu J. Sandplay Therapy as a Complementary Treatment for Children with ADHD: A Scoping Review. Issues Ment Health Nurs 2023; 44:911-917. [PMID: 37699060 DOI: 10.1080/01612840.2023.2249990] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
ADHD is a prevalent neurodevelopmental disorder that affects children's behavior, academic performance, and social interactions. This review aims to evaluate the existing evidence for Sandplay therapy, a nonverbal psychodynamic approach, as a complementary treatment for children with ADHD. Ten studies suggest Sandplay therapy improves ADHD symptoms, such as hyperactivity, impulsivity, and inattention, through symbolic expression, play, and mindfulness. Despite its promise, ethical and practical considerations, including therapist training and treatment cost, must be addressed. Further research is needed to determine long-term effectiveness and optimal patient population for this treatment, which may benefit children unresponsive to or experiencing side effects from traditional treatments.
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Affiliation(s)
- Siqi Li
- Department of VIP Clinic Nursing, West China Second University Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - You Lu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
- Department of Child Health Care Nursing, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Jinhui Wu
- West China School of Nursing, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
- Department of Child Health Care Nursing, West China Second University Hospital, Sichuan University, Chengdu, China
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Sevastidis A, Wanni Arachchige Dona S, Gold L, Sciberra E, Coghill D, Le HND. Social gradient in use of health services and health-related quality of life of children with attention-deficit/hyperactivity disorder: A systematic review. JCPP ADVANCES 2023; 3:e12170. [PMID: 37720590 PMCID: PMC10501702 DOI: 10.1002/jcv2.12170] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 04/04/2023] [Indexed: 09/19/2023] Open
Abstract
Aims ADHD (attention-deficit/hyperactivity disorder) affects 5% of children on average. Despite the high need to access services for ADHD treatment, not all children with ADHD utilise healthcare services equally. This study aims to systematically synthesise evidence of equity and equality in health service use/costs and health-related quality of life (HRQoL)/wellbeing of children with ADHD across socioeconomic (SES) classes. Methods The literature search was conducted across seven databases (Academic Search complete, MEDLINE Complete, PsycINFO, ERIC, Global Health, CINAHL and EconLit). The search was limited to peer-reviewed articles published to 23rd January 2023 in English and focused on children. Study quality was assessed using the Critical Appraisal Skills Program (CASP), Joanna Briggs Institute (JBI) and Mixed Methods Appraisal Tool (MMAT) checklists. Results 25 out of 1207 articles were eligible for inclusion. The results showed that SES was associated with different types of healthcare utilisation. Only three studies were found on HRQoL/well-being. Children with ADHD from low SES families had lower HRQoL than children from high SES families. Conclusion This study found that a social gradient exists in both healthcare service use and children's HRQoL among those with ADHD.
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Affiliation(s)
- Abraham Sevastidis
- Deakin Health EconomicsSchool of Health and Social DevelopmentFaculty of HealthDeakin UniversityBurwoodVictoriaAustralia
| | - Sithara Wanni Arachchige Dona
- Deakin Health EconomicsSchool of Health and Social DevelopmentFaculty of HealthDeakin UniversityBurwoodVictoriaAustralia
| | - Lisa Gold
- Deakin Health EconomicsSchool of Health and Social DevelopmentFaculty of HealthDeakin UniversityBurwoodVictoriaAustralia
- Murdoch Children's Research InstituteRoyal Children's HospitalBurwoodVictoriaAustralia
| | - Emma Sciberra
- Murdoch Children's Research InstituteRoyal Children's HospitalBurwoodVictoriaAustralia
- School of PsychologyFaculty of HealthDeakin UniversityBurwoodVictoriaAustralia
- Departments of Paediatrics and PsychiatryFaculty of Medicine, Dentistry and Health SciencesThe University of MelbourneBurwoodVictoriaAustralia
- The Centre for Social and Early Emotional Development (SEED)Deakin UniversityBurwoodVictoriaAustralia
| | - David Coghill
- Murdoch Children's Research InstituteRoyal Children's HospitalBurwoodVictoriaAustralia
- Departments of Paediatrics and PsychiatryFaculty of Medicine, Dentistry and Health SciencesThe University of MelbourneBurwoodVictoriaAustralia
| | - Ha Nguyet Dao Le
- Deakin Health EconomicsSchool of Health and Social DevelopmentFaculty of HealthDeakin UniversityBurwoodVictoriaAustralia
- Murdoch Children's Research InstituteRoyal Children's HospitalBurwoodVictoriaAustralia
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Song Y, Fan B, Wang C, Yu H. Meta-analysis of the effects of physical activity on executive function in children and adolescents with attention deficit hyperactivity disorder. PLoS One 2023; 18:e0289732. [PMID: 37590250 PMCID: PMC10434964 DOI: 10.1371/journal.pone.0289732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 07/25/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Executive function is a core deficit in children with attention deficit hyperactivity disorder (ADHD). This study systematically reviewed the evidence for the effects of physical activity (PA) interventions on executive function in children and adolescents with ADHD and explored the moderating effects of key variables of PA on executive function. METHODS Relevant literature in four electronic databases, Pubmed, Web of Science, Cochrane Library, and Embase, were systematically searched. Revman 5.4 was used for data analysis, and combined effect sizes, heterogeneity tests, subgroup analyses, and sensitivity analyses were calculated. Egger's test in Stata 15.0 was used for publication bias testing. RESULTS A total of 24 articles with 914 participants were included. Meta-analysis showed that PA interventions improved inhibitory control (SMD = -0.50, 95%CI [-0.71, -0.29], P < 0.00001), working memory (SMD = -0.50, 95%CI [-0.83, -0.16], P = 0.004) and cognitive flexibility in children and adolescents with ADHD (SMD = -0.45, 95%CI [-0.81, -0.09], P = 0.01). Subgroup analysis revealed a moderating effect of intervention intensity, motor skill type, sessions of PA, and weekly exercise volume on executive function. CONCLUSION PA interventions had positive effects on improvements in core executive functions in children and adolescents with ADHD and were influenced by intervention intensity, type of motor skill, sessions of PA, and amount of exercise. This has practical implications for the formulation of PA interventions programs.
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Affiliation(s)
- Yiling Song
- Department of Physical Education, Tsinghua University, Beijing, China
| | - Biyao Fan
- College of Physical Education and Sports, Beijing Normal University, Beijing, China
| | - Chunshun Wang
- Department of Physical Education, Tsinghua University, Beijing, China
| | - Hongjun Yu
- Department of Physical Education, Tsinghua University, Beijing, China
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14
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Schmengler H, Peeters M, Stevens GWJM, Hartman CA, Oldehinkel AJ, Vollebergh WAM. ADHD Symptoms and Educational Level in Adolescents: The Role of the Family, Teachers, and Peers. Res Child Adolesc Psychopathol 2023; 51:1051-1066. [PMID: 36952076 PMCID: PMC10271900 DOI: 10.1007/s10802-023-01047-y] [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: 02/22/2023] [Indexed: 03/24/2023]
Abstract
Few studies have explored the contribution of family and school factors to the association between ADHD symptoms and lower education. Possibly, having more ADHD symptoms contributes to poorer family functioning and less social support, and consequently a lower educational level (i.e., mediation). Moreover, the negative effects of ADHD symptoms on education may be stronger for adolescents with poorer family functioning or less social support (i.e., interaction). Using data of the Dutch TRAILS Study (N = 2,229), we evaluated associations between ADHD symptoms around age 11 and educational level around age 14, as well as between ADHD symptoms around age 14 and 16 years and subsequent changes in educational level around age 16 and 19, respectively. We assessed the potential mediating role of family functioning, and social support by teachers and classmates, all measured around ages 11, 14, and 16, while additionally evaluating interactions between ADHD symptoms and these hypothesized mediators. ADHD symptoms were associated with poorer family functioning, less social support by teachers and classmates, and lower education throughout adolescence. No conclusive evidence of mediation was found, because unique associations between family functioning and social support by teachers and classmates and education were largely absent. Furthermore, we found no interactions between ADHD symptoms and family functioning and social support by teachers and classmates. Although social support by teachers and classmates and good family functioning may benefit the wellbeing and mental health of adolescents with high levels of ADHD symptoms, they will not necessarily improve their educational attainment.
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Affiliation(s)
- Heiko Schmengler
- Department of Interdisciplinary Social Science, Utrecht University, Padualaan 14, Utrecht, 3584 CH, The Netherlands.
| | - Margot Peeters
- Department of Interdisciplinary Social Science, Utrecht University, Padualaan 14, Utrecht, 3584 CH, The Netherlands
| | - Gonneke W J M Stevens
- Department of Interdisciplinary Social Science, Utrecht University, Padualaan 14, Utrecht, 3584 CH, The Netherlands
| | - Catharina A Hartman
- Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center of Groningen, University of Groningen, Groningen, 9700 RB, The Netherlands
| | - Albertine J Oldehinkel
- Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center of Groningen, University of Groningen, Groningen, 9700 RB, The Netherlands
| | - Wilma A M Vollebergh
- Department of Interdisciplinary Social Science, Utrecht University, Padualaan 14, Utrecht, 3584 CH, The Netherlands
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15
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Russell D, Arnold LE. Complementary and Integrative Treatments for Attention-Deficit/Hyperactivity Disorder in Youth. Child Adolesc Psychiatr Clin N Am 2023; 32:173-192. [PMID: 37147036 DOI: 10.1016/j.chc.2022.08.005] [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: 05/07/2023]
Abstract
First-line psychopharmacologic and psychosocial treatments for attention-deficit/hyperactivity disorder in children are effective but limited by tolerability and accessibility problems. Many complementary and integrative strategies have been investigated as alternative or adjunctive treatments for the disorder, and the literature has progressed to meta-analyses for several. Although heterogeneity of study methods and risk of bias pervades the literature, we conclude that Omega-3 supplementation, dietary restriction of artificial food colorings, and physical activity can be considered evidence-based. Additionally, meditation, yoga, and sleep hygiene are safe, partially effective, cost effective and sensible adjunctive treatment strategies.
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Affiliation(s)
- Douglas Russell
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, c/o Seattle Children's Hospital, OA.5.154 PO Box 5371, Seattle, WA 98145-5005, USA.
| | - L Eugene Arnold
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, 395E McCampbell Hall, 1581 Dodd Drive, Columbus, OH 43210, USA
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16
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Wang M, Yang X, Yu J, Zhu J, Kim HD, Cruz A. Effects of Physical Activity on Inhibitory Function in Children with Attention Deficit Hyperactivity Disorder: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1032. [PMID: 36673793 PMCID: PMC9859519 DOI: 10.3390/ijerph20021032] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 12/29/2022] [Accepted: 01/04/2023] [Indexed: 06/17/2023]
Abstract
This systematic review and meta-analysis aimed to systematically evaluate the effect of physical activity (PA) on inhibitory function in children with ADHD. Experimental studies on the effect of PA on the inhibitory function of children with ADHD were retrieved. The data were obtained from PubMed, The Cochrane Library, Web of Science, EBSCO (MEDLINE, APA Psyclnfo, ERIC), Embase, Scopus, and ProQuest. The search period was from the date of inception of the respective databases to 4 May 2022, and Reviewer Manager software (version 5.3) was used for analysis. Eleven articles and 713 samples were included in the meta-analysis. Results revealed that PA can significantly improve the inhibitory function of children with ADHD (SMD = 0.78, 95% CI: 0.45−1.10, p < 0.001). Subgroup analysis showed that the effectiveness of PA as an intervention in improving the inhibitory function of children with ADHD was moderated by the frequency, intensity, duration, type, and length of intervention. Based on the findings, PA can effectively improve interference suppression inhibitory function in children with ADHD. Longitudinal open-skill exercise for 60 min or more, two times/week has the best effect on improving inhibitory function in children with ADHD.
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Affiliation(s)
- Meng Wang
- Department of Physical Education, Keimyung University, Daegu 42601, Republic of Korea
| | - Xinyue Yang
- College of Sports Science, Shenyang Normal University, Shenyang 110034, China
| | - Jing Yu
- College of Sports Science, Shenyang Normal University, Shenyang 110034, China
| | - Jian Zhu
- Department of Physical Education, Zhongyuan University of Technology, Zhengzhou 450007, China
| | - Hyun-Duck Kim
- Department of Sport Marketing, Keimyung University, Daegu 42601, Republic of Korea
| | - Angelita Cruz
- Department of Physical Education, Keimyung University, Daegu 42601, Republic of Korea
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17
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Zhu F, Zhu X, Bi X, Kuang D, Liu B, Zhou J, Yang Y, Ren Y. Comparative effectiveness of various physical exercise interventions on executive functions and related symptoms in children and adolescents with attention deficit hyperactivity disorder: A systematic review and network meta-analysis. Front Public Health 2023; 11:1133727. [PMID: 37033046 PMCID: PMC10080114 DOI: 10.3389/fpubh.2023.1133727] [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: 12/29/2022] [Accepted: 03/08/2023] [Indexed: 04/11/2023] Open
Abstract
Background Physical exercise has been recommended as an important nonpharmacological therapeutic strategy for managing attention deficit hyperactivity disorder (ADHD). We conducted a network meta-analysis (NMA) to assess the comparative impact of different physical exercise modalities on enhancing executive functions (EFs) and alleviating symptoms in children and adolescents with ADHD. Methods We searched Web of Science, PubMed, Embase, Cochrane Central Register of Controlled Trials, SPORTDiscus, PsycINFO, CNKI, and clinical trials databases from inception to October 20, 2022. Randomized controlled trials (RCTs) and quasi-experimental studies investigating physical exercise for ADHD-related symptoms of hyperactivity/impulsivity and inattention, and executive functions were included. The frequentist random-effect NMA method was applied to pool the results. Results A total of 59 studies (including 39 RCTs, 5 quasi-RCTs, and 15 self-controlled trials) published between 1983 and 2022 were incorporated into the systematic review, of which 44 studies with 1757 participants were eligible for meta-analysis. All types of physical exercise were effective in improving EFs (SMD = 1.15, 95% CI: 0.83 to 1.46), and open-skill activities which require participants to react in a dynamically changing and externally paced environment induced the most incredible benefits for executive functions (SUCRA = 98.0%, SMD = 1.96, and 95% CI: 1.15 to 2.77). Subgroup analyses for EFs revealed varied findings that open-skill activities were the most promising physical exercise type for improving inhibitory control (SUCRA = 99.1%, SMD = 1.94, and 95% CI: 1.24 to 2.64), and closed-skill activities dominated by aerobic exercises had a slightly higher probability of being the most promising physical exercise intervention for working memory (SUCRA = 75.9%, SMD = 1.21, and 95% CI: -0.22 to 2.65), and multicomponent physical exercise tended to be the most effective in cognitive flexibility (SUCRA = 70.3%, SMD = 1.44, and 95% CI: -0.19 to 3.07). Regarding ADHD-related symptoms, closed-skill activities dominated by aerobic exercises might be more advantageous for hyperactivity/impulsivity (SUCRA = 72.5%, SMD = -1.60, and 95% CI: -3.02 to -0.19) and inattention (SUCRA = 96.3%, SMD = -1.51, and 95% CI: -2.33 to -0.69) improvement. Conclusion Physical exercise can significantly help to alleviate the symptoms of ADHD and improve executive functions in children and adolescents with ADHD. Most of all, to promote adherence to treatment, they should be encouraged to perform the physical exercises that they enjoy most.
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Affiliation(s)
- Feilong Zhu
- College of Physical Education and Sports, Beijing Normal University, Beijing, China
| | - Xiaotong Zhu
- College of Physical Education and Sports, Beijing Normal University, Beijing, China
| | - Xiaoyu Bi
- College of Physical Education and Sports, Beijing Normal University, Beijing, China
| | - Dongqing Kuang
- College of Physical Education and Sports, Beijing Normal University, Beijing, China
| | - Boya Liu
- School of Social Ecology, University of California, Irvine, Irvine, CA, United States
| | - Jingyi Zhou
- College of Physical Education and Sports, Beijing Normal University, Beijing, China
| | - Yiming Yang
- College of Physical Education and Sports, Beijing Normal University, Beijing, China
| | - Yuanchun Ren
- College of Physical Education and Sports, Beijing Normal University, Beijing, China
- *Correspondence: Yuanchun Ren,
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18
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Meyer J, Zetterqvist V, Unenge Hallerbäck M, Ramklint M, Isaksson J. Moderators of long-term treatment outcome when comparing two group interventions for adolescents with ADHD: who benefits more from DBT-based skills training? BMC Psychiatry 2022; 22:767. [PMID: 36474201 PMCID: PMC9724371 DOI: 10.1186/s12888-022-04435-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Psychosocial interventions for adolescents with attention-deficit/hyperactivity disorder (ADHD), targeting emotional dysregulation and impulsive behaviors, have been requested, but the heterogeneity within this group makes it unlikely that there is one treatment that fits all. The aim of this study was to identify which adolescents with ADHD might have an effect from a structured skills training group (SSTG) based on dialectical behavioral therapy, by exploring pre-treatment characteristics as potential moderators of long-term treatment outcome. METHODS This study was based on follow-up data from a randomized controlled trial comparing the SSTG (n = 71) to a psychoeducational control intervention (n = 57) for adolescents with ADHD (15-18 years old). Clinical characteristics (sex, age, medication status, ADHD presentation, severity of ADHD symptom, psychiatric comorbidity, impairment of emotional dysregulation and functional impairment) were explored as potential moderators of pre-treatment to follow-up change in ADHD symptoms and functional impairment. Moderation analyses were performed using the PROCESS macro for SPSS. RESULTS Three moderators (severity of hyperactivity/impulsivity, conduct problems and impairment of emotional dysregulation) were identified in regard to the outcome self-rated change in ADHD symptoms. Participants with elevated pre-scores on these variables had a better effect of the SSTG than of the psychoeducational control intervention. No moderators were found in regard to the parental-rated outcomes. CONCLUSIONS The SSTG seems to be beneficial for adolescents with ADHD who perceive pronounced symptoms of hyperactivity/impulsivity, conduct problems and emotional dysregulation. Our findings need to be confirmed in future trials evaluating dialectical behavioral therapy-based skills training for adolescents with ADHD, where these moderators could be used as criteria for inclusion or stratification. TRIAL REGISTRATION https://doi.org/10.1186/ISRCTN17366720 , retrospectively registered.
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Affiliation(s)
- Jenny Meyer
- grid.8993.b0000 0004 1936 9457Department of Medical Sciences, Child and Adolescent Psychiatry Unit, Uppsala University, Uppsala, Sweden ,grid.4714.60000 0004 1937 0626Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Vendela Zetterqvist
- grid.8993.b0000 0004 1936 9457Department of Medical Sciences, Child and Adolescent Psychiatry Unit, Uppsala University, Uppsala, Sweden ,grid.4714.60000 0004 1937 0626Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Maria Unenge Hallerbäck
- grid.15895.300000 0001 0738 8966School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden ,grid.20258.3d0000 0001 0721 1351Public Health Sciences, Karlstad University, Karlstad, Sweden
| | - Mia Ramklint
- grid.8993.b0000 0004 1936 9457Department of Medical Sciences, Child and Adolescent Psychiatry Unit, Uppsala University, Uppsala, Sweden
| | - Johan Isaksson
- Department of Medical Sciences, Child and Adolescent Psychiatry Unit, Uppsala University, Uppsala, Sweden. .,Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
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19
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Dixon JF, Akins R, Miller E, Breslau J, Gill S, Bisi E, Schweitzer JB. Changing Parental Knowledge and Treatment Acceptance for ADHD: A Pilot Study. Clin Pediatr (Phila) 2022; 62:301-308. [PMID: 36171719 PMCID: PMC10108330 DOI: 10.1177/00099228221124676] [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: 11/16/2022]
Abstract
This pilot study assessed the feasibility and potential effectiveness of a single-session workshop in modifying parental beliefs/knowledge about attention-deficit/hyperactivity disorder (ADHD) in children and impact on treatment acceptance/utilization. Concerns raised by school professionals about lack of treatment follow-through after ADHD diagnosis and parental misinformation about medication usage catalyzed this project. A single-group pre-post quasi-experimental design was used. Sixty-eight parents completed ADHD knowledge/belief scales and stress inventories, and pre-ADHD and post-ADHD information workshop. Follow-up calls were made after the workshop to assess treatment utilization. Parents/caregivers experienced significant knowledge and belief changes regarding medication efficacy, willingness to accept physician treatment recommendations, and rejection of non-empirically based treatments. Follow-up data showed that 41% of contacted participants met with physicians to discuss medication utilization and behavioral treatments. Brief, one-session psycho-educational workshops were feasible and impacted parental beliefs and behaviors regarding scientifically supported interventions for ADHD.
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Affiliation(s)
- J F Dixon
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA, USA.,UC Davis MIND Institute, School of Medicine, University of California, Davis, Sacramento, CA, USA
| | - R Akins
- UC Davis MIND Institute, School of Medicine, University of California, Davis, Sacramento, CA, USA.,Department of Pediatrics, University of California, Davis, Sacramento, CA, USA
| | - E Miller
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA
| | - J Breslau
- Rand Corporation, Pittsburgh, PA, USA
| | - S Gill
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA, USA.,Palo Alto University, Palo Alto, CA, USA
| | - E Bisi
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA, USA.,UC Davis MIND Institute, School of Medicine, University of California, Davis, Sacramento, CA, USA
| | - J B Schweitzer
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA, USA.,UC Davis MIND Institute, School of Medicine, University of California, Davis, Sacramento, CA, USA
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20
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Li Y. Adolescent Psychological Assistance Treatment Strategy Integrating Home-School Coordination and Network Information. Occup Ther Int 2022; 2022:6393139. [PMID: 35912307 PMCID: PMC9303162 DOI: 10.1155/2022/6393139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 06/18/2022] [Indexed: 11/18/2022] Open
Abstract
With the continuous satisfaction of material life, teenagers' physical health has been generally improved, and all aspects of competition have posed a challenge to teenagers' mental health. Therefore, both at the family level and at the school level, teenagers' mental health education has been paid more and more attention. The school cooperative education model came into being, which has had an important impact on the mental health education of teenagers. Family education is the first level of education for teenagers. Parents' role model, family education concept, and education model all play a key role in the development of children's mental health. Based on this, this paper will focus on optimizing the home-school cooperation strategy, further clarify the main responsibilities of the school, teachers, and parents in the home-school cooperation education in the strategy, establish and improve the home-school cooperation mechanism based on this, and focus on the cultivation of parents' mental health education and teachers' mental health guidance professional skills in this process. Based on the current situation of network home-school mental health coordination and mental health education, this study takes teenagers as the research object, aiming at the common psychological problems in learning, social adaptation, and interpersonal communication, and tries to study the problems of promoting teenagers' mental health from the perspective of integrity and development. The developed home-school collaboration method is to verify that the network home-school collaboration method is more effective than the traditional home-school collaboration method in promoting the mental health development of primary school students, so as to provide a reference for the theory and practice of home-school collaboration under the network environment to carry out mental health education. According to the corresponding network information intelligent algorithm, this paper constantly adjusts the coordination strategy between family and school and guides teenagers to internalize the corresponding excellent behaviour into their own habits. In the experimental part, the psychological assistance treatment scheme proposed in this paper is verified and analysed. The experimental results show that the psychological assistance treatment program for adolescents proposed in this paper has obvious effects. School education has a special mental health counseling center and special psychological teachers, which can carry out mental health education more scientifically. The unity and cooperation between family education and school education can combine the educational power of parents and schools to fully develop the mental health of teenagers.
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Affiliation(s)
- Yaling Li
- Mental Health Education and Counseling Center, Shenzhen Technology University, Shenzhen, 518118 Guangdong, China
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21
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O'Dell SM, Gormley MJ, Schlieder V, Klinger T, DeHart K, Kettlewell PW, Kulchak Rahm A. Perspectives of Rural Primary Care Clinicians on Pediatric Attention-Deficit/Hyperactivity Disorder Care. J Dev Behav Pediatr 2022; 43:273-282. [PMID: 35353792 DOI: 10.1097/dbp.0000000000001056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 11/15/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Despite efficacious treatments, evidence-based guidelines, and increased availability of integrated behavioral health care, youth coping with attention-deficit/hyperactivity disorder (ADHD) receive suboptimal care. More research is needed to understand and address care gaps, particularly within rural health systems that face unique challenges. We conducted a qualitative study within a predominantly rural health system with a pediatric-integrated behavioral health care program to address research gaps and prepare for quality improvement initiatives, including primary care clinician (PCC) trainings and clinical decision support tools in the electronic health record (EHR). METHOD Semistructured interviews were conducted with 26 PCCs representing clinics within the health system. Interview guides were based on the Practical Robust Implementation and Sustainability Model to elicit PCC views regarding determinants of current practices and suggestions to guide quality improvement efforts. We used thematic analysis to identify patterns of responding that were common across participants. RESULTS PCCs identified several internal and external contextual factors as determinants of current practices. Of note, PCCs recommended increased access to continuing education trainings held in clinic over lunch and delivered in less than 30 minutes. Suggested improvements to the EHR included incorporating parent and teacher versions of the Vanderbilt Rating Scale into the EHR, documentation templates aligned with evidence-based guidelines, and alerts and suggestions to aid medication management during appointments. CONCLUSION Future research to identify implementation strategies to help rural PCCs adopt innovations are needed given the increased responsibility for managing ADHD care and intractable gaps in access to behavioral health care in rural regions.
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Affiliation(s)
- Sean M O'Dell
- Departments of Population Health Sciences
- Psychiatry and Behavioral Health, Geisinger, Danville, PA
| | - Matthew J Gormley
- Psychiatry and Behavioral Health, Geisinger, Danville, PA
- Department of Educational Psychology, University of Nebraska-Lincoln, Lincoln, NE
| | | | - Tracey Klinger
- Investigator Initiated Research Operations, Geisinger, Danville, PA
| | - Kathy DeHart
- Department of Pediatrics, Geisinger, Danville, PA
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22
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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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23
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Meyer J, Alaie I, Ramklint M, Isaksson J. Associated predictors of functional impairment among adolescents with ADHD-a cross-sectional study. Child Adolesc Psychiatry Ment Health 2022; 16:29. [PMID: 35382854 PMCID: PMC8985377 DOI: 10.1186/s13034-022-00463-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/24/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) in adolescence is associated with functional impairment in several domains of life. To enable development of interventions that more effectively target functional impairment in this age group, the associations between clinical characteristics and impairment need to be clarified. The aim of this study was to investigate the associations between ADHD and functional impairment, if they varied by sex, and the potential impact of comorbid psychiatric symptoms on the associations. METHODS This was a cross-sectional study including adolescents with ADHD (n = 164) and a reference group of adolescents without ADHD (n = 106). Self-ratings and parental ratings of functional impairment in different life domains were used as outcomes in all analyses. Differences between groups were investigated with comparative analyses. General linear models (GLMs) were used to explore associations between ADHD symptoms and functional impairment in adolescents with ADHD, while adjusting for of comorbid symptoms, sex, and medication. RESULTS Adolescents with ADHD displayed higher levels of functional impairment than peers without ADHD, and girls with ADHD rated higher impairment than their male counterparts. The combined ADHD presentation was associated with the highest levels of self-reported impairment, while parental ratings indicated comparable levels of overall impairment across presentations. In the adjusted GLMs, symptoms of inattention were strongly associated with self- and parent-rated impairment in school, but symptoms of hyperactivity/impulsivity were not, whereas symptoms of both inattention and hyperactivity/impulsivity were modestly associated with self-rated impairment with friends. Further, both emotional and conduct problems were associated with impairment in daily life. CONCLUSIONS Our results suggest that attention difficulties, in particular, seem to impair academic functioning in adolescents with ADHD, and interventions targeting such difficulties are warranted. In addition, comorbid symptoms need to be assessed and treated, and self-reports of functioning should be included in research and clinical practice involving adolescents.
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Affiliation(s)
- Jenny Meyer
- Child and Adolescent Psychiatry Unit, Department of Medical Sciences, Uppsala University, 751 85, Uppsala, Uppsala, Sweden.
| | - Iman Alaie
- grid.8993.b0000 0004 1936 9457Child and Adolescent Psychiatry Unit, Department of Medical Sciences, Uppsala University, 751 85 Uppsala, Uppsala, Sweden ,grid.4714.60000 0004 1937 0626Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Mia Ramklint
- grid.8993.b0000 0004 1936 9457Child and Adolescent Psychiatry Unit, Department of Medical Sciences, Uppsala University, 751 85 Uppsala, Uppsala, Sweden
| | - Johan Isaksson
- grid.8993.b0000 0004 1936 9457Child and Adolescent Psychiatry Unit, Department of Medical Sciences, Uppsala University, 751 85 Uppsala, Uppsala, Sweden ,grid.4714.60000 0004 1937 0626Centre for Psychiatry Research, Department of Women’s and Children’s Health, Karolinska Institute Centre of Neurodevelopmental Disorders (KIND), Karolinska Institutet, Stockholm, Sweden
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24
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Dekkers TJ, Hornstra R, van der Oord S, Luman M, Hoekstra PJ, Groenman AP, van den Hoofdakker BJ. Meta-analysis: Which Components of Parent Training Work for Children With Attention-Deficit/Hyperactivity Disorder? J Am Acad Child Adolesc Psychiatry 2022; 61:478-494. [PMID: 34224837 DOI: 10.1016/j.jaac.2021.06.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 06/02/2021] [Accepted: 06/25/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Behavioral parent training is an evidence-based intervention for children with attention-deficit/hyperactivity disorder (ADHD), but it is unknown which of its components are most effective. This meta-regression analysis investigated which specific behavioral techniques that parents learn in parent training are associated with effects on parental outcomes. METHOD A search was performed for randomized controlled trials on parent training for children with ADHD, with positive parenting, negative parenting, parenting sense of competence, parent-child relationship quality, and parental mental health as outcome measures. After screening 23,026 publications, 29 studies contributing 138 effect sizes were included (N = 2,345). For each study, the dosage of 39 behavioral techniques was derived from intervention manuals, and meta-regression determined which techniques were related to outcomes. RESULTS Parent training had robust small- to medium-sized positive effects on all parental outcomes relative to control conditions, both for unblinded and probably blinded measures. A higher dosage of techniques focusing on the manipulation of antecedents of behavior was associated with better outcomes on parenting sense of competence and parental mental health, and a higher dosage of techniques focusing on reinforcement of desired behaviors was related to larger decreases in negative parenting. Higher dosages of psychoeducation were negatively related to parental outcomes. CONCLUSION Although techniques were not investigated in isolation, the results suggested that manipulation of antecedents of behavior and reinforcement techniques are key components of parent training for children with ADHD in relation to parental outcomes. These exploratory findings may help to strengthen and tailor parent training interventions for children with ADHD.
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Affiliation(s)
- Tycho J Dekkers
- University of Groningen, the Netherlands; University of Amsterdam, the Netherlands; Levvel, Academic Center for Child- and Adolescent Psychiatry and Specialized Youthcare, Amsterdam, the Netherlands; Amsterdam University Medical Center, the Netherlands.
| | | | - Saskia van der Oord
- University of Amsterdam, the Netherlands; KU Leuven, Research Group Clinical Psychology, Belgium
| | - Marjolein Luman
- Levvel, Academic Center for Child- and Adolescent Psychiatry and Specialized Youthcare, Amsterdam, the Netherlands; Vrije Universiteit Amsterdam, the Netherlands
| | | | - Annabeth P Groenman
- University of Groningen, the Netherlands; University of Amsterdam, the Netherlands
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25
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Clinical Efficacy Evaluation of Psychological Nursing Intervention Combined with Drugs Treatment of Children with ADHD under Artificial Intelligence. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:1818693. [PMID: 35392149 PMCID: PMC8983230 DOI: 10.1155/2022/1818693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/22/2022] [Accepted: 02/26/2022] [Indexed: 11/18/2022]
Abstract
ADHD in children is one of the most common neurodevelopmental disorders. It is manifested as inattention, hyperactivity, impulsiveness, and other symptoms that are inconsistent with the developmental level in different occasions, accompanied by functional impairment in social, academic, and occupational aspects. At present, the treatment for children with ADHD is mainly based on psychological nursing intervention combined with drug therapy. Therefore, the actual efficacy evaluation of this treatment regimen is very important. Neural networks are widely used in smart medical care. This work combines artificial intelligence with the evaluation of clinical treatment effects of ADHD children and designs an intelligent model based on neural networks for evaluating the clinical efficacy of psychological nursing intervention combined with drug treatment of children with ADHD. The main research is that, for the evaluation of clinical treatment effect of ADHD in children, this paper proposes a 1D Parallel Multichannel Network (1DPMN), which is a convolutional neural network. The results show that network models can extract different data features through different channels and can achieve high accuracy evaluation of clinical efficacy of ADHD in children. On the basis of the model, performance is improved through the study of Adam optimizer to speed up the model convergence, adopts batch normalization algorithm to improve stability, and uses Dropout to improve the generalization ability of the network. Aiming at the problem of too many parameters, the 1DPMN is optimized through the principle of local sparseness, and the model parameters are greatly reduced.
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26
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Fabiano GA, Naylor J, Pelham WE, Gnagy EM, Burrows-MacLean L, Coles E, Chacko A, Wymbs BT, Walker KS, Wymbs F, Garefino A, Mazzant JR, Sastry AL, Tresco KE, Waschbusch DA, Massetti GM, Waxmonsky J. Special Education for Children with ADHD: Services Received and a Comparison to Children with ADHD in General Education. SCHOOL MENTAL HEALTH 2022. [DOI: 10.1007/s12310-022-09514-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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27
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Russell AE, Moore D, Sanders A, Dunn B, Hayes R, Kidger J, Sonuga-Barke E, Pfiffner L, Ford T. Synthesising the existing evidence for non-pharmacological interventions targeting outcomes relevant to young people with ADHD in the school setting: systematic review protocol. Syst Rev 2022; 11:28. [PMID: 35168685 PMCID: PMC8848797 DOI: 10.1186/s13643-022-01902-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 02/07/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Children and adolescents with attention-deficit/hyperactivity disorder (ADHD) have impairing levels of difficulty paying attention, impulsive behaviour and/or hyperactivity. ADHD causes extensive difficulties for young people at school, and as a result these children are at high risk for a wide range of poor outcomes. We ultimately aim to develop a flexible, modular 'toolkit' of evidence-based strategies that can be delivered by primary school staff to improve the school environment and experience for children with ADHD; the purpose of this review is to identify and quantify the evidence-base for potential intervention components. This protocol sets out our plans to systematically identify non-pharmacological interventions that target outcomes that have been reported to be of importance to key stakeholders (ADHD symptoms, organisation skills, executive-global- and classroom-functioning, quality of life, self-esteem and conflict with teachers and peers). We plan to link promising individual intervention components to measured outcomes, and synthesise the evidence of effectiveness for each outcome. METHODS A systematic search for studies published from the year 2000 that target the outcomes of interest in children and young people aged 3-12 will be conducted. Titles and abstracts will be screened using prioritisation software, and then full texts of potentially eligible studies will be screened. Systematic reviews, RCTs, non-randomised and case-series studies are eligible designs. Synthesis will vary by the type of evidence available, potentially including a review of reviews, meta-analysis and narrative synthesis. Heterogeneity of studies meta-analysed will be assessed, along with publication bias. Intervention mapping will be applied to understand potential behaviour change mechanisms for promising intervention components. DISCUSSION This review will highlight interventions that appear to effectively ameliorate negative outcomes that are of importance for people with ADHD, parents, school staff and experts. Components of intervention design and features that are associated with effective change in the outcome will be delineated and used to inform the development of a 'toolkit' of non-pharmacological strategies that school staff can use to improve the primary school experience for children with ADHD. TRIAL REGISTRATION PROSPERO number CRD42021233924.
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Affiliation(s)
- Abigail E. Russell
- University of Exeter College of Medicine and Health, South Cloisters, St Luke’s Campus, Exeter, EX1 2LU UK
| | - Darren Moore
- University of Exeter College of Medicine and Health, South Cloisters, St Luke’s Campus, Exeter, EX1 2LU UK
| | - Amy Sanders
- University of Exeter College of Medicine and Health, South Cloisters, St Luke’s Campus, Exeter, EX1 2LU UK
| | - Barnaby Dunn
- University of Exeter College of Medicine and Health, South Cloisters, St Luke’s Campus, Exeter, EX1 2LU UK
| | - Rachel Hayes
- University of Exeter College of Medicine and Health, South Cloisters, St Luke’s Campus, Exeter, EX1 2LU UK
| | | | | | - Linda Pfiffner
- University of California San Francisco, San Francisco, USA
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28
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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] [MESH Headings] [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)
| | | | | | - Valerie Harpin
- Ryegate Children’s Centre, Sheffield Children’s NHS Foundation Trust, Sheffield, UK
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29
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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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30
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Evaluation of a structured skills training group for adolescents with attention-deficit/hyperactivity disorder: a randomised controlled trial. Eur Child Adolesc Psychiatry 2022; 31:1-13. [PMID: 33721085 PMCID: PMC9343260 DOI: 10.1007/s00787-021-01753-2] [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: 08/11/2020] [Accepted: 02/26/2021] [Indexed: 10/25/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) in adolescence is associated with behavioural, emotional and interpersonal problems, and non-pharmacological treatments targeting these difficulties have been requested. The objective of this study was to evaluate the effectiveness and acceptance of an age-adapted structured skills training group (SSTG) for adolescents with ADHD. Adolescents (n = 184, ages 15-18 years) with a diagnosis of ADHD were randomly assigned to either the SSTG, which is based on dialectical behavioural therapy, or an active control group based on psychoeducation. Symptoms of ADHD, behavioural and emotional problems, functional impairment, and health-related outcomes were assessed with self-ratings and parental ratings two weeks before, two weeks after, and six months after treatment. All participants who completed the pre-treatment measurements (n = 164) were included in the main analyses, which were conducted using a linear mixed model. Our results demonstrated no significant group differences in favour of the SSTG for any of the study outcomes. A majority of the participants in both groups reported that they had increased their knowledge about ADHD, improved their ability to manage problems related to the diagnosis, and would recommend the treatment to others. We conclude that the SSTG seems to be acceptable for adolescents with ADHD in a clinical context. However, the treatment was not proved to be more effective or more acceptable than the psychoeducational control intervention.Trial registration: http://www.isrctn.com/ISRCTN17366720,11/05/2016 , retrospectively registered.
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31
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Reyes ADL, Talbott E, Power TJ, Michel JJ, Cook CR, Racz SJ, Fitzpatrick O. The needs-to-goals gap: How informant discrepancies in youth mental health assessments impact service delivery. Clin Psychol Rev 2021; 92:102114. [DOI: 10.1016/j.cpr.2021.102114] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 10/25/2021] [Accepted: 12/16/2021] [Indexed: 01/24/2023]
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32
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Dijk HH, Wessels LM, Constanti M, van den Hoofdakker BJ, Hoekstra PJ, Groenman AP. Cost-Effectiveness and Cost Utility of Treatment of Attention-Deficit/Hyperactivity Disorder: A Systematic Review. J Child Adolesc Psychopharmacol 2021; 31:578-596. [PMID: 34705525 DOI: 10.1089/cap.2021.0068] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objectives: This systematic review provides an overview of full economic evaluations of attention-deficit/hyperactivity disorder (ADHD) treatments, evaluates their outcomes, and highlights gaps in the literature. Data Sources: Electronic databases were searched for full economic evaluations of ADHD treatments for children, adolescents, or adults published in English or Dutch. Results: Twenty-nine studies met the inclusion criteria. Almost all studies that compared medication or psychosocial treatment to no treatment, placebo, or care as usual indicated that medication and psychosocial treatment were cost-effective compared to the control group. Stimulant treatment appeared to be cost-effective for the treatment of ADHD in children and adolescents. Only few studies focus on treatments in adults and psychosocial treatments and the number of studies with long time horizons and without industry funding is limited. Conclusions: Despite the rising interest in cost-effectiveness, this systematic review shows that more cost-effectiveness research of higher quality is warranted to aid in the optimal use of available treatments and resources for individuals with ADHD. Specifically, more studies should focus on treatments in adults and psychosocial treatments, and more studies with long time horizons and without industry funding are warranted. Nevertheless, we can conclude that treating ADHD is generally cost-effective compared to no treatment. PROSPERO: CRD42017060074. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=60074.
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Affiliation(s)
- Hermien H Dijk
- Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands.,Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Accare Child Study Center
| | - Lisa M Wessels
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Accare Child Study Center
| | - Margaret Constanti
- National Guideline Centre, Royal College of Physicians, London, United Kingdom
| | - Barbara J van den Hoofdakker
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Accare Child Study Center
| | - Pieter J Hoekstra
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Accare Child Study Center
| | - Annabeth P Groenman
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Accare Child Study Center
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33
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Green CD, Langberg JM. A Review of Predictors of Psychosocial Service Utilization in Youth with Attention-Deficit/Hyperactivity Disorder. Clin Child Fam Psychol Rev 2021; 25:356-375. [PMID: 34498154 DOI: 10.1007/s10567-021-00368-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2021] [Indexed: 11/29/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is one of the most common childhood disorders. Professional practice guidelines recommend combined treatment, psychopharmacological and psychosocial, for youth with ADHD. There have been multiple reviews of pharmacological prescription practices and utilization, however, less is known about predictors of ADHD psychosocial service utilization. Given the importance of accessing psychosocial treatment in relation to improving functional impairment, this review synthesizes evidence on predictors of ADHD psychosocial intervention utilization in clinic, community, and school settings. Eighteen studies were identified and included in the review. Findings are summarized across informant profile factors, predisposing characteristics, and barriers and facilitators. The most robust findings were for the impact of symptom severity/impairment, the presence of comorbidities, and age on ADHD psychosocial service utilization. Race/ethnicity, sex, parental knowledge of the disorder and insurance coverage were also identified as key factors. Future avenues of research are provided, and clinical and policy implications targeted at reducing psychosocial treatment disparities in youth with ADHD are discussed.
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Affiliation(s)
- Cathrin D Green
- Virginia Commonwealth University, 806 W. Franklin St, Box 842018, Richmond, VA, 23284, USA
| | - Joshua M Langberg
- Virginia Commonwealth University, 806 W. Franklin St, Box 842018, Richmond, VA, 23284, USA.
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34
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Hollingdale J, Adamo N, Tierney K. Impact of COVID-19 for people living and working with ADHD: A brief review of the literature. AIMS Public Health 2021; 8:581-597. [PMID: 34786421 PMCID: PMC8568596 DOI: 10.3934/publichealth.2021047] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 08/18/2021] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE COVID-19 lockdowns have changed the social and environmental context. Those with ADHD are more vulnerable to experiencing difficulties than their non-ADHD peers. This paper attempts to provide a brief summary of the literature that has emerged during the COVID-19 pandemic. METHOD A literature search was completed using the following databases; Embase, Ovid Medline, APA PsycInfo. A total of 36 papers were identified as relevant to the topic. RESULTS The pandemic has exacerbated the core symptoms of ADHD and co-occurring difficulties. Services have adapted their assessment and intervention protocols for tele-health working and findings suggest that tele-interventions present a viable alternative. However, much of this research utilises small sample sizes and a restricted number of population groups. CONCLUSIONS More research is required to determine the effectiveness of ADHD care during the pandemic and whether adaptations will be retained post-pandemic.
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Affiliation(s)
| | - Nicoletta Adamo
- SCAAND Department, Michael Rutter Centre, South London and Maudsley NHS Trust, London, UK
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Kevin Tierney
- SCAAND Department, Michael Rutter Centre, South London and Maudsley NHS Trust, London, UK
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35
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Mechler K, Banaschewski T, Hohmann S, Häge A. Evidence-based pharmacological treatment options for ADHD in children and adolescents. Pharmacol Ther 2021; 230:107940. [PMID: 34174276 DOI: 10.1016/j.pharmthera.2021.107940] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 05/06/2021] [Indexed: 12/15/2022]
Abstract
Attention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity, causing functional impairment. Its prevalence lies at approximately 5% in children and adolescents and at approximately 2.5% in adults. The disorder follows a multifactorial etiology and shows a high heritability. Patients show a high interindividual and intraindividual variability of symptoms, with executive deficits in several cognitive domains. Overall, ADHD is associated with high rates of psychiatric comorbidities, and insufficient treatment is linked to adverse long-term outcomes. Current clinical guidelines recommend an individualized multimodal treatment approach including psychoeducation, pharmacological interventions, and non-pharmacological interventions. Available medications include stimulants (methylphenidate, amphetamines) and non-stimulants (atomoxetine, guanfacine, clonidine). While available pharmacological treatment options for ADHD show relatively large effect sizes (in short-term trials) and overall good tolerability, there is still a need for improvement of current pharmacotherapeutic strategies and for the development of novel medications. This review summarizes available pharmacological treatment options for ADHD in children and adolescents, identifies current issues in research and evidence gaps, and provides an overview of ongoing efforts to develop new medications for the treatment of ADHD in children and adolescents by means of a systematic cross-sectional analysis of the clinical trials registry www.clinicaltrials.gov.
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Affiliation(s)
- Konstantin Mechler
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Sarah Hohmann
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Alexander Häge
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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36
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Systematic Review: Educational Accommodations for Children and Adolescents With Attention-Deficit/Hyperactivity Disorder. J Am Acad Child Adolesc Psychiatry 2021; 60:448-457. [PMID: 32745597 DOI: 10.1016/j.jaac.2020.07.891] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/25/2020] [Accepted: 07/24/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Children and adolescents with attention-deficit/hyperactivity disorder (ADHD) often receive instruction and take tests using educational accommodations. This review aims to summarize and integrate the research literature on accommodations for this specific population. METHOD Electronic databases in medicine (MEDLINE), psychology (PsycINFO), and education (ERIC) were systematically searched (last update January 13, 2020), with inclusion criteria selecting any document with a focus on accommodations in educational settings or on academic tasks for children or adolescents with ADHD. The search yielded 497 unique documents. Additional searches yielded 13 more documents. Of the 510 total potentially useful documents, 68 met criteria for topical relevance and age range, to be discussed in the narrative review. The wide range of document types led to a qualitative synthesis. RESULTS Accommodations are by far the most common response to ADHD in educational settings, with testing accommodations such as extended time being particularly prevalent. However, most accommodations fail to show evidence of benefits that are specific to students with ADHD, and many of the more common accommodations have few or no experimental studies supporting them. An exception is read-aloud accommodations, which have two randomized experiments finding specific benefits for younger students with ADHD. Students and those who work with them often express ambivalence and dissatisfaction over the accommodations process. CONCLUSION More empirical research is needed to examine the effects of these extremely common supports. In the absence of supportive evidence, health professionals should be hesitant to recommend accommodations immediately after a diagnosis. Even when such evidence exists, educational accommodations should only be provided along with evidence-based interventions, or after interventions have failed, as suggested by the "life course" model of managing ADHD.
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37
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Staff AI, van den Hoofdakker BJ, van der Oord S, Hornstra R, Hoekstra PJ, Twisk JWR, Oosterlaan J, Luman M. Effectiveness of Specific Techniques in Behavioral Teacher Training for Childhood ADHD: A Randomized Controlled Microtrial. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2021; 50:763-779. [PMID: 33471581 PMCID: PMC8802898 DOI: 10.1080/15374416.2020.1846542] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Objective: Behavioral teacher training is the most effective classroom-based intervention for children with attention-deficit/hyperactivity disorder (ADHD). However, it is currently unknown which components of this intervention add to its effectiveness and for whom these are effective. Method: In this microtrial, teachers of 90 children with impairing levels of ADHD symptoms (6–12 years) were randomly assigned to one of three conditions: a short (2 sessions), individualized intervention consisting of either (A) antecedent-based techniques (stimulus control), (B) consequent-based techniques (contingency management) or (C) waitlist. Primary outcome was the average of five daily assessments of four individualized problem behaviors, assessed pre and post intervention and three months later. Moderation analyses were conducted to generate hypotheses on child, teacher and classroom factors that may contribute to technique effectiveness. Results: Multilevel analyses showed that both antecedent- and consequent-based techniques were equally and highly effective in reducing problem behaviors compared to the control condition (Cohen’s d =.9); effects remained stable up to three months later. Child’s age and class size were moderators of technique effectiveness. For younger children, consequent-based techniques were more effective than antecedent-based techniques, whereas for older children the effect was in the opposite direction. Further, beneficial effects of antecedent-based techniques increased when the number of students per class decreased, whilst effectiveness of consequent-based techniques did not depend on class size. Conclusions: This study shows that both antecedent- and consequent-based techniques are highly effective in reducing problem behavior of children with ADHD. Interventions may be adapted to the child’s age and class size.
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Affiliation(s)
- Anouck I Staff
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam
| | - Barbara J van den Hoofdakker
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen.,Department of Clinical Psychology and Experimental Psychopathology, University of Groningen
| | - Saskia van der Oord
- Faculty of Psychology and Educational Sciences, KU Leuven.,Developmental Psychology, University of Amsterdam
| | - Rianne Hornstra
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen
| | - Pieter J Hoekstra
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen
| | - Jos W R Twisk
- Department of Epidemiology and Biostatistics, Vrije Universiteit Amsterdam
| | - Jaap Oosterlaan
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam.,Department of Pediatrics, Amsterdam Reproduction & Development, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Emma Neuroscience Group
| | - Marjolein Luman
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam
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Friedman LM, Dvorsky MR, McBurnett K, Pfiffner LJ. Do Parents' ADHD Symptoms Affect Treatment for their Children? The Impact of Parental ADHD on Adherence to Behavioral Parent Training for Childhood ADHD. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 48:1425-1437. [PMID: 32813210 PMCID: PMC7567125 DOI: 10.1007/s10802-020-00672-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Nearly half of all youth with Attention-Deficit Hyperactivity Disorder (ADHD) have at least one parent who also meets criteria for the disorder, and intergenerational ADHD is a significant risk factor for poor outcomes following evidence-based behavioral parent training (BPT) programs. Given that BPT is predicated on consistent parental involvement, symptoms of ADHD in parents may be a significant barrier to effective engagement with BPT treatment. In the present investigation, we examine the effect of parental ADHD symptoms on BPT treatment engagement for children with ADHD-predominantly inattentive presentation (N = 148, ages 7-11). We examine the following parent- and clinician-rated treatment engagement domains: between-session skill adherence, in-session participation, perceived skill understanding, treatment-engagement attitudes, and session attendance. Parent- and clinician-rated between-session adherence was the only treatment engagement domain related significantly to parental ADHD symptoms. This finding was robust and remained even after accounting for symptoms of parental anxiety and depression, child ADHD symptom severity, and various sociodemographic factors (parental education level, household income, employment status, and being a single parent). These findings suggest that targeting parental ADHD symptoms in the context of parenting interventions may be a promising approach for improving adherence and treatment outcomes for BPT interventions.
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Affiliation(s)
| | | | - Keith McBurnett
- Department of Psychiatry, University of California, San Francisco
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Fogler JM, Normand S, O’Dea N, Mautone JA, Featherston M, Power TJ, Nissley-Tsiopinis J. Implementing Group Parent Training in Telepsychology: Lessons Learned During the COVID-19 Pandemic. J Pediatr Psychol 2020; 45:983-989. [PMID: 32940702 PMCID: PMC7543438 DOI: 10.1093/jpepsy/jsaa085] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 08/03/2020] [Accepted: 08/25/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE We recently transitioned from in-person delivery of a brief behavioral parent intervention to telepsychology delivery to meet families' needs during the COVID-19 pandemic. In this topical review, we describe how we used treatment fidelity as a guiding principle to orient adaptations for telepsychology, as well as preliminary findings and early lessons learned in this implementation. Methods: Using rapid-cycle quality improvement methods, we adapted a brief parent training group (Bootcamp for Attention-Deficit/Hyperactivity Disorder; BC-ADHD) to three groups of caregivers (i.e., 5-7 families) of school-aged children with ADHD (n = 20; 85% males). Families were from the following ethnic backgrounds: 75% White non-Hispanic, 15% White Hispanic, and 10% Black. Clinicians completed measures on their implementation experience. Observers completed measures on content/process fidelity and attendance. Caregivers completed measures on demographics, treatment satisfaction, and telepsychology experience. RESULTS Telepsychology BC-ADHD can be implemented with comparably high levels of content and process fidelity and treatment satisfaction to in-person groups; and it appears to be feasible and acceptable to caregivers. Caregiver and clinician qualitative feedback revealed themes of appreciating the convenience of telepsychology, while experiencing some challenges in relating to others and sharing over video. CONCLUSIONS When treatment fidelity is used as a guiding tool, telepsychology parent training groups can be delivered with high fidelity and appear to be acceptable and feasible to caregivers and clinicians. Future research using larger and more diverse samples, multimethod and multi-informant measurement approaches, and controlled designs is needed to further assess the generalizability and efficacy of telepsychology parent training groups.
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Affiliation(s)
| | | | | | | | | | - Thomas J Power
- Children’s Hospital of Philadelphia, University of Pennsylvania
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