The Effects of Parent Training and Ritalin on the Parent-Child Interactions of Hyperactive Boys

Using a multiple baseline across subjects design, the present study assessed the effects of parent training alone and combined with methylphenidate on the social interactions of three mothers with their hyperactive boys. Two mothers received instruction in child behavior management while their sons remained off medication. Subsequently, these boys returned to medication to evaluate whether the drug further enhanced the effects of parent training. The third child received the drug treatment first and then remained on medication while his mother underwent the same parent training program. Results indicated that both treatments alone decreased the amount of commands given by the mother as well as parent ratings of deviant child behavior in the home, but produced variable improvements in child compliance to commands. More reliable improvements in child compliance to commands. More reliable improvements from each treatment occurred in the duration of compliance per command. the combination of treatments failed to produce any further improvements in mother-child interactions than that achieved by either treatment alone. Contrary to earlier research, only parent training resulted in increases in the mothers' use of positive attention following child compliance.     

Methylphenidate and cognitive therapy: A comparison of treatment approaches with hyperactive boys

This study of hyperactive boys evaluated the effects of three modes of treatment in relation to an untreated group. The treatments were administered over a 3-month period and included cognitive training, stimulant drug therapy (methylphenidate), and the two treatments combined. A follow-up assessment was conducted approximately 3 months after contact between the training staff and the child had ceased. Analyses of attentional deployment and cognitive style measures, tests of academic achievement, and behavioral ratings showed that only those children in the two medication treatment conditions demonstrated improvement in attentional deployment and behavioral ratings. In the cognitive therapy condition, there were changes only on measures of attentional deployment. The data did not provide evidence indicating that the combined medication and cognitive therapy condition was any more effective than that condition involving medication alone. Discussion provides future guidelines for evaluation of the relative effectiveness of stimulant drug therapy and other psychological treatment modalities.     

Motor timing deficits in community and clinical boys with hyperactive behavior: the effect of methylphenidate on motor timing

In a previous paper we showed that community children with hyperactive behavior were more inconsistent than controls in the temporal organization of their motor output. In this study we investigated: (1) various aspects of motor timing processes in 13 clinically diagnosed boys with attention deficit hyperactivity disorder (ADHD) who were compared to 11 community boys with hyperactive behavior and to a control group and (2) the effect of methylphenidate on the motor timing processes in the clinical group with ADHD in a double blind, cross-over, medication-placebo design, including 4 weeks of medication. The clinical group with ADHD, like the community group with hyperactivity, showed greater variability in sensorimotor synchronization and in sensorimotor anticipation relative to controls. The clinical group was also impaired in time perception, which was spared in the community group with hyperactivity. The persistent, but not the acute dose, of methylphenidate reduced the variability of sensorimotor synchronization and anticipation, but had no effect on time perception. This study shows that motor timing functions are impaired in both clinical and community children with hyperactivity. It is the first study to show the effectiveness of persistent administration of methylphenidate on deficits in motor timing in ADHD children and extends the use of methylphenidate from the domain of attentional and inhibitory functions to the domain of executive motor timing.     

A Dose-Ranging Study of Behavioral and Pharmacological Treatment in Social Settings for Children with ADHD

Placebo and three doses of methylphenidate (MPH) were crossed with 3 levels of behavioral modification (no behavioral modification, NBM; low-intensity behavioral modification, LBM; and high-intensity behavior modification, HBM) in the context of a summer treatment program (STP). Participants were 48 children with ADHD, aged 5–12. Behavior was examined in a variety of social settings (sports activities, art class, lunch) that are typical of elementary school, neighborhood, and after-school settings. Children received each behavioral condition for 3 weeks, order counterbalanced across groups. Children concurrently received in random order placebo, 0.15 mg/kg/dose, 0.3 mg/kg/dose, or 0.6 mg/kg/dose MPH, 3 times daily with dose manipulated on a daily basis in random order for each child. Both behavioral and medication treatments produced highly significant and positive effects on children’s behavior. The treatment modalities also interacted significantly. Whereas there was a linear dose–response curve for medication in NBM, the dose–response curves flattened considerably in LBM and HBM. Behavior modification produced effects as large as moderate doses, and on some measures, high doses of medication. These results replicate and extend to social-recreational settings previously reported results in a classroom setting from the same sample (Fabiano et al., School Psychology Review, 36, 195–216, 2007). Results illustrate the importance of taking dosage/intensity into account when evaluating combined treatments; there were no benefits of combined treatments when the dosage of either treatment was high but combination of the low-dose treatments produced substantial incremental improvement over unimodal treatment.     

SEPARATE AND COMBINED EFFECTS OF METHYLPHENIDATE AND A BEHAVIORAL INTERVENTION ON DISRUPTIVE BEHAVIOR IN CHILDREN WITH MENTAL RETARDATION

We investigated the separate and combined effects of a behavioral intervention and methylphenidate (Ritalin®) on disruptive behavior and task engagement in 3 children with severe to profound mental retardation. The behavioral intervention involved differential reinforcement of appropriate behavior and guided compliance. All 3 children demonstrated decreased disruptive behavior and improved task engagement in response to the behavioral intervention. Two of the 3 children demonstrated similar improvement in response to methylphenidate. Although both interventions were highly effective for these 2 participants, the relative efficacy of the interventions varied between the 2 children. There was no evidence of an additive or synergistic effect of the two interventions, but the high efficacy of each intervention alone limited our ability to detect such effects.     

Effects of methylphenidate (Ritalin) on information processing in hyperactive children

The effect of methylphenidate on information-processing efficiency was studied in 12 hyperactive, nonretarded children. Performance on six efficiency tasks (Posner Letter Matching, Reaction Time, Memory Search, Category Verification, Item Identification, and Word-Span) and a general measure of on-task behavior were compared for children receiving methylphenidate or a placebo. The median drug dosage was .38 mg/kg, and it was ingested 1 1/2 hours prior to testing. Children blind to the drug-placebo condition were tested on 4 days. In general, methylphenidate-related improvements in attention to on-task behaviors were found. An overall analysis of processing speed suggested that methylphenidate improved efficiency. Methylphenidate significantly decreased reaction times to simple and complex stimulus arrays; differences due to the drug remained even when on-task attentive behaviors were statistically removed. Significantly fewer identification errors occurred on the Posner task in the methylphenidate condition. Results indicated that methylphenidate improved general attentional behaviors and positively influenced processes that define perceptual efficiency.The first author was supported by NIH Training Grant No. HD 07184. We appreciate the assistance of Dr. Robert Sweeney in carrying out this research and the useful comments of Ellen B. Ryan and Jeanne D. Day.     

Treatment Sensitivity of a Brief Rating Scale for Attention-Deficit Hyperactivity Disorder (ADHD) Symptoms

This study examined the treatment sensitivity of the ADHD Questionnaire (ADHD-Q), which is a brief rating scale for measuring symptoms of inattention, hyperactivity, and impulsivity in children. Parent, teacher, and child self-report data of the ADHD-Q were obtained for 17 clinically referred children with ADHD on the three occasions: (1) during the regular intake assessment, (2) just before the start of the stimulant medication (i.e., methylphenidate) intervention, and (3) four weeks after the start of the medication intervention. Results showed that ADHD-Q scores remained fairly stable in the period prior to the intervention, but then showed a substantial decline after the stimulant medication had been administered. Clearly, this finding supports the treatment sensitivity of the ADHD-Q.     

Effects of methylphenidate on kinematic aspects of handwriting in hyperactive boys

Poor handwriting in hyperactive children often contributes to academic failure. Beneficial effects of methylphenidate on the quality of handwriting have been shown. Using a digitizing tablet, the handwriting of 21 hyperactive boys was examined both during methylphenidate treatment and following withdrawal of the drug. Half of the hyperactive boys were tested first on methylphenidate and then following withdrawal of the drug and the remaining hyperactive boys were examined in the reverse order. Twenty-one control boys underwent the same examination. Velocity and acceleration of handwriting movements were measured. Furthermore, every writing specimen was independently rated by four examiners regarding the quality of handwriting. Following withdrawal of the drug, the quality of handwriting specimens of hyperactive boys was poorer than during treatment with methylphenidate. Statistical comparison of writing movements of hyperactive boys on and off methylphenidate revealed that the medication resulted in a deterioration in handwriting fluency. The results showed that following withdrawal of medication, hyperactive children did not differ from control boys in handwriting movements. The improvement in hyperactive behavior through methylphenidate was associated with increased legibility and greater accuracy of handwriting. The intention to write neatly may interfere with the fluent writing process.     

RITALIN UPDATE: IMPLICATIONS FOR READING TEACHERS

Ritalin (methylphenidate hydrochloride) is a powerful stimulant drug frequently prescribed for children exhibiting hyperactive behavior, poor attention span, and/or distractibility. Reading teachers and other educators have a particular interest in Ritalin since they frequently have students in their classes taking this medication. The researchers in this study were interested in determining how Ritalin is prescribed for children in educational settings, what dosages seem appropriate, and specifically, what effect Ritalin has on reading achievement. Implications for reading teachers are discussed.     

The Role of Teacher Behavior Management in the Development of Disruptive Behaviors: An Intervention Study with the Good Behavior Game

The role of teacher behavior management for children’s disruptive behavior development (hyperactive and oppositional behavior) was investigated using a universal classroom preventive intervention study. Five-hundred seventy children were followed from second to third grade of elementary school. Observations of teacher behavior management and children’s on-task and off-task classroom behavior and peer reports of hyperactive and oppositional behavior were available. Results showed that the reduced use of negative remarks of intervention teachers predicted children’s increase in on-task behavior and decrease in talking-out behavior. These improved children’s classroom behaviors in turn mediated the impact of the intervention on the development of hyperactive and oppositional behavior over the studied period. These results were similar for girls and boys. The results underscore the role of teachers’ classroom management strategies in improving children’s classroom behavior, which, in turn is an important component in the reduction of disruptive behavior development.     

Psychoactive drug effects in a hyperactive child: A case study analysis of behavior change and teacher attention

The effects of methylphenidate on the behavior and teacher interactions of a 9-year-old hyperactive female were analyzed. Observations of the subject's task-related and disruptive behaviors and of interactions between the subject and her classroom teacher were made when the subject received the active drug and an inert placebo. Teacher's ratings of the subject's classroom behavior and measures of her academic performance were also obtained. Results showed that when the subject was receiving methylphenidate she engaged in task-related activities a greater percent of the time, had a higher percent of teacher interactions that were instructional in quality, and received lower behavior ratings by the teacher than when she was receiving a placebo. The results suggest that the use of medication may enable the hyperactive child to profit both behaviorally and academically.     

RITALIN VS. RESPONSE COST IN THE CONTROL OF HYPERACTIVE CHILDREN: A WITHIN-SUBJECT COMPARISON

A within-subject comparison was made of the effects of methylphenidate (Ritalin) and response cost in reducing the off-task behavior of two boys, 7 and 8 years of age, who had been diagnosed as having an attentional deficit disorder with hyperactivity. Several dosages of Ritalin (5 to 20 mg/day) were evaluated with the results indicating varying effects of the drug for both children. Response cost (with free-time as the reinforcer) was superior to Ritalin in raising levels of on-task behavior and in improving academic performance.     

The Electronic Home Note Program: An Internet-Based Intervention to Improve On-Task Behavior,Academic Performance,and Parental Review

The authors examined the effectiveness of the electronic home note program (EHNP). The program features an emailed version of the traditional home note intervention. In addition, the program uses motivational strategies for increasing rates of on-task behavior, academic productivity, and parent involvement. The authors used a multiple-probe, multiple-baseline design to evaluate implementation effects of the EHNP with four elementary-grade participants. Across all participants, there was an average Tau-U of 0.76 for on-task behavior, with gains maintained at two weeks postintervention. Inconsistent academic gains were found. Parent involvement was high, as most reviewed behavioral ratings data over the course of the intervention. Results also reflect high acceptability of the intervention program from parents, teachers, and participants.     

PILLS OR SKILLS FOR HYPERACTIVE CHILDREN

The controversial nature of drug treatment of hyperactivity, the incidence and sequelae of hyperactivity, and problems of differential diagnosis of hyperactivity versus aggression were discussed. The effects of psychostimulant medication and behavior therapy on hyperactive children were reviewed with regard to effects on their social and academic behavior. Both treatments have resulted in clear short-term changes in social behavior but neither long-term academic nor long-term social effects have been shown with either treatment. Short-term effects on academic behavior have resulted from behavioral interventions but not from psychostimulants. However, the interventions have been too brief to allow one to draw unequivocal conclusions about the clinical efficacy of behavioral treatments. Although there have been long-term evaluations of psychostimulant therapy, there have not been any evaluations of long-term behavioral treatment programs for hyperactive children. Given the salutary short-term effects of behavior therapy with hyperactive children, extended clinical trials of behavior therapy need to be conducted. Finally, specific directions are suggested for future research.     

Anger control in response to verbal provocation: Effects of stimulant medication for boys with ADHD

Although stimulant medication reduces hyperactive children's aggression in naturalistic settings, stimulant effects on anger control have not been demonstrated. We therefore assessed the role of methylphenidate in enhancing response to verbal provocation from familiar peers and from role-playing adults. Twenty-four boys with attention deficithyperactivity disorder (ADHD), aged 6–12, received small-group cognitivebehavioral intervention in anger management skills. During posttraining assessments, the children were randomly assigned to placebo versus. 6 mg/kg of methylphenidate. In the peer provocations, methylphenidate enhanced self-control, decreased physical retaliation, and marginally increased the display of coping strategies. Medication and prompting were minimally beneficial in the delayed, adult-administered generalization assessments. Among the issues discussed are (a) differences between peer and adult provocation and (b) the roles of medication dosage and multimodality intervention for promoting socially competent behavior in children with ADHD.We gratefully acknowledge the Fernald Child Study Center of the University of California, Los Angeles, which provided major support for this research. In addition, we acknowledge the dedication of the small-group trainers, too numerous to mention individually, who led the intervention procedures for the children, and the experimenters who performed the individual provocation assessments. The careful behavior observations of Linda Douglas, Rebecca Eiser, Deborah Gibson, Mike Glenn, Melissa Michaelson, Jon Rafuse, Fauzia Simjee, Leslie Sherman, and Madelin Tundidor were central to the study. Finally, our colleagues Barbara Henker and Carol K. Whalen were instrumental in facilitating all aspects of this investigation.     

Effects of the EXAT neuropsychological multilevel intervention on behavior problems in children with executive function deficits

This is a clinical intervention study of children with executive function (EF ) deficits. A neuropsychological multimodal group intervention called EXAT (rehabilitation of EX ecutive function and AT tention) was developed at the Psychology Clinic of the University of Tampere. Based on the principles of neuropsychological rehabilitation and behavioral modification, EXAT combines child group training, parent training, and teacher consultations. The aims of this study were to investigate behavior problems before and after the intervention in children attending EXAT and in controls, and to compare intervention effects in hyperactive, inattentive, and EF subgroups based on the primary deficit described in the referral. The participants were 86 children (6–12 years) with a mean IQ of 91.4 attending EXAT and 45 controls. The participants’ parents and teachers completed the Conners’ Rating Scales‐Revised. In addition, the Strengths and Difficulties Questionnaire was completed by the parents attending EXAT . The parents reported statistically significant decreases with medium effect sizes for the CPRS ‐R subscales for impulsivity, hyperactivity, and oppositional behavior. In the controls within the same time interval, there was increase in restless and impulsive behavior, and a decrease in total problems. The teachers reported positive changes after the intervention in ADHD symptoms and anxiousness/shyness, but the effects sizes were small. The intervention effects were larger in the hyperactive subgroup. Positive intervention effects were related to a younger age, lower IQ , and simultaneous learning support. In conclusion, EXAT – a structured multilevel group intervention – has positive effects on children's behavior regulation skills by decreasing impulsivity and restless behavior.     

Telehealth parent training for a young child at risk for autism spectrum disorder

The global pandemic has highlighted the importance of telehealth to access behavioral interventions. Face-to-face parent training improves the development and behaviors of young children at risk for autism spectrum disorder (ASD). We evaluated a telehealth parent training intervention for a child at risk for ASD. Two parents identified possible early ASD symptoms in their 30-month-old son (lack of imitation, pointing, and vocal manding). Both parents simultaneously received telehealth behavioral skills training on the Parent Intervention for Children at Risk for Autism program for 1 hour per week over 29 weeks. Multiple baseline designs across parent and child behaviors showed that both parents improved their parent teaching fidelity above 80% and the child improved on all trained behaviors. This study expands the utility of telehealth behavioral parent training to young children at risk for ASD to mitigate early symptoms of ASD.     

Pathways Triple P‐Positive Parenting Program: Effects on Parent‐Child Relationships and Child Behavior Problems

This study examined the effects of Pathways Triple P (PTP), an early intervention program designed to promote positive parent‐child relationships. Sixty parents met the inclusion criteria of borderline to clinically significant relationship disturbance and child emotional and behavioral problems. They were randomly allocated into PTP or a wait‐list (WL) control group. PTP was delivered in a group format for 9 weeks and consisted of parent skills training and cognitive behavior therapy targeting negative attributions for child behavior. Significant intervention effects were found for improving parent‐child relationships and reducing behavior problems with gains maintained at 3‐month follow‐up. Limitations of the study and implications for future research are discussed.     

Effects of parent enhancement therapy on the treatment outcome and generalization of a parent training program

The purpose of the present study was to examine the effectiveness of parent enhancement training in facilitating treatment and maintenance effects of a parent training program. Seventeen mothers and their clinic-referred noncompliant children were assigned to either a parent training alone group or a parent training plus parent enhancement therapy group. Fifteen mothers and their nonclinic children served as a quasi-control group. All clinic-referred mother-child dyads were treated individually by teaching the mother to reward compliance and other prosocial behavior and to use time-out for noncompliance. In addition, mothers in the parent training plus parent enhancement group also received treatment related to the following areas: parent's perception of their child's behavior, parent's personal adjustment, parent's marital adjustment, and parent's extrafamilial relationships. Assessment consisted of four home observations by independent observers prior to treatment, after treatment, and at a 2-month follow-up. The data indicated that the parent training plus parent enhancement therapy was more effective than parent training alone in changing child deviant behavior at posttreatment and in maintaining child compliance, child deviant behavior, parental rewards and parent contingent attention at follow-up. The control group did not change over the three assessment periods.