Treatment effectiveness of combined medication/behavioural treatment with chinese ADHD children in routine practice

BACKGROUND: The effectiveness of a combined methylphenidate/behavioural treatment (BT) versus methylphenidate-only for Chinese children with Attention-Deficit/Hyperactivity Disorder (ADHD) was tested in routine clinical practice in Hong Kong. METHODS: A randomized group comparison design was adopted with two treatment conditions (methylphenidate-only; methylphenidate/BT), which lasted for 6 months. There were four assessment time points (pre-treatment, post-treatment, and 6-month and 12-month follow-ups), using the Strengths and Weaknesses of ADHD Symptoms and Normal Behaviours (SWAN) Rating Scale. Parental attitude toward different treatment options of ADHD was also assessed at pre-treatment and post-treatment. Participants included 90 Chinese ADHD children (mean age=8 years, SD=.95). RESULTS: The combination of BT and a low-dose methylphenidate was significantly more effective than methylphenidate-only in reducing ADHD and ODD symptoms at post-treatment. At follow-ups, the benefits of the combined treatment were maintained, while the methylphenidate-only group caught up in improvement in ADHD symptoms. Parents in both treatment conditions showed improved attitude toward medication after the 6-month treatment phase, while their attitude toward BT was positive all along. CONCLUSIONS: This study supported the added benefits of BT, on top of medication, for Chinese ADHD children in routine practice with treatments conducted by regular medical and paramedical staffs.     

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.     

The role of treatment acceptability in the initiation of treatment for ADHD

Approximately 50% of families of children with ADHD fail to pursue, or adhere to, recommended treatments. The present study examines parent ratings of the acceptability of pharmacological and behavioral treatments for ADHD and the relationships between these ratings and subsequent pursuit of treatment. Fifty-five families whose children received an evaluation for ADHD completed questionnaires and were contacted 3 to 4 months later to assess their pursuit of treatment. Consistent with previous research, parents rated behavior therapy as more acceptable than medication. Parent ratings of medication acceptability significantly predict pursuit of pharmacological treatment, whereas ratings of the acceptability of behavior therapy do not predict pursuit of this treatment. Preliminary analyses found that Caucasian parents' ratings of medication are significantly higher than those of non-Caucasian parents. Furthermore, Caucasian families were more likely to pursue a recommendation for pharmacological treatment than non-Caucasian families. The clinical and research implications of these results are considered.     

Treatment of children with ADHD: psychopedagogical program at school versus psychostimulant medication

This study examined the impact of medication management compared to a psycho-educational program on parent and teacher ratings of children with combined type ADHD. The study lasted 14 weeks and included 50 children. 17 children took medication, 17 received psycho-educational intervention, and 16 children were assigned to the control group. The measures used were the IOWA Conners Scale, the School Problem Inventory, the Abbreviated Conners, and the DSM-IV Inattention-Disorganization and Hyperactivity-Impulsivity rating scales. Regarding teacher ratings, improvements were observed on: a) inattention and school problems in the medication group versus the control group; and b) hyperactivity symptoms in the psycho-pedagogical group versus the control and medication groups. Regarding to parent ratings, improvements were observed on: a)inattention in the psycho-pedagogical group versus the control and medication groups; and b) hyperactivity symptoms in the psycho-pedagogical group versus the control and the medication groups.     

Effect of treatment with stimulant medication on nonverbal executive function and visuomotor speed in children with attention deficit/hyperactivity disorder (ADHD).

This study used a novel hidden maze learning test to examine the nature and magnitude of impairment on separable aspects of executive function in 36 children with ADHD. A within-subject analysis of children with ADHD was also conducted to assess cognitive effects of open-label stimulant treatment. Compared to 31 age-matched controls, unmedicated children with ADHD were slower and made significantly more errors that were indicative of relative impairment in prepotent response inhibition and ability to "maintain set" while using simple rules to complete the task. Open-label administration of stimulant medication led to faster and more efficient performance, with children with ADHD making fewer perseverative and rule-break errors than when off medication. This instrument might be useful in monitoring treatment response in specific aspects of executive function and in assisting with dose-titration decisions.     

Sequenced neurocognitive and behavioral parent training for the treatment of ADHD in school-age children

The present study examines the potential of sequencing a neurocognitive intervention with behavioral parent training (BPT) to improve executive functions (EFs), psychiatric symptoms, and multiple indices of functional impairment in school-age children aged 7 to 11 years who have been diagnosed with attention-deficit/hyperactivity disorder (ADHD). Specifically, in a randomized controlled trial design, 85 children were assigned to either Cogmed Working Memory Training (CWMT) followed by an empirically supported, manualized BPT intervention, or to a placebo version of CWMT followed by the same BPT intervention. Working memory maintenance (i.e., attention control/short-term memory), working memory processing and manipulation, ADHD and oppositional defiant disorder (ODD) symptoms, impairment in parent–child dynamics, familial impairment, and overall functional compromise were evaluated as outcomes. The results suggest specific effects of the combined CWMT and BPT program on verbal and nonverbal working memory storage and nonverbal working memory processing and manipulation but no incremental benefits in regard to ADHD symptoms, ODD symptoms, and functional outcomes. The present findings do not support the hypothesis regarding the complementary and augmentative benefits of sequenced neurocognitive and BPT interventions for the treatment of ADHD. These results, the study’s limitations, and future directions for research are further discussed.     

Development of a school-based treatment program for middle school youth with ADHD

The authors conduct an evaluation of a middle school-based treatment program for youth with ADHD during early stages of treatment development. The studies focus on interpreting outcome trends in preliminary data and identifying assessment issues that will be important to consider when conducting a clinical trial. Parent reports indicate that the majority of students benefit from improvements in academic, social, and overall functioning. Although teachers report beneficial effects for the majority of the participants in the program, there is little agreement about individual students. Measurement problems are associated with understanding normal change during a school year, accounting for normal behavior changes in December and May, and considerable disagreement between teachers. Suggestions to guide future work in this area are provided.     

Preparing Families for Evidence-Based Treatment of ADHD: Development of Bootcamp for ADHD

Objective: Many families of children with attention-deficit/hyperactive disorder (ADHD) do not initiate evidence-based treatments (EBTs), placing these children at risk for poor outcomes. Bootcamp for ADHD (BC-ADHD) is a novel, four-session, group intervention designed to prepare parents as informed consumers to engage in multimodal EBTs for ADHD. This paper describes the theory of change and the development of BC-ADHD, outlines its components, and provides an initial proof of concept of the program. Method: Participants were 11 families of children with ADHD (ages 5–11; 55% male; 91% non-Hispanic; 55% White, 27% Black, 18% more than one race) who were the initial participants receiving BC-ADHD during a small-scale, randomized controlled trial. Parent-report outcome measures assessed parental empowerment, treatment preferences, affiliate stigma, intention to pursue treatment, and treatment initiation at baseline, posttreatment, and 6-week follow-up. Results: Parent engagement was high, as indicated by an 86% session attendance rate and high ratings of program satisfaction. Parents reported an increase in empowerment to access systems of care. Ratings of acceptability for behavior therapy increased at posttreatment and follow-up with minimal or no concerns about feasibility. The acceptability of medication was high at each assessment, although parents expressed increased concerns about stigma and adverse effects of medication at posttreatment and follow-up. Nonetheless, there was a marked increase in parental intention to use medication at posttreatment and follow-up. Accounting for ceiling effects, parents reported substantial increases in intention to use medication, behavioral parent training (BPT), and school services. Changes in treatment initiation were in the expected direction. Conclusions: BC-ADHD has the potential to promote family empowerment in seeking services and increase their intent to initiate EBTs, as well as actual initiation of these treatments.     

Working memory deficits can be overcome: Impacts of training and medication on working memory in children with ADHD

This study evaluated the impact of two interventions—a training program and stimulant medication—on working memory (WM) function in children with attention deficit hyperactivity disorder (ADHD). Twenty‐five children aged between 8 and 11 years participated in training that taxed WM skills to the limit for a minimum of 20 days, and completed other assessments of WM and IQ before and after training, and with and without prescribed drug treatment. While medication significantly improved visuo‐spatial memory performance, training led to substantial gains in all components of WM across untrained tasks. Training gains associated with the central executive persisted over a 6‐month period. IQ scores were unaffected by either intervention. These findings indicate that the WM impairments in children with ADHD can be differentially ameliorated by training and by stimulant medication. Copyright © 2009 John Wiley & Sons, Ltd.