Treatment effectiveness of combined medication/behavioural treatment with chinese ADHD children in routine practice.
ABSTRACT 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.
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).
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.
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.
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ABSTRACT: To systematically identify and review the currently available evidence on the long-term outcomes of recommended attention-deficit hyperactivity disorder (ADHD) interventions following randomized controlled trials with children and young people. A systematic search was conducted to identify trials >1 year in length using the following databases: CINAHL (January 1982- July 2012), MEDLINE (Ovid and Cambridge Scientific Abstracts [CSA]), Psych info, Science Direct (Elsevier), and Cochrane Library. Hand searches of key journals in the subject, book chapters, and conference proceedings were also carried out. Relevant papers were critically appraised using the Cochrane risk of bias tool. Eight controlled trials were identified as being relevant, of duration ranging from 1 year to 8 years (at follow up). The total number of participants in the studies was 1,057, of whom 579 (54.7%) were from one cohort and included 26 different outcome measures. Results suggest there is moderate-to-high-level evidence that combined pharmacological and behavioral interventions, and pharmacological interventions alone can be effective in managing the core ADHD symptoms and academic performance at 14 months. However, the effect size may decrease beyond this period. This review has highlighted the paucity and limitations of the evidence investigating the long-term outcomes of recommended interventions for managing ADHD symptoms. There is little evidence to suggest that the effects observed over the relatively short term are maintained throughout longer periods of impairment. Furthermore, much of the existing evidence examining effectiveness beyond 12 months does not include newer medications currently available or consider significant contextual and cultural differences, such as UK/European and Asian populations. Longitudinal studies are required to examine the long-term outcomes for children and young people with ADHD managed with currently recommended service interventions. They should also include the whole spectrum of ADHD, with its full range of coexisting conditions, and cultural and contextual diversity.Psychology Research and Behavior Management 01/2013; 6:87-99.
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ABSTRACT: The present pilot study evaluated the efficacy of the Level 4 Group Positive Parenting Program (Triple P) with Hong Kong Chinese parents who had a child with attention deficit/hyperactivity disorder (ADHD), using a randomised controlled trial design. It was a mixed research method involving quantitative measurement and semi-structured focus group. Participants were randomly assigned to Triple P (n = 8) or control group (n = 9) and completed measures on child disruptive behaviours, sense of parenting efficacy and satisfaction, family stress and service needs. Outcomes were assessed at pre-, post-, and 3-month follow-up. A focus group was also conducted with the participants in the intervention group upon the programme completion. Compared with the control group, the intervention group reported a significant reduction in intensity of child behaviour problems and a significant increase in parenting efficacy at post-intervention. The gain in reducing intensity of child disruptive behaviours maintained to 3 months after the completion of programme. Qualitative data suggested the three key elements to help both parents and children get positive changes: understanding and empathy, emotional control, and persistence in applying positive parenting strategies. The results partially provided preliminary evidence supporting the efficacy of Triple P in reducing child behaviour problems for ADHD in Chinese society.Australian Psychologist 06/2014; 49(3). · 0.61 Impact Factor
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ABSTRACT: Objective Behavioral interventions are recommended as attention-deficit/hyperactivity disorder (ADHD) treatments. However, a recent meta-analysis found no effects on core ADHD symptoms when raters were probably blind to treatment allocation. The present analysis is extended to a broader range of child and parent outcomes. Method A systematic search in PubMed, Ovid, Web of Knowledge, ERIC, and CINAHAL databases (up to February 5, 2013) identified published randomized controlled trials measuring a range of patient and parent outcomes for children and adolescents diagnosed with ADHD (or who met validated cutoffs on rating scales). Results Thirty-two of 2,057 nonduplicate screened records were analyzed. For assessments made by individuals closest to the treatment setting (usually unblinded), there were significant improvements in parenting quality (standardized mean difference [SMD] for positive parenting 0.68; SMD for negative parenting 0.57), parenting self-concept (SMD 0.37), and child ADHD (SMD 0.35), conduct problems (SMD 0.26), social skills (SMD 0.47), and academic performance (SMD 0.28). With probably blinded assessments, significant effects persisted for parenting (SMD for positive parenting 0.63; SMD for negative parenting 0.43) and conduct problems (SMD 0.31). Conclusion In contrast to the lack of blinded evidence of ADHD symptom decrease, behavioral interventions have positive effects on a range of other outcomes when used with patients with ADHD. There is blinded evidence that they improve parenting and decrease childhood conduct problems. These effects also may feed through into a more positive parenting self-concept but not improved parent mental well-being. J. Am. Acad. Child Adolesc. Psychiatry, 2014;16(x):xx–xx. Key Words: ADHD, parenting, intervention, conductJournal of the American Academy of Child and Adolescent Psychiatry 06/2014; · 6.97 Impact Factor