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

Kwai Chung Hospital, Hospital Authority, Hong Kong.
Behaviour Research and Therapy (Impact Factor: 3.85). 10/2008; 46(9):983-92. DOI: 10.1016/j.brat.2008.06.007
Source: PubMed


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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    • "Empirical studies have generally compared the efficacy of pharmacological treatment with other therapy options. With respect to behavioral interventions, So, Leung, and Hung (2008) indicated that the combination of methylphenidate and behavioral therapy was effective in reducing ADHD symptoms and that this combination favors a reduction of the initially prescribed dose of medication and increases parent acceptance of treatment. Sibley, Kuriyan, Evans, Waxmonsky, and Smith (2014) concluded that medication and behavior therapy produce similar range of therapeutic effects on the symptoms of adolescents with ADHD. "
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    ABSTRACT: The purpose of this study was to investigate the efficacy of neurofeedback, pharmacological treatment and behavioral therapy in Attention Deficit Hyperactivity Disorder (ADHD) through a controlled, randomized, multigroup design, with pre-, post- and follow-up treatment phases. The objectives of this study are: a) to analyze individual trajectories over time of each child in treatment, from specific measures of EEG (theta/beta ratio/TBR) considering age and sex and b) to determine the therapeutic effect on attentional and behavioral variables evaluated through the Integrated Visual and Auditory Continuous Performance Test. A total of 57 children (7-14 years) diagnosed with ADHD, were randomly assigned to one of the following experimental conditions: 1) 30 Theta/Beta training sessions, 2) Methylphenidate treatment and, 3) Behavior therapy administered according to a cognitive-behavioral protocol based on manuals. Data were analyzed using a Multilevel Longitudinal Regression Model. Results show that administered treatments are effective and cause similar effects on TBR variable, with no differences between them. However, significant differences were observed in the global attention (p=.002), auditory attention (p=.017) and visual attention (p=.028).
    International Journal of Clinical and Health Psychology 06/2015; 18. DOI:10.1016/j.ijchp.2015.04.003 · 2.79 Impact Factor
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    • "Of the scant published local studies in Hong Kong, the focus has been on the prevalence of ADHD among school-aged children and adolescents (P. W. Leung et al., 1996; So et al., 2008), but none have investigated ADHD medication prescribing. To our knowledge , this study is the first to investigate the prevalence of ADHD medication prescribing in Hong Kong. "
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    ABSTRACT: Objective: To investigate the prevalence of ADHD medication prescribing of school-aged children in Hong Kong (HK) from 2001 to 2013 and to compare with other countries. Method: Using the Hong Kong Hospital Authority Clinical Data Analysis and Reporting System, we investigated the epidemiology and prevalence of ADHD medication prescribing. Results: The prevalence of children on ADHD medication increased 14 times throughout the study period-0.072% in 2001 (95% confidence interval [CI] = [0.068%, 0.077%]) to 1.027% (95% CI = [1.008%, 1.047%]) in 2013. Prevalence in females increased at a faster rate than in males. The prescribing trend in kindergarten children (3- to 5-year-old) was relatively steady from 2001 to 2008-0.025% (95% CI = [0.019%, 0.033%]) in 2001-until a marked increase from 2009 to 2013-0.121% (95% CI = [0.105%, 0.139%]) in 2013. Conclusion: The prevalence of ADHD medication prescribing in Hong Kong is increasing but remains lower than most Western countries. However, the prevalence of ADHD medication prescribing for kindergarten children should be monitored to ensure appropriate use.
    Journal of Attention Disorders 07/2014; DOI:10.1177/1087054714536047 · 3.78 Impact Factor
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    • "Virtually identical results were found with the Year 2 data in terms of the SWAN scales' skewness, kurtosis, internal consistency, and correlations with the SDQ hyperactivity subscale. These psychometric properties are consistent with those of previous studies (e.g., Robaey et al. 2007; So et al. 2008). Good concurrent validity exists between the SWAN and other clinical tools that use the exact wording of the DSM-IV criteria for ADHD. "
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    ABSTRACT: Recent factor analytic studies in Attention-Deficit/Hyperactivity Disorder (ADHD) have shown that hierarchical models provide a better fit of ADHD symptoms than correlated models. A hierarchical model includes a general ADHD factor and specific factors for inattention, and hyperactivity/impulsivity. The aim of this 12-month longitudinal study was to test the generalizability of the hierarchical models of ADHD within an elementary school population of 6–9 year old children (250 boys, 260 girls). Examination of differences as a function of informant (parent vs. teacher ratings), sex, and time was conducted. Six potential factor structures for the 18 items of the SWAN (Strengths and Weaknesses of ADHD-symptoms and Normal-behavior) scale were tested using confirmatory and exploratory factor analyses. Hierarchical models with a general ADHD factor and two or three specific factors best accounted for parent and teacher reports of symptoms for both boys and girls and at two time points separated by a 12-month interval. Findings indicate that the 18 SWAN items measure a common latent trait as well as orthogonal factors or dimensions of inattention and hyperactivity/impulsivity.
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