Additive Effects of Psychostimulants, Parent Training, and Self-Control Therapy with ADHD Children

ArticleinJournal of the American Academy of Child & Adolescent Psychiatry 30(2):233-40 · April 1991with23 Reads
Impact Factor: 7.26 · DOI: 10.1097/00004583-199103000-00011 · Source: PubMed
Abstract

Utilizing a double-blind, placebo design, the effects of a high (0.8 mg/kg) and a low (0.4 mg/kg) dose of methylphenidate alone and in combination with behavioral parent training plus child self-control instruction were evaluated with 96 attention deficit hyperactivity disorder children. No evidence of the superiority of the combined conditions relative to medication alone was found. Some limited support was found for the hypothesis that the effects of a high dose of psychostimulant medication could be achieved by combining the low dose with a behavioral intervention. The importance of the latter finding is highlighted by the fact that both the benefits and untoward effects of the psychostimulants appear to increase with the dose.

    • "Studies focused on the efficacy of stimulant treatment, psychosocial treatments, combination of medication and psychosocial treatments, and the multimodal studies showed conflicting results. Some studies found superiority of pharmacological treatment over psychosocial treat-ment/ multimodal intervention in reducing core symptoms of ADHD, behavioural problems, academic performance and social skills3456 while others found vice versa789. Parents of children with ADHD very often experience considerable stress in their parenting roles. "
    [Show abstract] [Hide abstract] ABSTRACT: Background: To find the efficacy of multimodal intervention on attention deficit and hyperactivity, behavioral prob-lems in home and school situations and on academic achievement of children with ADHD and the impact of family stress and coping on the outcome of multi-modal intervention. Method: A sample (N = 40) of children aged 5 -10 years registered in the Child and Adolescent Mental Health Unit (CAMHU) with a diagnosis of ADHD (on the ICD-10) with or without comorbidity were randomly allocated to one of two groups: Group I (medical management with parent counseling, N = 20) or Group II (multimodal intervention (routine medical management, parent training and attention enhancement training), N = 20). Assessments (pre-assessment, re-assessment at one month and post assessment after 10 weeks) were carried out by investigator, parent, teacher and blind rater. Results: Significant improvement was noticed for both groups but multimodal intervention was superior to routine medical management and parent counselling in reducing ADHD symptoms, behavioural problems at home and school, and in improving academic performance. Effect size estimates and the rates of clinically significant change also supported this finding. Parental stress did not predict the outcome of intervention. Conclusions: Multimodal intervention was found to be promising in the treatment of ADHD.
    Full-text · Article · Jan 2012 · Journal of Behavioral and Brain Science
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    • "An abundant and longstanding body of work (e.g., Horn et al., 1991; Abikoff & Klein, 1992; Ialongo et al., 1993; MTA Cooperative Group, 1999; Pelham et al., 1993) has generally shown that psychosocial interventions can be effective in addressing the symptoms of ADHD and the highly comorbid disruptive behavior problems, as well. However, these outcome studies have largely been led and implemented by experts in the field (i.e., experienced Ph. "
    [Show abstract] [Hide abstract] ABSTRACT: The current study tested whether an abbreviated version of Defiant Children (Barkley, 1987), an efficacious parent training program to address the behavioral noncompliance often associated with disruptive behavior disorders, could be implemented successfully within a community mental health clinic setting by master's-level therapists. Ethnically and socioeconomically diverse parents of 16 children (ages 4 to 12 years old) completed a 6-session active treatment group emphasizing the use of differential attending skills, effective time-out strategies, and a structured reinforcement schedule to increase child compliance. Pre- and posttreatment measures of attention-deficit/hyperactivity disorder (ADHD), oppositional-defiant disorder (ODD), and conduct disorder (CD) symptom level were administered, as well as a measure tapping the contextual breadth (i.e., number of settings) and severity of disruptive behaviors. Parent satisfaction with the treatment was also assessed. Analyses indicated large treatment effects on all measures except CD behavior. Results are discussed in the context of implementing empirically supported therapies in settings where “treatment as usual” is the norm.
    Full-text · Article · Nov 2011 · Cognitive and Behavioral Practice
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    • "The sample size is calculated on the basis of a type I error (a) of 5% and a type II error (b) of 20%, thus a power of 80%, and an allocation ratio of 1:1. With a clinically relevant difference of a score of 4 between the experimental intervention group and the control group on the Conners 3 rd Edition Rating Scale 'hyperactivity-impulsivity' sub index (primary outcome) and an assumed standard deviation of 5 on the same scale [45,46], a sample size of 26 participants in each group is needed. This corresponds to a total of 52 participants to be randomised. "
    [Show abstract] [Hide abstract] ABSTRACT: Children with attention deficit hyperactivity disorder (ADHD) are hyperactive and impulsive, cannot maintain attention, and have difficulties with social interactions. Medical treatment may alleviate symptoms of ADHD, but seldom solves difficulties with social interactions. Social-skills training may benefit ADHD children in their social interactions. We want to examine the effects of social-skills training on difficulties related to the children's ADHD symptoms and social interactions. The design is randomised two-armed, parallel group, assessor-blinded trial. Children aged 8-12 years with a diagnosis of ADHD are randomised to social-skills training and parental training plus standard treatment versus standard treatment alone. A sample size calculation estimated that at least 52 children must be included to show a 4-point difference in the primary outcome on the Conners 3rd Edition subscale for 'hyperactivity-impulsivity' between the intervention group and the control group. The outcomes will be assessed 3 and 6 months after randomisation. The primary outcome measure is ADHD symptoms. The secondary outcome is social skills. Tertiary outcomes include the relationship between social skills and symptoms of ADHD, the ability to form attachment, and parents' ADHD symptoms. We hope that the results from this trial will show that the social-skills training together with medication may have a greater general effect on ADHD symptoms and social and emotional competencies than medication alone. ClinicalTrials (NCT): NCT00937469.
    Full-text · Article · Jan 2011 · Trials
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