A meta-analysis of behavioral treatments for attention-deficit/hyperactivity disorder. Clinical Psychology Review, 29(2), 129-140

University at Buffalo, State University of New York, Department of Counseling, School, and Educational Psychology, Buffalo, NY 14214, USA.
Clinical psychology review (Impact Factor: 7.18). 12/2008; 29(2):129-40. DOI: 10.1016/j.cpr.2008.11.001
Source: PubMed


There is currently controversy regarding the need for and the effectiveness of behavior modification for children with attention-deficit hyperactivity disorder (ADHD) despite years of study and multiple investigations reporting beneficial effects of the intervention. A meta-analysis was conducted by identifying relevant behavioral treatment studies in the literature. One-hundred seventy-four studies of behavioral treatment were identified from 114 individual papers that were appropriate for the meta-analysis. Effect sizes varied by study design but not generally by other study characteristics, such as the demographic variables of the participants in the studies. Overall unweighted effect sizes in between group studies (.83), pre-post studies (.70), within group studies (2.64), and single subject studies (3.78) indicated that behavioral treatments are highly effective. Based on these results, there is strong and consistent evidence that behavioral treatments are effective for treating ADHD.

    • "A multimodal stepped-care approach relying on medication and psychosocial interventions, including PCT, has been shown to be effective for the treatment of childhood ADHD (e.g. Daley et al., 2014; Fabiano et al., 2009; Faraone & Buitelaar, 2010; Hanwella, Senanayake, & de Silva, 2011; Hodgson, Hutchinson, & Denson, 2014; Young & Amarasinghe, 2010). In our trial, PCT was individually tailored according to a manualized treatment program (D€ opfner, Sch€ urmann, & Fr€ olich, 2007), which is widely used in German-speaking countries and is based on Forehand and McMahon (1981) and Barkley (1997). "
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    ABSTRACT: This is the first randomized controlled multicenter trial to evaluate the effect of two treatments of maternal attention-deficit hyperactivity disorder (ADHD) on response to parent-child training targeting children's external psychopathology. Mother-child dyads (n = 144; ADHD according to DSM-IV; children: 73.5% males, mean age 9.4 years) from five specialized university outpatient units in Germany were centrally randomized to multimodal maternal ADHD treatment [group psychotherapy plus open methylphenidate medication; treatment group (TG): n = 77] or to clinical management [supportive counseling without psychotherapy or psychopharmacotherapy; control group (CG): n = 67]. After 12 weeks, the maternal ADHD treatment was supplemented by individual parent-child training for all dyads. The primary outcome was a change in the children's externalizing symptom scores (investigator blinded to the treatment assignment) from baseline to the end of the parent-child training 6 months later. Maintenance therapy continued for another 6 months. An intention-to-treat analysis was performed within a linear regression model, controlling for baseline and center after multiple imputations of missing values. Exactly, 206 dyads were assessed for eligibility, 144 were randomized, and 143 were analyzed (TG: n = 77; CG: n = 66). After 6 months, no significant between-group differences were found in change scores for children's externalizing symptoms (adjusted mean TG-mean CG=1.1, 95% confidence interval -0.5-2.7; p = .1854), although maternal psychopathology improved more in the TG. Children's externalizing symptom scores improved from a mean of 14.8 at baseline to 11.4 (TG) and 10.3 (CG) after 6 months and to 10.8 (TG) and 10.1 (CG) after 1 year. No severe harms related to study treatments were found, but adverse events were more frequent in TG mothers than in CG mothers. The response in children's externalizing psychopathology did not differ between maternal treatment groups. However, multimodal treatment was associated with more improvement in maternal ADHD. Child and maternal treatment gains were stable (CCT-ISRCTN73911400). © 2015 Association for Child and Adolescent Mental Health.
    No preview · Article · Jun 2015 · Journal of Child Psychology and Psychiatry
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    • "Research on non-pharmacological interventions in ADHD treatment has shown that psychological treatments that incorporate behavioral techniques prove effective. Hodgson, Hutchinson, and Denson (2014) replicated the work by Fabiano et al. (2009), corroborating the efficacy of seven non-pharmacological interventions that included behavioral modification, neurofeedback, school programs and parent training. Specifically, there is clear evidence of the effects of parent training, whose interventions should be tried before medication among preschoolers with ADHD and results remain even after intervention ended (Charach et al., 2013). "
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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).
    Full-text · Article · Jun 2015 · International Journal of Clinical and Health Psychology
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    • "Beauchaine, Webster-Stratton, and Reid (2005) combined data from six randomized controlled trials (RCTs) of the Incredible Years parent training program and found that attention problems combined with CD neither moderated nor predicted outcomes of parent training when delivered in a group-based format . Moreover, in Fabiano et al.'s (2009) meta-analysis of behavioral treatment for ADHD, child comorbidity was not associated with study effect size. Some variables have been found to predict treatment outcomes in separate studies of ADHD and CP, and also in a few combined studies. "
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    ABSTRACT: To scale up evidence-based treatment of conduct problems, parent management training, Oregonmodel (PMTO) has been disseminated throughout Norway. This study examined whether Attention Deficit Hyperactivity Disorder (ADHD) predicted the outcomes of PMTO. Of 253 children and families, 97 were reported to have an ADHD diagnosis. Although different at intake, the groupswith and without ADHD had close to an equal change in behavioral status following treatment. Maternal depression and family income predicted the combined group’s behavior following PMTO. The study indicates that reductions in conduct problems following PMTO are of the same magnitude in children with or without ADHD. However, some characteristics may differentially predict outcomes for children with combined problems.
    Full-text · Article · Mar 2015 · Child & Family Behavior Therapy
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