Article

White Noise to Decrease Problem Behaviors in the Classroom for a Child With Attention Deficit Hyperactivity Disorder (ADHD)

Authors:
To read the full-text of this research, you can request a copy directly from the authors.

Abstract

Continuous white noise played through headphones was used as a classroom intervention to reduce off-task behavior and increase assignment production and accuracy for a child with Attention Deficit Hyperactivity Disorder (ADHD). When listening to white noise the student's off-task behavior decreased from 89% during baseline to 62%. Subsequently, he began taking a stimulant medication for his ADHD. Pharmacotherapy alone (65% off task) was approximately equivalent to white noise alone. When medication was combined with white noise his off-task behavior decreased to 45%. Assignment production was also enhanced while listening to white noise, whereas accuracy remained high throughout.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

... x x a Cook et al. 23 To investigate the effect of white noise on off-task behavior, assignment production and assignment accuracy for a child with ADHD. ...
... 24 Two studies examined the potential positive effect of white noise. 23,39 One study examined the effect of classroom reverberation time on children's behaviour. 31 Seven studies assessed the effect of chronic acoustic exposure, whereas eight studies assessed the effect of acute exposure during the data collection period. ...
... The most common form of assessing children's behaviour was via questionnaires/surveys filled out by the child, teacher, and/or parent, used in nine studies, 22,25,26,30,31,35,39,40 followed by observations by the researcher which were conducted in eight of the studies. 23,24,29,33,34,35,39,40 Other methods of data collection included a diary filled out by the parent 39 and interviews with the teacher 34 or child. 41 Outcomes Typically developing children. ...
Article
The aim of this scoping review was to determine what is known from the literature about the effect of different classroom acoustic conditions on different primary school children's behaviour. A scoping review using the PRISMA-ScR protocol was conducted in March 2022. ERIC, PubMed, Scopus and Web of Science databases were searched using the search term classroom AND (acoustic* OR noise OR reverb*) AND (behav* OR motivat* OR attitude OR persist* OR flexib* OR engage* OR interpersonal). In all, 14 articles were relevant. The populations studied included children who were typically developing, had autism spectrum disorder, attention deficit hyperactivity disorder or were deaf or hard of hearing. Several behaviours including learning, externalising and internalising behaviours were investigated. The results suggested that poor classroom acoustic conditions can negatively impact children's behaviour. However, due to heterogeneity of the methodologies used in this small number of studies, future research is proposed to better understand the relationship.
... Mulitple researchers have identified white noise as a potential intervention for children with ADHD (Cook, Johnson, & Bradley-Johnson, 2015;. Given the need for strong evidence-based interventions in clinical practice, it is important to obtain empirical support regarding the types of tasks and circumstances under which children with ADHD may benefit from concurrent noise. ...
... Previous studies have demonstrated a beneficial effect of white noise on cognitive performance and off-task behaviours in children with ADHD Cook et al., 2015), but the current thesis is the first to examine and compare the impact of white noise 1 on specific attentional processes. Based on the current results, the beneficial effect of concurrent noise observed in previous studies are unlikely to be explained by improvements in executive attention With respect to selective attention and vigilance, the results indicate that white noise may have a beneficial effect for some children with ADHD but not all. ...
... Consistent with our finding that white noise was beneficial for medicated children, two previous studies have shown that listening to white noise had a beneficial effect on assignment completion and off-task behaviours for children with ADHD on stimulant medication Cook et al., 2015). Cook and colleagues (2014) found that for three children with ADHD who were on stimulant medication, listening to white noise reduced passive off-task behaviours in the classroom setting. ...
Thesis
Attention Deficit/Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder that can have a significant impact on multiple facets of a child’s life. Children with ADHD are generally considered to be more susceptible to distraction than other children; however, recent research has suggested that under certain circumstances, concurrent noise (e.g., music or white noise) may improve academic and cognitive performance in children with ADHD (Abikoff, Courtney, Szeibel, & Koplewicz, 1996; Pelham et al., 2011; Söderlund, Sikström, & Smart, 2007). These studies were not able to draw conclusions about which underlying cognitive processes may be improving with the addition of a concurrent auditory stimulus. This thesis contributes to current knowledge by investigating the impact of a concurrent auditory stimulus on attention in children with ADHD, as measured by performance on computer-based attention tasks. We are interested in whether a possible improvement in basic attentional processes could account for the improvements task performance observed in previous studies. The aim of the current thesis was to start to tease out which attentional processes, if any, may benefit from the presence of concurrent auditory stimulus such as white noise. Twenty-eight children with a diagnosis of ADHD-PI or ADHD-C were administered a battery of computer-based attention tasks under two noise conditions: a classroom noise only condition, and a classroom noise + white noise condition. The white noise stimulus comprised sounds of rain, administered using an iPhone application called Sleep Machine. The test battery consisted of four tasks assessing different types of attention – selective attention, sustained attention/vigilance, and aspects of executive attention (response inhibition and conflict resolution). White noise had no impact on children’s performance on the task measuring response inhibition. For two of the attention tasks, the effects of white noise differed for medicated and non-medication children. Overall, a pattern emerged on the visual search and continuous performance tasks that suggested that white noise could improve attention in children with ADHD who are on stimulant medication (i.e., beneficial as an adjunct to medication). Further research is needed to clarify the impact of white noise on attentional processes for non-medicated children with ADHD. For the two executive attention tasks, a Go/no-go task and a Simon task, the white noise had no meaningful impact on task performance.
... The improvement in cognitive and behavioral tasks in subjects with ADHD by auditory WN has also been reported. For instance, in a case study of a child diagnosed with ADHD, auditory WN led to improvements on his writing and math assignments (Cook et al., 2015). Also, a study by Cook, Johnson and Bradley-Johnson (2015) reported three students with ADHD that displayed lower levels of off-task behavior when listening to WN while doing school tasks. ...
... For instance, in a case study of a child diagnosed with ADHD, auditory WN led to improvements on his writing and math assignments (Cook et al., 2015). Also, a study by Cook, Johnson and Bradley-Johnson (2015) reported three students with ADHD that displayed lower levels of off-task behavior when listening to WN while doing school tasks. ...
... White noise is a random mixture of audible frequencies that can improve the detection of simultaneously separated signals with equal power at each frequency. Recent research on white noise highlights many potential benefits, including improved cognition, speech comprehension, extrinsic behaviors, verbal working memory, and academic performance in individuals with ADHD [22][23][24][25][26][27]. However, not all objective methods have succeeded in showing that white noise positively affects ADHD symptoms. ...
Article
Full-text available
Several models have tentatively associated improving attention-deficit/hyperactivity disorder (ADHD) symptoms with arousal and external environmental stimulation. In order to further clarify the relationships between ADHD symptoms, arousal, and external stimulation, this study focused on exploring the “simultaneous” effects of white noise on intrinsic attentional performance and extrinsic on-task behaviors in preschoolers with and without ADHD. By using the computerized task (K-CPT 2), 104 preschoolers, including 52 ADHD children and 52 typically developing (TD) children, were tested and analyzed for their intrinsic attention (such as detectability, omission errors, commission errors, and reaction time). Simultaneously, these preschoolers’ external on-task behaviors were recorded for analysis through systematic observation. This study showed that white noise could effectively improve attention performance, including enhancing the ability to differentiate non-targets from targets and decreasing omission errors. It could also reduce the extrinsic hyperactive behaviors of preschoolers with ADHD. The findings of this study highlighted that white noise stimulation is a beneficial non-pharmacological treatment for preschoolers with ADHD. In contrast, for TD preschoolers, the results of this study showed that the external white noise stimuli were not only unhelpful but also a burden.
... Allerdings ist die Befundlage zur Frage der negativen Wirkung des Lärms auf Schüler*innen mit ADHS ebenso inkonsistent (für eine Übersicht, siehe Batho et al., 2020). So zeigten sich beispielsweise positive Effekte von Musik beim Lösen von arithmetischen Aufgaben (Abikoff et al., 1996), von neuartigen (zuvor noch nicht gehörten) Alltagsgeräuschen auf die Aufmerksamkeitsleistung (Tegelbeckers et al., 2016) und von weißem Rauschen auf das Aufgabenbezogene Verhalten (Cook et al., 2015). Insgesamt wird vermutet, dass spezifische Geräuschkulissen eine kognitiv-aktivierende Wirkung auf Schüler*innen mit ADHS haben könnten (Sikström & Söderlund, 2008). ...
Preprint
Full-text available
In der Fachliteratur wird die Anwendung von Kapselgehörschutz als lärmreduzierende und lernförderliche Unterrichtsmaßnahme insbesondere für Schüler*innen mit sonderpädagogischem Förderbedarf empfohlen. Gegenwärtig gibt es jedoch kaum Evidenzen zur lernförderlichen Wirkung und zur Anwendung von Kapselgehörschutz im Unterricht. Der schulpraktische Einsatz von Kapselgehörschutz basiert aller Voraussicht nach auf impliziten bzw. subjektiven Theorien der Lehrkräfte zur Wirksamkeit von Kapselgehörschutz. Die vorliegende Studie fokussiert daher anhand qualitativer Gruppendiskussionsdaten die Erfahrungen und Einstellungen angehender Lehrkräfte zum Einsatz von Kapselgehörschutz im inklusiven Unterricht und somit die Ableitung subjektiver Theorien zur Wirksamkeit von Kapselgehörschutz unter Berücksichtigung von Faktoren, die die Effektivität des Kapselgehörschutzes determinieren könnten: (a) Qualität und Intensität des Lärms, (b) Eigenschaften und Fähigkeiten der Lernenden, (c) Art, Form und Komplexität der Schulaufgabe sowie (d) potenzielle Nebenwirkungen des Kapselgehörschutzes.
... Some studies show mixed results, fail to show negative effects of noise, or even show beneficial effects of noise and sounds (especially music) on learning and cognition in students with ADHD, which has even resulted in recommendations to induce moderate levels of noise and sounds during class, such as running a fan or playing some music (Carbone, 2001). Recently, the benefits of listening to white noise during task performance for students with ADHD were discussed (Baijot et al., 2016;Cook et al., 2014Cook et al., , 2015Helps et al., 2014). Such hypotheses about the effectiveness of white noise in students with ADHD are grounded in theories of arousal and increased information processing. ...
Article
Full-text available
Classroom noise impairs students’ cognition and learning. At a first glance, it seems useful to prevent the negative effects of noise on academic learning by wearing noise-cancelling (NC) headphones during class. The literature and guidelines emphasize the academic benefits of wearing NC headphones (decreased auditory distraction, increased concentration, learning improvement, and decreased distress). These benefits are particularly expected for students with special needs. None of the recommendations to wear NC headphones during class refer to any empirical studies, indicating a potential research gap and lack of evidence. Therefore, the question arises: Is there any empirical evidence supporting academic benefits of wearing NC headphones during class for typically developing students or students with special needs? A total of 13 empirical studies (quantitative and qualitative) were identified through a systematic scoping review of the existing literature. A wide range of outcomes (cognition, learning, academic performance, behaviour, and emotions) were reported related to the use of NC headphones. Most of the studies refer to specific groups of students with special needs (learning disabilities, autism, ADHD, etc.). In view of the limited number of studies, small sample sizes, and lack of replication studies, all studies give the impression of being pilot studies on the academic benefits of wearing NC headphones. The practice of wearing NC headphones during class is an understudied topic. The current body of evidence does not meet the standards for evidence-based practices in both general and special education. Implications for educational practice and future research are discussed.
... However, most of these improvements are made at classroom-level; little has been done concerning the preferences and needs of individual child. Only for children with special requirements, some individually controlled devices are available, for example, the use of individual amplification systems for children with hearing loss [28]; or special headphones or earmuffs for children with autism spectrum disorder or with attention deficit disorder [29,30]. In fact, individual control, as an effective way to increase satisfaction, has already been used to improve many aspects of indoor environmental quality, such as thermal, air or light quality [31][32][33][34]. ...
Article
Full-text available
Previous studies indicate that acoustic improvements at classroom-level, such as using ceiling panels, do not work well to solve noise problems in classrooms. Therefore, this study introduced a new way-individual control-to improve classroom acoustics. The acoustic effect of five different classroom settings is simulated: two individual-level acoustic improvement settings (''Single-sided canopies" and ''Double-sided canopies"), two classroom-level acoustic improvement settings (''Half-ceiling" and ''Full-ceiling"), and one ''Control" setting. The simulation was accomplished with Computer Aided Theatre Technique (CATT-Acoustic TM), which is a ray-tracing-based room acoustics prediction software package. According to the two main ways of using classrooms (instruction and self-study), the simulations were run for two situations: instruction situation and self-study situation, and the Lombard Effect was taken into consideration in the self-study situation. The results showed that in both situations, all of these improvement settings, compared with the ''Control" setting, could shorten the reverberation time and increase the speech transmission index, and the improvements caused by the individually controlled canopies were more obvious than caused by the ceiling panels. Additionally, in the instruction situation, the individual-level improvements could increase the sound pressure level of the teacher's speech, while in the self-study situation, the individual-level improvements could decrease the sound pressure level of other children's talk. In the future, it is recommended to produce and test different individually controlled devices in a lab or real classroom to verify these results.
Article
Children with ADHD were administered 75 dB of continuous white noise during independent seat work in the classroom and during bedtime in their homes. Compared to baseline all three students exhibited decreases in off-task behavior. Off-task behavior returned to original baseline levels when white noise was removed and decreased again when reintroduced in classrooms. White noise also decreased bedtime sleep latency and spontaneous night wakings at home. Both sleep latencies and night wakings increased during return-to-baseline conditions. Surprisingly, when white noise was reintroduced only in the classrooms sleep improved a second time. White noise in classrooms with or without simultaneous treatment during sleep at night resulted in lower levels of off-task classroom behavior as well as less disruptive sleep. Results were independent of whether children were on ADHD medication. Children, teachers, and parents all rated white noise favorably.
Article
Full-text available
Objective. In the Multimodal Treatment Study of ADHD (MTA), the effects of medication management (MedMgt) and behavior modification therapy (Beh) and their combination ( Comb) and usual community comparison ( CC) in the treatment of attention-deficit/ hyperactivity disorder ( ADHD) differed at the 14-month assessment as a result of superiority of the MTA MedMgt strategy ( Comb or MedMgt) over Beh and CC and modest additional benefits of Comb over MedMgt alone. Here we evaluate the persistence of these beneficial effects 10 months beyond the 14 months of intensive intervention. Methods. Of 579 children who entered the study, 540 (93%) participated in the first follow-up 10 months after the end of treatment. Mixed-effects regression models explored possible persisting effects of the MTA medication strategy, the incremental benefits of Comb over MedMgt alone, and the possible superiority of Beh over CC on 5 effectiveness and 4 service use domains. Results. The MTA medication strategy showed persisting significant superiority over Beh and CC for ADHD and oppositional-defiant symptoms at 24 months, although not as great as at 14 months. Significant additional benefits of Comb over MedMgt and of Beh over CC were not found. The groups differed significantly in mean dose ( methylphenidate equivalents 30.4, 37.5, 25.7, and 24.0 mg/day, respectively). Continuing medication use partly mediated the persisting superiority of Comb and MedMgt. Conclusion. The benefits of intensive MedMgt for ADHD extend 10 months beyond the intensive treatment phase only in symptom domains and diminish over time.
Article
Full-text available
The purpose of the present research is to compare the effects of a Direct Instruction flashcard procedure on the mastery of multiplication facts by two high school students with attention deficit hyper-activity disorder (ADHD) and oppositional defiant disorder (ODD). Both students were enrolled in a separate high school for students with behavior disabilities. The effectiveness of the Direct Instruction flashcard procedure was evaluated across three different sets of math problems using a multiple baseline design. In addition, the effectiveness of various ratios of mastered to unmastered facts was examined. The overall outcomes indicate a large increase in correct responding by both of the participants during the Direct Instruction Flashcard System. An intermediate ratio of mastered to unmastered facts was correlated with fewer trials to mastery for each participant. The applicability of employing Direct Instruction flash card procedures was discussed and directions for future research were posed.
Article
Full-text available
The authors examined the utilization of stimulant medications for the treatment of ADHD in U.S. children during the period 1996–2008 to determine trends by age, sex, race/ethnicity, family income, and geographic region. The 1996–2008 database of the Medical Expenditure Panel Survey, a nationally representative annual survey of U.S. households, was analyzed for therapeutic stimulant use in children age 18 and younger. The data for 1987 were also recalculated for reference. An estimated 3.5% (95% confidence interval=3.0–4.1) of U.S. children received stimulant medication in 2008, up from 2.4% in 1996. Over the period 1996–2008, stimulant use increased consistently at an overall annual growth rate of 3.4%. Use increased in adolescents (annual growth, 6.5%), but it did not significantly change in 6- to 12-year-olds, and it decreased in preschoolers. Use remained higher in boys than in girls, and it remained consistently lower in the West than in other U.S. regions. While differences by family income have disappeared over time, use of stimulants in ADHD treatment is significantly lower in racial/ethnic minorities. Overall, pediatric stimulant use has been slowly but steadily increasing since 1996, primarily as a result of greater use in adolescents. Use in preschoolers remains low and has declined over time. Important variations related to racial/ethnic background and geographic region persist, thus indicating a substantial heterogeneity in the approach to the treatment of ADHD in U.S. communities.
Article
Full-text available
Parent-report of child homework problems was examined as a treatment outcome variable in the MTA-Multimodal Treatment Study of Children with Attention-Deficit/ Hyperactivity Disorder (ADHD). Five hundred seventy-nine children ages 7.0 to 9.9 were randomly assigned to either medication management, behavioral treatment, combination treatment, or routine community care. Results showed that only participants who received behavioral treatment (behavioral and combined treatment) demonstrated sustained improvements in homework problems in comparison to routine community care. The magnitude of the sustained effect at the 10-month follow-up assessment was small to moderate for combined and behavioral treatment over routine community care (d=.37, .40, respectively). Parent ratings of initial ADHD symptom severity was the only variable found to moderate these effects.
Article
Full-text available
Functional analyses revealed that peer attention was one variable maintaining the off-task behavior exhibited by 3 students with a diagnosis of attention deficit hyperactivity disorder (ADHD). Peer-mediated reinforcement plus prompting was then used to reduce off-task behavior in a simulated classroom environment. Implications for future applications of this procedure with children diagnosed with ADHD are discussed.
Article
Full-text available
This study examined the effects of two types of instructions on the academic responding of 4 children with attention deficit hyperactivity disorder. Tactical instructions specified how to distribute responding between two concurrently available sets of math problems associated with different variable-interval schedules of reinforcement. Strategic instructions provided a strategy to determine the best way to distribute responding. Instruction conditions were counterbalanced in an ABAB/BABA reversal design nested within a multiple baseline across participants design. Experimental sessions consisted of a learning session in which participants were provided with one type of instruction, followed by a test session in which no instruction was provided. The schedules of reinforcement were subsequently reversed during test sessions. When learning and test schedules were identical, the responding of all 4 participants closely matched the reinforcement schedules. When tactical instructions were provided and schedules were subsequently changed, responding often remained under the control of the instructions. When strategic instructions were provided, responding more quickly adapted to the changed contingencies. Analysis of postsession verbal reports indicated correspondence between the participants' verbal descriptions (whether accurate or inaccurate) and their nonverbal patterns of responding.
Article
Full-text available
In the intent-to-treat analysis of the Multimodal Treatment Study of Children With ADHD (MTA), the effects of medication management (MedMgt), behavior therapy (Beh), their combination (Comb), and usual community care (CC) differed at 14 and 24 months due to superiority of treatments that used the MTA medication algorithm (Comb+MedMgt) over those that did not (Beh+CC). This report examines 36-month outcomes, 2 years after treatment by the study ended. For primary outcome measures (attention-deficit/hyperactivity disorder [ADHD] and oppositional defiant disorder [ODD] symptoms, social skills, reading scores, impairment, and diagnostic status), mixed-effects regression models and orthogonal contrasts examined 36-month outcomes. At 3 years, 485 of the original 579 subjects (83.8%) participated in the follow-up, now at ages 10 to 13 years, (mean 11.9 years). In contrast to the significant advantage of MedMgt+Comb over Beh+CC for ADHD symptoms at 14 and 24 months, treatment groups did not differ significantly on any measure at 36 months. The percentage of children taking medication >50% of the time changed between 14 and 36 months across the initial treatment groups: Beh significantly increased (14% to 45%), MedMed+Comb significantly decreased (91% to 71%), and CC remained constant (60%-62%). Regardless of their treatment use changes, all of the groups showed symptom improvement over baseline. Notably, initial symptom severity, sex (male), comorbidity, public assistance, and parental psychopathology (ADHD) did not moderate children's 36-month treatment responses, but these factors predicted worse outcomes over 36 months, regardless of original treatment assignment. By 36 months, the earlier advantage of having had 14 months of the medication algorithm was no longer apparent, possibly due to age-related decline in ADHD symptoms, changes in medication management intensity, starting or stopping medications altogether, or other factors not yet evaluated.
Article
Full-text available
Noise is typically conceived of as being detrimental to cognitive performance. However, given the mechanism of stochastic resonance, a certain amount of noise can benefit performance. We investigate cognitive performance in noisy environments in relation to a neurocomputational model of attention deficit hyperactivity disorder (ADHD) and dopamine. The Moderate Brain Arousal model (MBA; Sikström & Söderlund, 2007) suggests that dopamine levels modulate how much noise is required for optimal cognitive performance. We experimentally examine how ADHD and control children respond to different encoding conditions, providing different levels of environmental stimulation. Participants carried out self-performed mini tasks (SPT), as a high memory performance task, and a verbal task (VT), as a low memory task. These tasks were performed in the presence, or absence, of auditory white noise. Noise exerted a positive effect on cognitive performance for the ADHD group and deteriorated performance for the control group, indicating that ADHD subjects need more noise than controls for optimal cognitive performance. The positive effect of white noise is explained by the phenomenon of stochastic resonance (SR), i.e., the phenomenon that moderate noise facilitates cognitive performance. The MBA model suggests that noise in the environment, introduces internal noise into the neural system through the perceptual system. This noise induces SR in the neurotransmitter systems and makes this noise beneficial for cognitive performance. In particular, the peak of the SR curve depends on the dopamine level, so that participants with low dopamine levels (ADHD) require more noise for optimal cognitive performance compared to controls.
Article
Full-text available
Attention-deficit/hyperactivity disorder (ADHD) is related to an attenuated and dysfunctional dopamine system. Normally, a high extracellular dopamine level yields a tonic dopaminergic input that down-regulates stimuli-evoked phasic dopamine responses through autoreceptors. Abnormally low tonic extracellular dopamine in ADHD up-regulates the autoreceptors so that stimuli-evoked phasic dopamine is boosted. The authors propose that these boosted phasic responses yield hypersensitivity to environmental stimuli in ADHD. Stimuli evoking moderate brain arousal lead to well-functioning performance, whereas either too little or too much stimuli attenuate cognitive performance. Strong, salient stimuli may easily disrupt attention, whereas an environment with impoverished stimuli causes low arousal, which is typically compensated for by hyperactivity. Stochastic resonance is the phenomenon that makes a moderate noise facilitate stimulus discrimination and cognitive performance. Computational modeling shows that more noise is required for stochastic resonance to occur in dopamine-deprived neural systems in ADHD. This prediction is supported by empirical data.
Article
Full-text available
Pelham, Wheeler, and Chronis (1998130. Pelham , W. E. , Wheeler , T. , & Chronis , A. ( 1998 ). Empirically supported psychosocial treatments for attention deficit hyperactivity disorder . Journal of Clinical Child Psychology , 27 , 190 – 205 . [Taylor & Francis Online], [PubMed], [CSA]View all references) reviewed the treatment literature on attention-deficit/hyperactivity disorder (ADHD) and concluded behavioral parent training (BPT) and behavioral classroom management (BCM) were well-established treatments for children with ADHD. This review updates and extends the finding of the prior review. Studies conducted since the 1998 review were identified and coded based on standard criteria, and effect sizes were calculated where appropriate. The review reinforces the conclusions of Pelham, Wheeler, and Chronis regarding BPT and BCM. Further, the review shows that intensive peer-focused behavioral interventions implemented in recreational settings (e.g., summer programs) are also well-established. The results of this update are discussed in the context of the existing treatment literature on ADHD. Implications for practice guidelines are suggested, as are directions for future research.
Article
White noise (sound covering the entire range of human hearing from 20-20,000 hertz) was investigated to promote sleep in college students. Four college students were provided white noise generators and instructed to use them all night between 60 and 75 decibels (dB) for one month. A multiple baseline design across participants design measured sleep latency and night wakings during each night at baseline, treatment, and follow-up. All students showed a decrease in both sleep latency and night wakings during treatment; however one's night wakings returned after white noise was discontinued at a one month follow-up and three of the four returned at a second follow-up the next semester. All were comfortable with white noise and would recommend it to other students with sleep problems. White noise reduced sleep problems in college students which supports its use as a non-pharmacological alternative to promote sleep. Like medication it appears to only be effective when administered.
Article
We evaluated the effects of white noise played through headphones on off-task behavior, percentage of items completed, and percentage of items completed correctly for 3 students with attention deficit hyperactivity disorder (ADHD). Headphones plus white noise were associated with decreases in off-task behavior relative to baseline and headphones-only (no white noise) control conditions. Little change in academic responding occurred across conditions for all participants.
Article
Contingent reward procedures have been found beneficial in improving classroom conduct of ADHD children. Based on the conceptualization of the Premack Principle, a previous single-subject study of an ADHD Autistic child suggested the novel use of physical activity availability as a reinforcer for attentive calmness of the Attention Deficit Hyperactivity Disorder (ADHD) child in a laboratory situation. The present study extended this finding to two older ADHD children in a typical special education classroom. The result is an increase of attentive calmness for the duration of the class for both children. These results suggest the possible use of this special type of reinforcer for general classroom usage in behavioral contingency management programs for ADHD children.
Article
White noise generators were turned on at 75 dB at bedtime and kept on all night to treat resistance going to sleep and night wakings in one-year-old toddlers. In a multiple baseline design four sets of parents recorded duration of resistance going to sleep, number of night wakings, completed surveys of their child's feeding and sleeping patterns and the Parenting Stress Index (PSI). Three of four toddlers were sleeping better at the end of treatment; however, one child's night wakings returned at follow-up when white noise was discontinued. All parents were comfortable with the white noise and most would recommend it to others. White noise may be effective for childhood night wakings and resistance going to sleep without being combined with other validated treatments.
Article
Stimulants used to treat attention-deficit/hyperactivity disorder (ADHD) have been well researched, but comparisons among stimulants are hindered by the absence of direct comparative trials. The goal of this work was to compare the efficacy of methylphenidate and amfetamine formulations through a meta-analysis of double-blind placebo-controlled trials. We analyzed recent published literature on the stimulant therapy of ADHD to describe the variability of drug-placebo effect sizes. A literature search was conducted to identify double-blind, placebo-controlled studies of ADHD in children and adolescents published after 1979. Meta-analysis regression assessed the influence of medication type and study design features on medication effects. Twenty-three trials met criteria and were included in this meta-analysis. These trials studied 11 drugs using 19 different outcome measures of hyperactive, inattentive, or impulsive behavior. We found significant differences between amfetamine and methylphenidate products, even after correcting for study design features that might have confounded the results. Our analyses indicate that effect sizes for amfetamine products are significantly, albeit moderately, greater than those for methylphenidate. We found that most measures of effect from all studies were statistically significant. Our findings suggest that amfetamine products may be moderately more efficacious than methylphenidate products, even after controlling for potentially confounding study design features. This difference in effect size may be due to differences between amfetamine and methylphenidate in the molecular mechanisms involved in facilitating the dopaminergic neurotransmission.
Article
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.
Article
To examine the trajectory of methylphenidate (MPH) dosage over time, following a controlled titration, and to ascertain how accurately the titration was able to predict effective long-term treatment in children with attention-deficit/hyperactivity disorder (ADHD). Using the 14-month-treatment database of the NIMH Collaborative Multisite Multimodal Treatment Study of Children With Attention-Deficit/Hyperactivity Disorder (MTA), the outcome of the initial placebo-controlled, double-blind, randomized daily switch titration of MPH was compared with the subsequent maintenance pharmacotherapy. Children received monthly monitoring visits and, when needed, medication adjustments. Of the 198 children for whom MPH was the optimal treatment at titration (mean +/- SD dose: 30.5 +/- 14.2 mg/day), 88% were still taking MPH at the end of maintenance (mean dose 34.4 +/- 13.3 mg/day). Titration-determined dose and end-of-maintenance dose were significantly correlated (r = 0.52-0.68). Children receiving combined pharmacotherapy and behavioral treatment ended maintenance on a lower dose (31.1 +/- 11.7 mg/day) than did children receiving pharmacotherapy only (38.1 +/- 14.2 mg/day). Of the 230 children for whom titration identified an optimal treatment, 17% continued both the assigned medication and dosage throughout maintenance. The mean number of pharmacological changes per child was 2.8 +/- 1.8 (SD), and time to first change was 4.7 months +/- 0.3 (SE). For most children, initial titration found a dose of MPH in the general range of the effective maintenance dose, but did not prevent the need for subsequent maintenance adjustments. For optimal pharmacological treatment of ADHD, both careful initial titration and ongoing medication management are needed.
Best practices in the assessment of children with attention deficit hyperactivity disorder: Linking assessment to response to intervention
  • R M Tobin
  • W J Schneider
  • S G Reck
  • S Landau