Article

Empirical Foundations of Applied Behavior Analysis for the Treatment of Attention Deficit-Hyperactivity Disorder (ADHD)

Article

Empirical Foundations of Applied Behavior Analysis for the Treatment of Attention Deficit-Hyperactivity Disorder (ADHD)

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Abstract

Attention deficit-hyperactivity disorder (ADHD) is characterized by inattention, hyperactivity and impulsivity, being the most common psychiatric disorder in childhood. In spite of most of ADHD cases choose stimulant drugs as their first treatment, applied behavior analysis has been used as a very successfully intervention tool on behaviors typically involved in this diagnosis. The present article reviews 40 years of publication of the Journal of Applied Behavior Analysis (JABA) on behavioral treatment of ADHD. All published journal numbers between 1968 and 2008 were consulted. The results enable the identification of several variables and their values and dimensions to which are necessary to pay attention to conduct the functional analysis that must precede the application of intervention procedures. Furthermore, the results show, in most cases, the procedures that dispense drug treatment and turn to installation and/or maintenance of relevant behaviors had more significant, intense and stable changes in the clinical picture presented by the participants of the studies.

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Chapter
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This chapter focuses on the attention deficit hyperactivity disorder (ADHD). It is a disorder of unknown etiology with defining characteristics of inattention, overactivity, and impulsivity. ADHD is chronic and persists over the life span. It frequently co-occurs with additional emotional, behavioral, and learning problems. Disruptive behavior disorders such as oppositional defiant disorder and conduct disorder are the most common, and are more frequently correlated with the hyperactive/impulsive type of ADHD. Internalizing disorders, such as depression, anxiety, and learning disabilities, are more frequently associated with the inattentive type of ADHD. The primary goal of a functional analytic model of ADHD is to understand the environmental conditions that may maintain or exacerbate specific problem behaviors associated with ADHD in order to develop effective, individually tailored interventions. The first step of a functional analysis of ADHD is to identify the specific context in which the problem behavior or behaviors occur. This is of particular importance, as assessment should occur either directly in that context or under conditions as representative of that context as possible.
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Analogue assessments were conducted with a common contingency (escape from tasks) that varied only by three different instructions describing the contingency. In one condition, the contingency was described as "taking a break," in another condition it was described as "time-out," and no description of the contingency was provided in a third condition. The participant was a typically developing 5-year-old child with a diagnosis of attention deficit hyperactivity disorder. Rates of inappropriate behavior varied substantially across the three conditions as an apparent effect of the prior instructions. Some implications for conducting functional analyses with verbal children are discussed.
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Medications used to treat attention-deficit/hyperactivity disorder (ADHD) have been well researched, but comparisons among drugs are hindered by the absence of direct comparative trials. We analyzed recent published literature on the pharmacotherapy 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 youth published after 1979. Meta-analysis regression assessed the influence of medication type and study design features on medication effects. Twenty-nine trials met criteria and were included in this meta-analysis. These trials studied 15 drugs using 17 different outcome measures of hyperactive, inattentive, impulsive, or oppositional behavior. The most commonly identified treatments included both methylphenidate and amphetamine compounds. After stratifying trials on the class of drug studied (short-acting stimulant vs long-acting stimulant vs nonstimulant), we found significant drug differences for both study design variables and effect sizes. The differences among the 3 classes of drug remained significant after correcting for study design variables. Conclusion: Uniformity appears to be lacking in how medication effectiveness is assessed and in many study design parameters. Comparing medication effect sizes from different studies will be biased without accounting for variability in study design parameters. Although these differences obscure comparisons among specific medications, they do allow for conclusions about the differential effects of broad classes of medications used to treat ADHD.