Psychosocial Interventions in Attention Deficit Hyperactivity Disorder

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This brief overview of psychosocial treatment approaches to attention deficit hyperactivity disorder (ADHD) concentrates on the two that receive the greatest research support, parent training in child behavior management and teacher training in classroom management. Cognitive-behavioral training of children who have ADHD has little evidence of efficacy and group social skills training has mixed or limited evidence of effectiveness. Research should focus on more theoretically driven psychosocial treatment approaches, on potential side effects or adverse events associated with this form of intervention, and on the complex pathways that affect impairment in major life activities that could guide subsequent treatment design for such impairments.

Section snippets

Parent training in behavioral management

Behavioral parent training (BPT) programs seem effective for children who have disruptive behaviors whether or not they have co-occurring attentional/hyperactive difficulties [9], [10]. Although nonspecific to ADHD, parent training in behavioral management also seems efficacious for youth who have ADHD [11], [12], [13], [14], [15], [16], [17]. Nonetheless, most of the studies on BPT are of short duration and do not assess maintenance of treatment effects [18]. BPT generally results in

Teacher training in classroom behavior management

Teachers often receive explicit training in classroom behavioral management during their training and education. Thus, it is not surprising that more research has occurred on the application of behavior management methods in the classroom than with parent training. A meta-analysis on school interventions for ADHD was conducted that comprised 70 separate experiments of various within- and between-subjects designs and single-case designs [32]. An overall mean effect size for contingency

Summer treatment program

One of the most well-known and well-regarded multimodality intervention programs is the summer treatment program (STP) developed by Pelham and colleagues [38] and conducted at Western Psychiatric Institute in Pittsburgh. This program relies on five major components of treatment: (1) parent training in child behavior management; (2) classroom implementation of behavior modification techniques; (3) academic and sports skills practice and tutoring; (4) social skills training (SST) (typically

Multimodal Treatment Study of Children with attention deficit hyperactivity disorder methodology

The MTA study was designed to provide more complete information regarding the long-term effectiveness of ADHD interventions, alone or in combination, on the multiple functional outcome areas on which ADHD has an impact [36], [39]. Children ages 7 through 9.9 years of age randomly were assigned to one of four treatment groups: medication alone (MedMgt), behavior modification alone (Beh), a combination of medication and behavior modification (Comb), and community comparison (CC). The MTA included

Cognitive-behavioral therapy

Although once believed effective for youth who have ADHD [49], neither cognitive behavioral therapy (CBT) nor cognitive therapy has much research support in pediatric ADHD [32], [50], [51], [52], [53]. Meta-analyses of CBT typically have reported the effect sizes as less than one third a SD [52]. Because of its limited efficacy, CBT was not included in the MTA treatment protocols.

Social skills training

SST in youth who have ADHD similarly is limited in efficacy; results are discouraging [54], [55], [56], [57]. For

Summary and future directions

ADHD is conceptualized now as a largely chronic disorder for most but not all children, similar in some respects to chronic medical disorders, such as diabetes or phenylketonuria. Although others have reported less promising results for psychosocial interventions in stimulant-responsive children [66], [67], the MTA study documents that for ADHD symptoms and associated problems, a combined and intensive treatment protocol likely is most efficacious. Psychosocial interventions that seem most

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    • Differential impact of a multimodal versus pharmacological therapy on the core symptoms of attention deficit/hyperactivity disorder in childhood

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      Along this vein, some studies have found that the dose of medication can be reduced when prescribed in combination with psychosocial interventions whilst obtaining the same results. Furthermore, a reduction of the possible side effects of long-term medication is also observed (Antshel & Barkley, 2008; Pelham, Burrows, Gnagy, & Fabiano, 2005; So, Leung, & Hung, 2008; Van der Oord, Prins, Oosterlaan, & Emmelkamp, 2012). In conclusion, the three interventions that have shown efficacy are pharmacological, psychosocial and combined.

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    Dr. Barkley is a consultant to and speaker for Eli Lilly Co., Shire, McNeil, Janssen-Ortho, and Novartis and receives royalties from Guilford Publications, Compact Clinicals, J & K Seminars, Continuing Education Online, and New England Educational Institute.

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