Untitled Behavioral Treatment for ADHD

Untitled Behavioral Treatment for ADHD

OVERVIEW

This untitled behavioral treatment is a multi-component intervention that was developed for children with ADHD. An evaluation found that combining behavioral treatment with medication management was more successful in treating ADHD and oppositional defiant disorder (ODD) symptoms than was medication management alone. However, behavioral treatment alone was not more successful than community care in treating ADHD and ODD symptoms. A follow-up study at 10 months found that children who received medication management or medication management and the behavioral intervention had fewer ADHD and ODD symptoms than those who received only the behavioral intervention or community care. However there were no differences between those who received medication management along with the behavioral intervention and those who received only medication management, or between those who received the behavioral intervention alone and those who received only community care.

DESCRIPTION OF PROGRAM

Target population: Children with ADHD

The intervention is implemented over the course of 14 months. The behavioral treatment involves parent training, child-focused treatment, and a school-based intervention. The parent training consists of 27 group sessions and eight individual sessions conducted by a therapist-consultant. The child-focused treatment is an intensive behavioral intervention administered by counselor/aides and supervised by therapist-consultants as part of a summer treatment program. It involves individualized academic skills practice and reinforcement of appropriate classroom behavior. The school-based treatment consists of 10 to 16 sessions of biweekly teacher consultation on classroom behavior management strategies, and twelve weeks of a paraprofessional aide working part-time with the child. The intervention is designed to have an impact on the outcomes of ADHD symptoms, ODD symptoms, social skills, internalizing symptoms, parent-child relations, and academic achievement.

EVALUATIONS OF PROGRAM

Study 1

Swanson, J.M., Kraemer, H.C., Hinshaw, S.P., Arnold, L.E., Conners, C.K., Abikoff, H.B., Clevenger, W., Davies, M., Elliott, G.R., Greenhill, L.L., Hechtman, L., Hoza, B., Jensen, P.S., March, J.S., Newcorn, J.H., Owens, E.B., Pelham, W.E., Schiller, E., Severe, J.B., Simpson, S., Vitiello, B., Wells, K., Wigal, T., & Wu, M. (2001). Clinical relevance of the primary findings of the MTA: Success rates based on severity of ADHD and ODD symptoms at the end of treatment. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 168-179.

Evaluated population: The sample was 579 children ages 7 to 10 with ADHD. The average age was 8.5 years. The sample was 80 percent male, 61 percent white, 20 percent African American, and 8 percent Hispanic.

Approach: Participants were randomly assigned to medication management, behavioral treatment, combined behavioral treatment and medication management, or community care (control). Medication management involved a 28-day trial to determine the best dose, and then 30-minute monthly medication maintenance sessions with a pharmacotherapist. Community care involved standard treatment by community providers. Children’s ADHD and ODD symptoms were assessed through parent and teacher ratings before treatment, at three and 9 months into treatment, and at the end of treatment. Parent and teacher ratings were averaged, and anyone with low symptom severity (not at all or just a little of the behavior) according to this calculation was considered to have had a successful treatment.

Results: The success rate for the combined treatment was higher than the success rate for medication management alone. However, the success rate for the behavioral intervention alone was no better than the success rate for community care.

Study 2

MTA Cooperative Group. (2004). National Institute of Mental Health multimodal treatment study of ADHD follow-up: 24-month outcomes of treatments strategies for attention-deficit/hyperactivity disorder. Pediatrics, 113, 754-761.

Evaluated population: 540 children, of the 579 in Study 1, who participated in the ten-month follow-up. The average age was 8.4 years, and the sample was 80 percent male, 61 percent white, 19 percent black, and 9 percent Hispanic.

Approach: See Study 1 for randomization procedure. At ten-month follow-up children were assessed on ADHD and ODD symptoms, academic achievement, negative or ineffective discipline, and social skills.

Results: Participants in the medication management and combined treatment groups had fewer ADHD and ODD symptoms compared with those in the behavioral and community care conditions. However, there were no differences in symptoms between the medication management and combined treatment groups or between the behavioral intervention and community care groups. The treatment had no impact on negative or ineffective discipline, social skills, or academic achievement.

Study 3

MTA Cooperative Group. (2004). National Institute of Mental Health multimodal treatment study of ADHD follow-up: Changes in effectiveness and growth after the end of treatment. Pediatrics, 113, 762-769.

Evaluated population: The same sample as in Study 2.

Approach: See Study 1 for randomization procedure. Assessments of ADHD symptoms at post-test and 10-month follow-up were compared.

Results: All groups experienced an increase in severity of ADHD symptoms between post-test and follow-up, but their symptom levels were still lower at follow-up than at baseline. However, there was a larger increase in ADHD symptoms for participants in the medication management condition and in the medication management plus behavioral intervention condition.

SOURCES FOR MORE INFORMATION

References

MTA Cooperative Group. (1999). A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. Archives of General Psychiatry, 56, 1073-1086.

KEYWORDS: Children (3-11), Elementary, Males and Females (Co-ed), Clinic/Provider-based, School-based, Parent or Family Component, Parent Training/Education, Skills Training, Conduct/Disruptive Disorders, Other Mental Health, Academic Achievement/Grades, Social Skills/Life Skills, Parent-Child Relationship

Program information last updated 11/4/10

		© Child Trends 2004