Child Psychology

Child Psychology And Attention Deficit

Last Updated Aug 20, 2008 03:28 AM

Studies of Childhood Attention-Deficit/Hyperactivity Disorder

A review of the literature was conducted to identify empirical, peer-reviewed studies of psychosocial and pharmacological treatments of children with attention-deficit/hyperactivity disorder (ADHD). Due to the disproportionately large number of treatment outcome studies of childhood ADHD relative to other childhood mental health disorders, a more selective selection process was used to locate studies appropriate for this review. Systematic computerized literature searches were conducted on PsycINFO and Medline databases, with keywords "attention deficit disorder" (PsycINFO) and "attention deficit disorder with hyperactivity" (Medline). The large number of references that resulted from the keyword search was reduced to include only those studies that: (1) were identified in the electronic databases by one or more of the following study descriptors: treatment outcome study, controlled clinical trial, or randomized controlled trial; (2) included subjects between the ages of 6 and 12 as the primary treatment target population, although studies that included adolescents as well were not excluded; (3) were published between 1985 and 1999; and (4) were written in the English language. Reference lists from review articles and book chapters were not included in the search. This search strategy yielded 132 empirical peer-reviewed studies that focused on the treatment of children with ADHD. Of these 132 studies, 54 studies were excluded for the following reasons: ADHD was a secondary rather than a primary diagnosis (n = 12); the study focus was other than treatment outcome (e.g., predictors of treatment adherence, profile of medication side effects; n = 24); and finally, subjects were not randomly assigned to treatment conditions (n = 18). The remaining 78 studies were reduced further by excluding pharmacological studies in which the sample size was less than 30 children (n = 47). The "greater than 30" sample size criterion was not applied to psychosocial or adjunctive treatments due to the limited number of these studies. This process identified 31 peer-reviewed treatment outcome studies of children with ADHD. These 31 studies are presented and described in table 1. A reference list of the excluded small n psychopharmacological studies is included in the reference section.

Attention-deficit/hyperactivity disorder is perhaps the most researched disorder in child mental health, with pharmacological interventions, psychosocial interventions, and adjunctive or multimodal interventions widely investigated.

Pharmacological treatments for ADHD have been well documented. Psychostimulant medications, including methylphenidate (Ritalin), dextroamphetamine (Dexedrine and Adderal®), and pemoline (Cylert) have been found to be quite effective short-term treatments for symptoms of ADHD. Psychostimulant medications have been shown to have their greatest effect on core symptoms (e.g., hyperactivity, impulsivity, and inattention) and associated features (e.g., defiance, aggression, and oppositionality) of ADHD. Small treatment effects have been reported for learning, school achievement, and cognitive tasks. Side effects of stimulant medications are a common concern for children and parents, but findings indicate that most side effects are mild, decrease over time, and are dose-dependent.

Behavioral training for parents and teachers and classroom contingency management are the primary psychosocial treatments investigated with children with ADHD. Individual psychosocial treatments, including cognitive behavior therapy, cognitive training, and social skills training have been less efficacious. While psychosocial treatments do not appear to achieve improvements as substantial as those found with stimulant medication, they have been found useful in changing parenting and teaching practices.

Adjunctive interventions are treatments that include both pharmacological and psychosocial modalities across multiple settings. Studies assessing the combined impact of cognitive training and stimulant medication have found little incremental benefit over medication alone. The most recent and largest adjunctive study to date, the Multimodal Treatment Study of Children with ADHD (MTA) has shown that combined treatment was not superior to well-delivered and well-monitored psychostimulant medication at reducing the core symptoms of ADHD. However, combined treatment outcomes were achieved with lower medication doses. Combined treatment was also superior at reducing associated features of ADHD, including defiance, aggression, oppositionality, internalizing symptoms, and parent-child relationships.


References
Studies of Childhood Attention-Deficit/Hyperactivity Disorder

Abikoff, H., Ganeles, D., Reiter, G., Blum, C., Foley, C., & Klein, R. (1988). Cognitive training in academically deficient ADDH boys receiving stimulant medication. Journal of Abnormal Child Psychology, 16, 411-432.

Abikoff, H., & Gittelman, R. (1985). Hyperactive children treated with stimulants: Is cognitive training a useful adjunct? Archives of General Psychiatry, 42, 953-961.

Biederman, J., Baldessarini, R. J., Wright, V., Knee, D., & Harmatz, J. S. (1989). A double-blind placebo controlled study of desipramine in the treatment of ADD: I. Efficacy. Journal of the American Academy of Child and Adolescent Psychiatry, 28, 777-784.

Brown, R. T., Borden, K. A., Wynne, M. E., Schleser, R., & Clingerman, S. (1986). Methylphenidate and cognitive therapy with ADD children: A methodological reconsideration. Journal of Abnormal Child Psychology, 14, 481-497.

Brown, R. T., Wynne, M. A., Borden, K. A., Clingerman, S. R., Geniesse, R., & Spunt, A. L. (1986). Methylphenidate and cognitive therapy in children with attention deficit disorder: A double-blind trial. Journal of Developmental and Behavioral Pediatrics, 7, 163-170.

Buitelaar, J. K., van der Gaag, R. J., Swaab-Barneveld, H., & Kuiper, M. (1996). Pindolol and methylphenidate in children with attention-deficit hyperactivity disorder. Clinical efficacy and side-effects. Journal of Child Psychology and Psychiatry and Allied Disciplines, 37, 587-595.

Buitelaar, J. K., van der Gaag, R. J., Swaab-Barneveld, H., & Kuiper, M. (1995). Prediction of clinical response to methylphenidate in children with attention-deficit hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 34, 1025-1032.

Conners, C. K., Casat, C. D., Gualtieri, C. T., Weller, E., Reader, M., Reiss, A., Weller, R. A., Khayrallah, M., & Ascher, J. (1996). Bupropion hydrochloride in attention deficit disorder with hyperactivity. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 1314-1321.

Fehlings, D. L., Roberts, W., Humphries, T., & Dawe, G. (1991). Attention deficit hyperactivity disorder: Does cognitive behavioral therapy improve home behavior? Journal of Developmental and Behavioral Pediatrics, 12, 223-228.

Gadow, K. D., Nolan, E., Sprafkin, J., & Sverd, J. (1995). School observations of children with attention-deficit hyperactivity disorder and comorbid tic disorder: Effects of methylphenidate treatment. Journal of Developmental and Behavioral Pediatrics, 16, 167-176.

Gadow, K.D., Sverd, J., Sprafkin, J., Nolan, E. E., & Ezor, S.N. (1995). Efficacy of methylphenidate for attention-deficit hyperactivity disorder in children with tic disorder. Archives of General Psychiatry, 52, 444-445.

Gadow, K. D., Sverd, J., Sprafkin, J., Nolan, E. E., & Grossman, S. (1999). Long-term methylphenidate therapy in children with comorbid attention-deficit hyperactivity disorder and chronic multiple tic disorder. Archives of General Psychiatry, 56, 330-336.

Gillberg, C., Melander, H., von Knorring, A. L., Janols, L. O., Thernlund, G., Hagglof, B., Eidevall-Wallin, L., Gustafsson, P., & Kopp, S. (1997). Long-term stimulant treatment of children with attention-deficit hyperactivity disorder symptoms: A randomized, double-blind, placebo-controlled trial. Archives of General Psychiatry, 54, 857-864.

Horn, W. F., Ialongo, N., Greenberg, G., Packard, T., & Smith-Winberry, C. (1990). Additive effects of behavioral parent training and self-control therapy with attention deficit hyperactivity disordered children. Journal of Clinical Child Psychology, 19, 98-110.

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