OBJECTIVE:Daily report cards (DRC) are an effective approach for improving behavior in children with attention-deficit/hyperactivity disorder (ADHD). Recently, they have been used to address behavioral goals that are commonly documented in individualized education programs for children with ADHD receiving special education supports. METHOD:The present study evaluated a DRC, established and supported by research study consultants, based on special education (i.e., individualized education program [IEP]) goals and objectives. The sample included 213 students (grades kindergarten to seventh) with ADHD enrolled in a randomized, controlled trial that compared the DRC with school as usual. RESULTS:Results indicated that children with ADHD who had the DRC intervention significantly reduced the frequency of classroom rule violations, and teachers rated reductions in ADHD symptoms and in functional impairment. There were no significant differences between groups for the teacher ratings of academic performance or improvement in meeting special education goals. IEP quality (i.e., alignment between identified needs and goals) was a significant moderator of outcomes, with children who had lower quality IEPs being better supported by the DRC intervention. CONCLUSIONS:Overall, the DRC appears to be a viable approach for positively supporting children with ADHD who are receiving special education supports in schools, particularly for improving behavior in the classroom. (PsycInfo Database Record (c) 2025 APA, all rights reserved).
The COVID-19 pandemic led many in-office therapeutic programs to pivot to virtual programming without empirical data supporting the acceptability and efficacy of the remote-delivered adaptations. These adaptations were essential for continuing care and addressing surging youth psychological problems at the time. To serve adolescents with comorbid psychiatric disorders and associated problems (e.g., emotion dysregulation), we adapted and implemented virtual and hybrid formats of a dialectical behavior therapy for adolescents (DBT-A; Rathus & Miller, 2015) program within a public university training clinic, such as separating the traditional multifamily group into adolescent-only and caregiver-only groups. Building on qualitative reports on virtual DBT-A, we explored preliminary service user and clinical outcomes of the virtual and hybrid DBT-A adolescent skills group component in a longitudinal retrospective cohort study for teenagers treated during the first 2 years of the pandemic (N = 21; 81% Hispanic/Latinx; 100% White). Aim 1 described service user outcomes (e.g., retention, group cohesion, client satisfaction) in the remote-delivered skills groups. Most youth completed treatment. Caregiver satisfaction was high, whereas adolescent satisfaction was mild. Aim 2 explored preliminary clinical outcomes of remote-delivered skills group adaptations. Overall anxiety, panic, and two emotion regulation facets (i.e., emotional awareness; goal pursuit when upset) significantly reduced across treatment. There were no significant reductions in depression. No suicide attempts or suicides occurred during the program. Further work is needed to clarify the efficacy of telehealth formats of DBT-A skills groups in larger, more racially diverse samples and to identify which adolescents are most appropriate for virtual and/or hybrid DBT-A.
Demographic data from nearly 50 years of treatment research for children and adolescents with attention-deficit/hyperactivity disorder (ADHD) are synthesized. Comprehensive search identified ADHD treatment studies that were between-group designs, included a psychosocial, evidence-based treatment, and were conducted in the United States. One hundred and twenty-six studies that included 10,604 youth were examined. Reporting of demographics varied with 48% of studies (k = 61) reporting ethnicity, 73% (k = 92) reporting race, 80% (k = 101) reporting age (M age = 8.81, SD = 2.82), and 88% (k = 111) reporting gender. Most participants identified as non-Hispanic/Latine (15.99% Hispanic/Latine), White (62.54%), and boys (74.39%; 24.47% girls). Since the 1970s, zero youth in ADHD treatment studies identified as Middle Eastern/North African, 0.1% were American Indian/Alaskan Native or Native Hawaiian Pacific Islander, 1.77% were Asian, 15.10% were Black, and 3.14% were Multiracial. Based on publication year, the proportions of girls, racially minoritized youth, and Hispanic/Latine youth included in ADHD treatment research have increased over time. Girls, non-binary and non-cisgender youth, young children, adolescents, Hispanic/Latine youth, and youth from all racial groups other than White are underrepresented in ADHD treatment research. Research gaps are discussed, and recommendations for comprehensive demographic reporting in child and adolescent psychological research are provided.
Attention-deficit/hyperactivity disorder (ADHD) is a chronic neurodevelopmental disorder defined by pervasive symptoms of inattention, hyperactivity, and impulsivity. Furthermore, children with ADHD show marked deficits in executive functioning (EF) such as attention, effortful control, and behavior, and are more likely to have poor self-regulatory skills. Current evidence-based interventions for children with ADHD include behavioral treatment (BT), psychopharmacological treatment, and their combination. Many other interventions are often used conjunction with or in lieu of evidence-based treatments for ADHD. One such example is the use of mindfulness-based interventions which have been shown to improve attention, reduce maladaptive behaviors, and increase self-regulatory abilities among children in general education settings. The current study is the first to evaluate the effect of mindfulness intervention in combination with BT on behavior, task-based executive functioning (EF), and mindful awareness in elementary-aged children with ADHD (N = 58). The study took place in a controlled analogue summer program setting (STP) in which children were randomized to receive either the mindfulness intervention in conjunction with BT or to a BT active control condition. Children completed a variety of EF cognitive tasks at baseline and post-treatment. Child behavioral responses were measured as teacher and staff-recorded frequencies of observed behavior. In addition, parent-reported and child self-reported measures on mindful awareness were collected. Overall, there were no beneficial incremental effects of mindfulness when used in combination with intensive BT with regard to observed child behavior, attention and inhibitory control, or mindful awareness.
TDs can substantially impact daily child functioning across social, familial, and academic domains leading to a significant public health impact of TDs. Additionally, an overwhelming majority of children with a TD have at least one co-occurring disorder. In particular, over 60% of children with a TD also meet criteria for ADHD. Comprehensive Behavioral Intervention for Tics (CBIT) is a first-line treatment for youth with TDs. It has been shown to be effective in reducing the frequency, duration, and severity of tics in children and adolescents. Nonetheless, access to trained CBIT providers remains limited, and common comorbid conditions are not addressed in the standard CBIT. Thus, there is a need for interventions that can simultaneously increase CBIT access and incorporate treatment strategies for TDs and common comorbidities. To address the critical need for increasing access to CBIT and simultaneously treating common comorbidities, the current case study presents and evaluates a two-week intensive approach to simultaneously address tic and ADHD symptoms in an 11-year-old male. The patient’s parents reported significant improvements in tic and ADHD symptoms following the end of treatment, which were maintained throughout two follow-up booster sessions Clinical implications and future directions to modify and improve the proposed treatment are discussed.
OBJECTIVE:Evaluate whether stimulant medication improves acquisition of academic material in children with attention deficit hyperactivity disorder (ADHD) receiving small-group, content-area instruction in a classroom setting. METHOD:Participants were 173 children between the ages of 7 and 12 years old (77% male, 86% Hispanic) who met Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for ADHD and were participating in a therapeutic summer camp. The design was a triple-masked, within-subject, AB/BA crossover trial. Children completed two consecutive phases of daily, 25-min instruction in both (a) subject-area content (science, social studies) and (b) vocabulary. Each phase was a standard instructional unit lasting for 3 weeks. Teachers and aides taught the material to small groups in a summer classroom setting. Each child was randomized to be medicated with daily osmotic-release oral system methylphenidate (OROS-MPH) during either the first or second of the instructional phases, receiving placebo during the other. RESULTS:Medication had large, salutary, statistically significant effects on children's academic seatwork productivity and classroom behavior on every single day of the instructional period. However, there was no detectable effect of medication on learning the material taught during instruction: Children learned the same amount of subject-area and vocabulary content whether they were taking OROS-MPH or placebo during the instructional period. CONCLUSIONS:Acute effects of OROS-MPH on daily academic seatwork productivity and classroom behavior did not translate into improved learning of new academic material taught via small-group, evidence-based instruction. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
There is nationwide concern that the abrupt transition to remote instruction in response to the Coronavirus disease (COVID-19) pandemic will have detrimental impacts on student learning. As a uniquely vulnerable group within schools, students with disabilities like attention deficit hyperactivity disorder (ADHD) may be at enhanced risk for these negative outcomes. The present study features a unique examination of achievement scores, collected for two Cohorts (2018-2019, 2019-2020) of students with ADHD. By collecting achievement data in both the fall and spring for each Cohort, direct comparisons between changes in achievement for Cohort One (2018-2019) can be made to those in Cohort Two (2019-2020). Analyses summarized remote learning practices, within-group changes in achievement data over time for Cohort Two, and between-group differences in score changes over time for Cohorts One and Two. Teachers used a variety of remote learning approaches, including videoconferencing and independently completed assignments. Student achievement scores in both Cohorts significantly improved from fall to spring. No significant differences were found in score growth between the Cohorts, indicating that the move to remote instruction did not have a differentially negative impact on Cohort Two. Implications focus on the promise of well-delivered remote instruction, and the need to examine individual factors (such as poor internet access) that may exacerbate the risk of students with disabilities receiving remote instruction. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Interventions for attention-deficit/hyperactivity disorder (ADHD) include positive behavior supports (e.g., parent training, school-based contingency management, behavioral peer interventions), training interventions (e.g., organizational skills training, social skills training, etc.), and other interventions (e.g., academic accommodations/modifications, self-monitoring). There is a need to conduct a comprehensive meta-analysis of psychosocial treatments for ADHD given discrepancies between meta-analyses. The present meta-analysis reports the results of between-group studies that compared a psychosocial treatment to a control condition from 1968 to 2016. In total, 226 studies were identified that met inclusion criteria. Results of the meta-analysis were organized by treatment type, rater, and domain of outcome assessed. Results indicated considerable variability across these parameters, with the strongest effects for proximal outcomes of behavioral parent training (improvements in parenting behaviors yielded a standardized mean difference of 0.70) and improvements in child behavior following implementation of behavioral school intervention (standardized mean difference of 0.66 and 0.72 for teacher ratings of ADHD symptoms and impairment, respectively). Other interventions were not extensively studied as stand-alone approaches. Results are discussed in light of current support for the use of psychosocial interventions for individuals with ADHD.
OBJECTIVETo inform the scope of future systematic reviews, meta-analyses, and treatment outcome studies, this review aims to describe the extent of the evidence for psychosocial interventions for children and adolescents with attention-deficit/hyperactivity disorder, with particular attention to specific types of interventions, targets of outcome assessment, and risk of bias.METHODA comprehensive search of relevant databases (i.e., Medline, PsychInfo, Education Resources Information Center, and ProQuest Dissertation Database) was conducted. Detailed information related to treatment type, outcome assessment, study design, and risk of bias was extracted by trained coders. Evidence and gap maps were created to summarize evidence within types of treatments and targets of outcome assessment. Indicators of risk of bias were assessed for selected combinations of treatments and outcome assessment.RESULTSWe identified 185 eligible individual studies and 3817 effect sizes. Behavioral parent training and cognitive training (COG) were the most commonly studied stand-alone interventions. Treatment versus control comparisons for stand-alone interventions (s = 70) were less common than for complex interventions involving combinations of psychosocial interventions (s = 100). Combinations of behavioral and child training (e.g., COG, organizational training) interventions were the most frequently studied.CONCLUSIONThere is a considerable variability within this literature regarding combinations of treatments across outcome assessment targets. To address gaps in existing evidence, more primary studies assessing direct comparisons of isolated and combined treatment effects of specific types of psychosocial treatments relative to control and other treatments are needed. Future meta-analyses should take into account the complexity and breadth of available evidence.
Current evidence-based, school-based interventions for children with attention deficit hyperactivity disorder (ADHD) include academic intervention, behavioral classroom management, and psychopharmacological intervention. However, some approaches that are commonly used have not been studied in controlled evaluations. The current study is the first rigorous evaluation of the effect of occupational therapy (OT) weighted vests and stability balls on classroom behavior and academic productivity in elementary-age children with ADHD (N = 64). The effect of psychostimulant medication and its combination with each of the OT interventions on classroom outcomes was also examined. The study consisted of a 2 (medication: methylphenidate, placebo) x 3 (OT intervention: stability ball, weighted vest, control) within-subjects design and was conducted over a 6-week period in a weekday, 60-min summer classroom. OT intervention was randomized daily within a medication crossover design. Overall, results indicated that medication but not weighted vest nor stability ball interventions resulted in improvement in two key areas of functioning in school settings: following classroom rules and academic productivity.