Cognitive behavioral therapy (CBT) may improve the home behavior of children with Attention Deficit/Hyperactivity Disorder (ADHD).

Advertisement


Advertisement
Similar documents
RESEARCH OBJECTIVE/QUESTION

CRITICALLY APPRAISED PAPER (CAP)

Advances in Psychological Treatments for Adult ADHD

Prepared by:jane Healey ( 4 th year undergraduate occupational therapy student, University of Western Sydney

Caring for Children With ADHD: A Resource Toolkit for Clinicians

Guidelines for Documentation of Attention Deficit/Hyperactivity Disorder In Adolescents and Adults

Documentation Guidelines for ADD/ADHD

Guidelines for Documentation of a A. Learning Disability

Learning Disabilities: ADHD/ADD. Dr. Wilfred Johnson September 29, 2005

ADHD in Children and Adolescents: Psychosocial Treatment. Dr Ong Say How Chief, Department of Child and Adolescent Psychiatry 30 August 2014

Attention Deficit/Hyperactivity Disorder (ADHD)

ADHD Treatment Home Management and School Accommodations Robin K. Blitz, MD. ADHD DIAGNOSTIC CLINIC Week 3

CRITICALLY APPRAISED PAPER (CAP)

Al Ahliyya Amman University Faculty of Arts Department of Psychology Course Description Special Education

Accommodations STUDENTS WITH DISABILTITES SERVICES

A Parent Management Training Program for Parents of Very Young Children with a Developmental Disability

Conners' Continuous Performance Test II (CPT II V.5)

J. Indian Assoc. Child Adolesc. Ment. Health 2015; 11(3): Case Report

Epilepsy in Children. Learning and School Performance

Clinical Practice Guidelines: Attention Deficit/Hyperactivity Disorder

AMERICAN REGISTRY OF RADIOLOGIC TECHNOLOGISTS

For more than 100 years, extremely hyperactive

CALIFORNIA STATE UNIVERSITY, SACRAMENTO

icahe Critical Appraisal Summary

Smart Isn t Everything: The Importance of Neuropsychological Evaluation for Students and Individuals on the Autism Spectrum

Guidelines for Documentation of a Learning Disability (LD) in Gallaudet University Students

Guidelines for the Clinical Research Program Test Accommodations Request Process

DEMYSTIFYING THE DEFINITIONS: Differentiating the Definitions of Learning Disability the diagnosis, the Exceptionality, and the ISA Profile in Ontario

MENTAL HEALTH ATTENTION DEFICIT/ HYPERACTIVITY DISORDER

Interdisciplinary Care in Pediatric Chronic Pain

Conners' Continuous Performance Test II (CPT II V.5)

Components of an Effective Evaluation for Autism Spectrum Disorder

CBT for PANS/PANDAS. Eric A. Storch, Ph.D. All Children s Hospital Guild Endowed Chair and Professor. University of South Florida

ADD and/or ADHD Verification Form

CRITICALLY APPRAISED PAPER (CAP)

Executive Summary Relationship of Student Outcomes to School-Based Physical Therapy Service PT COUNTS

Behavior Rating Inventory of Executive Function BRIEF. Interpretive Report. Developed by. Peter K. Isquith, PhD, Gerard A. Gioia, PhD, and PAR Staff

Early Childhood Measurement and Evaluation Tool Review

ADHD: Classroom Interventions BY STEPHEN E. BROCK, PHD, NCSP; BETHANY GROVE, EDS; & MELANIE SEARLS, EDS, California State University, Sacramento

Schmoga: Yoga-based self-regulation programming for children with Autism Spectrum Disorder in the school environment Kara Larson, OTD/S

Autism Spectrum Disorders: An Awareness Level Training for Educators

Examinee Information. Assessment Information

Management of depression in young people

ADHD AND ANXIETY AND DEPRESSION AN OVERVIEW

The Other Attention Disorder: Sluggish Cognitive Tempo vs. ADHD

DSM-5. Presented by CCESC School Psychologist Interns: Kayla Dodson, M.Ed. Ellen Doll, M.S. Rich Marsicano, Ph.D. Elaine Wahl, Ph.D.

The Plugged-In Parent s Guide to ADHD. Tips, Strategies, Apps, and Activities for Helping Kids with ADHD

Classroom Management and Teaching Strategies. Attention Deficit Hyperactivity Disorder. Allison Gehrling ABSTRACT. Law & Disorder

Summary of IVA-QS Research Studies

Diagnosis and management of ADHD in children, young people and adults

ADHD and Treatment HYPERACTIVITY AND INATTENTION (ADHD) Meghan Miller, MA, Stephen P. Hinshaw, PhD University of California, Berkeley, USA

Conners' Adult ADHD Rating Scales Observer Report: Long Version (CAARS O:L)

The core symptoms of ADHD, as the name implies, are inattentiveness, hyperactivity and impulsivity. These are excessive and long-term and

College of Education. Rehabilitation Counseling

please type in your questions

Attention-Deficit/Hyperactivity Disorder and Aggression in Jamaican Students

Understanding the SSI Disability Determination Process for Children with Speech Disorders and Language Disorders

A questionnaire and psychological tests for depression and self-esteem were administered as baseline screening (pre-test) after

Using Dialectical Behavioural Therapy with Eating Disorders. Dr Caroline Reynolds Consultant Psychiatrist Richardson Eating Disorder Service

Guidelines for Documentation of Occupational Therapy

Behavioural interventions for Attention Deficit Hyperactivity Disorder

Regence. Section: Mental Health Last Reviewed Date: January Policy No: 18 Effective Date: March 1, 2013

ADHD A Focus on the Brain

NICE Pathways bring together all NICE guidance, quality standards and other NICE information on a specific topic.

Self-Monitoring. Applied as a Classroom support. Deb Childs, Ph.D. Tier 2 Consultant

Language, learning, the links

Melanie Atmadja, Valerie Gribben, Noga Ravid Developmental and Behavioral Pediatrics April 23, 2013

ADHDInitiative. The Vermont A MULTIDISCIPLINARY APPROACH TO ADHD FOR FAMILIES/CAREGIVERS, EDUCATIONAL & HEALTH PROFESSIONALS

Disability and Education in New Zealand in 2006

Practice Test for Special Education EC-12

Music therapy as a treatment for schizophrenia

Interpretive Report of WMS IV Testing

UCLA-NPI/VA PG-2 Child & Adolescent Psychiatry Course Week 3:Attention Deficit Hyperactivity Disorder

REHABILITATION OF EXECUTIVE DISORDERS

Copyright 2006: Page 1 of 5

The WISC III Freedom From Distractibility Factor: Its Utility in Identifying Children With Attention Deficit Hyperactivity Disorder

Neuropsychological Services at CARD

Marc J. Tassé, PhD Nisonger Center UCEDD The Ohio State University

Cambridgeshire Community Services NHS Trust: delivering excellence in children and young people s health services

Critical Review: Does dialogic book reading improve overall language skills in preschoolers?

Comprehensive Special Education Plan. Programs and Services for Students with Disabilities

Critical Review: Effectiveness of delivering speech and language services via telehealth

MCPS Special Education Parent Summit

Special Education Program Descriptions

Early Childhood Measurement and Evaluation Tool Review

Policy for Documentation

AUTISM SPECTRUM DISORDERS

Presenter Pauline Watson Campbell MSc OT Pediatric Occupational Therapist (Behavioural and Developmental specialty)

Adolescent health literacy and development of high-risk behaviors

MRC Social Genetic and Developmental Psychiatry

Student, please sign in the box below giving our health-care provider authorization to release information to OSA.

the Pediatric Group, LLP

The Prevalence of ADHD and LD in Children with Hearing Loss

General Therapies for Individuals with Autism

WHAT IS COGNITIVE INTERVENTION/REHABILITATION?

Standards of Practice for Occupational Therapy

Interpreting Psychological Reports. Stephanie Verlinden, PsyD May 4, 2015

School-based Interventions for Students with ADHD. George J. DuPaul, Ph.D. School Psychology Program Lehigh University Bethlehem PA

AP PSYCHOLOGY CASE STUDY

Test Content Outline Effective Date: October 25, Psychiatric and Mental Health Nursing Board Certification Examination

Advertisement
Transcription:

ADHD 4 Cognitive behavioral therapy (CBT) may improve the home behavior of children with Attention Deficit/Hyperactivity Disorder (ADHD). CITATION: Fehlings, D. L., Roberts, W., Humphries, T., Dawe, G. (1991). Attention deficit hyperactivity disorder: Does cognitive behavioral therapy improve home behavior? Journal of Developmental & Behavioral Pediatrics, 12(4):223-8. LEVEL OF EVIDENCE: IA1a RESEARCH OBJECTIVE/ QUESTION To determine CBT s effectiveness in improving home behavior in children with ADHD. DESIGN X RCT Single case Case control Cohort Before after Cross-sectional RCT = randomized control trial 2 groups, 2 treatments SAMPLING PROCEDURE Random Consecutive X Controlled Convenience SAMPLE N=26 M age=9.5 years Male=26 Ethnicity= Female=0 = not reported PARTICIPANT CHARACTERISTICS Inclusion criteria: Boys between ages 7 and 13 years Diagnosis of ADHD

A rating by parents of 15 or greater on the Conners 10 Item scale and 150 or greater on the Self-Control Rating Scale (SCRS) A score of 85 or greater on the Wechsler Intelligence Scale (WISV R) verbal subtests Exclusion criteria: Were on stimulant medication Diagnosed with conduct disorder MEDICAL DIAGNOSIS/CLINICAL DISORDER ADHD OT TREATMENT DIAGNOSIS N/A OUTCOMES CBT and home behavior Measures Reliability Validity 1. SCRS, a measure of impulsivity 2. Revised Behavior Problem Checklist Attention Problem subscale, a measure of inattention 3. Parent ratings of the child on the Modified Werry Weiss Activity Scale (a measure of the child's activity level in the home) 4. Revised Matching Familiar Figures Task(MFFT) a cognitive measure of impulsivity, yielding a score for latency and number of errors 5. Piers Harris Self-Concept Scale (child rating) = Not reported All outcome measures were obtained before treatment, posttreatment (4 months), and 5 months posttreatment. Outcome OT terminology Performance components: Cognitive integration and cognitive components Psychosocial skills and psychological components Outcome ICIDH-2 terminology Impairments INTERVENTION CBT Supportive therapy (control group)

Description CBT: Direct instruction in cognitive behavioral strategies that were reinforced using a token contingency reward system. Problem solving was broken into a 5-step process that included (1) defining the problem, (2) setting a goal, (3) generating workable problemsolving strategies, (4) choosing a solution, and (5) evaluating the outcome with selfreinforcement (e.g., modeling, role playing, self-instructional training, cue cards, homework assignments and behavioral techniques [contingent social reinforcement, token system, and response cost]). Families received education about ADHD and instruction in CBT. Control: Children in the control group received the same amount of exposure to the therapist and tasks and the same number of rewards, but they were not instructed in cognitive behavioral strategies. Families received education about ADHD and exposure to the behavioral therapist at the same time as did the CBT group; however, instruction in CBT was replaced with supportive listening. Who delivered Behavioral therapist Setting Clinical setting Family sessions: Home environment Frequency/Duration Twelve 60-minute individual sessions with the child and the behavioral therapist at the clinic, 2 times per week, and eight 2-hour sessions once every 2 weeks with the family in their homes Follow-up Quality control: There was follow-up for all participants, with the exception of 1 family in the supportive therapy group. RESULTS Baseline comparability of groups: There were no statistically significant differences at baseline between the groups (p < 0.05). Primary analysis: Werry Weiss Activity Scale revealed a statistically significant treatment effect favoring CBT [F(1, 68) = 4.70, p < 0.03]. Secondary analysis: Teaching ratings: The Attention Problem subscale approached significance, with the CBT group improving more than the supportive therapy group [F(1, 68) = 3.78, p < 0.0056].. Child ratings: Piers Harris showed significant treatment effect, with children in the CBT group showing greater improvement in self-esteem [F(1, 68) = 4.62, p < 0.035].

A post-hoc paired t test assessing differences in the CBT group was significant at the pretreatment posttreatment comparison [t(1, 2) = 3.24, p < 0.01] and pre-treatment 5-month posttreatment comparisons [t(1, 2) = 3.65, p < 0.01]. Cognitive measure: The matching familiar figures tasks with respect to both latency and errors did not demonstrate a treatment effect [latency F(1, 68) = 0.94, p < 0.34 error rate F(1, 68) = 0.34, p < 0.056]. Family dysfunction: 3 of the families were undergoing a divorce, and in 1 family the primary caregiver met the criteria for a major depression. With these families removed from the primary analyses, the parent rating on the SCRS now demonstrated a significant treatment effect favoring CBT [F = 6.01, p < 0.02]. CONCLUSIONS Both a statistically and clinically significant treatment effect favoring CBT was found in the parent's perception of the child's hyperactivity. Clinically, for the children receiving CBT, at posttreatment, they were rated well into the normal range of activity (a score of <38) and maintained this improvement 5 months posttreatment. In the home, hyperactivity appeared to respond to CBT more than did inattentiveness and impulsivity. This study focused on the child's behavior in the home; the presence of moderate to severe family dysfunction may influence the ability of the family to respond to therapy. A secondary analysis with dysfunctional families (2 that were in the CBT and 2 in the supportive therapy group) did not alter the results, with the exception of the parent SCRS. The SCRS demonstrated a significant treatment effect favoring CBT, suggesting that the absence of family dysfunction may increase the responsiveness to CBT. Secondary analyses revealed that teacher ratings of inattentive behavior showed a greater improvement following CBT with the result approaching significance. This finding provides some support for a generalization of the effects of CBT into an environment outside the treatment setting. In summary, this research provides supports for the use of CBT in managing children with ADHD. LIMITATIONS Some of the statistical analyses may have been inappropriate. Considering the number of tests, the effects were limited and weak. Post hoc analyses involved dropping subjects whose parents they classified as moderate to severe dysfunctional. This classification was based on whether parents were undergoing a divorce, without any other independent measure of dysfunction reported. Terminology used in this document is based on two systems of classification current at the time the evidence-based literature reviews were completed: Uniform

Terminology for Occupational Therapy Practice Third Edition (AOTA, 1994) and International Classification of Functioning, Disability and Health (ICIDH-2) (World Health Organization [WHO], 1999). More recently, the Uniform Terminology document was replaced by Occupational Therapy Practice Framework: Domain and Process (AOTA, 2002), and modifications to ICIDH-2 were finalized in the International Classification of Functioning, Disability and Health (WHO, 2001). This work is based on the evidence-based literature review completed by Erna Imperatore Blanche, PhD, OTR/L, FAOTA, and Gustavo Reinoso, OTR/L. Contributions to the evidence brief were provided by Michele Youakim, PhD. For more information about the Evidence-Based Literature Review Project, contact the Practice Department at the American Occupational Therapy Association, 301-652-6611, x 2040. Copyright 2004 American Occupational Therapy Association, Inc. All rights reserved. This material may be reproduced and distributed without prior written consent.