Psychosocial and combined treatments for ADHD

Attention deficit/hyperactivity disorder (ADHD) is the most common mental health disorder of childhood and results in serious impairment across a variety of domains. The only empirically validated treatments for ADHD include psychostimulant medication, behavioral treatment, and their combination. This article reviews studies of behavioral treatments for ADHD, including clinical behavioral interventions (parent training, school interventions), contingency management techniques, and intensive treatments. Behavioral treatments are shown to be effective in improving the behavior and academic performance of children with ADHD. In addition, studies of combined behavioral and pharmacological treatments for ADHD are reviewed. Limitations of each single treatment (behavioral, pharmacological) alone are described in the context of the efficacy of combining modalities. Finally, directions for future study are discussed. MRDD Research Reviews 1999;5:225–236. ©1999 Wiley-Liss, Inc.

[1]  J. Coie,et al.  Predicting early adolescent disorder from childhood aggression and peer rejection. , 1992, Journal of consulting and clinical psychology.

[2]  J. Weisz,et al.  Effects of psychotherapy with children and adolescents revisited: a meta-analysis of treatment outcome studies. , 1995, Psychological bulletin.

[3]  R. Barkley.  Taking Charge of ADHD: The Complete, Authoritative Guide for Parents , 2000 .

[4]  J. L. Walker,et al.  Effects of continuous and partial reinforcement and methylphenidate on learning in children with attention deficit disorder. , 1986, Journal of abnormal psychology.

[5]  N. Ialongo,et al.  The effects of a multimodal intervention with attention-deficit hyperactivity disorder children: a 9-month follow-up. , 1993, Journal of the American Academy of Child and Adolescent Psychiatry.

[6]  H. Abikoff,et al.  Cognitive training in academically deficient ADDH boys receiving stimulant medication , 1988, Journal of abnormal child psychology.

[7]  S. Johnson,et al.  Empirically supported psychosocial interventions for children: an overview. , 1998, Journal of clinical child psychology.

[8]  S. Hinshaw.  Stimulant Medication and the Treatment of Aggression in Children With Attentional Deficits , 1991 .

[9]  R. Barkley,et al.  A comparison of three family therapy programs for treating family conflicts in adolescents with attention-deficit hyperactivity disorder. , 1992, Journal of consulting and clinical psychology.

[10]  M. Dulcan,et al.  ADHD Children's Responses to Stimulant Medication and Two Intensities of a Behavioral Intervention , 1992, Behavior modification.

[11]  J E Lochman.  Cognitive-behavioral intervention with aggressive boys: three-year follow-up and preventive effects. , 1992, Journal of consulting and clinical psychology.

[12]  W. Pelham,et al.  Behavior therapy and withdrawal of stimulant medication in hyperactive children. , 1978, Pediatrics.

[13]  G. Patterson,et al.  Parents and Adolescents Living Together, Part 2: Family Problem Solving , 1989 .

[14]  G. Wilson.  Manual-based treatments: the clinical application of research findings. , 1996, Behaviour research and therapy.

[15]  S. O'leary,et al.  Effects of reprimands and praise on appropriate behavior in the classroom , 1987, Journal of abnormal child psychology.

[16]  G. DuPaul,et al.  Parent training for attention-deficit hyperactivity disorder: Its impact on parent functioning , 1993, Journal of abnormal child psychology.

[17]  G. Patterson.  Families : Applications of Social Learning to Family Life , 1975 .

[18]  S. Eyberg,et al.  Effective psychosocial treatments of conduct-disordered children and adolescents: 29 years, 82 studies, and 5,272 kids. , 1998, Journal of clinical child psychology.

[19]  G. August,et al.  Effects of a school-based cognitive-behavioral intervention for ADHD children , 1991, Journal of abnormal child psychology.

[20]  M. Ironsmith,et al.  Generalization and maintenance of appropriate behavior through self-control. , 1975, Journal of consulting and clinical psychology.

[21]  K. O’leary,et al.  The Effects of Loud and Soft Reprimands on the Behavior of Disruptive Students , 1970, Exceptional children.

[22]  L. Rosén,et al.  The efficacy of an all-positive approach to classroom management. , 1985, Journal of applied behavior analysis.

[23]  S. O'leary,et al.  The efficacy of all-positive management as a function of the prior use of negative consequences. , 1987, Journal of applied behavior analysis.

[24]  G. Patterson,et al.  Coercive Family Process , 1982 .

[25]  W. Pelham,et al.  Intensive treatment: A summer treatment program for children with ADHD. , 1996 .

[26]  J. Parker,et al.  Peer relations and later personal adjustment: are low-accepted children at risk? , 1987, Psychological bulletin.

[27]  L. Pfiffner,et al.  Social skills training with parent generalization: treatment effects for children with attention deficit disorder. , 1997, Journal of consulting and clinical psychology.

[28]  R. Schain,et al.  A four-year follow-up study of the effects of methylphenidate on the behavior and academic achievement of hyperactive children , 1981 .

[29]  A. Kazdin.  Problem solving and parent management in treating aggressive and antisocial behavior. , 1996 .

[30]  K. O’leary,et al.  Behavior Modification of an Adjustment Class: A Token Reinforcement Program , 1967, Exceptional children.

[31]  R. Barkley.  Defiant Children: Parent-teacher Assignments , 1987 .

[32]  W. Sanderson,et al.  A Comparison of the Effects of Continuous and Intermittent Response Cost and Reprimands in the Classroom , 1985 .

[33]  W. Pelham,et al.  Single and combined effects of methylphenidate and behavior therapy on the classroom performance of children with attention-deficit hyperactivity disorder , 1992, Journal of abnormal child psychology.

[34]  G. Patterson.  Interventions for boys with conduct problems: multiple settings, treatments, and criteria. , 1974, Journal of consulting and clinical psychology.

[35]  W. Pelham,et al.  Separate and combined effects of methylphenidate and behavior modification on boys with attention deficit-hyperactivity disorder in the classroom. , 1993, Journal of consulting and clinical psychology.

[36]  W. Pelham,et al.  Behavioral Treatment of Hyperkinetic Children , 1976, Clinical pediatrics.

[37]  H. Abikoff.  Cognitive Training in ADHD Children: Less to It Than Meets the Eye , 1991, Journal of learning disabilities.

[38]  J S Bailey,et al.  Ritalin vs. response cost in the control of hyperactive children: a within-subject comparison. , 1982, Journal of applied behavior analysis.

[39]  J. Weisz,et al.  Identifying and developing empirically supported child and adolescent treatments. , 1998, Journal of consulting and clinical psychology.

[40]  P. Kendall,et al.  Cognitive-behavioral interventions , 1994 .

[41]  N. Ialongo,et al.  Behavorial Parent Training and Cognitive-Behavioral Self-Control Therapy With ADD-H Children: Comparative and Combined Effects , 1987 .

[42]  Gloria E. Miller,et al.  Enhancement of social learning family interventions for childhood conduct disorder. , 1990, Psychological bulletin.

[43]  John E. Lochman,et al.  Anger coping intervention for aggressive children: Conceptual models and outcome effects. , 1993 .

[44]  W. Pelham,et al.  Empirically supported psychosocial treatments for attention deficit hyperactivity disorder. , 1998, Journal of clinical child psychology.

[45]  H. Abikoff.  An Evaluation of Cognitive Behavior Therapy for Hyperactive Children , 1987 .

[46]  N. Ialongo,et al.  Additive Effects of Behavioral Parent Training and Self-Control Therapy With Attention Deficit Hyperactivity Disordered Children , 1990 .

[47]  J. Swanson,et al.  Stimulant Medications and the Treatment of Children with ADHD , 1995 .

[48]  P. McGrath,et al.  The effects of parent training on parenting stress and sense of competence. , 1992 .

[49]  M. Fischer.  Parenting Stress and the Child With Attention Deficit Hyperactivity Disorder , 1990 .

[50]  C. Johnston,et al.  Determinants of Parenting Stress: Illustrations from Families of Hyperactive Children and Families of Physically Abused Children , 1990 .

[51]  W. Pelham,et al.  Behavioral Intervention in Attention-Deficit/Hyperactivity Disorder , 1999 .

[52]  H. Abikoff,et al.  Behavior therapy and methylphenidate in the treatment of children with ADHD , 1997 .

[53]  W. Pelham,et al.  Behavioral and stimulant treatment of hyperactive children: a therapy study with methylphenidate probes in a within-subject design. , 1980, Journal of applied behavior analysis.

[54]  R. Wahler.  The insular mother: her problems in parent-child treatment. , 1980, Journal of applied behavior analysis.

[55]  P. McGrath,et al.  Outcome of parent-mediated treatment of preschoolers with attention deficit disorder with hyperactivity. , 1989, Journal of consulting and clinical psychology.

[56]  L. Rosén,et al.  The importance of prudent negative consequences for maintaining the appropriate behavior of hyperactive students , 1984, Journal of abnormal child psychology.

[57]  W. Pelham,et al.  Peer relationships in hyperactive children: Description and treatment. , 1982 .

[58]  Maureen A. Sullivan,et al.  Maintenance following reward and cost token programs , 1990 .

[59]  L. Rosén,et al.  Reducing off-task behavior in the classroom: A comparison of encouragement and reprimands , 1987, Journal of abnormal child psychology.

[60]  H. Kraemer,et al.  National Institute of Mental Health Collaborative Multimodal Treatment Study of Children with ADHD (the MTA). Design challenges and choices. , 1997, Archives of general psychiatry.

[61]  R. Milich,et al.  Socialization and peer relations in hyperactive children , 1982 .

[62]  M. E. Wynne,et al.  Compliance with pharmacological and cognitive treatments for attention deficit disorder. , 1987, Journal of the American Academy of Child and Adolescent Psychiatry.

[63]  P. Jensen,et al.  Introduction to the special section: efficacy and effectiveness in studies of child and adolescent psychotherapy. , 1995, Journal of consulting and clinical psychology.

[64]  S. O'leary,et al.  The relative impact of long and short reprimands on children's off-task behavior in the classroom , 1988 .

[65]  R. Barkley,et al.  Behavioral Treatment of Attention-Deficit Hyperactivity Disorder in the Classroom , 1992, Behavior modification.

[66]  J. Weisz,et al.  Relative effectiveness of behavioral versus nonbehavioral child psychotherapy. , 1995, Journal of consulting and clinical psychology.

[67]  M. Kelley,et al.  Promoting Academic Performance in Inattentive Children , 1995, Behavior modification.

[68]  J. Weisz,et al.  Bridging the gap between laboratory and clinic in child and adolescent psychotherapy. , 1995, Journal of consulting and clinical psychology.

[69]  J. Swanson,et al.  NIMH collaborative multisite multimodal treatment study of children with ADHD: I. Background and rationale. , 1995, Journal of the American Academy of Child and Adolescent Psychiatry.

[70]  A. Schell,et al.  A prospective study of delinquency in 110 adolescent boys with attention deficit disorder and 88 normal adolescent boys. , 1982, The American journal of psychiatry.

[71]  H. Abikoff,et al.  Does behavior therapy normalize the classroom behavior of hyperactive children? , 1984, Archives of general psychiatry.

[72]  Neil S. Jacobson,et al.  Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. , 1991 .

[73]  R. Barkley,et al.  Developmental changes in the mother-child interactions of hyperactive boys: effects of two dose levels of Ritalin. , 1985, Journal of child psychology and psychiatry, and allied disciplines.

[74]  R. McMahon,et al.  Helping the noncompliant child : a clinician's guide to parent training , 1981 .

[75]  S. Hinshaw,et al.  Covert antisocial behavior in boys with attention-deficit hyperactivity disorder: external validation and effects of methylphenidate. , 1992, Journal of consulting and clinical psychology.

[76]  W. Pelham,et al.  Effects of deviant child behavior on parental alcohol consumption. Stress-induced drinking in parents of ADHD children. , 1998, The American journal on addictions.

[77]  D. Meichenbaum,et al.  Training impulsive children to talk to themselves: a means of developing self-control. , 1971, Journal of abnormal psychology.

[78]  M. Rapport,et al.  The effects of a response cost treatment tactic on hyperactive children , 1980 .

[79]  W. Pelham,et al.  An Examination of the "Dosage" Effects of Both Behavior Therapy and Methylphenidate on the Classroom Performance of Two ADHD Children , 1992, Behavior modification.