Interventions Flashcards

1
Q

best to worst types of research ev

A
  1. meta-analysis
  2. systematic reviews
  3. RCTs
  4. cohort studies
  5. case-control studies
  6. case reports
  7. expert opinions
  8. testimonials
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2
Q

gold standard for systematic review

A

cochrane review

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3
Q

ways to evaluate interventions

A
  • effect sizes
  • bias
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4
Q

selection bias

A
  • difference between baseline characteristics of the groups that are compared
  • avoid by randomisation
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5
Q

performance bias

A
  • difference between groups in the care that is provided
  • avoid by double-blinding
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6
Q

detection bias

A
  • diffs between groups in how outcomes are determined
  • avoid by outcome assessor blinding
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7
Q

attrition bias

A
  • diffs between groups in withdrawals from a study, either due to exclusions or attritions
  • difficult to control for
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8
Q

reporting bias

A
  • diffs between reported & reported findings
  • avoid with pre-specified outcome measures
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9
Q

exercise & ADHD

A
  • growing body of research investigating impact of diff types of exercise on ADHD
  • yoga, playground games, exergaming
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10
Q

yoga as an intervention

jensen & kenny (2004)

A
  • 8-13yo boys with ADHD
  • treatment - 20 weekly 1hr sessions of yoga
  • control - monthly 1hr sessions of cooperative games & activities
  • unclear on all types of bias
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11
Q

playground games as an intervention

hoza et al. (2014)

A
  • 4-9yos neurotypical, at risk of ADHD
  • treatment - 12 weeks of games in playground
  • control - 12 weeks of art in classroom
  • low performance and attrition bias
  • unclear on other types of bias
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12
Q

exergaming as an intervention

benzing & schmidt (2019)

A
  • 8-12yos with ADHD
  • treatment - 8 weeks of shape up (xbox kinect)
  • control - waiting list control
  • low selection and performance bias
  • unclear detection and attrition bias
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13
Q

meta-analysis of exercise interventions

sun et al. (2022)

A
  • 15 RCTs of exercise interventions of ADHD
  • used cochrane collaboration tool to establish bias
  • 1 out of 15 high quality/low risk of bias
  • some ev that physical ev can improve inattentive symptoms, EFs & motor skills in children with ADHD
  • heterogeneity in findings may in part be due to diffs in intervention duration & freq
  • very few studies were at low risk of bias. for many studies there was insufficient info provided about allocation & blinding procedures
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14
Q

medications

A
  • stimulants e.g. methylphenidate
  • non-stimulants
  • biederman & faraone (2005) - stimulant medication has a large effect size than non-stimulant medication
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15
Q

effect of medication on cognition

A
  • medication improves ADHD symptoms but does it also improve cog performance?
  • can help us to understand causal pathways in ADHD
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16
Q

tamminga et al. (2016)

medication and executive functions

A
  • meta-analysis of 50 studies of effects of MPH on response inhibition, WM & sustained attention
  • medium effect sizes for response inhibition & sustained attention
  • low effect size for WM
  • MPH does tend to improve EFs but only certain aspects
17
Q

pietrzak et al. (2006)

medication and EF

A
  • MPH modulate striatal activity & –> motor & cog processes mediated by the striatum
  • reasons for inconsistencies between studies
  • multiple phenotypes
  • variability in medication response
  • repeated assessments (practice effects)
  • limitations - low power, only gave one size dose
18
Q

coghill et al. (2007)

medication and EF

A
  • placebo-controlled, double blinded, randomised, crossover trial
  • predictions: chronic exposure to MPH will enhance performance on executive tasks
  • didnt find this - if EF difficulties contribute significantly to the clinical presentation & impairments associated with ADHD, then those study ppts exhibiting the largest cog responses to MPH would also demonstrate the greatest clinical responses
19
Q

medication and reward processing

rubia et al. (2009)

A
  • control group & ADHD under MPH or placebo completed reward continuous performance test while in MRI scanner
  • no behavioural group diffs for rewarded vs non-rewarded targets
  • but activity in brain circuits associated with reward processing was normalised by the MPH
  • similar results found using EEG - groom et al. (2010)
20
Q

castellanos et al. (2005)

medication and RT variability

A
  • ADHD group had worse RT variability than controls at baseline
  • RT variability was reduced when ppts took MPH, but not when they took a placebo
  • authors propose catecholaminergic deficiency in the ability to appropriately modulate very low-freq fluctuations in neuronal activity
21
Q

coghill et al. (2014)

medication and RT variability

A
  • meta-analysis of the effects of MPH on cog function
  • medium effect size for RT variability
  • majority of studies found a difference
22
Q

are EFs improved by MPH

A

to some extent, mixed findings

23
Q

is reward processing improved by MPH

A

brain, not beh - this is because beh gets controlled for

24
Q

is RT variability improved by MPH

25
ways that pharmacological treatments are limited: sonuga-barke et al. (2013) ## Footnote further research
* normalisation is rare * long-term effectiveness has yet to be established * adverse effects on sleep, appetite and growth common * some parents & clinicians have reservations about medication use
26
swanson et al. (2011) ## Footnote further reading
* stimulant drugs * efficacy of low oral doses of MPH and amphetamine in reducing the behavioural symptoms of the disorder as reported by parents and teachers, both for the cognitive and non-cognitive domains * stimulant medications appear to have diff effects depending on the context of administration & the type of task required * stimulants may shift engagement of attentional resources from favouring fast shifting stim with rewards to slow, changing stim that require maintained engagement * little empasis has been placed on understanding the energy requirements for the cog performance & on how the stimulant medications may affect this
27
nonpharmacological interventions for ADHD | sonuga-barke et al. (2013)
* dietary domains - artificial food colour exclusions, elimination diet, free fatty acid supplementation * psychological domains - cognitive training, neurofeedback, behavioural/parenting interventions
28
artificial food colour exclusions
* the idea that food additives influence ADHD, introduced by Feingold (1970s) * to treat this Feingold proposed a diet free from synthetic colours & flavours * a commonly held assumption that additives can make kids 'hyper'
29
restricted elimination diest | pelsser et al. (2008)
* high number of children with ADHD have associated symptoms of allergic disorders * suggested ADHD may be a hypersensitivity to an environmental trigger * elimination diet minimises all or known foods that are known to be antigens/allergens * diet involves eating 'hypoallergenic' foods
30
free fatty acid supplementation | richardson (2006), antalis et al. (2006)
* omega-3&6 fatty acids are essential for brain health & dev but most be provided by the diet * in western cultures 3 is much lower than 6 intake * some children with ADHD show symptoms of dry skin & excessive thirst which are associated with essential fatty acid deficiency
31
cognitive training | klinberg et al. (2005)
* att/WM are poor in ADHD * can computerised training be used to improve att/WM> * does this also have an impact on ADHD symptoms?
32
neurofeedback | barry et al. (2003), banaschewski & brandeis (2007)
* based on findings using EEG * ADHD has been linked to too much slow wave activity & not enough faster activity * has also been linked to dysfunctional slow cortical potentials which are thought to represent task-dependent engagement of cortical processing resources * if training can be used to teach children with ADHD to regulate these brain processes then it may improve their ADHD symptoms
33
behavioural interventions
* difficult family envs are common in families of children with ADHD, led some to suggest that parenting practices have maintained or exacerbated disruptive beh * parenting interventions aim to modify parental beh by * encouraging parents to engage with their child in +ve interactive play * teaching them behavioural management strategies
34
do non-pharmacological interventions work | sonuga-barke et al. (2013)
* systematic review * in many studies raters werent blind to treatment condition * some interventions compared to 'treatment as usual' e.g. medication * effects of free fatty acid supplementation are small * food colour exclusions may only be beneficial in those with food sensitivities
35
combined interventions
* multimodal treatment study of children with ADHD * assigned to 1 of 4 groups: medication management, intensive behavioural treatment, combined, standard community care * medication & combined groups showed a greater reduction in ADHD symptoms than the behavioural treatment & community care groups * for other measures, the combined group improved more than the community care group while the medication only group did not