W3 L6 412

Question 0

Assesment

Answer 0

Neuropsychological/biological méthods
Ask about head trauma and sickness to rule out biological, if it started recently, but no blood test to rule it in,

Neuropsychological tests used in research but not diagnostically.
Like continuous performance test. Or stop signal task.
Measure impulsivity or Inattention.

Classroom observation. Over days and contexts.
Esp. Off task behaviour, and excessive gross motor activity, negative focalization a.

Clinical observation
May have low external validity though! Typically look better (1:1)
Good for formal testing.

Question 1

And or rule for symptoms

Answer 1

Could be for symptoms or for diagnosis.

Dsm doesn’t specify if should/.could use and rule.
And rule likely too restrictive even at two informants. So ppl tend to use or rle for symptoms.

Question 2

Treatment approaches overview then mta results
What works?
What works FOR WHOM?
Both imp. Q’s for moderators of treatment.

Answer 2

Medication, stimulants. Like Ritalin. Increase activity in prefrontal cortex. Methylphenidate.
Fast acting! Like 30min
But short effect, wears of have side effects, like weight, appetite, hr sleep.
That’s why they must titrate up
Conclusion: large main effects, so yes they do work generally.
But 20% of children may not improve!
And even for those improving, it does not cure them. Can still have dysfunctions, social issues.
May not be maintained over time! Esp. If meds are stopped.

Behavioural treatments
Classroom, management, parent training and peer training,

Pmt for parents:
Set clear rules, operant conditioning.reinforce and punish
Set up sit to minimize peoblems. Make life easier!
Works but may not be as effective as meds.
Classroom management is same as above, it’s contingency management.

Peer interventions:
Bad rela with other kids so social skills training and discussion and role playing may help. Hmm here s where my comes in?
But doing so in clinic useless, you need to be with other kids!
Group setting, bring it to school or CAMP then.
SAW VIDEO: 1.5:1 ratio. Contingency management.
Do s’il training and coach grouped play.
Studies do show significant imp. Rewarding behaviour hopefully will find it self rewarding.

Question 3

Other interventions

Answer 3

Cognitive interventions not supported though, like positive self talk.

Question 4

Onto MTA STUDY
Multimodal treatment of adhd
Objectives: long term meds and behaviour treatment, additional benefits of combination, what about community vs researxh setting?

Results?

Answer 4

First sample:
Needed 6 sites and about 600 kids. 
Parents and teachers rating scales
80% males. Had to be adhd-C
Used and dignitic criteria, severe sample. 

Random assignment to 4 groups. Longitudinal as 2 years follow nup, after 6 month treatment.

1. Meds,tightly controlled. 28days.
2. Psycholosocial treatment. Summer treatment, pimp my treatment. Lots of interventions.
   3.combinatin treatmen
3. Treatment as usual. (TAU)
   Could, be nothing could include some of the above.

Question 5

Now onto MTA results

Answer 5

Teacher rating of hyperactivity:
All go down over time: not sure if it is really treatment or time as no nothing control group, but that was unethical.
Medication and combined did best though. Community one had ppl taking meds despite this. So interesting. Psychosocial = tau

Parent child conflict:
Combined group, and psychosocial was bette than tau.
Medication was the same.

Parents prefer behavioural treatments.
But meds did better at getting rid of symptoms. But did not help social skills.

Combined and meds, did not differ between each other,

Combined and meds do better than tau.
Behavioural treatment did not do better than tau.
Except when considers other areas of dysfunction like child parent conflict.

Question 6

Long term follow up of mta.

Answer 6

Over time, all converge
After 6 year all look the same,
No long term effects.
Also note, compared to normative, even best we’re not even close in treatment groups.

Functioning worse than control group. Despite sig. Improvement.
Less severe, and responded more quickly did grist over time.

Question 7

Mta generally concludes, kids need. For adhd

Answer 7

Meds.

What about composite measure of functioning of child.
Then combined does brtter !