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PSYC 412 > Week 3: ADHD Treatment > Flashcards

Week 3: ADHD Treatment Flashcards

1
Q

Behavioral treatments (Parent Management Training -PMT)

A

Parent Management Training (PMT)
-Contingency management
-Establish clear rules and expectations
-Provide rewards for behaviors you want to see and consequences for
behaviors you do not want to see
-Set up situations to minimize problems
-A number of studies have demonstrated that this treatment results in improved behavior
-May not show effects as large as medication but is an important intervention for conduct problems

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2
Q

Behavioral treatments (Behavioral Classroom Management)

A
  • Contingency management in the classroom

- Studies have demonstrated effectiveness

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3
Q

Behavioral treatments (Behavioral Peer Interventions)

A
  • Used to be done in the clinic, often as a role play between therapist and child.
  • Evidence suggests this is ineffective

Instead use other interventions;

  • Targeting peer relationships in recreational settings
  • Summer programs, day-long programs that last for multiple weeks
  • Social skills training followed by coached group play where they have a skill they are working on and they get reinforcement for it
  • Contingency management
  • Studies have suggested significant improvement
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4
Q

Cognitive Interventions

A

Cognitive interventions

  • Cognitive techniques that children can use to control attention and behavior (e.g., verbal self-instruction, problem solving)
  • Insufficient scientific evidence of benefit
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5
Q

What are multisite treatment trials?

A

Randomized control trials, groups are called arms

  • Require recruitment of many patients and services of many clinicians as doing these investigations individually would take years
  • Often done at multiple sites simultaneously
    e. g.
  • CAMS (Anxiety)
  • POTS (OCD)
  • TADS (Depression)
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6
Q

Multimodal Treatment of ADHD - MTA (objectives)

3 things

A

Three key objectives:

(1) Compare long-term medication and behavioral treatments for ADHD
(2) Determine if there are additional benefits if meds and behavioral treatment are combined
(3) Compare systematic administration of treatment to treatment as delivered in community settings

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7
Q

MTA (Participants)

A

6 sites

  • 579 youths enrolled
  • Schools, pediatricians, mental health clinics
  • age 7 to 9
  • 80% male (reflects ADHD prevalence)
  • ADHD-C diagnosis
  • parent-reported
  • All over dimensional thresholds on parent and teacher report

So had to score over the threshold on both measures

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8
Q

MTA (Grouping)

A

Randomly assigned to one of 4 groups (arms)

(1) Medication only
(2) Psychosocial (Behavioral) treatment only
(3) Combined Medication and Psychosocial treatment
(4) Assessment and Referral (Community control)

4 was because there was already established, good ADHD treatments

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9
Q

MTA (Treatments)

A

(1) Medication management
- Stimulant medication
- 28 day titration period
(2) Psychosocial treatment
- Parent training
- 27 group sessions and 8 individual sessions
- Educational interventions
- 16 to 20 sessions of teacher consultation
- 12 weeks of half-time classroom behavioral specialist
- Summer treatment program

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10
Q

MTA (Results - Core Symptoms)

A

All four groups showed a reduction in ADHD symptoms over time:
-At final assessment, combination and medication were better than psychosocial and Treatment As Us
-Psychosocial was the same as TAU
(This is very had for psychosocial as in TAU, participants could have been getting drugs prescribed in the community)

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11
Q

MTA (Results - Parent-Child Relationship)

A

Combination treatment and psychosocial treatment both show more significant improvement than treatment as usual
-Medication = Treatment as usual

So in terms of Parent-Child conflict, behavioral was very good

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12
Q

MTA - Summary of results

A

Summary of Results

(1) Compare long term medication and behavioral treatments for ADHD
-For improving ADHD symptoms (as rated by both parents and teachers), medication outperformed behavioral treatment
-But, this was not true for many other outcomes (e.g., observed classroom behavior, parent and teacher reported social skills)
-Children who got behavioral treatment did improve on
ADHD symptoms
-Parents prefer behavioral treatments

(2) Determine if there are additional benefits if meds and behavioral treatment are combined
- Combined treatment and medication treatment did not differ for any outcome
- Note that for parent-child conflict, combined was better than TAU and medication was not better than TAU, but in a direct comparison, combined was not better than medication

(3) Compare systematic administration of treatment to treatment as delivered in community settings
- Combined treatment and meds outperformed TAU for most ADHD outcomes
- Behavioral treatment did not
- Note that behavioral treatment and combined treatment both outperformed TAU when outcome was reducing parent-child conflict (meds did not)

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13
Q

MTA - Summary of results

A

Summary of Results

(1) Compare long term medication and behavioral treatments for ADHD
-For improving ADHD symptoms (as rated by both parents and teachers), medication outperformed behavioral treatment
-But, this was not true for many other outcomes (e.g., observed classroom behavior, parent and teacher reported social skills)
-Children who got behavioral treatment did improve on
ADHD symptoms
-Parents prefer behavioral treatments

(2) Determine if there are additional benefits if meds and behavioral treatment are combined
- Combined treatment and medication treatment did not differ for any outcome
- Note that for parent-child conflict, combined was better than TAU and medication was not better than TAU, but in a direct comparison, combined was not better than medication

(3) Compare systematic administration of treatment to treatment as delivered in community settings
- Combined treatment and meds outperformed TAU for most ADHD outcomes
- Behavioral treatment did not
- Note that behavioral treatment and combined treatment both outperformed TAU when outcome was reducing parent-child conflict (meds did not)

Medicine is very effective for ADHD

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14
Q

MTA (Long term follow up)

A

Followed participants up 8 years later

  • There were no differences between any of the treatment groups on any of the outcomes assessed
  • On average, children in MTA showed gains relative to baseline
  • Functioning worse than a community control group without ADHD
  • Children with better clinical presentation at start of study and better initial treatment response had best prognosis

Over time many participants had stopped taking medication but this difference was not associated with any significant difference

They were still worse than non-ADHD children

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15
Q

New thoughts on the MTA

A

Was re analyzed by one of the original authors who used a composite measure encompassing all outcomes

In this case combined > medication

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16
Q

MTA: What works for whom? (Basics)

A

Sample
– Young
– Male
– Combined type

Other factors?
– Symptom severity
– Youth comorbidity
– Parent comorbidity
– Cognitive functioning
– Poverty
– Ethnicity

These could all be relevant. If we have enough in the study, we can analyze for moderating factors

17
Q

MTA: What works for whom? (Moderators)

A

A moderator is a variable that influences the direction strength of the relationship between two variables

The first moderator was treatment group. Those in the medical and combination group did better.

Within this group, parental depression was a moderator.

For both kids with depressed parents and those without, Severity of symptoms was a huge moderator

Only among children in the treatment group who had high levels of parental depression and high symptom severity, a final moderator was the child’s IQ

18
Q

MTA (Summary)

A

The MTA was a large, multisite treatment trial comparing the efficacy of different ADHD treatments

  • At immediate follow-up, results suggested that medication was essential for reduction of core ADHD symptoms, and that psychosocial treatment was beneficial for other outcomes (e.g., reducing parent-child conflict)
  • These differences between groups were not maintained at 8-yearfollow up
  • Moderators of the efficacy of combined treatment and medication only were identified

-More recent analyses suggests that when all outcomes are considered, youth who received combined psychosocial treatment show greater improvement than do youth receiving only
medication

PSYC 412 (47 decks)

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