Interventions in School Settings for Students With ADHD

This article consists of a review of 16 research studies on treatments in school settings for children with attention deficit hyperactivity disorder (ADHD) carried out in the last decade. It includes both simple interventions and multicomponent interventions where different techniques are combined. Based on this revision, the conclusion is drawn that, based on the evidence, school-based treatments for ADHD are effective in the short run for reducing disruptive behaviors and improving on-task behavior and academic performance of children with ADHD. Issues regarding the limitations to generalizing the improvements over time and across content areas are discussed. Furthermore, results from the MTA¿a study designed to compare the efficacy of behavioral treatment (BT), medical management (MM), combined treatment (BT and MM), and a routine community care control group¿are discussed. The MTA findings suggest that the most effective treatment for ADHD is a multimodal intervention that frequently includes concurrent medication in addition to parent training, school interventions, and child intervention

Evolución de los síntomas del TDAH y problemas asociados: efectos del tratamiento farmacológico

Introducción. El objetivo de esta investigación fue analizar los efectos del tratamiento con psicoestimulantes sobre la severidad de los síntomas de TDAH y problemas asociados. Método. 65 niños con TDAH fueron clasificados de acuerdo con su historial de medicación en tres grupos: Grupo-1: TDAH-MP (medicación prolongada; N=23), con medicación al menos durante tres años; Grupo-2: TDAH-MB (medicación breve; N=20), con medicación menos de tres años y Grupo-3: TDAH-SM (sin medicación; N=22). En la fase-1 y en la fase-2 de seguimiento los padres cumplimentaron la escala de Conners. Resultados. Las manifestaciones de inatención, hiperactividad e impulsividad y los problemas de conducta en general disminuyeron en el seguimiento en comparación con la primera fase. La ansiedad fue la única variable que mostró un aumento significativo en el tiempo. Respecto a la medicación, en las variables relacionadas con síntomas del TDAH se observó la misma tendencia, mostrando el grupo TDAH-MP puntuaciones significativamente superiores al grupo TDAH-SM. No aparecieron efectos de interacción de Tiempo X Medicación. Conclusiones. Los resultados evidencian la necesidad de análisis más complejos para valorar la respuesta a largo plazo de los fármacos en el tratamiento del TDAH.Introduction. The aim of this research was to analyze the effects of psychostimulant treatment on the severity of ADHD symptoms and associated problems. Method. 65 children with ADHD were classified into three groups according to their medication history: Group-1: ADHD-MP (long-term medication, N=23), under medication for at least three years; Group-2: ADHD-MB (short medication, N=20), under medication for less than three years and Group-3: ADHD-SM (without medication, N=22). In time 1 and time 2 (follow-up) parents filled out the Conners rating scale. Results. Generally, inattention, hyperactivity and impulsivity symptoms and behavioral problems decreased in the follow-up. Anxiety was the only variable that showed a significant increase over time. Moreover, the ADHD-MP group showed significantly higher scores than ADHD-SM group on variables related to ADHD symptoms. There were no interaction effects of Time x Medication. Conclusions. The results suggest the need for more complex analysis to assess the long-term response to medication in the treatment of ADHD

Análisis de factores moduladores de la intervención psicosocial en preescolares con trastorno por déficit de atención/hiperactividad

INTRODUCTION. Although the diagnosis of attention deficit hyperactivity disorder in preschoolers is increasingly common, relatively little is known about the treatment in this developmental period. Some side effects of pharmacological intervention discourage its use as first-line intervention at this age. AIM. To analyze the effectiveness of psychosocial interventions designed to respond to the needs presented by these children, especially those based on cognitive-behavioral and socio-constructivist models. DEVELOPMENT. The review highlights the effectiveness of parent training programs, alone or combined with interventions at school and with the children. Communication between parents and teachers has been shown to be a determinant of their success. Another aspect that seems to favor the efficacy of treatment in this stage of education is the inclusion in the school curriculum of mediated activities aimed at developing self-regulation. CONCLUSIONS. In preschoolers with attention deficit hyperactivity disorder, preventive action based on these models, increasing the intensity of the intervention depending on the student’s response, can help to avoid future problems.Introducción. Aunque el diagnóstico del trastorno por déficit de atención/hiperactividad (TDAH) en preescolares es cada vez más frecuente, se sabe relativamente poco acerca de su tratamiento en este período evolutivo. Algunos efectos adversos de la intervención farmacológica no aconsejan su uso como primera opción de intervención en estas edades. Objetivo. Analizar la eficacia de las intervenciones psicosociales para responder tempranamente a las necesidades de niños con TDAH, especialmente las enmarcadas en los modelos cognitivoconductuales y socioconstructivistas. Desarrollo. La revisión de las investigaciones realizadas en los últimos años en relación con este tema destaca la eficacia de los programas de entrenamiento a padres, solos o combinados con intervenciones en la escuela y con los propios niños. La comunicación entre padres y profesores se ha mostrado como factor determinante del éxito de dichos programas. Otro aspecto que parece propiciar la eficacia del tratamiento en esta etapa educativa es la inclusión dentro del currículo escolar de actividades mediadas encaminadas a desarrollar la autorregulación. Conclusiones. En preescolares con TDAH, una actuación preventiva basada en estos modelos, que incremente la intensidad de la intervención en función de la respuesta del alumno, podrá evitar problemas futuros

Analysis of personal and family factors in the persistence of attention deficit hyperactivity disorder: results of a prospective follow-up study in childhood

Objectives To study the course of ADHD during childhood and analyze possible personal and family predictor variables of the results. Method Sixty-one children with ADHD who were between 6 and 12 years old at the baseline assessment were evaluated 30 months later (mean age at baseline: 8.70 ± 1.97; mean age at follow-up: 10.98 ± 2.19). Status of ADHD in follow-up was identified as persistent (met DSM-IV-TR criteria according to parents’ and teachers’ ratings), contextually persistent (met ADHD criteria according to one informant, and there was functional impairment) and remitted ADHD (with subthreshold clinical symptomatology). Associated psychological disorders of the three groups were analyzed in the follow-up with the Conners' Rating Scales. The groups were compared on ADHD characteristics (symptoms of ADHD and impairment), child psychopathology, executive functioning (EF; inhibition, working memory) and parenting characteristics (parental stress and discipline styles) at baseline. Results At the follow-up, 55.7% of the children continued to meet the DSM-IV-TR criteria for ADHD, 29.5% showed contextual persistence, and 14.8% presented remission of the disorder. The persistent and contextually persistent ADHD groups showed more associated psychological disorders. Inattention, oppositional problems, cognitive problems and impairment at baseline distinguished the remitted ADHD children from the persistent and contextually persistent ADHD children. Moreover, the persistent groups had significantly more emotional liability and higher parental stress than the group in remission, while no differences in EF where found among the groups. Conclusions ADHD children continue to present symptoms, as well as comorbid psychological problems, during adolescence and early adulthood. These findings confirm that persistence of ADHD is associated with child psychopathology, parental stress and impairment in childhood.MICINN (Ministerio de Educacion y Ciencia, Spain) EDU2009-0767

Children with autism spectrum disorder and comorbid attention deficit hyperactivity disorder. Relationships between symptoms and executive function, social cognition, and behavioral problems

Numerous studies have mentioned the importance of discovering the mechanisms underlying the association between autism spectrum disorder (ASD) and comorbid attention deficit hyperactivity disorder (ADHD), with executive function (EF) deficits and theory of mind (ToM) being the most widely investigated cognitive processes. The present study proposed, first, to analyze the executive profile and social cognition processes in children with ASD, ASD+ADHD, ADHD, and typical development (TD). A second objective was to explore the relationship between ASD and ADHD symptoms and EF, ToM, and behavioral problems in children with ASD+ADHD. Participants were 124 children between 7 and 11 years old, distributed in four groups: 37 TD, 35 ADHD, 30 ASD, and 22 ASD+ADHD, matched on age and IQ. The teachers evaluated the EF with the BRIEF, and the parents assessed the application of ToM skills and the behavioral problems. In addition, a subscale of the NEPSY-II battery was administered to measure performance on emotion recognition. The results showed a similar profile of executive deficits in the ASD+ADHD and ADHD groups, whereas the difficulties in ToM skills in the group with ASD+ADHD were similar to those of the group with ASD. Finally, in children with ASD+ADHD, inattention symptoms were significantly associated with metacognitive deficits and ToM difficulties, and ASD symptoms were associated with behavioral problems. These findings support the need to take inattention symptoms into account and provide training in communication strategies when designing treatments for children with ASD

Funcionamiento ejecutivo temprano en niños con dificultades matemáticas persistentes

El objetivo del presente estudio consistió en examinar las diferencias en las funciones ejecutivas de inhibición y memoria de trabajo (MT) evaluadas en Educación Infantil entre sujetos con dificultades persistentes en el área de matemáticas en 2º de Educación Primaria y niños con un rendimiento adecuado. La muestra final del estudio estuvo conformada por 180 niños (inicialmente compuesta por 209 preescolares), de los cuales un 6.6% presentaron dificultades matemáticas persistentes (n = 12) y el 45.5% mostraron un rendimiento adecuado en ambas mediciones (n = 82). En Educación Infantil, se administraron seis tareas neuropsicológicas relacionadas con las funciones ejecutivas de inhibición, MT verbal y MT viso-espacial. Los resultados evidenciaron diferencias en 5 de las 6 tareas aplicadas en el primer momento de evaluación, con efectos especialmente importantes para las funciones ejecutivas de inhibición y MT verbal. Se comentan las implicaciones de estos hallazgos para la investigación y la práctica psicoeducativa.The aim of this study was to examine the differences in executive functions of inhibition and working memory (WM) assessed in kindergarten between subjects with persistent difficulties in the area of mathematics in 2nd grade of Primary School and children with typical achievement. The final study sample consisted of 180 children (originally composed of 209 preschoolers), 6.6% of whom had persistent mathematical difficulties (n = 12) and 45.5% showed average performance in both measurements (n = 82). At Kindergarten, six neuropsychological tasks related to the executive functions of inhibition, verbal WM and visuospatial WM were administered. The results showed differences in 5 of the 6 tasks applied at the first assessment, with particularly significant effects on inhibition and verbal WM. The implications of these findings for psychoeducational research and practice are discussed.El presente trabajo ha sido financiado por el Ministerio de Economía y Competitividad de España (EDU2012-37452) y la Universitat Jaume I de Castellón (beca pre-doctoral; 2I005-PREDOC/ 2013/34)

The Impact of Inattention, Hyperactivity/Impulsivity Symptoms, and Executive Functions on Learning Behaviors of Children with ADHD

Children diagnosed with attention deficit/hyperactivity disorder (ADHD) are at risk of experiencing lower academic achievement compared to their peers without ADHD. However, we have a limited understanding of the mechanisms underlying this association. Both the symptoms of the disorder and the executive functions can negatively influence learning behaviors, including motivation, attitude toward learning, or persistence, key aspects of the learning process. The first objective of this study was to compare different components of learning behaviors in children diagnosed with ADHD and typically developing (TD) children. The second objective was to analyze the relationships among learning behaviors, executive functioning, and symptoms of hyperactivity/impulsivity in both groups. Participants were 35 children diagnosed with ADHD and 37 with TD (7–11 years old), matched on age and IQ. The teachers filled out the Behavior Rating Inventory of Executive Function (BRIEF) and the Learning Behaviors Scale, which evaluates Competence/motivation, Attitude toward learning, Attention/persistence, and Strategy/flexibility. In addition, parents and teachers filled out the DSM-5 diagnostic criteria for ADHD. ANOVAs showed significant differences between children with ADHD and TD children on all the learning behaviors. Moreover, in both the ADHD and TD groups, the behavioral regulation index of the BRIEF predicted the search for strategies, and the metacognition index was a good predictor of motivation. However, attitude toward learning was predicted by metacognition only in the group with ADHD. Therefore, the executive functions had greater power than the typical symptoms of inattention and hyperactivity/impulsivity in predicting learning behaviors of children with ADHD. The findings are in line with other studies that support the influence of the executive functions on performance, highlighting the importance of including their development as a top priority from early ages in the school setting in order to strengthen learning behaviors.This work is supported by the Spanish State Research Agency (Agencia Española de Investigación, AEI) and the European Regional Development Fund (Fondo Europeo de Desarrollo Regional, FEDER) through the Project PSI2016-78109 (AEI/FEDER, UE) and by the University of Valencia (UV-INVPREDOC15- 265889)

Social Cognition in Children with High-Functioning Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder. Associations with Executive Functions

Autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) are neurodevelopmental disorders characterized by social impairments. The first objective of this study was to analyze social cognition deficits of children with ADHD, high-functioning ASD (HFASD), and typical development (TD) in their performance on explicit and applied measures of theory of mind (ToM). The second objective was to investigate the relationships between executive functions and social cognition in HFASD and ADHD. One hundred and twenty-six 7- to 11-year old children, 52 with HFASD, 35 with ADHD, and 39 with TD, performed the NEPSY-II social perception subtests. Parents estimated their children’s ToM skills using the Theory of Mind Inventory (ToMI). Teacher-reported data from the Behavior Rating Inventory of Executive Function (BRIEF) were also obtained. The HFASD and ADHD groups showed worse performance on the verbal ToM task than the TD group, and only the performance of the HFASD group was significantly lower than the TD group on the contextual ToM task. Parents also estimated that the HFASD group had more difficulties on the applied ToM than the ADHD and TD groups. Furthermore, there is a different executive function-theory of mind link in the HFASD and ADHD groups: behavioral regulation processes such as inhibition and emotional control are more associated with social cognition in children with ADHD, whereas metacognitive processes such as initiation and planning have a strong association with social cognition in children with HFASD. These findings have implications for understanding social perception deficits in neurodevelopmental disorders, highlighting the need for early intervention

Influence of the symptoms of Attention Deficit Hyperactivity Disorder (ADHD) and comorbid disorders on functioning in adulthood

Antecedentes: el TDAH es un trastorno crónico que afecta la adaptación sociopersonal. Los objetivos de este estudio fueron comprobar el funcionamiento adaptativo de adultos con TDAH en comparación a adultos sin el trastorno y analizar la influencia de la inatención e hiperactividad/impulsividad y de los trastornos comórbidos en este funcionamiento. Método: la muestra incluyó 77 adultos entre 17 y 24 años, 40 con un diagnóstico de TDAH subtipo combinado y 37 controles que cumplimentaron el Weiss Functional Impairment Scale, el Weiss Symptom Record y el Conners' Adult ADHD Rating Scale. Resultados: se encontraron diferencias significativas entre adultos con y sin TDAH en el funcionamiento familiar y académico. Además, la sintomatología de TDAH predijo déficits significativos en el ámbito familiar y en el autoconcepto y concretamente la inatención predijo un peor funcionamiento académico y de habilidades cotidianas. Las comorbilidades influyeron principalmente en los dominios familiar y de actividades de riego (conducción temeraria, conductas ilegales, abuso de sustancias y conductas sexuales inapropiadas). Conclusiones: los resultados reflejan la importancia de desarrollar un enfoque multimodal en adultos con TDAH para tratar los trastornos comórbidos, ofreciéndoles entrenamiento para la organización de actividades diarias e incorporando a la familia y/o pareja en el plan de tratamiento.Background: ADHD is a chronic disorder that generally has a negative effect on socio-personal adaptation. The objectives of the current study were to examine the adaptive functioning in the daily lives of adults with ADHD compared to adults without the disorder and to test the influence of ADHD symptoms and comorbid problems on different areas of adaptive functioning. Method: Seventy-seven adults between 17 and 24 years old, 40 with a clinical diagnosis of combined-subtype ADHD in childhood and 37 controls, filled out the Weiss Functional Impairment Scale, the Weiss Symptom Record and Conners' Adult ADHD Rating Scale. Results: Significant differences were found between adults with and without ADHD in family and academic functioning. Moreover, the ADHD symptomatology as a whole predicted significant deficiencies in the family environment and self-concept, whereas inattention specifically predicted worse academic performance and life skills. The comorbidities mainly affected the family and risky activity domains (dangerous driving, illegal behaviors, substance misuse and sexually inappropriate behaviors). Conclusions: The results illustrate the importance of developing a multimodal approach to helping ADHD adults cope with associated comorbid disorders, offering them supportive coaching in organizing daily activities, and incorporating the family and/or partner in the treatment plan