MyADHD.com

Research Updates
Study investigates the benefits of combined pharmacologic and psychosocial treatments for children with ADHD. The July 2004 issue of the Journal of the Academy
of Child and Adolescent Psychiatry reports on findings from a two-year treatment study of multi-modal treatment of ADHD by Rachel Klein, Howard Abikoff, Lily Hechtman, and Gabrielle Weiss.

Despite the unquestionable efficacy of stimulants to improve ADHD symptoms, these medications have a number of limitations: they have relatively short duration of effect and lack of 24 hour coverage; stimulants do not eliminate all aspects of dysfunction typically associated with ADHD such as poor social skills, low motivation in school, and poor academic performance; and use of stimulants childhood may not protect the child from developing significant problems in adulthood.

With this in mind, researchers designed and conducted a study (1990-1995) to investigate the benefits of multimodal treatment for children with ADHD. The study was implemented in two medical centers (New York and Montreal) and included 103 boys and girls ages seven to nine years of age in grades 1 through 4 who were diagnosed with ADHD, but who did not have a learning disability or conduct disorder or any diagnosable neurological disorders, psychosis, or significant medical illness or current sexual of physical abuse.

Three related clinical goals guided the study design:

The first was to maximize the adjustment of children with ADHD,above and beyond
what was obtainable with a stimulant alone, through the addition of an intensive, long-term multimodal psychosocial intervention.
The second goal was to enable children's acquisition of social and academic skills and
to optimize parental management skills to the point that stimulant treatment was no longer essential to manage the children's behavior.
The third goal was to instill enhanced interpersonal, academic, and emotional coping skills that would affect children's long-term outcome.

The investigators hypothesized: (1) that children with ADHD who, in addition to methylphenidate, received two years of multimodal treatment would exhibit significantly superior functioning compared with children treatment with methylphenidate alone, (2) that there were specific attributes of the psychosocial treatment that could be identified as providing benefits above and beyond professional attention alone, (3) that significantly more children who received multimodal treatment for one year would be able to be withdrawn from medication compared with children who did not receive psychosocial treatment, and (4) that the benefits accrued from the combination treatment would have long-lasting effects and those children receiving this treatment would have superior functioning over time compared with children who had not received the enriched treatment.

Children were assigned to one of three treatment groups for two years:
(1) methylphenidate alone, (2) methylphenidate and psychosocial treatments combined, (3) methylphenidate and attention control psychosocial treatment. To provide maximal benefit, methylphenidate was prescribe three times a day (t.i.d) 7 days per week, and the dose was increased gradually to a maximum of 50 mg/day. Children on methylphenidate were seen along with their parents weekly, at first, and then monthly, by a child psychiatrist who adjusted the dose based on side effects and parents' and teachers' school reports. Teachers were interviewed weekly over the telephone with a semistructured questionnaire and were also asked to complete a 10-item rating scale. Psychosocial treatments, which were delivered after school at the sites, consisted of one year of weekly intensive intervention and a second year of monthly booster sessions that included social skills training, academic skills remediation, individual psychotherapy, and parent training. Psychosocial interventions were given twice-weekly during the first year and twice-monthly during the second year.

The July 2004 issue of the JACAP published a number of the findings of this multimodal treatment study. In a nutshell, here is what the investigators found:

Combination treatment (methylphenidate plus psychosocial treatments) did not lead to superior functioning and did not facilitate methlyphenidate discontinuation. Significant improvement occurred across all treatments and continued over two years. Investigators concluded that in children who responded well to stimulant therapy, there is no support for adding ambitious long-term psychosocial intervention to improve ADHD and oppositional defiant disorder symptoms.
No advantage was found on any measure of academic performance or emotional status for the combination treatment over methylphenidate alone and over methlyphenidate plus attention control. The investigators concluded that in children who do not have a learning disability or conduct disorder and who respond well to stimulants there is no support for academic assistance and psychotherapy to enhance academic achievement or emotional adjustment.
No advantage was found on any measure of social functioning for the combination treatment over methylphenidate alone or methylphenidate plus attention control. The investigators concluded that in young children with ADHD, there is no support for clinic-based social skills training as part of a long-term psychosocial intervention to improve social behavior.
Psychosocial treatment led to significantly better knowledge of parenting principles but did not enhance parenting practices, as rated by parents and children. There was improvement in mothers' negative parenting across all treatments. The investigators concluded that in nonconduct-disordered, stimulant treated children with ADHD, parent training does not improve self-rated parental behavior.

ADHD children are at greater risk to be victims of bullying in school. A study published in the Journal of Interpersonal Violence (2003) and summarized in the ADHD Report (2004) examined bullying and bully victimization in a middle school sample in terms of ADHD, self-control, and student physical characteristics. 1,315 students in grades 6 to 8 completed a series of questionnaires on which they reported the frequency with which they had engaged in or been the victim of bullying. The investigators reported children with ADHD were more likely than non-ADHD children to be victims of bullying (34% versus 22%). Being overweight and in the ADHD group increased the risk of bullying. Somewhat more ADHD students reported bullying compared to other students (13% versus 8%). Children with ADHD tend to have fewer friends and poor social skills which may lead them to become targets for bullying. Parents and teachers should be aware of the increased potential for ADHD children to be bully victims and should take proactive steps to avoid this from occurring.

ADHD Experts On Call: One Day Event!—Monday, August 9, 2004
You won't want to miss this one day opportunity to gain valuable insight from leading AD/HD experts. This extremely successful and very popular program is being repeated for the sixth year. Anyone interested in learning more about ADHD can call toll-free and ask questions to English or Spanish speaking panel of experts including physicians, mental health professionals, educators, nurses, advocates, and patients. Phone lines are available from 8:00 am to midnight EDT. Call 1-888-ASK-ADHD (1-888-275-2343). This program is sponsored by Shire US Inc. For more details visit www.adhdexpertsoncall.com.

September 7th is ADHD Awareness Day.
The US Senate designated September 7th as "National ADHD Awareness Day". ADHD is a major public health concern about which there is a dearth of correct information. The purpose of this resolution is to create more awareness of ADHD and to promote better understanding of this condition. The resolution was introduced by Senator Richard Durbin (D-Illinois)and was spearheaded by the Attention Deficit Disorder Association. For more information, visit www.add.org/news/resolution.html.

August's Featured myADHD.com's Tools
Treatment tools in myADHD.com can help students develop better study strategies to more effectively manage their work in school. Subscribers to myADHD.com can view the forms below (along with many others) and print them for use in their practice, classroom, or home. We have provided links to a few samples below. Visit myADHD.com Treatment Tools for a complete listing of study strategy worksheets for elementary and secondary students.
No. 1003 School Supplies Checklist
No. 1005 How to Organize New School Papers
No. 2026 The Learning Station
No. 2037 Roadblocks to Concentration
No. 2040 Proofreading Your Work
No. 3009 Raise Your Hand Before Speaking
No. 2020 Homework Self-Check
No. 2021 Using a Homework Planner
No. 2024 Start a Study Buddy Club
No. 6015 Organizing Long-Term Projects
No. 7006 Using Abbreviations in Note-Taking
No. 7009 Using Paraphrasing
No. 7011 Taking Notes Using a Simple Outline