Parenting as a Mechanism of Change in Psychosocial Treatment for Youth with ADHD, Predominantly Inattentive Presentation Efficacy of the Incredible Years Basic parent training programme as an early intervention for children with conduct problems and ADHD. An efficacy study of a combined parent and teacher management training programme for children with ADHD Social Skills Training in Children With Attention Deficit Hyperactivity Disorder: A Randomized-Controlled Clinical Trial Randomised social-skills training and parental training plus standard treatment versus standard treatment of children with attention deficit hyperactivity disorder - The SOSTRA trial protocol Combining Parent and Child Training for Young Children with ADHD A randomized controlled trial of a parent training and emotion socialization program for families of hyperactive preschool-aged children. Neurofeedback in ADHD: a single-blind randomized controlled trial Effectiveness of a School-Based Multicomponent Program for the Treatment of Children with ADHD A randomized, controlled trial of integrated home-school behavioral treatment for ADHD, predominantly inattentive type. Effectiveness and cost-effectiveness of a brief school-based group programme for parents of children at risk of ADHD: a cluster randomised controlled trial. [The prevalence of attention-deficit/hyperactivity disorder (ADHD) among children and adolescents in Germany. Initial results from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS)]. Computerized training of working memory in children with ADHD--a randomized, controlled trial. Predictors of Boys’ ADHD Symptoms from Early to Middle Childhood: The Role of Father–Child and Mother–Child Interactions Parent-assisted transfer of children's social skills training: effects on children with and without attention-deficit hyperactivity disorder. Treating Parents with Attention-Deficit/Hyperactivity Disorder: The Effects of Behavioral Parent Training and Acute Stimulant Medication Treatment on Parent–Child Interactions Development and preliminary evaluation of an integrated treatment targeting parenting and depressive symptoms in mothers of children with attention-deficit/hyperactivity disorder. A two-site randomized clinical trial of integrated psychosocial treatment for ADHD-inattentive type. Children with ADHD treated with long-term methylphenidate and multimodal psychosocial treatment: impact on parental practices. Parent-based therapies for preschool attention-deficit/hyperactivity disorder: a randomized, controlled trial with a community sample. In a randomized case–control trial with 10-years olds suffering from attention deficit/hyperactivity disorder (ADHD) sleep and psychological functioning improved during a 12-week sleep-training program Social-Skills and Parental Training plus Standard Treatment versus Standard Treatment for Children with ADHD – The Randomised SOSTRA Trial Parental Influence on Children with Attention-Deficit/Hyperactivity Disorder: II. Results of a Pilot Intervention Training Parents as Friendship Coaches for Children A small-scale randomized controlled trial of the self-help version of the New Forest Parent Training Programme for children with ADHD symptoms Is neurofeedback an efficacious treatment for ADHD? A randomised controlled clinical trial. Does maternal ADHD reduce the effectiveness of parent training for preschool children's ADHD? Symptomatic improvement in children with ADHD treated with long-term methylphenidate and multimodal psychosocial treatment. A Randomized Trial Examining the Effects of Aerobic Physical Activity on Attention-Deficit/Hyperactivity Disorder Symptoms in Young Children A Waitlist-Controlled Trial of Behavioral Parent Training for Fathers of Children with ADHD A randomized clinical trial of Cogmed Working Memory Training in school-age children with ADHD: a replication in a diverse sample using a control condition. Effect of Supplementation with Polyunsaturated Fatty Acids and Micronutrients on Learning and Behavior Problems Associated with Child ADHD Academic achievement and emotional status of children with ADHD treated with long-term methylphenidate and multimodal psychosocial treatment. Randomised controlled trial of parent groups for child antisocial behaviour targeting multiple risk factors: the SPOKES project. Design and rationale of controlled study of long-term methylphenidate and multimodal psychosocial treatment in children with ADHD. Computer-Assisted Management of Attention-Deficit/Hyperactivity Disorder Enhancing Behavioral and Social Skill Functioning in Children Newly Diagnosed with Attention-Deficit Hyperactivity Disorder in a Pediatric Setting Training of slow cortical potentials in attention-deficit/hyperactivity disorder: evidence for positive behavioral and neurophysiological effects Atomoxetine, Parent Training, and Their Combination in Children With Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder. Computer-Based Attention Training in the Schools for Children With Attention Deficit/Hyperactivity Disorder: A Preliminary Trial The effects of a stress-management program on self-concept, locus of control, and the acquisition of coping skills in school-age children diagnosed with attention deficit hyperactivity disorder. A study on the effectiveness of videoconferencing on teaching parent training skills to parents of children with ADHD. Depression, anxiety and obsessive-compulsive symptoms and quality of life in children with attention-deficit hyperactivity disorder (ADHD) during three-month methylphenidate treatment Parent-child interaction therapy for Puerto Rican preschool children with ADHD and behavior problems: a pilot efficacy study. Effects of atomoxetine with and without behavior therapy on the school and home functioning of children with attention-deficit/hyperactivity disorder. Enhancing Traditional Behavioral Parent Training for Single Mothers of Children with ADHD Multimodal treatment in children and adolescents with attention-deficit/hyperactivity disorder: a 6-month follow-up Effect of vitamin D treatment in children with attention-deficit hyperactivity disorder Social functioning in children with ADHD treated with long-term methylphenidate and multimodal psychosocial treatment. Worse Quality of Life for Children With Newly Diagnosed Attention-Deficit/Hyperactivity Disorder, Compared With Asthmatic and Healthy Children Critical influences affecting response to various treatments in young children with ADHD: a case series.
We investigated whether parenting and child behavior improve following psychosocial treatment for Attention-Deficit/Hyperactivity Disorder , Predominantly Inattentive Presentation ( ADHD-I ) and whether parenting improvements mediate child outcomes . We analyzed data from a r and omized clinical trial investigating the efficacy of a multicomponent psychosocial intervention ( Child Life and Attention Skills , CLAS , n = 74 ) in comparison to Parent-Focused Treatment ( PFT , n = 74 ) and treatment as usual ( TAU , n = 51 ) for youth with ADHD-I ( average child age = 8.6 years , range 7–11 years , 58 % boys ) . Child and parent/family functioning were assessed prior to treatment , immediately following treatment , and at follow-up into the subsequent school year using parent and teacher reports of inattention , organization , social skills , academic competency ( teachers only ) , parenting daily hassles , and positive and negative parenting behaviors ( parents only ) . Both treatment groups improved on negative parenting and home impairment , but only CLAS families also improved on positive parenting as well as academic impairment . Improvements in positive and negative parenting mediated treatment effects on child impairment independent of improvements in child inattention , implicating parenting as an important mechanism of change in psychosocial treatment for ADHD-I. Further , whereas parent-focused training produces improvements in negative parenting and impairment at home for children with ADHD-I , a multicomponent approach ( incorporating child skills training and teacher consultation ) more consistently produces improvements at school and in positive parenting , which may contribute to improvements in social skills into the next school year BACKGROUND The efficacy of the Incredible Years ( IY ) Basic parent training ( PT ) programme for a community-based sample of families with pre-school children at risk of developing both conduct problems and attention deficit hyperactivity disorder ( ADHD ) was examined . METHODS Pre-school children displaying signs of both early-onset conduct problems and ADHD were r and omly allocated to either IY PT intervention , or to a waiting list ( WL ) control group . Child symptoms were assessed before and after the intervention . RESULTS Post intervention , the intervention group was associated with significantly lower levels of parent-reported inattention and hyperactive/impulsive difficulties , even after controlling for post-intervention changes in child deviance . In addition , 52 % of those in the intervention condition , compared with 21 % in the control condition , displayed clinical ly reliable improvements post intervention , giving an absolute risk reduction of 31 % and a number needed to treat of 3.23 . CONCLUSIONS Findings from this study indicate that the IY PT programme is a valuable intervention for many pre-school children displaying early signs of ADHD Background : Several parent training programmes and behavioural teacher training programmes built on learning theory have been developed for problem prevention and treatment of attention-deficit/hyperactivity disorder ( ADHD ) and /or oppositional defiant disorder ( ODD ) during the last few decades . Group format has often been used for parent training but single-subject design s are more common in teacher training . More studies have focussed on pre-school children than on older children , and a minority have been conducted in public mental health setting s. Aim : This study aim ed to evaluate a combined parent and teacher manual-based group training programme for children with ADHD conducted by the staff at a child and adolescent psychiatric clinic in Sweden . Method : The intervention was a modified version of Barkley 's programme .  Children were r and omized to an Intervention or a Control group .  Sixty-one parents and 68 teachers answered questions about ADHD and ODD symptoms , and about behavioural problems when the study started and at a 3-month follow-up . Results : Results showed that the intervention result ed in a reduction of the number of children who met DSM-IV criteria for ADHD and /or ODD . Effects were more pronounced in the home setting than in the school setting , and were further accentuated when both parents and teachers of the same child took part in the intervention . Teachers with more problematic classroom situations benefited most from the intervention . Conclusion : The programme , “ Strategies in Everyday Life ” , has , in a regular clinical setting , demonstrated promising effects on children 's disruptive behaviour , and a clinical implication was to recommend involving both parents and teachers in the programme Evaluated efficacy of social skills training ( SST ) on children with 2 subtypes of attention deficit hyperactivity disorder ( ADHD ) . Participants were 120 children ( 30 girls , 90 boys ) , ages 8 to 12 with ADHD-Inattentive type ( ADHD-I ; n = 59 ) or Combined type ( ADHD-C ; n = 61 ) . The children were r and omly assigned within diagnosis subtype to the treatment condition ( 8 weeks of SST ) or the no-intervention control condition . SST led to greater improvements in both parent- and child-perceived assertion skills in the children with ADHD , yet did not affect the other domains of social competence . Diagnostically heterogeneous groups led to greater improvements on parent-report of their child 's cooperation and assertion abilities as well as children 's report of their own empathy skills . Diagnostically homogeneous groups led to greater decreases in externalizing behaviors at posttreatment but not at follow-up . Children with comorbid oppositional defiant disorder ( ODD ) did not benefit as much from the intervention . Children with ADHD-I improved in assertion skills more than children with ADHD-C , yet the 2 diagnostic entities did not differ in improvement levels across all other social skills Background Children with attention deficit hyperactivity disorder ( ADHD ) are hyperactive and impulsive , can not maintain attention , and have difficulties with social interactions . Medical treatment may alleviate symptoms of ADHD , but seldom solves difficulties with social interactions . Social-skills training may benefit ADHD children in their social interactions . We want to examine the effects of social-skills training on difficulties related to the children 's ADHD symptoms and social interactions . Methods / Design The design is r and omised two-armed , parallel group , assessor-blinded trial . Children aged 8 - 12 years with a diagnosis of ADHD are r and omised to social-skills training and parental training plus st and ard treatment versus st and ard treatment alone . A sample size calculation estimated that at least 52 children must be included to show a 4-point difference in the primary outcome on the Conners 3rd Edition subscale for ' hyperactivity-impulsivity ' between the intervention group and the control group . The outcomes will be assessed 3 and 6 months after r and omisation . The primary outcome measure is ADHD symptoms . The secondary outcome is social skills . Tertiary outcomes include the relationship between social skills and symptoms of ADHD , the ability to form attachment , and parents ' ADHD symptoms . Discussion We hope that the results from this trial will show that the social-skills training together with medication may have a greater general effect on ADHD symptoms and social and emotional competencies than medication alone . Trial registration Clinical Trials ( NCT ) : The efficacy of the Incredible Years parent and child training programs is established in children diagnosed with oppositional defiant disorder but not among young children whose primary diagnosis is attention-deficit/hyperactivity disorder ( ADHD ) . We conducted a r and omized control trial evaluating the combined parent and child program interventions among 99 children diagnosed with ADHD ( ages 4–6 ) . Mother reported significant treatment effects for appropriate and harsh discipline , use of physical punishment , and monitoring , whereas fathers reported no significant parenting changes . Independent observations revealed treatment effects for mothers ' praise and coaching , mothers ' critical statements , and child total deviant behaviors . Both mothers and fathers reported treatment effects for children 's externalizing , hyperactivity , inattentive and oppositional behaviors , and emotion regulation and social competence . There were also significant treatment effects for children 's emotion vocabulary and problem-solving ability . At school teachers reported treatment effects for externalizing behaviors and peer observations indicated improvements in treated children 's social competence The present study evaluated the effectiveness of a parent training and emotion socialization program design ed specifically for hyperactive preschoolers . Participants were 31 preschool-aged children whose parents were r and omly assigned to a  parent training ( PT ) or waitlist ( WL ) control group .  PT parents took part in a 14-week parenting program that involved teaching parenting strategies for managing hyperactive and disruptive behavior as well as emotion socialization strategies for improving children 's emotion regulation . Compared to WL mothers , PT mothers reported significantly less child inattention , hyperactivity , oppositional defiance , and emotional lability ; were observed using significantly more positive and less negative parenting ; and reported significantly less maternal verbosity and unsupportive emotion socialization practice s. Results provide some support for the effectiveness of this parenting program for reducing attention-deficit hyperactivity disorder ( ADHD ) symptoms and associated problems in preschool-aged children Neurofeedback treatment has been demonstrated to reduce inattention , impulsivity and hyperactivity in children with attention deficit/hyperactivity disorder ( ADHD ) . However , previous studies did not adequately control confounding variables or did not employ a r and omized reinforcer-controlled design . This study addresses those method ological shortcomings by comparing the effects of the following two matched biofeedback training variants on the primary symptoms of ADHD : EEG neurofeedback ( NF ) aim ing at theta/beta ratio reduction and EMG biofeedback ( BF ) aim ing at forehead muscle relaxation . Thirty-five children with ADHD ( 26 boys , 9 girls ; 6–14 years old ) were r and omly assigned to either the therapy group ( NF ; n = 18 ) or the control group ( BF ; n = 17 ) . Treatment for both groups consisted of 30 sessions . Pre- and post-treatment assessment consisted of psychophysiological measures , behavioural rating scales completed by parents and teachers , as well as psychometric measures . Training effectively reduced theta/beta ratios and EMG levels in the NF and BF groups , respectively . Parents reported significant reductions in primary ADHD symptoms , and inattention improvements in the NF group were higher compared to the control intervention ( BF , dcorr = −.94 ) . NF training also improved attention and reaction times on the psychometric measures . The results indicate that NF effectively reduced inattention symptoms on parent rating scales and reaction time in neuropsychological tests . However , regarding hyperactivity and impulsivity symptoms , the results imply that non-specific factors , such as behavioural contingencies , self-efficacy , structured learning environment and feed-forward processes , may also contribute to the positive behavioural effects induced by neurofeedback training The objective of this study was to evaluate the efficacy of a multicomponent program for treating attention-deficit/hyperactivity disorder ( ADHD ) carried out by teachers in a classroom context . Dependent measures included neuropsychological tasks , behavioral rating scales for parents and teachers , direct observation of behavior in the classroom , and academic records of children with ADHD . Fifty children with ADHD participated in the study . The teachers of 29 of the 50 students  were trained in the use of behavior modification techniques , cognitive behavior strategies , and instructional management strategies . The other 21 students formed the  control group . Parents ' and teachers'ratings detected improvements in primary symptoms ( inattention — disorganization , hyperactivity — impulsivity ) and in behavioral difficulties usually associated with ADHD ( e.g. , antisocial behavior , psychopathological disorders , anxiety ) . Furthermore , the results showed increased academic scores , enhanced classroom behavioral observations , and improved teachers ' knowledge about the strategies directed toward responding to the children 's educational needs OBJECTIVE To evaluate the efficacy of a behavioral psychosocial treatment integrated across home and school ( Child Life and Attention Skills Program ) with attention-deficit/hyperactivity disorder ( ADHD ) predominantly inattentive type ( ADHD-I ) . METHOD Sixty-nine children ages 7 to 11 years were r and omized to the Child Life and Attention Skills Program or a control group who did not receive the intervention .  We compared groups posttreatment and at 3- to 5-month follow-up on parent and teacher ratings of inattention , sluggish cognitive tempo , and functional impairment . RESULTS Children r and omized to the Child Life and Attention Skills Program were reported to have significantly fewer inattention and sluggish cognitive tempo symptoms , and significantly improved social and organizational skills , relative to the control group . Gains were maintained at follow-up . CONCLUSIONS Behavioral psychosocial treatment , when specifically adapted for ADHD-I and coordinated among parents , teachers , and children , appears efficacious in reducing symptoms and impairment associated with BACKGROUND National Institute for Health and Care Excellence guidelines recommend a stepped care approach for the identification and management of children with , or at risk of , attention-deficit/hyperactivity disorder ( ADHD ) . We investigated the effectiveness , cost-effectiveness and acceptability of a group parenting intervention programme ( + /- a teacher session ) for children at risk of ADHD . METHODS In a three-arm cluster r and omised controlled trial , 12 primary schools were r and omly assigned to  control , parent-only and combined ( parent + teacher ) intervention arms . Eligible children had high levels of parent-rated hyperactivity/inattention ( n = 199 ) . At 6 month follow-up , the primary outcome measure was the parent-completed Conners ' Rating Scale - Revised ( ADHD index ) . Secondary outcomes included the Conners ' sub-scales ( hyperactivity , cognitive problems/inattention and oppositional behaviour ) , the teacher-completed Conners ' Rating Scale - Revised , child health-related quality of life , parental burden and parental mental health . The cost-effectiveness analyses reflected a health and personal social services perspective . TRIAL REGISTRATION IS RCT N87634685 . RESULTS Follow-up data were obtained from 76 parents and 169 teachers . There was no effect of the parent-only ( mean difference = -1.1 , 95 % CI -5.1,2.9 ; p = 0.57 ) or combined interventions ( mean difference = -2.1 , 95 % CI -6.4,2.1 ; p = 0.31 ) on the ADHD index . The combined intervention was associated with reduced parent-reported hyperactivity symptoms ( mean difference = -5.3 ; 95 % CI -10.5,-0.01 ; p = 0.05 ) and the parent-only intervention with improved parental mental health ( mean difference = -1.9 ; 95 % CI -3.2,-0.5 ; p = 0.009 ) . The incremental costs of the parent-only and the combined interventions were £ 73 and £ 123 , respectively . Above a willingness-to-pay of £ 31 per one-point improvement in the ADHD index , the parent-only programme had the highest probability of cost-effectiveness . Participants found the interventions acceptable . CONCLUSIONS For children at risk of ADHD , this school-based parenting programme was not associated with improvement in core ADHD symptoms . Secondary analyses suggested a possible reduction in parent-reported hyperactivity and parental mental health problems . Future research should compare targeted interventions against watchful waiting and specialist referral The cardinal symptoms of attention-deficit/hyperactivity disorder ( ADHD ) are inattention , hyperactivity and impulsivity . Etiologically , ADHD is mainly put down to genetic causes ; it entails a considerable range of psychosocial problems for those affected and their social environment . The parents of a total of 7,569 boys ( B ) and 7,267 girls ( G ) aged 3 - 17 who took part in the German Health Interview and Examination Survey for Children and Adolescents ( KiGGS ) answered a self-administered question naire including an ADHD diagnosis question and the  Strengths and Difficulties Question naire ( SDQ )  . In addition behavioural observations of 7,919 children ( aged 3 - 11 ) were carried out during the medical and physical tests . Participants whose parents reported that they had ever been given an ADHD diagnosis by a doctor or psychologist were classified as ADHD cases . Participants were classified as suspected cases of ADHD if they had a value of > or = 7 on the SDQ inattention/hyperactivity scale . ADHD had ever been diagnosed in 4.8 % of the children and adolescents altogether ( B : 7.7 % , G : 1.8 % ) . Another 4.9 % of the participants can be considered as suspected cases . Already 1.8 % of the preschoolers had been given an ADHD diagnosis . At primary school age ( 7 - 10 years old ) the frequency of diagnosis rises sharply . At age 11 - 17 , ADHD had ever been diagnosed in 1 in 10 boys and 1 in 43 girls . ADHD had been diagnosed significantly more frequently among participants of low socio-economic status ( SES ) than among participants of high SES . A diagnosis of ADHD is reported less often for migrants , they rank more frequently among the suspected cases . The discrepancy between confirmed and suspected cases of ADHD among migrants may point to lower diagnosis rates or lower utilization of medical services . The short- and long-term medical , social and health-economic effects of ADHD illustrate the major public health relevance of the disorder . As for prevention , the high share of genetic factors in ADHD etiology primarily suggests secondary prevention ( early support and early diagnosis ) and tertiary prevention measures . Further analysis of the KiGGS data could prospect ively identify risk groups more precisely and refine preventional approaches OBJECTIVE Deficits in executive functioning , including working memory ( WM ) deficits , have been suggested to be important in attention-deficit/hyperactivity disorder ( ADHD ) . During 2002 to 2003 , the authors conducted a multicenter , r and omized , controlled , double-blind trial to investigate the effect of improving WM by computerized , systematic practice of WM tasks . METHOD Included in the trial were 53 children with ADHD ( 9 girls ; 15 of 53 inattentive subtype ) , aged 7 to 12 years , without stimulant medication . The compliance criterion ( > 20 days of training ) was met by 44 subjects , 42 of whom were also evaluated at follow-up 3 months later . Participants were r and omly assigned to use either the treatment computer program for training WM or a comparison program . The main outcome measure was the span-board task , a visuospatial WM task that was not part of the training program . RESULTS For the span-board task , there was a significant treatment effect both post-intervention and at follow-up . In addition , there were significant effects for secondary outcome tasks measuring verbal WM , response inhibition , and complex reasoning . Parent ratings showed significant reduction in symptoms of inattention and hyperactivity/impulsivity , both post-intervention and at follow-up . CONCLUSIONS This study shows that WM can be improved by training in children with ADHD . This training also improved response inhibition and reasoning and result ed in a reduction of the parent-rated inattentive symptoms of ADHD This prospect i ve 3 year longitudinal study investigated preschool paternal and maternal parenting predictors of Attention-Deficit/Hyperactivity Disorder(ADHD ) in a community sample of 93 school-age boys . Participants were recruited on the basis of inattention-hyperactivity at age 4 and fathers and mothers were observed interacting with their sons . Teachers , fathers , and mothers reported children 's ADHD symptoms and impairment . Results from dimensional analysis showed that less observed paternal sensitivity and maternal positive regard predicted higher levels of inattentiveness in middle childhood , and that intrusive paternal behavior was predictive of hyperactive-impulsive behavior at school . In categorical analysis , less maternal warmth and sensitivity were predictive of later ADHD . These predictions held after statistical adjustment for the effects of preschool ADHD behaviors and conduct problems . At follow-up , parents of boys with ADHD reported more negative child-parent relationship perceptions than comparison parents . Findings highlight the importance of examining responsive parenting behaviors of both fathers and mothers in relation to multi-informant ratings of ADHD symptoms OBJECTIVE Previous research has demonstrated that peer rejection is a significant part of the clinical presentation of many children with attention-deficit hyperactivity disorder ( ADHD ) . Outcome studies of treatment interventions have typically failed to show generalization of treatment gains to the home and classroom . This has been especially true for children who have comorbid oppositional defiant disorder ( ODD ) . The present study was intended to demonstrate generalization of an outpatient social skills training program when parents were trained in skills relevant to their child 's social adjustment . METHOD Thirty-five children with ADHD and 14 children without ADHD were given  12 sessions of treatment ( treatment group ) . Outcome was compared with 12 children with ADHD and 12 children without ADHD who were on a waitlist for treatment ( waitlist group ) .  Nineteen children with ODD were in the treatment group and five in the waitlist . Stimulant medication was prescribed for all children with ADHD . RESULTS Subjects with ADHD showed improvement comparable with that of subjects without ADHD on all teacher- and parent-reported measures of peer adjustment and social skills , except teacher-reported withdrawal . Children with ODD had outcome comparable with that of children without ODD . Effect sized ranged from 0.93 to 1.34 indicating that the average treatment group subject was better off than 83.4 % of waitlist subjects on outcome measures . CONCLUSIONS The present results suggest that children with ADHD are best heiped by a combination of social skills training for themselves , collateral training for their parents and stimulant medication This multiple baseline study evaluated the efficacy of behavioral parent training ( BPT ) for 12 parents ( M age = 39.17 years ; 91 % mothers ) and their children ( ages 6–12 ; 83 % boys ) both with Attention-Deficit/Hyperactivity Disorder ( ADHD ) , and also explored the acute effect of stimulant medication for parents before and after BPT .  Parents rated their own and their children ’s symptoms and impairment and were stabilized on optimally dosed medication . Then , parents discontinued medication and were r and omly assigned to a 3 , 4 , or 5 week baseline ( BL ) , during which they provided twice-weekly ratings of their impairment , parenting , and their child ’s behavior . Following BL , parents and their children completed two laboratory tasks , once on their optimally dosed medication and once on a placebo to assess observable effects of medication on parent – child behavior , and they completed additional assessment s of family functioning . Parents then completed eight BPT sessions , during which they were unmedicated . Twice-weekly ratings of parent and child behavior were collected during BPT and additional ratings were collected upon completing BPT . Two more parent – child tasks with and without parent medication were conducted upon BPT completion to assess the observable effects of BPT and BPT plus medication . Ten ( 83.33 % ) parents completed the trial .  Improvements in parent and child behavior were observed , and parents reported improved child behavior with BPT . Few benefits of BPT emerged through parent reports of parent functioning , with the exception of inconsistent discipline , and no medication or interaction effects emerged . These results , although preliminary , suggest that some parents with ADHD benefit from BPT . While pharmacological treatment is the most common intervention for adults with ADHD , further examination of psychosocial treatments for adults is needed OBJECTIVE More than 50 % of mothers of children with attention-deficit/hyperactivity disorder ( ADHD ) have a lifetime history of major depressive disorder ( MDD ) . Maternal depressive symptoms are associated with impaired parenting and predict adverse developmental and treatment outcomes for children with ADHD . For these reasons , we developed and examined the preliminary efficacy of an integrated treatment targeting parenting and depressive symptoms for mothers of children with ADHD . This integrated intervention incorporated elements of 2 evidence -based treatments : behavioral parent training ( BPT ) and cognitive behavioral depression treatment . METHOD Ninety-eight mothers with at least mild depressive symptoms were r and omized to receive either st and ard BPT ( n = 51 ) or the integrated parenting intervention for ADHD ( IPI-A ; n = 47 ) . Participants were assessed at baseline , posttreatment , and 3- to 6-month follow-up on measures of ( a ) self-reported maternal depressive symptoms , ( b ) observed positive and negative parenting , and ( c ) observed and mother-reported child disruptive behavior and mother-reported child and family impairment . RESULTS The IPI-A produced effects of small to moderate magnitude relative to BPT  on maternal depressive symptoms , observed negative parenting , observed child deviance , and child impairment at posttreatment and on maternal depressive symptoms , child disruptive behavior , child impairment and family functioning at follow-up . Contrary to expectations , the BPT group demonstrated moderate to large effects relative to IPI-A on observed positive parenting at follow-up . CONCLUSIONS This treatment development study provides encouraging preliminary support for the integrated intervention targeting parenting and depressive symptoms in mothers of children with ADHD . Future studies should examine whether this integrated intervention improves long-term developmental outcomes for children with ADHD . ( PsycINFO Data base Record ( c ) 2013 APA , all rights reserved ) OBJECTIVE This study evaluated the efficacy of the Child Life and Attention Skills ( CLAS ) program , a behavioral psychosocial treatment integrated across home and school , for youth with attention-deficit/hyperactivity disorder-inattentive type ( ADHD-I ) . METHOD In a 2-site r and omized controlled trial , 199 children ( ages 7 - 11 years ) were r and omized to  CLAS ( N = 74 ) , parent-focused treatment ( PFT , N = 74 ) , or treatment as usual ( TAU , N = 51 ) . We compared groups on parent and teacher ratings of inattention symptoms , organizational skills , social skills , and global improvement at posttreatment and also at follow-up during the subsequent school year . RESULTS CLAS result ed in greater improvements in teacher-reported inattention , organizational skills , social skills , and global functioning relative to both PFT and TAU at posttreatment . Parents of children in CLAS reported greater improvement in organizational skills than PFT and greater improvements on all outcomes relative to TAU at posttreatment . Differences between CLAS and TAU were maintained at follow-up for most parent-reported measures but were not significant for teacher-reported outcomes . CONCLUSIONS These findings extend support for CLAS across 2 study sites , revealing that integrating parent , teacher , and child treatment components , specifically adapted for ADHD-I , is superior to parent training alone and to usual care . Direct involvement of teachers and children in CLAS appears to amplify effects at school and home and underscores the importance of coordinating parent , teacher , and child treatment components for cross- setting effects on symptoms and impairment associated with OBJECTIVE To test the hypothesis that multimodal psychosocial intervention , which includes parent training , combined with methylpheni date significantly enhances the behavior of parents of children with attention-deficit/hyperactivity disorder ( ADHD ) , compared with methylpheni date alone and compared with methylpheni date and nonspecific psychosocial treatment ( attention control ) . METHOD One hundred three children with ADHD ( ages 7 - 9 ) , free of conduct and learning disorders , who responded to short-term methylpheni date therapy were r and omized for 2 years to receive either ( 1 ) methylpheni date treatment alone ; ( 2 ) methylpheni date plus psychosocial treatment that included parent training and counseling , social skills training , academic assistance , and psychotherapy ; or ( 3 ) methylpheni date plus attention control treatment . Parents rated their knowledge of parenting principles and negative and positive parenting behavior . Children rated their parents ' behavior . RESULTS Psychosocial treatment led to significantly better knowledge of parenting principles but did not enhance parenting practice s , as rated by parents and children . Significant improvement in mothers ' negative parenting occurred across all treatments and was maintained . CONCLUSIONS In nonconduct-disordered , stimulant-treated children with ADHD , parent training does not improve self-rated parental behavior . The benefits of brief stimulant treatment for negative parental behavior are sustained with extended treatment OBJECTIVE To evaluate two different parent-based therapies for preschool attention-deficit/hyperactivity disorder ( ADHD ) in a community sample . METHOD Three-year-old children displaying a preschool equivalent of ADHD ( n = 78 ) were r and omly assigned to either a parent training ( PT ; n = 30 ) , a parent counseling and support ( PCO&S ; n = 28 ) , or a waiting-list control group ( n = 20 ) . The PT group received coaching in child management techniques . The PC&S group received nondirective support and counseling .  Measures of child symptoms and mothers ' well-being were taken before and after intervention and at 15 weeks follow-up . RESULTS ADHD symptoms were reduced ( F2,74 = 11.64 ; p < .0001 ) and mothers ' sense of well-being was increased by PT relative to both other groups ( F2,74 = 10.32 ; p < .005 ) . Fifty-three percent of children in the PT group displayed clinical ly significant improvement ( chi 2 = 4.08 ; p = .048 ) . CONCLUSIONS PT is a valuable treatment for preschool ADHD . PC&S had little effect on children 's behavior . Constructive training in parenting strategies is an important element in the success of parent-based interventions . Psychostimulants are not a necessary component of effective treatment for many children with preschool ADHD Abstract Objectives . We tested the hypothesis that sleep training would improve emotional , social and behavioural functioning in children with attention-deficit/hyperactivity disorder ( ADHD ) compared to children with ADHD without such intervention and to healthy controls . Methods . Forty children with ADHD were r and omly assigned to intervention and control conditions . Parents of 20 children with ADHD were instructed and thoroughly supervised in improving their children 's sleep schedules and sleep behaviour .  Parents of the other 20 children with ADHD and parents of 20 healthy children  received general information about sleep hygiene . At baseline and 12 weeks later , parents and children completed question naires related to children 's sleep and psychological functioning . Results . Relative to the control groups , children in the intervention group improved sleep quantitatively and qualitatively ( F values < 3.33 , P values < 0.05 ) . The intervention group children reported improvements in mood , emotions , and relationships ( F values < 2.99 , P values < 0.05 ) . Parents reported that their children improved in physical and psychological wellbeing , mood , emotions , relationships , and social acceptance ( F values < 3.02 , P values < 0.05 ) . Conclusions . Training and monitoring parents of children with ADHD in regulating and supervising children 's sleep schedules leads to positive changes in the emotions , behaviour and social lives of these children Objective To investigate the effects of social-skills training and parental training programme for children with attention deficit hyperactivity disorder ( ADHD ) .  Methods We conducted a r and omized two-armed , parallel group , assessor-blinded superiority trial consisting of social-skills training plus parental training and st and ard treatment versus st and ard treatment alone . A sample size calculation showed at least 52 children should be included for the trial with follow up three and six months after r and omization . The primary outcome measure was ADHD symptoms and secondary outcomes were social skills and emotional competences . Results 56 children ( 39 boys , 17 girls , mean age 10.4 years , SD 1.31 ) with ADHD were r and omized , 28 to the experimental group and 27 to the control group . Mixed-model analyses with repeated measures showed that the time course ( y = a + bt + ct2 ) of ADHD symptoms ( p = 0.40 ) , social skills ( p = 0.80 ) , and emotional competences ( p = 0.14 ) were not significantly influenced by the intervention . Conclusions Social skills training plus parental training did not show any significant benefit for children with attention deficit hyperactivity disorder when compared with st and ard treatment . More and larger r and omized trials are needed . Trial Registration Clinical Trials.gov We report findings from a pilot intervention that trained parents to be “ friendship coaches ” for their children with Attention-Deficit/Hyperactivity Disorder ( ADHD ) . Parents of 62 children with ADHD ( ages 6–10 ; 68 % male ) were r and omly assigned to receive the parental friendship coaching ( PFC ) intervention , or to be in a no-treatment control group .  Families of 62 children without ADHD were included as normative comparisons . PFC was administered in eight , 90-minute sessions to parents ; there was no child treatment component . Parents were taught to arrange a social context in which their children were optimally likely to develop good peer relationships . Receipt of PFC predicted improvements in children ’s social skills and friendship quality on play date s as reported by parents , and peer acceptance and rejection as reported by teachers unaware of treatment status . PFC also predicted increases in observed parental facilitation and corrective feedback , and reductions in criticism during the child ’s peer interaction , which mediated the improvements in children ’s peer relationships . However , no effects for PFC were found on the number of play date s hosted or on teacher report of child social skills . Findings lend initial support to a treatment model that targets parental behaviors to address children ’s peer problems The efficacy of a self-help parent training programme for children with attention deficit hyperactivity disorder ( ADHD ) was evaluated . The New Forest Parenting Programme Self-help ( NFPP-SH ) is a 6-week written self-help psychological intervention design ed to treat childhood ADHD . Forty-three children were r and omised to either NFPP-SH intervention or a waiting list control group . Outcomes were child ADHD symptoms measured using question naires and direct observation , self-reported parental mental health , parenting competence , and the quality of parent – child interaction . Measures of child symptoms and parental outcomes were assessed before and after the intervention . ADHD symptoms were reduced , and parental competence was increased by self-help intervention . Forty-five percent of intervention children showed clinical ly significant reductions in ADHD symptoms . Self-help intervention did not lead to improvements in parental mental health or parent – child interaction . Findings provide support for the efficacy of self-help intervention for a clinical sample of children with ADHD symptoms . Self-help may provide a potentially cost-effective method of increasing access to evidence -based interventions for clinical population BACKGROUND For children with attention deficit/hyperactivity disorder ( ADHD ) , a reduction of inattention , impulsivity and hyperactivity by neurofeedback ( NF ) has been reported in several studies . But so far , unspecific training effects have not been adequately controlled for and /or studies do not provide sufficient statistical power . To overcome these method ological shortcomings we evaluated the clinical efficacy of neurofeedback in children with ADHD in a multisite r and omised controlled study using a computerised attention skills training as a control condition . METHODS 102 children with ADHD , aged 8 to 12 years , participated in the study . Children performed either 36 sessions of NF training or a computerised attention skills training within two blocks of about four weeks each ( r and omised group assignment ) . The combined NF treatment consisted of one block of theta/beta training and one block of slow cortical potential ( SCP ) training . Pre-training , intermediate and post-training assessment encompassed several behaviour rating scales ( e.g. , the German ADHD rating scale , FBB-HKS ) completed by parents and teachers . Evaluation ( ' placebo ' ) scales were applied to control for parental expectations and satisfaction with the treatment . RESULTS For parent and teacher ratings , improvements in the NF group were superior to those of the control group . For the parent-rated FBB-HKS total score ( primary outcome measure ) , the effect size was .60 . Comparable effects were obtained for the two NF protocol s ( theta/beta training , SCP training ) . Parental attitude towards the treatment did not differ between NF and control group . CONCLUSIONS Superiority of the combined NF training indicates clinical efficacy of NF in children with ADHD . Future studies should further address the specificity of effects and how to optimise the benefit of NF as treatment module for ADHD OBJECTIVE To assess the impact of maternal attention-deficit/hyperactivity disorder ( ADHD ) symptoms on the effectiveness of a parent training ( PT ) program for preschool ADHD . METHOD Eighty-three 3-year-old children with ADHD and their mothers selected from two community cohorts living in Hampshire , Engl and ( 1992 - 93 and 1995 - 96 , respectively ) , completed an 8-week PT program .  ADHD symptoms and a number of other parent and child factors , including adult ADHD symptoms , were measured prior to the start of treatment ( week 1 : T1 ) , immediately after treatment ( week 8 : T2 ) , and at 15 weeks follow-up ( week 23 : T3 ) . RESULTS Mothers were divided into three groups on the basis of their scores ( T1 ) on the Adult AD/HD Rating Scale ( high , medium , low ) . Children of mothers in the high-ADHD group displayed no improvement after PT , whereas the levels of ADHD symptoms of the children of mothers in either the medium or low ADHD groups reduced substantially ( F(4,60 ) = 3.13 , p < .05 ) . This association persisted after other child and maternal factors were controlled for in multiple regression analyses ( beta > .30 , p < .05 ) . CONCLUSIONS High levels of maternal ADHD symptoms limit the improvement shown by children with ADHD after a program of PT . This effect was unrelated to other aspects of maternal mental health and child functioning . The treatment of parental ADHD may be a prerequisite for the success of psychosocial interventions for childhood ADHD OBJECTIVE To test the hypotheses that in children with attention-deficit/hyperactivity disorder ( ADHD ) ( 1 ) symptoms of ADHD , oppositional defiant disorder , and overall functioning are significantly improved by methylpheni date combined with intensive multimodal psychosocial treatment compared with methylpheni date alone and with methylpheni date plus attention control and ( 2 ) more children receiving combined treatment can be taken off methylpheni date . METHOD One hundred three children with ADHD ( ages 7 - 9 ) , free of conduct and learning disorders , who responded to short-term methylpheni date were r and omized for 2 years to ( 1 ) methylpheni date alone ; ( 2 ) methylpheni date plus psychosocial treatment that included parent training and counseling , social skills training , psychotherapy , and academic assistance , or ( 3 ) methylpheni date plus attention psychosocial control treatment . Assessment s included parent , teacher , and psychiatrist ratings , and observations in academic and gym classes . RESULTS Combination treatment did not lead to superior functioning and did not facilitate methylpheni date discontinuation . Significant improvement occurred across all treatments and continued over 2 years . CONCLUSIONS In stimulant-responsive children with ADHD , there is no support for adding ambitious long-term psychosocial intervention to improve ADHD and oppositional defiant disorder symptoms . Significant benefits from methylpheni date were stable over 2 years The goal of this study was to compare the effects of before school physical activity ( PA ) and sedentary classroom-based ( SC ) interventions on the symptoms , behavior , moodiness , and peer functioning of young children ( Mage = 6.83 ) at risk for attention-deficit/hyperactivity disorder ( ADHD-risk ; n = 94 ) and typically developing children ( TD ; n = 108 ) . Children were r and omly assigned to either PA or SC and participated in the assigned intervention 31 min per day , each school day , over the course of 12 weeks . Parent and teacher ratings of ADHD symptoms ( inattention , hyperactivity/impulsivity ) , oppositional behavior , moodiness , behavior toward peers , and reputation with peers , were used as dependent variables . Primary analyses indicate that the PA intervention was more effective than the SC intervention at reducing inattention and moodiness in the home context . Less conservative follow-up analyses within ADHD status and intervention groups suggest that a PA intervention may reduce impairment associated with ADHD-risk in both home and school domains ; interpretive caution is warranted , however , given the liberal approach to these analyses . Unexpectedly , these findings also indicate the potential utility of a before school SC intervention as a tool for managing ADHD symptoms . Inclusion of a no treatment control group in future studies will enable further underst and ing of PA as an alternative management strategy for ADHD symptoms Fathers , in general , have been underrepresented in studies of parent training outcome for children with attention deficit hyperactivity disorder ( ADHD ) , and the present study aim ed to investigate the efficacy of a behavioral parent training program developed expressly for fathers . The present investigation r and omly assigned 55 fathers of children ages 6 to 12 with ADHD to the Coaching Our Acting-out Children :  Heightening Essential Skills ( COACHES ) program or a waitlist control group . Outcomes for the study included objective observations of parent behaviors and parent ratings of child behavior . Results indicated that fathers in the COACHES group reduced their rates of negative talk and increased rates of praise as measured in parent – child observations , and father ratings of the intensity of problem behaviors were reduced , relative to the waitlist condition . Groups did not differ on observations of use of comm and s or father ratings of child behavior problems . Untreated mothers did not significantly improve on observational measures or behavioral ratings . This study provides preliminary evidence for the efficacy of the COACHES parenting program for fathers of children with ADHD . Results are cast in light of the larger literature on behavioral parent training for ADHD as well as how to best work with fathers of children with ADHD in treatment context BACKGROUND Cogmed Working Memory Training ( CWMT ) has received considerable attention as a promising intervention for the treatment of Attention-Deficit/Hyperactivity Disorder ( ADHD ) in children . At the same time , method ological weaknesses in previous clinical trials call into question reported efficacy of CWMT . In particular , lack of equivalence in key aspects of CWMT ( i.e. , contingent reinforcement , time-on-task with computer training , parent-child interactions , supportive coaching ) between CWMT and placebo versions of CWMT used in previous trials may account for the beneficial outcomes favoring CWMT . METHODS Eighty-five 7- to 11-year old school-age children with ADHD ( 66 male ; 78 % ) were r and omized to either st and ard CWMT ( CWMT Active ) or a well-controlled CWMT placebo condition ( CWMT Placebo ) and evaluated before and 3 weeks after treatment . Dependent measures included parent and teacher ratings of ADHD symptoms ; objective measures of attention , activity level , and impulsivity ; and psychometric indices of working memory and academic achievement ( Clinical trial title : Combined cognitive remediation and behavioral intervention for the treatment of Attention-Deficit/Hyperactivity Disorder ; http:// clinical trials.gov/ct2/show/NCT01137318 ) . RESULTS CWMT Active participants demonstrated significantly greater improvements in verbal and nonverbal working memory storage , but evidence d no discernible gains in working memory storage plus processing/manipulation . In addition , no treatment group differences were observed for any other outcome measures . CONCLUSIONS When a more rigorous comparison condition is utilized , CWMT demonstrates effects on certain aspects of working memory in children with ADHD ; however , CWMT does not appear to foster treatment generalization to other domains of functioning . As such , CWMT should not be considered a viable treatment for children with ADHD Methods : Various developmental problems including attention-deficit/hyperactivity disorder ( ADHD ) have been linked to biological deficiencies in polyunsaturated fatty acids ( PUFAs ) . Additionally , there is evidence that symptoms may be reduced with PUFA supplementation . This study investigated effects of supplementation with PUFAs on symptoms typically associated with ADHD . Because nutrients work synergistically , additional effects of micronutrient supplementation were also investigated . A total of 132 Australian children aged 7 to 12 years with scores ≥2 SD above the population average on the Conners ADHD Index participated in a r and omized , placebo-controlled , double-blind intervention over 15 weeks , taking PUFAs alone , PUFAs + micronutrients , or placebo . Due to unreturned question naires , data were only available for 104 children . Results : Significant medium to strong positive treatment effects were found on parent ratings of core ADHD symptoms , inattention , hyperactivity/impulsivity , on the Conners Parent Rating Scale ( CPRS ) in both PUFA treatment groups compared with the placebo group ; no additional effects were found with the micronutrients . After a one-way crossover to active supplements in all groups for a further 15 weeks , these results were replicated in the placebo group , and the treatment groups continued to show significant improvements on CPRS core symptoms . No significant effects were found on Conners Teacher Rating Scales . Conclusion : These results add to preliminary findings that ADHD-related problems with inattention , hyperactivity , and impulsivity might respond to treatment with PUFAs and that improvements may continue with supplementation extending to 30 weeks OBJECTIVE To test the hypothesis that intensive multimodal psychosocial intervention ( that includes academic assistance and psychotherapy ) combined with methylpheni date significantly enhances the academic performance and emotional status of children with attention-deficit/hyperactivity disorder ( ADHD ) compared with methylpheni date alone and with methylpheni date combined with nonspecific psychosocial treatment ( attention control ) . METHOD One hundred three children with ADHD ( ages 7 - 9 ) , free of conduct and learning disorders , who responded to short-term methylpheni date were r and omized for 2 years to receive one of three treatments : ( 1 ) methylpheni date alone , ( 2 ) methylpheni date plus psychosocial treatment that included academic remediation , organizational skills training , and psychotherapy as well as parent training and counseling and social skills training , or ( 3 ) methylpheni date plus attention control treatment . Children 's function was assessed through academic testing , parent ratings of homework problems , and self-ratings of depression and self-esteem . RESULTS No advantage was found on any measure of academic performance or emotional status for the combination treatment over methylpheni date alone and over methylpheni date plus attention control . Significant improvement occurred across all treatments and was maintained over 2 years . CONCLUSIONS In stimulant-responsive young children with ADHD without learning and conduct disorders , there is no support for academic assistance and psychotherapy to enhance academic achievement or emotional adjustment . Significant short-term improvements were maintained over 2 years BACKGROUND There is a pressing need for cost-effective population -based interventions to tackle early-onset antisocial behaviour . As this is determined by many factors , it would seem logical to devise interventions that address several influences while using an efficient means of delivery . The aim of this trial was to change four risk factors that predict poor outcome : ineffective parenting , conduct problems , attention deficit/hyperactivity disorder ( ADHD ) symptoms , and low reading ability . METHODS A r and omised controlled trial was carried out in eight schools in London , Engl and . Nine hundred and thirty-six ( 936 ) 6-year-old children were screened for antisocial behaviour , then parents of 112 high scorers were r and omised to parenting groups held in schools or control ; 109 were followed up a year later . The intervention lasted 28 weeks and was novel as it had components to address both child behaviour ( through the Incredible Years programme ) and child literacy ( through a new ' SPOKES ' programme to help parents read with their children ) . Fidelity of implementation was emphasised by careful training of therapists and weekly supervision . Controls received an information helpline . Assessment of conduct problems was by parent interview , parenting by direct observation and child reading by psychometric testing . RESULTS At follow-up parents allocated to the intervention used play , praise and rewards , and time out more often than controls , and harsh discipline less ; effect sizes ranged from .31 to .59 sd ( p-values .046 to .005 ) . Compared to control children , whose behaviour did n't change , intervention children 's conduct problems reduced by .52sd , ( p < .001 ) , dropping from the 80th to the 61st percentile ; oppositional-defiant disorder ( ODD ) halved from 60 % to 31 % ( p = .003 ) . ADHD symptoms reduced by .44sd ( p = .002 ) , and reading age improved by six months ( .36sd , p = .027 ) . Teacher-rated behaviour did n't change . The programme cost pound2,380 ( $ 3,800 ) per child . CONCLUSIONS Effective population -based early intervention to improve the functioning of with antisocial behaviour is practically feasible by targeting multiple risk factors and emphasising implementation fidelity OBJECTIVE To describe the rationale , methodology , and sample characteristics of a dual-site treatment study ( New York and Montreal ) of children with attention-deficit/hyperactivity disorder ( ADHD ) conducted between 1990 and 1995 . The hypotheses were that ( 1 ) methylpheni date combined with comprehensive multimodal psychosocial treatment was superior to methylpheni date alone in improving multiple functions and ( 2 ) the efficacy of the psychosocial intervention result ed from its specific components and not from nonspecific treatment effects . METHOD One hundred three children with ADHD ( ages 7 - 9 ) , free of conduct and learning disorders , who responded to methylpheni date , were r and omized for 2 years to ( 1 ) methylpheni date treatment alone ; ( 2 ) methylpheni date combined with multimodal psychosocial treatment that included parent training and counseling , academic assistance , psychotherapy , and social skills training ; or ( 3 ) methylpheni date plus attention control treatment that excluded specific aspects of the psychosocial intervention . Children were switched to single-blind placebo after 12 months ; methylpheni date was reinstituted when clinical ly indicated . Assessment s included ratings by parents , teachers , children , and psychiatrists ; school observations in academic and gym classes ; and academic performance tests . Almost 80 % of families completed the 2-year study . Companion papers present treatment effects . CONCLUSIONS A comprehensive 2-year psychosocial treatment was delivered successfully to children with ADHD and their families OBJECTIVES : Medication management of attention-deficit/hyperactivity disorder ( ADHD ) is often suboptimal . We examined whether ( 1 ) brief physician training plus computer-assisted medication management led to greater reduction in ADHD symptoms and ( 2 ) adherence to the recommended titration protocol produced greater symptomatic improvement . METHODS : A r and omized medication trial was conducted that included 24 pediatric practice s. Children who met criteria for ADHD were r and omly assigned by practice to treatment-as-usual or a specialized care group in which physicians received 2 hours of didactic training on medication management of ADHD plus training on a software program to assist in monitoring improvement . Parent and teacher reports were obtained before treatment and 4 , 9 , and 12 months after starting medication . RESULTS : Children in both specialized care and treatment-as-usual groups improved on the ADHD Rating Scales and SNAP-IV , but there were no group differences in improvement rates . Brief physician training alone did not produce improvements . When recommended titration procedures were followed , however , outcomes were better for total and inattentive ADHD symptoms on both the ADHD Rating Scales and SNAP-IV parent and teacher scales . Results were not attributable to discontinuation because of adverse effects or failure to find an effective medication dose . CONCLUSIONS : Brief physician training alone did not lead to reductions in ADHD symptoms , but adherence to a protocol that involved titration until the child 's symptoms were in the average range and had shown a reliable change led to better symptom reduction . Computer-assisted medication management can contribute to better treatment outcomes in primary care medication treatment of ADHD ABSTRACT . The objective of this study was to evaluate the effectiveness of an 8-week behavioral and social skill ( BSS ) class for children newly diagnosed with attention-deficit hyperactivity disorder ( ADHD ) and their parents , initiating stimulant treatment in primary care . The subjects were 100 children , aged 5 to 12 years , recently diagnosed with ADHD and treated with stimulant medication , and their parents or guardians . Eligible families were r and omly assigned to an intervention group ( IG : n = 59 ) or control group ( CG : n = 41 ) . The BSS function of each child was assessed using DuPaul ’s ADHD Parent Rating Scale ( 18-item ) and Child Attention Profile ( 12-item ) during blinded baseline and follow-up interviews . Parent discipline practice was assessed using a five-item inventory based on Likert-scale ratings during identical periods . Computerized pharmacy records were used to track psychostimulant use over time . IG children exhibited significantly lower parent-rated ADHD symptoms , whereas IG parents reported significantly better and more consistent discipline practice s compared with CG parents across time . No significant differences were found between groups in Child Attention Profile scores across time . Psychostimulant use did not significantly differ between groups across time .  BSS training  was well accepted and seemed to significantly improve BSS functioning among IG children in the home setting only BACKGROUND Learned self-control of slow cortical potentials ( SCPs ) may lead to behavioral improvement in attention-deficit/hyperactivity disorder ( ADHD ) . Hence , training effects should also be reflected at the neurophysiological level . METHODS Thirteen children with ADHD , aged 7 - 13 years , performed 25 SCP training sessions within 3 weeks . Before and after training , the German ADHD rating scale was completed by parents , and event-related potentials were recorded in a cued continuous performance test ( CPT ) . For a waiting-list group of nine children with ADHD , the same testing was applied . RESULTS ADHD symptomatology was reduced by approximately 25 % after SCP training . Moreover , a decrease of impulsivity errors and an increase of the contingent negative variation were observed in the CPT task . CONCLUSIONS This study provides first evidence for both positive behavioral and specific neurophysiological effects of SCP training in children with ADHD OBJECTIVE Impairments associated with attention-deficit/hyperactivity disorder ( ADHD ) and noncompliance are prevalent in children with autism spectrum disorder ( ASD ) . However , ADHD response to stimulants is well below rates in typically developing children , with frequent side effects . Group studies of treatments for noncompliance are rare in ASD . We examined individual and combined-effectiveness of atomoxetine ( ATX ) and parent training ( PT ) for ADHD symptoms and noncompliance . METHOD In a 3-site , 10-week , double-blind , 2 × 2 trial of ATX and PT , 128 children ( ages 5 - 14 years ) with ASD and ADHD symptoms were r and omized to  ATX , ATX+PT , placebo+PT , or placebo . ATX was adjusted to optimal dose ( capped at 1.8 mg/kg/day ) over 6 weeks and maintained for 4 additional weeks . Nine PT sessions were provided . Primary outcome measures were the parent-rated DSM ADHD symptoms on the Swanson , Nolan and Pelham ( SNAP ) scale and Home Situations Question naire ( HSQ ) . RESULTS On the SNAP , ATX , ATX+PT and placebo+PT were each superior to placebo ( effect sizes 0.57 - 0.98 ; p values of .0005 , .0004 , and .025 , respectively ) . For noncompliance , ATX and ATX+PT were superior to placebo ( effect sizes 0.47 - 0.64 ; p values .03 and .0028 , respectively ) . ATX was associated with decreased appetite but was otherwise well tolerated . CONCLUSION Both ATX and PT result ed in significant improvement on ADHD symptoms , whereas ATX ( both alone and combined with PT ) was associated with significant decreases on measures of noncompliance . ATX appears to have a better side effects profile than psychostimulants in the population with ASD . CLINICAL TRIAL REGISTRATION INFORMATION Atomoxetine , Placebo and Parent Management Training in Autism ; http:// clinical trials.gov/ ; NCT00844753 Objective . This study examined the efficacy of 2 computer-based training systems to teach children with attention deficit/hyperactivity disorder ( ADHD ) to attend more effectively . Design / methods . A total of 41 children with ADHD from 2 middle schools were r and omly assigned to receive 2 sessions a week at school of either neurofeedback ( NF ) or attention training through a st and ard computer format ( SCF ) , either immediately or after a 6-month wait ( waitlist control group ) . Parents , children , and teachers completed question naires pre- and postintervention . Results . Primary parents in the NF condition reported significant ( P < .05 ) change on Conners ’s Rating Scales — Revised ( CRS-R ) and Behavior Assessment Scales for Children ( BASC ) subscales ; and in the SCF condition , they reported significant ( P < .05 ) change on the CRS-R Inattention scale and ADHD index , the BASC Attention Problems Scale , and on the Behavioral Rating Inventory of Executive Functioning ( BRIEF ) . Conclusion . This r and omized control trial provides preliminary evidence of the effectiveness of computer-based interventions for ADHD and supports the feasibility of offering them in a school setting PROBLEM What is the effectiveness of a stress-management program on self-concept , locus of control , and acquisition of appropriate coping strategies in children with attention deficit hyperactivity disorder ( ADHD ) ? METHODS Forty-two children with ADHD ( age range 9 - 12 ) were r and omly assigned to a control group , a therapist-led group , or a group in which the stress-management techniques were taught by the parents . The subjects were pre- and posttested on self-concept , locus of control , and acquisition of coping skills . FINDINGS Although there were no significant changes in any of the three groups for acquisition of coping skills , the children in the therapist-led group reported more appropriate coping strategies . CONCLUSIONS Involving parents in a cognitive-behavioral approach could improve  parent-child relationships and further increase the opportunities for successful academic and social functioning OBJECTIVE Many geographic locations are without services and staff available to provide treatment for children with attention deficit hyperactivity disorder ( ADHD ) . This is a r and omized controlled trial to evaluate the effectiveness of group parent training on ADHD treatment delivered via videoconferencing . SUBJECTS AND METHODS Twenty-two subjects were enrolled in the study , with 9 subjects in the videoconference session ( treatment group ) and 13 in the face-to-face session ( control group ) . The parent child relationship question naire for child and adolescents ( PCQ-CA ) , V and erbilt assessment scales ( parent and teacher versions ) , children global assessment scale , clinical global impression-severity score , clinical global impression-improvement score , and social skills rating system assessed the effectiveness of the treatment . A Likert scale evaluated parents ' acceptance of the training modality . Our results showed that the parent training program significantly improved parents ' disciplinary practice s based on the PRQ-CA , parent ratings of ADHD , oppositional defiant disorder , and conduct disorder symptoms , and the children 's global functioning . RESULTS The treatment effects did not differ between the videoconference and face-to-face groups ; however , the videoconference group evidence d statistically greater improvement on the hyperactive symptoms of V and erbilt assessment scales . Our findings suggest that parent training through a videoconferencing modality may be as effective as face-to-face training and is well accepted by parents . CONCLUSIONS Parent training via videoconferencing may be an important tool for addressing ADHD in geographic locations that do not have access to appropriate treatment providers The current study was design ed to investigate the changes that occur in depression , anxiety , obsessive — compulsive symptoms and health-related quality of life during methylpheni date ( MPH ) treatment in children with attention-deficit hyperactivity disorder ( ADHD ) . Forty-five treatment naive children with ADHD , aged 8—14 , were assessed based on self , parent and teacher reports at the baseline and at the end of the first and third month of MPH treatment regarding changes in inattention , hyperactivity , impulsivity , depression , anxiety and obsessive — compulsive symptoms . Changes in the quality of life were also noted . Repeated measures of analysis of variance ( ANOVA ) tests with Bonferroni corrections were conducted in order to evaluate the data . Symptoms of inattention , hyperactivity and impulsivity were significantly reduced ( p < 0.017 ) following a three-month MPH treatment . There were significant decreases in depression ( p = 0.004 ) , trait anxiety ( p = 0.000 ) and checking compulsion symptom scores ( p = 0.001 ) . Moreover , parents reported significant improvements in psychosocial ( p = 0.001 ) and total scores ( p = 0.009 ) of quality of life , despite no change in physical health scores ( p > 0.05 ) . Children ’s ratings of quality of life measures showed no significant changes in physical health and psychosocial scores ( p > 0.05 ) , while total scores significantly improved ( p = 0.001 ) after the treatment . Over a three-month MPH treatment , depression , trait anxiety and checking compulsion symptoms decreased and quality of life seemed to improve along with those of inattention , hyperactivity and impulsivity This study evaluates the initial efficacy of the Parent-Child Interaction Therapy ( PCIT ) for Puerto Rican preschool children aged 4 - 6 years with a diagnosis of attention-deficit/hyperactivity disorder ( ADHD ) , combined or predominantly hyperactive type , and significant behavior problems . Thirty-two families were r and omly assigned to PCIT ( n = 20 ) or a 3.5-month waiting-list condition ( WL ; n = 12 ) . Participants from both groups completed pretreatment and posttreatment assessment s. Outcome measures included child 's ADHD symptoms and behavior problems , parent or family functioning , and parents ' satisfaction with treatment . ANCOVAs with pretreatment measures entered as covariates were significant for all posttreatment outcomes , except mother 's depression , and in the expected direction ( p < .01 ) . Mothers reported a highly significant reduction in pretreatment hyperactivity and inattention and less aggressive and oppositional-defiant behaviors , conduct problems assessed as problematic , parenting stress associated with their child 's behavior , and an increase in the use of adequate parenting practice s. For the WL group , there were no clinical ly significant changes in any measure . Treatment gains obtained after treatment were maintained at a 3.5-month follow-up assessment . PCIT seems to be an efficacious intervention for Puerto Rican families who have young children with significant behavior problems OBJECTIVE To evaluate the effects of atomoxetine alone and in combination with behavior therapy on the school functioning of children with attention-deficit/hyperactivity disorder ( ADHD ) . Most atomoxetine studies have not assessed school functioning other than by measuring the change in ADHD symptoms . Combining behavior therapy with atomoxetine may be particularly beneficial for the academic domain as medication has not been found to produce sustained benefits in this realm . However , there is little research examining the effects of combining atomoxetine and behavior therapy . METHOD In an 8-week open-label trial , 56 children aged 6 - 12 years with ADHD diagnosed according to DSM-IV-TR were r and omly assigned to receive  atomoxetine and behavior therapy or atomoxetine alone . Behavior therapy consisted of an 8-week parenting course , a child social skills course , and a teacher-implemented daily report card of classroom behavior . The primary outcome was direct observation of the subject 's classroom behavior . Secondary outcomes included change in ADHD symptoms and functioning at home and school . All data were collected between March 2007 and May 2008 . RESULTS Classroom observations showed that atomoxetine decreased rule violations ( P < .0001 ) . Moreover , atomoxetine was associated with significant improvements in ADHD and oppositional defiant disorder symptoms at home and school and enhanced functioning in both domains ( Impairment Rating Scale : all P < .001 ) . Combined treatment led to greater improvements in parent-rated symptoms of inattention ( P < .01 ) , problem behaviors ( P < .001 ) , and academic impairment ( P < .05 ) . However , teachers did not report significant group differences . CONCLUSIONS Atomoxetine improved ADHD symptoms and classroom functioning as measured by parents , teachers , and direct observation . The addition of behavior therapy led to further improvements at home but not at school . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00918567 Behavioral parent training is an efficacious treatment for attention-deficit/hyperactivity disorder ( ADHD ) . However , single-mother households are at high risk for poor outcomes during and following behavioral parent training . This study r and omly assigned cohorts of 120 single mothers of children ( ages 5–12 years ) with ADHD to a waitlist control group , a traditional behavioral parent training program , or an enhanced behavioral parent training program — the Strategies to Enhance Positive Parenting (  STEPP )  program . Intent-to-treat analysis demonstrated benefits of participating in behavioral parent training , in general , and the STEPP program more specifically at immediate posttreatment on child and parental functioning . Moreover , the STEPP program result ed in increased engagement to treatment . However , results indicated that behavioral parent training does not normalize behavior for most children and treatment gains are not maintained Abstract Background : Different treatment approaches aim ed at reducing attention-deficit/hyperactivity disorder ( ADHD ) core symptoms are available . However , factors such as intolerance , side-effects , lack of efficacy , high new technology costs , and placebo effect have spurred on an increasing interest in alternative or complementary treatment . Aim : The aim of this study is to explore efficacy of multimodal treatment consisting of st and ard stimulant medication ( methylpheni date ) and neurofeedback ( NF ) in combination , and to compare it with the single treatment in 6-month follow-up in ADHD children and adolescents . Methods : This r and omized controlled trial with 6-month follow-up comprised three treatment arms : multimodal treatment ( NF + MED ) , MED alone , and NF alone .  A total of 130 ADHD children/adolescents participated , and 62 % completed the study .  ADHD core symptoms were recorded pre-/post-treatment , using parents ’ and teachers ’ forms taken from Barkley ’s Defiant Children : A Clinician ’s Manual for Assessment and Parent Training , and a self-report question naire . Results : Significant ADHD core symptom improvements were reported 6 months after treatment completion by parents , teachers , and participants in all three groups , with marked improvement in inattention in all groups . However , no significant improvements in hyperactivity or academic performance were reported by teachers or self-reported by children/adolescents , respectively , in the three groups . Changes obtained with multimodal treatment at 6-month follow-up were comparable to those with single medication treatment , as reported by all participants . Conclusions : Multimodal treatment using combined stimulant medication and NF showed 6-month efficacy in ADHD treatment . More research is needed to explore whether multimodal treatment is suitable for ADHD children and adolescents who showed a poor response to single medication treatment , and for those who want to reduce the use of stimulant medication Background In this research the symptom improvement of attention-deficit hyperactivity disorder ( ADHD ) of children was assessed by oral vitamin D administration  in Tabriz , Iran . Methods In this double-blind , r and omized clinical trials , 96 children ( 2–18 years ) were enrolled to placebo and vitamin D groups . Children took vitamin D pearl ( 50,000 IU/week ) or placebo for 6 weeks . Children , who had the change in methylpheni date dosage and received any anticonvulsants and corticosteroids were excluded from the research . ADHD symptoms were diagnosed by Conners parent rating scale ( CPRS ) test at baseline and after intervention . ADHD Conners divided into inattention ( IA ) , hyperactivity/impulsivity ( H/I ) and combination type ( C ) subscales .  Vitamin D serum level was assessed at baseline and after 8 weeks in both groups . Results The differences between CPRS and its subscales were not significant at baseline ( P > 0.05 ) . The Conners IA score was decreased in vitamin D group ( P < 0.05 ; adjusted with age and baseline values ) . ADHD Conners and all subscale scores reduced remarkably after intervention in patients with insufficient level of vitamin D compared to placebo ( P < 0.05 ) . Conclusions Oral vitamin D  improved ADHD symptoms with a particular effect on inattention symptoms . In addition , symptoms related to all subscales were improved remarkably in patients with insufficient level of vitamin D. Vitamin D treatment in children with ADHD could be considered due to the exp and benefit of vitamin D in body OBJECTIVE To test that methylpheni date combined with intensive multimodal psychosocial intervention , which includes social skills training , significantly enhances social functioning in children with attention-deficit/hyperactivity disorder ( ADHD ) compared with methylpheni date alone and methylpheni date plus nonspecific psychosocial treatment ( attention control ) . METHOD One hundred three children with ADHD ( ages 7 - 9 ) , free of conduct and learning disorders , who responded to short-term methylpheni date were r and omized for 2 years to receive ( 1 ) methylpheni date alone , ( 2 ) methylpheni date plus multimodal psychosocial treatment that included social skills training , or ( 3 ) methylpheni date plus attention control treatment . Assessment s included parent , child , and teacher ratings of social function and direct school observations in gym . RESULTS No advantage was found on any measure of social functioning for the combination treatment over methylpheni date alone or methylpheni date plus attention control . Significant improvement occurred across all treatments and continued over 2 years . CONCLUSIONS 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 . Significant benefits from methylpheni date were stable over 2 years Objective . To evaluate the quality of life ( QOL ) of untreated children with newly diagnosed attention-deficit/hyperactivity disorder ( ADHD ) , compared with asthmatic and healthy children . Methods . This prospect i ve , case-control study included a group of 120 children , 6 to 12 years of age , with newly diagnosed ADHD according to the Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition . Subjects were matched according to age , gender , and health care area with 2 control groups , ie , 93 asthmatic children and 120 healthy children . Sociodemographic characteristics and Child Health Question naire scores were collected . Results . The QOL of children with ADHD was rated worse than that of asthmatic or healthy children for most Child Health Question naire domains . The greatest differences were found in behavior , social limitations attributable to physical problems , emotional impact on parents , and family activities . Almost every psychosocial domain was more affected in comparison with asthmatic children and both psychosocial and physical domains in comparison with healthy children . Conclusions . ADHD interferes with the daily lives of children , parents , and families even more than asthma , primarily in areas related to psychosocial functioning , although evidence of impaired physical functioning also emerged . Delays in recognition , assessment , and management of ADHD may affect negatively the QOL of those children BACKGROUND While the use of stimulant medication as a treatment for children with attention deficit hyperactivity disorder ( ADHD ) has been the most studied therapy in child psychiatry , there is debate about its use with young children . This study describes a series of cases seen in a normal clinical context , treated with one of four different treatment programmes . METHODS Sixteen pre-school children diagnosed with ADHD and their parents were r and omly assigned to receive one of four treatments : ( 1 ) 0.3 mg/kg methylpheni date , parent training programme ; ( 2 ) 0.3 mg/kg methylpheni date , parent support programme ; ( 3 ) placebo medication , parent training ; and ( 4 ) placebo medication , parent support . Changes were assessed at the individual level , using clinical observations , parent and teacher rating scales and measures of parenting and family factors . RESULTS Children were more likely to improve when the treatment involved at least one active component ( medication or parent training ) . However , there was notable variability in individual parental and child participants ' responses to all treatment conditions , indicating the importance of interactions between treatment variables and other factors . CONCLUSIONS Findings are discussed within the framework of a transactional model , and inferences are drawn about the limitations of the idea that there is a ' best treatment ' that is universally applicable
In this latter study , outcomes were better for girls and for children on medication .
Positive results on an inventory of child behaviour problems were reported for one small study ( n = 24 ) with the caveat that results were only positive when parent training was delivered to individuals and not groups .
Results for this outcome from a small study ( n = 24 ) suggested a long-term benefit for mothers who received the intervention at an individual level ; in contrast , fathers benefited from short-term group treatment .
Parent training may have a positive effect on the behaviour of children with ADHD .
It may also reduce parental stress and enhance parental confidence .
BACKGROUND Attention Deficit Hyperactivity Disorder ( ADHD ) is a neurodevelopmental disorder characterised by high levels of inattention , hyperactivity and impulsivity that are present before the age of seven years , seen in a range of situations , inconsistent with the child 's developmental level and causing social or academic impairment .
Parent training programmes are psychosocial interventions aim ed at training parents in techniques to enable them to manage their children 's challenging behaviour .
OBJECTIVES To determine whether parent training interventions are effective in reducing ADHD symptoms and associated problems in children aged between five and eigtheen years with a diagnosis of ADHD , compared to controls with no parent training intervention .