Also in this Issue:
-
Preventing
Drug Abuse in Schools
-
Reading Disability and
Problem Behaviours
-
Is Increased Income a Protective
Factor against Violence?
-
Youth Victimization, Suicide
and Violence
-
Effects of Family and Friends
on Antisocial Behaviour in Youth
-
Services for Families in
School Settings
-
Adult Criminal Behaviour
can be Predicted
-
Early Onset Delinquency
may be Genetically Determined
-
The Effects of Bullying
Behaviours on Primary School Children
ADHD:
The Latest Research Findings 
By: Dr.
L.Bassarath*
 This
is a report of a large study conducted at six centers to determine the
effectiveness of four treatment conditions in ADHD children. The
four conditions were:
- Medication only:
Dose of the medication was adjusted according to the feedback from the
teacher and the parent.
- Psychosocial treatment
only: It consisted of parent training, school intervention which
included helping teachers to implement behavioural principles. There
was a summer program aimed at social skills training and small-group
sports skills.
- Medication & Psychosocial
treatment.
- A comparison group of
community-based treatment: Most children received medication.
All children
whose results are reported below had ADHD.
Results
- All four types of treatments
led to improvement.
- There was not much difference
in the degree of improvement with medication only and medication &
psychosocial treatment.
- Medication only and medication
& psychosocial treatment were superior to psychosocial treatment
only and community based treatment.
- There was not much difference
in the degree of improvement between psychosocial treatment alone and
community based treatment.
- Medication & Psychosocial
treatment was the only condition, which was consistently better than
community-based treatment although the difference was small.
- Children with anxiety did
better if treatment included behaviour therapy.
- Children with Oppositional
Defiant Disorder (ODD) or Conduct Disorder (CD) did best with medication
treatment with or without psychosocial treatment.
- Children with anxiety, ODD
and CD responded best to medication plus psychosocial treatment.
There
were other findings besides the effectiveness of treatments, which included
the following:
- 20% of ADHD children had
one parent who was considered "hyperactive" as a child. The
authors suggested that this indicated that there is a genetic component
in the development of the disorder. It is also suggested that the parents
of ADHD children should also be assessed and treated for their own symptoms.
- It was found that father's
who attributed lack of effort and bad mood as being the reason for their
ADHD child's lack of compliance to treatment, had poor success. Fathers
more than mothers who felt less capable as parents of handling their
difficult child had poor results.
- Mothers who had poor self-esteem
tend to have poor results.
- Practices such as yelling,
spanking, giving in, poor follow through, lecturing, and multiple warnings
are associated with a negative outcome. Ineffective parenting (physical
discipline, inconsistency and poor follow through), not only leads to
poor results in treatment of ADHD but also to the development of antisocial
behaviour.
- Communication and coordination
of school behavioural practices and parenting strategies with the use
of medication leads to not only in the improvement in the symptoms of
ADHD but also in child's social functioning.
- Children with ADHD plus
Oppositional Defiant Disorder were more impulsive than inattentive.
- Children with ADHD plus
Anxiety Disorder were more inattentive than impulsive.
- Girls with ADHD were less
impaired on most items than boys with ADHD.
References
- 1. MTA Cooperative Group
(1999).
- A 14-month randomized
clinical trial of treatment strategies for Attention Deficit Hyperactivity
Disorder (ADHD). Archives of General Psychiatry, 56, pp1073-1086.
- 2. Epstein JN, Conners
CK, Erhardt D, Arnold LE, Hechtman L, Hinshaw SP and others.
- Familial aggregation
of ADHD characteristics. Journal of Abnormal Child Psychology, 2000,
Vol 28, Iss 6, pp585-594.
- 3. Hoza B, Owens JS,
Pelham WE, Swanson JM, Conners CK, Hinshaw SP and others.
- Parent cognitions as
predictors of child treatment response in attention-deficit/hyperactivity
disorder. Journal of Abnormal Child Psychology, 2000, Vol 28, Iss
6, 569-583.
- 4. Hinshaw SP, Owens
EB, Wells KC, Kraemer HC, Abikoff HB, Arnold LE, Conners CK, Elliott,
G, Greenhill, LL, Hechtman L and others.
- Family processes and
treatment outcome in the MTA: Negative/ineffective parenting practices
in relation to multimodal treatment. Journal of Abnormal Child Psychology,
2000, Vol 28, Iss 6, pp555-568.
- 5. Wells KC, Epstein
JN, Hinshaw SP, Conners, CK, Klaric J, Abikoff HB, Abramowitz A and
others.
- Parenting and family
stress treatment outcomes in Attention Deficit Hyperactivity Disorder
(ADHD): An empirical analysis in the MTA study. Journal of Abnormal
Psychology, 2000 Vol 28, Iss6, pp543-553. 6. March JS, Swanson JM,
Arnold LE, Hoza B, Conners CK, Hinshaw SP, Hechtman L and others. Anxiety
as a predictor and outcome variable in the multimodal treatment study
of children with ADHD (MTA). Journal of Abnormal Child Psychology,
2000, Vol 28, Iss 6, pp527-541. 7.
Pelham WE, Gnagy EM, Greiner AR, Hoza B, Hinshaw SP, Swanson JM, Simpson
S, Shapiro C and others. Behavioural versus behavioural and pharmacological
treatment in ADHD children attending a summer treatment program. Journal
of Abnormal Child Psychology, 2000, Vol 28, Iss 6, pp507-525.
- 8. Barkley RA.
- Commentary on the multimodal
treatment study of children with ADHD. Journal of Abnormal Child
Psychology, 2000, Vol 28, Iss 6, pp595-599.
- 9. Wells KC, Pelham WE,
Kotkin RA, Hoza B, Abikoff HB, Abramowitz A and others.
- Psychosocial treatment
strategies in the MTA study: Rationale, methods, and critical issues
in design and implementation. Journal of Abnormal Child Psychology,
2000, Vol 28, Iss 6, pp483-505. 10. Jenson PS, Hinshaw SP, Kraemer
HC, Lenora N, Newcorn JH, Abikoff HB, March JS, Arnold LE and others.
ADHD comorbidity findings from the MTA study: Comparing comorbid subgroups.
Journal of the American Academy of Child and Adolescent Psychiatry,
2000, Vol 40, Iss 2, pp 147-158.
*Dr.
Lindley Bassarath is the Head of the Young Offender Team and the Resident
Coordinator with the Child Psychiatry Program at the Centre for Addiction
and Mental Health.
Preventing Drug Abuse in
Schools
Botvin,
G.J. (2000). Preventing drug abuse in schools: Social and competence
enhancement approaches targeting individual-level etiologic factors.
Addictive Behaviors, 25:6, 887-897.
Reviews
of drug prevention programs show that the most promising approaches target
individuals during the beginning of adolescence and teach drug resistance
skills in combination with general personal and social skills. Effective
resistance training has three social influence components:
- Teaching students to recognize
high-risk situations (including peer pressure).
- Increasing awareness of
pro-drug media influences (movies, TV, rock videos, music, etc.).
- Refusal skills training
(form, content and rehearsal of effective refusal responses).
It
has been found that an adolescent's pro-drug thoughts, attitudes and beliefs
influence drug use. These factors, in combination with poor personal and
social skills, are believed to increase susceptibility to drug use. Drug
prevention programs, which include generic self-management and social
skills (or Life Skills Training), have shown initial smoking prevention
effects of from 40% to 80%. Booster sessions have enhanced outcomes to
87%. One large long-term study measured the effects of 15 drug prevention
sessions in grade seven, 10 booster sessions in grade eight and 5 booster
sessions in grade nine. No intervention took place during grades ten through
grade twelve. At the end of grade twelve, rates of smoking, alcohol and
marijuana use were 44% lower for trainees versus non-participants. Prevention
effects extended to elicit drug use and were reasonably durable past high
school.
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Institute
for the study of Antisocial behaviour in Youth (lAY) 
