Behavioral treatments for attention-deficit/hyperactivity disorder

Behavioral treatments for attention-deficit/hyperactivity disorder

A meta-analysis assessed the efficacy of behavioral modification techniques in children and adolescents with attention-deficit/hyperactivity disorder.

A US meta-analysis of Fabiano and colleagues published in the Clinical Psychology Review in 2009 clarifies, based on 174 clinical trials, the effectiveness of behavioral modification techniques in children and adolescents suffering from a disorder called “attention-deficit/hyperactivity disorder” (ADHD). The analyzes including data from various methodologies show convincing results of the effectiveness of behavioral modification techniques among these groups. These may be offered to children, parents or teachers.

The Study Rationale

The attention-deficit/hyperactivity disorder (ADHD) is a chronic neurological disease. Its symptoms include difficulty concentrating and impulsivity also called hyperactivity. They damage the relationships with parents, siblings, teachers and peers all throughout life. In adults, this disorder can cause delinquency and substance abuse. The disease affects 2% to 9% of the population. She is one of the most commonly reported problems by schools and children’s health services. Its management costs more than $ 50 million per year to American society.

Modification techniques behaviors could be effective non-pharmacological interventions. They are based on the theory of learning which includes the principles of classical and operant conditioning. They are also based on social learning theory and cognitive-behavioral techniques.

Everything suggests that the behavioral modification techniques should improve attention deficit and hyperactivity in children and adolescents.

The Question

Behavior change program used in the school or family setting it is effective in children with attention-deficit/hyperactivity disorder (ADHD)?

The Method

An American meta-analysis of Fabiano and colleagues chose 174 clinical trials. Individuals must be under 18 and have been diagnosed with ADHD. Children and adolescents should have a successful Intelligence Quotient (IQ) above 80 and behaviors as aggression, opposition and conduct disorder. ADHD should not be organic as a head injury.

Four categories of studies are reported in this meta-analysis. The studies “between groups” compared the benefits of behavior change intervention to a control group without intervention. The studies “before and after” compared the results of a single group at the beginning and end of the intervention program. The studies ‘within’ using several treatments over time. The “case” studies students regrouped data tracked over time with individual received behavioral modification techniques.

The Non-Pharmacological Intervention (NPI) assessed

Behavioral modification techniques aimed at improving the behavior of children with attention-deficit/hyperactivity disorder (ADHD). For this, the educational and therapeutic program for children, parents and/or teachers. It is based on the principles of conditioning and social learning and cognitive-behavioral techniques.

Main Results

The results of this meta-analysis show the effectiveness of behavioral modification techniques on the problematic functioning of children with ADHD, and that when the interventional groups were compared with control groups. The benefits are similar regardless of the place of practice, at home, at school or in a community.

Given the choice of authors to collect different study designs data, the meta-analysis highlights the great heterogeneity of results in statistical level but a convergence of results regardless of the method used. It is the same depending on the chosen performance criteria. The size of the effect is multiplied by 5 if parents are observers of behavior in comparison with a video review of the child.

Behavioral modification techniques are effective in improving attention, impulsivity and aggression in children diagnosed with ADHD.

What it means for Patients

Behavioral modification techniques improve symptoms of children with ADHD and help parents better understand their child’s illness and adopt more positive attitudes.

What it means for Healthcare Professionals

Techniques to change behavior improve the functioning of children with attention deficit and/or hyperactivity in their family, school and society. Professionals have everything to gain form these techniques and/or direct parents to experts in the field.

What it means for Researchers

This meta-analysis is the first to achieve a synthesis of the literature interventional studies based on behavioral treatments for children with ADHD. The tested techniques are effective in several places (in school, at home, in hospital) and for all children.

However, the included studies are too heterogeneous to conclude definitively on the issue. Furthermore, it lacks studies verifying the maintenance of the alleged benefits in time.

What it means for Policymakers

Each American school class has at least one child with attention-deficit/hyperactivity disorder (ADHD). This chronic neurological disease generates considerable costs to society. A recent report by the American Psychological Association recommended the use of behavioral modification techniques as a first line for these students present a disorder of attention and hyperactivity. This meta-analysis in this direction and encourages the use of these interventions in families, schools and mental health facilities.

The Reference

Fabiano G, Pelham W, Coles E, Gnagy E, Chronis-Tuscano A, O’Connor B (2009). A meta-analysis of behavioral treatments for attention-deficit/hyperactivity disorder. Clinical Psychology Review, 29, 129-140.

Related articles on Blog en Sante ©

Same topic

Same population

Same non-pharmacological intervention

To reference this Blog en Sante © article.

Ninot G (2015). Behavioral treatments for attention-deficit/hyperactivity disorder. Blog en Sante, A46.

© Copyright 2015 Gregory Ninot. All rights reserved.

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