Edmund Sonuga-Barke, Paraskevi Bitsakou, Margaret Thompson
Beyond the dual pathway model: evidence for the dissociation of timing, inhibitory, and delay-related impairments in attention-deficit/hyperactivity disorder.
J Am Acad Child Adolesc Psychiatry. 2010 Apr;49(4):345-55. doi: 10.1016/j.jaac.2009.12.018.
Abstract/Text
OBJECTIVE: The dual pathway model explains neuro-psychological heterogeneity in Attention Deficit/Hyperactivity Disorder (ADHD) in terms of dissociable cognitive and motivational deficits each affecting some but not other patients. We explore whether deficits in temporal processing might constitute a third dissociable neuropsychological component of ADHD.
METHOD: Nine tasks designed to tap three domains (inhibitory control, delay aversion and temporal processing) were administered to ADHD probands (n=71; ages 6 to 17 years), their siblings (n=71; 65 unaffected by ADHD) and a group of non-ADHD controls (n=50). IQ and working memory were measured.
RESULTS: Temporal processing, inhibitory control and delay-related deficits represented independent neuropsychological components. ADHD children differed from controls on all factors. For ADHD patients, the co-occurrence of inhibitory, temporal processing and delay-related deficits was no greater than expected by chance with substantial groups of patients showing only one problem. Domain-specific patterns of familial co-segregation provided evidence for the validity of neuropsychological subgroupings.
CONCLUSION: The current results illustrate the neuropsychological heterogeneity in ADHD and initial support for a triple pathway model. The findings need to be replicated in larger samples.
齊藤万比古, 原田 譲. 反抗挑戦性障害.精神科治療学14（2）:153-159,1999.
David Daley, Saskia Van Der Oord, Maite Ferrin, Samuele Cortese, Marina Danckaerts, Manfred Doepfner, Barbara J Van den Hoofdakker, David Coghill, Margaret Thompson, Philip Asherson, Tobias Banaschewski, Daniel Brandeis, Jan Buitelaar, Ralf W Dittmann, Chris Hollis, Martin Holtmann, Eric Konofal, Michel Lecendreux, Aribert Rothenberger, Paramala Santosh, Emily Simonoff, Cesar Soutullo, Hans Christoph Steinhausen, Argyris Stringaris, Eric Taylor, Ian C K Wong, Alessandro Zuddas, Edmund J Sonuga-Barke
Practitioner Review: Current best practice in the use of parent training and other behavioural interventions in the treatment of children and adolescents with attention deficit hyperactivity disorder.
J Child Psychol Psychiatry. 2018 Sep;59(9):932-947. doi: 10.1111/jcpp.12825. Epub 2017 Oct 30.
Abstract/Text
BACKGROUND: Behavioural interventions are recommended for use with children and young people with attention deficit hyperactivity disorder (ADHD); however, specific guidance for their implementation based on the best available evidence is currently lacking.
METHODS: This review used an explicit question and answer format to address issues of clinical concern, based on expert interpretation of the evidence with precedence given to meta-analyses of randomised controlled trials.
RESULTS: On the basis of current evidence that takes into account whether outcomes are blinded, behavioural intervention cannot be supported as a front-line treatment for core ADHD symptoms. There is, however, evidence from measures that are probably blinded that these interventions benefit parenting practices and improve conduct problems which commonly co-occur with ADHD, and are often the main reason for referral. Initial positive results have also been found in relation to parental knowledge, children's emotional, social and academic functioning - although most studies have not used blinded outcomes. Generic and specialised ADHD parent training approaches - delivered either individually or in groups - have reported beneficial effects. High-quality training, supervision of therapists and practice with the child, may improve outcomes but further evidence is required. Evidence for who benefits the most from behavioural interventions is scant. There is no evidence to limit behavioural treatments to parents with parenting difficulties or children with conduct problems. There are positive effects of additive school-based intervention for the inattentive subtype. Targeting parental depression may enhance the effects of behavioural interventions.
CONCLUSIONS: Parent training is an important part of the multimodal treatment of children with ADHD, which improves parenting, reduces levels of oppositional and noncompliant behaviours and may improve other aspects of functioning. However, blinded evidence does not support it as a specific treatment for core ADHD symptoms. More research is required to understand how to optimise treatment effectiveness either in general or for individual patients and explore potential barriers to treatment uptake and engagement. In terms of selecting which intervention formats to use, it seems important to acknowledge and respond to parental treatment preferences.
© 2017 Association for Child and Adolescent Mental Health.
Rae Thomas, Bridget Abell, Haley J Webb, Elbina Avdagic, Melanie J Zimmer-Gembeck
Parent-Child Interaction Therapy: A Meta-analysis.
Pediatrics. 2017 Sep;140(3). doi: 10.1542/peds.2017-0352.
Abstract/Text
CONTEXT: Parent-child interaction therapy (PCIT) is effective at reducing children's externalizing behavior. However, modifications are often made to PCIT, and it is not known whether these impact effectiveness.
OBJECTIVE: To systematically review and meta-analyze the effects of PCIT on child externalizing behaviors, considering modifications, study design, and bias.
DATA SOURCES: We searched PubMed, PsycINFO, Education Resources Information Center, Sociological Abstracts, and A+ Education.
STUDY SELECTION: We selected randomized controlled or quasi-experimental trials.
DATA EXTRACTION: We analyzed child externalizing and internalizing behaviors, parent stress, parent-child interactions, PCIT format, and study design and/or characteristics.
RESULTS: We included 23 studies (1144 participants). PCIT was superior to control for reducing child externalizing (standardized mean difference [SMD]: -0.87, 95% confidence interval [CI]:-1.17 to -0.58). PCIT studies that required skill mastery had significantly greater reductions in externalizing behavior than those that did not (Mastery: SMD: -1.09, 95% CI: -1.44 to -0.73; Nonmastery: SMD: -0.51,95% CI: -0.85 to -0.17, P = .02). Compared with controls, PCIT significantly reduced parent-related stress (mean difference [MD]: -6.98, 95% CI: -11.69 to -2.27) and child-related stress (MD: -9.87, 95% CI: -13.64 to -6.09). Children in PCIT were observed to be more compliant to parent requests (SMD: 0.89, 95% CI: 0.50 to 1.28) compared with controls. PCIT effectiveness did not differ depending on session length, location (academic versus community settings), or child problems (disruptive behaviors only compared with disruptive behavior and other problems).
LIMITATIONS: Results for parent-child observations were inconsistently reported, reducing the ability to pool important data.
CONCLUSIONS: PCIT has robust positive outcomes across multiple parent-reported and observed parent-child interaction measures, and modifications may not be required even when implemented in diverse populations.
Copyright © 2017 by the American Academy of Pediatrics.
Yushiro Yamashita, Akiko Mukasa, Chizuru Anai, Yuko Honda, Chie Kunisaki, Junichi Koutaki, Yahuhiro Tada, Chiyomi Egami, Naoko Kodama, Masayuki Nakashima, Shin-ichiro Nagamitsu, Toyojiro Matsuishi
Summer treatment program for children with attention deficit hyperactivity disorder: Japanese experience in 5 years.
Brain Dev. 2011 Mar;33(3):260-7. doi: 10.1016/j.braindev.2010.09.005. Epub 2010 Oct 12.
Abstract/Text
In 2005 we established the first American-style summer treatment program (STP) for children with attention deficit hyperactivity disorder (ADHD) located outside North America. This program was based on methods established by professor Pelham and has been used in a number of studies and at a number of sites in the USA. A total of 137 children diagnosed with ADHD, ranging in age from 6 to 12 years, participated in at least one of five annual summer treatment programs in Kurume city, Japan, during 2005-2009. The duration of the STP was 2 weeks in 2005, 2008, and 2009; 3 weeks in 2006 and 2007. A set of evidence-based behavioral modification techniques comprising the STP behavioral program (e.g., point system, daily report card, positive reinforcement, time out) was used. We also assessed the cognitive function of individual children before and after STP using the CogState(R) batteries. Every year, regardless of the duration of the STP, most children showed positive behavioral changes in multiple domains of functioning, demonstrated by significant improvement in points earned daily, which reflect behavior frequencies. Cognitive functions, particularly the rate of anticipatory errors in executive function, significantly improved after the STP, suggesting that STP has positive effects not only on behavioral aspects but also on some cognitive functions. Further studies are necessary to confirm this finding by studying sequential cognitive function of age-matched children who do not attend STP.
Copyright © 2010 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.
Alain Joseph, Rajeev Ayyagari, Meng Xie, Sean Cai, Jipan Xie, Michael Huss, Vanja Sikirica
Comparative efficacy and safety of attention-deficit/hyperactivity disorder pharmacotherapies, including guanfacine extended release: a mixed treatment comparison.
Eur Child Adolesc Psychiatry. 2017 Aug;26(8):875-897. doi: 10.1007/s00787-017-0962-6. Epub 2017 Mar 3.
Abstract/Text
This study compared the clinical efficacy and safety of attention-deficit/hyperactivity disorder (ADHD) pharmacotherapy in children and adolescents 6-17 years of age. A systematic literature review was conducted to identify randomized controlled trials (RCTs) of pharmacologic monotherapies among children and adolescents with ADHD. A Bayesian network meta-analysis was conducted to compare change in symptoms using the ADHD Rating Scale Version IV (ADHD-RS-IV), Clinical Global Impression-Improvement (CGI-I) response, all-cause discontinuation, and adverse event-related discontinuation. Thirty-six RCTs were included in the analysis. The mean (95% credible interval [CrI]) ADHD-RS-IV total score change from baseline (active minus placebo) was -14.98 (-17.14, -12.80) for lisdexamfetamine dimesylate (LDX), -9.33 (-11.63, -7.04) for methylphenidate (MPH) extended release, -8.68 (-10.63, -6.72) for guanfacine extended release (GXR), and -6.88 (-8.22, -5.49) for atomoxetine (ATX); data were unavailable for MPH immediate release. The relative risk (95% CrI) for CGI-I response (active versus placebo) was 2.56 (2.21, 2.91) for LDX, 2.13 (1.70, 2.54) for MPH extended release, 1.94 (1.59, 2.29) for GXR, 1.77 (1.31, 2.26) for ATX, and 1.62 (1.05, 2.17) for MPH immediate release. Among non-stimulant pharmacotherapies, GXR was more effective than ATX when comparing ADHD-RS-IV total score change (with a posterior probability of 93.91%) and CGI-I response (posterior probability 76.13%). This study found that LDX had greater efficacy than GXR, ATX, and MPH in the treatment of children and adolescents with ADHD. GXR had a high posterior probability of being more efficacious than ATX, although their CrIs overlapped.
