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Attention Deficit/Hyperactivity Disorder (ADHD)

Treatment

Only two intervention strategies have shown research-based evidence for the treatment of ADHD: (a) stimulant medications, such as methylphenidate or dextroamphetamine, which regulate dopamine neurotransmission and (b) behavioral strategies such as parent management training, school consultation, and direct contingency management in classroom or special educational settings (Pelham, Wheeler, and Chronis 1998). Indeed, individual therapies that do not directly target the child's social, behavioral, and academic problems have not yielded clear support regarding intervention for ADHD. Medication typically yields stronger effects than behavioral interventions in terms of improving core symptomatology, but (a) psychosocial treatments may be preferable for some families (who may be philosophically opposed to medication); (b) perhaps as many as 20 percent of the youths with ADHD either do not respond optimally to medication or show prohibitive side effects; (c) medication alone is typically insufficient for helping the child learn new academic or social skills or for the family to learn and practice new management skills; and (d) combining well-delivered pharmacological intervention with systematic behavioral family and school treatment is most likely to yield normalization of behavioral, social, and academic targets (Pelham, Wheeler, and Chronis 1998). It is important to note that both pharmacological and behavioral treatments for ADHD share a common limitation: their benefits tend to persist only as long as the intervention is delivered. ADHD is a chronic condition and may well require chronic treatment.

Unfortunately, in light of the strongly heritable nature of ADHD and the documented success of pharmacological interventions, it could be concluded that family and school environments are not particularly important and that psychosocial interventions have limited potential for success. Such thinking fails to take into account the demonstrated facts that (a) conditions with clear psychosocial etiology may respond to biological treatment regimens and (b) conditions with strong psychobiological underpinnings may respond to A mother dispenses stimulant medication to her son. Although medication is the most effective form of treatment for ADHD, it is not always the preferred form of treatment. Research has shown behaviorial therapy to be an effective form of treatment as well. STOCK BOSTON, INC. treatments emphasizing skill enhancement or environmental manipulation. In fact, recent evidence suggests that even for a condition as heritable as ADHD a combination of treatments may be the answer: when combined pharmacological and behavioral treatments produce optimal benefits for youth with ADHD, a key explanatory factor is the family's reduction of harsh and ineffective discipline strategies at home (Hinshaw et al. 2000). Thus, the family's learning of more productive management strategies at home and their coordination of intervention efforts with the school are necessary components of a viable treatment plan for ADHD. The development of self-regulation requires active teaching by parents and teachers, often in concert with pharmacological interventions to enhance attention and regulate impulse control. Such consistent intervention from families appears necessary to break the intergenerational cycle that is often found with ADHD.


Bibliography

American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edition. Washington, DC: American Psychiatric Press.

Barkley, R. A. (1998). Attention Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment, 2nd edition. New York: Guilford.

Carlson, E. A.; Jacobvitz, D.; and Sroufe, L. A. (1995). "A Developmental Investigation of Inattentiveness and Hyperactivity." Child Development 66:37–54.

DeGrandpre, R., and Hinshaw, S. P. (2000). "Attention- Deficit Hyperactivity Disorder: Psychiatric Problem or American Cop-Out?" Cerebrum 2:12–38.

Hinshaw, S. P. (1999). "Psychosocial Intervention for Childhood ADHD: Etiologic and Developmental Themes, Comorbidity, and Integration with Pharmacotherapy." In Rochester Symposium on Developmental Psychopathology, Vol. 9: Developmental Approaches to Prevention and Intervention, ed. D. Ciccehetti and S. L. Toth. Rochester, NY: University of Rochester Press.

Hinshaw, S. P.; Owens, E. B.; Wells, K. C.; Kraemer, H. C.; Abikoff, H. B.; Arnold, L. E.; Conners, C. K.; Elliott, G.; Greenhill, L. L.; Hechtman, L.; Hoza, B.; Jensen, P. S.; March, J. S.; Newcorn, J.; Pelham, W. E.; Swanson, J. M.; Vitiello, B.; and Wigal, T. (2000). "Family Processes and Treatment Outcome in the MTA: Negative/Ineffective Parenting Practices in Relation to Multimodal Treatment." Journal of Abnormal Child Psychology 28:555–568.


Hinshaw, S. P., and Park, T. (1999). "Research Issues and Problems: Toward a More Definitive Science of Disruptive Behavior Disorders." In Handbook of Disruptive Behavior Disorders, ed. H. C. Quay and A. E. Hogan. New York: Plenum.

Hinshaw, S. P.; Zupan, B. A.; Simmel, C.; Nigg, J. T.; and Melnick, S. M. (1997). "Peer Status in Boys With and Without Attention-Deficit Hyperactivity Disorder: Predictions from Overt and Covert Antisocial Behavior, Social Isolation, and Authoritative Parenting Beliefs." Child Development 64:880–896.

Johnston, C., and Mash, E. J. (2001). "Families of Children with Attention-Deficit/Hyperactivity Disorder: Review and Recommendations for Future Research." Clinical Child and Family Psychology Review 4:183–207.

Mannuzza, S., and Klein, R. G. (1999). "Adolescent and Adult Outcomes in Attention-Deficit/Hyperactivity Disorder." In Handbook of Disruptive Behavior Disorders, ed. H. C. Quay and A. E. Hogan. New York: Plenum.

Patterson, G. R.; Reid, J.; and Dishion, T. (1992). Antisocial Boys. Eugene, OR: Castalia.


Pelham, W. E.; Wheeler, T.; and Chronis, A. (1998). "Empirically Supported Psychosocial Treatments for ADHD." Journal of Clinical Child Psychology 27:189–204.

Simmel, C.; Brooks, D.; Barth, R. P.; and Hinshaw, S. P. (2001). "Externalizing Symptomatology Among Adoptive Youth: Prevalence and Preadoption Risk Factors." Journal of Abnormal Child Psychology 29:57–69.


Tannock, R. (1998). "Attention Deficit Hyperactivity Disorder: Advances in Cognitive, Neurobiological, and Genetic Research." Journal of Child Psychology and Psychiatry 39:65–99.

STEPHEN P. HINSHAW

Additional topics

Marriage and Family EncyclopediaFamily Health IssuesAttention Deficit/Hyperactivity Disorder (ADHD) - Demographics, Developmental Course, And Etiology, Family Processes And Adhd, Culture And Ethnicity, Treatment