Faraone ADHD: Non-Pharmacologic Interventions, An Issue of Child and Adolescent Psychiatric Clinics of North America

1. Auflage 2014
ISBN: 978-0-323-32602-5
Verlag: Elsevier HealthScience EN
Format: EPUB
Kopierschutz: Adobe DRM (»Systemvoraussetzungen)

E-Book, Englisch, Band Volume 23-4, 100 Seiten

Reihe: The Clinics: Internal Medicine

This issue of Child and Adolescent Psychiatric Clinics focuses on non-pharmacologic interventions for ADHD in children and adolescents. Editors Stephen Faraone's and Kevin Antshel's goal with this publication is to help the clinician decipher the literature base in an attempt to make informed decisions and recommendations for the families that they treat in light of new non-pharmacologic interventions. To guide readers of this issue, Authors present information in a specific structure designed to describe the non-pharmacologic intervention theoretically and practically, as well as provide clinically useful information regarding who is most likely to respond and which outcomes are most likely to be affected by treatment. Likewise, Authors include information on adverse effects / contraindications of the non-pharmacologic treatments and how treatments should be sequenced and/or integrated with other treatments.  Science is translated into clinical practice that can be easily applied; this volume strikes a balance between reviewing the evidence base and providing clinically useful information. Among the topics are: Cognitive Behavioral Therapy for Adolescents with ADHD; Nutritional Supplements for the Treatment of ADHD; School-Based Interventions for Elementary School Students with ADHD; Middle and High School Based Interventions for Adolescents with ADHD; Healthy Body, Healthy Mind? The Effectiveness of Physical Activity to Treat ADHD in Children; Neurofeedback for Attention-Deficit/Hyperactivity Disorder: A Review of Current Evidence; Social Skills Training; Behavior Management for Preschool-Aged Children; Computer-based Cognitive Training for Attention-Deficit/Hyperactivity Disorder: A review of current evidence; Restriction and Elimination Diets in ADHD Treatment; Traditional Chinese Medicine in the Treatment of ADHD: A Review; Summer Treatment Programs for Youth with ADHD; Non-Pharmacologic Treatments for ADHD; Behavior Management for School Aged Children with ADHD; Family Therapy for Adolescents with Attention Deficit Hyperactivity Disorder; An Integrated Dietary/Nutritional Approach to ADHD; Toward an Evidence-Based Taxonomy of Non-Pharmacologic Treatments for Attention Deficit Hyperactivity Disorder.

Autoren/Hrsg.

Faraone, Stephen V.

Leseproben

School-Based Interventions for Elementary School Students with ADHD
George J. DuPaul, PhD*[e-mail], Matthew J. Gormley, MEd and Seth D. Laracy, MEd,     Department of Education and Human Services, Lehigh University, 111 Research Drive, Bethlehem, PA 18015, USA *Corresponding author. Children with attention-deficit/hyperactivity disorder (ADHD) experience significant difficulties with behavior, social functioning, and academic performance in elementary school classrooms. Although psychotropic medication may enhance classroom behavior, pharmacologic treatment is rarely sufficient in addressing the many challenges encountered by individuals with ADHD in school settings. This article describes 3 evidence-based strategies including behavioral, academic, and self-regulation interventions. Future directions for research on school-based interventions are discussed. Keywords Attention-deficit/hyperactivity disorder Elementary school Behavioral intervention Academic intervention Self-regulation intervention Key points
• Children with attention-deficit/hyperactivity disorder experience significant behavioral, academic, and social difficulties in elementary school classrooms. • Although stimulant and other medications can reduce symptoms, these are rarely sufficient in comprehensively addressing school functioning. • Teachers and other school personnel can implement behavioral, academic, and self-regulation interventions to directly target symptoms and associated impairment. • Empiric evidence supporting classroom interventions is relatively strong, particularly for behavioral treatment. Abbreviations ADHD Attention-deficit/hyperactivity disorder CAI Computer-assisted instruction CWPT Classwide peer tutoring DRC Daily report card OCEBM Oxford Centre for Evidence-Based Medicine Introduction/Background
Children with attention-deficit/hyperactivity disorder (ADHD) frequently experience significant difficulties in school settings. This should not be surprising given that the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) criteria for this disorder require symptoms to be associated with impairment in academic and/or social functioning.1 There are at least 3 areas that must be targeted by school-based interventions. First, the symptomatic behaviors (ie, inattention and hyperactivity/impulsivity) comprising ADHD can significantly disrupt classroom activities to a degree that deleteriously affects the learning of all children, not just those with ADHD. Thus, the reduction of disruptive, off-task behavior is an important goal for treatment. Second, symptomatic behaviors also negatively impact children’s interactions with peers, teachers, and other school professionals. A common goal for school-based treatment is increased positive social interactions with concomitant reduction in verbal and physical aggression. Third, inattentive and hyperactive–impulsive behaviors frequently compromise learning and academic achievement. Thus, the success of school-based interventions is judged not only on reduction of disruptive, off-task behavior, but also with respect to improvement in the completion and accuracy of academic work. The need for treatment of ADHD in school settings is clear from both theoretical and empiric perspectives. From a theoretical or conceptual standpoint, it would be hard to design a more problematic setting for individuals with ADHD than the typical elementary school classroom. Students are expected to sit still, listen to academic instruction, follow multistep directions, complete independent work, wait their turn, and behave appropriately with peers and teachers. In particular, they are expected to delay responding and think before acting. These requirements are exceptionally challenging for students with ADHD given underlying difficulties in delaying their response to the environment,2 motivation,3 and executive functioning.4 Thus, it is not surprising that children with ADHD experience significantly lower standardized achievement scores and school grades and higher rates of grade retention and school dropout compared with their same-aged peers.5 In fact, one of the most ubiquitous and problematic long-term outcomes associated with ADHD is educational underachievement.6 The purpose of this article is to describe and review the empiric evidence supporting the use of treatment strategies to address ADHD symptoms and associated impairment in elementary classroom settings. A guide to clinical decision making is provided, and the authors discuss future directions for research and practice in this area. Interventions
Three broad types of intervention have been used to address symptoms and impairment exhibited by elementary school students with ADHD, including behavioral, academic, and self-regulation strategies. Theoretical context, description, and empiric support are described separately for each intervention approach. Behavioral Interventions
Theoretical overview Behavioral interventions aim to replace socially undesirable behavior (eg, calling out) with socially appropriate behavior (eg, working quietly). From the behavioral perspective, each behavior must be understood in the context of its antecedents and consequences.7 More specifically, behavior is theorized to serve one of 4 main functions: (1) escape or avoidance of a nonpreferred activity or setting, (2) gain attention, (3) gain access to materials or preferred settings, or (4) sensory stimulation.8 Proactive behavioral interventions target the antecedents of disruptive behaviors, making students less likely to engage in such behaviors (eg, reviewing classroom expectations). Conversely, reactive behavioral interventions target the consequences of a given behavior, reinforcing desirable behavior and ignoring or punishing interfering behaviors (eg, verbal reprimand for calling out). Successful interventions are those that facilitate the function (eg, attention) of the student's interfering behavior (eg, calling out) by reinforcing a socially appropriate replacement behavior (eg, raising his or her hand5). Description Proactive strategies The use of cues and prompts has been found to increase compliance with desired behavior.9 By providing students with age-appropriate, nonequivocal rules regarding classroom expectations, teachers can improve classroom behavior.10 There are several basic strategies that have been found to help maintain positive classroom behavior for students with ADHD: Remind students of classroom rules throughout the day and publically praise students for appropriate behavior Maintain appropriate eye contact with students Remind students of behavioral expectations prior to the start of a new activity Actively monitor students by moving throughout the classroom Use nonverbal cues to redirect behavior Maintain appropriate pacing for classroom activities Provide a clear schedule of activities5 Teacher attention Differential teacher attention has also been found effective for students with ADHD.11 Teachers should catch their students being good and provide positive attention for the socially desirable behavior. Praise should occur immediately following the desired behavior and should be specific in nature (eg, “James, you’re doing a great job completing your worksheet!”). Additionally, teachers can extinguish minor disruptive behaviors (eg, tapping a pencil) through ignoring. It should be noted, however, that ignoring minor behaviors may sometimes lead to more intrusive behaviors (eg, calling out), because students are not gaining the attention that they desire and have not been provided a socially acceptable replacement.8 Conversely, evidence also suggests that teacher reprimands can be effective in reducing interfering behaviors.12 Redirections should be brief and specific and should be consistently delivered immediately following the negative behavior in a calm and quiet manner. Token reinforcement/response–cost Token reinforcement is a reactive strategy that provides students an immediate reinforcer (eg, a sticker) for achieving a specific behavioral expectation (eg, completing a worksheet). These initial reinforcers or tokens are exchanged for back-up reinforcers (eg, additional computer time) later in the day or at the end of the week.8 Token reinforcement programs are particularly helpful for students with ADHD...