Assessing the Quality of Parent-Teacher Relationships for Students with ADHD.

Family involvement in education, including quality of family-school communication, has been demonstrated repeatedly to have a substantial effect on child development and success in school; however, measures of this construct are limited. The purpose this study was to examine the factor structure and concurrent validity of the Quality of the Parent-Teacher Relationship, a subscale of the Parent-Teacher Involvement Questionnaire (PTIQ) in a sample of children with ADHD. Participants were 260 parents and teachers of children diagnosed with ADHD in grades K to 6. Results provided support for a two-factor model, consisting of separate factors for parents and teachers, and correlational findings provided support for concurrent validity. This measure appears to have utility in assessing parent-teacher relationships and evaluating the effectiveness of family-school interventions.

Efficacy of a methylphenidate transdermal system versus t.i.d. methylphenidate in a laboratory setting.

OBJECTIVE: To test the efficacy and tolerability of the methylphenidate transdermal formulation (MTS) against immediate-release methylphenidate (IR MPH) and placebo in a 12-hr analog classroom setting. METHOD: A total of nine boys ages 6 to 9 years, medicated with MPH for ADHD, complete a within-subject, double-blind study. For the purpose of the study, the boys are administered a dose of 20 cm(2) MTS, a matched dose of IR MPH 10 mg TID, and placebo. ADHD symptoms and frequency counts of classroom rule violations and the number of math problems completed are assessed hourly, during three consecutive analog classroom sessions. RESULTS: Findings show that, across measures and throughout the day, both treatments significantly differentiated from placebo (p < .05) but not from each other. It is also observed that the MTS produced more consistent results across the day but had a delayed onset versus IR MPH. Both medications are well tolerated with only mild reductions in sleep onset. CONCLUSION: The MTS demonstrates comparable efficacy and tolerability to TID IR MPH.

Psychosocial Interventions to Improve the School Performance of Students with Attention-Deficit/Hyperactivity Disorder.

Children with ADHD typically show impairments throughout the school day. A number of interventions have been demonstrated to address both the academic and behavioral impairments associated with this disorder. Although the focus of research has been on classroom-based strategies of intervention for children with ADHD, school-based interventions applicable for non-classroom environments such as lunchrooms and playgrounds are beginning to emerge. This paper provides a brief description of the guiding principles of behavioral intervention, identifies selected strategies to address behavioral and academic concerns, discusses how school contextual factors have an effect on intervention selection and implementation, and considers the effects of using psychosocial interventions in combination with medication.

School-based interventions for students with attention-deficit/hyperactivity disorder.

Children with attention-deficit/hyperactivity disorder typically manifest impairments in multiple settings. Perhaps the most common reason for referral relates to the school impairments experienced by these children. A wide range of intervention strategies have been developed for these children to improve attention and behavior, enhance academic competence, and promote social competence. A strong majority of the research on nonpharmacologic interventions has focused on strategies to improve attention and behavior. More recently, strategies specifically designed to promote the academic and social competence of these children are being developed. Also, most of the research has focused on elementary school-age children, but evidence-based strategies for intervening with preschoolers and adolescents are beginning to emerge.

Enhancing academic achievement for children with Attention-Deficit Hyperactivity Disorder: evidence from school-based intervention research.

Although children with Attention-Deficit Hyperactivity Disorder (ADHD) exhibit significant academic difficulties in school settings, considerably less attention is devoted to remediating their academic problems when compared to behavioral and social difficulties. The purpose of this article is to review empirically supported academic interventions for children with ADHD. Specific evidence-based academic interventions are described under the categories of reading and mathematics, with examples that illustrate teacher-mediated interventions focusing on basic skills (e.g., phonological awareness in reading, mathematics computation) and higher-level cognitive skills (e.g., collaborative strategic reading, CSR; schema-based instruction, SBI). Finally, implications for educational practice and directions for future research on school-based academic interventions for students with ADHD are discussed.

Consultation-based academic interventions for children with ADHD: effects on reading and mathematics achievement.

The purpose of this investigation was to evaluate the relative efficacy of two consultation-based models for designing academic interventions to enhance the educational functioning of children with attention-deficit/hyperactivity disorder (ADHD). Children (N=167) meeting DSM-IV criteria for ADHD were randomly assigned to one of two consultation groups: Individualized Academic Intervention (IAI; interventions designed using a data-based decision-making model that involved ongoing feedback to teachers) and Generic Academic Intervention (GAI; interventions designed based on consultant-teacher collaboration, representing "consultation as usual"). Teachers implemented academic interventions over 15 months. Academic outcomes (e.g., standardized achievement test, and teacher ratings of academic skills) were assessed on four occasions (baseline, 3 months, 12 months, 15 months). Hierarchical linear modeling analyses indicated significant positive growth for 8 of the 14 dependent variables; however, trajectories did not differ significantly across consultation groups. Interventions in the IAI group were delivered with significantly greater integrity; however, groups did not differ with respect to teacher ratings of treatment acceptability. The results of this study provide partial support for the effectiveness of consultation-based academic interventions in enhancing educational functioning in children with ADHD; however, the relative advantages of an individualized model over "consultation as usual" have yet to be established.

Transdermal methylphenidate, behavioral, and combined treatment for children with ADHD.

Stimulant medication and behavioral treatments are evidence-based for children with attention-deficit/hyperactivity disorder, but the combination of the 2 treatments has been understudied. In this investigation, methylphenidate (MPH) was crossed with 2 levels of behavior modification (BMOD) in a summer treatment program. Twenty-seven children with attention-deficit/hyperactivity disorder, aged 6-12, participated. Children received placebo and 3 doses of transdermal MPH (12.5 cm(2), 25.0 cm(2), and 37.5 cm(2)). BMOD was implemented on alternating weeks. Both treatments produced large and significant effects. Combined treatment was superior to either treatment alone. The effects of transdermal MPH were comparable to those found in this setting in previous studies with multiple stimulant medications and formulations. Consistent with other research, low doses of MPH--even lower than in previous studies--yielded enhanced effects in combination with behavior modification.

A dose-ranging study of a methylphenidate transdermal system in children with ADHD.

OBJECTIVE: This was a multicenter, double-blind, randomized, dose-ranging study of a methylphenidate (MPH) transdermal system (MTS). Medication (placebo, 0.45, 0.9, and 1.8 mg/h) was crossed with application time (6 a.m., 7 a.m.) to evaluate MTS efficacy and influence of exposure time on morning effects. METHOD: The study took place in a summer treatment program (STP) at three sites, with 36 children aged 7-12 years with attention-deficit/hyperactivity disorder. Each treatment was administered for 1 day in random order, for a total of 8 days. Behavioral and academic measures were taken as well as patch wear characteristics and side effects. RESULTS: Evaluable participant data were analyzed in a series of dose x application time multivariate analyses of variance. All MTS conditions were significantly different from placebo across measures. Time of application had no significant effect on daily behavior, and effects of application time on morning behavior were inconclusive. Consistent with previous results in this setting, the highest dose produced limited incremental benefit compared with the mid-range dose. The wear characteristics of the MTS were acceptable, and the formulation was well tolerated. CONCLUSIONS: The MTS produced significant effects that were similar to those previously reported with comparable MPH doses. There does not appear to be a substantial effect of application time on total daily functioning in this setting; further controlled time-course studies will be necessary to evaluate the question of morning onset fully.