Peer-Based Intervention for Socioemotional Concerns Among Children with ADHD.

This study examined the potential benefits of peer-based dyadic interventions for improving the socioemotional functioning of children with ADHD. Participants included children ages 8-12 diagnosed with ADHD-combined type (n = 34) pooled from a larger randomized study comparing peer-based dyadic interventions. Self-concept and depressive symptoms were evaluated at pre- and post-treatment using single group design. Results showed significantly positive child responses to intervention for self-concept. Further, improvements in self-concept were not moderated by the type of dyadic intervention received or by treatment related changes in externalizing behaviors. The severity of reported depressive symptoms, however, did not significantly change. This suggests therapeutic interaction with peers, as demonstrated in peer-based dyadic intervention models, can improve self-concept in children with ADHD even when socioemotional concerns are not a primary target of treatment and independent of behavioral outcomes achieved. These preliminary findings support promoting prosocial peer behavior as a critical domain for ADHD intervention for children.

Do Comorbid Oppositional Symptoms Predict ADHD Behavioral Treatment Outcomes?

Parent management training (PMT) is considered a best-practice for treating childhood ADHD. However, the magnitude of change in response to PMT differs across individuals. This study examined comorbid oppositional symptoms as a predictor of ADHD treatment outcomes. We predicted children with more severe baseline oppositionality would exhibit greater improvements in externalizing behaviors overall, including core ADHD symptoms. Participants consisted of 67 children aged 7-10 diagnosed with ADHD-Combined Type. Participants and their families received a manualized ten-session intervention, Family Skills Training for ADHD-Related Symptoms (Family STARS), combining PMT with a simultaneously occurring child skills training intervention. Pre- and post-treatment parent and teacher rating scales were collected to assess changes in ADHD and oppositional symptoms. Results demonstrated that children with more severe ratings of oppositional behaviors achieved commensurate ADHD symptom outcomes compared to those with less severe oppositionality. Implications are discussed with regard to the utilization of ADHD impairment-specific treatment targets.

The association between parenting stress, parenting self-efficacy, and the clinical significance of child ADHD symptom change following behavior therapy.

We examined parenting stress (PST) and self-efficacy (PSE) following participation in behavioral parent training (BPT) with regard to child treatment response. Forty-three families of children diagnosed with ADHD participated in a modified BPT program. Change in PST and PSE was evaluated using a single group, within-subjects design. Parenting outcomes based on child treatment response were evaluated based upon (1) magnitude and (2) clinical significance of change in child symptom impairment. Parents reported significant improvements in stress and self-efficacy. Parents of children who demonstrated clinically significant reduction in ADHD symptoms reported lower stress and higher self-efficacy than those of children with continued impairments. Magnitude of child impairment was not associated with parent outcomes. Clinical implications for these results include extending treatment duration to provide more time for symptom amelioration and parent-focused objectives to improve coping and stress management.

Classroom changes in ADHD symptoms following clinic-based behavior therapy.

This study examined classroom behavioral outcomes for children with Attention-Deficit/Hyperactivity Disorder (ADHD) following their participation in a manualized, 10-week intervention called Family Skills Training for ADHD-Related Symptoms (Family STARS). Family STARS combined behavioral parent training (BPT) and child-focused behavioral activation therapy (CBAT). Participants were children ages 7-10 diagnosed with ADHD-Combined Type. Pre- and post-treatment teacher ratings of ADHD symptoms were compared using a single group, within-subjects research design. Intervention effectiveness was analyzed using paired-samples t-tests. Results indicated statistically significant classroom improvements for externalizing behaviors and attention problems with medium and large main effects (respectively) for the intervention. Possible implications for combining CBAT with BPT for the treatment of ADHD are discussed as well as the relevance of these results for improving the effectiveness and portability of empirically supported interventions.

Child skills training for attention-deficit/hyperactivity disorder (ADHD): A randomized controlled trial of structured dyadic behavior therapy (SDBT).

This pilot study examined structured dyadic behavior therapy (SDBT) as a novel, child skills training intervention for attention-deficit/hyperactivity disorder (ADHD). The purpose of this study was to (a) pilot the feasibility of SDBT, a manualized, child skills training intervention, (b) determine the potential clinical benefits of SDBT as an independent psychotherapy for ADHD, and (c) examine parents' intervention acceptability. Children of 8-12 years of age with ADHD-combined type (N = 34) were randomly assigned to either SDBT or an "attention control" condition receiving child-centered dyadic therapy (CCDT). SDBT targeted high-frequency behavioral and social demands often challenging for children with ADHD. CCDT provided nondirective, experiential psychotherapy without any contingency management methods. Descriptive data revealed a high level of treatment attendance and completion (90%) for both conditions. General linear modeling techniques (multivariate analysis of variance) examined group differences in ADHD outcomes. Results indicated statistically significant differences between the two groups, with greater ADHD symptom reduction for SDBT (Wilks' λ = .61), F(3, 30) = 6.36, p = .002, ηp² = .39. SDBT also demonstrated clinically meaningful changes, with ADHD symptom severity reduced below categorical levels of functional impairment. Despite superior behavioral outcomes for SDBT, intervention acceptability did not significantly differ for the two psychotherapies. Results support SDBT as a feasible, clinically promising, and acceptable intervention for ADHD. Parent satisfaction ratings suggest dyadic therapies may benefit participants beyond symptom reduction. Implications for intervention portability and treating ADHD without direct adult participation are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Physician Utilization of a Universal Psychosocial Screening Protocol in Pediatric Primary Care.

This study evaluated physicians' utilization of a universal psychosocial screening protocol within a pediatric primary care setting. Pediatricians (n = 20) adopted a multitiered screening algorithm using the Pediatric Symptom Checklist-17 (PSC-17) within well-child checkups (WCC) for children, ages 7 and 11 years. Descriptive analyses were performed to evaluate the initial 3 years of physician screening protocol implementation to: (1) determine frequency and proportion of use and (2) examine patient outcomes associated with accessing behavioral health care. Physicians frequently initiated the protocol, administering the PSC-17 within 3678 WCC encounters, with frequency progressively increasing over the 3-year period. Results highlighted elements of screener utilization, cost-effectiveness, screening algorithm fidelity, and prevalence of psychosocial concerns identified. Secondary implementation challenges were observed after initial screening, specific to implementation of prescribed follow-up procedures. Primary care behavioral health collaborations appear helpful for improving universal screening utilization and cost-effectiveness, and for ensuring children with psychosocial problems are identified early and directed to follow-up care as needed.

Structured dyadic behavior therapy processes for ADHD intervention.

Children with Attention-Deficit/Hyperactivity Disorder (ADHD) present significant problems with behavioral disinhibition that often negatively affect their peer relationships. Although behavior therapies for ADHD have traditionally aimed to help parents and teachers better manage children's ADHD-related behaviors, therapy processes seldom use peer relationships to implement evidence-based behavioral principles. This article introduces Structured Dyadic Behavior Therapy as a milieu for introducing effective behavioral techniques within a socially meaningful context. Establishing collaborative behavioral goals, benchmarking, and redirection strategies are discussed to highlight how in-session dyadic processes can be used to promote more meaningful reinforcement and change for children with ADHD. Implications for improving patient care, access to care, and therapist training are also discussed.