Evidence-Based Psychosocial Treatments for Children and Adolescents with Attention-Deficit/Hyperactivity Disorder

Abstract

The purpose of this research was to update the Pelham and Fabiano (2008) review of evidence-based practices for children and adolescents with attention-deficit/hyperactivity disorder. We completed a systematic review of the literature published between 2007 and 2013 to establish levels of evidence for psychosocial treatments for these youth. Our review included the identification of relevant articles using criteria established by the Society of Clinical Child and Adolescent Psychology (see Southam-Gerow & Prinstein, in press) using keyword searches and a review of tables of contents. We extend the conceptualization of treatment research by differentiating training interventions from behavior management and by reviewing the growing literature on training interventions. Consistent with the results of the previous review we conclude that behavioral parent training, behavioral classroom management, and behavioral peer interventions are well-established treatments. In addition, organization training met the criteria for a well-established treatment. Combined training programs met criteria for Level 2 (Probably Efficacious), neurofeedback training met criteria for Level 3 (Possibly Efficacious), and cognitive training met criteria for Level 4 (Experimental Treatments). The distinction between behavior management and training interventions provides a method for considering meaningful differences in the methods and possible mechanisms of action for treatments for these youth. Characteristics of treatments, participants, and measures, as well as the variability in methods for classifying levels of evidence for treatments, are reviewed in relation to their potential effect on outcomes and conclusions about treatments. Implications of these findings for future science and practice are discussed.

Acknowledgments

During the preparation of this article, Steven Evans was partially supported by a grant from the National Institute of Mental Health (MH074713) and both Steven Evans and Julie Sarno Owens were partially supported by grants from the Department of Education, Institute for Education Sciences (IES; R324C080006, R305A110059, R324A120272). We appreciate the assistance of the students and staff in the Center for Intervention Research in Schools at Ohio University and Greg Fabiano and Saskia van der Oord who read an earlier version of this manuscript.

Notes

Note. Adapted from Silverman and Hinshaw (2008).

¹The terms treatment and intervention are used synonymously throughout the article.

Note. Race/Ethnicity is as reported by the authors; C = Caucasian, AA. = African American, As = Asian, L = Latino, H = Hispanic, O = other. Diagnostic Assessment Measures: 1 = structured parent interview; 2 = parent symptom ratings; 3 = parent impairment ratings; 4 = teacher symptoms ratings; 5 = teacher impairment ratings; 6 = age of onset. Outcome Measures: 1 = ADHD symptoms; 2 = academic functioning; 3 = peer relations; 4 = family functioning; 5 = behavioral functioning; 6 = neurological or physiological performance; a = parent report; b = teacher report; c = objective indicator; d = child report; e = clinician/summer counselor or summer teacher report. Nathan & Gorman (2002) Type: 1 = type 1; 2 = type 2. WWC = What Works Clearinghouse Standards: a = meets evidence standards; b = meets evidence standards with reservations.

Note: Bold indicates that comparison is well-established treatment. APRS = Academic Performance Rating Scale; BASC = Behavior Assessment Scale for Children; BCM = behavioral classroom management; BDI = Beck depression inventory; BPT = behavioral parenting training; Bracken = Bracken Basic Concepts Scale—Revised; CBT = cognitive behavioral treatment; COSS = Children's Organizational Skills Scale; CPRS-R:S = Conners Parent Rating Scale-Revised: Short Form; CPRS-R-L = Conners Parent Rating Scales - Revised Long Form; CPS = Classroom Performance Survey; CS = clinically significant; CTRS-R-L = Conners Teacher Rating Scales - Revised Long Form; DBD = disruptive behavior disorders rating scale; DIBELS = Dynamic Indicators of Basic Early Literacy Skills; DPICS = Dyadic Parent–Child Interaction System; DPICSPP = Dyadic Parent-Child Interaction Coding System – Positive Parenting; DPICSNP = Dyadic Parent-Child Interaction Coding System – Negative Parenting; DSAS = Dishion Social Acceptance Scale; ECBI = Eyberg Child Behavior Inventory; ES = effect sizes as reported by the study's authors; Cohen's d unless otherwise noted by a superscript; and positive ES indicates that the primary treatment being tested is superior); F = Father ratings; HPC = Homework Problem Checklist; ; HPQ = Homework Performance Questionnaire; IRS = impairment rating scale; LA = Language Arts; M = Mother ratings; NS = nonsignificant with insufficient data to calculate an effect size; OR = Odds ratio; Par = parent; PCRQ = Parent–Child Relationship Questionnaire; PSI = parenting stress index; PTIQ Parent–Teacher Involvement Questionnaire; RCI – reliable change index; SNAP = Swanson, Nolan, and Pelham ADHD rating scale; SPED = special education; SSRS = Social Skills Rating System; STP = summer treatment program; Tch = teacher; VADPRS = Vanderbilt ADHD Diagnostic Parent Rating Scale.

Because of the different metric used to calculate effect sizes, effect sizes should not be compared across studies. They simply indicate the magnitude of a given treatment within the conditions of that given study.

^a Effect size is .

^b Effect size is η².

^c Effect size is f ².

^d Effect size is Cohen's d as calculated by the authors of the current article (posttreatment treatment mean – posttreatment control mean/square root of the pooled standard deviations at posttreatment).

^e Effect size is Hedge's unbiased g as calculated by the authors of the current article.

^f We used the highest dose of medication in the context of no behavior modification as the alternative treatment against which to compare the high behavior modification only (i.e., placebo) treatment.

^h Due to nonequivalence of groups at baseline, effect sizes for this article are calculated by the authors of the current article using the following equation (baseline to posttreatment change in treatment group – baseline to posttreatment change in control group/pooled baseline standard deviation)

^g Effect sizes were calculated using the t statistic from the assessment point by group parameter estimate.

*A significant effect of treatment, as defined by the analyses for that study.

²Per the What Works Clearinghouse standards (Institute of Education Sciences, 2011), a study that met criteria for either Meets Evidence Standards or Meets Evidence Standards with Reservations was conducted within a relevant time frame, tested a relevant intervention with a relevant sample, employed relevant and adequate (i.e., valid and reliable) outcomes measures, provided enough information to calculate an effect size for at least one outcome measure, and was a randomized controlled trial or a quasi-experiment. For a study to be categorized as Meets Evidence Standards, the study also had to employ random assignment or functionally random haphazard assignment, the research team had to demonstrate the absence of high overall or of high differential attrition, groups had to be equated on a pretest of the outcome measure, and the intervention had to be free of intervention contamination. If a study failed to meet one or more of the criteria for Meets Evidence Standards but employed a quasi-experimental design, group assignment, equating and baseline equivalence; had no severe overall or differential attrition or, if it did have severe attrition, such attrition is accounted for in the analysis, and had no intervention contamination; it was categorized as Meets Evidence Standards with Reservations. All studies that met the five task force method criteria used in this review met one of these two WWC standards. The Nathan and Gorman categorization ranges from 1 to 6 and all studies that met criteria for being included in this review met criteria for either Type 1 or 2. Type 1 studies employ the most rigorous scientific evaluations and are randomized, prospective clinical trials with comparison groups, blind assessments, state-of-the-art diagnostic procedures, clear inclusion and exclusion criteria, an adequate sample size and a clear description of statistical methodology. Type 2 studies are clinical trials wherein an intervention is tested but the study lacks one component of Type 1 criteria.

³We understand that this study may have been classified in the BPT section; however, the purpose of the intervention was to train adults to modify contingencies in the environments with which children socially interacted with peers for the purpose of enhancing their social functioning, therefore, we judged that it fit better in the BPI category than BPT.