Objective This study examined several questions about the diagnosis of attention-deficit/hyperactivity disorder (ADHD) in young adults using data from a childhood-diagnosed sample of 200 individuals with ADHD (age M = 20.20 years) and 121 demographically similar non-ADHD controls (total N = 321). Method We examined the use of self-versus informant ratings of current and childhood functioning and evaluated the diagnostic utility of adult-specific items versus items from the Diagnostic and Statistical Manuel of Mental Disorders (DSM). Results Results indicated that although a majority of young adults with a childhood diagnosis of ADHD continued to experience elevated ADHD symptoms (75%) and clinically significant impairment (60%), only 9.6%–19.7% of the childhood ADHD group continued to meet DSM–IV–TR (DSM, 4th ed., text rev.) criteria for ADHD in young adulthood. Parent report was more diagnostically sensitive than self-report. Young adults with ADHD tended to underreport current symptoms, while young adults without ADHD tended to overreport symptoms. There was no significant incremental benefit beyond parent report alone to combining self-report with parent report. Non-DSM-based, adult-specific symptoms of ADHD were significantly correlated with functional impairment and endorsed at slightly higher rates than the DSM-IV-TR symptoms. However, DSM-IV-TR items tended to be more predictive of diagnostic group membership than the non-DSM adult-specific items due to elevated control group item endorsement. Conclusions Implications for the assessment and treatment of ADHD in young adults are discussed (i.e., collecting informant reports, lowering the diagnostic threshold, emphasizing impairment, and cautiously interpreting retrospective reports).
Behavioral parent training (BPT) is one of the empirically supported psychosocial treatments for ADHD. Over many years and in many studies, BPT has been documented to improve both child ADHD behavior and maladaptive parenting behavior. In some studies, BPT has also been found to result in benefits in additional domains, such as parenting stress and child classroom behavior. However, the BPT literature on children selected as having ADHD lags behind research conducted on BPT for children selected as having oppositional defiant and conduct disorders (ODD and CD, respectively) with regard to examination of factors that may limit treatment attainment, compliance, and outcomes, such as single parenthood, parental psychopathology, and child comorbidity. Because of the high degree of comorbidity between ADHD and ODD/CD, it is difficult to separate the two BPT literatures. The parameters of BPT (e.g.. format and setting), parent factors, and child factors that may contribute to treatment outcomes for families of children with ADHD are reviewed here and recommendations for future BPT research in the area of ADHD are made.
Objective-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.Method-We completed a systematic review of the literature published between 2008 and 2013 to establish levels of evidence for psychosocial treatments for these youth. The 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.Results-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 concluded that behavioral parent training, behavioral classroom management and behavioral peer interventions were wellestablished 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). Conclusions-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.Correspondence should be addressed to Steven W. Evans, Center for Intervention Research in Schools, Department of Psychology, Ohio University, Porter Hall, Athens, Ohio 45701. evanss3@ohio.edu.. Numerous studies document that children and adolescents with Attention-Deficit/ Hyperactivity Disorder (ADHD) experience poor outcomes across several domains of functioning, including education, vocation, interpersonal relations, and health risk. These problems lead to substantial impairment (Wehmeier, Schacht & Barkley, 2010), parent distress (Wymbs, Pelham, Molina & Gnagy, 2008), and extensive costs to society (Pelham, Foster & Robb, 2007;Robb et al., 2011). Research on the development and evaluation of psychosocial treatments 1 for children and adolescents (hereafter 'children') with ADHD has been focused on improving these outcomes for almost 40 years (see Antshel & Barkley, 2011 for a historical review). Reports of progress in this work have been highlighted in two special issues of the Journal of Clinical Child and Adolescent Psychology (JCCAP). In 1998, Pelham, Wheeler and Chronis published the first in this series of literature reviews of psychosocial treatments for ADHD, and Pelham and Fa...
Behavioral parent training is an efficacious treatment for attention-deficit=hyperactivity disorder (ADHD). However, single-mother households are at high risk for poor outcomes during and following behavioral parent training. This study randomly assigned cohorts of 120 single mothers of children (ages 5-12 years) with ADHD to a waitlist control group, a traditional behavioral parent training program, or an enhanced behavioral parent training program-the Strategies to Enhance Positive Parenting (STEPP) program. Intent-to-treat analysis demonstrated benefits of participating in behavioral parent training, in general, and the STEPP program more specifically at immediate posttreatment on child and parental functioning. Moreover, the STEPP program resulted in increased engagement to treatment. However, results indicated that behavioral parent training does not normalize behavior for most children and treatment gains are not maintained.
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