Clinical Effects of an ACT-Group Training in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder

Abstract

Objective The aim of the present study is evaluate the effectiveness of an Acceptance and Commitment Therapy (ACT)based training protocol, in adjunct to token economy and previous parent training, in a sample of children with Attention-Deficit/Hyperactivity Disorder (ADHD). By promoting the reduction of immediate responses to thoughts and feelings, we aimed to reduce the impulsive behaviour of children and to improve their self-regulation. Methods The protocol was centred on awareness of the present moment, defusion and acceptance of feelings and emotions. Behavioural (Conners' Parent Rating Scale-Revised: Long version, CPRS-R:L) and severity measures (Clinical Global Impression-Severity, CGI-S) were assessed before and after treatment in a clinical sample of 31 children aged 8-13 years. Results At the end of the ACT protocol, children showed significant improvement in global functioning and behavioural symptoms. There were significant improvements in the CPRS subscales Cognitive Problems (p = 0.005), Hyperactivity (p = 0.006), Perfectionism (p = 0.017), ADHD Index (p = 0.023), Global Index: Restless-Impulsive (p = 0.023), Global Index: Total (p = 0.036), DSM IV Inattentive (p = 0.029), DSM IV Hyperactive-Impulsive (p = 0.016), and DSM IV Total (p = 0.003). When controlling for the confounding effect of pharmacological therapy, comorbidities and socioeconomic status, treatment maintained a significant effect on the CPRS subscales Perfectionism (partial η 2 = 0.31, p < 0.01), Global Index: Restless-Impulsive (partial η 2 = 0.29, p < 0.01), Global Index: Total (partial η 2 = 0.31, p < 0.01), DSM IV Hyperactive-Impulsive (partial η 2 = 0.20, p = 0.02). Symptom severity as rated by CGI-S scores decreased in 74.2% of the children. Conclusions This preliminary work on an Acceptance and Commitment Therapy-based child training in children affected by ADHD resulted in significant improvements, measured by a rating scale specific for ADHD. Keywords ADHD • Acceptance and Commitment Therapy • Rehabilitation • Conners parent rating scale • Child training Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurobehavioral disorder common in childhood, with symptoms including troubles in paying and maintaining attention, hyperactivity and impulsive behaviour. The

Does ACT-Group Training Improve Cognitive Domain in Children with Attention Deficit Hyperactivity Disorder? A Single-Arm, Open-Label Study

“…Indeed, fluctuations of the cognitive tasks’ scores observed during this preliminary study are likely to represent either random fluctuations or developmental changes in the performance, not real treatment effects. The results reported here, therefore, seem to point out that the previous findings (Murrell et al, 2015; Vanzin et al, 2020) of a possible significant benefit of ACT-based child training could be limited to ADHD behavioural symptoms. In particular, the present findings do not replicate, on a cognitive level, the recent results of Vanzin et al (2020) showing a reduction of inattention as behaviourally rated by parents via the Conners’ Parent Rating Scale-Revised, in a partially overlapping set of participants.…”

“…The results reported here, therefore, seem to point out that the previous findings (Murrell et al, 2015; Vanzin et al, 2020) of a possible significant benefit of ACT-based child training could be limited to ADHD behavioural symptoms. In particular, the present findings do not replicate, on a cognitive level, the recent results of Vanzin et al (2020) showing a reduction of inattention as behaviourally rated by parents via the Conners’ Parent Rating Scale-Revised, in a partially overlapping set of participants. This result is not surprising in light of previous evidence, suggesting that different mechanisms could be responsible for the improvement in cognitive performance and ameliorations of behavioural symptoms, respectively (Coghill, Rhodes, & Matthews, 2007).…”

“…The effects of ACT-group training on behavioural ADHD symptoms were previously reported (Vanzin et al, 2020). Thus, the focus of the present work was to investigate the effects of this training on the cognitive domain as assessed by Amsterdam Neuropsychological Tasks programme.…”

“…The focuses and exercises of the different sessions are summarised in Table 1. For a more detailed description of the intervention, see Vanzin et al (2020).…”

“…They found significant reliable change index scores on the Behaviour Assessment Scale for Children — second edition and the Bull's-Eye Values Assessment in two out of nine participants. Accordingly, a more recent investigation (Vanzin et al, 2020) indicated that 26 weeks (90-min sessions) of ACT-based group child training delivered over 9 months had positive effects on the behaviour of 31 school-aged children and adolescents diagnosed with ADHD at post-treatment. More specifically, this explorative single-arm, open-label study found improvements in ADHD symptoms measures, on clinical rating scales such as the Conners’ Parent Rating Scale-Revised and Clinical Global Impression-Severity.…”