Teletherapy Delivery of Caregiver Behavior Training for Children with Attention-Deficit Hyperactivity Disorder

Abstract

Background: Preliminary studies suggest that videoteleconferencing (VTC) may be an effective means to deliver behavioral interventions to families. Subjects consisted of a subsample of children (n = 37) and caregivers who participated in the Children's Attention-Deficit Hyperactivity Disorder (ADHD) Telemental Health Treatment Study (CATTS) (n = 223), a randomized trial testing the effectiveness of delivering treatments for ADHD to families residing in their home communities using distant technologies. Families randomized to the CATTS intervention arm received pharmacotherapy and caregiver behavior training. Materials and Methods: Thirty-seven families from the CATTS intervention arm participated. All families received pharmacotherapy through VTC. Twelve families received the caregiver behavior training through VTC, or teletherapy, and 25 received the intervention in-person. We assessed children's outcomes at 25 weeks with the Vanderbilt ADHD Parent Rating Scale and the Columbia Impairment Scale. We assessed caregivers' outcomes using measures of distress in caring for a child with ADHD, including depression, stress, strain, and empowerment. We used analysis of covariance to assess outcomes from baseline to 25 weeks. Results: Families in the two conditions showed comparable attendance at sessions and satisfaction with their care. Caregivers in both conditions reported comparable outcomes for their children's ADHD-related behaviors and functioning, but caregivers in the teletherapy group did not report improvement in their own distress. Conclusions: Findings support the feasibility, acceptability, and effectiveness of treating children with ADHD through teletherapy. Future work should investigate how teletherapy may improve caregivers' distress. Teletherapy is a promising modality for delivering behavioral interventions for children with ADHD.

Research in the Integration of Behavioral Health for Adolescents and Young Adults in Primary Care Settings: A Systematic Review

“…We did not identify any randomized controlled trials addressing behavioral health integration for anxiety, the most prevalent disorder during adolescence, nor eating disorders among adolescents which are often medically managed in primary care. Similarly, although integrated care models have been tested among younger children with attention deficit disorder, 60–63 studies have not included adolescents above age 13 or young adults. Additional opportunities for new research areas include: examining effectiveness of brief interventions developed for primary care administration in adult settings among adolescent and young adult populations, evaluation of technological strategies to increase access to psychotherapy in primary care, and improved models for the primary care integration of web-based psychotherapy methods that have been shown to be effective for depression and anxiety in adolescent and young adult populations.…”

The Children’s Attention-Deficit Hyperactivity Disorder Telemental Health Treatment Study: Caregiver Outcomes

“…This finding portends well for the ability of telehealth technologies to extend the reach of empirically-supported psychotherapeutic treatments to children and caregivers in geographically underserved communities. It also suggests next steps to build on the few small studies supporting the delivery of caregiver behavior training through synchronous videoconferencing (Reese, et al, 2012; Tse, McCarty, Vander Stoep, & Myers, 2015; Xie, et al, 2013). …”

Clinical Update: Telepsychiatry With Children and Adolescents

“…Outcomes of the behavioral treatment of tics through ITV also appear comparable to in-person treatment. 22 Two pre-to postintervention outcome studies have suggested the benefit of treatment delivered through ITV including behavior management training 24,25 and consultation to PCPs in the psychiatric care of young patients. 29 Five small randomized trials have demonstrated potential effectiveness of providing family or parenting interventions through ITV.…”

“…20 children (age 8e17 y) with Tourette's disorder or chronic motor tic disorder YGTS, PTQ, CGI-S, CGI-I youth in ITV and in-person service delivery modalities experienced significant tic decrease with no between-group differences Myers et al, 2015 23 223 youth (age 5.5e12.9 y) with ADHD DISC-IV, CBCL, VADPRS, VADTRS, CIS caregivers reported improved inattention, hyperactivity, combined ADHD, ODD, role performance, and impairment; teachers reported improvement in ODD and role performance Xie et al, 2013 24 22 children (age 6e14 y) with behavioral disorder PCQ-CA, VADPRS, CGAS parent training through ITV was as effective as in-person training and was well accepted by parents Tse et al, 2015 25 38 children (age 5.5e12 y) with ADHD VADRS, CIS, PSI, CSQ, PHQ-9, FES parents of children with ADHD received parent training in person or through ITV; children in the 2 groups improved comparably; parents' distress did not change for those who received training through ITV Comer et al, 2017 26 children 3e5 y old with disruptive behaviors 33 30 children (age 4e16 y; mean 13 y) satisfaction questionnaire showed high satisfaction of children, teens, parents, and psychiatrists with ITV Kopel et al, 2001 34 136; article does not specify age but refers to participants as "young persons" satisfaction questionnaire high satisfaction by families and rural health workers in New South Wales, Australia Greenberg et al, 2006 35 35 to March 2017, in the English language, and on human species. In Medline, PsycInfo, and Embase, appropriate Medical Subject Headings (MeSH), terms from the Thesaurus of Psychological Index Terms, and Emtree headings were used, respectively, in addition to text words, and the search strategy was adapted for other databases as appropriate.…”