Anne M. P. Michalek

Psychosocial Treatments for ADHD: A Systematic Appraisal of the Evidence

Objective: Children with learning disabilities often experience comorbid ADHD, impacting on the effectiveness of interventions for those children. In addition to pharmacologic intervention, clinicians and educators employ a variety of psychosocial methods to address the behavioral and social issues that arise in children with ADHD, including those with co-occurring learning disabilities. Numerous systematic reviews and meta-analyses have been conducted examining treatment studies using psychosocial interventions for children with ADHD. Because of the importance of such reviews to evidence based clinical and educational practice, it is essential that reviews be conducted with rigorous methodologies to avoid bias in conclusions (Schlosser, Wendt, & Sigafoos, 2007). The purpose of this study was to evaluate the quality of systematic reviews and meta-analyses conducted for psychosocial treatments of ADHD in children. Method: Electronic databases were searched for peer-reviewed, English language studies of psychosocial treatments for ADHD in children up to 18-years-old from 1998 to 2010. Twenty-one studies were identified that met inclusion criteria (13 systematic reviews, 8 meta-analyses). Independent examiners used the quality rating scale proposed by Auperin, Pignon, and Pynard (1997) to rate the characteristics of good systematic reviews and meta-analyses. Results: Results indicated that certain methodological characteristics were common across trials reviewed, yet shortcomings were common among most reviews, including inadequate descriptions of data extraction methods and lack of quality ratings for trials included in the reviews. Conclusion: Synthesis of findings from the five top-rated reviews and the literature on ADHD suggest that psychosocial treatments contribute to improvements on behavioral and social outcomes. How ADHD and LD interplay in treatment outcomes is largely unexplored.

Effects of noise and audiovisual cues on speech processing in adults with and without ADHD

Abstract Objective: This study examined the interplay among internal (e.g. attention, working memory abilities) and external (e.g. background noise, visual information) factors in individuals with and without ADHD. Design: A 2 × 2 × 6 mixed design with correlational analyses was used to compare participant results on a standardized listening in noise sentence repetition task (QuickSin; 17), presented in an auditory and an audiovisual condition as signal-to-noise ratio (SNR) varied from 25–0 dB and to determine individual differences in working memory capacity and short-term recall. Study sample: Thirty-eight young adults without ADHD and twenty-five young adults with ADHD. Results: Diagnosis, modality, and signal-to-noise ratio all affected the ability to process speech in noise. The interaction between the diagnosis of ADHD, the presence of visual cues, and the level of noise had an effect on a persons ability to process speech in noise. Conclusion: Young adults with ADHD benefited less from visual information during noise than young adults without ADHD, an effect influenced by working memory abilities.

Using a Child-Specific Social Story to Improve Communication and Social Skills in Two Preschoolers with Cochlear Implants: An Exploratory Classroom Case Study

Abstract This case study explored the efficacy of reading the same child-specific social story prior to a five-minute unstructured play session with two four-year-old children with cochlear implants. Results revealed that after the social story was read one participant produced a moderate–high increase in initiated verbal comments while the other child manifested a slight increase, both used vocabulary from the story in their play, and that play turns increased. This strategy may offer promise for educators in separate and inclusive classrooms, although more research is needed.

Critical appraisal of systematic reviews of executive function treatments in TBI

ABSTRACT Objective: To appraise the quality of systematic reviews (SRs) and meta-analyses (MAs) that summarize the treatment literature for executive function (EF) impairments following traumatic brain injury (TBI). Methods: We used five data sources (PubMed; PsycINFO; ANCDS.org; Cochrane Collaboration; American Speech–Language–Hearing Association Compendium; Psychological Database for Brain Impairment Treatment Efficacy) and identified 19 reviews that met eligibility criteria (adults with TBI; behavioural treatments for EF impairments; no pharmacologic treatments). Two reviewers independently and reliably rated each paper using two appraisal tools (Critical Appraisal of Systematic Review or Meta-Analysis and Evidence in Augmentative and Alternative Communication systematic review scale). Results: Five MAs received highest ratings. Four SRs also addressed the majority of SR criteria. Reviews were better at addressing SR criteria as outcome measures across studies varied considerably, posing a challenge to quantitatively synthesize TBI outcomes. The strongest research evidence favours compensatory treatments that train individuals with TBI to use strategies to circumvent EF impairments in daily activities. Smaller effects are reported for direct training approaches. Conclusions: Researchers need to identify core outcome measures to facilitate future rigorous MAs of the EF rehabilitation literature. SRs/MAs need to be conducted with thorough methods that are reported with detail.

Linking Executive Functions and Written Language: Intervention forStudents with Language Learning Disorders

Purpose: School based speech-language pathologists (SLPs) has an important role in the identification and intervention of problems in oral and written language. In collaboration with classroom teachers, they often are asked to develop intervention plans that include evidence-based practices for those students with language learning disabilities (LLD) who have language deficits. The purpose of this article is to bridge theory to practice by explaining an evidence-based instructional model, the self-regulated strategy development model (SRSD), for SLPs to consider as they deliver instruction to support the written language deficits of students with LLD. Method: The authors examine critically the relationship between executive functions (EFs) and written expression. They discuss the EFs researchers have identified as important to students’ development of written expression and the difficulties students with LLD encounter in completing written expression tasks. The authors outline a model of EFs in relationship to the “Not-So-Simple view of writing” model which provides a framework for viewing the multiple components of the writing system. Conclusion: Based on the review of the literature, the SRSD is an effective evidence-based teaching model for instructing students with LLD that integrates and scaffolds the EFs essential for developing written expression skills.

Enhancing Service Coordination Knowledge Through Professional Development

All eligible infants and toddlers who receive early intervention services under Part C of Individuals with Disabilities Education Act are entitled to service coordination. To examine the effectiveness of one states service coordination training and its impact on knowledge and skill development, a pretest–posttest design with follow-up survey was employed. Thirty-nine service coordinators and other early intervention practitioners participated in the 2-day Kaleidoscope, New Perspectives in Service Coordination—Level I training. Participation in training resulted in significant increases in knowledge about service coordination practices. Survey respondents reported that they perceived the training to be useful and that their knowledge related to what they learned had improved. Respondents also indicated needs for further resources and training in providing effective service coordination to children and families. Implications for professional development in service coordination are discussed.

Impact of an Activity Mini-Schedule on the Inattention of Preschoolers with Cochlear Implants during a Group Activity

This pilot study evaluated the effectiveness of using an activity mini-schedule which divided a circle time activity into four sub-activities with four preschoolers who were deaf and had received cochlear implants. Often preschoolers with cochlear implants display difficulty directing attention to appropriate stimuli during large group activities (Chute & Nevins, 2003). It was hypothesized that the use of an activity mini-schedule would decrease inattention. Using a multiple baseline design across participants, an activity mini-schedule was introduced to each participant sequentially by a paraeducator who sat behind the children during circle time. Participants’ behaviors were videotaped and coded. The introduction of an activity mini-schedule decreased inattention in all participants, yet individual outcomes varied. Although this study offers some evidence that activity mini-schedules may positively impact attention in young children, more research is needed.