Kathi A. Borden

Compliance With Pharmacological and Cognitive Treatments for Attention Deficit Disorder

Abstract Fifty-eight children with attention deficit disorder were the subjects in a medication and therapy treatment study. Slightly more than one half of these children completed the 3-month treatment protocol, a combination of methylpenidate or placebo and cognitive therapy or an attention-control procedure. The children who completed treatment were demographically similar to the children who did not complete treatment. For “completers,” compliance with medication was more of a problem than compliance with psychotherapy, although these two types of compliance measures were related. Parent interview data were also related to the pharmacists pill counts, although parents underestimated the number of dosages missed. Treatment groups did not influence compliance rates, and compliance rates were not related to therapy outcome. The findings suggest that subjects of low socioeconomic status may be at more risk for compliance difficulties than other groups. Implications for the practitioner are discussed.

Methylphenidate and cognitive therapy with ADD children: A methodological reconsideration.

The present doubleblind study examined the effects of methylphenidate, cognitive therapy, and their combination in attention deficitdisordered (ADD) children. Four treatment groups were compared on measures of attentional deployment and cognitive style, tests of academic achievement, and behavioral rating scales. In contrast to a previous study conducted in this laboratory, children in this study were not receiving medication during posttesting. Results were interpreted to suggest that measurable effects of stimulant medication dissipate rapidly upon discontinuation of pharmacotherapy. The combination of methylphenidate and cognitive therapy was not found to be any more efficacious than either of the treatments studied alone. Discussion suggests that medication status at follow-up is an essential feature of research design.

Depression in Attention-Deficit-Disordered and Normal Children and their Parents

Childrens Depression Inventory (CDI) scores and correlates were examined in 116 ADD and normal children. Results indicated that ADD children and their parents reported higher levels of depression than did their normal counterparts. In normal children, a marginally significant relationship was found between mothers depression and CDI scores. In accord with previous research, no significant relationships were found among IQ, sex, age, or family status and CDI scores. The discussion section within the limitations of the present study, supports the idea of a demoralization syndrome in ADD children and their parents, as discussed by Cantwell and Carlson Although the CDI may be the “best researched” instrument for childrens self-reported depression, more systematic research will be needed before adapting the CDI to the clinical setting.

Attributional Outcomes: The Subtle Messages of Treatments for Attention Deficit Disorder

The attributional effects of combining medication with cognitive behavior therapy in the treatment of children diagnosed as having attention deficit disorder (ADD) were examined. Thirty ADD subjects received a 22-session cognitive training program focusing on self-control. Children were also randomly assigned to receive methylphenidate, placebo, or no pill. Medication group influenced parent attributions. Although child measures did not reveal significant effects, group means were directionally similar to those of the parents. Parents in the no-pill group believed most strongly that their children were capable of solving their own presenting problems. The placebo group most strongly believed that solutions would result from external and uncontrollable factors. The motivational effects of combining medication with cognitive therapy or other behavior change techniques are discussed. Also discussed are the implications for combined treatment tactics in clinical and research settings and applications to behavioral medicine.

Methylphenidate and cognitive therapy in children with attention deficit disorder: a double-blind trial.

Stimulant medications have been the treatment of choice for children with Attention Deficit Disorder (ADD), yet long-term benefits have not been found. The present study examined the ability of an adjunctive cognitive behavioral self-control therapy program to improve upon these long-term results. Findings only partially supported the efficacy of the cognitive therapy, as demonstrated on the Matching Familiar Figures Test of impulsivity. However, this improvement did not persist over time. Results are discussed in terms of the need for pediatricians to consider individual differences in therapeutic response across patients.

Achievement attributions and depressive symptoms in attention deficit-disordered and normal children

Abstract Depressive symptoms and achievement attributions were examined in attention deficit-disordered (ADD) and normal schoolchildren. The findings indicate that the ADD children acknowledged having more depressive symptoms and displayed more external attributions both for positive and for negative achievement. In addition, correlations reveal that the normal childrens achievement attributions became more internal with age, whereas the ADD children became more external for negative events. The patterns of the relationships among measures are discussed.

The performance of attention-deficit-disordered and normal children on conservation tasks.

The present study was designed to investigate whether a specific subgroup of learning-disabled children (attention-deficit-disordered, ADD) differed from their normal counterparts on Piagetian tasks of conservation. The subjects were 34 third-and fourth-grade children. Seventeen children had been diagnosed as ADD; the remaining half were designated as normal. The two groups were equivalent in chronological age, mental age, and intelligence. The results indicated significant differences between the two groups on tasks tapping conservation of substance and number. These results may support the theory of a lag in the development of conservation in children with specific learning disabilities (ADD). Implications of the present research for therapeutic and remedial programs that serve ADD children are also discussed.