Philip Firestone

The role of parent training in treatment of preschoolers with ADDH

The efficacy of group parent training was assessed in improving compliance and time on task in preschoolers with attention-deficit disorder with hyperactivity. Positive effects were obtained on measures of child compliance, but not on measures of attention. Parental compliance-management skills and overall style of interaction were also positively affected. The use of parent training for early intervention with ADDH children is discussed.

Effects of Methylphenidate on Preschool Children With ADHD: Cognitive and Behavioral Functions

OBJECTIVEnTo report on implications for methylphenidate treatment of this very young age group and the need to examine factors related to achieving compliance.nnnMETHODnThirty-one children with attention-deficit hyperactivity disorder (ADHD), aged 4 to 6 years, participated in a double-blind, placebo-controlled study using placebo, 0.3 mg/kg, and 0.5 mg/kg of methylphenidate twice per day.nnnRESULTSnImprovements related to medication were obtained on cognitive tests of attention and impulsivity as well as behaviors assessed by parent rating scales. In an interactive setting with their mothers, attentional abilities and the childrens ability to work more productively also showed improvement. However, no changes were obtained with respect to the childrens tendency to comply with parental requests. Side effects increased slightly with the high dosage of medication but remained mild.nnnCONCLUSIONnThe results suggest that methylphenidate can be used to improve the functioning of preschool-age children with ADHD, in a manner similar to their school-age counterparts.

Differential Effects of Parent Training and Stimulant Medication with Hyperactives: A Progress Report.

Abstract During a 3-month intervention program, 43 hyperactive children and their families were assessed and followed. Families were randomly assigned to one of three groups: parent training in behavior modification while the child was administered a placebo; parent training plus methylphenidate; and methylphenidate only. All groups showed improved home and school behavior. However, only with medication were there also gains on measures of attention and impulse control. The results also revealed greater improvement in the area of academic achievement and classroom behavior in the medication groups as compared with children on placebo. There was no evidence of significant benefit from the addition of parent training to the administration of medication.

An analysis of the hyperactive syndrome: a comparison of hyperactive, behavior problem, asthmatic, and normal children

In an attempt to determine whether the commonly described deficits associated with hyperactivity — inappropriate activity, short attention span, low frustration tolerance, and impulsivity — are unique to this population, hyperactive, behavior problem, asthmatic, and normal control children were studied. The tests most often used in research with hyperactives were administered. Hyperactives, when compared to normals, did show deficits in the aforementioned areas. However, when compared to the behavior problem and asthmatic children only the attentional deficits clearly differentiated hyperactives from the other children.

The Effects of Caffeine and Methylphenidate on Hyperactive Children

Abstract Twenty-one hyperactive children received in turn 500 mg. caffeine, 300 mg. caffeine, and 20 mg. methylphenidate per day in a double-blind crossover design investigation. Each drug was given for three weeks. Methylphenidate resulted in significantly improved behavior in the children as rated by mothers and teachers, and on tests of impulsivity and motor control. There were no significant improvements in either of the caffeine conditions, although some children showed some slight improvements with caffeine. The negative side effects with both caffeine and methylphenidate were minimal.

The effects of anxiety management training on the control of juvenile diabetes mellitus.

The present study was designed to determine whether diabetic control could be improved through the direct psychological management of stress and anxiety. Five poorly controlled female adolescent diabetics ranging in age from 15 to 18 years were used as subjects. All were seen on an outpatient basis over a 6-month period. A single-subject format employing a multiple-baseline design across subjects was used. The independent variable used was a technique known as anxiety management training. Baseline, attention-control, and treatment data were collected on a number of dependent measures. Subjective estimates of anxiety and tension by each subject were gathered on a biweekly basis using the Multifactorial Scale of Anxiety. Diabetic control was assessed daily using the Diastix method and weekly using the 24-hr quantitative glucose method. Data on the five subjects suggested that improved control of stress and anxiety had a positive effect on diabetic regulation. Lower and more stable urine glucose levels using both urine testing methods were found. However, no decreases in the subjects personal assessment of tension and anxiety were evident.

Hyperactivity and physical anomalies.

Hyperactive elementary school boys were matched for age and IQ to a group of normal control children, and the frequency of minor physical anomalies in each group was recorded. Although hyperactives had more of these anomalies than the control children there was not a significant correlation between the degree of hyperactivity and the frequency of anomalies.

A Review of Psychopharmacological and Behavioral Approaches to the Treatment of Hyperactive Children.

One hundred sixty-one children between 9 and 17 years of age who had migraine headaches participated in a behaviourally oriented treatment programme. Data were collected on factors related to staying in treatment and adherence to treatment instructions. The results revealed that older children were less likely to drop out during treatment. In addition, children with fewer headaches were more likely to adhere to treatment regimen. Demographic data on the families and personality measures on the migraineurs did not distinguish between those subjects who stayed in the programme or dropped out and those who were good or poor adherents. RÉSUMÉ Cent soixante et un enfants âgés entre 9 et 17 ans sujets à des migraines ont participé à un programme de traitement béhavioral. Des données furent recueillies concernant des facteurs reliés au fait de demeurer dans le programme et à ladhérence aux directives du traitement. Les résultats ont révélé que les enfants plus âgés étaient moins portés à abandonner le programme durant le traitement. En plus. les enfants avec moins de migraines étaient plus susceptibles à adhérer aux directives du traitement. Des données démographiques sur les familles et les mesures de personnalité des migraineurs ne permirent pas de distinguer entre les enfants qui persistèrent dans le programme et ceux qui abandonnèrent celui-ci, ni entre ceux qui adhérèrent aux directives du traitement et ceux qui ne le firent pay Compliance to therapeutic regimens has become an increasingly important issue -: health care (Dunbar, 1983: Sackett & Snow. 1979). Research has demonstrated ,a t patients have a great deal of difficulty in carrying out even simple health care -istructions such as taking a pill once or twice per day (Firestone. 1982: Sackett, 979). In a compliance study of children diagnosed as suffering from streptococcal narvngitis and acute otitis media. Bergman and Werner (1963) discovered that 56% ad stopped taking the medication by the third day. 71% by the sixth. and 82% by ne ninth day. Similarly. Mattar. Markello, and Jaffe (1975) found that only 7.3% 4 300 pediatric outpatients completed their course of antibiotics for otitis media. I)verall. it has been estimated that 50% of adults and children do not take medica-. o n as prescribed (Briant. 1978; Dunbar. 1983) and thus reduce its effectiveness. Given the relative ease of taking medication as compared to the more time-consuming and demanding requirements of a psychologically based intervention, This research was supported by the Ontario Ministry of Health (DM-5361 and the Ontario Ministry of jommunity and Social Services. Dr. McGrath is supported by a Career Scientist Award from the Ontario Ministry of Health. Reprint requests should be sent to Dr. Philip Firestone. Child Study Centre. University of Ottawa, 120 Université Priv.. Ottawa. ON, Canada KIN 6N5. ..This paper was accepted for publication during the editorship of Dr. Kenneth D. Craig.

The effects and side effects of timeout on an aggressive nursery school child

Abstract Timeout was used to eliminate the aggressive behavior of a nursery school child. Systematic observations of target and non-target behavior were undertaken. The results indicated that as the aggressive behavior was eliminated, the child showed increases in some desirable behaviors. The possible side effects of timeout are discussed.

Desensitization in children and adolescents: A review

Abstract Twenty‐one controlled evaluations of the usefulness of desensitization techniques in children are reviewed. The studies were subdivided according to the nature of the target behavior into non‐clinical, sub‐clinical and clinical investigations. Only three studies worked with clinic populations and treatment effectiveness was best demonstrated in the least disturbed groups of patients. Major methodologic problems were a lack of adequate follow‐up, poor choice of controls, ambiguously applied procedures and questionable dependent measures. It was concluded that these techniques have not yet been adequately examined. Apart from their therapeutic range and effectiveness, researchers should delineate any limiting (e.g. cognitive) factors which may be peculiar to this younger group.