Richard Gallagher

Remediating Organizational Functioning in Children with ADHD: Immediate and Long-Term Effects from a Randomized Controlled Trial.

OBJECTIVE The study compared the efficacy of 2 behavioral interventions to ameliorate organization, time management, and planning (OTMP) difficulties in 3rd- to 5th-grade children with attention-deficit/hyperactivity disorder (ADHD). METHOD In a dual-site randomized controlled trial, 158 children were assigned to organizational skills training (OST; N = 64); PATHKO, a performance-based intervention that precluded skills training (N = 61); or a wait-list control (WL, N = 33). Treatments were 20 individual clinic-based sessions over 10-12 weeks. OST involved skills building provided primarily to the child. PATHKO trained parents and teachers to reinforce children contingently for meeting end-point target goals. Primary outcomes were the Childrens Organizational Skills Scales (COSS-Parent, COSS-Teacher). Other relevant functional outcomes were assessed. Percentage of participants no longer meeting inclusion criteria for OTMP impairments informed on clinical significance. Assessments occurred at post-treatment, 1-month post-treatment, and twice in the following school year. RESULTS OST was superior to WL on the COSS-P (Cohens d = 2.77; p < .0001), COSS-T (d = 1.18; p < .0001), childrens COSS self-ratings, academic performance and proficiency, homework, and family functioning. OST was significantly better than PATHKO only on the COSS-P (d = 0.63; p < .005). PATHKO was superior to WL on most outcomes but not on academic proficiency. Sixty percent of OST and PATHKO participants versus 3% of controls no longer met OTMP inclusion criteria. Significant maintenance effects were found for both treatments. CONCLUSIONS Two distinct treatments targeting OTMP problems in children with ADHD generated robust, sustained functional improvements. The interventions show promise of clinical utility in children with ADHD and organizational deficits.

The diagnosis and neuropsychological assessment of adult attention deficit/hyperactivity disorder. Scientific study and practical guidelines.

Abstract: The recognition of attention deficit/hyperactivity disorder (ADHD) in adults is a well documented, but relatively new development. Investigations of the disorder have indicated that disturbances in behavior and adjustment are common. These disturbances may be linked to poorly developed executive functions. This paper reviews the neuropsychological studies that have compared persons with ADHD to normal controls and to psychiatric controls. The review indicates that persons with ADHD share many neuropsychological characteristics with other persons with serious psychiatric conditions, although those with ADHD may have a particular profile of slowed performance in tasks of sustained attention and set shifting, and their use of working memory may be particularly impaired. The implications of research for clinical assessment are discussed. We contend that a neuropsychological orientation is necessary for making the diagnosis and gaining a full understanding of adult ADHD. A model for clinical assessment is proposed which utilizes a neuropsychological orientation and the targeted administration of neuropsychological instruments. The careful use of neuropsychological measures is warranted in providing an elaborate picture of a persons functioning, although the use of neuropsychological tests is not necessary to make the diagnosis.

Effective Methods to Improve Recruitment and Retention in School-Based Substance Use Prevention Studies

BACKGROUND Poor recruitment and high attrition may invalidate results of research studies. This paper describes successful recruitment and retention strategies in a school-based substance use prevention trial and explores factors associated with intervention attendance and retention. METHODS A total of 384 parent-child dyads from 15 schools in the New York Metropolitan area participated in a control trial, testing the efficacy of parent-training to prevent youth substance use. Assessments were completed immediately post-intervention and 6-, 12-, and 24-month postintervention. Logistic regression analyses were used to determine which familial and study characteristics predicted attendance in the intervention and retention by parents and youth. RESULTS 84% of intervention parents attended 4 of the 5 workshops; 83% of control parents attended their single workshop. Intervention attendance was predicted by parent job status, but this was not significant after controlling for other family factors. Retention rates ranged from 87% to 91% over the 2 years. No family characteristics predicted retention, but time since baseline and attendance at treatment workshops and the control workshop did. For children, age at baseline and ethnicity predicted retention, but this did not remain significant in the adjusted model. CONCLUSION Intervention attendance was high and retention rates far exceeded the minimum standard of 70% retention in behavioral studies. Recruitment and retention strategies were effective for different family constellations. Efforts to maximize participation in both treatment and control interventions are critical to retention in longitudinal trials.

Soft Signs in Children of Parents with Agoraphobia

OBJECTIVE To study a proposed relationship between anxiety disorders and neurological soft signs by determining whether children of agoraphobic parents would have an increased prevalence of soft signs compared to children of parents without agoraphobia. METHOD Family study methodology was used to compare 25 children of agoraphobic adults and 25 age- and sex-matched children of nonagoraphobic adults on a structured soft signs examination and on structured psychiatric interviews. Also, soft signs of 12 agoraphobic adults were compared with soft signs of 16 control adults. RESULTS Children of agoraphobic adults had significantly more right- and left-side motor slowness on finger tapping and hand patting (p values < .05) than did children of controls. Seventy-six percent of the children of agoraphobic adults had at least one slow motor sign, compared with 28% of the control children (p < .001). There were no significant differences in soft signs between agoraphobic and control adults. CONCLUSIONS The study provides additional support for a relationship between soft signs and anxiety disorder.