Stephanie Schürmann

Effectiveness of an adaptive multimodal treatment in children with Attention-Deficit Hyperactivity Disorder -- global outcome.

AbstractBackgroundThe meaning of different components within a multimodal treatment of ADHD remains to be further clarified.ObjectiveTo evaluate the effectiveness of behaviour therapy and drug treatment within an adaptive and individually tailored multimodal treatment for children with ADHD.MethodAfter an initial psychoeducation n = 75 school-children aged 6–10 years with a diagnosis of ADHD/HKD were assigned to either behaviour therapy (including continued psychoeducation) or medical management with methylphenidate plus psychoeducation. Depending on the effectiveness, the treatment was either terminated (if totally effective) with long–term aftercare and continuation of medication if needed, or (if partially effective) the other treatment component was added (combined treatment), or (if ineffective) the treatment components were replaced. Thus a treatment rationale was applied which resulted in an adaptive and individually tailored therapy – similar to a strategy that may be useful in clinical practice.ResultsOf the children who started with behaviour therapy after initial psychoeducation 26% received a combined treatment in later treatment stages. In most of the cases (82%) with initial medical management, behaviour therapy was added. ADHD symptoms, individually defined behaviour problems and comorbid symptoms were significantly reduced during the course of treatment. On core measures large pre–post effect sizes were found. On teacher ratings combined treatment was more effective than behaviour therapy.ConclusionsBoth, behaviour therapy and combined treatment are effective interventions within an adaptive and individually tailored multimodal treatment strategy.

Long-Term Course After Adaptive Multimodal Treatment for Children With ADHD An 8-Year Follow-Up

Objective: This study reassessed adolescents and young adults (15-22 years old) who received individually tailored multimodal treatment for ADHD (behavior therapy and/or stimulant medication) during childhood 6 to 12 years after treatment (M = 8.8 years, SD = 1.6). Method: All participants (N = 75) provided information about their social functioning. Most parents (83%) completed behavior rating scales. Results: Participants demonstrated significant improvement in behavior during the follow-up period with effect sizes on ADHD symptoms of d = 1.2 and 68% of the former patients in the normal range at follow-up. Participants reported elevated rates of grade retention (51%), school dropout (13%), special education service use (17%), school change (47%), and conviction (16%), but few were unemployed (4%). Conclusion: This study provides evidence that the effects of individually tailored multimodal treatment for ADHD in childhood are maintained into adolescence and young adulthood. No hints could be found that continued medication results in a more favorable long-term outcome.

Angeleitete Selbsthilfe für Eltern von Kindern mit Aufmerksamkeitsdefizit-/ Hyperaktivitätsstörung Konzept, Inanspruchnahme und Effekte eines bundesweiten Angebotes - eine Beobachtungsstudie

OBJECTIVES The effects of guided self-help interventions for parents of children with ADHD have already been proven in randomized controlled trials. The objective of this study was to assess the effectiveness of this novel form of intervention under routine care conditions in a nationwide trial. METHOD Registered pediatricians as well as child and youth psychiatrists enrolled 274 children between 6 and 12 years old (83.6% male) diagnosed with ADHD to a self-help program for parents of children with ADHD. The program lasted for 1 year and consisted of eight booklets with advice for parenting children with ADHD as well as complementary telephone consultations (14 calls, up to 20 minutes each). The course of the ADHD symptoms and the comorbid symptoms as well as the development of the child’s individual problems were assessed in a pre-post design. RESULTS 63% of the enrolled parents adhered to the program until the end. The families who cancelled the program did not differ concerning the severity of ADHD symptoms, but they did more often show an impaired familial and social background, and their children received pharmacological treatment more often. Three-fourths of the children who completed the program had received pharmacological treatment at the beginning of the program. The children had more severe ADHD symptoms than a clinical control group. During the intervention, ADHD symptoms as well as psychosocial functioning improved with large effect sizes of d>0.9. Additionally, comorbid oppositional and emotional symptoms decreased. CONCLUSIONS These results indicate that guided self-help programs for families with children with ADHD are effective, also as an addition to pharmacological treatment.

Angeleitete Selbsthilfe für Eltern von Kindern mit Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung

OBJECTIVES The effects of guided self-help interventions for parents of children with ADHD have already been proven in randomized controlled trials. The objective of this study was to assess the effectiveness of this novel form of intervention under routine care conditions in a nationwide trial. METHOD Registered pediatricians as well as child and youth psychiatrists enrolled 274 children between 6 and 12 years old (83.6% male) diagnosed with ADHD to a self-help program for parents of children with ADHD. The program lasted for 1 year and consisted of eight booklets with advice for parenting children with ADHD as well as complementary telephone consultations (14 calls, up to 20 minutes each). The course of the ADHD symptoms and the comorbid symptoms as well as the development of the child’s individual problems were assessed in a pre-post design. RESULTS 63% of the enrolled parents adhered to the program until the end. The families who cancelled the program did not differ concerning the severity of ADHD symptoms, but they did more often show an impaired familial and social background, and their children received pharmacological treatment more often. Three-fourths of the children who completed the program had received pharmacological treatment at the beginning of the program. The children had more severe ADHD symptoms than a clinical control group. During the intervention, ADHD symptoms as well as psychosocial functioning improved with large effect sizes of d>0.9. Additionally, comorbid oppositional and emotional symptoms decreased. CONCLUSIONS These results indicate that guided self-help programs for families with children with ADHD are effective, also as an addition to pharmacological treatment.

Familienbeziehungen und psychische Auffälligkeiten im Jugendalter – eine Analyse mit der Jugendlichenfassung des Family Relations Test für Kinder und Jugendliche

Family relations and behavioral-emotional problems in adolescents - an analysis with the adolescent version of the Family Relations Test for Children and Adolescents Abstract. OBJECTIVES So far hardly any instruments are available for the German-speaking countries, covering family relations from the perspective of young people reliably. Moreover, the relationship between family relations from the perspective of young people and behavioral problems has been rarely investigated. METHOD Based on the Family Relations Test, which has been developed originally for children, the Family Relations Test for Children and Adolescents was developed in order to assess the family relations from the perspective of adolescents (94 items, 44 % newly developed). A clinical sample (n = 152) and a field sample (n = 132) was tested with this instrument and additionally behavioural problems of the adolescents were rated by the parents and the adolescents. RESULTS The two-factor solution of the principal component analysis resulted in a clear distinction between two factors describing positive and negative family relations. The internal consistencies (Cronbachs Alpha) of the scales describing positive and negative relations are between .91 and .93. On these total scores young people from the clinic sample describe overall stronger negative relations in their families compared to young people in the field sample. Within the clinic sample moderate correlations between the extent of mental problems of young people rated by themselves and their parents could be found. CONCLUSIONS Positive and negative relationships of young people to the individual family members and to all members of the family as a whole can be assessed reliably and factorially valid. As expected, significant correlations between negative family relations and mental problems could be found. The adolescent version of the Family Relations Test for Children and Adolescents proves to be a useful tool, to assess family relationships from the perspective of young people and thus to identify possible factors maintaining mental disorders of young people.

Behavioral Versus Nonbehavioral Guided Self-Help for Parents of Children With Externalizing Disorders in a Randomized Controlled Trial

Self-help interventions for parents, which have a behavioral basis, are considered to be an effective treatment option for children with externalizing disorders. Nonbehavioral approaches are widely used but have little empirical evidence. The main objective of this trial was to compare the efficacy of a behavioral and a nonbehavioral guided self-help program for parents. Families of children (aged 4-11 years) diagnosed with attention-deficit/hyperactivity disorder (ADHD) or oppositional defiant disorder (ODD) were randomized to either a behavioral or a nonbehavioral guided self-help program including 8 parenting booklets and 10 counseling telephone calls. The analyses considered the ratings of 5 informants: blinded clinician, therapist, participant, (her or his) partner, and teacher. Of the 149 families randomized to treatment (intention-to-treat sample [ITT]), 110 parents completed the intervention (per-protocol sample [PP]). For the 4 primary outcome measures (blinded clinician- and participant-rated ADHD and ODD) at post-assessment, the analysis revealed a treatment advantage for the behavioral group in blinded clinician-rated ODD symptoms (ITT: d = 0.37; PP: d = 0.35). Further treatment differences, all in favor of the behavioral group (ITT and PP), were detected in therapist ratings (i.e., ODD) and participant ratings (e.g., parental self-efficacy [only PP], negative parenting behavior, parental stress). In both samples, no differences were found at post-assessment for ratings of the partner and the teacher, or at the 12-month follow-up (only participant ratings available). Behavioral guided self-help shows some treatment advantage in the short term. No superiority over nonbehavioral therapy was detected 12 months after treatment termination.

Intellektuelle Fähigkeiten bei Jugendlichen mit früherer ADHS-Diagnose

OBJECTIVE The current analysis was conducted on 16- to 22-year-old persons who had received a multimodal treatment for ADHD during their childhood. The main objective was to analyse the relationships between current intellectual abilities and current ADHD symptoms, comorbid symptoms, and medication history. METHOD In an 8.5-year follow-up study current intellectual ability was assessed with the German version of the KAIT (K-TIM). Behavioural problems were rated by parents and the former patients via standardized questionnaires and a semistructured interview. T-tests, Pearson correlations, and multiple regression analyses were then conducted. RESULTS No significant correlations were found between former treatment with medication and current intellectual abilities. Moreover, no relationship was found between intellectual abilities and current ADHD symptoms as assessed by self- and parent-rating via questionnaires. However, adolescents with lower IQ did show higher scores of problematic performance behavior during the test. Also, a correlation was found between overall clinical judgement and externalizing problem behavior at home and in school. CONCLUSIONS Only small correlations were found between the current residual symptoms and intelligence in adolescent and young adults who had received a diagnosis of ADHD in childhood.