PSYC 412 Lecture 6: ADHD II
12 Feb 2019
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PSYC412: Development Psychopathology
1
Lecture 6: ADHD II
• Treatment of ADHD
o What works?
▪ To reduce symptoms, to improve functioning
o What works for whom?
▪ Efficacy will depend on the age of receiver, what specific types of
symptoms, their ability to come to therapy multiple times a week
• Overview of treatment approaches
o Medication
▪ Stimulants
Part of brain responsible for planning isn’t as active as normal
▪ Methylphenidate (Concerta, Ritalin)
▪ Increase activity in the prefrontal cortex
▪ Very fast acting
30 minutes
Effects stop when the drug wears off
▪ Side effects
Reduced appetite, weight loss, slowing of growth, increase in heart
rate, difficulty falling asleep
In kids, they may not lose weight, but we won’t see that expected
weight gain as the child grows older
▪ “Stimulant medications have large, beneficial, acute effects on multiple
key domains of functioning in ADHD”
▪ BUT
▪ 20% of children may not improve
For children who do improve, behaviour is better but may still be
problematic
May not look like typical behavior of kids without ADHD
PSYC412: Development Psychopathology
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▪ May not help academic performance, peer relationships, or family
functioning
Not translating to other parts of their lives
▪ Beneficial effects may not be maintained over time and will stop once
medication is stopped
As long as child is on medication, they will improve, but as soon as
medication stops, behaviour will be the same as before
No evidence of long-term gains
o Behavioural treatments
▪ Behavioural parent training (BPT)
▪ Behavioural classroom management (BCM)
Contingency management in the classroom
Studies have demonstrated effectiveness
▪ Behavioural peer interventions (BPI)
Traditionally, social skills training is done in the clinic or office
Not an effective intervention for kids with ADHD
Discussion and role-playing
Studies have suggested that these types of interventions not
effective for children with ADHD
Targeting peer relationships in recreational settings
Summer programs, day-long programs that last for multiple weeks
Social skills training followed by coached group play
Contingency management
Studies have suggested significant improvement
▪ Parent management training (PMT)
Contingency management
Clear rules, rewards for behaviour you want to see, consequences
for behaviours you do not want to see
PSYC412: Development Psychopathology
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Respond to children’s behaviour in ways the encourage
liked behaviours and discourage undesirable behaviours
Consistently reinforcing the child
Setting up situations to minimize problems
Kid jumps out of car and runs off before mom can get the
other two kids out of the car seats
Solution: putting kid with ADHD on far seat so
they’re the last to exit the vehicle
A number of studies have demonstrated that this treatment results
in improved behaviour
May not show effects as large as medication
Many parents don’t want to put their kids on medication
right away so it’s usually last resort
Important intervention for conduct problems
o Other interventions
▪ Cognitive interventions
Cognitive techniques that children can use to control attention and
behaviour
E.g., verbal self-instruction, problem solving
Not supported
• MTA study
o MTA treatments
▪ Three key objectives
Compare long-term medication and behavioural treatments for
ADHD
Therapy is very expensive, so we want to be sure if
effective before putting many kids in therapy
Determine if there are additional benefits if meds and behavioural
treatment are combined
Document Summary
Part of brain responsible for planning isn"t as active as normal: methylphenidate (concerta, ritalin) Increase activity in the prefrontal cortex: very fast acting. Effects stop when the drug wears off: side effects. Reduced appetite, weight loss, slowing of growth, increase in heart rate, difficulty falling asleep. For children who do improve, behaviour is better but may still be problematic. May not look like typical behavior of kids without adhd. 2: may not help academic performance, peer relationships, or family functioning. Not translating to other parts of their lives: beneficial effects may not be maintained over time and will stop once medication is stopped. As long as child is on medication, they will improve, but as soon as medication stops, behaviour will be the same as before. No evidence of long-term gains: behavioural treatments, behavioural parent training (bpt, behavioural classroom management (bcm) Studies have demonstrated effectiveness: behavioural peer interventions (bpi) Traditionally, social skills training is done in the clinic or office.
