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Interventions for ADHD (an overview of the evidence-base) - Coggle Diagram
Interventions for ADHD (an overview of the evidence-base)
ADHD
neurodevelopmenta disorder
persistent, impairing, developmentally inappropriate inattentive and/or hyperactive/impulsive behaviors
primary symptoms: 1. inattention, 2. impulsivity. 3. hyperactivity
pharmacological interventions
different classes, stimulant and non-stimulant
primary targets: dopaminergic system and noradrenergic system
geographic and developmental variation in sequencing og intervention
considerations when pharmacological interventions are selected:
psychosocial environment
legal concerns
access to medication
severity of symptoms
presence of comorbidities
periods for symptom relief
medical contraindications and side effects
noteworthy limitations:
considerable minority of children fail to show improvements
side effects (e.g. sleep, appetite, growth, cardiovascular)
long-term effectiveness not established
normalization is rar
inconsistency in domains of ADHD-related impairments
non-adherence and preference for non-pharmacological interventions
non-pharmacological interventions
dietary
: 2 main types: eliminations diets and supplementation
elimination diets include exclusions of items associated with food hypersensitivity and artificial food color exclusions
supplementation include macro-nutrient supplementation and micro nutrient supplementation
behavioral training
most common psychological treatment
large variety can include training for:
parents (preschoolers and grade-school children)
teachers (preschoolers and grade-school children)
individual (adolescents and adults)
offered in group or individual sessions
primarily based on principles of: positive/negative reinforcement (operant conditioning) and social learning (observation, imitation, modeling)
primary and secondary targets: -
reduction of primary symptoms (behaviors)
increase core regulatory abilities
quality of parenting (e.g. discipline, interactions)
developmental of practical skills, social skills and academic achievement
behavioral parent training (BPT)
considerations for effectiveness
age of child
format (group, individual, mixed)
focus (behavioral management, developing relationships
homework (e.g. feasible, obstacles for completions, too complicated)
maintenance of treatment gains (e.g. additional programs)
common elements across BPT programs:
intervention parameters - 12 1-hour weekly sessions.
therapeutic alliance - focus on rapport building and collaborative goal setting.
therapeutic content: psychoeducation, praise, positive attending and positive parent-child quality time, planned ignoring (when safe), effective commands, incentive systems and problem solving
in
classroom
setting behavioral interventions often include use of:
proactive strategies
teacher attention
token reinforcers/respons-cost
continual feedback loops
Neurofeedback
non-invasive treatment using biofeedback
form of operant conditioning:
capitalises on brain plasticity (growth and reorganization)
overall premise: training on self-regulation --> control over brain activity patterns --> reduction in symptoms
How does it work?
measurement of brainwave activity (EEG frequency bands)
real-time feedback (e.g. visual, auditory cues) on neural activity
operant conditioning (learning to modify brainwave activity --> more effective self-regulation)
neuroplasticity (adaptive changes in neural networks)
cognitive training
focuses on improving cognitive functioning via:
structured and targeted exercises
repetition and practice
reinforcement
most common focus in cognitive training programs:
WM (visual, verbal)
attention control
inhibitory control
typically delivered online (computer-based games
adaptive procedures used
Evaluating the evidence-base
methodological issues to be aware of:
blinding.
selection criteria
sparsity of long-term assessments
adverse effects (often) not properly assessed
enriched samples in pharmacological interventions