"Our findings indicate that children with ADHD and their parents receiving standard community care that includes medication may benefit from a low-intensity and economical behavioral and social skill program," says study author Steve Tutty, M.A., of the Group Health Cooperative's Center for Health Studies in Seattle, Wash.
ADHD, which affects 3 percent to 5 percent of U.S. school-aged children, is usually treated solely with stimulant medications, which have been proven to help reduce core symptoms, such as hyperactivity. Few physicians currently supplement patient medication with behavior therapy because the effectiveness of this combined approach has not been validated.
Tutty and colleagues studied 100 children aged 5 to 12 who had recently been diagnosed with ADHD and were receiving stimulant medication treatment. More than half of the children and their parents were assigned to an eight-week behavioral and social skill class, while the rest did not take a class. At three and six months after treatment began, an independent telephone interviewer spoke to the parents and the teachers of the children to determine the effectiveness of the class.
The class sessions, designed to help parents and children cope with the disorder, presented common ADHD case histories and included exercises on listening, self-esteem and friendship building. The class leaders incorporated visual aids such as a "boiling-point thermometer" for assessing moods and a "star board" for assessing progress. The children also participated in writing exercises, such as completing open-ended statements ("I get angry whenever somebody ..."), to help them identify their anger, while their parents received additional training in behavioral modification strategies.
Compared with those not enrolled in the class, the researchers found that parents enrolled in the behavioral and social skill class reported significantly fewer ADHD symptoms in their children and more consistent use of discipline practices with their children. The study results are published in the February 2003 issue of the Journal of Developmental and Behavioral Pediatrics.
The primary school teachers of the ADHD study participants, however, reported no differences in symptoms between those enrolled and those not enrolled in the behavioral and social skill class. The researchers suggest that teachers, in addition to parents, may benefit from participating in workshops that increase ADHD awareness and management skills. Teachers who participate in such workshops "may become more sensitive in detecting their pupil's ADHD symptoms, while using specific tools for managing those challenges in the classroom," Tutty says.
"In addition, teachers could learn how to provide an ADHD weekly report card to parents about their child's challenges and accomplishments," he adds.
Tutty and colleagues note several study limitations, including that the study group was mostly white and lower-middle class, which makes it difficult to generalize their findings to other socioeconomic and cultural groups. They also note the class may have taught parents to be more understanding of their child's ADHD behaviors and this class side effect may have led parents to report reduced ADHD symptoms.
This research was supported by the Group Health Cooperative (GHC)/Kaiser Permanente Community Foundation through a grant to the GHC's Center for Attention Deficit Disorders.
FOR MORE INFORMATION
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Journal of Developmental and Behavioral Pediatrics: Contact Mary Sharkey at (212) 595-7717.
By Ann Quigley, Contributing Writer
Health Behavior News Service