Re: ** A New Treatment for Children with Inattentive ADHD: Encouraging Findings **

[Guest guest]

Just for what it's worth, I can administer Cogmed. I work for Dr.

a Tsukahara, at ADDAustin (www.addaustin.com). Kids on the Autism

Spectrum can do this, if there IQ is in the " normal range. " I'll be

happy to talk to anyone who's interested in more info. You can also get

more info rom Cogmed at Cogmed.com.

Brown

--- Martha Moyer wrote:

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> ---- Original Message -----

> From: Attention Research Update

> To: mmoyer@...

> Sent: Tuesday, January 08, 2008 7:00 AM

> Subject: ** A New Treatment for Children with Inattentive ADHD:

> Encouraging Findings **

>

>

> Note: Attention Research Update is sent to over 35,000 subscribers

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>

> **** ATTENTION RESEARCH UPDATE ****

> **** January 2008 - A New Treatment for Children with Inattentive

> ADHD: Encouraging Findings ****

>

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>

>

> Dear Subscriber,

>

> I hope that you had an enjoyable holiday and that the New Year is off

> to a good start.

>

> This issue of Attention Research Update reviews a recent study of a

> hew home-school behavioral intervention for children with the

> inattentive type of ADHD, i.e., children with high levels of

> inattentive symptoms but who do not also show high rates of

> hyperactive-impulsive behavior. This is an important study because

> despite the hundreds of medication and behavioral studies conducted

> on children with ADHD, there has been remarkably little work that has

> looked at treatment for inattentive children specifically. In fact,

> the MTA Study - which is the largest treatment study of ADHD ever

> conducted - was restricted to children with the combined type of

> ADHD, i.e., those who showed high rates of both inattentive and

> hyperactive-impulsive symptoms. Thus, the extent to which the

> behavioral intervention results from MTA would apply to children with

> the inattentive form of ADHD are unknown.

>

> As you will see below, the authors report some encouraging results

> for their newly developed intervention.

>

>

> *** Newsletter Sponsor - Thanks to Cogmed for supporting Attention

> Research Update ***

>

> Cogmed, a company I consult with closely,is introducing a new

> approach to help children and adults with attention deficits that

> involves computerized training of working memory, which is a key

> cognitive ability that underlies many important tasks. You will find

> additional information about Cogmed Working Memory Training below at

> the end of this issue. I encourage you to learn more about this new

> training approach that has growing research support by visiting

> www.cogmed.com.

>

>

> Thanks again for your ongoing interest in the newsletter. I hope that

> you enjoy today's issue.

>

> Sincerely,

>

> Rabiner, Ph.D.

> Senior Research Scientist

> Duke University

> Durham, NC 27705

>

> P.S. Please feel free to forward this newsletter to others you know

> who may be interested - you'll find a " Forward to a Friend " link at

> the end of this message. If this has been forwarded to you, and you

> would like to receive Attention Research Update on a regular basis,

> just visit www.helpforadd.com to subscribe.

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>

> ** A New Treatment for Children with Inattentive ADHD: Encouraging

> Findings **

>

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>

>

> The core symptoms of ADHD are inattention and

> hyperactivity-impulsivity. Although most children with ADHD struggle

> in both areas, and are diagnosed as having the combined subtype of

> ADHD, a substantial number show high levels of inattentive symptoms

> only. These children are frequently described as having ADD rather

> than ADHD; technically, however, the correct term is ADHD,

> Predominantly Inattentive Type, or ADHD-I.

>

> Some prominent ADHD researchers have suggested that although children

> with the inattentive and combined subtypes of ADHD both show high

> rates of attention difficulties, these are really very different

> disorders. Children with the inattentive type tend of have more

> severe alertness/orientation problems, including more symptoms of

> sluggish cognitive tempo and slower processing speed. Socially, they

> are less aggressive but more highly withdrawn and passive and may

> have even greater social difficulties.

>

> Given the large number of ADHD treatment studies that have been

> conducted it is surprising to note how little work has focused

> exclusively on treatment for children with ADHD-I. The limited

> evidence that is available for the treatment of ADHD-I is focused

> primarily on stimulant medication and initial results suggest that

> medication treatment is about as effective for these children as for

> children with the combined type of ADHD.

>

> Behavioral interventions for children with ADHD-I, however, have not

> previously examined and this is an important gap in the literature.

> The literature on behavior therapy for ADHD has focused on evaluating

> programs that have been for children whose ADHD includes both

> inattentive and hyperactive-impulsive symptoms. These children have

> substantially greater problems with aggression and other forms

> externalizing behavior than children with ADHD-I and tend to have

> different types of social difficulties. Thus, programs that may be

> effective for them may not adequately target the different types of

> problems experienced by children whose difficulties are restricted to

> inattention.

>

> Given the absence of research on behavioral therapy for children with

> inattentive ADHD, a study published in a recent issue of the Journal

> of the American Academy of Child and Adolescent Psychiatry represents

> an important addition to the field [Pfiffner, L., et al. (2007). A

> randomized, controlled trial of integrated home-school behavioral

> treatment for ADHD, Predominantly Inattentive Type. JAACAP, 46,

> 1041-1050.]

>

> Participants were 69 2nd-5th grade children (23 females) all of whom

> were diagnosed with ADHD-I. The sample had a good representation of

> minorities and included families from a wide range of socioeconomic

> backgrounds. Only 2 children were taking medication at the beginning

> of the study and none began medication during the 12-week program.

>

> Participants were randomly assigned to the newly developed

> intervention called the CLAS Program (Child Life and Attention

> Skills) or to a " treatment as usual " control group. (Unfortunately,

> details on what treatment as usual consisted of are not provided.)

> Unlike existing behavioral treatments for ADHD, The CLAS Program was

> designed to target the most prominent difficulties for children with

> ADHD-I and included the three inter-related components described

> below.

>

>

> - Teacher Consultation -

>

> Each child's teacher was given an overview of behavioral

> interventions and classroom-based accommodations for ADHD-I, followed

> by 4-5 1/2 hour meetings of teacher, parent, child, and therapist

> over 12 weeks. In addition, a daily report card system in which

> teachers rated key target behaviors for each child, e.g., completion

> of assigned work, accuracy of completed work, appropriate social

> behavior) was implemented so that parents were kept informed of their

> child's progress in these key areas. This enabled parents to reward

> children on a daily basis for attaining important classroom goals.

> Environmental and academic accommodations such as preferential

> seating, reduction in assigned work, help with organization) were

> provided as needed to each child.

>

>

> - Parent Training -

>

> A 12-week parent-training program that included 6-8 families began

> with an overview of ADHD-I followed by a set of strategies for

> managing ADHD-I and associated impairments. Strategies covered

> included the use of positive attention, rewards, establishing

> effective routines, planning activities, giving directions and

> commands, and using prudent negative consequences.

>

> In contrast to parent training programs developed for children with

> the combined type of ADHD, where acting out behavior problems are

> more common, there was less focus on disciplinary strategies and

> greater focus on improving homework routines, independence, and

> organizational and time-management skills to improve academic

> performance. Parents were also taught ways to promote and reinforce

> their child's use of social skills that were covered in the

> children's groups (see below).

>

>

> - Child Skills Training -

>

> The Child Skills Training Groups met concurrently with the parent

> training groups. Child groups were divided into modules focused on

> skills for independence, e.g., academic, study and organizational

> skills) and skills for social competence, e.g., being a good sport,

> combating " spaciness " , being assertive, dealing with teasing, and

> initiating friendships.

>

> Each module provided children with knowledge about the specific

> skills being addressed as well as providing ample opportunity for

> rehearsal and practice. Children were helped to become more " alert "

> by group-reinforced attention checks during which the children were

> prompted to repeat the last comment made or the last activity that

> had occurred. Role-plays of common problem situations for children

> with ADHD-I were included in each module. Each week children brought

> in a record of rewards they had earned at home and school to exchange

> for rewards in the group setting. This was done both to motivate the

> children and to promote the generalization of desired behaviors

> across settings.

>

>

> - Measures -

>

> A wide variety of measures were collected before, immediately

> following, and approximately 4-6 months after treatment ended to

> evaluate the impact of the CLAS program. The primary outcome measure

> was the average ratings made by parents and teachers for the 9

> inattentive symptoms of ADHD. Parents and teachers also completed

> ratings of behavior indicative of " sluggish cognitive tempo " , e.g.,

> daydreaming, lost in a fog, sluggish/drowsy, which were also

> averaged.

>

> In addition to these primary outcomes, parents and teachers rated

> each child's social skills, organizational skills, and overall degree

> of improvement. As with the primary outcome measures, parent and

> teacher ratings for these secondary measures were averaged.

>

>

> - Results -

>

> Compared to the treatment as usual group, children in CLAS showed a

> significant decline in DSM-IV inattentive symptoms. Both groups

> started with an average of approximately 6.3 symptoms (out of 9)

> before treatment. Immediately following treatment this had dropped to

> 3.0 symptoms for the CLAS group and to 5.1 symptoms for the control

> group. Symptoms levels at follow up were 3.2 and 4.4 respectively.

> Following treatment, 55% of the treated group had scores in the

> normal range compared to only 27% of the control group. Similar

> results were found for ratings of sluggish cognitive tempo.

>

> In addition to these positive results for the primary outcome

> measures, children in the CLAS group were also rated as showing

> greater improvement in social skills, organizational skills, and on

> overall impressions of improvement.

>

> Finally, all parents rated their overall level of satisfaction with

> the CLAS program as " very satisfied " and all but one rated their

> child's attention problems as improved. More than 90% rated the

> strategies and skills taught as either " useful " or " very useful " . The

> vast majority of children - roughly 80% - reported enjoying the

> program and that it helped them to do better at home and school.

>

>

> - Summary and Implications -

>

> Results from this study support the efficacy of behaviorally based

> psychosocial treatment for children with ADHD-I. As noted above, the

> CLAS Program " ..led to statistically and clinically significant

> reductions in attention problems and improvement in organizational

> and social skills relative to the control group, and these reductions

> were maintained at follow-up. " The magnitude of the effect on

> inattentive symptoms was similar to what has been reported in studies

> of stimulant medication treatment for children with ADHD-I.

>

> These are extremely encouraging results and the authors are to be

> commended for developing and beginning to evaluate a psychosocial

> intervention specifically geared to children with ADHD-I. There are

> several important limitations to this study, however, several of

> which are acknowledged by the authors, which makes it premature to

> consider this an established treatment.

>

> First, there is limited information provided on the services received

> by children in the treatment as usual control group. We are told that

> only 2 of these children began medication during the study, which is

> a strikingly low rate. How results for the CLAS Program would compare

> to children who received adequate medication treatment is thus

> unknown.

>

> Second, because the authors averaged parent and teacher ratings for

> all outcomes, it is not possible to know whether similar improvements

> were observed by both parents and teachers, or whether the overall

> effects were primarily attributed to greater improvements seen by

> only one of these groups. In particular, because parents committed

> significant time to the program, it is possible that they were

> " biased " to see improvement in their child. If both parents and

> teachers observed similar improvements, this would be quite

> impressive but the data is not presented in a way that enables this

> to be determined.

>

> Third, there were no objective measures provided of children's

> academic performance. Thus, whether the program resulted in tangible

> gains in children's academic success is unknown.

>

> Despite these important limitations, results from this study are

> certainly encouraging and suggest that a psychosocial intervention

> that specifically targets the difficulties experienced by children

> with ADHD-I can be effective. As the authors note, " future

> randomized, controlled trials are needed to compare and contrast the

> CLAS Program and medication treatment and examine their combination

> in multimodal approaches to identify the most efficacious approach to

> treating ADHD-I over time. " As such studies are hopefully published,

> I will be sure to include them in future issues of Attention Research

> Update.

>

>

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>

>

> ** Sponsor's Message from Cogmed **

>

> ** Learn About Working Memory Training from Cogmed - A New,

> Research-Based Intervention for Children and Adults with Working

> Memory Problems and Attention Deficits **

>

> Working memory - the ability to hold information in one's mind for

> subsequent use - is a cognitive skill that is important for a variety

> of learning related tasks. Cogmed, a company I consult with, is

> introducing a computerized training program for working memory as a

> new intervention to help children and adults with ADHD and/or working

> memory difficulties.

>

> The use of working memory training for individuals with ADHD is based

> on several interrelated findings:

>

> 1) A number of studies have documented that individuals with ADHD

> show significant deficits in working memory; 2) Accumulating research

> evidence that working memory is a cognitive skill that can be

> improved with practice; and, 3) Improvements in working memory

> functioning have been shown to be associated with meaningful declines

> in ADHD symptoms and enhanced functioning for many individuals with

> ADHD.

>

> Working memory training has been offered for several years in Europe

> and is now being introduced to the US by Cogmed via a growing network

> of carefully selected clinics. This is an intensive 5-week program

> that children and adults complete in the convenience of their home

> with support provided by a Cogmed-trained coach.

>

> Although I do not endorse or recommend any specific intervention for

> ADHD, working memory training represents a new and promising approach

> that nicely complements existing interventions for attention and

> learning problems. You can learn more about this new treatment

> approach by visiting www.cogmed.com

>

>

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>

>

> Thanks again for your ongoing interest in the newsletter. I hope you

> enjoyed the above article and found it to be useful to you.

>

> Sincerely,

>

> Rabiner, Ph.D.

> Senior Research Scientist

> Center for Child and Family Policy

> Duke University

> Durham, NC 27708

>

> P.S. If you have not already done so, please confirm your

> subscription by clicking on the appropriate link below. This will

> help to insure that the newsletter continues to reach you. Of course,

> you may still unsubscribe any time you wish to.

>

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>

> © 2008 Rabiner, Ph.D.

>

> To change your email address, confirm your subscription, or

> unsubscribe, just click on the appropriate link below. Information

> presented in Attention Research Update is for informational purposes

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