Comprehensive Meta-Analysis of Attention-Deficit/Hyperactivity Disorder Psychosocial Treatments Investigated Within Between Group Studies

Interventions for attention-deficit/hyperactivity disorder (ADHD) include positive behavior supports (e.g., parent training, school-based contingency management, behavioral peer interventions), training interventions (e.g., organizational skills training, social skills training, etc.), and other interventions (e.g., academic accommodations/modifications, self-monitoring). There is a need to conduct a comprehensive meta-analysis of psychosocial treatments for ADHD given discrepancies between meta-analyses. The present meta-analysis reports the results of between-group studies that compared a psychosocial treatment to a control condition from 1968 to 2016. In total, 226 studies were identified that met inclusion criteria. Results of the meta-analysis were organized by treatment type, rater, and domain of outcome assessed. Results indicated considerable variability across these parameters, with the strongest effects for proximal outcomes of behavioral parent training (improvements in parenting behaviors yielded a standardized mean difference of 0.70) and improvements in child behavior following implementation of behavioral school intervention (standardized mean difference of 0.66 and 0.72 for teacher ratings of ADHD symptoms and impairment, respectively). Other interventions were not extensively studied as stand-alone approaches. Results are discussed in light of current support for the use of psychosocial interventions for individuals with ADHD.

Comparative efficacy and acceptability of psychosocial treatments for disruptive behaviour disorders in children and adolescents: study protocol for a systematic review and network meta-analysis

IntroductionDisruptive behaviour disorders are common among children and adolescents, with negative impacts on the youths, their families and society. Although multiple psychosocial treatments are effective in decreasing the symptoms of disruptive behaviour disorders, comprehensive evidence regarding the comparative efficacy and acceptability between these treatments is still lacking. Therefore, we propose a systematic review and network meta-analysis, integrating both direct and indirect comparisons to obtain a hierarchy of treatment efficacy and acceptability.Methods and analysisThe present protocol will be reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. Ten databases, including Web of Science, PubMed, PsycINFO, MEDLINE, APA PsycArticles, Psychology and Behavioral Sciences Collection, OpenDissertations, The Cochrane Library, Embase and CINAHL, will be searched from inception for randomised controlled trials of psychosocial treatments for children and adolescents with disruptive behaviour disorders, without restrictions on language, publication year and status. The primary outcomes will be efficacy at post-treatment (severity of disruptive behaviour disorders at post-treatment) and acceptability (dropout rate for any reason) of psychosocial treatments. The secondary outcomes will involve efficacy at follow-up, severity of internalising problems and improvement of social functioning. Two authors will independently conduct the study selection and data extraction, assess the risk of bias using the revised Cochrane Collaboration’s Risk of Bias tool and evaluate the quality of the evidence using the Grading of Recommendations Assessment, Development and Evaluation framework to network meta-analysis. We will perform Bayesian network meta-analyses with a random effects model. Subgroup and sensitivity analyses will be performed to evaluate the robustness of the findings.Ethics and disseminationThe research does not require ethical approval. Results are planned to be published in journals or presented at conferences. The network meta-analysis will provide information on a hierarchy of treatment efficacy and acceptability and help make a clinical treatment choice.PROSPERO registration numberCRD42020197448.

Psychosocial Treatments for Early Psychosis

This chapter discusses the importance of psychosocial treatments for psychosis. The recovery process focuses as much on resuming school, work, relationships, and recreation/leisure activities as it does on treating symptoms. The purpose of psychosocial treatments is to help young people with psychosis overcome common challenges in these areas and resume a full life. Group therapy can help young people to feel less alone and give them a chance to talk to others who are going through similar difficulties and discover what’s working for them. Family interventions help families to cope with stress, improve their social supports, and reduce the effects of stigma. Supported employment aims to move young people toward successful paid employment. Social skills training focuses on teaching people how to approach and navigate personal and professional social situations through a combination of learning new techniques and practicing these skills in various settings.

Strategies for incorporating culture into psychosocial treatments for youth of color

Objective: This review summarized the literature on psychosocial interventions for youth of color, using a distillation model to identify common strategies for incorporating culture into treatment. Method: Ninety-three journal articles of randomized clinical trials, with samples comprised of youth of color, published between 1974 and 2018 were coded for sample characteristics, treatment characteristics, and strategies for incorporating culture into treatment. Results: Results found 69 psychosocial treatments to be efficacious for youth of color; 32% of these psychosocial treatments included a strategy for incorporating culture into psychotherapy. The evidence base was strongest for Black and Latinx populations and for psychosocial treatments targeting disruptive behavior problems. The most common strategies for incorporating culture into treatment among effective psychosocial interventions were selecting specific procedures (e.g., initiating discussions about issues of discrimination), using culturally-relevant materials (e.g., providing handouts with representations of youth of color), including family members in psychotherapy sessions, and attending to treatment engagement. The inclusion of strategies for incorporating culture was not associated with treatment efficacy. Conclusion: Findings from this review highlight the laudable efforts that have been made to identify efficacious psychosocial interventions for youth of color and illuminate remaining gaps in the evidence base (e.g., efficacious psychosocial treatments for Asian, Native American and Alaska Native, and Pacific Islander youth). Findings also emphasize the nuance of providing effective and culturally responsive mental health services and allude to the promise of decision support tools to help providers determine whether, when, and how to culturally tailor their psychotherapy with youth of color.

Pharmacological Treatment of ADHD

The pharmacological treatment for ADHD has been researched well and we have efficacious drugs. Drugs are the mainstay of treatment particularly for over 6 years of age. There are two broad classes of drugs that are used in the treatment, psychostimulants and non-stimulants. Transcranial current stimulation and neurofeedback are other mechanisms that have been tried. There are various formulations and doses available for each and only certain drugs are available in India. The various guidelines broadly put stimulant Methylphenidate as the first choice and recommend early shift to a longer acting formulation. Treatment, various comorbidities, and side-effects of these drugs have to be kept in mind and dealt accordingly. Further psychosocial treatments should be used concurrently to improve the outcome.