30 June 2008
New research at Victoria University into Attention Deficit Hyperactivity Disorder (ADHD) examines the impact of two treatments - medication alone and medication combined with low intensity family centred therapy.
The results showed that over a period of six months 27 children diagnosed with ADHD and exhibiting behavioural and cognitive difficulties were able to achieve impressive rates of normalisation using both forms of treatment. While both treatments were found to be effective the research also indicates positive longer term outcomes when using the combined therapy approach.
Monique Roper was awarded a Doctor of Psychology (Clinical Neuropsychology) at Victoria University's graduation ceremonies held on Thursday May 29 for her thesis: 'A Comparison of two forms of treatment for children with Attention Deficit Hyperactivity Disorder: Effects on executive functioning and behaviour'.
Monique said, "I don't know if most people will realise how prevalent ADHD is becoming. The National Survey of Mental Health and Wellbeing (1998) reported that approximately 11 per cent of Australian children aged between 6 and 17 have a diagnosis of ADHD with the disorder having a greater frequency in boys than in girls."
Current thought suggests that ADHD can be divided into three types - hyperactive/impulsive, inattentive, and combined. The most recent and widely accepted conceptual theories surrounding ADHD have indicated that children suffering from ADHD also have problems with executive functioning.
Monique explained, "Executive functions are those functions that allow for analysis of complex information, integration with current knowledge, planning and organisation, self-monitoring, mobilising attention, and inhibitory responses. Executive functioning processes include goal selection, strategic planning, self regulation, mental flexibility and inhibitory control."
"Current researchers have highlighted one key aspect of executive function - inhibition - as being primary to ADHD. Inhibition comes into play in situations requiring withholding or sudden interruption of a response."
Monique said, "For the general public, parents and teachers, ADHD is associated with poor behaviour, with treatments being seen as effective if they reduced the symptoms i.e. improve out of control behaviour. Therefore, much current research has concentrated on improving behaviour with little attention being focussed on the underlying problems with executive functioning particularity inhibitory control."
"In 'normal' children response inhibition allows for a delay in responding that provides time for other self-regulatory thinking processes to occur. In children with ADHD lack normal inhibitory responses and their thought processes are prevented or interrupted."
"In my research I have looked at the efficacy of intervention on this key aspect of cognition- especially inhibition. Cognition refers to the process of acquiring knowledge by the use of reasoning, intuition, or perception This study is one of the first to examine the impact of stimulant medications on both cognitive and behavioural measures of inhibition."
Participants in the study comprised a total sample of 27 children between the ages of 7 and 12 all of whom had received a recent diagnosis of ADHD by their consulting paediatrician; 85 per cent of the sample were male. All children had been prescribed stimulant medication by their paediatrician. They were receiving no other formal therapy. The sample was divided into two treatment groups - medication alone and combined medication, behavioural therapy group.
An initial (baseline) cognitive assessment was organised. For the purpose of obtaining base line results all children who had already commenced medication withheld their regular dose on the day of testing. The children were tested in two broad categories. The first category included tests for general intelligence, academic achievement, and executive functioning with focus on inhibition and the second involved how parents rated their children's behaviour and how it related to executive functioning.
After approximately 12 weeks of treatment all 27 returned for follow up treatment assessment, and then 23 children returned for a six month follow up.
The data showed that those on medication alone improved significantly over the first three months, however there was an absence of continued significant improvement across most cognitive measures from three months to six months. The combined group improved over three months of continued combined therapy and that group continued to demonstrate significant improvements in cognition and behaviour over the six months of treatment.
Monique said, "To our knowledge this is the first extended duration, prospective follow up study to examine the comparative effects of medication alone and low intensity, individualised family centred behavioural therapy on both behavioural and cognitive based measures of executive functioning. This research adds to a broad body of research which will help us better understand the best ways to treat children with ADHD."
This research has been undertaken as part of a larger body of work into ADHD by Victoria University, under the direction of Dr Alan Tucker from the School of Psychology who was also the supervisor of this research.
Dr Monique Roper and Dr Alan Tucker are available for interview.
Media Contact: Ms Christine White, Media Manager,
Marketing & Communications Department, Victoria University
Ph: (03) 9919 4322; mobile: 0434 602 884
