Brittany M. Merrill

Children with ADHD have significant difficulties with social skill application (e.g., waiting turn, interpreting social cues). Behavioral treatments to promote social skills, such as the Summer Treatment Program (STP), incorporate daily social skills training with systematic opportunities to apply skills as part of peer group interactions. Recreational periods are particularly well-suited for examining these behaviors, as social skills are essential during game play. The current study examined undesirable behaviors during board games and explored underlying factors (e.g., inhibitory control, sensitivity to reinforcement) that may contribute to undesirable behaviors during play. Twenty-eight children with ADHD participated in the current cross-over design study. At baseline, children completed a task of inhibitory control and their parents rated their child’s sensitivity to reinforcement. During the STP, children played competitive or cooperative board games, when taking either stimulant medication or placebo, in small groups of 3–4 children across 20 days. Undesirable behaviors were recorded during game play. Overall, medication use reduced rule violations, poor sportsmanship, and other behaviors. Only cooperative board games decreased teasing behavior. There was a reward x game interaction, such that those with higher reward sensitivity exhibited more poor sportsmanship during competitive games. Collectively, these findings suggest that stimulant medication attenuates undesirable peer interactions during board game play, cooperative board games may decrease teasing relative to competitive games, and the board game setting may be a potential avenue to better understand and address peer interactions in children with ADHD.

The quality of parent–child interaction is critical for child cognitive development. The Dyadic Parent–Child Interaction Coding System (DPICS) is commonly used to assess parent and child behaviors. However, manual annotation of DPICS codes by parent–child interaction therapists is a time-consuming task. To assist therapists in the coding task, researchers have begun to explore the use of artificial intelligence in natural language processing to classify DPICS codes automatically. In this study, we utilized datasets from the DPICS book manual, five families, and an open-source PCIT dataset. To train DPICS code classifiers, we employed the pre-trained fine-tuned model RoBERTa as our learning algorithm. Our study shows that fine-tuning the pre-trained RoBERTa model achieves the highest results compared to other methods in sentence-based DPICS code classification assignments. For the DPICS manual dataset, the overall accuracy was 72.3% (72.2% macro-precision, 70.5% macro-recall, and 69.6% macro-F-score). Meanwhile, for the PCIT dataset, the overall accuracy was 79.8% (80.4% macro-precision, 79.7% macro-recall, and 79.8% macro-F-score), surpassing the previous highest results of 78.3% accuracy (79% precision, 77% recall) averaged over the eight DPICS classes. These results show that fine-tuning the pre-trained RoBERTa model could provide valuable assistance to experts in the labeling process.

Behavioral treatment, stimulants, and their combination are the recommended treatments for childhood attention-deficit/hyperactivity disorder (ADHD). The current study utilizes within-subjects manipulations of multiple doses of methylphenidate (placebo, 0.15, 0.30, and 0.60 mg/kg/dose t.i.d.) and intensities of behavioral modification (no, low, and high intensity) in the summer treatment program (STP) and home settings. Outcomes are evaluated in the home setting. Participants were 153 children (ages 5–12) diagnosed with ADHD. In alignment with experimental conditions implemented during the STP day, parents implemented behavioral modification levels in three-week intervals, child medication status varied daily, and the orders were randomized. Parents provided daily reports of child behavior, impairment, and symptoms and self-reported parenting stress and self-efficacy. At the end of the study, parents reported treatment preferences. Stimulant medication led to significant improvements across all outcome variables with higher doses resulting in greater improvement. Behavioral treatment significantly improved child individualized goal attainment, symptoms, and impairment in the home setting and parenting stress and self-efficacy. Effect sizes indicate that behavioral treatment combined with a low-medium dose (0.15 or 0.30 mg/kg/dose) of medication results in equivalent or superior outcomes compared to a higher dose (0.60 mg/kg/dose) of medication alone. This pattern was seen across outcomes. Parents overwhelmingly reported preferring treatment with a behavioral component as a first-choice treatment (99%). Results underscore the need to consider dosing as well as parent preference when utilizing combined treatment approaches. This study provides further evidence that combining behavioral treatment and stimulant medication may reduce the stimulant dose needed for beneficial effects.

During the COVID-19 pandemic, schools rapidly changed from in-class instruction to remote learning. Parent involvement and management of the home learning situation was greatly emphasized, and this presented challenges and opportunities for parents of children with attention-deficit/hyperactivity disorder (ADHD). There was an urgent need for effective parent support in the home learning situation, particularly for parents of youth with ADHD. The current study implemented a behavioral parent training (BPT) program, an evidence-based intervention for childhood ADHD, modified to target home learning and be delivered via telehealth. The intervention was evaluated in a multiple baseline trial across families of youth with ADHD (n = 3). The primary outcome was daily, parent-reported academic engagement during home learning. Parents also completed daily ratings of their child’s respectful and disruptive behavior, and remote, home observations of academic tasks were recorded at baseline and post-treatment. Based on visual analysis of baseline, treatment and post-treatment daily ratings, two of the three participants had a positive response to treatment indicated by improved academic engagement. These findings provide preliminary support for the home-learning, telehealth-delivered BPT program in supporting families during the COVID pandemic.

Attention-deficit/hyperactivity disorder (ADHD) is a chronic neurodevelopmental disorder defined by pervasive symptoms of inattention, hyperactivity, and impulsivity. Furthermore, children with ADHD show marked deficits in executive functioning (EF) such as attention, effortful control, and behavior, and are more likely to have poor self-regulatory skills. Current evidence-based interventions for children with ADHD include behavioral treatment (BT), psychopharmacological treatment, and their combination. Many other interventions are often used conjunction with or in lieu of evidence-based treatments for ADHD. One such example is the use of mindfulness-based interventions which have been shown to improve attention, reduce maladaptive behaviors, and increase self-regulatory abilities among children in general education settings. The current study is the first to evaluate the effect of mindfulness intervention in combination with BT on behavior, task-based executive functioning (EF), and mindful awareness in elementary-aged children with ADHD (N = 58). The study took place in a controlled analogue summer program setting (STP) in which children were randomized to receive either the mindfulness intervention in conjunction with BT or to a BT active control condition. Children completed a variety of EF cognitive tasks at baseline and post-treatment. Child behavioral responses were measured as teacher and staff-recorded frequencies of observed behavior. In addition, parent-reported and child self-reported measures on mindful awareness were collected. Overall, there were no beneficial incremental effects of mindfulness when used in combination with intensive BT with regard to observed child behavior, attention and inhibitory control, or mindful awareness.

Evaluate whether stimulant medication improves acquisition of academic material in children with ADHD receiving small-group, content-area instruction in a classroom setting. Participants were 173 children between the ages of 7 and 12 (77% male, 86% Hispanic) who met DSM −5 criteria for ADHD and were participating in a therapeutic summer camp. The design was a triple-masked, within-subject, AB/BA crossover trial. Children completed two consecutive phases of daily, 25-minute instruction in both (a) subject-area content (science, social studies) and (b) vocabulary. Each phase was a standard instructional unit lasting for 3 weeks. Teachers and aides taught the material to small groups in a summer classroom setting. Each child was randomized to be medicated with daily osmotic-release oral system methylphenidate (OROS-MPH) during either the first or second of the instructional phases, receiving placebo during the other. Medication had large, salutary, statistically significant effects on children’s academic seatwork productivity and classroom behavior on every single day of the instructional period. However, there was no detectable effect of medication on learning the material taught during instruction: children learned the same amount of subject-area and vocabulary content whether they were taking OROS-MPH or placebo during the instructional period. Acute effects of OROS-MPH on daily academic seatwork productivity and classroom behavior did not translate into improved learning of new academic material taught via small-group, evidence-based instruction.