A Comparison of Effectiveness of Attention Process Training (APT) with Parenting Management Training (PMT) in Reducing Symptoms of Attention Deficit Hyperactivity Disorder
,
Abstract
Objective: Child-oriented psychotherapies, such as Attention Process Training (APT), target ADHD symptoms directly, whereas family-oriented interventions, like Parent Management Training (PMT), address its functional impairments. The aim of this study was to compare the effectiveness of APT and PMT in treating ADHD symptoms.
Method: This research was a randomized controlled trial in which 45 children (26 females and 19 males, with a mean age of 8.47 ± 1.66 years) with ADHD were selected conveniently and assigned randomly to one of three groups (PMT = 15, APT = 15, and CTRL = 15). The groups had no significant differences in ADHD severity. The PMT children were managed with parenting techniques. Children in the APT group practiced attention techniques, while children in the control group did not receive any intervention. Ritalin was prescribed to all the children in the three groups. The score on the Conners Parenting Rating Scale-Revised: Short form was the outcome variable.
Results: Both interventions decreased ADHD symptoms severity more than the control group. Howver, the reduction in the APT group was more than in the PMT group (P-value < 0.001). The scores of 40% of the APT group and 80% of the PMT group did not fall below the cut-off point. In the APT group after the intervention, the inattention subscale was significantly lower than the hyperactivity subscale, while in the PMT group, the hyperactivity subscale was lower. The effect sizes of APT and PMT were 2.18 and 2.09, respectively.
Conclusion: For ADHD, psychological interventions are crucial in addition to medication. According to the results of this study, APT is more effective for inattention symptoms, while PMT is more effective for hyperactivity symptoms. When selecting psychotherapy, the subtype of ADHD should be taken into account. Treatment sessions must also be completed according to intervention protocols.
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7. Connor DF, Steeber J, McBurnett K. A review of attention-deficit/hyperactivity disorder complicated by symptoms of oppositional defiant disorder or conduct disorder. Journal of Developmental & Behavioral Pediatrics. 2010;31(5):427-40.
8. Sibley MH, Graziano PA, Ortiz M, Rodriguez L, Coxe S. Academic impairment among high school students with ADHD: The role of motivation and goal-directed executive functions. Journal of school psychology. 2019;77:67-76.
9. Smith ZR, Langberg JM. Review of the evidence for motivation deficits in youth with ADHD and their association with functional outcomes. Clinical child and family psychology review. 2018;21(4):500-26.
10. Sodano SM, Tamulonis JP, Fabiano GA, Caserta AM, Hulme KF, Hulme KL, et al. Interpersonal problems of young adults with and without attention-deficit/hyperactivity disorder. Journal of attention disorders. 2021;25(4):562-71.
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24. Rubia K, Westwood S, Aggensteiner P-M, Brandeis D. Neurotherapeutics for attention deficit/hyperactivity disorder (ADHD): a review. Cells. 2021;10(8):2156.
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35. Wylock J-F, Borghini A, Slama H, Delvenne V. Child attachment and ADHD: a systematic review. European child & adolescent psychiatry. 2021:1-12.
36. Kazdin AE, Whitley MK. Comorbidity, case complexity, and effects of evidence-based treatment for children referred for disruptive behavior. Journal of consulting and clinical psychology. 2006;74(3):455.
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38. Mabe PA, Turner MK, Josephson AM. Parent management training. Child and adolescent psychiatric clinics of North America. 2001;10(3):451-64.
39. Mack KN, Lebowitz ER, Silverman WK. Contemporary family psychotherapy: Behavioral and cognitive-behavioral theories. 2019.
40. Mockford C, Barlow J. Parenting programmes: some unintended consequences. Primary Health Care Research & Development. 2004;5(3):219-27.
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44. Mingebach T, Kamp-Becker I, Christiansen H, Weber L. Meta-meta-analysis on the effectiveness of parent-based interventions for the treatment of child externalizing behavior problems. PLoS One. 2018;13(9):e0202855.
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50. Séguin M, Lahaie A, Matte-Gagné C, Beauchamp MH. Ready! Set? Let's Train!: Feasibility of an intensive attention training program and its beneficial effect after childhood traumatic brain injury. Annals of physical and rehabilitation medicine. 2018;61(4):189-96.
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2. Erskine HE, Ferrari AJ, Nelson P, Polanczyk GV, Flaxman AD, Vos T, et al. Research Review: Epidemiological modelling of attention‐deficit/hyperactivity disorder and conduct disorder for the Global Burden of Disease Study 2010. Journal of Child Psychology and Psychiatry. 2013;54(12):1263-74.
3. Song M, Dieckmann NF, Nigg JT. Addressing discrepancies between ADHD prevalence and case identification estimates among US children utilizing NSCH 2007-2012. Journal of attention disorders. 2019;23(14):1691-702.
4. Mohammadi MR, Ahmadi N, Khaleghi A, Mostafavi SA, Kamali K, Rahgozar M, et al. Prevalence and correlates of psychiatric disorders in a national survey of Iranian children and adolescents. Iranian journal of psychiatry. 2019;14(1):1.
5. Mohammadi M-R, Zarafshan H, Khaleghi A, Ahmadi N, Hooshyari Z, Mostafavi S-A, et al. Prevalence of ADHD and its comorbidities in a population-based sample. Journal of attention disorders. 2021;25(8):1058-67.
6. August GJ, Realmuto GM, MacDonald AW, Nugent SM, Crosby R. Prevalence of ADHD and comorbid disorders among elementary school children screened for disruptive behavior. Journal of abnormal child psychology. 1996;24(5):571-95.
7. Connor DF, Steeber J, McBurnett K. A review of attention-deficit/hyperactivity disorder complicated by symptoms of oppositional defiant disorder or conduct disorder. Journal of Developmental & Behavioral Pediatrics. 2010;31(5):427-40.
8. Sibley MH, Graziano PA, Ortiz M, Rodriguez L, Coxe S. Academic impairment among high school students with ADHD: The role of motivation and goal-directed executive functions. Journal of school psychology. 2019;77:67-76.
9. Smith ZR, Langberg JM. Review of the evidence for motivation deficits in youth with ADHD and their association with functional outcomes. Clinical child and family psychology review. 2018;21(4):500-26.
10. Sodano SM, Tamulonis JP, Fabiano GA, Caserta AM, Hulme KF, Hulme KL, et al. Interpersonal problems of young adults with and without attention-deficit/hyperactivity disorder. Journal of attention disorders. 2021;25(4):562-71.
11. Tamm L, Loren RE, Peugh J, Ciesielski HA. The association of executive functioning with academic, behavior, and social performance ratings in children with ADHD. Journal of Learning Disabilities. 2021;54(2):124-38.
12. Aduen PA, Day TN, Kofler MJ, Harmon SL, Wells EL, Sarver DE. Social problems in ADHD: Is it a skills acquisition or performance problem? Journal of psychopathology and behavioral assessment. 2018;40(3):440-51.
13. Van der Oord S, Prins PJ, Oosterlaan J, Emmelkamp PM. The association between parenting stress, depressed mood and informant agreement in ADHD and ODD. Behaviour Research and Therapy. 2006;44(11):1585-95.
14. Retz W, Ginsberg Y, Turner D, Barra S, Retz-Junginger P, Larsson H, et al. Attention-Deficit/Hyperactivity Disorder (ADHD), antisociality and delinquent behavior over the lifespan. Neuroscience & Biobehavioral Reviews. 2021;120:236-48.
15. Tarver J, Daley D, Sayal K. Attention‐deficit hyperactivity disorder (ADHD): an updated review of the essential facts. Child: care, health and development. 2014;40(6):762-74.
16. Lambez B, Harwood-Gross A, Golumbic EZ, Rassovsky Y. Non-pharmacological interventions for cognitive difficulties in ADHD: A systematic review and meta-analysis. Journal of psychiatric research. 2020;120:40-55.
17. Caye A, Swanson JM, Coghill D, Rohde LA. Treatment strategies for ADHD: an evidence-based guide to select optimal treatment. Molecular psychiatry. 2019;24(3):390-408.
18. Biederman J, Monuteaux MC, Mick E, Spencer T, Wilens TE, Silva JM, et al. Young adult outcome of attention deficit hyperactivity disorder: a controlled 10-year follow-up study. Psychological medicine. 2006;36(2):167-79.
19. Kutcher S, Aman M, Brooks SJ, Buitelaar J, Van Daalen E, Fegert J, et al. International consensus statement on attention-deficit/hyperactivity disorder (ADHD) and disruptive behaviour disorders (DBDs): clinical implications and treatment practice suggestions. European Neuropsychopharmacology. 2004;14(1):11-28.
20. Doulou A, Drigas A. ADHD and comorbidity: The role of pharmacotherapy. Technium Social Sciences Journal. 2022;27:194-206.
21. Zhou Z, Betts KA, Bocharova I, Kinrich D, Spalding WM. Concomitant use of psychotropic medication with stimulants for the treatment of ADHD in children and adolescents: A retrospective insurance claims study in the United States. Journal of attention disorders. 2020;24(2):336-47.
22. van de Loo-Neus GH, Rommelse N, Buitelaar JK. To stop or not to stop? How long should medication treatment of attention-deficit hyperactivity disorder be extended? European Neuropsychopharmacology. 2011;21(8):584-99.
23. Meijer WM, Faber A, van den Ban E, Tobi H. Current issues around the pharmacotherapy of ADHD in children and adults. Pharmacy world & science. 2009;31:509-16.
24. Rubia K, Westwood S, Aggensteiner P-M, Brandeis D. Neurotherapeutics for attention deficit/hyperactivity disorder (ADHD): a review. Cells. 2021;10(8):2156.
25. Berger I, Dor T, Nevo Y, Goldzweig G. Attitudes toward attention-deficit hyperactivity disorder (ADHD) treatment: parents' and children's perspectives. Journal of child neurology. 2008;23(9):1036-42.
26. Nageye F, Cortese S. Beyond stimulants: a systematic review of randomised controlled trials assessing novel compounds for ADHD. Expert review of neurotherapeutics. 2019;19(7):707-17.
27. Abedi A, Jamali S, Faramarzi S, Aghaie E, Behruz M. A comprehensive meta-analysis of the common interventions in ADHD. Contemporary psychology. 2012;7(1):17-34.
28. Khan MU, Aslani P. A review of factors influencing the three phases of medication adherence in people with attention-deficit/hyperactivity disorder. Journal of child and adolescent psychopharmacology. 2019;29(6):398-418.
29. Evans SW, Owens JS, Bunford N. Evidence-based psychosocial treatments for children and adolescents with attention-deficit/hyperactivity disorder. Journal of Clinical Child & Adolescent Psychology. 2014;43(4):527-51.
30. Bloch MH, Qawasmi A. Omega-3 fatty acid supplementation for the treatment of children with attention-deficit/hyperactivity disorder symptomatology: systematic review and meta-analysis. Journal of the American Academy of Child & Adolescent Psychiatry. 2011;50(10):991-1000.
31. Johnston C, Mash EJ. Families of children with attention-deficit/hyperactivity disorder: Review and recommendations for future research. Clinical child and family psychology review. 2001;4(3):183-207.
32. Türk S, Korfmacher A-K, Gerger H, Van der Oord S, Christiansen H. Interventions for ADHD in childhood and adolescence: A systematic umbrella review and meta-meta-analysis. Clinical Psychology Review. 2023:102271.
33. Qiu H, Liang X, Wang P, Zhang H, Shum DH. Efficacy of non-pharmacological interventions on executive functions in children and adolescents with ADHD: a systematic review and meta-analysis. Asian Journal of Psychiatry. 2023:103692.
34. Van der Oord S, Tripp G. How to improve behavioral parent and teacher training for children with ADHD: Integrating empirical research on learning and motivation into treatment. Clinical child and family psychology review. 2020;23(4):577-604.
35. Wylock J-F, Borghini A, Slama H, Delvenne V. Child attachment and ADHD: a systematic review. European child & adolescent psychiatry. 2021:1-12.
36. Kazdin AE, Whitley MK. Comorbidity, case complexity, and effects of evidence-based treatment for children referred for disruptive behavior. Journal of consulting and clinical psychology. 2006;74(3):455.
37. Leitch S, Sciberras E, Post B, Gerner B, Rinehart N, Nicholson JM, et al. Experience of stress in parents of children with ADHD: A qualitative study. International journal of qualitative studies on health and well-being. 2019;14(1):1690091.
38. Mabe PA, Turner MK, Josephson AM. Parent management training. Child and adolescent psychiatric clinics of North America. 2001;10(3):451-64.
39. Mack KN, Lebowitz ER, Silverman WK. Contemporary family psychotherapy: Behavioral and cognitive-behavioral theories. 2019.
40. Mockford C, Barlow J. Parenting programmes: some unintended consequences. Primary Health Care Research & Development. 2004;5(3):219-27.
41. Danforth JS, Connor DF, Doerfler LA. The development of comorbid conduct problems in children with ADHD: An example of an integrative developmental psychopathology perspective. Journal of attention disorders. 2016;20(3):214-29.
42. Anastopoulos AD, Shelton TL, DuPaul GJ, Guevremont DC. Parent training for attention-deficit hyperactivity disorder: Its impact on parent functioning. Journal of abnormal child psychology. 1993;21(5):581-96.
43. Pelham Jr WE, Wheeler T, Chronis A. Empirically supported psychosocial treatments for attention deficit hyperactivity disorder. Journal of clinical child psychology. 1998;27(2):190-205.
44. Mingebach T, Kamp-Becker I, Christiansen H, Weber L. Meta-meta-analysis on the effectiveness of parent-based interventions for the treatment of child externalizing behavior problems. PLoS One. 2018;13(9):e0202855.
45. Saba M, Rwabihama J-P, Bouvard É, Mettling P, Sztulman É, Lemarié N, et al. The Effect of Attention Process Training (APT-II) On Cognitive and Daily Life Functioning in Patients With a Mild Cognitive Impairment: A Randomized Controlled Trial. 2021.
46. Sohlberg MM, Mateer CA. Effectiveness of an attention-training program. Journal of clinical and experimental neuropsychology. 1987;9(2):117-30.
47. Markovic G, Schult M-L, Elg M, Bartfai A. Beneficial Effects of Early Attention Process Training After Acquired Brain Injury: A Randomized Controlled Trial. Journal of rehabilitation medicine. 2020;52(1).
48. Markovic G, Bartfai A, Ekholm J, Nilsson C, Schult M-L, Löfgren M. Daily management of attention dysfunction two–four years after brain injury and early cognitive rehabilitation with attention process training: a qualitative study. Neuropsychological rehabilitation. 2020;30(3):523-44.
49. Lee JB, Sohlberg MM, Harn B, Horner R, Cherney LR. Attention Process Training-3 to improve reading comprehension in mild aphasia: A single-case experimental design study. Neuropsychological rehabilitation. 2018.
50. Séguin M, Lahaie A, Matte-Gagné C, Beauchamp MH. Ready! Set? Let's Train!: Feasibility of an intensive attention training program and its beneficial effect after childhood traumatic brain injury. Annals of physical and rehabilitation medicine. 2018;61(4):189-96.
51. DeLuca J, Chiaravalloti ND, Sandroff BM. Treatment and management of cognitive dysfunction in patients with multiple sclerosis. Nature Reviews Neurology. 2020;16(6):319-32.
52. Mateer C, Sohlberg M, Youngman P. The management of acquired attention and memory deficits. Cognitive rehabilitation in perspective: Routledge; 2018. p. 68-96.
53. Meyer KN, Santillana R, Miller B, Clapp W, Way M, Bridgman-Goines K, et al. Computer-based inhibitory control training in children with Attention-Deficit/Hyperactivity Disorder (ADHD): Evidence for behavioral and neural impact. PLoS One. 2020;15(11):e0241352.
54. Kerns KA, Eso K, Thomson J. Investigation of a direct intervention for improving attention in young children with ADHD. Developmental neuropsychology. 1999;16(2):273-95.
55. Shalev L, Tsal Y, Mevorach C. Computerized progressive attentional training (CPAT) program: effective direct intervention for children with ADHD. Child neuropsychology. 2007;13(4):382-8.
56. Ghanizadeh A, Sayyari Z, Mohammadi MR. Effect of methylphenidate and folic acid on ADHD symptoms and quality of life and aggression: a randomized double blind placebo controlled clinical trial. Iranian Journal of Psychiatry. 2013;8(3):108.
57. Mohammadi MR, Soleimani AA, Farahmand Z, Keshavarzi S, Ahmadi N. A comparison of effectiveness of regulation of working memory function and methylphenidate on remediation of attention deficit hyperactivity disorder (ADHD). Iranian Journal of Psychiatry. 2014;9(1):25.
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| Files | ||
| Issue | Vol 19 No 3 (2024) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijps.v19i3.15802 | |
| Keywords | ||
| Attention Deficit Hyperactivity Disorders Parenting Parent-Child Relationship Cognitive Psychotherapy Visual Auditory Spatial Processing | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Nadermohammadi Moghadam M, Bakhshi P, Azarkollah A, Moulai B, Molavi P. A Comparison of Effectiveness of Attention Process Training (APT) with Parenting Management Training (PMT) in Reducing Symptoms of Attention Deficit Hyperactivity Disorder. Iran J Psychiatry. 2024;19(3):254-264.
