Treatment procedure of randomized clinical trial and cross-sectional study design
Domains | Pfiffner et al. [31] | Hart et al. [27] |
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Recruitment | Schools, school mental health providers, learning specialists | Local professionals or schools, advertisements or reports in the local media |
Screening | Parent/Teacher telephone interviews and assessed for demographics, school and mental status (Children who failed the initial screening requirements were further evaluated) | Nil |
Diagnostic | Parents and teachers rated the children using: - Child Symptom Inventory (CSI-4) - Disability Rating Scale (IRS) |
Parents and teachers rated the children using: - Disruptive Behavior Disorder Rating Scale - IOWA Conners Rating Scale Children who met the evidence-based diagnostic criteria got enrolled into the Summer Treatment Program (STP) |
Academic Testing | Nil | - Woodcock-Johnson Tests of Academic Achievement (WJ-III) (Subtests: Letter Word Identification, Reading Fluency, Work Attack, Math Calculation, and Math Fluency) - Peabody Vocabulary Test (PPVT-III) |
Targeted Measures | Efficacy of Child Life and Attention Skills Treatment: Parent component - planning, working memory, multitasking, prioritizing Child component - independence (academic, study and organizational skills: self-care and daily living skills) and social skills (good sportsmanship, assertion, conversational skills, dealing with teasing, friendship making, play-date skills) |
- On task behavior during instructional period - On task behavior and work productivity during testing |
Intervention procedure | A. Child Life and Attention Skills Treatment (CLAS) CLAS attempts to maximize the efficacy of psychosocial treatment for the Inattentive Type of ADHD. CLAS included: - The reliance of techniques such as scaffolding, reminders and routinization. - Parent component (PA), child component (CA), and teacher component (TA) Strategies included: a. PA: rewards, praise, establishing daily routines, directions and commands, avoiding power struggles, parent stress management, organize/structure the home b. CA: problem solving steps, self-cues, reminder lists focusing on independence and social skills c. TA: evidence based classroom management strategies B. Parent-Focused Treatment (PFT) Received the same number of parent group and individual family meetings as CLAS families |
STP offered state-of-the-art treatment to children with ADHD and related problems - Included Whole Group (WG) condition, Small Group (SG) condition, and Independent Seatwork (IS) condition - Both the instructional and testing periods were present in all three conditions, with the instructional period focusing on reading comprehension and the testing period on worksheet completion. |
C. Treatment as usual (TAU)—Booster session for PFT and CLAS Families received a written diagnostic report and a list of community treatment providers |
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Duration of session | Ten 90 min parent group meetings Ten 90 min child group meetings One 30 min orientation meeting |
10 min each for WG, SG, and IS conditions (instructional and testing periods) |
Personnel for data recording | Therapists | Teachers and Research assistant |
Post intervention analysis | -DSM-IV inattention symptoms rated on a 4-point scale -Organization skills were rated on a 4-point rating scale by teachers and parents -Social skills rated using Social-Skills Improvement system (SSIS) by teachers and parents -Functional Impairment was rated using the Impairment Rating Scale (IRS) -Global psychosocial functioning was rated on a 7 point rating scale using Global Impression Scale |
Nil |
Treatment/procedure integrity and fidelity | Interrater reliability for the CLAS and PFT was >97% | The average observation rating: - Appropriately administered treatment components: 98.7 % - Average percentage of appropriate commands: 89.2% |
Social validity | Ascertained from parents and teachers using a 5-point scale pertaining to the usefulness and appropriateness of the CLAS and PFT program. Degree of satisfaction (CLAS): Parents: >95%; Teachers: 94% Degree of satisfaction (PFT): Parents: 94-95% |
Nil |
Results | Post hoc comparison between CLAS, PFT and TAU was done and the results (level of significance) are as follows: A. Inattention symptoms: Child Symptom Inventory (CSI) CLAS-PFT: Parent Report (PR)-0.35 & Teacher Report (TR)-0.21 CLAS-TAU: PR-0.68 & TR -0.17 PFT-TAU:PR-0.33 & TR-0.04 B. Organizational skills: Children’s organizational skill scale(COSS) CLAS-PFT: PR-0.35 & TR -0.25 CLAS-TAU: PR-0.46 & TR-0.16 PFT-TAU: PR-0.12 & TR -0.09 C. Social skills: Social skills improvement system(SSIS) CLAS-PFT: PR-0.12 & TR-0.26 CLAS-TAU: PR-0.34 & TR-0.02 PFT-TAU: PR-0.22 & TR-0.24 D. Overall improvement: PR: Clinical Global Impressions- Improvement(CGI-I) TR: Clinical Global Impression- Severity (CGI-S) CLAS-PFT: PR-0.23 & TR-0.16 CLAS-TAU: PR-0.67 & TR-0.17 PFT-TAU: PR-0.45 & TR-0.01 |
Post hoc comparison between Independent seatwork, small group and whole group condition On-Task Behavior during Instructional and testing period:Instructional Period: a) IS - F(1, 31) = 10.44, p< .001 b) SG- F(1, 32) = 20.0, p<.001 c) WG- F(1, 32) = 6.01, p = .020 Testing Period: F(2, 31) =1.695, p =.200 Post hoc analyses were not interpreted to evaluate differences between conditions, suggests that the on-task behavior of children with ADHD does not differ between testing contexts Work Productivity during Testing: a) IS: F(2, 31) =7.501, p =.002 b) SG: F(1, 32) =8.845, p =.006 c) WG: F(1, )32 14.785, p =.001 |