Behavioral treatments for ADHD: For which children do they work?

A study in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP), reports that certain children with ADHD should be given priority when it comes to behavioral treatment.

"Behavioral treatments are found to reduce symptoms of ADHD, tackle behavioral problems, and reduce functional impairment in children with ADHD. However, these treatments may not be equally effective for all children with ADHD, said first author Annabeth Groenman, Ph.D., Assistant Professor at Accare, Department of Child and Adolescent Psychiatry, University Medical Center Groningen, and Research Institute Child Development and Education, University of Amsterdam.

"It is important to understand what children (or families) respond better or worse to behavioral treatments to identify target groups for intervention more accurately. To better determine which children can benefit more from behavioral treatments, we needed a large database with a high number of participants."

The findings are based on a database developed under the Psychosocial ADHD INTerventions (PAINT) collaboration, containing a team of 33 researchers from around the world, who shared data of their individual trials studying the effectiveness of behavioral treatment to be used in an individual participant data meta-analysis (IPDMA).

Dr. Groenman and colleagues then reviewed the effects of behavioral treatment on more than 2,200 children with ADHD below the age of 18 included in 21 randomized controlled trials. They analyzed the effect on the children's symptoms of ADHD, behavioral problems, and global impairment children experience in their daily lives.

The research showed that behavioral treatment for children with ADHD can help reduce attention problems, hyperactivity, impulsiveness and behavioral problems; treatment also reduces how children experience functional impairment due to their behavior. In addition, the researchers identified subgroups that respond differently to behavioral interventions. Children with conduct disorder symptoms accompanying their ADHD clearly deteriorate without treatment. This is also true for children with more severe ADHD and children from single-parent families.

"These findings emphasize the importance of direct access to behavioral treatment for children with ADHD who have more severe ADHD or conduct disorder symptoms, as it prevents deterioration of their problems," said Barbara van der Hoofdakker, Ph.D., University of Groningen, on behalf of the PAINT consortium research team. PAINT would like to see that efforts are made to make behavioral interventions easily and quickly accessible to all.

The most important conclusion of this study is that certain subgroups of children with ADHD should be treated promptly with behavioral interventions to prevent them from deteriorating.