A two-site randomized clinical trial of integrated psychosocial treatment for ADHD-inattentive type.

Abstract

Objective This study evaluated the efficacy of the Child Life and Attention Skills (CLAS) program, a behavioral psychosocial treatment integrated across home and school, for youth with Attention Deficit Hyperactivity Disorder-Inattentive Type (ADHD-I). Method In a two-site randomized controlled trial, 199 children (ages 7-11) were randomized to CLAS (N=74), parent-focused treatment (PFT, N=74), or treatment as usual (TAU, N=51). We compared groups on parent and teacher ratings of inattention symptoms, organizational skills, social skills, and global improvement at post-treatment, and also at follow-up during the subsequent school year. Results CLAS resulted in greater improvements in teacher-reported inattention, organizational skills, social skills, and global functioning relative to both PFT and TAU at post-treatment. Parents of children in CLAS reported greater improvement in organizational skills than PFT and greater improvements on all outcomes relative to TAU at post-treatment. Differences between CLAS and TAU were maintained at follow-up for most parent-reported measures but were not significant for teacher-reported outcomes. Conclusions These findings extend support for CLAS across two study sites, revealing that integrating parent, teacher, and child treatment components, specifically adapted for ADHD-I, is superior to parent training alone and to usual care. Direct involvement of teachers and children in CLAS appears to amplify effects at school and home and underscores the importance of coordinating parent, teacher, and child treatment components for cross-setting effects on symptoms and impairment associated with ADHD-I.

A Randomized Controlled Trial of a School-Implemented School–Home Intervention for Attention-Deficit/Hyperactivity Disorder Symptoms and Impairment

“…The substantial reduction in ADHD symptom severity is consistent with our prior study of multicomponent treatment (Child Life and Attention Skills program [CLAS] 16 ). That study found moderate effect sizes for inattention symptom reduction per parent (d=.64) and teacher (d=.7) report as compared to effect sizes in the large range per parent (d=1.05) and moderate range per teacher (d=.67) report in this study.…”

“…In that study, medication usage was relatively high in all groups, and the treatment was compared to a psychoeducational intervention, which may have limited the extent to which behavioral treatment would show effects beyond services already provided. Our supposition is that the coordinated components and intensity that are specific to CLAS 16 and CLS confer greater efficacy for ADHD and ODD symptom reduction. However, because both of our samples used medication infrequently, we cannot rule out the possibility that concurrent medication use would substantially reduce room for improvement of ADHD symptoms for all behavioral treatments, including ours.…”

“…13,14 To address this research-to-practice gap, Pfiffner et al (2011) developed the Collaborative Life Skills (CLS) program. CLS was adapted from an evidence-based, clinic-delivered intervention for ADHD-predominantly inattentive presentation (ADHD-I) 15, 16 for implementation in schools by school mental health providers (SMHPs). Locating the intervention in schools was intended to maximize access, as school is the setting where the vast majority (70%) of children receive mental health services for ADHD.…”

“…,16 With a sample of K=24 schools and N=135 students, estimated detectable effect size for this study is 0.48 (intraclass correlation coefficient [ICC] =.01, alpha=.05, two-sided).…”

Evidence-Based Psychological Treatments of Pediatric Mental Disorders

“…The Collaborative Life and Attention Skills Program [93] focuses on school-related impairments for children with predominantly inattentive symptoms of ADHD. The program consists of BPT, behavioral teacher consultation with contingencies targeting attention and organizational skills, a school-home report card system, and social and cognitive skills training directly with the child.…”