Psychosocial Interventions for Attention-Deficit/Hyperactivity Disorder: Systematic Review with Evidence and Gap Maps

Abstract

Objective: To inform the scope of future systematic reviews, meta-analyses, and treatment outcome studies, this review aims to describe the extent of the evidence for psychosocial interventions for children and adolescents with attention-deficit/hyperactivity disorder, with particular attention to specific types of interventions, targets of outcome assessment, and risk of bias. Method: A comprehensive search of relevant databases (i.e., Medline, PsychInfo, Education Resources Information Center, and ProQuest Dissertation Database) was conducted. Detailed information related to treatment type, outcome assessment, study design, and risk of bias was extracted by trained coders. Evidence and gap maps were created to summarize evidence within types of treatments and targets of outcome assessment. Indicators of risk of bias were assessed for selected combinations of treatments and outcome assessment. Results: We identified 185 eligible individual studies and 3817 effect sizes. Behavioral parent training and cognitive training (COG) were the most commonly studied stand-alone interventions. Treatment versus control comparisons for stand-alone interventions (s = 70) were less common than for complex interventions involving combinations of psychosocial interventions (s = 100). Combinations of behavioral and child training (e.g., COG, organizational training) interventions were the most frequently studied. Conclusion: There is a considerable variability within this literature regarding combinations of treatments across outcome assessment targets. To address gaps in existing evidence, more primary studies assessing direct comparisons of isolated and combined treatment effects of specific types of psychosocial treatments relative to control and other treatments are needed. Future meta-analyses should take into account the complexity and breadth of available evidence.

Comprehensive Meta-Analysis of Attention-Deficit/Hyperactivity Disorder Psychosocial Treatments Investigated Within Between Group Studies

“…The results of this review indicate differences in treatment-type density within the larger, scholarly literature (Schatz et al, 2020) with behavioral parent training having the greatest density of study and other treatments having minimal study of stand-alone effects (e.g., organizational skills training; behavioral peer interventions). Contingency management in schools was also not frequently studied in between-group studies as a stand-alone intervention (i.e., fewer than 10 independent research studies), but it is important to note that companion papers investigating pre-post, crossover, and single-case design studies will include many more investigations of this approach (see also DuPaul & Eckert, 1997; DuPaul et al, 2013; Fabiano et al, 2009; Pelham & Fabiano, 2008; Pelham et al, 1998).…”

“…To achieve this aim, a comprehensive meta-analysis of between-group design studies was conducted. This article will report on the results of the meta-analysis, with companion papers addressing the current topography of the research literature (Schatz et al, 2020), meta-analyses of alternative research designs (e.g., pre-post assessments of efficacy; single-subject design studies), and alternative analyses (e.g., network meta-analysis) to follow in independent reports.…”

“…Indeed, another meta-analysis has indicated greater effect size magnitudes for planned combinations of treatments (Moore et al, 2018), and combined treatment is widely recommended for ADHD (Barbaresi et al, 2020). Planned companion papers will further investigate the role of these psychosocial combinations in a network meta-analysis (Schatz et al, 2021).…”

“…It is also important to emphasize that although the methodological approach in the present meta-analysis generally investigated single, psychosocial intervention, when in practice, it would be typical that multiple psychosocial treatments would be combined together to address impairment across settings (e.g., behavioral parent training combined with contingency management in the classroom). A companion paper is addressing the network of effect sizes across treatment combinations (Schatz et al, 2021). Depending on the measure, the findings approach the efficacy of stimulant medication (e.g., Faraone, 2009), and of note, the range of raters and outcomes assessed for efficacy are more diverse than typical stimulant medication trials.…”

Comparison of the Effectiveness of Mindfulness Therapy, Neurofeedback and Therapy Based on SPARK Perceptual-Motor Exercises on the Difficulty of Emotion Regulation in Children with Attention Deficit Hyperactivity Disorder (ADHD)

“…One of the most common neurodevelopmental disorders in childhood is Attention Deficit Hyperactivity Disorder (ADHD) (1) which affects more than five percent of children who present symptoms like sustained attention, irritability, and hyperactivity (2). Its common comorbidities include mood, anxiety, behavioral, learning, and substance use disorders (3). Emotion regulation problems in these children are also associated with social problems.…”