Review of cognitive, cognitive-behavioral, and neural-based interventions for Attention-Deficit/Hyperactivity Disorder (ADHD)

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Abstract

Primary evidence-based treatment approaches for ADHD involve pharmacological and behavioral treatments. However, there continue to be investigations of cognitive-behavioral, cognitive, and neural-based intervention approaches that are not considered evidence-based practice. These particular treatments are summarized, as they all involve training in cognitive skills or cognitive strategies. We identified 26 studies (six cognitive-behavioral, six cognitive, and 14 neural-based), and calculated effect sizes where appropriate. Overall, our analysis suggests that further research is needed to determine the efficacy of these approaches on both cognitive and behavioral outcome measures, but that some of these methods show promise for treating ADHD. We discuss some important conceptual and methodological issues that need to be taken into account for future research in order to evaluate the clinical efficacy of these approaches.

Section snippets

Characterizing cognitive, cognitive-behavioral, and neural-based interventions

The strategy of this review was to broadly include those interventions that use cognitive-based strategies. Namely, included were those approaches that have the goal of remediating deficiencies in thinking or cognitive processes in individuals with ADHD. Specifically, studies classified as cognitive-behavioral included strategy and metacognitive training. Cognitive studies included direct skills training of cognitive skills, such as working memory or attention. Neural-based interventions

Changing conceptualizations of ADHD

An important aspect of any useful treatment or intervention is the theory that supports the intervention. The theoretical conceptualizations of ADHD have also undergone a considerable amount of change in recent years. It was only in the DSM-IV (APA, 1995) that the three subtypes of ADHD were formally recognized, including the Inattentive subtype, Hyperactive/Impulsive subtype, and the Combined subtype. Research in recent years has highlighted the importance of differentiating the impact of

Evidence-based practice for treatment of ADHD

The largest and most influential study on the treatment of ADHD is likely the Multimodal Treatment Study of children with ADHD study (MTA Cooperative Group, 1999), which included a sample of 579 children diagnosed with ADHD Combined subtype, between 7 to 9.9 years of age, who were followed for 14 months. The overall interpretation of the results indicated that medication management significantly decreased ADHD symptoms compared to the behavior program alone, and that the combined medication and

Review of cognitive, cognitive-behavioral, and neural-based interventions

The goal of this review was to include studies that have used cognitive-behavioral, cognitive, or neural-based treatment approaches for individuals with ADHD. The net was cast widely to include studies from childhood to adulthood. We conducted a search using the PubMed online database to capture any articles on cognitive-behavioral, cognitive, or neural-based treatment in ADHD from the date range of March 1981 to May 2007. We identified a total of 26 studies, which included six studies

Summary

In this review, the empirical evidence for cognitive-behavioral, cognitive, and neural-based interventions was examined. While all of these studies reported significant effects, there are some important limitations and possible alternative explanations that require further empirical study. Consistent across the CBT and neural-based studies, controlling for medication status will be important, to determine whether effects are attributable to medication or an interaction between the target

Conclusions

This is an important time in the field of ADHD to give careful consideration to what cognitive-based treatments will be examined and how they will be carried out. This review included 26 studies characterized by considerable heterogeneity in sample characteristics, methods, and dependent measures. In order to advance the field to truly determine the efficacy of cognitive-behavioral, cognitive, and neural-based approaches in the study of ADHD, we have identified a number of important

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