Non-pharmacological treatment of ADHD is considered important; however, strategies to maintain initial results of these treatments is, in the authors’ opinion, scarce. Therefore, empirical evidence for a long-term behavioural treatment strategy is warranted due to the chronicity of the disorder. The authors of this editorial highlight a recent long-term study by Qian et al. 2021 and, from their own meta-analysis, show the importance of not delaying non-pharmacological treatments in children with ADHD.
Briefly, Qian et al. 2021 found that booster ecological executive skills training for children with ADHD (which included a behaviour parent training component) one year after initial training led to improvements in executive functioning (planning abilities and delay aversion) compared with a waitlist control group. Improvements in executive functioning were also maintained one year after the booster training ended (Qian et al. 2021). The authors indicate that this study by Qian et al. 2021 may demonstrate a promising approach to establishing long-term effects of non-pharmacological interventions for children with ADHD.
In the authors’ opinion, there is little meta-analytical evidence on the long-term effects of non-pharmacological treatments for ADHD. They referenced the study by Groenman et al. 2021, which was an individual participant data meta-analysis (IPDMA) of behavioural interventions of >2200 children with ADHD. The authors indicate that IPDMA includes data at the individual level rather than at study level, which enables exploration of potential treatment moderators (e.g. age, sex, symptom severity and comorbidities). The findings from this study confirmed the short-term benefit of behavioural interventions on childhood ADHD and behavioural symptoms and impairments as rated by informants most proximal to the treatments. Subgroups of children who responded differently to behavioural interventions were also identified. For example, children from a single parent family, higher ADHD and conduct disorder symptom severity and presence of comorbid conduct disorder moderated treatment outcome. In the control group, these moderators indicated a worsening of symptoms. The authors suggest that these data indicate that some children with ADHD need treatment to prevent symptom deterioration (Groenman et al. 2021).
Disclaimer: The views expressed here are the views of the author(s) and not those of Takeda.
Groenman AP, Hornstra R, Hoekstra PJ, et al. An individual participant data meta-analysis: behavioural treatments for children and adolescents with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 2021; S0890-8567(21):00233-1.
Hoekstra PJ, van der Hoofdakker BJ, Groenman AP. The importance of achieving long-term treatment effects in ADHD. Eur Child Adolesc Psychiatry 2021; 30(6): 825-827.
Qian Y, Fan Z, Gao B, et al. Efficacy and acceptability of a second dose of ecological executive skills training for children with ADHD: a randomized controlled study and follow-up. Eur Child Adolesc Psychiatry 2021; 30(6): 921-935.