Abstract
ObjectiveThe aim of the present study is evaluate the effectiveness of an Acceptance and Commitment Therapy (ACT)-based training protocol, in adjunct to token economy and previous parent training, in a sample of children with Attention-Deficit/Hyperactivity Disorder (ADHD). By promoting the reduction of immediate responses to thoughts and feelings, we aimed to reduce the impulsive behaviour of children and to improve their self-regulation.MethodsThe protocol was centred on awareness of the present moment, defusion and acceptance of feelings and emotions. Behavioural (Conners’ Parent Rating Scale -Revised: Long version, CPRS-R:L) and severity measures (Clinical Global Impression -Severity, CGI-S) were assessed before and after treatment in a clinical sample of 31 children aged 8–13 years.ResultsAt the end of the ACT protocol, children showed significant improvement in global functioning and behavioural symptoms. There were significant improvements in the CPRS subscales Cognitive Problems (p = 0.005), Hyperactivity (p = 0.006), Perfectionism (p = 0.017), ADHD Index (p = 0.023), Global Index: Restless–Impulsive (p = 0.023), Global Index: Total (p = 0.036), DSM IV Inattentive (p = 0.029), DSM IV Hyperactive–Impulsive (p = 0.016), and DSM IV Total (p = 0.003). When controlling for the confounding effect of pharmacological therapy, comorbidities and socio-economic status, treatment maintained a significant effect on the CPRS subscales Perfectionism (partial η2 = 0.31, p < 0.01), Global Index: Restless–Impulsive (partial η2 = 0.29, p < 0.01), Global Index: Total (partial η2 = 0.31, p < 0.01), DSM IV Hyperactive–Impulsive (partial η2 = 0.20, p = 0.02). Symptom severity as rated by CGI-S scores decreased in 74.2% of the children.ConclusionsThis preliminary work on an Acceptance and Commitment Therapy-based child training in children affected by ADHD resulted in significant improvements, measured by a rating scale specific for ADHD.
Highlights
The worldwide prevalence of AttentionDeficit/Hyperactivity Disorder (ADHD) is estimated at 7.2% (Thomas et al 2015), making it the most prevalent psychiatric disorder of childhood
ADHD is more frequently diagnosed in boys than in girls, with an estimated ratio of 10:1 in clinic-referred or 3:1 in community samples (Biederman et al 2002)
The life domains that are mostly impaired in individuals with ADHD are the academic, occupational, social, mental-health and self-conceptual ones, negatively impacting the lives of children and of their families (Barkley et al 2008; Matheson et al 2013; Stein, 2008)
Summary
All parents had completed an ACT-based Cognitive Behavioural Parent Training (according to the protocol described in Vanzin et al 2018b) a maximum of 3 months before the evaluation of children for the inclusion in this study. Potential participants for this study were selected, following enrolment criteria, among all children with a diagnosis of ADHD enlisted for a group psychological treatment. Inclusion criteria were age between 8 and 13 years and a diagnosis of ADHD. Any major neurological or medical condition, a psychiatric diagnosis of autism spectrum disorder or specific language impairment (but no other psychiatric co-morbidities), or the fact that parents did not complete their ACT-based parent training, were considered exclusion criteria. Thirty-one patients remained in the study until its end and they had a complete set of data (Fig. 1)
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