Evidenced-Based Treatment for Child ADHD: "Real-World" Practice Implications.

Abstract

The purpose this article is to discuss evidenced-based treatment for 7- to 1O-year-old children experiencing ADHD (combined type) with the goal potentially informing real-world mental health counselor practice. This article first discusses the results the landmark Multimodal Treatment Study Children with ADHD (MTA; MTA Cooperative Group, 1999a). Then, clinical implications this well controlled study for outpatient practice are addressed. Specifically, a family-based, behaviorally oriented, multimodal, and multisystemic approach is suggested by the study. The comprehensive treatment approach includes parent management training, school interventions, and medication. Common treatment considerations relevant to working with child ADHD are discussed. ********** Attention-deficit/hyperactivity disorder (ADHD) is a complex and chronic mental health disorder involving problems with inattention and hyperactivity-impulsivity developmentally inconsistent with the age the child. Behavioral disinhibition appears to be a central feature child ADHD (Barkley, 1997a). Child ADHD seems to be a disorder performance rather than a skills and/or knowledge problem. As Barkley (1998a) notes, child ADHD involves a problem of doing what one knows, rather than knowing what to (p. 69). It is estimated that 3% to 7% school-age children (most frequently males) experience ADHD disorder (American Psychiatric Association, 2000). Moreover, child ADHD referrals constitute a significant proportion child referrals for mental health services (Goldman, Genel, Bezman, & Slanetz, 1998; Popper, 1988). ADHD significantly impacts the child's emotional, family, school, and social functioning (Barkley, 1998b). Furthermore, comorbid disorders are common including oppositional defiant disorder, conduct disorder, and learning disorders (Barkley, 1996). Due to the complexity, chronicity, prevalence, and multisystem impact child ADHD, mental health counselors' knowledge and use effective outpatient treatment for children experiencing ADHD is imperative. Yet, how can counselors find out about effective treatment such that they can use it in their day-to-day practice? The most accurate resource for counselors is the treatment outcome literature, which is primarily published in professional journals. However, there are many good reasons why counselors do not access the outcome research concerning child ADHD. First, counselors might not know how to conduct literature searches to locate relevant journal articles. Second, treatment outcome articles can be boring and not one's first choice for reading material. Third, the articles can be difficult to understand and possibly not relevant to daily practice. Fourth, counselors in full-time outpatient practice often have little time to read in the context seeing many clients, keeping up with written documentation requirements (e.g., progress notes), and case management responsibilities (e.g., returning phone calls). The purpose this article is to discuss the clinical implications recent treatment efficacy research concerning child ADHD with the goal informing mental health counselor outpatient practice in a potentially useful manner. This article is written in an attempt to translate the results such that they are clinically meaningful to practitioners. In essence, I am attempting to address the following challenge: What can mental health counselors `take' from the evidenced-based ADHD outcome research that will inform their practice in the next hour with a child experiencing ADHD? Although this is not a how-to article, it is hoped that mental health counselors can utilize the information in their clinical settings. I first discuss a recent landmark National Institute Mental Health sponsored study (MTA Cooperative Group, 1999a) and follow-up report (Conners et al., 2001). Then I discuss clinical implications to potentially inform real-world practice. …