A comparison of two forms of treatment for children with attention deficit hyperactivity disorder: effects on executive functioning and behaviour

Attention Deficit Hyperactivity Disorder (ADHD) is a common childhood disorder presenting with a variety of behavioural and cognitive manifestations. Recent conceptual theories of ADHD have implicated a key impairment in executive functioning, namely inhibition, however inconsistencies in the pattern of findings warrant further investigation. As a consequence of increasing awareness of the underlying deficits in ADHD, studies have emerged dedicated to investigating the efficacy of interventions, including psychostimulants and multimodal treatments (medication and behavioural therapy). Whilst the short term efficacy of these treatments is supported, there is a relative absence of convincing empirical evidence to support long term treatment in improving behaviour and cognition. Furthermore, the additive benefit of a combined treatment approach remains contradictory. The aim of the present study was to explore the executive function profile of ADHD and determine the impact of two treatments: medication alone and low intensity, family centred combined therapy treatment on cognition and behaviour. Cognitive test performance and parent ratings relative to published norms were assessed among 27 school age children with ADHD. These children were either assigned medication alone or combined therapy and were followed up over six months to compare treatment efficacy. Changes in performance based executive functioning and parent reported behaviours were evaluated at baseline, three months and six months for the two treatment groups. Results showed that the ADHD children performed poorly relative to test norms across most cognitive and behavioural measures sensitive to executive functions at baseline, however not all children demonstrated significant impairments in inhibition. Both treatment groups evidenced significant improvements with treatment over the six month follow-up period, however this is one of the first studies showing that the combined group was associated with greater and wider ranging improvements than medication alone treatment. Correlational analyses revealed mostly non-significant or low to moderate relationships between objective and subjective executive function measures. These results are discussed in the context of Barkley’s theory of ADHD (1997a) and the value of low intensity, family centred combined treatment for ADHD