- مبلغ: ۸۶,۰۰۰ تومان
- مبلغ: ۹۱,۰۰۰ تومان
Description of the Disorder
Attention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by attention deficits and hyperactive behaviors. According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2013), ADHD can be divided into three subtypes based on the inattention and hyperactivity dimensions: a predominantly inattentive type, a predominantly hyperactive–impulsive type, and a combined hyperactive–inattentive type. The worldwide prevalence of ADHD is approximately 3.4% for children and adolescents (Polanczyk, Salum, Sugaya, Caye, & Rohde, 2015) and 5% for adults (Willcutt, 2012). More males tend to be affected than females. ADHD interferes with academic performance (Loe & Feldman, 2007) and is associated with a high risk for comorbid conditions, such as conduct disorders (Waschbusch, 2002), anxiety (Jarrett & Ollendick, 2008), depression (Blackman, Ostrander, & Herman, 2005), accidental injuries (Nigg, 2013), and suicidality (Barbaresi et al., 2013). ADHD is a major public health concern as the disease is burdensome on both individuals and society (Pelham, Foster, & Robb, 2007; Robb et al., 2011). The annual costs related to education, treatment, and juvenile justice for ADHD children and adolescents are estimated to be around $43 billion. For adults, ADHD results in approximately 121 million missed work days, with $20 billion lost in salary alone (Pelham et al., 2007). Costs associated with ADHD are comparable to those associated with major depression and stroke (Pelham et al., 2007). Therefore, the development of effective treatments for ADHD is important on both the individual and the societal levels.
Conclusions and Discussion
Implications for Research According to David and Montgomery’s (2011) evaluative framework, current treatments for ADHD fall into four main categories: Category I (evidence-based psychotherapies), Category II (intervention-driven psychotherapies), Category III (theory-driven psychotherapies), and Category IV (investigational psychotherapies). Importantly, we were not able to identify strong contradictory evidence. Even though we found equivocal data (preliminary or mixed findings) for most of the therapeutic packages, no study investigated possible harmful effects. Consequently, as this chapter did not aim to investigate ADHD interventions exhaustively, pseudoscientific approaches to ADHD treatment could exist, but we might not have identified them as such.
Our classification of ADHD evidence-based psychotherapies (David & Montgomery, 2011) differs from current guidelines and suggests that far more research is needed in order to establish evidence-based psychotherapies for ADHD. Let us consider the case of behavioral parent training, currently recommended by NICE guidelines as an evidence-based psychotherapy for a child with ADHD. According to David and Montgomery’s classification system, this intervention falls in Category III (theory-driven psychotherapies), which means that it has a well-supported theory and an insufficiently tested treatment package. Due to mixed data regarding its equivalence or superiority to standard treatment as a function of unblinded versus blinded assessors’ ratings (e.g., parents, teachers, or clinicians), further research is necessary to control for possible biases. By testing these biases in RCTs, ADHD interventions could move from one category to another, either in the direction of scientifically oriented psychotherapies (if there is evidence for a well-supported treatment package or theory) or to pseudoscientifically oriented psychotherapies (if there is strong contradictory evidence showing absence of benefit or evidence of harm). Research should also bring evidence regarding the maintenance of gains after treatment (e.g., consider the scarcity of studies that investigated the long-term effects of neurofeedback interventions) and investigate not only the clinical efficacy of an available treatment option but also its costefficiency.