2PSYCHOLOGICAL AND COMBINED INTERVENTIONS

Treatment effectiveness, choice and moderating factors
2.1For people with ADHD, do
  1. psychological interventions:52
    • cognitive training
    • CBT
    • behavioural approaches/parent (effectiveness) training
    • multimodal interventions
  2. other approaches:
    • biofeedback
    • physical therapies (relaxation and so on)
    • other approaches
when compared with:
  • no intervention
  • waiting lists
  • ‘standard care’
  • other psychological interventions
  • medication for ADHD
produce harm/benefits on the desired outcomes* and does this depend on:
  • ADHD subtype
  • associated disorder
  • social context
  • age
  • gender
  • severity
  • delivery systems (group/individual, family/group of family, manualised or not, student versus specialist, rater)?
*ADHD symptoms/associated mental health problems/peer relationships/school learning and progress/family relationships/quality of life/care needs, self-esteem
Plus additional outcomes agreed as relevant to psychological interventions for ADHD
2.2Is the use of more than one type of psychological therapy more effective than single therapies (including psychological interventions with the child combined with parent interventions)?53
2.3Is there evidence of the added value in terms of benefits/harm from combined treatment (medication for ADHD plus psychological interventions)?54
  • Medication for ADHD plus psychological intervention versus medication for ADHD only.
  • Medication for ADHD plus child psychological intervention versus medication for ADHD plus parent-training intervention.
  • Medication for ADHD plus psychological intervention versus psychological intervention.
  • Parent training plus child psychological intervention (or multimodal psych intervention) versus medication for ADHD.
Treatment decisions: initiation, duration, discontinuation and effect evaluation
2.4When should psychological treatment be initiated?
  • Does waiting for a treatment influence outcome?
2.5What is the optimum duration of treatment?
  • What are the long-term consequences of treatment?
2.6What is the most effective first-line treatment and under what circumstances (for example, epilepsy, potential for misuse, tics, Tourette’s syndrome, and so on)?
  • What is the recommended order of combined treatments?
Adherence
2.7What approaches can be used to optimise adherence with psychological treatment?

The clinical questions originally listed: family therapy (systemic/psychodynamic, behavioural); CBT (individual behavioural therapy, individual cognitive therapy, environmental manipulation and management.

Inserted in place of question under Interventions for carers: ‘Is there evidence on: the effectiveness of combined therapies compared with a single therapy?’

Separate section for clinical questions on combined interventions deleted and combination comparisons rationalised to fit the scheme for psychological interventions (combinations of drugs are dealt with in the pharmacological interventions questions).

From: APPENDIX 6, CLINICAL QUESTIONS

Cover of Attention Deficit Hyperactivity Disorder
Attention Deficit Hyperactivity Disorder: Diagnosis and Management of ADHD in Children, Young People and Adults.
NICE Clinical Guidelines, No. 72.
National Collaborating Centre for Mental Health (UK).
Leicester (UK): British Psychological Society (UK); 2009.
Copyright © 2009, The British Psychological Society & The Royal College of Psychiatrists.

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