The lack of sufficiency of the primary treatment modalities for children with Attention-Deficit Hyperactivity Disorder (ADHD)-operant behaviormodification procedures and psychostimulant medications-have prompted exploration of cognitive-behavioral self-management treatments as altematives or adjuncts. Although self-instructional treatments are not adequate interventions for such children, reinforcement-and rehearsal-based behavioral interventions can be combined with self-management approaches to supplement and extend the gains induced by behavioral procedures. After presenting background material regarding cognitive-behavioral treatments for ADHD, we present case material related to multimodality treatment, with focus on training in anger management and self-evaluation skills. We argue against unsubstantiated claims for the efficacy of cognitive-behavioral interventions but contend that, when combined with pharnacologic and behavioral approaches, self-management procedures deserve consideration for the difficult social and behavioral problems of ADHD children.
References
1.
Abikoff, H. (1987). An evaluation of cognitive behavior therapy for hyperactive children. In B. B. Lahey & A. E. Kazdin (Eds.), Advances in clinical child psychology (Vol. 10, pp. 171-216). New York: Plenum.
2.
Abikoff, H. , Ganeles, D., Reiter, G., Blum, C., Foley, C., & Klein, R. G. (1988). Cognitive training in academically deficient ADHD boys receiving stimulant medication. Journal of Abnormal Child Psychology, 16, 411-432.
3.
Abikoff, H. , & Gittelman, R. (1985). Hyperactive children treated with stimulants: Is cognitive training a useful adjunct?Archives of General Psychiatry, 42, 953-961.
4.
Abramowitz, A. J. , Eckstrand, D., O'Leary, S. G., & Dulcan, M. K. (1992). ADHD children's responses to stimulant medication and two intensities of a behavioral intervention. Behavior Modification, 16, 193-203.
5.
American Psychiatric Association . (1987). Diagnostic and statistical manual of mental disorders (3rd ed., rev.). Washington, DC: Author.
6.
Barkley, R. A. , Fischer, M., Edelbrock, C. S., & Smallish, L. (1990). The adolescent outcome of hyperactive children diagnosed by research criteria: 1. An 8-year prospective follow-up study. Journal of the American Academy of Child and Adolescent Psychiatry, 29, 546-557.
7.
Barkley, R. A. , McMurray, M. B., Edelbrock, C. S., & Robbins, K. (1989). The response of aggressive and nonaggressive ADHD children to methylphenidate. Journal of the American Academy of Child and Adolescent Psychiatry, 28, 873-881.
8.
Cameron, M. I. , & Robinson, V.M.J. (1980). Effects of cognitive training on academic and on-task behavior of hyperactive children. Journal of Abnormal Child Psychology, 8, 405-419.
9.
Dodge, K. A. , Bates, J. E., & Pettit, G. S. (1990). Mechanisms in the cycle of violence. Science, 250, 1678-1683.
10.
Douglas, V. I. (1980). Treatment and training approaches to hyperactivity: Establishing intemal or extemal control. In C. K. Whalen & B. Henker (Eds.), Hyperactive children: The social ecology of identification and treatment (pp. 283-317). New York: Academic Press.
11.
Douglas, V. I. , Parry, P., Marton, P., & Garson, C. (1976). Assessment of a cognitive training program for hyperactive children. Journal of Abnormal Child Psychology, 4, 389-410.
12.
Drabman, R. , Spitalnik, R., & O'Leary, K. D. (1973). Teaching self-control to disruptive children. Journal of Abnormal Psychology, 82, 10-16.
13.
Fergusson, D. M. , Horwood, L. J., & Lloyd, M. (1991). Confinnatory factor models of attention deficit and conduct disorder. Journal of Child Psychology and Psychiatry, 32, 257-274.
14.
Gittelnan, R. , Abikoff, H., Pollack, E., Klein, D. F., Katz, S., & Mattes, J. (1980). A controlled trial of behaviormodification and methylphenidate in hyperactive children. In C. K. Whalen & B. Henker (Eds.), Hyperactive children: The social ecology of identification and treatment (pp. 283-317). New York: Academic Press.
15.
Goyette, C. H. , Conners, C. K., & Ulrich, R. F. (1978). Normative data on revised Conners Parent and Teacher Rating Scales. Journal of Abnormal Child Psychology, 6, 221-236.
16.
Hinshaw, S. P. (1987). On the distinction between attentional deficits/hyperactivity and conduct problems/aggression in child psychopathology. Psychological Bulletin, 101, 443-463.
17.
Hinshaw, S. P. (1992). Extemalizing behavior problems and academic underachievement in childhood and adolescence: Causal relationships and underlying mechanisms. Psychological Bulletin, 111, 127-155.
18.
Hinshaw, S. P. , Buhrmester, D., & Heller, T. (1989). Anger control in response to verbal provocation: Effects of methylphenidate for boys with ADHD. Journal of Abnormal Child Psychology, 17, 393-407.
19.
Hinshaw, S. P. , & Erhardt, D. (1991). Attention deficit-hyperactivity disorder. In P. C. Kendall (Ed.), Child and adolescent therapy: Cognitive-behavioral procedures (pp. 98-128). New York: Guilford.
20.
Hinshaw, S. P., Henker, B., & Whalen, C. K. (1981). Self-regulation for hyperactive boys: A training manual. Unpublished manuscript, University of California, Los Angeles.
21.
Hinshaw, S. P. , Henker, B., & Whalen, C. K. (1984a). Cognitive-behavioral and pharmacologic interventions for hyperactive boys: Comparative and combined effects. Journal of Consulting and Clinical Psychology, 52, 739-749.
22.
Hinshaw, S. P. , Henker, B., & Whalen, C. K. (1984b). Self-control in hyperactive boys in anger-inducing situations: Effects of cognitive-behavioral training and of methylphenidate. Journal of Abnormal Child Psychology, 12, 55-77.
23.
Horn, W. F. , Ialongo, N., Greenberg, G., Packard, T., & Smith-Winberry, C. (1990). Additive effects of behavioral parent training and self-control therapy with attention deficit hyperactivity disordered children. Journal of Clinical Child Psychology, 19, 98-110.
24.
Hoza, B. , Pelham, W. E., Sams, S. E., & Carlson, C. (1992). An examination of the "dosage" effects of both behavior therapy and methylphenidate on the classroom perfornance of two ADHD children. Behavior Modification, 16, 164-192.
25.
Huesmann, L. R. , Eron, L. D., Leikowitz, M. M., & Walder, L O. (1984). Stability of aggression over time and generations. Developmental Psychology, 20, 1120-1134.
26.
Kazdin, A. E. , Bass, D., Siegel, T., & Thomas, C. (1989). Cognitive-behavioral therapy and relationship therapy in the treatment of children referred for antisocial behavior. Journal of Consulting and Clinical Psychology, 57, 522-535.
27.
Kazdin, A. E. , Esveldt-Dawson, K., French, N. H., & Unis, A. S. (1987). Problem-solving skills training and relationship therapy in the treatment of antisocial behavior. Journal of Consulting and Clinical Psychology, 55, 76-85.
28.
Kendall, P. C. , & Braswell, L. (1985). Cognitive-behavioral therapyfor impulsive children. New York: Guilford.
29.
Lahey, B. B. , Piacentini, J. C., McBumett, K., Stone, P., Hartdagan, S., & Hynd, G. (1988). Psychopathology in the parents of children with conduct disorder and hyperactivity. Journal of the American Academy of Child and Adolescent Psychiatry, 27, 163-170.
30.
Loney, J. (1987). Hyperactivity and aggression in the diagnosis of attention deficit disorder. In B. B. Lahey & A. E. Kazdin (Eds.), Advances in clinical child psychology (Vol. 10, pp. 99-135). New York: Plenum.
31.
Loney, J. , & Milich, R. (1982). Hyperactivity, inattention, and aggression in clinical practice. In M. Wolraich & D. K. Routh (Eds.), Advances in developmental and behavioral pediatrics (Vol. 2, pp. 113-147). Greenwich, CT: JAI.
32.
Meichenbaum, D. H. (1977). Cognitive behavior modification: An integrative approach. New York: Plenum.
33.
Meichenbaum, D. H. , & Goodman, J. (1971). Training impulsive children to talk to themselves: A means of developing self-control. Journal of Abnormal Psychology, 77, 115-126.
34.
Milich, R. , & Landau, S. (1982). Socialization and peer relations in the hyperactive child. In K. D. Gadow & I. Bialer (Eds.), Advances in learning and behavioral disabilities (Vol. 1, pp. 283-339). Greenwich, CT: JAI Press.
35.
Novaco, R. W. (1979). The cognitive regulation of anger and stress. In P. C. Kendall & S. D. Hollon (Eds.), Cognitive-behavioral interventions: Theory, research, and procedures (pp. 241-285). New York: Academic Press.
36.
Parker, J. G. , & Asher, S. R. (1987). Peer relations and later personal adjustment: Are low accepted children at risk?Psychological Bulletin, 102, 357-389.
37.
Pelham, W. E. , & Bender, M. E. (1982). Peer relationships in hyperactive children: Description and treatment. In K. D. Gadow & I. Bialer (Eds.), Advances in learning and behavioral disabilities (Vol. 1, pp. 365-436). Greenwich, CT: JAI.
38.
Pelham, W. E. , Carlson, C., Sams, S., & Vallano, G. (in press). Separate and combined effects of methylphenidate and behavior modification on the classroom behavior and academic performance of ADHD boys: Group effects and individual differences. Journal ofConsulting and Clinical Psychology.
39.
Pelham, W. E. , & Hinshaw, S. P. (in press). Attention deficit disorder. In S. M. Tumer, K. S. Calhoun, & H. E. Adams(Eds.), Handbookof clinical behaviortherapy (2nd ed.). New York: Wiley.
40.
Pelham, W. E. , & Murphy, H. A. (1986). Behavioral and pharnacological treatment of attention deficit and conduct disorders. In M. Hersen (Ed.), Pharmacological and behavioral treatment: An integrative approach (pp. 108-148). New York: Wiley.
41.
Pfiffner, L. J. , & O'Leary, S. G. (in press). Psychological treatments: School-based. In J. L. Matson (Ed.), Hyperactive children: A handbook. New York: Pergamon.
42.
Reid, M. K. , & Borkowski, J. G. (1987). Causal attributions of hyperactive children: hnplications for teaching strategies and self-control. Journal of Educational Psychology, 79, 296-307.
43.
Schachar, R. (1991). Childhood hyperactivity. Journal of Child Psychology and Psychiatry, 32, 155-191.
44.
Turkewitz, H. , O'Leary, K. D., & Ironsmith, M. (1975). Generalization and maintenance of appropriate behavior through self-control. Journal of Consulting and Clinical Psychology, 43, 577-583.
45.
Ullmann, R. K. , Sleator, E. K., & Sprague, R. L. (1985). A change of mind: The Conners Abbreviated Rating Scales reconsidered. Journal of Abnormal Child Psychology, 13, 553-565.
46.
Weiss, G. , & Hechtman, L. (1986). Hyperactive children grown up. New York: Guilford.
47.
Whalen, C. K. , & Henker, B. (1985). The social worlds of hyperactive (ADDH) children. Clinical Psychology Review, 5, 447-478.
48.
Whalen, C. K. , & Henker, B. (1991). Therapies for hyperactive children: Comparisons, combinations, and compromises. Journal of Consulting and Clinical Psychology, 59, 126-137.
49.
Zupan, B. (1991). Aggressive schemata in boys with attention deficit-hyperactivity disorder. Unpublished doctoral dissertation, University of Califomia, Los Angeles.
