Academic journal article Indian Journal of Psychological Medicine

Nonpharmacological Interventions for Children with Attention Deficit Hyperactivity Disorder in India: A Comprehensive and Comparative Research Update

Academic journal article Indian Journal of Psychological Medicine

Nonpharmacological Interventions for Children with Attention Deficit Hyperactivity Disorder in India: A Comprehensive and Comparative Research Update

Article excerpt

Byline: Sujata. Satapathy, Vandana. Choudhary, Renu. Sharma, Rajesh. Sagar

The nonpharmacological treatments for children with attention deficit hyperactivity disorder (ADHD) have witnessed a sea change from a rudimentary and haphazard psychosocial to cognitive interventions to social and behavioral skills to body oriented interventions to more sophisticated neurocognitive interventions. As the objective of each treatment varied, the method or procedure of each treatment also differed across studies. Indian research although not very rigorous, did witness changes emphasizing on exploring interventions in reducing symptoms and improving overall behavior. The research literature between 2005 and 2015 was searched using PubMed, Google Scholar, IndMED, MedIND, ResearchGate, and other indexed databases. Results of 110 studies were organized into five broad categories of themes of interventions such as psychosocial, body-focused, cognitive/neuro-cognitive, and cognitive behavioral. Effects of ADHD on cognitive, academic, and behavioral outcomes were also highlighted before the themes of intervention to establish linkage with discussion. However, a limited number (n = 9) of reported Indian studies focusing either on the impact of ADHD on the function of children or on interventions were found, suggesting a huge gap between global and Indian research in the area of children with ADHD. It also highlights the need for development and efficacy testing of indigenous intervention program in different areas of intervention for research and clinical practice.

Introduction

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental,[sup][1] sociobehavioral, and cognitive disorder characterized by developmentally inappropriate levels of inattention, impulsivity, and hyperactivity often persist into adulthood.[sup][2] Its clinical complexity and heterogeneity [sup][3] resulted in largest referrals in mental health, educational, and medical settings [sup][4] in past. ADHD results in poor performance of vigilance, working memory, sustained attention, planning, and executive functions.[sup][5],[6]

The nonpharmacological treatments in 1980s focused on cognitive training (CT) program containing self-instructional and self-management skills for improvement in classroom behavior and academics.[sup][7] Studies in 1990s reported more advantages of behavior modification strategies than cognitive or cognitive-behavioral approaches to behavior management. Classroom-based interventions such as instructional materials,[sup][8] behavior management and cognitive-behavioral therapy,[sup][9] self-management strategies,[sup][10],[11],[12] reinforcement-based attention training system,[sup][13],[14] and ADHD classroom-wide kit [sup][15] were also advocated.

The outcomes variables in 2000s shifted from behavioral improvements to reduction in cognitive deficits [sup][16],[17],[18],[19] and also witnessed effects of interventions on parenting skills training, social skills, and problem-solving training.[sup][20] Systematic reviews (between-group, within-subject, and single-subject study designs) synthesized the behavioral treatments and reported moderate to sustainable development for disruptive behaviors.[sup][21],[22],[23]

The paper provides a review of key nonpharmacological interventions and identifies gaps/emerging needs.

Materials and Methods

The search period was from January 1, 2005, to August 31, 2015. The electronic databases were PubMed, Google Scholar, IndMED, MedIND, and ResearchGate. Seven levels of screening had different search parameters with specific inclusion and exclusion criteria. From screening level III onward papers were included based on a review of the title, abstract, and reference. The key word ADHD was combined separately with psychosocial, cognitive, and behavioral intervention; nonmedical/nonpharmacological treatment; parents/peer relationship/friendship training; mindfulness-based-interventions; social skills training; school/home-based intervention; neurofeedback (NF)/computer training; physical exercises; play and music therapy; classroom-based therapy; mindfulness-training; working memory; and attention training. …

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