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Annotated Bibliography: Controversies in PsychologyBy successfully completing this assignment, you will demonstrate your proficiency in the following course competencies and assignment criteria:Competency 3: Analyze scholarly information and research findings through critical thinking to solve problems in the field of psychology.State clearly the relationship of the article to the thesis in five articles.Provide five article summaries that are succinct and capture the main points of the articles.Competency 5: Communicate in a manner that is scholarly, professional, and consistent with expectations for professionals in the field of psychology.Write in a manner that is scholarly in tone, easy to follow, and free from grammatical and spelling errors.Format five article references according to APA guidelines.In Unit 9, you will complete and submit your final paper for the course. The topics you may choose from include:Does cosmetic surgery promote or hinder self-esteem?Does use of electronic technology promote or detract from well-being?Is medication or are behavioral interventions more effective in treating attention deficit/hyperactivity disorder (ADHD)?Are virtual teams or traditional teams more effective?Does online learning or traditional (face-to-face) learning lead to higher academic performance?In this assignment, you will compile and submit an annotated bibliography of the potential sources you will use for your final paper.Your annotated bibliography will consist of:A minimum of five scholarly articles.The reference for each of the sources you are considering for your paper.A brief summary of the article.An explanation of how this source relates to your thesis. Describe how it either supports the thesis of your position or how it presents a counterargument to your thesis.Submit a draft of your annotated bibliography to SafeAssign and review your results before submitting it to your instructor for grading.Refer to the Annotated Bibliography: Controversies in Psychology Scoring Guide to understand how this assignment will be graded and ensure you meet the grading criteria. In addition, you may wish to refer to the Joel Taylor Sample Annotated Bibliography, linked in the Resources.Note: Your instructor may also use the Writing Feedback Tool to provide feedback on your writing. In the tool, click the linked resources for helpful writing information.Portfolio Prompt: You may choose to save this learning activity to your ePortfolio. You will learn more about your ePortfolio in Unit 10.ResourcesAnnotated Bibliography: Controversies in Psychology Scoring Guide.APA Style and Format.SafeAssign.Joel Taylor Sample Annotated Bibliography.Writing Feedback Tool.ePortfolio.Five scholarly articles:References1. Daley, David, PhD|van der Oord, Saskia, PhD|Ferrin, Maite, MD, PhD|Danckaerts, Marina, MD, PhD|Doepfner, Manfred, PhD|Cortese, Samuele, MD, PhD|Sonuga-Barke,Edmund J.S., PhD, & European ADHD Guidelines Group. (2014). Behavioral interventions in attention-deficit/hyperactivity disorder: A meta-analysis of randomized controlled trials across multiple outcome domains. Journal of the American Academy of Child & Adolescent Psychiatry, 53(8), 847.e5. doi:10.1016/j.jaac.2014.05.0132. Ferguson, J. H. (2000). National institutes of health consensus development conference statement: Diagnosis and treatment of attention-deficit/hyperactivity disorder (ADHD). Journal of the American Academy of Child & Adolescent Psychiatry, 39(2), 182-193. doi:10.1097/00004583-200002000-000183. Ogrim, G., & Hestad, K. A. (2013). Effects of neurofeedback versus stimulant medication in attention-deficit/hyperactivity disorder: A randomized pilot study. Journal of Child and Adolescent Psychopharmacology, 23(7), 448-457. doi:10.1089/cap.2012.00904. Pfiffner, L. J., PhD. (2014). Meta-analysis supports efficacy of behavioral interventions for attention-deficit/hyperactivity Disorder–Related problems. Journal of the American Academy of Child & Adolescent Psychiatry, 53(8), 830-832. doi:10.1016/j.jaac.2014.03.0065. Tarver, J., Daley, D., & Sayal, K. (2014). Attention-deficit hyperactivity disorder ( ADHD): An updated review of the essential facts. Child: Care, Health & Development, 40(6), 762-774. doi:10.1111/cch.12139


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Behavioral Interventions in Attention-Deficit/
Hyperactivity Disorder: A Meta-Analysis of
Randomized Controlled Trials Across Multiple
Outcome Domains
David Daley, PhD, Saskia van der Oord, PhD, Maite Ferrin, MD, PhD,
Marina Danckaerts, MD, PhD, Manfred Doepfner, PhD,
Samuele Cortese, MD, PhD, Edmund J.S. Sonuga-Barke, PhD,
on behalf of the European ADHD Guidelines Group
Objective: Behavioral interventions are recommended as attention-deficit/hyperactivity disorder (ADHD) treatments. However, a recent meta-analysis found no effects on core ADHD
symptoms when raters were probably blind to treatment allocation. The present analysis is
extended to a broader range of child and parent outcomes. Method: A systematic search in
PubMed, Ovid, Web of Knowledge, ERIC, and CINAHAL databases (up to February 5, 2013)
identified published randomized controlled trials measuring a range of patient and parent
outcomes for children and adolescents diagnosed with ADHD (or who met validated cutoffs
on rating scales). Results: Thirty-two of 2,057 nonduplicate screened records were analyzed.
For assessments made by individuals closest to the treatment setting (usually unblinded), there
were significant improvements in parenting quality (standardized mean difference [SMD] for
positive parenting 0.68; SMD for negative parenting 0.57), parenting self-concept (SMD 0.37),
and child ADHD (SMD 0.35), conduct problems (SMD 0.26), social skills (SMD 0.47), and
academic performance (SMD 0.28). With probably blinded assessments, significant effects
persisted for parenting (SMD for positive parenting 0.63; SMD for negative parenting 0.43)
and conduct problems (SMD 0.31). Conclusion: In contrast to the lack of blinded evidence
of ADHD symptom decrease, behavioral interventions have positive effects on a range of other
outcomes when used with patients with ADHD. There is blinded evidence that they improve
parenting and decrease childhood conduct problems. These effects also may feed through into a
more positive parenting self-concept but not improved parent mental well-being. J. Am. Acad.
Child Adolesc. Psychiatry, 2014;53(8):835–847. Key Words: ADHD, parenting, intervention,
(ADHD) is characterized by ageinappropriate, persistent, and pervasive
inattention and/or overactivity/impulsiveness
that impairs daily functioning1 and is associated
with substantial long-term burden on patients,
families, and health and educational services.2,3
This article is discussed in an editorial by Dr. Linda J. Pfiffner on
page 830.
This article can be used to obtain continuing medical education
(CME) at
Supplemental material cited in this article is available online.
Multimodal treatment approaches are recommended.4 Medication is typically used as the
first-line intervention, especially for severe cases.5
Despite robust evidence of medium-term symptom control,6 medication has some limitations.
A proportion of patients shows partial or no
response.6 Long-term effectiveness remains to be
established.7,8 Important aspects of functioning
may not improve (e.g., academic achievement9).
Adverse effects on sleep, appetite, and growth,
although rarely serious and generally manageable, are common and may not be well tolerated.10 Treatment compliance can be low,
especially during adolescence.11 Parents and
clinicians can have reservations about
DALEY et al.
medication use12 and may prefer nonpharmacologic approaches.13
Interventions using behavioral techniques
also are recommended and commonly used as
ADHD treatments.14 Systematic reviews of treatment trials have provided evidence to support
their efficacy.15-17 However, these reviews can
be difficult to interpret, because they sometimes
include nonrandomized controlled trials (RCTs),
mix individuals with and without ADHD, and
have not always drawn clear boundaries between ADHD-specific and other outcomes. Furthermore, outcome assessment is often made
unblinded by individuals taking an active part
in the intervention (e.g., parents receiving
parent training), which is likely to inflate efficacy
estimates.18 Sonuga-Barke et al.19 published a
meta-analysis of RCTs of behavioral interventions. Stringent inclusion and exclusion
criteria addressed some limitations of previous
meta-analyses. There was a moderate, statistically
significant, positive effect on ADHD core symptoms for assessments made by individuals most
proximal to the therapeutic setting—typically
unblinded parent ratings. However, these effects
were not corroborated by probably blinded measurements made by observers or raters unaware
of treatment allocation when the effect size
decreased to near 0 and became nonsignificant. A
similar, although less marked, decrease was
found for neural feedback and cognitive training.
There are some possible explanations for these
findings. First, that unblinded raters are biased
and overestimate treatment effects.20 Second, that
interventions increase parental tolerance for
ADHD or their ability to cope with its negative
impact rather than decreasing symptom levels.19
Third, that probably blinded measurements
were less valid than most proximal measurements.21 Fourth, that intervention effects did not
generalize from the therapeutic setting (e.g., the
home) to other settings (e.g., school).22 The authors concluded that more evidence from studies
with blinded assessments is required before
behavioral interventions can be supported as treatments for core ADHD symptoms.
The limited effects of behavioral approaches
on blinded core ADHD measurements may be
explicable if one considers the treatment models
on which many are based. For instance, although
most treatments in the trials included in the metaanalysis of Sonuga-Barke et al.19 were implemented to target ADHD symptoms, they were
initially developed and have been used
extensively for children with oppositional and
conduct problems.23-25 For many of these, the
rationale is that children’s challenging behavior
develops because of coercive interactional cycles
that, over time, co-reinforce noncompliant and
oppositional behaviors in the child and negative
and inappropriate responses from significant
adults (usually the parent but also potentially
teachers and other caregivers).26 During intervention, the adult is taught to apply behavior
modification techniques to reinforce appropriate
and discourage inappropriate child behaviors,
enhance effective and enjoyable adult–child interactions,27 and so transform negative into positive interactional cycles. Such interventions, it
could be argued, are unlikely to be effective as
treatments for core ADHD symptoms because
ADHD does not emerge along a similar environmentally mediated route as conduct problems
and therefore is less likely to respond to the
modification of environmental contingencies.28
However, the value of behavioral interventions
does not rest exclusively on their potential effects
on ADHD symptoms. Patients with ADHD often
have conduct problems29 and other comorbidities30 in addition to poor social and organizational skills and low academic achievement. Their
parents can have poor parenting self-concept and
mental health problems.31 These associated features of the disorder are important treatment targets in and of themselves because each is
associated with substantial burden to the child,
the child’s family, and society through the criminal justice, social, and health systems.22,32
Behavioral interventions may have an important
role in treating these problems whether or not they
decrease core ADHD symptoms. Indeed, behavioral treatments used with patients with ADHD
have targeted ADHD-related but nonspecific aspects of impairment rather than ADHD symptoms
themselves (e.g., social skills,33 organizational
skills,34 and academic achievement35).
In this article, the authors build on the previous
meta-analysis19 to address the broader impact
of behavioral interventions for children with
ADHD. They address 3 related questions. First,
given that most, although not all, interventions are
implemented by changes in the behavior of
responsible adults (typically parents or teachers), do
behavioral interventions improve adult responses
to children with ADHD? Second, do they improve
the sense of efficacy and competence and decrease
the mental health problems of adults working with
children with ADHD? Third, do they decrease
levels of child oppositional behavior and other
comorbidities and other aspects of impairment such
as social skills and academic performance? To
address these questions, most proximal and probably
blinded assessments were contrasted.
Please see the registered protocol CRD42011001393 at for more details.
Inclusion Criteria
Only published peer-reviewed RCTs were included,
although the authors acknowledge that many welldesigned studies using single-subject research designs
examining the effects of behavioral interventions have
been published. Following the recommendation of the
Cochrane group, the search was limited to published
trials to ensure a level of methodologic adequacy and
rigor among included trials and to avoid the inevitable
problems with securing access to a full set of unpublished trials and the bias that this would introduce.36
Participants needed to be 3 to 18 years old and have
an ADHD diagnosis (any subtype) or have met
accepted cutoffs on validated ADHD rating scales.
Trials involving only rare comorbid disorders (e.g.,
fragile X syndrome) were excluded. Acceptable control
conditions were “treatment as usual,” “wait list,” or
“active” controls. “Treatment as usual” could include
medication, but trials were excluded if the behavioral
intervention was an adjunct to medication or if pharmacologic and behavioral interventions were combined into 1 therapeutic arm as part of the study
design. For the present extended review, trials could
be included despite not having an ADHD-related
outcome (as required in the original protocol).
Search Strategy
The search was updated to February 5, 2013. Drs.
Cortese and Ferrin blindly conducted and crosschecked the updated search using the same databases, search strategy, and search terms as used
previously19 (see protocol). The searches were conducted for records included from the inception of the
databases. Behavioral interventions were defined as
those interventions directed at changing behaviors
(increasing desired and decreasing undesired behaviors). They encompass classic contingency management, behavior therapy (mainly through mediators
such as parents or teachers), and cognitive behavior
therapy (such as verbal self-instruction, problemsolving strategies, or social skills training). The treatment
search terms covered a wide variety of intervention
types with the aim of including trials involving any
form of behaviorally based therapies, implemented
in any setting (home or school), and indirectly by an
adult or directly to the child (see protocol).
Outcome Measurements
To increase analytical robustness, outcome domains
were only considered if at least 5 RCTs were available.
Outcome measurements meeting this criterion were
pre- to posttreatment changes in positive and negative
parenting, parent mental health (e.g., anxiety, depression) and parenting self-concept (e.g., sense of competence and efficacy), child ADHD, conduct problems
(i.e., negative and noncompliant behavior including
symptoms of oppositional defiance [ODD] and conduct disorders [CD]), social skills, and academic
achievement. There were too few RCTs (n < 5) to examine changes in teacher behavior and well-being, child impairment, internalizing problems, executive/ organizational skills, or more general measurements of family functioning. Study Selection Article titles and abstracts were screened. Final inclusion was based on the full text. Trials were blindly double-coded for eligibility. Study quality was assessed by 2 independent raters according to the criteria of Jadad et al.37 (Table 1).24,25,33-35,40-66 These provide a rating for each trial in terms of standard definitions for randomization, blinding, and treatment of missing data defined by Jadad et al.37 Jadad scores for blinding were adapted for use with multiple outcomes so that studies with at least 1 blinded outcome yielded a score of 1 on this dimension. A score of at least 3 is regarded as indicating acceptable quality. Initial disagreements (n ¼ 4) were resolved by the coders through discussion without recourse to an independent arbitrator. Data Extraction and Statistical Analysis Trial information was entered into RevMan 5.1 ( Data extraction was independently rated by 2 authors. The standardized mean difference (SMD), namely the mean pre- to posttreatment change minus the mean pre- to posttreatment control group change divided by the pooled pretest standard deviation with a bias adjustment, was calculated.39 SMDs for trials in each domain were combined using the inverse-variance method.36 Given the inherent heterogeneity of studies, randomeffects models were used. The I2 statistic was calculated, a posteriori, to estimate between-trial SMD heterogeneity. Most proximal and probably blinded analyses were performed for all domains except parent mental health, parenting self-concept, child social skills, and academic outcomes for which insufficient trials with probably blinded measurements were available. When multiple measurements were available for an outcome, the one most frequently reported across included trials was included. For the most proximal analysis, parent ratings, if available, were used, except for teacher-based interventions, when teacher ratings or direct observations were preferred. JOURNAL OF THE AMERICAN ACADEMY OF C HILD & ADOLESCENT PSYCHIATRY VOLUME 53 NUMBER 8 AUGUST 2014 837 Characteristics of Included Studies Treatment Delivery Type Control Jadad Rating Abikoff et al. (2012)34 Antshel and Remer (2003)43 Bloomquist et al. (1991)44 Bor et al. (2002)24 Brown et al. (1986)45 Chacko et al. (2009)46 Evans et al. (2011)47 parent and teacher child and parent child, parent, and teacher parent child parent parent and child wait list wait list wait list wait list attention control wait list TAU Fabiano et al. (2010)48 Fabiano et al. (2012)49 Fehlings et al. (1991)50 Hoath and Sanders (2002)51 Horn et al. (1991)52 Jones et al. (2008)53 Kapalka (2005)54 Langberg et al. (2008)55 Langberg et al. (2012)35 Mikami et al. (2011)56 Molina et al. (2008)57 MTA (1999, 2000, 2006)40-42 children parent parent and child parent parent and child parent parent child and parent child and parent parent child and parent child, parent, and teacher Pfiffner and McBurnett (1997)33 Pfiffner et al. (2007)58 Pisterman et al. (1989)59 Pisterman et al. (1992)60 Power et al. (2012)61 child and parent child and parent parent parent child and parent Sonuga-Barke et al. (2001)62 Sonuga-Barke et al. (2004)63 Thompson et al. (2009)64 Tracey and Tripp (2005)65 Van den Hoofdakker et al. (2007)66 Webster-Stratton et al. (2011)25 parent parent parent parent parent parent and child behavioral training social skills training CBT behavioral training self-control training behavioral training behavioral and social skills training daily report card behavioral training CBT behavioral training behavioral and self-control training behavioral training behavioral training organizational skills training organizational skills training parent coaching on social skills organizational skills training Multicomponent: home, school, and camp behavioral training and CBT behavioral training and CBT behavioral training behavioral training behavioral and academic skills training behavioral training behavioral training behavioral training stress management behavioral training behavioral training Trial Sample Size Age Range (y) JOURNAL OF THE AMERICAN ACADEMY OF C HILD & ADOLESCENT PSYCHIATRY VOLUME 53 NUMBER 8 AUGUST 2014 T C 2 2 2 3 2 2 1 61 80 20 26 10 40 31 33 40 16 37 8 40 18 8-11 8-12 8.58 mean 3.6 mean 5-13 5-12 11-13 TAU wait list attention control wait list placebo wait list wait list wait list wait list wait list community TAU 2 2 2 1 2 3 0 1 2 2 2 4 33 27 13 9 16 50 45 24 23 32 11 144 30 28 13 11 16 29 41 13 24 30 9 146 6-12 6-12 8-11 5-9 7-11 3.8 mean 5-10 grades 4-7 grades 6-8 6-10 grades 6-8 8.33 mean wait list wait list wait list wait list attention 2 2 3 3 2 9 36 23 23 100 9 33 23 22 99 8-10 7-11 4.1 mean 4.1 mean grades 2-6 counseling wait list wait list wait list TAU wait list 3 2 4 2 2 3 30 59 21 20 48 49 28 30 20 20 48 50 2-4 2-4 2-6 6-15 4-12 6.4 mean Boys, % Medicated for ADHD, % 69 75 69 73 85 73 71 36 93 0 in analysis 0 0 38.75 57 86 87 100 76 no info 68 100 83 74 68 75 80 72 66 80 91 68 62 no info 73 88 76 75 52 54 0 70 0 0 no info 43 66 64.5 31 47 44 3 11 9 43 0 0 0 88 40 13 Note: ADHD ¼ attention-deficit/hyperactivity disorder; C ¼ control; CBT ¼ cognitive behavioral therapy; grade ¼ school year; MTA ¼ National Institute of Mental Health Multimodal Treatment Study of Attention-Deficit/ Hyperactivity Disorder; no info ¼ no information provided in article; T ¼ treatment; TAU ¼ treatment as usual. DALEY et al. 838 TABLE 1 BEHAVIORAL INTERVENTIONS FOR ADHD Probably blinded assessments were made by an individual likely to be blind to allocation. In trials in which more than 1 such measurement was available, the best blinded measurement was selected. This affected only trials with a home-based element where direct observations by an independent researcher and teacher ratings were the probably blinded measurement. In such cases, direct observation was selected over teacher ratings. Sensitivity analyses examined the impact of background ADHD medication use in trial samples for which at least 3 trials had fewer than 30% of participants receiving medications (i.e., were no-/low-medication trials) and the effects of outliers identified using funnel plots within RevMan 5.1.38 Meta-regression tested whether effect sizes were larger in lowerquality trials according to Jadad et al.37 For 1 study,34 2 active treatment arms were suitable for analysis. Parents and Teachers Helping Children Organize and Organizational Skills Treatment yielded similar results, so only 1 arm, Parents and Teachers Helping Children Organize, which was considered the more standard behavioral intervention, was included in the final analysis. For another study,40 outcomes were taken from 3 publications.40-42 FIGURE 1 Flowchart showing the selection of trials. See Table S1 (available online) for specific reasons for exclusion. RESULTS significant in the 2 analyses (c2 for most proximal ¼ 63.55, I2 ¼ 87%, p < .01; c2 for probably blinded ¼ 40.58, I2 ¼ 83%, p < .01). Effects were unaffected by limiting the analyses to no-/ low-medication trials (n ¼ 5, SMD for most proximal 1.23, 95% CI 0.26-2.20; n ¼ 4, SMD for probably blinded 0.89, 95% CI 0.65-2.13), although heterogeneity remained high (c2 for most proximal ¼ 28.35, I2 ¼ 89%, p < .01; c2 probably blinded ¼ 23.29, I2 ¼ 87%, p < .01). Removing outliers decreased effect sizes (n ¼ 2, SMD most proximal 0.32, 95% CI 0.06 to 0.58; n ¼ 1, SMD probably blinded 0.44, 95% CI 0.14-0.75). Heterogeneity was no longer significant (c2 most proximal ¼ 3.46, I2 ¼ 0%, p ¼ .48; c2 for probably blinded ¼ 0.83, I2 ¼ 0%, p ¼ .66). Fourteen trials measured negative parenting. The 9 most proximal measurements were parent ratings (4 observations and 1 speech sample). Eight studies me ... Purchase answer to see full attachment

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