Effectiveness of a Behavioral Treatment Program for Attention Deficit Hyperactivity Disorder, Inattentive Type

Attention deficit hyperactivity disorder (ADHD) is a common childhood disorder in which
problems with focusing disrupt a normal life. There are two subtypes of ADHD: combined type
(ADHD-C), which includes symptoms of inattention and hyperactivity or impulsivity, and
inattentive type (ADHD-I), in which symptoms are limited to inattention. The profile of
ADHD-I, including attention deficits, comorbid disorders, social impairments, and
neurocognitive functioning, is sufficiently different from the profile of ADHD-C that
treatments effective for ADHD-C may not also be effective in treating ADHD-I. Most studies
of ADHD treatment evaluate ADHD-C, and there is very little research into treatments aimed
specifically at ADHD-I. The Child Life and Attention Skills (CLAS) Program is a behavioral
program designed specifically for ADHD-I and combines life skills training for the child,
teacher consultation, and parent training techniques adapted from ADHD-C treatments. This
study will compare the effectiveness of the CLAS Program, standard parent training, and
community referrals in treating children with ADHD-I.

Participation in this study will last 11 to 12 weeks, followed by a 5- to 7-month follow-up
period. On the basis of parent and teacher evaluations of each child's behavior, invitations
to participate in screening procedures for the study will be extended to children and their
parents. There will be two screening visits, during which the child will undergo reviews of
medical and developmental history, diagnostic interviews, intelligence testing, academic
achievement testing, and neuropsychological testing. The child and parent will be videotaped
in a series of interactions, and both will complete questionnaires about child functioning,
parent functioning, family functioning, and family relations. The child's teacher and school
principal will also be contacted to ensure that they are willing to participate in the
study.

Eligible participants will then be randomly assigned to receive the CLAS Program,
parent-focused training (PFT), or community referrals. The CLAS Program will involve a
half-hour orientation and up to five half-hour weekly meetings with the child's teacher,
therapist, and parent over 11 to 12 weeks. The program will also involve ten 1.5-hour group
sessions for parents, with separate group sessions for children at the same time, and up to
five individual family sessions led by a therapist. Teachers will participate in a
school-home note system for maintaining and rewarding child behavior; parents will be taught
strategies for giving commands, using rewards and consequences, and establishing routines
and organizational schemes; and children will be taught social interaction skills, homework
skills, and organizational skills.

Participants in the PFT group will attend the ten 1.5-hour parent group sessions and up to
five individual family sessions. Participants in the community referrals group will only
receive referrals to community mental health practitioners.

All participants will undergo assessments that are similar to those in the screening visit
after completing treatment and again at a follow-up visit 5 to 7 months later. Participants
in the CLAS and PFT groups will continue monthly individual family sessions with a therapist
until undergoing the follow-up assessment.