For harassed doctors and stressed-out parents, it can be tempting to treat a challenging child with ADHD (attention deficit hyperactivity disorder) with pills and leave it at that. After all, early results from the one of the largest trials of its kind in the United States – the Multimodal Treatment Study of Children with ADHD (MTA) – showed that behavioural outcomes were better for children given the psychostimulant Ritalin, than for those given psychological treatment. However, follow-up data over several years has shown that the advantages of drug treatment aren’t sustained over the longer term. The position of the UK’s independent health advisory body, NICE, is that drug treatments for ADHD should only ever be part of a broader treatment package, including psycho-educational sessions for parents (pdf). The hunt continues for the most effective treatment or mix of treatments.
It’s in this context that a team of German psychologists, led by Wolf-Dieter Gerber at the University of Kiel, has published a new report looking at the benefits of combining drug treatment for ADHD with an intensive Summer Camp.
Eighteen children with an ADHD diagnosis (aged 9 to 17 years), all on medication, spent 12 days at one such camp, which included social skills training conducted in a playful manner, attention training and sports. Crucially, the camp also incorporated “response cost token-based behaviour training” – that is, the children earned or lost tokens according to whether they followed or broke the camp rules. They were encouraged to compare their token totals each evening and a winner was declared for each day following an “Olympics style” format. At the end of the camp, the tokens could be exchanged for prizes.
A control group of 19 age-matched children with ADHD, also on medication, didn’t go to camp, but their parents received a one-and-a-half hour-long psycho-educational session in which they were taught, amongst other things, about using a token strategy in the home.
Six months later, the children from both groups were tested on a range of neuropsychological measures and their outcomes compared with their pre-intervention test performance.
The key finding is that only the Summer Camp kids showed a reduction in the variability of their reaction times. This is significant because highly sporadic reaction times are a hallmark of ADHD, indicative of reduced self control. Moreover, only the Summer Camp group showed significant improvements in selective and sustained attention and the capacity to integrate information. It’s likely these cognitive changes were clinically significant. Only those children who received higher ratings from their teachers (in terms of improved impulsivity, hyperactivity and inattention) showed positive changes in the variability of their reaction time scores on the neuropsych tests.
“We believe this study has merit” the researchers said, “as the ADHD Summer Camp can be regarded as a novelty in ADHD treatment. We could find no comparable intervention programmes that included stringent … [token reward and punishment] techniques.”
Gerber, W., Gerber-von Müller, G., Andrasik, F., Niederberger, U., Siniatchkin, M., Kowalski, J., Petermann, U., and Petermann, F. (2012). The impact of a multimodal Summer Camp Training on neuropsychological functioning in children and adolescents with ADHD: An exploratory study. Child Neuropsychology, 18 (3), 242-255 DOI: 10.1080/09297049.2011.599115