مقایسه‌ی اثربخشی روش‌های مختلف درمان در اختلال نقص توجه- بیش‌فعالی کودکان

نوع مقاله : مقاله های پژوهشی

نویسندگان

1 کارشناس ارشد، گروه روان‌شناسی بالینی، دانشکده‌ی روان‌شناسی، دانشگاه شیراز، شیراز، ایران

2 دانشیار، گروه روان‌شناسی بالینی، دانشکده‌ی روان‌شناسی، دانشگاه شیراز، شیراز، ایران

3 دانشیار، گروه روان‌پزشکی، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی شیراز، شیراز، ایران

4 استادیار، گروه روان‌شناسی بالینی، دانشکده‌ی روان‌شناسی، دانشگاه شیراز، شیراز، ایران

5 کارشناس ارشد، گروه آموزش بهداشت، دانشکده‌ی بهداشت، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

چکیده

مقدمه: این مطالعه با هدف بررسی میزان اثربخشی و مقایسه‌ی سه روش درمانی آموزش رفتاری مادران، خودآموزی کلامی ‌به کودک و دارو درمانی، در درمان اختلال نقص توجه- بیش‌فعالی کودکان انجام شد.روش‌ها: در این مطالعه‌ی نیمه تجربی، 51 نفر از دانش‌آموزان پسر مدارس ابتدایی شهر شیراز و مبتلا به اختلال نقص توجه– بیش‌فعالی که در مطالعه‌ی مقدماتی از میان 1760 دانش‌آموز مورد غربالگری، شناسایی شدند به صورت تصادفی در سه گروه آموزش رفتاری مادران، خودآموزی کلامی‌ به کودکان و گروه شاهد تقسیم شدند. علاوه بر آن، 22 نفر از دانش‌آموزان به شیوه‌ی در دسترس انتخاب و در گروه دارو درمانی قرار گرفتند. همه‌ی گروه‌های مورد مطالعه پیش، پس از مداخله و 2 ماه پس از آن به وسیله‌ی پرسش‌نامه‌ی علایم مرضی کودک (CSI-4) مورد ارزیابی قرار گرفتند.یافته‌ها: نتایج نشان داد که نوع درمان تأثیر معنی‌داری بر میزان ارزیابی مادران از شدت بی‌توجهی (04/0 > P)، شدت بیش فعالی- تکانش‌گری (005/0 > P) و شدت کلی علایم اختلال (03/0 > P) در کودکان داشت. علاوه بر آن در طول زمان پی‌گیری تفاوت معنی‌داری بین گروه‌های مختلف مورد مطالعه در میزان ارزیابی مادران نشان دیده شد (001/0 > P).نتیجه‌گیری: با توجه نتایج این مطالعه در خصوص شدت بی‌توجهی کودکان روش خودآموزی کلامی، در خصوص شدت بیش‌فعالی– تکانش‌گری کودکان مداخله‌ی آموزش رفتاری مادران و در خصوص شدت کلی علایم اختلال نقص توجه- بیش‌فعالی کودکان دو روش آموزش رفتاری مادران و دارو درمانی مؤثرترین و کارامدترین روش‌های درمانی می‌باشد.

کلیدواژه‌ها


عنوان مقاله [English]

Comparison of the Effectiveness of different Treatment Methods in Child-ren’s Attention Deficit-Hyperactivity Disorders

نویسندگان [English]

  • Sayyed Davood Meftagh 1
  • Norallah Mohammadi 2
  • Ahmad Ghanizadeh 3
  • Changiz Rahimi 4
  • Arash Najimi 5
1 Department of Clinical Psychology, School of Education and Psychology, Shiraz University, Shiraz, Iran
2 Associate Professor, Department of Clinical Psychology, School of Education and Psychology, Shiraz University, Shiraz, Iran
3 Associate Professor, Department of Psychiatry, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
4 Assistant Professor, Department of Clinical Psychology, School of Education and Psychology, Shiraz University, Shiraz, Iran
5 Department of Health promotion and Health education, School of Health, Isfahan University of Medical Sciences,Isfa-han, Iran
چکیده [English]

Background: This study was designed to evaluate and compare the effectiveness of three treating methods; namely mother’s behavioral education, Verbal self-instruction to the children, and Pharmacotherapy in children’s attention deficit hyperactivity disorder (ADHD).Methods: In this semi-experimental study, 51 elementary students with ADHD were randomly divided to three treatment groups including mothers’ behavioral education, verbal self-instruction to the children, and control group. Moreover, 22 students with ADHD were selected among the patients referring to Hafez hospital and were put in pharmacotherapy group. Data collection tool was Child Symptoms Inventory (CSI-4). All of the subjects were evaluated by CSI-4 before and after the intervention and also 2 months later, i.e in follow up period.Findings: The results show significant differences between the groups in mother’s evaluation of attention deficit (P = 0.04), the severity of hyperactivity-impulsivity (P = 0.005), and the general/total severity of the symptoms of disorder (P = 0.03). Conclusion: The most effective treatment for the severity of attention deficit in children is verbal self-instruction. The severity of hyperactivity-impulsivity is best treated using mother’s behavioral education. Considering the result obtained in the case of general severity of symptoms in children’s ADHD, mother’s behavior education and pharmacotherapy _were the most effective and useful treatment methods.

کلیدواژه‌ها [English]

  • Attention deficit-hyperactivity disorder
  • Mother’s behavioral education
  • Verbal self-instruction
  • Pharmacotherapy
  1. Fabiano GA, Chacko A, Pelham WE, Jr., Robb J, Walker KS, Wymbs F, et al. A comparison of behavioral parent training programs for fathers of children with attention-deficit/hyperactivity disorder. Behav Ther 2009; 40(2): 190-204.
  2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR. 4th ed. Washington DC: Amer Psychiatric Pub; 2000.
  3. Lehner-Dua LL. The effectiveness of Russell A. Barkley's parent training program on parents with school-aged children who have ADHD on their perceived severity of ADHD, stress, and sense of competence. New York: Hofstra University; 2001.
  4. Shelton TL, Barkley RA. Critical Issues in the Assessment of Attention Deficit Disorders in Children. Topics in Language Disorders 1994; 14(4): 26-41.
  5. Shiels K, Hawk LW, Jr. Self-regulation in ADHD: the role of error processing. Clin Psychol Rev 2010; 30(8): 951-61.
  6. Ghanizadeh A. Distribution of symptoms of attention deficit-hyperactivity disorder in schoolchildren of Shiraz, south of Iran. Arch Iran Med 2008; 11(6): 618-24.
  7. Johnston C, Hommersen P, Seipp C. Acceptability of behavioral and pharmacological treatments for attention-deficit/hyperactivity disorder: relations to child and parent characteristics. Behav Ther 2008; 39(1): 22-32.
  8. So CY, Leung PW, Hung SF. Treatment effectiveness of combined medication/behavioural treatment with chinese ADHD children in routine practice. Behav Res Ther 2008; 46(9): 983-92.
  9. Fehlings DL, Roberts W, Humphries T, Dawe G. Attention deficit hyperactivity disorder: does cognitive behavioral therapy improve home behavior? J Dev Behav Pediatr 1991; 12(4): 223-8.
  10. Daly BP, Creed T, Xanthopoulos M, Brown RT. Psychosocial treatments for children with attention deficit/hyperactivity disorder. Neuropsychol Rev 2007; 17(1): 73-89.
  11. Toplak ME, Connors L, Shuster J, Knezevic B, Parks S. Review of cognitive, cognitive-behavioral, and neural-based interventions for Attention-Deficit/Hyperactivity Disorder (ADHD). Clin Psychol Rev 2008; 28(5): 801-23.
  12. Arco L, Cohen L, Geddes K. Verbal self-regulation of impulsive behavior of persons with frontal lobe brain injury. Behavior Therapy 2004; 35(3): 605-19.
  13. Durston S, Konrad K. Integrating Genetic, Psychopharmacological and Neuroimaging Studies: A Converging Methods Approach to Understanding the Neurobiology of ADHD. Developmental Review 2007; 27(3): 374-95.
  14. Tavakkolizadeh J, Bolhari J, Mehryar AH, Dezhkam M. Epidemiology of attention deficit and disruptive behavior disorders in elementary school children of gonabad. Iran J Psych Clin Psycol 1997; 3(9-10): 40-51.
  15. Barkley RA. Defiant children: a clinician's manual for assessment and parent training. 2nd ed. New York: Guilford Press; 1997.
  16. Hadianfard H, Najarian B. Introduction to Cognitive therapy, verbal self- instruction training. Journal of News Psychotherapy 2001; 19-20: 67-79.
  17. Meichenbaum DH, Goodman J. Training impulsive children to talk to themselves: A means of developing self – control. Journal of Abnormal Psychology 1971; 77(2): 115-26.
  18. Klingberg T, Fernell E, Olesen PJ, Johnson M, Gustafsson P, Dahlstrom K, et al. Computerized training of working memory in children with ADHD--a randomized, controlled trial. J Am Acad Child Adolesc Psychiatry 2005; 44(2): 177-86.
  19. Stevenson CS, Whitmont S, Bornholt L, Livesey D, Stevenson RJ. A cognitive remediation programme for adults with Attention Deficit Hyperactivity Disorder. Aust N Z J Psychiatry 2002; 36(5): 610-6.
  20. Corkum PV, Siegel LS. Is the Continuous Performance Task a valuable research tool for use with children with Attention-Deficit-Hyperactivity Disorder? J Child Psychol Psychiatry 1993; 34(7): 1217-39.
  21. Norooz Ghaleh V. ADHD children, medication therapy or mental and training approach. Foundations of Educations Research 2001; 2(2): 99-115.
  22. Han DH, Lee YS, Na C, Ahn JY, Chung US, Daniels MA, et al. The effect of methylphenidate on Internet video game play in children with attention-deficit/hyperactivity disorder. Compr Psychiatry 2009; 50(3): 251-6.
  23. Van der Oord S, Prins PJ, Oosterlaan J, Emmelkamp PM. Efficacy of methylphenidate, psychosocial treatments and their combination in school-aged children with ADHD: a meta-analysis. Clin Psychol Rev 2008; 28(5): 783-800.
  24. Biederman J, Spencer TJ. Psychopharma-cological interventions. Child Adolesc Psychiatr Clin N Am 2008; 17(2): 439-58.
  25. Pietrzak RH, Mollica CM, Maruff P, Snyder PJ. Cognitive effects of immediate-release methylphenidate in children with attention-deficit/hyperactivity disorder. Neurosci Biobehav Rev 2006; 30(8): 1225-45.
  26. Hinshaw SP. Treatment for children and adolescents with Attention - deficit/hyperactivity disorder. In: Kendall PC, editor. Child and Adolescent Therapy. 3rd ed. New York: Guilford Press; 2006.
  27. Barkley RA, DuPaul GJ, McMurray MB. Comprehensive evaluation of attention deficit disorder with and without hyperactivity as defined by research criteria. J Consult Clin Psychol 1990; 58(6): 775-89.
  28. Fabiano GA, Pelham WE, Jr., Coles EK, Gnagy EM, Chronis-Tuscano A, O'Connor BC. A meta-analysis of behavioral treatments for attention-deficit/hyperactivity disorder. Clin Psychol Rev 2009; 29(2): 129-40.
  29. Antshel KM, Barkley R. Psychosocial interventions in attention deficit hyperactivity disorder. Child Adolesc Psychiatr Clin N Am 2008; 17(2): 421-37.
  30. Chronis AM, Fabiano GA, Gnagy EM, Onyango AN, Pelham WE, Lopez-Williams A, et al. An Evaluation of the Summer Treatment Program for Children with Attention-Deficit/ Hyperactivity Disorder Using a Treatment Withdrawal Design. Behavior Therapy 2004; 35(3): 561-85.
  31. Kalantari M, Abbedi MR. The effect of behavioral training on reduction of maternal behavior disorders in preschool children. Journal of Human Sciences, University of Isfahan 1998; 9: 59-74.
  32. Wilson HK, Cox DJ, Merkel RL, Moore M, Coghill D. Effect of extended release stimulant-based medications on neuropsychological functioning among adolescents with Attention-Deficit/Hyperactivity Disorder. Arch Clin Neuropsychol 2006; 21(8): 797-807.
  33. Schachter HM, Pham B, King J, Langford S, Moher D. How efficacious and safe is short-acting methylphenidate for the treatment of attention-deficit disorder in children and adolescents? A meta-analysis. CMAJ 2001; 165(11): 1475-88.
  34. Kendall PC. On the efficacious use of verbal self-instructional procedures with children. Cognitive Therapy and Research 1977; 1(4): 331-41.
  35. Pelham WE, Jr., Carlson C, Sams SE, Vallano G, Dixon MJ, Hoza B. Separate and combined effects of methylphenidate and behavior modification on boys with attention deficit-hyperactivity disorder in the classroom. J Consult Clin Psychol 1993; 61(3): 506-15.