- Email: [email protected]
Hyperactivity Disorder
SYMPOSIA 44.3 – 45.0
ADHD (n ¼ 22) and without (N ¼ 20) ADHD. We found that children with ADHD had reduced connectivity in two neural circuits: 1) underlying executive attention (EA); and 2) the emotional regulation (ER). We also found double dissociation between these two neural circuits and their behavioral correlates, such that reduced connectivity in the EA circuit correlated with EA deficits (r ¼ 0.79, p < 0.001), but not with emotional lability (r ¼ 0.12, df ¼19; p ¼ 0.6). On the other hand, reduced connectivity in the ER circuit correlated with emotional lability (r ¼ 0.63; p ¼ 0.002) but not with EA deficits (r ¼ 0.03; p ¼ 0.9). In study 3, rs-fcMRI scans were obtained from children with ADHD (n ¼ 23) and without (N ¼ 23) ADHD. Graph analysis indicated that connections within the default mode network (DMN) were indicative of delayed maturation on this neural circuit. Of all of the DMN connections quantified, 10 of the 13 connections that typically increase in strength over age were found to be stronger among HC children. In contrast, the one DMN connection known to decrease in strength with age was found to be stronger in the group with ADHD. Conclusions: ADHD is a heterogeneous disorder, and several neural circuits probably underlie this complex disorder. Novel treatments might use these circuits as targets for treatment development and to aid in developing more personalized interventions.
ADHD IMAGS ND http://dx.doi.org/10.1016/j.jaac.2016.07.380
44.3 DISTINCT INTRINSIC FUNCTIONAL CONNECTIVITY OF LEFT MIDDLE-FRONTAL GYRUS FOR LITERACY AND NUMERACY: IMPLICATIONS FOR DYSLEXIA AND DYSCALCULIA Maki Koyoma, PhD, Icahn School of Medicine Department of Psychiatry, 1470 Madison Ave, New York, NY 10029 Objectives: This study aimed to simultaneously examine intrinsic functional connectivity (iFC) profiles underlying literacy and numeracy in adults by controlling for the effect of one competency on another. The use of this approach, a relatively uncommon practice in the MRI literature of literacy and numeracy, was based on two observations: 1) the high comorbidity rates of dyslexia and dyscalculia; and 2) demonstrations of more generalized deficits in these two learning disorders (e.g., attention, IQ). Methods: Seventy healthy, right-handed adults of English readers (ages 20– 50 years; IQ > 80) participated. Literacy and numeracy were assessed by two subtests of the Wechsler Individual Achievement Test: “word reading” and “numerical operations,” respectively. Each participant completed a 10-minute multiband resting-state fMRI scan (904 volumes; TR ¼ 645 ms; voxel-size ¼ 3 3 3 mm). No participant exceeded the value of mean frame-wise displacement by 0.2 mm. After preprocessing, we first ran a data-driven analysis, a multivariate distance matrix regression (MDMR), to identify regions/clusters whose whole-brain iFC patterns vary with each result of literacy and numeracy. As a post hoc, seed-based analysis, clusters identified by MDMR were examined to delineate their iFC patterns associated with each competency. For these analyses, both literacy and numeracy variables were included in the same model. Results: MDMR showed that the left middle frontal gyrus (L.MFG) was associated with both literacy and numeracy, but post-hoc iFC results revealed dissociation in the brain-behavior relationship for these two competencies. Most notably, individuals with greater iFC between L.MFG and left inferior parietal lobule (L.IPL) tended to have better literacy, whereas those with greater iFC in the same connection tended to have poorer numeracy. Conclusions: Our result of the L.MFG-L.IPL connection is consistent with a view that regions in the frontoparietal network acts as flexible hubs, switching connectivity patterns according to task demands. The frontoparietal iFC profiles found in our study can explain previous findings of dyslexia and dyscalculia and, thus, have a potential for characterizing these learning disorders and their comorbidities.
IMAGS LD NEURODEV http://dx.doi.org/10.1016/j.jaac.2016.07.381
J OURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016
44.4 FRONTOSTRIATAL CONTROL CIRCUITS IN CHILDREN WITH DYSLEXIA Amy Margolis, PhD, Child Psychiatry, Columbia University Medical Center, 1051 Riverside Drive, New York, NY 10032 Objectives: Previous fMRI findings from children with dyslexia suggest functional abnormalities in circuits underlying word reading and language processes. Cognitive control probably plays a role in children’s ability to apply phonetic rules to novel words when learning to read (e.g., reading the word “rate” requires activating the long “a” vowel sound and inhibiting the short “ah” sound). Thus, for the first time, we investigated structural and functional abnormalities in control circuits in children with dyslexia (DYS). Methods: MRI data was collected from 18 children with DYS and 18 matched healthy control (HC) children (ages 7–13 years) during their performance of the Simon task. Reading proficiency was quantified based on below average performance on multiple reading tests; the effects of reading problems on frontostriatal activations during conflict resolution were assessed with general linear model. Groups were also compared in cortical thickness (CT) with FreeSurfer. Results: Compared to the HC children, those with DYS made more errors on the Simon task (p < 0.005). Across the whole sample group, children with the least reading proficiency relied most on temporal cortices during conflict resolution. Significantly greater CT in left supramarginal gyrus was detected in children with DYS compared to HC children. Conclusions: These findings suggest that children with DYS have deficits in cognitive control, and this behavioral deficit may be derived from functional and anatomical abnormalities in temporoparietal cortices. Over-reliance on temporal cortices during cognitive control and conflict resolution may be attributed to inefficient functioning within frontal cortices. This altered pattern of brain activation during the resolution of cognitive conflict may underlie the behavioral difficulties that children demonstrated on the cognitive control task. Thus, the addition of cognitive control training to traditional reading remediation strategies may be beneficial. Beginning such training at preschool age may prevent the manifestation of reading problems, as well as comorbid psychiatric symptoms (i.e., ADHD), that are prevalent in children with learning disability and also associated with cognitive control deficits.
IMAGS LD ND http://dx.doi.org/10.1016/j.jaac.2016.07.382
SYMPOSIUM 45 NONPHARMACOLOGICAL INTERVENTIONS FOR PRESCHOOL CHILDREN WITH ATTENTIONDEFICIT/HYPERACTIVITY DISORDER David Daley, PhD, Division of Psychiatry and Applied Psychology, University of Nottingham, Institute of Mental Health, Triumph Rd., Jubilee Campus, University of Nottingham, Nottingham, NG7 2TR, United Kingdom; George DuPaul, PhD Objectives: The purpose of this session is to explore the scientific evidence base for behavioral interventions for preschool children with ADHD and provide an evidenced-based clinical view. Methods: Three new randomized controlled trials will be reported at the symposium. The Comparison of Preschool Parenting Interventions (COPPI) trial will explore the cost effectiveness of an individual behavioral intervention, New Forest Parenting Programme (NFPP), against a group-based intervention incredible year (IY) and treatment as usual (TAU) for preschoolers with ADHD. The DSNAPP trial (Training in the Treatment of ADHD in Young Children) will explore the effectiveness of an individual behavioral intervention delivered as part of routine care for preschoolers with ADHD referred into psychiatry services. The TEAMS (Training Executive, Attention and Motor Skills) trial will explore a play-based intervention designed to facilitate
www.jaacap.org
S329
SYMPOSIA 45.1 – 45.3
neurodevelopment and improve the clinical trajectories of preschool children with ADHD through training executive, attention, and motor skills. Results: The COPPI trial found no statistically significant differences between NFPP and IY on observed or parent-assessed ADHD symptoms at T2 or T3 or on other outcomes at either T2 or T3. Small benefits of NFPP over TAU were seen for parent-rated ADHD (p ¼ 0.053) and conduct problems (p < 0.05). NFPP was significantly less costly than IY (£1,509 versus £2,103), with the difference attributed to the higher interventionrelated costs of IYs. The DSNAPP trial has yet to report its findings. Analysis is underway and will be completed soon. In the TEAMS trial, twoway (group time) mixed-model ANOVAs yielded several significant main effects for time, indicating clinical and neuropsychological improvements after treatment. However, there were few significant main effects or interactions involving the group. Separate examinations of effect size for TEAMS and the comparison condition relative to pretreatment at all three posttreatment time points indicated consistently larger effect sizes for TEAMS as judged by teachers and clinicians; between-group effect sizes were small. Conclusions: The symposium highlights the challenges of intervening during the preschool period. Positive results in the preschool period may be dependent on the sample group, mode of delivery, and intervention content.
ADHD PSC RCT http://dx.doi.org/10.1016/j.jaac.2016.07.384
45.1 EFFICACY AND COST-EFFECTIVENESS OF INDIVIDUAL VERSUS GROUP-BASED PARENT TRAINING FOR PRESCHOOL ATTENTION-DEFICIT/ HYPERACTIVITY DISORDER: A MULTI-CENTER RANDOMIZED CONTROLLED TRIAL David Daley, PhD, Division of Psychiatry and Applied Psychology, University of Nottingham, Institute of Mental Health, Triumph Rd., Jubilee Campus, University of Nottingham, Nottingham, NG7 2TR, United Kingdom Objectives: The goal of this presentation is to compare the efficacy and cost effectiveness of New Forest Parenting Programme (NFPP)—an individually delivered approach—with a group-based approach (incredible years, IY) and treatment as usual (TAU) in a sample group of preschool children with ADHD. Methods: The Comparison of Preschool Parenting Interventions (COPPI) trial was a three-arm parallel group, randomized controlled trial. The trial recruited 307 preschool children that met standard ADHD diagnostic criteria. Children were block-randomized to NFPP, IY, or TAU on a 3:3:1 ratio. NFPP is a specialist parent-training (PT) program for parents of preschool children with ADHD delivered on a one-to-one basis. The toddler version of IY is a group-based PT program delivered over 12-weekly sessions designed to address problems of challenging and oppositional conduct in young children. Results: In total, 307 participants were randomized (NFPP: N ¼ 134; IY: N ¼ 131; TAU: N ¼ 42). The sample group included a high proportion of single parents (30 percent), low-income families, children with language difficulties (50 percent), and parents with mental health problems (77 percent). No statistically significant differences between NFPP and IY were observed in parent-assessed ADHD symptoms at T2 (primary end point: mean for NFPP, 1.715; mean for IY, 1.724; mean difference, 0.009; 95% CI 0.191 to 0.173; p ¼ 0.921) or T3 or in other secondary or healthrelated outcomes at either T2 or T3. Small benefits of NFPP over TAU were seen for parent-rated ADHD (adjusted mean, 1.693 for NFPP and 1.881 for TAU; mean difference, 0.189; 95% CI 0.380 to 0.003; p ¼ 0.053) and conduct problems (p < 0.05). NFPP was significantly less costly than IY (mean total cost per patient, £1,509 vs. £2,103), with the difference being attributed to higher intervention-related costs of IY. Cost utility analysis, in terms of incremental cost/quality-adjusted life-year (QALY) gained, showed that NFPP was dominant over IY and thus likely to be cost-effective, albeit based on small QALY gain differences.
S330
www.jaacap.org
Conclusions: High-quality, group-based PT may be more expensive to deliver than some forms of individually delivered equally efficacious PT programs. Both formats should be available to families.
PSC Supported by the National Institute of Health Research UK http://dx.doi.org/10.1016/j.jaac.2016.07.385
45.2 THE EFFECTIVENESS OF PARENT TRAINING AS A TREATMENT FOR PRESCHOOL ATTENTIONDEFICIT/HYPERACTIVITY DISORDER: A MULTICENTER RANDOMIZED CONTROLLED TRIAL OF THE NEW FOREST PARENTING PROGRAM IN EVERYDAY CLINICAL PRACTICE Anne-Mette Lange, MSc, Research Department, Centre for Child and Adolescent Psychiatry, Aarhus University Hospital, Risskov, Aarhus, 240 Risskov, Denmark Objectives: Parent training is recommended as first-line treatment for ADHD in preschool children. The New Forest Parenting Programme (NFPP) is an evidence-based parenting program developed specifically to target preschool ADHD. This talk will present fresh results from a multicenter trial designed to investigate whether the NFPP can be delivered effectively for children who are referred through official community pathways in everyday clinical practice. Methods: A multicenter randomized controlled parallel arm trial design was incorporated. There were two treatment arms, NFPP and treatment as usual. NFPP consisted of eight individually delivered parenting sessions where the child attended three of the sessions. Outcomes were examined at three time points as follows: T1, baseline; T2, week 12, postintervention; and T3, 6month follow-up. Children (N ¼ 165; ages 3–7 years) with a clinical diagnosis of ADHD, informed by the Development and Well-Being Assessment (DAWBA), were recruited from three child and adolescent psychiatry departments in Denmark. Randomization was on a 1:1 basis and stratified for age and gender. Results: The primary endpoint showed a change in ADHD symptoms as measured by the Preschool ADHD-Rating Scale (Preschool ADHD-RS) by T2. Secondary outcome measures included the following: effects on this measure at T3; T2 and T3 measures of teacher-reported preschool ADHD-RS scores; parent- and teacher-rated scores on the Strength and Difficulties Questionnaire; direct observation of ADHD behaviors during child’s solo play; observation of parent–child interaction; parent sense of competence; and family stress. Conclusions: This trial will provide evidence on whether NFPP is a more effective treatment for preschool ADHD than the treatment usually offered in everyday clinical practice.
PSC Supported by the Trygfonden Foundation, Denmark http://dx.doi.org/10.1016/j.jaac.2016.07.386
45.3 THINKING OUTSIDE THE PILL BOX: INITIAL RESULTS OF A RANDOMIZED CONTROLLED TRIAL OF A NOVEL PLAY-BASED INTERVENTION FOR PRESCHOOL ATTENTION-DEFICIT/HYPERACTIVITY DISORDER Jeffrey Halperin, PhD, Psychology, Queens College, City University of New York, 65-30 Kissena Blvd., Flushing, NY 11367 Objectives: Training Executive, Attention, and Motor Skills (TEAMS) is a playbased intervention designed to facilitate neurodevelopment and improve the clinical trajectories of preschool children with ADHD. An open clinical trial indicated clinical improvement that persisted 3 months after treatment as indicated by parent and teacher ratings. This initial double-blind RCT was conducted to estimate effect sizes of TEAMS relative to an active comparison
J OURNAL
OF THE
AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016
ADHD (n ¼ 22) and without (N ¼ 20) ADHD. We found that children with ADHD had reduced connectivity in two neural circuits: 1) underlying executive attention (EA); and 2) the emotional regulation (ER). We also found double dissociation between these two neural circuits and their behavioral correlates, such that reduced connectivity in the EA circuit correlated with EA deficits (r ¼ 0.79, p < 0.001), but not with emotional lability (r ¼ 0.12, df ¼19; p ¼ 0.6). On the other hand, reduced connectivity in the ER circuit correlated with emotional lability (r ¼ 0.63; p ¼ 0.002) but not with EA deficits (r ¼ 0.03; p ¼ 0.9). In study 3, rs-fcMRI scans were obtained from children with ADHD (n ¼ 23) and without (N ¼ 23) ADHD. Graph analysis indicated that connections within the default mode network (DMN) were indicative of delayed maturation on this neural circuit. Of all of the DMN connections quantified, 10 of the 13 connections that typically increase in strength over age were found to be stronger among HC children. In contrast, the one DMN connection known to decrease in strength with age was found to be stronger in the group with ADHD. Conclusions: ADHD is a heterogeneous disorder, and several neural circuits probably underlie this complex disorder. Novel treatments might use these circuits as targets for treatment development and to aid in developing more personalized interventions.
ADHD IMAGS ND http://dx.doi.org/10.1016/j.jaac.2016.07.380
44.3 DISTINCT INTRINSIC FUNCTIONAL CONNECTIVITY OF LEFT MIDDLE-FRONTAL GYRUS FOR LITERACY AND NUMERACY: IMPLICATIONS FOR DYSLEXIA AND DYSCALCULIA Maki Koyoma, PhD, Icahn School of Medicine Department of Psychiatry, 1470 Madison Ave, New York, NY 10029 Objectives: This study aimed to simultaneously examine intrinsic functional connectivity (iFC) profiles underlying literacy and numeracy in adults by controlling for the effect of one competency on another. The use of this approach, a relatively uncommon practice in the MRI literature of literacy and numeracy, was based on two observations: 1) the high comorbidity rates of dyslexia and dyscalculia; and 2) demonstrations of more generalized deficits in these two learning disorders (e.g., attention, IQ). Methods: Seventy healthy, right-handed adults of English readers (ages 20– 50 years; IQ > 80) participated. Literacy and numeracy were assessed by two subtests of the Wechsler Individual Achievement Test: “word reading” and “numerical operations,” respectively. Each participant completed a 10-minute multiband resting-state fMRI scan (904 volumes; TR ¼ 645 ms; voxel-size ¼ 3 3 3 mm). No participant exceeded the value of mean frame-wise displacement by 0.2 mm. After preprocessing, we first ran a data-driven analysis, a multivariate distance matrix regression (MDMR), to identify regions/clusters whose whole-brain iFC patterns vary with each result of literacy and numeracy. As a post hoc, seed-based analysis, clusters identified by MDMR were examined to delineate their iFC patterns associated with each competency. For these analyses, both literacy and numeracy variables were included in the same model. Results: MDMR showed that the left middle frontal gyrus (L.MFG) was associated with both literacy and numeracy, but post-hoc iFC results revealed dissociation in the brain-behavior relationship for these two competencies. Most notably, individuals with greater iFC between L.MFG and left inferior parietal lobule (L.IPL) tended to have better literacy, whereas those with greater iFC in the same connection tended to have poorer numeracy. Conclusions: Our result of the L.MFG-L.IPL connection is consistent with a view that regions in the frontoparietal network acts as flexible hubs, switching connectivity patterns according to task demands. The frontoparietal iFC profiles found in our study can explain previous findings of dyslexia and dyscalculia and, thus, have a potential for characterizing these learning disorders and their comorbidities.
IMAGS LD NEURODEV http://dx.doi.org/10.1016/j.jaac.2016.07.381
J OURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016
44.4 FRONTOSTRIATAL CONTROL CIRCUITS IN CHILDREN WITH DYSLEXIA Amy Margolis, PhD, Child Psychiatry, Columbia University Medical Center, 1051 Riverside Drive, New York, NY 10032 Objectives: Previous fMRI findings from children with dyslexia suggest functional abnormalities in circuits underlying word reading and language processes. Cognitive control probably plays a role in children’s ability to apply phonetic rules to novel words when learning to read (e.g., reading the word “rate” requires activating the long “a” vowel sound and inhibiting the short “ah” sound). Thus, for the first time, we investigated structural and functional abnormalities in control circuits in children with dyslexia (DYS). Methods: MRI data was collected from 18 children with DYS and 18 matched healthy control (HC) children (ages 7–13 years) during their performance of the Simon task. Reading proficiency was quantified based on below average performance on multiple reading tests; the effects of reading problems on frontostriatal activations during conflict resolution were assessed with general linear model. Groups were also compared in cortical thickness (CT) with FreeSurfer. Results: Compared to the HC children, those with DYS made more errors on the Simon task (p < 0.005). Across the whole sample group, children with the least reading proficiency relied most on temporal cortices during conflict resolution. Significantly greater CT in left supramarginal gyrus was detected in children with DYS compared to HC children. Conclusions: These findings suggest that children with DYS have deficits in cognitive control, and this behavioral deficit may be derived from functional and anatomical abnormalities in temporoparietal cortices. Over-reliance on temporal cortices during cognitive control and conflict resolution may be attributed to inefficient functioning within frontal cortices. This altered pattern of brain activation during the resolution of cognitive conflict may underlie the behavioral difficulties that children demonstrated on the cognitive control task. Thus, the addition of cognitive control training to traditional reading remediation strategies may be beneficial. Beginning such training at preschool age may prevent the manifestation of reading problems, as well as comorbid psychiatric symptoms (i.e., ADHD), that are prevalent in children with learning disability and also associated with cognitive control deficits.
IMAGS LD ND http://dx.doi.org/10.1016/j.jaac.2016.07.382
SYMPOSIUM 45 NONPHARMACOLOGICAL INTERVENTIONS FOR PRESCHOOL CHILDREN WITH ATTENTIONDEFICIT/HYPERACTIVITY DISORDER David Daley, PhD, Division of Psychiatry and Applied Psychology, University of Nottingham, Institute of Mental Health, Triumph Rd., Jubilee Campus, University of Nottingham, Nottingham, NG7 2TR, United Kingdom; George DuPaul, PhD Objectives: The purpose of this session is to explore the scientific evidence base for behavioral interventions for preschool children with ADHD and provide an evidenced-based clinical view. Methods: Three new randomized controlled trials will be reported at the symposium. The Comparison of Preschool Parenting Interventions (COPPI) trial will explore the cost effectiveness of an individual behavioral intervention, New Forest Parenting Programme (NFPP), against a group-based intervention incredible year (IY) and treatment as usual (TAU) for preschoolers with ADHD. The DSNAPP trial (Training in the Treatment of ADHD in Young Children) will explore the effectiveness of an individual behavioral intervention delivered as part of routine care for preschoolers with ADHD referred into psychiatry services. The TEAMS (Training Executive, Attention and Motor Skills) trial will explore a play-based intervention designed to facilitate
www.jaacap.org
S329
SYMPOSIA 45.1 – 45.3
neurodevelopment and improve the clinical trajectories of preschool children with ADHD through training executive, attention, and motor skills. Results: The COPPI trial found no statistically significant differences between NFPP and IY on observed or parent-assessed ADHD symptoms at T2 or T3 or on other outcomes at either T2 or T3. Small benefits of NFPP over TAU were seen for parent-rated ADHD (p ¼ 0.053) and conduct problems (p < 0.05). NFPP was significantly less costly than IY (£1,509 versus £2,103), with the difference attributed to the higher interventionrelated costs of IYs. The DSNAPP trial has yet to report its findings. Analysis is underway and will be completed soon. In the TEAMS trial, twoway (group time) mixed-model ANOVAs yielded several significant main effects for time, indicating clinical and neuropsychological improvements after treatment. However, there were few significant main effects or interactions involving the group. Separate examinations of effect size for TEAMS and the comparison condition relative to pretreatment at all three posttreatment time points indicated consistently larger effect sizes for TEAMS as judged by teachers and clinicians; between-group effect sizes were small. Conclusions: The symposium highlights the challenges of intervening during the preschool period. Positive results in the preschool period may be dependent on the sample group, mode of delivery, and intervention content.
ADHD PSC RCT http://dx.doi.org/10.1016/j.jaac.2016.07.384
45.1 EFFICACY AND COST-EFFECTIVENESS OF INDIVIDUAL VERSUS GROUP-BASED PARENT TRAINING FOR PRESCHOOL ATTENTION-DEFICIT/ HYPERACTIVITY DISORDER: A MULTI-CENTER RANDOMIZED CONTROLLED TRIAL David Daley, PhD, Division of Psychiatry and Applied Psychology, University of Nottingham, Institute of Mental Health, Triumph Rd., Jubilee Campus, University of Nottingham, Nottingham, NG7 2TR, United Kingdom Objectives: The goal of this presentation is to compare the efficacy and cost effectiveness of New Forest Parenting Programme (NFPP)—an individually delivered approach—with a group-based approach (incredible years, IY) and treatment as usual (TAU) in a sample group of preschool children with ADHD. Methods: The Comparison of Preschool Parenting Interventions (COPPI) trial was a three-arm parallel group, randomized controlled trial. The trial recruited 307 preschool children that met standard ADHD diagnostic criteria. Children were block-randomized to NFPP, IY, or TAU on a 3:3:1 ratio. NFPP is a specialist parent-training (PT) program for parents of preschool children with ADHD delivered on a one-to-one basis. The toddler version of IY is a group-based PT program delivered over 12-weekly sessions designed to address problems of challenging and oppositional conduct in young children. Results: In total, 307 participants were randomized (NFPP: N ¼ 134; IY: N ¼ 131; TAU: N ¼ 42). The sample group included a high proportion of single parents (30 percent), low-income families, children with language difficulties (50 percent), and parents with mental health problems (77 percent). No statistically significant differences between NFPP and IY were observed in parent-assessed ADHD symptoms at T2 (primary end point: mean for NFPP, 1.715; mean for IY, 1.724; mean difference, 0.009; 95% CI 0.191 to 0.173; p ¼ 0.921) or T3 or in other secondary or healthrelated outcomes at either T2 or T3. Small benefits of NFPP over TAU were seen for parent-rated ADHD (adjusted mean, 1.693 for NFPP and 1.881 for TAU; mean difference, 0.189; 95% CI 0.380 to 0.003; p ¼ 0.053) and conduct problems (p < 0.05). NFPP was significantly less costly than IY (mean total cost per patient, £1,509 vs. £2,103), with the difference being attributed to higher intervention-related costs of IY. Cost utility analysis, in terms of incremental cost/quality-adjusted life-year (QALY) gained, showed that NFPP was dominant over IY and thus likely to be cost-effective, albeit based on small QALY gain differences.
S330
www.jaacap.org
Conclusions: High-quality, group-based PT may be more expensive to deliver than some forms of individually delivered equally efficacious PT programs. Both formats should be available to families.
PSC Supported by the National Institute of Health Research UK http://dx.doi.org/10.1016/j.jaac.2016.07.385
45.2 THE EFFECTIVENESS OF PARENT TRAINING AS A TREATMENT FOR PRESCHOOL ATTENTIONDEFICIT/HYPERACTIVITY DISORDER: A MULTICENTER RANDOMIZED CONTROLLED TRIAL OF THE NEW FOREST PARENTING PROGRAM IN EVERYDAY CLINICAL PRACTICE Anne-Mette Lange, MSc, Research Department, Centre for Child and Adolescent Psychiatry, Aarhus University Hospital, Risskov, Aarhus, 240 Risskov, Denmark Objectives: Parent training is recommended as first-line treatment for ADHD in preschool children. The New Forest Parenting Programme (NFPP) is an evidence-based parenting program developed specifically to target preschool ADHD. This talk will present fresh results from a multicenter trial designed to investigate whether the NFPP can be delivered effectively for children who are referred through official community pathways in everyday clinical practice. Methods: A multicenter randomized controlled parallel arm trial design was incorporated. There were two treatment arms, NFPP and treatment as usual. NFPP consisted of eight individually delivered parenting sessions where the child attended three of the sessions. Outcomes were examined at three time points as follows: T1, baseline; T2, week 12, postintervention; and T3, 6month follow-up. Children (N ¼ 165; ages 3–7 years) with a clinical diagnosis of ADHD, informed by the Development and Well-Being Assessment (DAWBA), were recruited from three child and adolescent psychiatry departments in Denmark. Randomization was on a 1:1 basis and stratified for age and gender. Results: The primary endpoint showed a change in ADHD symptoms as measured by the Preschool ADHD-Rating Scale (Preschool ADHD-RS) by T2. Secondary outcome measures included the following: effects on this measure at T3; T2 and T3 measures of teacher-reported preschool ADHD-RS scores; parent- and teacher-rated scores on the Strength and Difficulties Questionnaire; direct observation of ADHD behaviors during child’s solo play; observation of parent–child interaction; parent sense of competence; and family stress. Conclusions: This trial will provide evidence on whether NFPP is a more effective treatment for preschool ADHD than the treatment usually offered in everyday clinical practice.
PSC Supported by the Trygfonden Foundation, Denmark http://dx.doi.org/10.1016/j.jaac.2016.07.386
45.3 THINKING OUTSIDE THE PILL BOX: INITIAL RESULTS OF A RANDOMIZED CONTROLLED TRIAL OF A NOVEL PLAY-BASED INTERVENTION FOR PRESCHOOL ATTENTION-DEFICIT/HYPERACTIVITY DISORDER Jeffrey Halperin, PhD, Psychology, Queens College, City University of New York, 65-30 Kissena Blvd., Flushing, NY 11367 Objectives: Training Executive, Attention, and Motor Skills (TEAMS) is a playbased intervention designed to facilitate neurodevelopment and improve the clinical trajectories of preschool children with ADHD. An open clinical trial indicated clinical improvement that persisted 3 months after treatment as indicated by parent and teacher ratings. This initial double-blind RCT was conducted to estimate effect sizes of TEAMS relative to an active comparison
J OURNAL
OF THE
AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016