This annual report - Taranaki District Health Board

A 2005 Cochrane review on whether or not family therapy without medication can reducethe core symptoms of ADHD identified only two high quality RCTS addressing this issue[414]. One found that family therapy was slightly superior to placebo medication and theother found no difference between the efficacy of family therapy and that of treatment asusual.AACAP states that psychosocial treatment is a helpful adjunct to pharmacologicaltreatment if a patient with ADHD has a sub-optimal response to medication, a comorbiddisorder such as Oppositional Defiant Disorder or Conduct Disorder, or stressors in familylife. Both SIGN and AACAP recommend parent behaviour management training forcomorbid problems in conjunction with medication to treat the core symptoms of ADHD. A2011 Cochrane review of parent training studies found that while there have many studies(the reviewers evaluated over 100) only five RCTs met Cochrane review quality criteria byincluding only specialist-diagnosed children with ADHD (meeting DSM-III/DSM-IV or ICD-10 criteria and over five years old), and comparing parent training with no treatment, awaiting list or treatment as usual (adjunctive or otherwise) [415]. The review authorsconcluded that parent training may improve the behaviour of children with ADHD, reduceparental stress and enhance parental confidence but there were risks of bias in thestudies’ results and a lack of data on many important outcomes including schoolachievement and adverse effects.There have been a number of studies investigating social skills training for children withADHD. Such training typically focuses on teaching children how to pick up the nuances ofsocial communication in order to be able to wait for their turn to speak, know when to shifttopics during a conversation, be able to recognise the emotional expressions of others,and conform to social 'rules', and the expectations of others. A 2011 Cochrane reviewfound even the RCTs among these studies had methodological flaws leading to high risksof bias which limited the reliability of their conclusions and that, at present, it is not possibleto either recommend or discourage social skills training for children with ADHD [416].Alternative TreatmentsA number of alternative treatments have been the subject of Cochrane reviews which havenot found any evidence for their efficacy: acupuncture [417], homeopathy [418], meditation[419], and polyunsaturated fatty acids (PUFA) [420].Oppositional Defiant Disorder and Conduct DisorderFeaturesOppositional behaviour and conduct problems are very common reasons for referral toCAMHS [421,422]. The essential features of Oppositional Defiant Disorder (ODD) are apersistent pattern of defiant, negativistic and hostile behaviour, and disobedience toauthority figures. The DSM-IV criteria are set out in the text box below.To qualify for a diagnosis of ODD according to DSM-IV the behaviour must have been present for at least sixmonths, be causing impairment in social, academic or occupational functioning, and include at least four of thefollowing eight:often loses temperoften argues with adultsoften actively defies or refuses to comply with adults’ requests or rulesoften deliberately annoys peopleoften blames others for his or her mistakes or behaviouris often touchy or easily annoyed by othersis often angry and resentfulis often spiteful or vindictiveThe behaviours must occur more often and/or be of greater severity than is usual for individuals of the child’sage and developmental level and not occur as part of a psychotic or mood disorder. If the diagnostic criteria forConduct Disorder are also met, then that diagnosis takes precedence [402].Conduct Disorder (CD) is characterised by more serious aggressive and anti-socialbehaviour. The DSM-IV criteria are listed in the text box below.In-Depth Topic: Mental Health Issues in Children - 379