Treatment development
Methodological needs
DSM-IV criteria are in many ways inappropriate for diagnosing ADHD in adolescents and adults. Revised diagnostic criteria and outcome measures that capture real world functioning are needed to advance treatment development. New statistical tools are being developed and translated from other fields to measure treatment response at both the individual and group levels. For example, growth mixture models allow researchers to compare baseline and treatment responses for subgroups based on their characteristics (e.g., aggression), as well as interaction effects (e.g., of psychosocial and pharmacologic treatments).
Novel approaches
Pharmacology: Looking beyond the role of dopamine in therapeutic responses may expand our range of treatment targets to include, for example, noradrenergic, serotonergic, glutamatergic, muscarinic, nicotinic, and GABAergic receptors. Another novel approach may be to combine efficacious treatments. For example, combining agonism that is more dopaminergic with agonism that is more adrenergic might yield superior symptomatic improvement.
Genetics: The identification of genes that underlie treatment variability may be a more tractable problem than the genetics of the pathophysiology of ADHD. Genetics studies may help predict individual responses to medications and psychosocial treatments and adverse events (e.g., abnormal movements, irritability), as well as potentially contribute to the prevention of comorbidity, such as that with depression.
School-based treatments for adolescents: New efforts to address adolescent needs that impact school performance are targeting organizational skills for school-related (e.g., homework management) and other domains (e.g., social skills). Checklists are used for monitoring progress and for use by counselors and parents in implementing contingencies. Social skills are approached by helping students meet their own social goals and interpret context using coaching and skills groups.
Organizational skills training: New research is testing the efficacy of adjunctive organizational skills training for elementary school children with an eye toward preparing them for the greater independence associated with the adolescent period. Treatments teaching organization, time management, and planning skills in ecologically-relevant contexts are being evaluated.
ADHD-specific cognitive-behavioral therapy: Using patient input, researchers are developing a comprehensive, ADHD-specific cognitive-behavioral intervention targeted toward improving functioning in adults and facilitating generalization to all life domains. Treatment modules, developed to address the problems most frequently reported by patients, are addressing organizational skills (e.g., use of a task list and calendar), planning, coping with distractibility, and cognitive restructuring to help with associated anxiety and depression.
Cognitive training: Cognitive training seeks to improve a specific cognitive skill, such as attention or working memory, by beginning with a relatively easy task and gradually increasing the complexity and difficulty level, similar to interventions used in the head injury literature. Recent efforts employing computerized training with children have begun to show promise in improving behavior, e.g., ability to complete assignments. However, effect sizes are modest and greater evidence of generalization is needed.
