Date of Award

Winter 12-16-2016

Level of Access Assigned by Author

Campus-Only Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Psychology

Advisor

Erika K. Coles

Second Committee Member

Shawn W. Ell

Third Committee Member

Cynthia A. Erdley

Additional Committee Members

Douglas W. Nangle

Sandra T. Sigmon

Anne Uecker

Abstract

Behavioral treatments for Attention Deficit Hyperactivity Disorder (ADHD) reduce symptoms and impairment but do not provide sustained benefit beyond the course of treatment implementation. This may be because established interventions fail to remediate the underlying neurocognitive deficits associated with the disorder. A strong research base supports delayed and deficient Executive Functions (EFs) as intrinsic to pathophysiology of the disorder and recent literature demonstrates that these EFs can be “trained” through computer or classroom-based interventions. Despite this, few studies have examined EFs as outcomes measures following behavioral interventions for ADHD. Tying together the links between cognitive, developmental, and treatment literatures, the present study sought to determine whether a multimodal behavioral treatment could alter the neuropsychological outcomes of children with ADHD, including scores on measures of EF, observation, and parent and teacher ratings. A secondary objective also evaluated the role of EFs in treatment response, and whether remediation of executive dysfunction contributed to improved behavioral outcomes as reported by parents and teachers.

Participants were 40 children (30 males) aged 7 through 10 with confirmed diagnoses of ADHD (M age = 8.73 years). Half the sample participated in an 8-week, evidence-based, multimodal behavioral treatment program for ADHD, the Summer Treatment Program (STP; Pelham, Grenier, & Gnagy, 2012), which included components of contingency management, response cost, physical activity, and behavioral parent training. Half the sample received no treatment. All participants underwent neuropsychological testing at three time points (pre, post treatment, and three months later). Parent, teacher, and self-report of symptoms and impairment were collected.

Results revealed mixed evidence across measures and domains. Strongest evidence for sustained remediation of EFs occurred on measures of working memory. Improvements in functioning were also demonstrated on verbal response inhibition, and measures of emotion regulation. Some changes in set-shifting were evident, although normative-type functioning was not restored. No changes were exhibited on tests of auditory or visuo-spatial response inhibition, measures and observation of attention, tests of planning/organization, or most parent and teacher ratings of EFs. Response inhibition emerged as a significant predictor of parent-rated improvements in symptoms and impairment, confirming a body of evidence establishing deficient response inhibition as the primary deficit in the disorder. Findings add to a growing body of research validating limited generalizability of interventions across EF domains. Findings of this study have implications for the research and provision of future interventions targeting domains of impairment in ADHD. Future research should seek to better understand the underlying neuropsychological processes associated with the disorder and their relationship to treatment response.

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