New studies on ADHD in adolescents at FIU Center for Children and Families
FIU’s Center for Children and Families (CCF), one of the premier centers in the world for attention deficit hyperactivity disorder (ADHD) treatment, is working on three new research projects involving adolescents with ADHD in 2013. Each study addresses different aspects of ADHD, one of the most recognized and treated psychiatric disorders of childhood.
Working with Adolescents with ADHD
Two of CCF’s new grants focus on improving academic success in adolescents with ADHD.
“Increasing Academic Success in Middle School Students with ADHD,” funded by the National Institute of Mental Health (NIMH), develops and evaluates a parent coordinated parent-teen-teacher collaborative intervention to improve the academic functioning of middle school students with ADHD (Supporting Teens’ Academic Needs Daily; STAND). Participants in the three-year project are Miami-Dade middle school students with ADHD.
Under the leadership of Margaret Sibley, assistant professor of psychiatry at FIU, STAND works with middle school students, teachers and parents to monitor and correct academic problems such as disorganized belongings, poor time management, homework completion, study practices, note taking, and off-task classroom behavior. During a combination of group and individual sessions, STAND program clinicians will teach parents and students how to systematically correct the problem behavior, monitor success and reward good performance. In order to monitor academic issues that occur at school, the STAND program will also teach parents and teens to involve teachers in treatment by setting up a home-school communication system. Parents will be coached to work effectively with teachers in order to maximize communication.
The next project builds upon CCF’s proven success with summer treatment of ADHD. “A Summer Preparatory Program (SPP) for Middle and High School Students with ADHD,” funded by the Institute of Education Sciences, will try to improve the functioning of students with ADHD who are transitioning to middle school and high school. This project will be conducted in partnership with Miami-Dade County Public Schools. Participants in the study will be students with a diagnosis of ADHD who have just completed fifth or eighth grade and will be entering sixth or ninth grade in the fall.
Adapted from Pelham’s award-winning Summer Treatment Program (STP) for elementary-aged ADHD children, the SPP is an intensive summer program that teaches academic and social preparatory skills to students and their parents. The SPP consists of a series of rotating modules of academics and psychosocial areas, such as organization skills training, substance use prevention, therapeutic recreational activities, problem-solving training and a vocational program. Parents receive weekly group parent training sessions designed to help them learn how to monitor their children, manage their behavior, and design a home privilege program to reinforce success during the program and during the upcoming school year.
“We are looking at students with ADHD at the most critical junctures of school – entering middle and high school – to see if we can help boost their GPAs and help them overcome the other roadblocks they face to academic success,” says William E. Pelham, Jr., chair of FIU’s Department of Psychology and director of CCF. “We’re trying to work directly with parents because they can have the greatest impact,” says Sibley.
Looking at Medication Tolerance
The third study, which began in April, addresses one of the most important issues in the treatment of ADHD – medication tolerance. This research is also funded by the NIMH.
Numerous studies have shown that children with ADHD show considerable improvement on stimulant medication – initially. But research from the large NIMH Multisite Treatment Study for ADHD has also shown that constantly increasing the dosage of a stimulant medication was also required for the medications to continue to be effective. Further, in as little as two years, the children who were on medication no longer showed any significant improvement. “We know that there isn’t any residual benefit from taking medication for an extended period of time, but 'Why not?' is the holy grail question,” says Pelham.
Tolerance to the drugs is one likely explanation, but “no one has come up with a design to see how and why the drug tolerance is actually occurring,” says Pelham.
Pelham and James Swanson, who were part of the original landmark ADHD treatment study, along with James Waxmonsky, M.D., are now working as a team at CCF to evaluate tolerance – and possibly how to overcome it. This five-year NIMH study is the only one of its kind currently underway and could possibly shift the paradigm of ADHD treatment.
CCF’s study will evaluate different treatment combination options for children taking medicine for ADHD, including trying medication “holidays.” "Maybe a solution to the tolerance problem is to give kids the medication on school days but not on weekends – in theory disrupting a build-up of tolerance," Pelham says.
“We have so many good treatments for ADHD kids, but they don't work as well as we would like – why not? And as the kids change into adolescents, what do we need to be doing?” asks Pelham. The new CCF work aims to find out.