Behavior, Health and Psychopathology, KU Leuven, Tiensestraat 102, 3000, Leuven, Belgium.
Developmental Psychology, University of Amsterdam, Nieuwe Achtergracht 129, 1018 WS, Amsterdam, The Netherlands.
Clin Child Fam Psychol Rev. 2020 Dec;23(4):577-604. doi: 10.1007/s10567-020-00327-z. Epub 2020 Sep 24.
Attention deficit hyperactivity disorder [ADHD] is one of the most common psychiatric disorders of childhood with poor prognosis if not treated effectively. Recommended psychosocial evidence-based treatment for preschool and school-aged children is behavioral parent and teacher training [BPT]. The core elements of BPT are instrumental learning principles, i.e., reinforcement of adaptive and the ignoring or punishment of non-adaptive behaviors together with stimulus control techniques. BPT is moderately effective in reducing oppositional behavior and improving parenting practices; however, it does not reduce blinded ratings of ADHD symptoms. Also after training effects dissipate. This practitioner review proposes steps that can be taken to improve BPT outcomes for ADHD, based on purported causal processes underlying ADHD. The focus is on altered motivational processes (reward and punishment sensitivity), as they closely link to the instrumental processes used in BPT. Following a critical analysis of current behavioral treatments for ADHD, we selectively review motivational reinforcement-based theories of ADHD, including the empirical evidence for the behavioral predictions arising from these theories. This includes consideration of children's emotional reactions to expected and unexpected outcomes. Next we translate this evidence into potential ADHD-specific adjustments designed to enhance the immediate and long-term effectiveness of BPT programs in addressing the needs of children with ADHD. This includes the use of remediation strategies for proposed deficits in learning not commonly used in BPT programs and cautions regarding the use of punishment. Finally, we address how these recommendations can be effectively transferred to clinical practice.
注意缺陷多动障碍(ADHD)是儿童中最常见的精神障碍之一,如果治疗不及时,预后较差。推荐对学龄前和学龄儿童进行基于循证的心理社会治疗,即行为父母和教师培训(BPT)。BPT 的核心要素是工具学习原则,即强化适应性行为,忽视或惩罚非适应性行为,同时结合刺激控制技术。BPT 在减少对立行为和改善养育实践方面是中等有效的;然而,它不能减少对 ADHD 症状的盲目评分。而且,在训练效果消失后。
基于 ADHD 潜在的因果过程,本实践综述提出了可以改善 ADHD 的 BPT 结果的步骤。重点是改变动机过程(奖励和惩罚敏感性),因为它们与 BPT 中使用的工具过程密切相关。在对当前 ADHD 的行为治疗进行批判性分析之后,我们选择性地回顾了 ADHD 的基于动机强化的理论,包括这些理论产生的行为预测的实证证据。这包括考虑儿童对预期和意外结果的情绪反应。
接下来,我们将这些证据转化为潜在的 ADHD 特定调整,旨在增强 BPT 计划在满足 ADHD 儿童需求方面的即时和长期效果。这包括针对学习中常见的补救策略的建议,以及对惩罚的使用的注意事项。最后,我们讨论了如何将这些建议有效地转移到临床实践中。