1. Psychoeducational group therapy within a pediatric residency clinic:
A novel treatment approach for children with ADHD
GC Mooneyham¹ MD MS, D Szczepaniak¹ MD, P Sullivan¹ PhD,
A Pottenger¹,²BA, N Bauer¹,²MD MPH
1Indiana University School of Medicine, Dept of Pediatrics, 2Section of Children’s Health Services Research, Indianapolis, Indiana
GROUP VISIT CURRICULUM
BACKGROUND
GROUP VISITS
RESULTS (con’t)
Children in intervention had fewer parent reported ADHD symptoms on Vanderbilt at 1 year compared to controls (3 vs. 8)
Themes from audiotaped participant feedback
Children reported:
group enjoyment
application of skills learned
improved ability to make friends
increased organization
identified emotions & how to control
Parents reported:
increased knowledge about parenting & educational advocacy
acquired social support
improved family interactions & communication
gained time to discuss common issues with other parents & providers
improved communication with their child and positive impact on their children’s self esteem
Clinic follow up improved in intervention group
average 5.3 ADHD visits vs. 3.4 ADHD visits for usual care
7 out of 9 families assigned to intervention arm attended all group visits
Primary care providers face numerous challenges around management of patients with Attention Deficit Hyperactivity Disorder (ADHD):
Short visits limit time to effectively educate families
High volume of patients
Medication titration requires frequent visits
Psychoeducational group therapy - underutilized resource in primary care that can be used to address barriers:
focuses on education
group members with shared diagnosis
central message can be shared with participants simultaneously
learning as a community
decrease stigma & normalize experiences
Study Purpose:
Provide more meaningful opportunities for families with children diagnosed with ADHD in our clinic
Engage families in the medical home
Resource for teaching & support
Fostering collaborative partnerships
Parent-child dyads participated in 5 separate group therapy visits once every 3 months
Groups lasted 60 minutes followed by 15 minute individual physical exam and medication review
Child curriculum
written by child psychologist
implemented by resident physician
Parent curriculum
written by behavioral pediatrician
implemented by general pediatrician
PARENT GROUP
CHILD GROUP
Understanding ADHD & your child
Build comfort & normalize experiences: share parenting challenges & child strengths
What is ADHD all about?
Build comfort & normalize experiences: share challenges & self-identified strengths
Understanding treatment options & partnership to reach goals
Review common medications & understand how to monitor positive & negative effects
Feelings: Identification, handling and use of feeling charts
Enhance ability to respond appropriately to emotions including anger management
Advocating for Child’s Educational Success
Understand parental educational rights, how to collaborate with teacher & become an advocate for child
Friendships, Hobbies, Empathy & Handling Rejection
Foster positive relationships with family members, friends & classmates
Managing Children’s Behavior with Positive Parenting Techniques
Learn ABCs of behavior, review of strategies for time-in, praise, effective commands & transition warnings
School: Classroom Etiquette, Learning Difficulties, and Homework Help
Reinforce organizational strategies & positive classroom behavior for academic success
Techniques to Defuse Common Parenting Challenges & Wrap Up
Review of ignore, natural & logical consequences & time-out & how to manage parental stress
Wrap Up
Review of covered topics & celebration with group
Significant difference in adaptive functioning
Intervention mean baseline 5.5 vs. 12 month score: 3.7, p=0.0036
Usual care control mean baseline score 4.7 vs. 12 month score 4.4, p=0.8003
RESULTS
Recruitment of children (ages 6-18) with ADHD receiving care in general pediatric resident clinic along with their parent
Randomized to intervention or usual care
Exclusion criteria:
Conduct disorder, Autism, moderate to severe intellectual impairment
Length of study = 1 Year
Inclusion of ADHD inattentive & combined types
Stable on medications x 3 months
Data collection included:
Home Situations Questionnaire (HSQ) for adaptive functioning
Vanderbilt checklist for ADHD symptoms
Informal feedback from parent-child dyads
# of routine ADHD follow up visits attended
METHODS
CONCLUSIONS
Psychoeducational group therapy can be applied to teaching families about the diagnosis & management of ADHD
Group visits are feasible even within a busy pediatric clinic & led to improved follow up
Participation in group therapy led to significant parent-reported improvements for our patients
scheduled & maintained 3 month medication management visits (seen by resident & attending MD)
Families encouraged to call between visits for acute concerns
USUAL CARE
Special thanks to Dr. Stephen M Downs & the IUSOM Pediatric Research Network (PResNet) as well as the staff, faculty, & resident physicians at Riley MSA 1 General Pediatrics clinic.
Authors have no conflict of interest or financial disclosures to report.