Occupational Therapy for Children with Attention Deficit Hyperactivity Disorder (ADHD), Part 2: a Multicentre Evaluation of an Assessment and Treatment Package

In part 1 of this article, an occupational therapy model of practice for children with attention deficit hyperactivity disorder (ADHD) was described (Chu and Reynolds 2007). It addressed some specific areas of human functioning related to children with ADHD in order to guide the practice of occupational therapy. The model provides an approach to identifying and communicating occupational performance difficulties in relation to the interaction between the child, the environment and the demands of the task. A family-centred occupational therapy assessment and treatment package based on the model was outlined. The delivery of the package was underpinned by the principles of the family-centred care approach. Part 2 of this two-part article reports on a multicentre study, which was designed to evaluate the effectiveness and acceptability of the proposed assessment and treatment package and thereby to offer some validation of the delineation model. It is important to note that no treatment has yet been proved to ‘cure’ the condition of ADHD or to produce any enduring effects in affected children once the treatment is withdrawn. So far, the only empirically validated treatments for children with ADHD with substantial research evidence are psychostimulant medication, behavioural and educational management, and combined medication and behavioural management (DuPaul and Barkley 1993, A family-centred occupational therapy assessment and treatment package for children with attention deficit hyperactivity disorder (ADHD) was evaluated. The package involves a multidimensional evaluation and a multifaceted intervention, which are aimed at achieving a goodness-of-fit between the child, the task demands and the environment in which the child carries out the task. The package lasts for 3 months, with 12 weekly contacts with the child, parents and teacher. A multicentre study was carried out, with 20 occupational therapists participating. Following a 3-day training course, they implemented the package and supplied the data that they had collected from 20 children. The outcomes were assessed using the ADHD Rating Scales, pre-intervention and post-intervention. The results showed behavioural improvement in the majority of the children. The Measure of Processes of Care – 20-item version (MPOC-20) provided data on the parents’ perceptions of the family-centredness of the package and also showed positive ratings. The results offer some support for the package and the guiding model of practice, but caution should be exercised in generalising the results because of the small sample size, lack of randomisation, absence of a control group and potential experimenter effects from the research therapists. A larger-scale randomised controlled trial should be carried out to evaluate the efficacy of an improved package.