Virtual educational therapy: A case study of clinical supports and advocacy

A case study is a research approach that is used to generate an in-depth, multifaceted understanding of a complex issue in its real-life context. It is both time- and space-bound and is useful to explore, describe, and explain phenomena. It is an established research design that is used extensively in a wide variety of disciplines, particularly in the social sciences, including education. Many master's programs employ the case study methodology as the basis for the culminating project. The case study methodology is especially relevant to advancing "younger disciplines" such as educational therapy. Many do not understand the training and difference in approaches between an Educational Therapist and a tutor, so publishing case studies is crucial. This book presents a board-certified educational therapist's year-long case study of clinical supports and advocacy for a student with learning disabilities who is attending school remotely during the COVID-19 pandemic. With online and blended learning, now the norm in K-12 education, educational therapists need new models of intervention, treatment, and relationship-building for their child-age clients. The book offers detailed single-case research focused on a middle-school student who is learning virtually while challenged with attention-deficit/hyperactivity disorder as well as visual and verbal memory issues, but who is nonetheless found ineligible for special education services. Across eight chapters, the book describes the neuropsychological principles, research-based techniques, personal interactions, clinical approaches, and advocacy efforts that led to a vulnerable student's significant gains in academic skills and outcomes. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Postsecondary students with ld/adhd facing a sudden shift to online learning during the covid-19 pandemic-emotional costs and implications

This study examined the emotional costs and well-being of postsecondary students with learning disabilities (LD) and attention deficit hyperactivity disorder (ADHD) who faced a sudden shift to emergency remote teaching (ERT) during the COVID-19 pandemic. The study was conducted with 237 postsecondary students in Israel from June to July 2020. With regard to online learning, the LD/ADHD subjects reported significantly higher levels of stress, anxiety, and depression and lower well-being than their neurotypical counterparts. However, no significant differences were found in emotional costs and well-being when the same students had experienced online learning prior to the pandemic. These findings have practical implications for policymakers in academia with regard to the emotional toll of online learning among students with LD/ADHD and their specific needs when facing ERT during the COVID-19 pandemic as well as the contribution of previous online learning when facing ERT. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Parent adherence to psychological evaluation recommendations

A psychological evaluation is often the first step towards intervention for children displaying difficulties associated with ADHD symptoms. The degree to which impairment associated with ADHD can be diminished relies in part on the extent to which patients follow through on recommendations that are provided as part of the psychological evaluation. Currently, there is little research that examines adherence to psychological evaluation recommendations. Two pioneer studies (Dreyer et al., 2010;Mucka et al., 2017) have found support for barriers and level of parent stress in predicting non-adherence to assessment recommendations. The present study expands upon previous research by examining adherence to psychological evaluation recommendations through the Common Sense Model (CSM;Leventhal et al., 1980), which hypothesizes that individuals create cognitive representations of an illness which promote coping behavior. Thirty-five caregiver/child dyads were recruited through an ADHD evaluation clinic and caregivers completed a telephone interview focused on adherence to assessment recommendations approximately 10 to 12 weeks after the evaluation feedback session. It was predicted that caregiver perceptions of child behavior and knowledge about ADHD would be associated with adherence to psychological evaluation recommendations. Results revealed that caregivers reported an average adherence rate of 66.62% to evaluation recommendations. In line with previous research, perceived barriers to recommendations were a significant predictor of adherence to recommendations. There was also a trend for caregiver knowledge about ADHD to be associated with adherence. The most commonly reported barrier was the COVID-19 pandemic. Contrary to hypotheses, caregiver perceptions of stability and child control over behavior were not associated with adherence to recommendations. Results suggest that increasing knowledge of ADHD is one factor that could improve outcomes for children diagnosed with ADHD. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Expected changes in parenting after an online parent training for ADHD.

BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in children and adolescents. Treatments for this population should be multidisciplinary and must be initiated as early as possible. Non-pharmacological interventions for ADHD include psychoeducation, parent behavioural training programs and school interventions and accommodations. In response to the COVID-19 pandemic, we developed an online version of a combined psychoeducation and behavioural training program to facilitate access to mental health treatment and ensure continuity of care. OBJECTIVE: The study assessed the acceptability of this online parent training program, among parents and caretakers of children and adolescents with ADHD. METHODS: The program consisted of ten online sessions over the course of two consecutive days (five sessions a day). Satisfaction, usefulness and general comments about the program were assessed with open-ended questions and visual-analogous scales. Parents/caretakers' use of strategies to manage behavioural problems was assessed using the Parenting and Family Adjustment Scales. RESULTS: A total of 206 parents participated in the online program 175 of whom completed the evaluation. Participants were satisfied with the content of the program. More than half of participants had already started using strategies included in the program. The engagement was high and no major obstacles were identified other than some internet connection issues. DISCUSSION: In our survey, online delivery was described as more convenient, and participants were satisfied with the content of the program finding it beneficial for their child. Despite this, some difficulties in implementing new strategies were observed. Online BTP increased access to the BTP programs while being effective on ADHD symptoms and behavioural disturbances. CONCLUSIONS: With these measures, we hope to improve engagement in online psychoeducation and behavioural therapy programs. Future research evaluating online behavioural training programs should focus on ways to make them more accessible and adaptable to families' obstacles.

Experience of parents in delivering pediatric tuina to children with symptoms of attention deficit hyperactivity disorder during the COVID-19 pandemic: qualitative findings from focus group interviews.

BACKGROUND: Evidence suggests that pediatric tuina, a modality of traditional Chinese medicine (TCM), might have beneficial effects on the symptoms of attention deficit hyperactivity disorder (ADHD), such as overall improvements in concentration, flexibility, mood, sleep quality, and social functioning. This study was conducted to understand the facilitators and barriers in the delivery of pediatric tuina by parents to children with ADHD symptoms. METHODS: This is a focus group interview embedded in a pilot randomized controlled trial on parent-administered pediatric tuina for ADHD in preschool children. Purposive sampling was employed to invite 15 parents who attended our pediatric tuina training program to participate voluntarily in three focus group interviews. The interviews were audio-recorded and transcribed verbatim. The data were analyzed through template analysis. RESULTS: Two themes were identified: (1) facilitators of intervention implementation and (2) barriers to intervention implementation. The theme of the facilitators of intervention implementation included the subthemes of (a) perceived benefits to children and parents, (b) acceptability to children and parents, (c) professional support, and (d) parental expectations of the long-term effects of the intervention. The theme of barriers to intervention implementation included the subthemes of (a) limited benefits for children's inattention symptoms, (b) manipulation management difficulties, and (c) limitations of TCM pattern identification. CONCLUSION: Perceived beneficial effects on the children's sleep quality and appetite and parent-child relationships, as well as timely and professional support, mainly facilitated the implementation of parent-administered pediatric tuina. Slow improvements in the children's inattention symptoms and the possible inaccuracies of online diagnosis were the dominant barriers of the intervention. Parents have high expectations for the provision of long-term professional support during their practice of pediatric tuina. The intervention presented here can be feasibly used by parents.

Predicting growth in prosocial and externalizing behaviors during a summer treatment program for children with ASD, ADHD, and comorbid ASD and ADHD

Children ages 6-12 with Autism Spectrum Disorders (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD) often demonstrate similar challenges in in social skills and externalizing behavior (e.g., Leitner, 2014;May et al., 2018). Although distinct evidence-based intervention strategies for improving social skills and externalizing behavior have been shown to have positive effects for children with ASD (e.g., Wong et al., 2015) as well as children with ADHD (e.g., Fabiano et al., 2014), less is known about how a single evidence-based intervention might differentially affect children with ASD, ADHD, or both (Davis & Kollins, 2012).This study examined behavioral trajectories of children with ASD (n = 39), ADHD (n = 50), or both (n = 28) who participated in Apex Summer Camp prior to the COVID-19 pandemic. Apex is an intensive behavioral intervention modeled after the Summer Treatment Program (Pelham et al., 2012). Hierarchical linear modeling was used to model growth in prosocial and externalizing behaviors during camp, and to test whether diagnosis and pre-camp parent-reported child behavior ratings (i.e., Social Responsiveness Scale and Child Behavior Checklist) predicted growth. Results showed that all children, on average, had significant increases in most prosocial behaviors, but no overall changes in most externalizing behaviors. More importantly, campers with ASD and comorbid ASD and ADHD were rarely different from their counterparts with ADHD alone, though comorbid diagnosis was more often associated with less desirable outcomes. Last, parent pre-intervention behavior ratings were largely not predictive of positive behavior growth but predicted the intercept of some externalizing behaviors. Implications for clinical and school-based practice are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Parent adherence to psychological evaluation recommendations

A psychological evaluation is often the first step towards intervention for children displaying difficulties associated with ADHD symptoms. The degree to which impairment associated with ADHD can be diminished relies in part on the extent to which patients follow through on recommendations that are provided as part of the psychological evaluation. Currently, there is little research that examines adherence to psychological evaluation recommendations. Two pioneer studies (Dreyer et al., 2010;Mucka et al., 2017) have found support for barriers and level of parent stress in predicting non-adherence to assessment recommendations. The present study expands upon previous research by examining adherence to psychological evaluation recommendations through the Common Sense Model (CSM;Leventhal et al., 1980), which hypothesizes that individuals create cognitive representations of an illness which promote coping behavior. Thirty-five caregiver/child dyads were recruited through an ADHD evaluation clinic and caregivers completed a telephone interview focused on adherence to assessment recommendations approximately 10 to 12 weeks after the evaluation feedback session. It was predicted that caregiver perceptions of child behavior and knowledge about ADHD would be associated with adherence to psychological evaluation recommendations. Results revealed that caregivers reported an average adherence rate of 66.62% to evaluation recommendations. In line with previous research, perceived barriers to recommendations were a significant predictor of adherence to recommendations. There was also a trend for caregiver knowledge about ADHD to be associated with adherence. The most commonly reported barrier was the COVID-19 pandemic. Contrary to hypotheses, caregiver perceptions of stability and child control over behavior were not associated with adherence to recommendations. Results suggest that increasing knowledge of ADHD is one factor that could improve outcomes for children diagnosed with ADHD. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Mindful attention for reading and class (MARC): A DBT-informed group intervention for college students with attention-deficit/hyperactivity disorder

Up to 80% of children diagnosed with ADHD have symptoms that persist into adulthood (Barkley et al., 2007), and up to 8% of college students report having the disorder (DuPaul et al., 2009). COVID-19 has exacerbated ADHD-related difficulties with concentration, academic performance, and emotional distress (Breaux et al., 2021;Pollak et al., 2021). Dialectical Behavior Therapy (DBT) skills training has shown promise as an effective intervention for ADHD in college students (Fleming et al., 2015) although DBT has typically been delivered face to face over a number of months. The current study was designed to assess the effectiveness of a brief (2-session) DBT-informed group intervention delivered via telehealth. Thirty-three students with at least five DSM-5 symptoms of ADHD were randomized to either a DBT skills group or a Brain Training group which consisted of online puzzle and attention games. Students in both groups received validation, discussion with peers, and psychoeducation. Students completed several measures related to number of ADHD symptoms, quality of life, mindfulness, and visual and auditory attention across three time points (pre, post, and one month follow-up). Statistical analyses revealed no differences based on treatment condition. However, regardless of group intervention, students did report improvements in quality of life, use of mindful nonjudgement skills, and number of ADHD symptoms. The results of this study suggest that providing an open and supportive environment for students with ADHD to meet and discuss their symptoms, learn about their disorder, and provide support to one another, may be beneficial. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Social behaviors of college students with ADHD symptoms on Instagram

Individuals with attention-deficit/hyperactivity disorder (ADHD) have impaired social functioning that makes them vulnerable to negative consequences. Research suggests that this impairment is better explained by an inconsistent use of previously acquired social skills, or a deficit in performance, than by a lack of knowledge about social skills. Although the poor social skills used by people with ADHD in face-to-face interactions have also been found on social media, no research has examined the social skills of people with ADHD on Instagram, which may have greater potential to impact user well-being as a preferred site among emerging adults. Additionally, research has not examined whether a skill deficit or a performance deficit accounts for impairments on social media for people with ADHD. This study assessed whether IUP students with a high level of ADHD symptoms are as knowledgeable about Instagram social skills as their peers. This study also compared the social skills of students with and without ADHD symptoms by examining their Instagram pages to identify differences in social behavior on this platform. The sample consisted of 75 undergraduate students from a mid-sized, rural mid-Atlantic university. Results found that students with both high and low levels of ADHD symptoms had similar knowledge of Instagram social skills. In contrast to expectations, individuals high in ADHD symptoms posted content that displayed social behaviors that promote and hinder well-being as frequently as their peers with low levels of ADHD symptoms. Explanations for these results are discussed in light of the COVID-19 pandemic, social media changes, and methodological factors. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Effects of ADHD symptoms on state mindfulness following a mindfulness induction

Mindfulness is often conceptualized as nonjudgmental awareness of the present moment and has been utilized in a variety of mental health interventions. Mindfulness programs have recently been used in treatment for attention-deficit/hyperactivity disorder (ADHD), as attentional networks are implicated in both mindfulness practices and ADHD deficits. One theory explaining the efficacy of mindfulness programs posits that repeatedly accessing and increasing a state of mindfulness increases overall trait mindfulness, which is said to improve mental health outcomes and, more specifically ADHD-related symptoms. However, the potential impact of ADHD symptoms on achieving state mindfulness through commonly practiced means of mindfulness meditation has not been investigated. This study examined the associations between ADHD symptoms, trait mindfulness, previous mindfulness experience, and meditation compliance, in relation to improvements in self-reported state mindfulness following a mindfulness induction. The sample consisted of 1637 students in Phase I, 70 students in Phase II with 35 each for high and low ADHD symptom group, and 20 students in Phase III. Participants were recruited from a rural mid-sized mid-Atlantic public university. Results showed that the brief mindfulness induction was effective at raising state mindfulness irrespective of ADHD symptom severity. However, there were no significant differences shown between high and low ADHD symptom groups in terms of change in state mindfulness level from the induction, or effect of previous mindfulness experience on mindfulness levels. Explanations for these findings are reviewed in context of ADHD symptomatology, mindfulness experience, and participant and situational factors, including the impact of the COVID-19 pandemic. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Relation between ADHD and COVID-19: A Narrative Review to Guide Advancing Clinical Research and Therapy.

Objective: To cope with the COVID-19 pandemic, national health authorities temporarily closed cultural, religious, and educational institutions such as universities and schools. Children and adolescents with ADHD were challenged with the restrictions caused by the Covid-19 pandemic such as homeschooling and reduced physical activity. The present narrative review aimed to summarize the state-of-the-art regarding associations between COVID-19-related social restrictions and possible psychological and behavioral issues in children and adolescents with ADHD. Additionally, we discussed the underlying possible reasons of the association focusing on the role of parental influence and physical activity, vulnerabilities of individuals with ADHD to Covid-19 infection and to school closure and remote learning. Method: To collect data for the present narrative review, recent publications on these topics between February 1st, 2020 and January 10th, 2021 were retrieved from the most popular search engines (PubMed; Scopus; Google Scholar; Psych Info; Embase) through a comprehensive search using relevant keywords. Results: During confinement, children and adolescents with ADHD reported increased behavioral and ADHD-related symptoms and overall decreased psychological well-being. Factors negatively impacting children's and adolescents' behavioral symptoms and well-being were: less physical activity, adverse parental behavior, difficulties in coping with preventive guidelines, and school closure and remote learning consequences. Conclusion: Children and adolescents with ADHD and their caregivers faced both specific and general psychological issues related to the school lockdowns and homeschooling. Additionally, Individuals with ADHD seem to be more vulnerable to Covid-19 infection which highlights the need for better healthcare adaptation.

A cohort study examining the association between children's symptoms of inattention and hyperactivity, internalizing symptoms, and mindful parenting during the COVID-19 pandemic.

Objectives: Increased mental health difficulties have been reported in Canadian children as a result of the COVID-19 pandemic, and emerging research suggests that children with high levels of symptoms of inattention and hyperactivity have been disproportionately impacted. Accordingly, the pandemic has impacted families as well. The purpose of this study was the following: (1) to examine whether children's symptoms of inattention and hyperactivity at the beginning of the 2020 and 2021 academic year were associated with mindful parenting at the end of the academic year and (2) to examine whether children's depressive and anxiety symptoms at the end of the year moderated this relationship. Methods: Parents of 114 young children in a large Canadian city participated in this study in the Winter of 2020 and the Spring of 2021. Parents completed several self-report scales used to measure children's mental health symptomatology and mindfulness in parenting. Results: Children's symptoms of inattention and hyperactivity were significantly, negatively associated with mindful parenting across the pandemic year, and children's depressive symptoms moderated this relationship. Specifically, when children's depressive symptoms were low or average it was found that higher symptoms of inattention and hyperactivity were associated with lower levels of mindful parenting. However, when children's depressive symptoms were high their symptoms of inattention and hyperactivity were not predictive of mindful parenting. Conclusions: Children's mental health, namely symptoms of inattention/hyperactivity and depression, are related to challenges in mindful parenting during COVID-19. These results may inform practitioners about which families require additional support during the pandemic.

Pandemic perspectives: Impacts of COVID-19 school closures on students with disabilities and their families

The unprecedented school closures in response to COVID-19 have been associated with a number of negative impacts on students and their families. In addition to these difficulties, parents of student with disabilities are faced with pre-pandemic stresses and challenges that may be exacerbated by the school closures. This qualitative study aimed to investigate the experiences and struggles of parents of children identified with a disability during the COVID-19 school closures. The 15 participants were parents of children with a range of disabilities, including Autism, Down Syndrome, ADHD, and learning disabilities. The analyses revealed four major themes: school connection, virtual learning, potential impacts for students, and managing change. The experiences of these caregivers during the COVID-19 school closures and subsequent shift to remote learning have implications for educational and treatment planning. Recommendations for how school psychologists and school teams may best support students with disabilities and their families are included. (PsycInfo Database Record (c) 2022 APA, all rights reserved)