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Improving Outcomes for Youth with ADHD: A Conceptual Framework for Combined Neurocognitive and Skill-Based Treatment Approaches

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Abstract

Attention-deficit/hyperactivity disorder (ADHD) is a prevalent and chronic mental health condition that often results in substantial impairments throughout life. Although evidence-based pharmacological and psychosocial treatments exist for ADHD, effects of these treatments are acute, do not typically generalize into non-treated settings, rarely sustain over time, and insufficiently affect key areas of functional impairment (i.e., family, social, and academic functioning) and executive functioning. The limitations of current evidence-based treatments may be due to the inability of these treatments to address underlying neurocognitive deficits that are related to the symptoms of ADHD and associated areas of functional impairment. Although efforts have been made to directly target the underlying neurocognitive deficits of ADHD, extant neurocognitive interventions have shown limited efficacy, possibly due to misspecification of training targets and inadequate potency. We argue herein that despite these limitations, next-generation neurocognitive training programs that more precisely and potently target neurocognitive deficits may lead to optimal outcomes when used in combination with specific skill-based psychosocial treatments for ADHD. We discuss the rationale for such a combined treatment approach, prominent examples of this combined treatment approach for other mental health disorders, and potential combined treatment approaches for pediatric ADHD. Finally, we conclude with directions for future research necessary to develop a combined neurocognitive + skill-based treatment for youth with ADHD.

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Notes

  1. As discussed previously, our reading of the ADHD neurocognitive literature suggests that central executive working memory and sustained attention may be key intervention targets due to the magnitude of observed impairments and links to ADHD behavioral symptoms and functional impairments. Alternate models, however, hypothesize that targeting other/additional processes may provide maximum benefits (Table 1), and issues of within-group heterogeneity and equifinality (Nigg and Casey 2005) will need to be considered when adapting training protocols for individual children (Epstein and Tsal 2010). Regardless of intervention target(s), we echo cognitive methodologists’ calls for demonstrating proof-of-concept and training task validity—that the tasks impact their intended training target—via experimental studies prior to advancing to clinical trials (cf. Shipstead et al. 2012).

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Authors and Affiliations

  1. Department of Applied Psychology, New York University, New York, NY, USA

    Anil Chacko

  2. Department of Psychology, Florida State University, Tallahassee, FL, USA

    Michael Kofler

  3. Department of Psychology, University of Alabama, Tuscaloosa, AL, USA

    Matthew Jarrett

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  1. Anil Chacko
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  2. Michael Kofler
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  3. Matthew Jarrett
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Correspondence to Anil Chacko.

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Chacko, A., Kofler, M. & Jarrett, M. Improving Outcomes for Youth with ADHD: A Conceptual Framework for Combined Neurocognitive and Skill-Based Treatment Approaches. Clin Child Fam Psychol Rev 17, 368–384 (2014). https://doi.org/10.1007/s10567-014-0171-5

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