Family therapy for attention-deficit disorder or attention-deficit/hyperactivity disorder in children and adolescents.
BACKGROUND
Attention-deficit hyperactivity disorder (ADHD) is diagnosed in between 3% and 7% of school-age children and consists of the core symptoms of inattention, impulsivity and hyperactivity. Children are often treated with medication, usually stimulant medication such as methylphenidate. Stimulant medication has been found to be effective for alleviating ADHD symptoms, at least in the short term. ADHD is also treated with a variety of psychosocial and psychoeducational interventions for parents, children, and with multicomponent interventions combined with medication management. However, many patients (10 to 13% of patients) cannot or prefer not to take medication. Family therapy without medication may help to develop structure in the family, help to manage children's behaviour, and may help families cope with distress from the presence of the disorder.


OBJECTIVE
This review seeks to address the question of whether family therapy without medication can reduce the core symptoms of ADHD as compared to no treatment or standard treatment.


METHODS
The following electronic databases were searched using a specific search strategy: The Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2004), MEDLINE (1966 to April 2004), PsycINFO (1872 to April 2004), CINAHL (1982 to April 2004), Biosis (Biological Abstracts) (1985 to March 2004), Dissertation Abstracts (1980 to April 2004), and Sociological Abstracts (Sociofile) (1963 to April 2004). Hand searches of relevant journals and bibliographies were also conducted and experts in the field were contacted for further information.


METHODS
Included studies were randomised controlled trials investigating the efficacy of behavioural family therapy, cognitive behavioural family therapy, or functional family therapy for children with ADHD or ADD (Attention Deficit Disorder).


METHODS
Studies were evaluated for methodological quality and to determine whether they met the inclusion criteria.


RESULTS
This assessment yielded two studies. Data were extracted for both studies. The findings from Jensen 1999 (N=579) indicate that no difference can be detected between the efficacy of behavioural family therapy and treatment as usual in the community. The finding from the available data from Horn 1991 slightly favours treatment over medication placebo.


CONCLUSIONS
Further research examining the effectiveness of family therapy versus a no-treatment control condition is needed to determine whether family therapy is an effective intervention for children with ADHD. There were no results available from studies investigating forms of family therapy other than behavioural family therapy.
Bjornstad
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G
Social Policy and Social Work, University of Oxford, Wolfson College, Linton Road, Oxford, Oxon, UK, OX2 6UD. gretchen.bjornstad@wolfson.oxford.ac.uk
Montgomery
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P
D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy / Q000628:therapy*; D002648:Child; D005196:Family Therapy / Q000379:methods*; D006801:Humans; D016032:Randomized Controlled Trials as Topic