Table 6.

Published Studies of Psychosocial Treatments in Preschhool Children with Attention-Deficit/Hyperactivity Disorder: Child Training

Authors	Age in years	N	Procedure for ADHD Diagnosis & Inclusion Criteria	Psychosocial intervention	Study Design/Duration	Outcome Assessment (for ADHD and disruptive behaviors)	Study Outcome
Allen et al., 1967	4.5	1	No clinical diagnosis of ADHD, preschool classroom teacher complaint of moving constantly from 1 activity to another confirmed by classroom observation	Teacher administered shaping procedure with contingent social reinforcement	Single-subject, prospective, open-label treatment, four-stage design: baseline, reinforcement, reversal and reinstatement/Forty-seven 50-minute periods	Classroom observation for number of activity changes	Number of activity changes decreased by 50% compared to baseline and reversal conditions.
Bornstein & Quevillon, 1976	4	3	No clinical diagnosis of ADHD, Head Start teacher complaint of highly disruptive classroom behavior, inability to complete standard preschool classroom tasks, short attention span, not attending to tasks, overactivity	Individual 2-hour massed self-instruction training session with verbal modeling, prompts, reinforcement and fading	Case series, prospective, blind, multiple baseline design across subjects and an observer-expectancy control manipulation/40 observation days over 10 weeks	Classroom observation for on-task behavior	On-task behavior increased from an average of 11.7% at baseline to 77% post-treatment and 70.7% at follow-up 22.5 weeks later. Behavioral gains were transferred to the classroom setting. Gains maintained at follow-up 22.5 weeks later
Bryant & Budd, 1982	4–5	3	No clinical diagnosis of ADHD, remedial classroom teacher complaint of low rates of on-task behavior, high distractibility and non-compliance	Nine or more individually administered 10-minute sessions of self-instructional training over 3–8 days followed by classroom intervention with contingent reinforcement by the teacher	Case series, prospective, open-label treatment, multiple baseline design across subjects and sequential administration of self-instructional training and classroom intervention/8 days	Classroom observation for on-task and disruptive behaviors, work completion, and work accuracy	On-task behavior increased from an average of 43.8% at baseline to 53.3% after self-instructional training and 67.7% after introduction of the classroom intervention, work accuracy increased with self-instructional training. Rate of work completion increased after the classroom intervention with contingent reinforcement was instituted.
Billings & Wasik, 1985	4.2–4.8	4	No clinical diagnosis of ADHD, Head Start teacher complaint of off-task, disruptive and inattentive behavior, and at least 25% off-task behavior on observation	Individual 2-hour massed self-instruction training session with verbal modeling, prompts, reinforcement and fading	Case series, prospective, open-label treatment, multiple baseline design across subjects; one child used as control/4 weeks	Blinded classroom observation for on-task behavior and teacher interactions. Self-control Rating Scale completed by the teacher	Increase in attending behavior immediately following treatment phase, but gains were not maintained at follow-up 2 weeks later. Observed high levels of teacher attention to negative behaviors may have maintained the inappropriate behaviors in the children.
McCain & Kelley, 19931	5	1	ADHD diagnosis by the referring pediatrician, teacher complaints of inattentive, impulsive, distractible, and disruptive classroom behavior, Conners' Rating Scale-Teacher (CRS-T) scores >2 SD	Daily school-home notes and home-based positive reinforcement contingency	Single-subject, prospective, open-label treatment reversal (ABAB) design/4 weeks	Blinded classroom observation for on-task, number of activity changes and disruptive behaviors	On-task behaviors increased from an average of 58% in the baseline and reversal conditions to 84.5% in the active treatment conditions. Number of activity changes and disruptive behaviors decreased from an average of 7 and 31% respectively in the baseline and reversal conditions to 2 and 8% in the active treatment conditions.
McGoey & DuPaul, 2000	4.3–5.1	4	ADHD diagnosis on a parent interview using the Diagnostic Interview for Children and Adolescents and parent or teacher rated Early Childhood Inventory; cutoff threshold on the Hyperactivity and the Attention Problems subscales of the Behavioral Assessment System for Children	Teacher administered token reinforcement and response cost	Single-subject, prospective, open-label treatment, reversal design to compare token reinforcement and response cost counterbalanced between participants; a peer comparison child matched for age from each classroom for a measure of expected behavior in the classroom/36–40 sessions	Teacher-ratings on the ADHD Rating Scale, Preschool and Kindergarten Behavior Scales, Teacher Acceptability Ratings, blinded classroom observation	Both interventions were associated with reductions in hyperactivity and disruptive behaviors in 3 of the 4 participants to levels commensurate with their matched peers. Reductions in disruptive behaviors observed initially with both interventions for the 4th participant were replicated with reintroduction of response cost but were not replicated with reintroduction of token reinforcement. Gains maintained at 2 week follow up

¹Parents had previously participated in a group parent training with improvement in the child's behavior at home, but behavioral problems in the preschool had continued.

ADHD = attention-deficit/hyperactivity disorder.