Dataset Information

Health and Wellness Coaching and Psychiatric Care Collaboration in a Multimodal Intervention for Attention-Deficit/Hyperactivity Disorder: A Case Report.

ABSTRACT: INTRODUCTION:Stimulant medications are the most common treatment for attention-deficit/hyperactivity disorder (ADHD). However, a multimodal approach that includes behavioral interventions may yield better outcomes. Coaching is gaining recognition as a client-centered behavioral intervention for the management of ADHD. OBJECTIVE:To examine the collaboration between ADHD-focused health and wellness coaching and psychiatric care to support a client's improved self-management of ADHD. METHODS:Using the internationally developed CARE (CAse REport) guidelines designed to improve transparency and accuracy in health research reporting, this case report is based on a systematic review of data collected from the point of care. RESULTS:An 8-week collaboration between a psychiatrist and a health and wellness coach both expanded what the psychiatrist had been able to achieve alone in working with a client with ADHD and resulted in client improvement in self-efficacy and various functional impairments, including organizational skills and academic achievement. The client achieved her goal of resuming graduate studies and both integrated and maintained her behavioral changes for more than 6 months, successfully graduating from her program. DISCUSSION:This is the first case report, to our knowledge, describing the process of coaching for ADHD and exploring its integration with psychiatric care. It illustrates beneficial outcomes and the promising role of health and wellness coaching in assisting individuals with ADHD in achieving successful behavior change. The client in this case report made progress that was sustained beyond the 6-month mark, an important milestone in the trajectory of behavior change. CONCLUSION:This case report suggests that health and wellness coaching can be effective in supporting beneficial outcomes and can be useful in the multimodal management of ADHD.

SUBMITTER: Ahmann E

PROVIDER: S-EPMC6844547 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Publications

Health and Wellness Coaching and Psychiatric Care Collaboration in a Multimodal Intervention for Attention-Deficit/Hyperactivity Disorder: A Case Report.

Ahmann Elizabeth E Smith Katherine K Ellington Laurie L Pille Rebecca O RO

The Permanente journal 20191023

<h4>Introduction</h4>Stimulant medications are the most common treatment for attention-deficit/hyperactivity disorder (ADHD). However, a multimodal approach that includes behavioral interventions may yield better outcomes. Coaching is gaining recognition as a client-centered behavioral intervention for the management of ADHD.<h4>Objective</h4>To examine the collaboration between ADHD-focused health and wellness coaching and psychiatric care to support a client's improved self-management of ADHD. ...[more]

PMID: 31710834

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Project description:Objectives: We examined primary care providers' (PCPs') management of attention-deficit/hyperactivity disorder (ADHD) during and following families' participation in two arms of the Children's ADHD Telemental Health Treatment Study. We hypothesized that more intensive treatment during the trial would show an "after-effect" with more assertive PCPs' management during short term follow-up. Methods: We conducted a pragmatic follow-up of PCPs' management of children with ADHD who had been randomized to two service delivery models. In the Direct Service Model, psychiatrists provided six sessions over 22 weeks of pharmacotherapy followed by behavior training. In the Consultation Model, psychiatrists provided a single-session consultation and made treatment recommendations to PCPs who implemented these recommendations at their discretion for 22 weeks. At the end of the trial, referring PCPs for both service delivery models resumed ADHD treatment for 10 weeks. We performed intent-to-treat analysis using all 223 original participants. We applied linear regression models on continuous outcomes, Poisson regression models on count outcomes, and logistic regression models to binary outcomes. Missing data were addressed through imputations. Results: Participants in the Direct Service Model had more ADHD visits than those in the Consultation Model across the full 32 weeks (mean = 7.05 visits vs. 3.36 visits; adjusted rate ratio = 2.1 [1.85-2.38]; p < 0.0001). During follow-up, participants in the DSM were more likely to be taking ADHD-related medications (82% vs. 61%; adjusted odds ratio = 2.44 [1.24-4.81], p = 0.01). At 32 weeks, participants in the Direct Service Model had higher stimulant dosages (adjusted difference = 5.64 [0.12-11.15] mg; p = 0.046). Conclusion: These results from a pragmatic follow-up of a randomized trial suggest an "after-effect" for brief intensive treatment in the Direct Service Model on the short term follow-up management of ADHD in primary care.

Project description:Attention-deficit/hyperactivity disorder (ADHD) is one of the most common brain diseases among children. The current criteria of ADHD diagnosis mainly depend on behavior analysis, which is subjective and inconsistent, especially for children. The development of neuroimaging technologies, such as magnetic resonance imaging (MRI), drives the discovery of brain abnormalities in structure and function by analyzing multimodal neuroimages for computer-aided diagnosis of brain diseases. This paper proposes a multimodal machine learning framework that combines the Boruta based feature selection and Multiple Kernel Learning (MKL) to integrate the multimodal features of structural and functional MRIs and Diffusion Tensor Images (DTI) for the diagnosis of early adolescent ADHD. The rich and complementary information of the macrostructural features, microstructural properties, and functional connectivities are integrated at the kernel level, followed by a support vector machine classifier for discriminating ADHD from healthy children. Our experiments were conducted on the comorbidity-free ADHD subjects and covariable-matched healthy children aged 9-10 chosen from the Adolescent Brain and Cognitive Development (ABCD) study. This paper is the first work to combine structural and functional MRIs with DTI for early adolescents of the ABCD study. The results indicate that the kernel-level fusion of multimodal features achieves 0.698 of AUC (area under the receiver operating characteristic curves) and 64.3% of classification accuracy for ADHD diagnosis, showing a significant improvement over the early feature fusion and unimodal features. The abnormal functional connectivity predictors, involving default mode network, attention network, auditory network, and sensorimotor mouth network, thalamus, and cerebellum, as well as the anatomical regions in basal ganglia, are found to encode the most discriminative information, which collaborates with macrostructure and diffusion alterations to boost the performances of disorder diagnosis.

Dataset Information

Health and Wellness Coaching and Psychiatric Care Collaboration in a Multimodal Intervention for Attention-Deficit/Hyperactivity Disorder: A Case Report.

Publications

Health and Wellness Coaching and Psychiatric Care Collaboration in a Multimodal Intervention for Attention-Deficit/Hyperactivity Disorder: A Case Report.

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