Multimodal treatment effects on empathic skills in youth with ADHD

The current observational pilot study explores the effects of multimodal
treatment on empathic skills in youth with attention-deficit hyperactivity
disorder (ADHD) with or without comorbid disruptive behavior disorder (DBD).
Empathy, defined as the tendency to understand and feel the emotions of another
person, is thought to play an important role in the therapeutic process (Allen
et al., 2008). Not only the therapist, also the patient need to be able to
reflect on his own thoughts and feelings, and to understand the thoughts and
feelings of another person. Lack of empathy is associated with a variety of
childhood disorders, such as autismspectrumdisorders, anorexia nervosa, ADHD,
and DBD in particular (Konings & van Strien, 2005). Forensic psychologists,
psychiatrists and social workers are frequently faced with patients showing
little empathy, which may disturb the therapeutic process.
The present pilot study will be conducted in close collaboration with "Accare
Forensische Jeugd en Orthopsychiatrie (FJP) Zwolle en Deventer". Accare FJP is
a mental health institute, offering care to delinquent and at risk youth. Many
patients have ADHD with or without DBD. Those with severe forms of ADHD
commonly receive behavior therapy combined with medication, that is multimodal
treatment (Swaab et al., 2011). Multimodal treatment is also a common
treatment of ADHD at Accare FJP. Clinicians have the impression that
multimodal treatment promotes empathy and prosocial behavior. However,
empirical evidence is lacking and it woulbe interesting to know whether
multimodal treatment enhances empathy in adolescents with ADHD or only in those
with comorbid ADHD/DBD.
There is some evidence suggesting that medication (methylphenidate) improves
neurocognitive functions, such as attention and inhibition (Hellwig-Brida et
al., 2011; Yilmaz et al., 2013), that are known to play a determinant role in
emotion regulation (Eisenberg & Sulik, 2012), and therefore also in the empathy
process (Eisenberg, 2000). Empathy is a multimodal construct, involving
affective and cognitive components. In the current pilot we will explore the
effects of multimodal treatment (with methylphenidate) upon aspects of cogntive
and affective (trait&state) empathy. A secundary goal is to explore the effects
of multimodal treatment upon antisocial behavior.


References
Eisenberg, N., 2000. Emotion, regulation, and moral development. Annual Review
of Psycholy, 51, 665-697.
Eisenberg, N., & Sulik, M. (2012). Emotion-related self-regulation in children.
Teaching of Psychology, 39, 77-83.
Hellwig-Brida, S., Daseking, M., Keller, F., Petermann, F., & Goldbeck, L.
(2011). Effects of methylphenidate on intelligence and attention components in
boys with attention-deficit/hyperactivity disorder. Journal of Child and
Adolescent Psychopharmacology, 21, 245-253.
Konings, I., & van Strien, T. (2005). Tekort aan empathie: een bruikbaar begrip
in de kinder- en jeugdpsychocpathologie? Tijdschrift voor Orthopedagogiek,
Kinderpsychiatrie en Kinderpsychologie, 30, 17-28.
Swaab, H., Bouma, A., Hendriksen, J., & Konig, C. (2011). Klinische
Kinderneuropsychologie. Amsterdam: Uitgeverij Boom.

The main objective is to explore the effects of mulimodal treatment upon
empathic skills in forensic male adolescents with ADHD, with or without DBD. A
secundair objective is to explore the effects of multimodal treatment upon
antisocial behavior.

The current study is a naturalistic study in which youngsters are sequentially
tested: three times during a control period (baseline) and three time during
treatment. The researcher has no influence on treatment. During every test
session,the youngster and his/her parents are asked to fill out questionnaires
to assess aspects of affective and cognitive trait empathy, and aspects of
problem behavior. In addition, the youngster is asked to perform a computertask
to assess aspects of affective and cognitive state empathy. After all six test
sessions, the youngsters are interviewed in groups about their experience with
the treatment, the therapist and therapeutic process.

Participation in the study requires extra time (to complete all tests), but
there are no risks involved. Participation offers the opportunity to
interchange experiences with other patients, which is often experienced as
positive. The current study can only be performed with patients because we are
interested in the effects of regular treatment upon empathic skills in at risk
youngsters with ADHD with or without comorbid DBD. The current study is
important because lack of empathy is often associated with ADHD/DBD, and this
may hamper the therapeutic process. Knowledge about the effects of treatment
upon empathic skills may be used to improve intervention programs.