Treatment Outcomes of the Summer Treatment Program for Children with Adhd and Comorbid ...

148 Pages·2016·1.42 MB·English

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Anthony Regis Pizzuti
Cleveland State University
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Pizzuti, Anthony Regis, "Treatment Outcomes of the Summer Treatment Program for Children with Adhd
and Comorbid Mental Health Diagnoses" (2013). ETD Archive. 244.
https://engagedscholarship.csuohio.edu/etdarchive/244
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TREATMENT OUTCOMES OF THE SUMMER TREATMENT PROGRAM FOR
CHILDREN WITH ADHD AND COMORBID MENTAL HEALTH DIAGNOSES

ANTHONY REGIS PIZZUTI

Bachelor of Arts and Science

John Carroll University

May, 1996

Masters of Arts in Community Counseling

John Carroll University

December, 1999

Submitted in partial fulfillment of requirements for the degree

DOCTOR OF PHILOSOPHY IN URBAN EDUCATION

at the

CLEVELAND STATE UNIVERSITY

December, 2013
©COPYRIGHT BY ANTHONY REGIS PIZZUTI 2013
We hereby approve the dissertation of
Anthony Pizzuti
Candidate for the Doctor of Philosophy in Urban Education degree
This Dissertation has been approved for the
Office of Doctoral Studies,
College of Education and Human Services
and
CLEVELAND STATE UNIVERSITY
College of Graduate Studies by:

_________________________________________
Sarah Toman, Ph.D., Dissertation Chairperson
Counseling Administration, Supervision, & Adult Learning

_________________________________________
Michael Horvath, Ph.D., Methodologist
Psychology

_________________________________________
Elizabeth Welfel, Ph.D., Member
Counseling Administration, Supervision, & Adult Learning

_________________________________________
Justin C. Perry, Ph.D., Member
Counseling Administration, Supervision, & Adult Learning

_________________________________________
Paula J. Britton, Ph.D., Member
John Carroll University

December 2, 2013
Student’s Date of Defense
ACKNOWLEDGEMENTS
I would like to thank a number of people who greatly assisted and supported me
in the completion of this research. First, I would like to thank my chairperson, Dr. Sarah
Toman, whose inspiration and encouragement has been present from the beginning of
this research and who has always reminded me to never give up. I thank you for your
positive attitude, direction, feedback and continued motivation, especially during the days
when I second guessed myself.
Second to my committee, Dr. Elizabeth Welfel, Dr. Michael Horvath, Dr. Paula
Britton and Dr. Justin Perry, whose support and patience has allowed me the chance to
fulfill a lifelong dream of completing my doctorate degree as well as to the wonderful
faculty at Cleveland State University and the Urban Education program.
A very special thank-you to Benjamin Nutter, Dr. Michael Manos and Dr. Tom
Frazier from the Cleveland Clinic as well as to both Hilary Parsons and Craig Sidol from
Summer Treatment Program; I appreciate your professionalism, confidence, guidance,
support and access to the data utilized in this dissertation.
There are also a number of very special individuals who also have assisted me in
this educational journey including my friends and family. Thank you to Don Caserta
whose clinical skills are so evidently apparent as well as to your exceptional knowledge
of the STP. Thank you to my Pittsburgh and Ohio families, I truly do not feel I could not
have completed this dissertation without your support and encouragement.
To my wife Candice, who has given me all the love and support necessary to
complete this dissertation. Thank you for your understanding and patience.
To my daughters Rachel and Jillian, you all are truly the researchers in our house
and I am amazed by you sense of inquiry and wonderment. Never stop asking the
question of “why” and always keep searching for your answers. You will both do great
things in your future and I am so proud of you.
Finally to my father and mother who have sacrificed much, giving me much more
than I can ever return, I appreciate your guidance, support, and belief in me while
preparing me for future success. I appreciate all that you have done for me and I cannot
thank you enough.
TREATMENT OUTCOMES OF THE SUMMER TREATMENT PROGRAM FOR
CHILDREN WITH ADHD AND COMORBID MENTAL HEALTH DIAGNOSES
ANTHONY REGIS PIZZUTI
ABSTRACT
Although there is substantial support for the efficacy of the Summer Treatment
Program (Pelham, Gnagy et al., 2010) for children diagnosed with attention deficit
hyperactivity disorder (ADHD), limited research has evaluated whether children
diagnosed with additional mental health disorders (comorbidity) show positive outcomes
and improvements when exposed to an intensive behavior program such as the Summer
Treatment Program (STP). Furthermore, there is no research available that shows
whether children from differing ages or gender who are diagnosed with additional mental
health disorders (comorbidity) show improvements over the course of treatment. With
such limited research, this study investigated a few of the questions raised about the
treatment outcomes of the STP and whether children diagnosed ADHD, with and without
comorbid conditions, have positive treatment outcomes and efficacy differences as a
function of comorbidity, gender and age.
This particular research study examined archival data from 345 children, aged 6
to 12 years old, who enrolled in a 7-week Summer Treatment Program from the summers
of 1999 – 2012. The dependent variable included the STP point system total weekly
points earned from the program utilized as the indicator of the rate of change. A series of
mixed-effects regression models were computed with the independent measures for age
group, gender comparisons, and ADHD comorbidity to address four research questions.
The results of this investigation indicated no significant difference for children diagnosed
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with ADHD alone in treatment outcomes from those children diagnosed with ADHD
comorbidity. Both children with ADHD alone and those with ADHD comorbidity made
treatment gains over the course of the program. Secondly, significant differences were
found between males and females diagnosed with ADHD comorbidity regarding
treatment outcomes, in that females earned significantly more points than males during
the summer treatment program. Thirdly, there were no significant age group differences
in treatment outcomes with children diagnosed with ADHD comorbidity. Lastly, of all
ADHD comorbid diagnoses, only Oppositional Defiant Disorder (ODD) was significantly
associated with lower weekly scores than children with a diagnosis of ADHD only.
The results indicate that treatment matching may reduce some of the clinical
uncertainty in the literature regarding treatment options for children diagnosed with
ADHD comorbidity.

v
TABLE OF CONTENTS
ABSTRACT ....................................................................................................................... iv
LIST OF TABLES ............................................................................................................. ix
I. INTRODUCTION ............................................................................................ 1
Evolving Concepts of ADHD ................................................................. 1
Etiology, Features and Prevalence of ADHD ........................................ 5
Family Influences ................................................................................... 8
Research Questions .............................................................................. 17
Conclusion ............................................................................................ 18
II. LITERATURE REVIEW ............................................................................... 19
Gender, ADHD and Comorbidity ........................................................ 22
Academic Performance ........................................................................ 26
Learning Disabilities ............................................................................ 27
Gender and Psychosocial Competence ................................................. 29
Medication Treatment and Comorbidity .............................................. 38
Oppositional defiant disorder ................................................... 41
Callous and unemotional traits ................................................. 42
Psychosocial ADHD Treatments .......................................................... 44
Multimodal Treatment Study of ADHD .............................................. 46
MTA Study: Comparing Subgroups ..................................................... 52
Summer Treatment Program ................................................................ 55
Conclusion ............................................................................................ 61
III. METHODOLOGY ......................................................................................... 63
vi
Introduction .......................................................................................... 63
Data Source .......................................................................................... 63
STP Implementation History ................................................................ 63
Data Collection ..................................................................................... 64
Ensuring Confidentiality ...................................................................... 65
Sample .................................................................................................. 65
Recruitment, Screening and Application processes for the STP .......... 67
STP Inclusion and exclusion criteria .................................................... 68
Demographics and descriptive information ......................................... 68
Verification of ADHD Comorbidity .................................................... 69
Definition of Comorbid Subgroups ...................................................... 70
Procedures ............................................................................................ 71
Dependent Variable: Point System and Token Economy .................... 73
Treatment Integrity and Fidelity ........................................................... 75
Daily Report Card ................................................................................ 76
Treatment Outcomes ............................................................................ 77
Analyses and Statistics ......................................................................... 77
Conclusion ............................................................................................ 81
IV. RESULTS ....................................................................................................... 82
Research Question 1 ............................................................................. 82
Research Question 2 ............................................................................. 85
Research Question 3 ............................................................................. 87
Research Question 4 ............................................................................. 89
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