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Review Article
Effects of Cognitive Behavioral Therapy on Attention Deficit Hyperactivity Disorder among School-aged Children in Korea: A Meta-Analysis
Wan-Ju Park, Shin-Jeong Park, Sung-Dong Hwang
Journal of Korean Academy of Nursing 2015;45(2):169-182.
DOI: https://doi.org/10.4040/jkan.2015.45.2.169
Published online: April 30, 2015

1College of Nursing·Research Institute of Nursing Science, Kyungpook National University, Daegu, Korea.

2College of Social Sciences, Kyungpook National University, Daegu, Korea.

Address reprint requests to: Hwang, Sung-Dong. College of Social Sciences, Kyungpook National University, 80 Daehak-ro, Buk-gu, Daegu 702-701, Korea. Tel: +82-53-950-5253, Fax: +82-53-950-6251, sungdong@knu.ac.kr
• Received: October 7, 2014   • Revised: October 14, 2014   • Accepted: February 23, 2015

© 2015 Korean Society of Nursing Science

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0/) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

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  • Purpose
    This study was a meta-analysis designed to identify effects of Cognitive Behavioral Therapy (CBT) interventions in alleviating main symptoms of Attention Deficit Hyperactivity Disorder (ADHD) among school-aged children in Korea.
  • Methods
    Examination of several databases including Research Information Sharing Service, Korean Studies Information Service System, Data Base Periodical Information Academic and hand-searched article references, resulted in identification of 1,298 studies done between 2000 and 2013 of which 21 met the inclusion criteria. Comprehensive Meta-Analysis version 2.0 was used to analyze effect sizes, explore possible causes of heterogeneity, and check publication bias with a funnel plot and its trim-and-fill analysis.
  • Results
    Overall effect size of CBT intervention was large (g=1.08) along with each outcome of self-control (g=1.26), lack of attention (g=1.02), social skills (g=0.92), and hyperactivity (g=0.92). For heterogeneity, moderator analysis was performed, but no significant differences were found between the RCT (Randomized Controlled Trials) group and the NRCT (Non RCT) group. Also, meta-regression was performed using sample size, number of sessions, and length of session as predictors, but no statistically significant moderators were found. Finally, a funnel plot along with trim-and-fill analysis was produced to check for publication bias, but no significant bias was detected.
  • Conclusion
    Based on these findings, there is clear evidence that CBT intervention has significant positive effects on the main symptoms of school-aged children suffering ADHD. Further research is needed to target diverse age groups with ADHD along with more RCT studies to improve the effectiveness of the CBT intervention.
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Appendix 1

Studies Included in Meta-Analysis

jkan-45-169-a001.jpg
T=Thesis; J=Published journal article; ADHD=Attention Deficit Hyperactivity Disorder; CBT=Cognitive Behavioral Therapy.
Appendix 2

Quality Assessment of Studies Included in Meta-Analysis

jkan-45-169-a002.jpg
Y=YES; N=No; N/R=Not-reported; ++=All or most of the criteria have been fulfilled; Where they have not been fulfilled the conclusions of the study or review are thought very unlikely to be altered; +=Some of the criteria have been fulfilled; Those criteria that have not been fulfilled or not adequately described are thought unlikely to alter the conclusions.
Figure 1

Flowchart of study selection.

jkan-45-169-g001.jpg
Figure 2

Forest plots of the effects of CBT on ADHD children (random-effects model).

jkan-45-169-g002.jpg
Figure 3

Effects of moderator variables.

jkan-45-169-g003.jpg
Figure 4

Results of publication bias analysis.

jkan-45-169-g004.jpg
Table 1

Descriptive Summary of Included Studies

jkan-45-169-i001.jpg

RCT=Randomized controlled trials; NRCT=Non-randomized controlled trials; N/R=Not reported; SST=Social skill training; REBT=Rational emotive behavioural therapy; SCA=Self control approaches; PSA=Problem solving approaches; CM=Cognitive modeling; cCBT=Delivery of computerised CBT; MT=Multimodal therapy; AIT=Attention improved training; TAT=Think aloud training; SIT=Self instructional training; AT=Art therapy; CET=Cognitive enhancement training; ACRS=Abbreviated conners parent-teacher rating scale-revised; ADDES=The attention deficit disorders evaluation scale; ADS=ADHD diagnostic system; AES-C=Attention deficit hyperactivity disorder evaluation scale-children version; AHS=Attention deficit and hyperactivity rating scale; BBRS=Burks behavior rating scales; DTA=Diagnostic test of aggression; CTRS-28=Conners teacher rating scale-28; DS&DS/C=Digit span of K-WISC-III & digit symbol/coding; FAIR=Frankfurter aufmerksamkeits-inventar; K-ARS=Korean-ADHD Rating scale; K-CBCL=Korean-child behavior checklist; K-IOWA=Korean-IOWA conners rating scale; MESSY=Matson evaluation of social skills with youngsters; MFFT=Matching Familiar figures test; SCRS=Self-control rating scale; SSRS=Social skills rating system; STA=Stratified test of attention; P=Parent; T=Teacher; C,T=Children, teacher.

Figure & Data

REFERENCES

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    Effects of Cognitive Behavioral Therapy on Attention Deficit Hyperactivity Disorder among School-aged Children in Korea: A Meta-Analysis
    Image Image Image Image
    Figure 1 Flowchart of study selection.
    Figure 2 Forest plots of the effects of CBT on ADHD children (random-effects model).
    Figure 3 Effects of moderator variables.
    Figure 4 Results of publication bias analysis.
    Effects of Cognitive Behavioral Therapy on Attention Deficit Hyperactivity Disorder among School-aged Children in Korea: A Meta-Analysis

    Descriptive Summary of Included Studies

    RCT=Randomized controlled trials; NRCT=Non-randomized controlled trials; N/R=Not reported; SST=Social skill training; REBT=Rational emotive behavioural therapy; SCA=Self control approaches; PSA=Problem solving approaches; CM=Cognitive modeling; cCBT=Delivery of computerised CBT; MT=Multimodal therapy; AIT=Attention improved training; TAT=Think aloud training; SIT=Self instructional training; AT=Art therapy; CET=Cognitive enhancement training; ACRS=Abbreviated conners parent-teacher rating scale-revised; ADDES=The attention deficit disorders evaluation scale; ADS=ADHD diagnostic system; AES-C=Attention deficit hyperactivity disorder evaluation scale-children version; AHS=Attention deficit and hyperactivity rating scale; BBRS=Burks behavior rating scales; DTA=Diagnostic test of aggression; CTRS-28=Conners teacher rating scale-28; DS&DS/C=Digit span of K-WISC-III & digit symbol/coding; FAIR=Frankfurter aufmerksamkeits-inventar; K-ARS=Korean-ADHD Rating scale; K-CBCL=Korean-child behavior checklist; K-IOWA=Korean-IOWA conners rating scale; MESSY=Matson evaluation of social skills with youngsters; MFFT=Matching Familiar figures test; SCRS=Self-control rating scale; SSRS=Social skills rating system; STA=Stratified test of attention; P=Parent; T=Teacher; C,T=Children, teacher.

    Table 1 Descriptive Summary of Included Studies

    RCT=Randomized controlled trials; NRCT=Non-randomized controlled trials; N/R=Not reported; SST=Social skill training; REBT=Rational emotive behavioural therapy; SCA=Self control approaches; PSA=Problem solving approaches; CM=Cognitive modeling; cCBT=Delivery of computerised CBT; MT=Multimodal therapy; AIT=Attention improved training; TAT=Think aloud training; SIT=Self instructional training; AT=Art therapy; CET=Cognitive enhancement training; ACRS=Abbreviated conners parent-teacher rating scale-revised; ADDES=The attention deficit disorders evaluation scale; ADS=ADHD diagnostic system; AES-C=Attention deficit hyperactivity disorder evaluation scale-children version; AHS=Attention deficit and hyperactivity rating scale; BBRS=Burks behavior rating scales; DTA=Diagnostic test of aggression; CTRS-28=Conners teacher rating scale-28; DS&DS/C=Digit span of K-WISC-III & digit symbol/coding; FAIR=Frankfurter aufmerksamkeits-inventar; K-ARS=Korean-ADHD Rating scale; K-CBCL=Korean-child behavior checklist; K-IOWA=Korean-IOWA conners rating scale; MESSY=Matson evaluation of social skills with youngsters; MFFT=Matching Familiar figures test; SCRS=Self-control rating scale; SSRS=Social skills rating system; STA=Stratified test of attention; P=Parent; T=Teacher; C,T=Children, teacher.


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