OT Practice

Occupational Therapy Intervention for Children with ADHD with Cog-Fun EBP

May 18, 2021

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Introduction

The latest OT research for children with ADHD. Historically, medications were used to treat children with ADHD, but had side effects and were effective in some children. Alternative interventions such as Cog-Fun provide an alternative approach to treatment for children with ADHD so they can lead functional lives in school, home, and other natural environments. What is the Cog-Fun? Can OTs use it? Is it effective? We’ll look at the pilot study published in the AJOT and recent findings to support the use of cog-fun for children with ADHD.

Background

ADHD is characterized by a persistent pattern of inattention and/or hyperactivity–impulsivity that interferes with functioning or development that can affect life at home, school, and other environments. ADHD also lasts into adulthood, but treatment is different for older age groups than pre-schoolers and younger children. ADHD is thought of as a neurobiological disorder that affects the emotions, behavior, and cognitive state of 4%–7% of children worldwide. According to the ADHD institute, the first line intervention for children that are nonpharmacological include 1. Parent-led behavioral interventions 2. Class-room led behavioral interventions and 3. Cognitive behavioral therapy. Interestingly, evidence is also pointing to a shift back to cognitive interventions instead of behaviorally based interventions. To me, this kind of makes sense because ADHD is recognized as playing a large role in impaired executive functioning in regards to neurocognitive impairments. That is kind of what the cognitive-functional approach dails into and addresses as its basis.

Pilot Study

In 2011, a pilot study was published in the American Journal of Occupational Therapy that focused on these executive function deficits to promote improvement in ADHD symptoms. Examples of executive function include memory, planning, and emotional regulation. The cognitive-functional intervention, or cog-fun was based on the dynamic interactional approach by Toglia. This approach highlights the dynamic interaction between the person, the task, and the environment, when addressing problems in performance. One major component of cog-fun based on the dynamic interactional approach is the use of metacognition strategies to emphasize practice in different settings. Metacognition strategies include things like self-monitoring and self-evaluation of thoughts. Metacognition is awareness of your own thoughts, or “thinking about your thinking”.

Intervention

Compared to prior methods such as computerized training which have not been statistically significant, the Cog-fun helps to promote transfer into the goal setting, such as from the therapy clinic to the home. As ADHD institute recommends in its first line intervention using parent-led approaches, the Cog-fun also uses parents and has them attend the therapy as well implement the program in the child’s natural environment, such as at home. The parent’s role at home was to progressively increase the cognitive and behavioral demands of games as children mastered necessary skills. “Basic strategies (inhibition, effort, monitoring, and planning) are learned in a playful setting, practiced according to individualized functional goals that are meaningful to the child and parents…Parents learn to provide necessary supports (i.e., positive verbal mediation, daily planner, timer, checklists) and modifications (i.e., preparing materials in advance, reducing clutter and distractions) for their child in the home environment to promote transfer of strategies and successful occupational performance at home.”

Results

Results pointed to a significant reduction of ADHD symptoms according to parent and teacher ratings. Here are the main points from the research so far.

Main Points

Licensed occupational therapists can implement this program with training in cog-fun.
Certification is awarded to OTs who successfully complete a 6-month 60-hr theoretical and practical training course.
Children who participate will likely already be diagnosed with ADHD based on the DSM.
Parents participate in therapy and in the child’s natural setting such as at home and are key player’s in the child’s success.
The child sets several goals to be achieved in the natural setting. After the completion of 1 goal, the child moves on to the next.
The child learns basic strategies in playful settings based on meaningful functional goals.
The parent provides necessary supports and modifications in the natural environment.

Discussion

So what do you think about the Cog-fun? What do you think are it’s strengths and weaknesses? Although OTs need to be certified to provide cog-fun intervention, what aspects of Cog-fun do you think make it so successful with children who have ADHD?