A Dose-Ranging Study of Behavioral and Pharmacological Treatment in Social Settings for Children with ADHD

Abstract

Placebo and 3 doses of methylphenidate (MPH) were crossed with 3 levels of behavioral modification (no behavioral modification, NBM; low-intensity behavioral modification, LBM; and high-intensity behavior modification, HBM) in the context of a summer treatment program (STP). Participants were 48 children with ADHD, aged 5–12. Behavior was examined in a variety of social settings (sports activities, art class, lunch) that are typical of elementary school, neighborhood, and after-school settings. Children received each behavioral condition for 3 weeks, order counterbalanced across groups. Children concurrently received in random order placebo, .15 mg/kg/dose, .3 mg/kg/dose, or .6 mg/kg/dose MPH, 3 times daily with dose manipulated on a daily basis in random order for each child. Both behavioral and medication treatments produced highly significant and positive effects on children's behavior. The treatment modalities also interacted significantly. Whereas there was a linear dose-response curve for medication in NBM, the dose-response curves flattened considerably in LBM and HBM. Behavior modification produced effects as large as moderate doses, and on some measures, high doses of medication. These results replicate and extend to social-recreational settings previously reported results in a classroom setting from the same sample (Fabiano et al., 2007). Results illustrate the importance of taking dosage/intensity into account when evaluating combined treatments; there were no benefits of combined treatments when the dosage of either treatment was high but combination of the low-dose treatments produced substantial incremental improvement over unimodal treatment.

A Randomized Controlled Trial of a School-Implemented School–Home Intervention for Attention-Deficit/Hyperactivity Disorder Symptoms and Impairment

“…33 If so, an alignment of public policy may substantially ameliorate the current and projected underservice of needy children that is a function of too few child psychiatrists. 9 As a public health measure, this would be consistent with providing the lowest-risk intervention first.…”

Psychosocial Interventions in Attention-Deficit/Hyperactivity Disorder

“…Several studies have indicated that STP participants require lower doses of stimulant medication when participating in the STP, even when delivered in a modified, less intensive fashion. 17,94 STPs have a substantial research base; more than 15 randomized controlled trials (either between-group or crossover design) have been completed, which support the efficacy of STPs. 47 The STP was included in the largest previous intervention study of ADHD, the Multimodal Treatment of ADHD (MTA) Study.…”

“…138,139 Likewise, the STP model, not feasible for many families, is being piloted in a less intensive version in after-school, school, and community settings. 94 Nonetheless, future research should continue to focus on improving psychosocial treatment portability and accessibility. These efforts will likely use various existing technologies (eg, interactive Internetbased treatment and/or training) applied in a more novel fashion to high-risk groups.…”

School-Based Cognitive-Behavioral Therapy for an Adolescent Presenting with ADHD and Explosive Anger: a Case Study

“…Goal 2: Selecting Evidence-Based Interventions Because the developmental and psycho-educational history interview with Dean's mother revealed a grade-school diagnosis of ADHD, overall selection of evidence-based treatment was guided by research support indicating that cognitivebehavior strategies in conjunction with stimulant medication are effective treatment for ADHD symptomology (see Pelham et al 2005;Pelham & Fabiano, 2008;Pelham et al 2014;MTA Cooperative Group, 1999). Due to his limited response to Tier I and II interventions, as well as his mother's high level of motivation and involvement in supporting Dean's success, a comprehensive behavior intervention with home/school collaboration was an appropriate choice for Dean's variegated needs.…”