The Relative Efficacy of Methylphenidate (Ritalin) and Behavior‐modification Techniques in the Treatment of a Hyperactive Child

Abstract

Drug versus placebo effects were contrasted with those of contingency management in the treatment of a hyperactive child. Several criterion behaviors were monitored in two different settings to gauge the breadth and generalizability of drug and behavior-management effects. Medication and contingency management effects were both found to be situation specific. No interaction effects were found. Accuracy of task performance, amount of eye contact with the experimenters, frequency of repetitive hand movements, and distractible behavior were apparently unaffected by medication (Ritalin versus placebo) within the clinic. A multiple-baseline design incorporating contingency reversals revealed the reinforcement contingencies to be the crucial variable controlling behavior within the clinic. Medication effects were shown to be significant within the home setting where reinforcement contingencies were not changed. While aggressive behavior decreased as a function of Ritalin, repetitive hand movements increased.

Clinical Behavioral Pharmacology: Methods for Evaluating Medications and Contingency Management

“…However, there are few well-controlled studies comparing drug and behavioral treatments with the mentally retarded, and results are equivocal. In some studies, behavioral treatments have been more effective than neuroleptics (McConahey, Thompson, & Zimmerman, 1977) and stimulants (Ayllon, Layman, & Kandel, 1975;Christenson, 1975;Rapport, Murphy, & Bailey, 1982;Shafto & Sulzbacher, 1977;Wulbert & Dries, 1977). In another study, behavioral treatment combined with stimulant medication was more effective than either treatment alone (Wells et al, 1981).…”

Ritalin vs. Response Cost in the Control of Hyperactive Children: A Within‐subject Comparison

“…First, "behavior therapy" (Gittelman, Abikoff, Pollack, Klein, Katz, & Mattes, 1980;GittelmanKlein, Klein, Abikoff, Katz, Gloisten, & Kates, 1976;Loney, Weissenburger, Woolson, & Lichty, 1979;O'Leary, Pelham, Rosenbaum, & Price, 1976;Pelham et al, 1980) which consists of an initial training of teachers in behavior management techniques followed by (often weekly) consultation sessions. Second, "direct contingency management" which relies on immediate point reinforcement for appropriate behavior (Ayllon, Layman, & Kandel, 1975;Christensen, 1975;Wulbert & Dries, 1977), point reduction for inappropriate behavior (Rapport, Murphy, & Bailey, 1980), or continuous teacher attention (Shafto & Sulzbacher, 1977).…”

The Speculative Neuroscience of the Future Human Brain

“…In addition, since DA modulates motivation, the increases in DA could also enhance task saliency by facilitating interest in the task, thus improving performance. Despite several countries reporting significant increases in MPH prescriptions in children and young adolescents in the last decade [211][212][213][214], the literature recommends modulating doses depending on context and the kinds of outcomes desired [215][216][217][218]. MPH also has a side-effect profile when used chronically in larger doses than prescribed [219].…”