Single and Combined Effects of Multiple Intensities of Behavioral Modification and Methylphenidate for Children with ADHD in the Home Setting

Behavioral treatment, stimulants, and their combination are the recommended treatments for childhood attention-deficit/hyperactivity disorder (ADHD). The current study utilizes within-subjects manipulations of multiple doses of methylphenidate (placebo, 0.15, 0.30, and 0.60 mg/kg/dose t.i.d.) and intensities of behavioral modification (no, low, and high intensity) in the summer treatment program (STP) and home settings. Outcomes are evaluated in the home setting. Participants were 153 children (ages 5–12) diagnosed with ADHD. In alignment with experimental conditions implemented during the STP day, parents implemented behavioral modification levels in three-week intervals, child medication status varied daily, and the orders were randomized. Parents provided daily reports of child behavior, impairment, and symptoms and self-reported parenting stress and self-efficacy. At the end of the study, parents reported treatment preferences. Stimulant medication led to significant improvements across all outcome variables with higher doses resulting in greater improvement. Behavioral treatment significantly improved child individualized goal attainment, symptoms, and impairment in the home setting and parenting stress and self-efficacy. Effect sizes indicate that behavioral treatment combined with a low-medium dose (0.15 or 0.30 mg/kg/dose) of medication results in equivalent or superior outcomes compared to a higher dose (0.60 mg/kg/dose) of medication alone. This pattern was seen across outcomes. Parents overwhelmingly reported preferring treatment with a behavioral component as a first-choice treatment (99%). Results underscore the need to consider dosing as well as parent preference when utilizing combined treatment approaches. This study provides further evidence that combining behavioral treatment and stimulant medication may reduce the stimulant dose needed for beneficial effects.

This version of the article has been accepted for publication, after peer review (when applicable) and is subject to Springer Nature’s AM terms of use, but is not the Version of Record and does not reflect post-acceptance improvements, or any corrections. The Version of Record is available online at: http://dx.doi.org/10.1007/s10802-023-01093-6

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Work Title Single and Combined Effects of Multiple Intensities of Behavioral Modification and Methylphenidate for Children with ADHD in the Home Setting
Access
Open Access
Creators
  1. Brittany M. Merrill
  2. Fiona L. Macphee
  3. Lisa Burrows-MacLean
  4. Erika K. Coles
  5. Brian T. Wymbs
  6. Anil Chacko
  7. Kathryn Walker
  8. Frances Wymbs
  9. Allison Garefino
  10. Jessica Robb Mazzant
  11. Elizabeth M. Gnagy
  12. James G. Waxmonsky
  13. Greta M. Massetti
  14. Daniel A. Waschbusch
  15. Gregory A. Fabiano
  16. William E. Pelham
Keyword
  1. ADHD
  2. Parent training
  3. Methylphenidate
  4. Treatment preference
  5. Combined treatment
License In Copyright (Rights Reserved)
Work Type Article
Publisher
  1. Research on Child and Adolescent Psychopathology
Publication Date June 29, 2023
Publisher Identifier (DOI)
  1. https://doi.org/10.1007/s10802-023-01093-6
Deposited December 01, 2023

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Version 1
published

  • Created
  • Added Merrill_et_al__2023_June__-_SRP_parent_study-1.pdf
  • Added Creator Brittany M. Merrill
  • Added Creator Fiona L. Macphee
  • Added Creator Lisa Burrows-MacLean
  • Added Creator Erika K. Coles
  • Added Creator Brian T. Wymbs
  • Added Creator Anil Chacko
  • Added Creator Kathryn Walker
  • Added Creator Frances Wymbs
  • Added Creator Allison Garefino
  • Added Creator Jessica Robb Mazzant
  • Added Creator Elizabeth M. Gnagy
  • Added Creator James G. Waxmonsky
  • Added Creator Greta M. Massetti
  • Added Creator Daniel A. Waschbusch
  • Added Creator Gregory A. Fabiano
  • Added Creator William E. Pelham
  • Published
  • Updated Keyword Show Changes
    Keyword
    • ADHD, Parent training, Methylphenidate, Treatment preference, Combined treatment
  • Updated