Treatment Sequencing for Childhood ADHD: A Multiple-Randomization Study of Adaptive Medication and Behavioral Interventions
| Autor: | William E. Pelham, Gregory A. Fabiano, James G. Waxmonsky, Andrew R. Greiner, Elizabeth M. Gnagy, Stefany Coxe, Jessica Verley, Ira Bhatia, Katie Hart, Kathryn Karch, Evelien Konijnendijk, Katy Tresco, Inbal Nahum-Shani, Susan A. Murphy |
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| Rok vydání: | 2016 |
| Předmět: |
Male
Parents medicine.medical_specialty Randomization Psychological intervention Article law.invention Cohort Studies 03 medical and health sciences 0302 clinical medicine Randomized controlled trial Behavior Therapy law Developmental and Educational Psychology medicine Humans 0501 psychology and cognitive sciences Child Referral and Consultation Methylphenidate 05 social sciences Attendance Combined Modality Therapy Clinical Psychology Treatment Outcome Attention Deficit Disorder with Hyperactivity Parent training Physical therapy Central Nervous System Stimulants Female School Teachers Psychology 030217 neurology & neurosurgery Report card 050104 developmental & child psychology Clinical psychology Cohort study medicine.drug |
| Zdroj: | Journal of Clinical Child & Adolescent Psychology. 45:396-415 |
| ISSN: | 1537-4424 1537-4416 |
| Popis: | Behavioral and pharmacological treatments for children with attention deficit/hyperactivity disorder (ADHD) were evaluated to address whether endpoint outcomes are better depending on which treatment is initiated first and, in case of insufficient response to initial treatment, whether increasing dose of initial treatment or adding the other treatment modality is superior. Children with ADHD (ages 5-12, N = 146, 76% male) were treated for 1 school year. Children were randomized to initiate treatment with low doses of either (a) behavioral parent training (8 group sessions) and brief teacher consultation to establish a Daily Report Card or (b) extended-release methylphenidate (equivalent to .15 mg/kg/dose bid). After 8 weeks or at later monthly intervals as necessary, insufficient responders were rerandomized to secondary interventions that either increased the dose/intensity of the initial treatment or added the other treatment modality, with adaptive adjustments monthly as needed to these secondary treatments. The group beginning with behavioral treatment displayed significantly lower rates of observed classroom rule violations (the primary outcome) at study endpoint and tended to have fewer out-of-class disciplinary events. Further, adding medication secondary to initial behavior modification resulted in better outcomes on the primary outcomes and parent/teacher ratings of oppositional behavior than adding behavior modification to initial medication. Normalization rates on teacher and parent ratings were generally high. Parents who began treatment with behavioral parent training had substantially better attendance than those assigned to receive training following medication. Beginning treatment with behavioral intervention produced better outcomes overall than beginning treatment with medication. |
| Databáze: | OpenAIRE |
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