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

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Abstract

Placebo and three 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, 0.15 mg/kg/dose, 0.3 mg/kg/dose, or 0.6 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., School Psychology Review, 36, 195–216, 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.

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Acknowledgments

This study was funded by a grant from the National Institute of Mental Health (MH62946). During the conduct of this study and preparation of this report, Dr. Pelham was also funded by grants from the National Institutes of Health (MH62946, MH69614, MH53554, MH69434, MH65899, MH78051,MH062946, NS39087, AA11873, DA12414, HD42080), and the Institute of Education Sciences (L03000665A). Dr. Fabiano was supported in part by a Ruth S. Kirschstein National Research Service Award Predoctoral Fellowship (1F31MH064243-01A1) and by the Department of Education, Institute of Education Sciences (R324J06024,, R324B06045).

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Authors and Affiliations

  1. Psychology and Psychiatry, Center for Children and Families MMC, Florida International University, AHC 1 Rm 146, 11200 SW 8th Street, Miami, FL, 33199, USA

    William E. Pelham, Elizabeth M. Gnagy, Erika K. Coles, James G. Waxmonsky & Daniel A. Waschbusch

  2. University at Buffalo, The State University of New York, Buffalo, NY, USA

    Lisa Burrows-MacLean, Gregory A. Fabiano, Kathryn S. Walker & Martin T. Hoffman

  3. Ohio University, Athens, OH, USA

    Brian T. Wymbs & Frances Wymbs

  4. City University of New York, New York City, NY, USA

    Anil Chacko

  5. Kennesaw State University, Kennesaw, GA, USA

    Allison Garefino

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  1. William E. Pelham
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  2. Lisa Burrows-MacLean
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  3. Elizabeth M. Gnagy
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  4. Gregory A. Fabiano
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  7. Anil Chacko
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  8. Kathryn S. Walker
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  9. Frances Wymbs
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  11. Martin T. Hoffman
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  12. James G. Waxmonsky
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  13. Daniel A. Waschbusch
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Correspondence to William E. Pelham.

Additional information

This research was funded by a grant from the National Institute of Mental Health (MH62946). Dr. Pelham was also supported in part by grants from the National Institute of Mental Health (MH092466, MH53554, MH065899, MH62988), the Institute of Education Sciences (R37A120169 LO30000665A, R324B06045), the National Institute of Alcohol Abuse and Alcoholism (AA11873), the National Institute on Drug Abuse (DA12414, DA12986), and the National Institute of Child Health and Human Development (HD040935).

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Pelham, W.E., Burrows-MacLean, L., Gnagy, E.M. et al. A Dose-Ranging Study of Behavioral and Pharmacological Treatment in Social Settings for Children with ADHD. J Abnorm Child Psychol 42, 1019–1031 (2014). https://doi.org/10.1007/s10802-013-9843-8

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