Send to

Choose Destination
J Clin Child Adolesc Psychol. 2016 Jul-Aug;45(4):396-415. doi: 10.1080/15374416.2015.1105138. Epub 2016 Feb 16.

Treatment Sequencing for Childhood ADHD: A Multiple-Randomization Study of Adaptive Medication and Behavioral Interventions.

Author information

a Center for Children and Families, Department of Psychology , Florida International University.
b Department of Counseling, School, and Educational Psychology , State University of New York at Buffalo.
c Department of Psychiatry, Pennsylvania State Hershey Medical Center , Pennsylvania State University.
f Center for Children and Families , Florida International University.
d REACH Institute, Department of Psychology , Arizona State University.
g State University of New York at Buffalo.
h Department of Psychology , Philadelphia College of Osteopathic Medicine.
e Institute for Social Research , University of Michigan.
i Institute for Social Research, Departments of Statistics and Psychiatry , University of Michigan.


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.

[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for PubMed Central
Loading ...
Support Center