TY - JOUR
T1 - Reduced Efficacy of Behavior Therapy Following Initial Multimodal Treatment of ADHD
AU - Ramos, Marcela C.
AU - Piscitello, Jennifer
AU - Robertson, Emily
AU - Altszuler, Amy R.
AU - Merrill, Brittany M.
AU - Macphee, Fiona L.
AU - Gnagy, Elizabeth M.
AU - Greiner, Andrew R.
AU - Pelham, William E.
AU - Swanson, James M.
AU - Waxmonsky, James G.
AU - Pelham, William E.
N1 - Publisher Copyright:
© 2024 Society of Clinical Child & Adolescent Psychology.
PY - 2024
Y1 - 2024
N2 - Background: Evidence-based treatments for childhood attention-deficit/hyperactivity disorder (ADHD) include behavioral treatment and psychostimulants, preferably in combination. Research on the treatment of ADHD underscores a gap in the literature regarding the optimal sequencing of treatments (Pelham et al. 2020). Emerging evidence supports starting with behavioral treatment before psychostimulants, though the mechanisms of this sequencing effect are not entirely understood. Objective: This study explores one plausible mechanism–that psychostimulants reduce behaviors targeted by behavioral treatment, thereby reducing opportunities for children to learn and practice self-regulation skills. The article reports post hoc findings from a triple-masked, AB/BA crossover study, conducted in the Summer Treatment Program (STP). Method: Two-hundred forty-eight children diagnosed with ADHD; 77% male; 85% Hispanic) were randomized to receive either (a) intensive behavior therapy plus medication (“COMB”) or (b) intensive behavior therapy plus placebo (“BT”) for 3 weeks, then crossed over to the other condition for 3 weeks. Behavior in recreational settings was systematically recorded and analyzed as a function of medication status and order of treatments. Results: We found evidence that initial medication reduced the efficacy of subsequent behavior therapy. That is, children exhibited significantly more misbehaviors when unmedicated if they started with combined treatment, then had medication withdrawn, than if they started with behavior therapy alone. Conclusion: These findings suggest that starting with a combined treatment approach had an unintended adverse impact on children’s behavioral functioning when medication was withdrawn. The results support current clinical recommendations, which are to start treatment of ADHD with behavior therapy alone and to add medication as necessary.
AB - Background: Evidence-based treatments for childhood attention-deficit/hyperactivity disorder (ADHD) include behavioral treatment and psychostimulants, preferably in combination. Research on the treatment of ADHD underscores a gap in the literature regarding the optimal sequencing of treatments (Pelham et al. 2020). Emerging evidence supports starting with behavioral treatment before psychostimulants, though the mechanisms of this sequencing effect are not entirely understood. Objective: This study explores one plausible mechanism–that psychostimulants reduce behaviors targeted by behavioral treatment, thereby reducing opportunities for children to learn and practice self-regulation skills. The article reports post hoc findings from a triple-masked, AB/BA crossover study, conducted in the Summer Treatment Program (STP). Method: Two-hundred forty-eight children diagnosed with ADHD; 77% male; 85% Hispanic) were randomized to receive either (a) intensive behavior therapy plus medication (“COMB”) or (b) intensive behavior therapy plus placebo (“BT”) for 3 weeks, then crossed over to the other condition for 3 weeks. Behavior in recreational settings was systematically recorded and analyzed as a function of medication status and order of treatments. Results: We found evidence that initial medication reduced the efficacy of subsequent behavior therapy. That is, children exhibited significantly more misbehaviors when unmedicated if they started with combined treatment, then had medication withdrawn, than if they started with behavior therapy alone. Conclusion: These findings suggest that starting with a combined treatment approach had an unintended adverse impact on children’s behavioral functioning when medication was withdrawn. The results support current clinical recommendations, which are to start treatment of ADHD with behavior therapy alone and to add medication as necessary.
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U2 - 10.1080/23794925.2024.2384092
DO - 10.1080/23794925.2024.2384092
M3 - Article
AN - SCOPUS:85201096124
SN - 2379-4925
JO - Evidence-Based Practice in Child and Adolescent Mental Health
JF - Evidence-Based Practice in Child and Adolescent Mental Health
ER -