Long-Term Methylphenidate and Multimodal Psychosocial Treatment

Guide to Effective Programs
for Children and Youth

Long-Term Methylphenidate and Multimodal Psychosocial Treatment

OVERVIEW

This two-year methylphenidate and multimodal psychosocial treatment for ADHD is designed to improve the academic functioning, emotional functioning, social skills, and behavior at home and school for children with ADHD and to improve their parents’ child-rearing practices. The treatment combines the usual medicinal treatment of methylphenidate with a multimodal psychosocial treatment over the course of two years. The treatment was compared to methylphenidate only and methylphenidate along with an attention control psychosocial treatment. Positive impacts included an increase in positive and neutral responses from other children and mothers’ increased knowledge of behavioral principles. There was no impact on academic performance, emotional status, positive behavior initiations, or parental practices.

DESCRIPTION OF PROGRAM

Target population: Children with ADHD

Before the start of the intervention, participants complete a five week clinical trial of methylphenidate to confirm that it will have a positive impact with few side effects. The methylphenidate portion of the intervention involves children being given an individualized dose of methylphenidate. After the dose is stabilized, children and parents have monthly medication sessions with a child psychiatrist that last 30 to 45 minutes to assess side effects, overall condition, and provide general support. The multimodal psychosocial treatment portion of the intervention involves parent training/family therapy, academic organizational skills training, individualized academic assistance, academic remediation (if necessary), social skills training, and individual psychotherapy. The parent training, social skills training, and academic organizational skills training components are done in groups. Each component is delivered once a week for the first year, requiring two clinic visits per week, and then once a month in the second year, requiring two clinic visits per month. The multimodal psychosocial treatment targets parental child-rearing behavior, children’s behavior at home and at school, and children’s academic functioning, emotional functioning, and social skills. It was hypothesized that children who received the methylphenidate and multimodal psychosocial treatment would demonstrate higher functioning than children who only received methylphenidate, and that the treatment would be effective because of the specific content of the psychosocial treatment, rather than nonspecific treatments effects. It was also hypothesized that more children who received the combined treatment would be able to stop taking medication, compared with children who did not receive the psychosocial aspect of the treatment, and that the combined treatment would have a long-term impact on functioning. Three papers were published on the treatment, each evaluating different outcomes.

EVALUATIONS OF PROGRAM

Study 1

Hectman, L., Abikoff, H., Klein, R.G., Weiss, G., Respitz, C., Kouri, J., Blum, C., Greenfield, B., Etcovitch, J., Fleiss, K., & Pollack, S. (2004). Academic achievement and emotional status of children with ADHD treated with long-term methylphenidate and multimodal psychosocial treatment. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 812-819.

Evaluated population: 103 children ages 7 to 10 years old with ADHD. The sample was 93 percent male, 84 percent white, 13 percent African-American, 2 percent Hispanic, and 1 percent other.

Approach: Children were randomly assigned to receive methylphenidate and multimodal psychosocial treatment (M + MPT), which is the intervention condition, only methylphenidate (M), which is the usual treatment for ADHD, or methylphenidate and an attention control psychosocial treatment (M + ACT). Participants were assessed on academic performance and emotional status.

Results: There were no differences at the end of the second year of treatment between the three groups for academic performance or emotional status, but all subjects experienced improvements in academic achievement and self-concept, regardless of condition.

Study 2

Abikoff, H., Hecktman, L., Klein, R.G., Gallagher, R., Fleiss, K., Etcovitch, J., Cousins, L., Greenfield, B., Martin, D., & Pollack, S. (2004). Social functioning children with ADHD treated with long-term methylphenidate and multimodal psychosocial treatment. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 820-829.

Evaluated population: See Study 1. This is a follow-up evaluation of the same sample, but examining different outcomes.

Approach: See Study 1 for randomization procedures. Social functioning of participants was assessed through parent and teacher rating scales and direct school observations.

Results: At the end of year one, participants had increased their positive behavior initiations, but there were no differences by condition. At the end of year two, there were no differences between the three groups in terms of parent and teacher ratings or initiation, but the M + MPT group had more positive and neutral responses from other children.

Study 3

Hectman, L., Abikoff, H., Klein, R.G., Greenfield, B., Etcovitch, J., Cousins, L., Fleiss, K., Weiss, M., & Pollack, S. (2004). Children with ADHD treated with long-term methylphenidate and multimodal psychosocial treatment: Impact on parental practices. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 830-838.

Evaluated population: See Study 1. This is a report on the evaluation of the same study, but examining different outcomes, specifically parental practices.

Approach: See Study 1 for randomization procedures. Parents’ knowledge of behavioral principles, parenting satisfaction and efficacy, positive and negative parenting practices, and children’s perception of their parents’ positive and negative parenting practices were assessed.

Results: At the end of the first year there were no differences between the groups. At the end of the second year mothers in the M + MPT and the M groups had increased knowledge of behavioral principles compared with the M + ACT group. There were no treatment effects on parental practices, children’s perceptions of parental practices, or parental satisfaction.

SOURCES FOR MORE INFORMATION

Klein, R.G., Abikoff, H., Hechtman, L., & Weiss, G. (2004). Design and rationale of controlled study of long-term methylphenidate and multimodal psychosocial treatment in children with ADHD. Journal of the Academy of Child and Adolescent Psychiatry, 43, 792-801.

KEYWORDS: Children (3-11), Elementary, Males and Females (Co-ed), Clinic-Provider-based, Counseling/Therapy, Parent or Family Component, Family Therapy, Parent Training/Education, Skills Training, Other Mental Health, Academic Achievement/Grades, Social Skills/Life Skills, Self-Esteem/Self-Concept

Program information last updated 11/29/10.