Program

Nov 29, 2010

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

References

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.

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.

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.

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.