A DoseRanging Study of Behavioral and Pharmacolog

Authors: William E Pelham Lisa BurrowsMacLean Elizabeth M Gnagy Gregory A Fabiano Erika K Coles Brian T Wymbs Anil Chacko Kathryn S Walker Frances Wymbs Allison Garefino Martin T Hoffman James G Waxmonsky Daniel A Waschbusch

Publish Date: 2014/01/16

Volume: 42, Issue: 6, Pages: 1019-1031

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Abstract

Placebo and three doses of methylphenidate MPH were crossed with 3 levels of behavioral modification no behavioral modification NBM lowintensity behavioral modification LBM and highintensity 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 afterschool settings Children received each behavioral condition for 3 weeks order counterbalanced across groups Children concurrently received in random order placebo 015 mg/kg/dose 03 mg/kg/dose or 06 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 socialrecreational 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 lowdose treatments produced substantial incremental improvement over unimodal treatmentThis 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 HD040935This 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 MH78051MH062946 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 1F31MH06424301A1 and by the Department of Education Institute of Education Sciences R324J06024 R324B06045

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