The effectiveness of an experimental treatment when compared to care as usual depends on the type of care as usual

In psychotherapy, effectiveness of an experimental treatment often is compared to care as usual. However, little if any attention has been paid to the heterogeneity of care as usual. The authors examined the effectiveness of manualized behavior therapy on school-aged disruptive behavior disordered (DBD) children in everyday clinical practice. A total of 77 DBD children (8-13 years) were randomly assigned to the Utrecht Coping Power Program (UCPP) condition or the care as usual condition. Care as usual consisted of family therapy (FT) or behavior therapy (BT). Decrease in parent-reported overt aggression was significantly larger in the UCPP condition than in the FT condition, but UCPP and BT did not differ significantly in this respect. The effect sizes of difference scores on other variables were more in favor of UCPP when compared to FT than to BT. The comparison of an experimental treatment to care as usual depends on the type of usual treatment

Which Child Will Benefit From a Behavioral Intervention for ADHD? A Pilot Study to Predict Intervention Efficacy From Individual Reward Sensitivity

Objective: This article aims to assess whether individual differences in reward sensitivity can be used to predict which children with attention-deficit/hyperactivity disorder (ADHD) will benefit most from behavioral interventions that include reinforcement. Methods: A 12-week behavioral intervention was offered to 21 children with ADHD and their parents. Reward sensitivity was assessed prior to the intervention using a combination of psychological and physiological measures. ADHD symptoms were assessed pre- and posttreatment using the Strengths and Weaknesses of ADHD and Normal behavior (SWAN) rating scale. Results: Lower scores on one of the questionnaire scales were associated with greater pre/posttreatment differences in ADHD symptoms. Conclusion: We found that pre/posttreatment change was associated with one measure of parent-rated reward sensitivity. Children with low impulsive negative behavior toward gaining reward improved most during treatment. This result suggests that aspects of reward-related behaviors in ADHD may be useful to predict the effectiveness of treatment