A controlled evaluation of behavioral treatment with children with ADHD attending a summer treatment program

Individual treatment response to behavior modification was examined in the context of a summer treatment program. Four children ages 11 to 12 and diagnosed with attention-deficit/hyperactivity disorder were examined in a BABAB design in which a comprehensive behavioral program was utilized and withdrawn across an 8-week period. Dependent measures included frequency counts of negative behaviors, rule violations in recreational and class-room settings, and academic seatwork completion and accuracy. Results documented the effectiveness of the behavioral intervention with all 4 children. Some children showed consistent responses regardless of setting, while others showed differential responses in classroom and recreational settings. In general, behavior worsened progressively over days during the withdrawal weeks. The second withdrawal of treatment produced deleterious effects for several children that persisted for a time even when behavior modification was reinstated. The individual response patterns of each of the 4 children are discussed

Transdermal methylphenidate, behavioral, and combined treatment for children with ADHD

Stimulant medication and behavioral treatments are evidence-based for children with attention-deficit/hyperactivity disorder, but the combination of the 2 treatments has been understudied. In this investigation, methylphenidate (MPH) was crossed with 2 levels of behavior modification (BMOD) in a summer treatment program. Twenty-seven children with attention-deficit/hyperactivity disorder, aged 6-12, participated. Children received placebo and 3 doses of transdermal MPH (12.5 cm2, 25.0 cm2, and 37.5 cm 2). BMOD was implemented on alternating weeks. Both treatments produced large and significant effects. Combined treatment was superior to either treatment alone. The effects of transdermal MPH were comparable to those found in this setting in previous studies with multiple stimulant medications and formulations. Consistent with other research, low doses of MPH-even lower than in previous studies-yielded enhanced effects in combination with behavior modification. Copyright 2005 by the American Psychological Association

A dose-ranging study of a methylphenidate transdermal system in children with ADHD

Objective: This was a multicenter, double-blind, randomized, dose-ranging study of a methylphenidate (MPH) transdermal system (MTS). Medication (placebo, 0.45, 0.9, and 1.8 mg/h) was crossed with application time (6 a.m., 7 a.m.) to evaluate MTS efficacy and influence of exposure time on morning effects. Method: The study took place in a summer treatment program (STP) at three sites, with 36 children aged 7-12 years with attention-deficit/hyperactivity disorder. Each treatment was administered for 1 day in random order, for a total of 8 days. Behavioral and academic measures were taken as well as patch wear characteristics and side effects. Results: Evaluable participant data were analyzed in a series of dose x application time multivariate analyses of variance. All MTS conditions were significantly different from placebo across measures. Time of application had no significant effect on daily behavior, and effects of application time on morning behavior were inconclusive. Consistent with previous results in this setting, the highest dose produced limited incremental benefit compared with the mid-range dose. The wear characteristics of the MTS were acceptable, and the formulation was well tolerated. Conclusions: The MTS produced significant effects that were similar to those previously reported with comparable MPH doses. There does not appear to be a substantial effect of application time on total daily functioning in this setting, further controlled time-course studies will be necessary to evaluate the question of morning onset fully. ©2005 Journal of the American Academy of Child and Adolescent Psychiatry