Cited by 251Attention Deficit Hyperactivity DisorderBehavioral and Psychological StudiesChild and Adolescent Psychosocial and Emotional Development

Treatment Sequencing for Childhood ADHD: A Multiple-Randomization Study of Adaptive Medication and Behavioral Interventions

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Pelham, William E., Fabiano, Gregory A., Waxmonsky, James G., Greiner, Andrew R., Gnagy, Elizabeth M., Pelham, William E., Coxe, Stefany, Verley, Jessica +7 more·2016·Journal of Clinical Child & Adolescent Psychology

Abstract

Behavioral and pharmacological treatments for children with attention deficit/hyperactivity disorder (ADHD) were evaluated to address whether endpoint outcomes are better depending on which treatment is initiated first and, in case of insufficient response to initial treatment, whether increasing dose of initial treatment or adding the other treatment modality is superior. Children with ADHD (ages 5-12, N = 146, 76% male) were treated for 1 school year. Children were randomized to initiate treatment with low doses of either (a) behavioral parent training (8 group sessions) and brief teacher consultation to establish a Daily Report Card or (b) extended-release methylphenidate (equivalent to .15 mg/kg/dose bid). After 8 weeks or at later monthly intervals as necessary, insufficient responders were rerandomized to secondary interventions that either increased the dose/intensity of the initial treatment or added the other treatment modality, with adaptive adjustments monthly as needed to these secondary treatments. The group beginning with behavioral treatment displayed significantly lower rates of observed classroom rule violations (the primary outcome) at study endpoint and tended to have fewer out-of-class disciplinary events. Further, adding medication secondary to initial behavior modification resulted in better outcomes on the primary outcomes and parent/teacher ratings of oppositional behavior than adding behavior modification to initial medication. Normalization rates on teacher and parent ratings were generally high. Parents who began treatment with behavioral parent training had substantially better attendance than those assigned to receive training following medication. Beginning treatment with behavioral intervention produced better outcomes overall than beginning treatment with medication.

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Crossref · 10.1080/15374416.2015.1105138

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  • The dosage of OROS-MPH was sufficient to produce large effects on academic seatwork productivity and classroom behavior and detectable effects on test scores.

    “However, this dosage was sufficient to produce large effects on academic seatwork productivity and classroom behavior and detectable effects on test scores and has been similarly efficacious in numerous prior studies (Fabiano et al., 2007; Pelham Jr. et al., 2016; Pelham, Burrows-MacLean, et al., 2005; Pelham et al., 2001).”

    From The effect of stimulant medication on the learning of academic curricula in children with ADHD: A randomized crossover study. (2022) · cites this paper as Pelham Jr. et al., 2016

    The Methods (Treatment Descriptions; page unavailable) describe a low dose of extended-release methylphenidate selected because prior studies found significant effects over placebo. The Discussion (page unavailable) says that dose was sufficient in the school setting for 53% of children. The paper does not identify the preparation as OROS-MPH or report large effects on seatwork productivity and classroom behavior or detectable effects on test scores. (LLM, conf=0.83)

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3 of the 71 references couldn’t be matched to a known paper.

Research works printed but not linked: 3

  1. Fabiano GA Vujnovic R Pelham WE Waschbusch DA Massetti GM Yu J … Volker M 2010 Enhancing the effectiveness of special education programming for children with ADHD using a daily report card School Psychology Review 39 219 239
  2. Pelham WE 1999 The NIMH multimodal treatment study for ADHD: Just say yes to drugs alone? Canadian Journal of Psychiatry 44 981 990 10637677
  3. Pelham WE Burrows-MacLean L Gnagy EM Fabiano GA Coles EK Wymbs BT … Coxe S 2015 Behavioral, pharmacological, and combined treatment for ADHD: A dose-ranging, between groups analysis Manuscript under review

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Authors
Pelham, W. E., Fabiano, G. A., Waxmonsky, J. G., Greiner, A. R., Gnagy, E. M., Pelham, W. E., Coxe, S., Verley, J., Bhatia, I., Hart, K., Karch, K., Konijnendijk, E., Tresco, K., Nahum-Shani, I., & Murphy, S. A.
Affiliations
  • University at Buffalo, State University of New York (US)
  • Pennsylvania State University (US)
  • Florida International University (US)
  • Philadelphia College of Osteopathic Medicine (US)
  • University of Michigan (US)
Venue
Journal of Clinical Child & Adolescent Psychology
Published
2016-02-16
Volume
45
Issue
4
Pages
396-415
ISSN
  • 1537-4416 (ISSN-L)
  • 1537-4424
OpenAlex
W2276801646
Cited by
251
References
71
Citations by year
2026: 12 · 2025: 13 · 2024: 21 · 2023: 23 · 2022: 28 · 2021: 39 · 2020: 25 · 2019: 27 · 2018: 30 · 2017: 21 · 2016: 10 · 2015: 1 · 2014: 1
FWCI
26.07
Type
journal article
Language
en
Open access
Locations
  • Journal of Clinical Child & Adolescent Psychology (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • Digital Commons - PCOM (Philadelphia College of Osteopathic Medicine) (submittedVersion)
Funders
  • National Institute of Mental Health (MH069614, MH069434, MH092466, MH53554, MH065899, MH62988)
  • National Institute on Alcohol Abuse and Alcoholism (AA11873)
  • National Institute on Drug Abuse (DA12414, DA12986)
  • Institute of Education Sciences (R324B060045, R324J060024, LO30000665A)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
  • Social Sciences › Psychology › Developmental and Educational Psychology › Behavioral and Psychological Studies
  • Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
Keywords
attention deficit hyperactivity disorder, treatment sequencing, behavioral parent training, extended-release methylphenidate, treatment response, student discipline, oppositional behavior, medication adherence, children
MeSH terms
School Teachers, Central Nervous System Stimulants, Attention Deficit Disorder with Hyperactivity, Behavior Therapy, Child, Combined Modality Therapy, Female, Humans, Male, Methylphenidate, Parents, Referral and Consultation, Cohort Studies, Treatment Outcome

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