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

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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, Bhatia, Ira, Hart, Katie, Karch, Kathryn, Konijnendijk, Evelien, Tresco, Katy, Nahum-Shani, Inbal, Murphy, Susan A.·2016·Journal of Clinical Child & Adolescent Psychology

DOI 10.1080/15374416.2015.1105138PMC PMC4930381

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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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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)
ORCID: Fabiano, Gregory A.
Waxmonsky, James G.
Coxe, Stefany
Hart, Katie
Nahum-Shani, Inbal
Murphy, Susan A.
Venue: Journal of Clinical Child & Adolescent Psychology
Publisher: Informa UK Limited
Published: 2016-02-16
Volume: 45
Issue: 4
Pages: 396-415
ISSN: 1537-4416 (ISSN-L)
1537-4424
DOI: 10.1080/15374416.2015.1105138
PMC: PMC4930381
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
FWCI: 26.07
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
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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Treatment Sequencing for Childhood ADHD: A Multiple-Randomization Study of Adaptive Medication and Behavioral Interventions

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