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Multimodal Treatments for Childhood Attention-deficit/Hyperactivity Disorder: Interpreting Outcomes in the Context of Study Designs

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Abstract

The goal of this article was to outline issues critical to evaluating the literature on incremental benefit of multiple effective treatments used together, vs. a single effective treatment, for childhood ADHD. These issues include: (1) sequencing and dosage of treatments being combined and compared; (2) difficulty drawing valid conclusions about individual components of treatment when treatment packages are employed; (3) differing results emerging from measurement tools that purportedly measure the same domain; and (4) the resultant difficulty in reaching a summary conclusion when multiple outcome measures yielding conflicting results are used. The implications of these issues for the design and conduct of future studies are discussed, and recommendations are made for future research.

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  1. Of course, intensive behavioral therapies, similarly to high doses of medication, have limitations. Specifically, aside from the limited availability and high cost of intensive, complex, direct contingency management programs (see Barkley 2000, for a discussion of this issue in regard to the MTA study), an added difficulty for psychosocial treatment generally is that gains are difficult to maintain outside the treatment setting (Richters et al. 1995). Indeed, generalization of gains and persistence of effects following participation in an intensive behavioral treatment program (e.g., Pelham and Hoza 1996; Pelham et al. 2005b) has not been adequately studied. In addition, follow-up studies into adolescence and young adulthood of children who participated in intensive behavioral treatments as children are rare, and have only recently begun to appear in the literature. Consistent with other long-term follow-up studies of ADHD samples (for a brief review, see Richters et al. 1995), these studies document continuing adjustment problems and risky behaviors into adolescence and adulthood relative to controls (e.g., Flory et al. 2006; Molina et al. 2007; Thompson et al. 2007). This suggests that short-term intensive behavioral treatment, like medication, has limitations.

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Acknowledgments

During the preparation of this manuscript, all authors were supported in part by a grant from the National Institute of Mental Health to the first author: R01 MH065899. The first author also was supported in part by N01 MH12010 to B.S.G. Molina; and the first and third authors were supported in part by R43 MH076359 to A. Terrazas. The views represented in this article are solely those of the authors.

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  1. Elizabeth Hurt

    Present address: Department of Psychology, University of Vermont, 2 Colchester Ave., Burlington, VT, 05405-0134, USA

Authors and Affiliations

  1. Department of Psychology, University of Vermont, 2 Colchester Ave., Burlington, VT, 05405-0134, USA

    Betsy Hoza

  2. Department of Psychiatry, University of California, San Francisco, 401 Parnassus Ave., CPT, San Francisco, CA, 94143-0984, USA

    Nina M. Kaiser

  3. Purdue University, West Lafayette, IN, USA

    Elizabeth Hurt

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Correspondence to Betsy Hoza.

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Hoza, B., Kaiser, N.M. & Hurt, E. Multimodal Treatments for Childhood Attention-deficit/Hyperactivity Disorder: Interpreting Outcomes in the Context of Study Designs. Clin Child Fam Psychol Rev 10, 318–334 (2007). https://doi.org/10.1007/s10567-007-0025-5

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