title: Randomised social-skills training and parental training plus standard treatment versus standard treatment of children with attention deficit hyperactivity disorder - The SOSTRA trial protocol Separate and combined effects of methylphenidate and behavior modification on boys with attention deficit-hyperactivity disorder in the classroom. Psychotic Side Effects of Psychostimulants: A 5-Year Review Symptomatic improvement in children with ADHD treated with long-term methylphenidate and multimodal psychosocial treatment. Evidence at a glance: error matrix approach for overviewing available evidence 3-year follow-up of the NIMH MTA study. Social functioning in children with ADHD treated with long-term methylphenidate and multimodal psychosocial treatment. GRADE guidelines: 4. Rating the quality of evidence--study limitations (risk of bias). The efficacy and tolerability of methylphenidate and behavior modification in children with attention-deficit/hyperactivity disorder and severe mood dysregulation. PREVALENCE ESTIMATIONS OF ATTENTION-DEFICIT/HYPERACTIVITY DISORDER: DIFFERENTIAL DIAGNOSES AND COMORBIDITIES IN A COLOMBIAN SAMPLE The MTA at 8 years: prospective follow-up of children treated for combined-type ADHD in a multisite study. Intervention Groups for Adolescents With Conduct Problems: Is Aggregation Harmful or Helpful? A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. The MTA Cooperative Group. Multimodal Treatment Study of Children with ADHD. A randomized, controlled trial of integrated home-school behavioral treatment for ADHD, predominantly inattentive type. Social skills and problem-solving training for children with early-onset conduct problems: who benefits? Behavioral versus Behavioral and Pharmacological Treatment in ADHD Children Attending a Summer Treatment Program Effectiveness of an adaptive
  multimodal treatment in children
  with Attention–Deficit Hyperactivity
  Disorder – global outcome A family-school intervention for children with ADHD: results of a randomized clinical trial. Social-Skills and Parental Training plus Standard Treatment versus Standard Treatment for Children with ADHD – The Randomised SOSTRA Trial The effects of the fast track preventive intervention on the development of conduct disorder across childhood. Methylphenidate in aggressive-hyperactive boys: I. Effects on peer aggression in public school settings. Parent-Reported Homework Problems in the MTA Study: Evidence for Sustained Improvement with Behavioral Treatment An efficacy study of a combined parent and teacher management training programme for children with ADHD Responsiveness of children with attention deficit-hyperactivity disorder to reward and response cost: differential impact on performance and motivation. Social skills training with parent generalization: treatment effects for children with attention deficit disorder. Effectiveness of a School-Based Multicomponent Program for the Treatment of Children with ADHD Adult psychiatric status of hyperactive boys grown up. Citation bias of hepato-biliary randomized clinical trials. Feasibility and Preliminary Efficacy of an After-School Program for Middle Schoolers With ADHD Behavioral and stimulant treatment of hyperactive children: a therapy study with methylphenidate probes in a within-subject design. Does brief, clinically based, intensive multimodal behavior therapy enhance the effects of methylphenidate in children with ADHD? Social Skills Training in Children With Attention Deficit Hyperactivity Disorder: A Randomized-Controlled Clinical Trial Hyperactive children treated with stimulants. Is cognitive training a useful adjunct? Behavioral, situational, and temporal effects of treatment of ADHD with methylphenidate. Academic achievement and emotional status of children with ADHD treated with long-term methylphenidate and multimodal psychosocial treatment. Empirical Support for a Treatment Program for Families of Young Children With Externalizing Problems Findings from the NIMH Multimodal Treatment Study of ADHD (MTA): Implications and Applications for Primary Care Providers Effects of methylphenidate alone and in combination with behavior modification procedures on the behavior and academic performance of hyperactive children Transdermal methylphenidate, behavioral, and combined treatment for children with ADHD. National Institute of Mental Health Multimodal Treatment Study of ADHD follow-up: changes in effectiveness and growth after the end of treatment. National Institute of Mental Health Multimodal Treatment Study of ADHD follow-up: 24-month outcomes of treatment strategies for attention-deficit/hyperactivity disorder. Long-term stimulant treatment of children with attention-deficit hyperactivity disorder symptoms. A randomized, double-blind, placebo-controlled trial. Design and rationale of controlled study of long-term methylphenidate and multimodal psychosocial treatment in children with ADHD. Nine Months of Multicomponent Behavioral Treatment for ADHD and Effectiveness of MTA Fading Procedures The effects of a stress-management program on self-concept, locus of control, and the acquisition of coping skills in school-age children diagnosed with attention deficit hyperactivity disorder. Family Processes and Treatment Outcome in the MTA: Negative/Ineffective Parenting Practices in Relation to Multimodal Treatment Parent and Teacher SNAP-IV Ratings of Attention Deficit Hyperactivity Disorder Symptoms Psychosocial Treatment Strategies in the MTA Study: Rationale, Methods, and Critical Issues in Design and Implementation Effects of Methylphenidate on Impulsive Responding in Children With Attention-Deficit Hyperactivity Disorder Methylphenidate and behavior modification in children with ADHD and comorbid ODD or CD: main and incremental effects across settings. Effects of ethnicity on treatment attendance, stimulant response/dose, and 14-month outcome in ADHD. Effects of atomoxetine with and without behavior therapy on the school and home functioning of children with attention-deficit/hyperactivity disorder. Enhancing Behavioral and Social Skill Functioning in Children Newly Diagnosed with Attention-Deficit Hyperactivity Disorder in a Pediatric Setting Influence of Reported Study Design Characteristics on Intervention Effect Estimates From Randomized, Controlled Trials
abstract: Background Children with attention deficit hyperactivity disorder ( ADHD ) are hyperactive and impulsive , can not maintain attention , and have difficulties with social interactions . Medical treatment may alleviate symptoms of ADHD , but seldom solves difficulties with social interactions . Social-skills training may benefit ADHD children in their social interactions . We want to examine the effects of social-skills training on difficulties related to the children 's ADHD symptoms and social interactions . Methods / Design The design is r and omised two-armed , parallel group , assessor-blinded trial . Children aged 8 - 12 years with a diagnosis of ADHD are r and omised to social-skills training and parental training plus st and ard treatment versus st and ard treatment alone . A sample size calculation estimated that at least 52 children must be included to show a 4-point difference in the primary outcome on the Conners 3rd Edition subscale for ' hyperactivity-impulsivity ' between the intervention group and the control group . The outcomes will be assessed 3 and 6 months after r and omisation . The primary outcome measure is ADHD symptoms . The secondary outcome is social skills . Tertiary outcomes include the relationship between social skills and symptoms of ADHD , the ability to form attachment , and parents ' ADHD symptoms . Discussion We hope that the results from this trial will show that the social-skills training together with medication may have a greater general effect on ADHD symptoms and social and emotional competencies than medication alone . Trial registration Clinical Trials ( NCT ) : This study evaluated the separate and combined effects of behavior modification and 2 doses of methylpheni date ( MPH ; 0.3 and 0.6 mg/kg ) compared with baseline ( no behavior modification and a placebo ) on the classroom behavior and academic performance of 31 ADHD ( attention deficit-hyperactivity disorder ) boys attending a summer treatment program . Results revealed significant effects of both interventions , with the mean effect size of medication being more than twice as great as that of behavior modification . Relatively small incremental value was gained by the higher dose of medication or the addition of behavior modification , compared with the effects of the low dose of MPH . In contrast , the addition of either dose of MPH result ed in improvement beyond the effects of behavior modification alone . These group effects reflected those obtained in analyses of individual differences . Furthermore , comparisons of individual responsiveness showed that boys who responded to one treatment also responded to the other Objective : To examine the rate of psychotic and mood-congruent psychotic side effects of stimulant medications in children treated for attention-deficit hyperactivity disorder ( ADHD ) . Method : A chart review was completed of all children diagnosed with ADHD in an outpatient clinic from January 1989 to March 1995 . Results : Over 5 years , 192 children were diagnosed with ADHD . Ninety-eight children received treatment at the clinic with stimulants .  Six children developed psychotic or mood-congruent psychotic symptoms during treatment . Children on medication were followed for an average of 1 year and 9 months . Conclusions : Awareness of the potential for psychotic side effects from stimulant medications is important when prescribing for children . A large prospect i ve study would be useful to predict the frequency and classification of the side effects in children OBJECTIVE To test the hypotheses that in children with attention-deficit/hyperactivity disorder ( ADHD ) ( 1 ) symptoms of ADHD , oppositional defiant disorder , and overall functioning are significantly improved by methylpheni date combined with intensive multimodal psychosocial treatment compared with methylpheni date alone and with methylpheni date plus attention control and ( 2 ) more children receiving combined treatment can be taken off methylpheni date . METHOD One hundred three children with ADHD ( ages 7 - 9 ) , free of conduct and learning disorders , who responded to short-term methylpheni date were r and omized for 2 years to ( 1 ) methylpheni date alone ; ( 2 ) methylpheni date plus psychosocial treatment that included parent training and counseling , social skills training , psychotherapy , and academic assistance , or ( 3 ) methylpheni date plus attention psychosocial control treatment . Assessment s included parent , teacher , and psychiatrist ratings , and observations in academic and gym classes . RESULTS Combination treatment did not lead to superior functioning and did not facilitate methylpheni date discontinuation . Significant improvement occurred across all treatments and continued over 2 years . CONCLUSIONS In stimulant-responsive children with ADHD , there is no support for adding ambitious long-term psychosocial intervention to improve ADHD and oppositional defiant disorder symptoms . Significant benefits from methylpheni date were stable over 2 years Background Clinical evidence continues to exp and and is increasingly difficult to overview . We aim ed at conceptualizing a visual assessment tool , i.e. , a matrix for overviewing studies and their data in order to assess the clinical evidence at a glance . Methods A four-step matrix was constructed using the three dimensions of systematic error , r and om error , and design error . Matrix step I ranks the identified studies according to the dimensions of systematic errors and r and om errors . Matrix step II orders the studies according to the design errors . Matrix step III assesses the three dimensions of errors in studies . Matrix step IV assesses the size and direction of the intervention effect . Results The application of this four-step matrix is illustrated with two examples : peri-operative beta-blockade initialized in relation to surgery versus placebo for major non-cardiac surgery , and antiarrhythmics for maintaining sinus rhythm after cardioversion of atrial fibrillation .  When clinical evidence is deemed both internally and externally valid , the size of the intervention effect is to be assessed . Conclusion The error matrix provides an overview of the validity of the available evidence at a glance , and may assist in deciding which interventions to use in clinical practice OBJECTIVE In the intent-to-treat analysis of the Multimodal Treatment Study of Children With ADHD ( MTA ) , the effects of medication management ( MedMgt ) , behavior therapy ( Beh ) , their combination ( Comb ) , and usual community care ( CC ) differed at 14 and 24 months due to superiority of treatments that used the MTA medication algorithm ( Comb+MedMgt ) over those that did not ( Beh+CC ) . This report examines 36-month outcomes , 2 years after treatment by the study ended . METHOD For primary outcome measures ( attention-deficit/hyperactivity disorder [ ADHD ] and oppositional defiant disorder [ ODD ] symptoms , social skills , reading scores , impairment , and diagnostic status ) , mixed-effects regression models and orthogonal contrasts examined 36-month outcomes . RESULTS At 3 years , 485 of the original 579 subjects ( 83.8 % ) participated in the follow-up , now at ages 10 to 13 years , ( mean 11.9 years ) . In contrast to the significant advantage of MedMgt+Comb over Beh+CC for ADHD symptoms at 14 and 24 months , treatment groups did not differ significantly on any measure at 36 months . The percentage of children taking medication > 50 % of the time changed between 14 and 36 months across the initial treatment groups : Beh significantly increased ( 14 % to 45 % ) , MedMed+Comb significantly decreased ( 91 % to 71 % ) , and CC remained constant ( 60%-62 % ) . Regardless of their treatment use changes , all of the groups showed symptom improvement over baseline . Notably , initial symptom severity , sex ( male ) , comorbidity , public assistance , and parental psychopathology ( ADHD ) did not moderate children 's 36-month treatment responses , but these factors predicted worse outcomes over 36 months , regardless of original treatment assignment . CONCLUSIONS By 36 months , the earlier advantage of having had 14 months of the medication algorithm was no longer apparent , possibly due to age-related decline in ADHD symptoms , changes in medication management intensity , starting or stopping medications altogether , or other factors not yet evaluated OBJECTIVE To test that methylpheni date combined with intensive multimodal psychosocial intervention , which includes social skills training , significantly enhances social functioning in children with attention-deficit/hyperactivity disorder ( ADHD ) compared with methylpheni date alone and methylpheni date plus nonspecific psychosocial treatment ( attention control ) . METHOD One hundred three children with ADHD ( ages 7 - 9 ) , free of conduct and learning disorders , who responded to short-term methylpheni date were r and omized for 2 years to receive ( 1 ) methylpheni date alone , ( 2 ) methylpheni date plus multimodal psychosocial treatment that included social skills training , or ( 3 ) methylpheni date plus attention control treatment . Assessment s included parent , child , and teacher ratings of social function and direct school observations in gym . RESULTS No advantage was found on any measure of social functioning for the combination treatment over methylpheni date alone or methylpheni date plus attention control . Significant improvement occurred across all treatments and continued over 2 years . CONCLUSIONS In young children with ADHD , there is no support for clinic-based social skills training as part of a long-term psychosocial intervention to improve social behavior . Significant benefits from methylpheni date were stable over 2 years In the GRADE approach , r and omized trials start as high- quality evidence and observational studies as low- quality evidence , but both can be rated down if most of the relevant evidence comes from studies that suffer from a high risk of bias . Well-established limitations of r and omized trials include failure to conceal allocation , failure to blind , loss to follow-up , and failure to appropriately consider the intention-to-treat principle . More recently recognized limitations include stopping early for apparent benefit and selective reporting of outcomes according to the results . Key limitations of observational studies include use of inappropriate controls and failure to adequately adjust for prognostic imbalance . Risk of bias may vary across outcomes ( e.g. , loss to follow-up may be far less for all-cause mortality than for quality of life ) , a consideration that many systematic review s ignore . In deciding whether to rate down for risk of bias -- whether for r and omized trials or observational studies -- authors should not take an approach that averages across studies . Rather , for any individual outcome , when there are some studies with a high risk , and some with a low risk of bias , they should consider including only the studies with a lower risk of bias OBJECTIVES This study examines the tolerability and efficacy of methylpheni date ( MPH ) and behavior modification therapy ( BMOD ) in children with attention-deficity/hyperactivity disorder ( ADHD ) and severe mood dysregulation ( SMD ) . METHODS Children ( ages 5 - 12 ) from a summer program for ADHD were screened for SMD and additional manic-like symptoms using structured assessment s and direct clinical interview with the Young Mania Rating Scale ( YMRS ) . The SMD group was comprised of 33 subjects with SMD and elevated YMRS scores ( mean = 23.7 ) . They underwent weekly mood assessment s plus the daily ADHD measures that are part of the program . The comparison group ( n = 68 ) was comprised of the rest of the program participants . Using a crossover design , all subjects in both groups were treated with three varying intensities of BMOD ( no , low , high ) each lasting 3 weeks , with MPH dose ( placebo , 0.15 mg/kg t.i.d . , 0.3mg/kg t.i.d . , and 0.6 mg/kg t.i.d . ) varying daily within each behavioral treatment . RESULTS Groups had comparable ADHD symptoms at baseline , with the SMD group manifesting more oppositional defiant disorder/conduct disorder ( ODD/CD ) symptoms ( p < 0.001 ) . Both groups showed robust improvement in externalizing symptoms ( p < 0.001 ) . There was no evidence of differential treatment efficacy or tolerability . Treatment produced a 34 % reduction in YMRS ratings in SMD subjects ( p - 0.001 ) . However , they still exhibited elevated YMRS ratings , more ODD/CD symptoms ( p < 0.001 ) , and were more likely to remain significantly impaired at home than non-SMD subjects ( p < 0.05 ) . CONCLUSIONS MPH and BMOD are tolerable and effective treatments for children with ADHD and SMD , but additional treatments may be needed to optimize their functioning The aim of this article was to analyze the prevalence of Attention Deficit/ Hyperactivity Disorder ( ADHD ) in Colombian Paisa children and adolescents . A r and omized sample of 4- to 17-year-old children and adolescents--176 males and 154 females -- was selected from schools in Manizales , Colombia . The diagnosis of ADHD was obtained using a semistructured psychiatric and neurological interview , medical histories revision , and neurological or psychiatric evaluations .  Several rating scales and a neuropsychological assessment  were administered in order to confirm the diagnosis . Children with Full Scale Intelligence Quotient ( FSIQ ) between 71 and 84 were recorded as having Borderline Intellectual Functioning ( BIF ) , and those with a history of mild motor retardation , and /or Performance Intelligence Quotient ( PIQ ) lower than 71 , were recorded as having a Developmental Coordination disorder ( DCD ) , after confirmation by neurological and neuropsychological examinations . BIF and DCD children were excluded from the ADHD group . Total prevalence of ADHD adjusted by sex was 16.4 % ( males 19.8 % and females 12.3 % ) . Prevalence of clean ADHD cases was 11.5 % , distrib uted as follows : combined type , 6.4 % ; inattentive , 4.8 % ; and hyperactive-impulsive , 0.3 % . Distribution by sex was as follows : males , 14.8 % ; and females , 7.7 % ; with an odds ratio of 2.1 ( 95 % CI : 1 - 4.5 , h 2 = 4.0 , p < . 05 ) . Clean prevalence of ADHD adjusted by equal sex distribution was 11.3 % . Prevalence of BIF was 5.8 % , DCD 3.0 % , and mild mental retardation 3.9 % . Prevalence of ADHD did not show differences by socioeconomic status ( SES ) , in contrast to mild mental retardation in which BIF and DCD were significantly more frequent in the lower SES OBJECTIVES To determine any long-term effects , 6 and 8 years after childhood enrollment , of the r and omly assigned 14-month treatments in the NIMH Collaborative Multisite Multimodal Treatment Study of Children With Attention-Deficit/Hyperactivity Disorder ( MTA ; N = 436 ) ; to test whether attention-deficit/hyperactivity disorder ( ADHD ) symptom trajectory through 3 years predicts outcome in subsequent years ; and to examine functioning level of the MTA adolescents relative to their non-ADHD peers ( local normative comparison group ; N = 261 ) . METHOD Mixed-effects regression models with planned contrasts at 6 and 8 years tested a wide range of symptom and impairment variables assessed by  parent , teacher , and youth report . RESULTS In nearly every analysis , the originally r and omized treatment groups did not differ significantly on repeated measures or newly analyzed variables ( e.g. , grade s earned in school , arrests , psychiatric hospitalizations , other clinical ly relevant outcomes ) . Medication use decreased by 62 % after the 14-month controlled trial , but adjusting for this did not change the results . ADHD symptom trajectory in the first 3 years predicted 55 % of the outcomes . The MTA participants fared worse than the local normative comparison group on 91 % of the variables tested . CONCLUSIONS Type or intensity of 14 months of treatment for ADHD in childhood ( at age 7.0 - 9.9 years ) does not predict functioning 6 to 8 years later . Rather , early ADHD symptom trajectory regardless of treatment type is prognostic . This finding implies that children with behavioral and sociodemographic advantage , with the best response to any treatment , will have the best long-term prognosis . As a group , however , despite initial symptom improvement during treatment that is largely maintained after treatment , children with combined-type ADHD exhibit significant impairment in adolescence . Innovative treatment approaches targeting specific areas of adolescent impairment are needed Past research has suggested that the aggregation of deviant peers during treatment may cause harmful effects ( T. J. Dishion , J. McCord , & F. Poulin , 1999 ) . This study compared the effectiveness of problem-solving skills training groups in which all members had conduct problems ( “ pure ” group condition ) with  groups that consisted of adolescents with and without behavior problems ( “ mixed ” group condition ) . Participants were 139 sixth- and seventh- grade rs ( mean age = 12.7 ; 63 % male ; 55 % White ) enrolled at public middle schools . Pre- , post- , and 6-month follow-up data were collected , along with intervention process variables . Results showed that , contrary to the deviancy training hypothesis , adolescents in the pure-group condition engaged in more adaptive in-session behavior and received lower scores on the parent and teacher ratings of externalizing behavior at postintervention than those in the mixed-group condition . Mediation analyses showed that the deviancy training that occurred in the mixed-group condition accounted for their worse postintervention scores , findings consistent with the deviancy training hypothesis BACKGROUND Previous studies have demonstrated the short-term efficacy of pharmacotherapy and behavior therapy for attention-deficit/hyperactivity disorder ( ADHD ) , but no longer-term ( i.e. , > 4 months ) investigations have compared these 2 treatments or their combination . METHODS A group of 579 children with ADHD Combined Type , aged 7 to 9.9 years , were assigned to 14 months of medication management ( titration followed by monthly visits ) ; intensive behavioral treatment ( parent , school , and child components , with therapist involvement gradually reduced over time ) ; the two combined ; or st and ard community care ( treatments by community providers ) . Outcomes were assessed in multiple domains before and during treatment and at treatment end point ( with the combined treatment and medication management groups continuing medication at all assessment points ) . Data were analyzed through intent-to-treat r and om-effects regression procedures . RESULTS All 4 groups showed sizable reductions in symptoms over time , with significant differences among them in degrees of change . For most ADHD symptoms , children in the combined treatment and medication management groups showed significantly greater improvement than those given intensive behavioral treatment and community care . Combined and medication management treatments did not differ significantly on any direct comparisons , but in several instances ( oppositional/aggressive symptoms , internalizing symptoms , teacher-rated social skills , parent-child relations , and reading achievement )  combined treatment proved superior to intensive behavioral treatment and /or community care while medication management did not . Study medication strategies were superior to community care treatments , despite the fact that two thirds of community-treated subjects received medication during the study period . CONCLUSIONS For ADHD symptoms , our carefully crafted medication management was superior to behavioral treatment and to routine community care that included medication . Our combined treatment did not yield significantly greater benefits than medication management for core ADHD symptoms , but may have provided modest advantages for non-ADHD symptom and positive functioning outcomes OBJECTIVE To evaluate the efficacy of a behavioral psychosocial treatment integrated across home and school ( Child Life and Attention Skills Program ) with attention-deficit/hyperactivity disorder ( ADHD ) predominantly inattentive type ( ADHD-I ) . METHOD Sixty-nine children ages 7 to 11 years were r and omized to the Child Life and Attention Skills Program or a control group who did not receive the intervention .  We compared groups posttreatment and at 3- to 5-month follow-up on parent and teacher ratings of inattention , sluggish cognitive tempo , and functional impairment . RESULTS Children r and omized to the Child Life and Attention Skills Program were reported to have significantly fewer inattention and sluggish cognitive tempo symptoms , and significantly improved social and organizational skills , relative to the control group . Gains were maintained at follow-up . CONCLUSIONS Behavioral psychosocial treatment , when specifically adapted for ADHD-I and coordinated among parents , teachers , and children , appears efficacious in reducing symptoms and impairment associated with Families of 99 children with early-onset conduct problems , aged 4 - 8 years , were r and omly assigned to a  child training treatment group ( CT ) utilizing the Incredible Years Dinosaur Social Skills and Problem Solving Curriculum or a waiting-list control group ( CON ) . Post-treatment CT children had significantly fewer externalizing problems at home , less aggression at school , more prosocial behavior with peers , and more positive conflict management strategies than CON children . Significantly more CT than CON children showed clinical ly significantly improvements on reports and independent observations of aggressive and noncompliant behavior . The differential treatment response was evaluated according to child comorbidity with attention deficit hyperactivity disorder ( ADHD ) , parenting discipline practice s. and family risk factors . The only risk factor related to failure to make improvements in child conduct problems after treatment was negative parenting ( i.e. , maternal critical statements and physical force ) . The long-term follow-up 1 year later indicated that most of the significant post-treatment changes were maintained As part of the behavioral treatment in the Multimodal Treatment Study of Children with ADHD ( MTA ) , children participated in an intensive summer treatment program ( STP ) . This study examined the differences between 57 children in the combined treatment ( Comb ) group , who were medicated , and 60 children in the behavioral treatment ( Beh ) group , who were unmedicated throughout the STP .  Comb children were significantly better than Beh on 5 measures : rule following , good sportsmanship , peer negative nominations , and STP teacher posttreatment ratings of inattention/overactivity . Groups did not differ on any of the other 30 measures , and responded similarly to the STP over time . Comparisons to normative data revealed that Comb children were more likely to fall within the normative range on 6 measures . The differences between these results and the main MTA results , in which Comb was always superior to Beh , are discussed in terms of the relative intensity of combined treatments . The implication s for future studies of pharmacological and behavioral treatment for ADHD are discussed Abstract Background The meaning of different components within a multimodal treatment of ADHD remains to be further clarified . Objective To evaluate the effectiveness of  behaviour therapy  and drug treatment  within an adaptive and individually tailored multimodal treatment for children with ADHD . Method After an initial psychoeducation n = 75 school-children aged 6–10 years with a diagnosis of ADHD/HKD were assigned to either behaviour therapy ( including continued psychoeducation ) or medical management with methylpheni date plus psychoeducation . Depending on the effectiveness , the treatment was either terminated ( if totally effective ) with long – term aftercare and continuation of medication if needed , or ( if partially effective ) the other treatment component was added ( combined treatment ) , or ( if ineffective ) the treatment components were replaced . Thus a treatment rationale was applied which result ed in an adaptive and individually tailored therapy – similar to a strategy that may be useful in clinical practice . Results Of the children who started with behaviour therapy after initial psychoeducation 26 % received a combined treatment in later treatment stages . In most of the cases ( 82 % ) with initial medical management , behaviour therapy was added . ADHD symptoms , individually defined behaviour problems and comorbid symptoms were significantly reduced during the course of treatment . On core measures large pre – post effect sizes were found . On teacher ratings  combined treatment was more effective than behaviour therapy . Conclusions Both , behaviour therapy and combined treatment are effective interventions within an adaptive and individually tailored multimodal treatment strategy OBJECTIVE Accumulating evidence highlights the importance of using psychosocial approaches to intervention for children with attention-deficit/hyperactivity disorder ( ADHD ) that target the family and school , as well as the intersection of family and school . This study evaluated the effectiveness of a family-school intervention , Family-School Success ( FSS ) , design ed to improve the family and educational functioning of students in Grade s 2 - 6 who meet criteria for ADHD combined and inattentive types . Key components of FSS were conjoint behavioral consultation , daily report cards , and behavioral homework interventions . METHOD FSS was provided over 12 weekly sessions , which included 6 group sessions , 4 individualized family sessions , and 2 school-based consultations .  Participating families were given the choice of placing their children on medication ; 43 % of children were on medication at the time of r and om assignment . Children ( n = 199 ) were r and omly assigned to FSS or a comparison group controlling for non-specific treatment effects ( Coping With ADHD Through Relationships and Education [ CARE ] ) . Outcomes were assessed at post-intervention and 3-month follow-up . The analyses controlled for child medication status . RESULTS FSS had a significant effect on the quality of the family-school relationship , homework performance , and parenting behavior . CONCLUSIONS The superiority of FSS was demonstrated even though about 40 % of the participants in FSS and CARE were on an optimal dose of medication and there were significant time effects on each measure . This relatively brief intervention produced effect sizes comparable to those of the more intensive Multimodal Treatment Study of Children With ADHD ( MTA ) behavioral intervention Objective To investigate the effects of social-skills training and parental training programme for children with attention deficit hyperactivity disorder ( ADHD ) .  Methods We conducted a r and omized two-armed , parallel group , assessor-blinded superiority trial consisting of social-skills training plus parental training and st and ard treatment versus st and ard treatment alone . A sample size calculation showed at least 52 children should be included for the trial with follow up three and six months after r and omization . The primary outcome measure was ADHD symptoms and secondary outcomes were social skills and emotional competences . Results 56 children ( 39 boys , 17 girls , mean age 10.4 years , SD 1.31 ) with ADHD were r and omized , 28 to the experimental group and 27 to the control group . Mixed-model analyses with repeated measures showed that the time course ( y = a + bt + ct2 ) of ADHD symptoms ( p = 0.40 ) , social skills ( p = 0.80 ) , and emotional competences ( p = 0.14 ) were not significantly influenced by the intervention . Conclusions Social skills training plus parental training did not show any significant benefit for children with attention deficit hyperactivity disorder when compared with st and ard treatment . More and larger r and omized trials are needed . Trial Registration Clinical Trials.gov The impact of the Fast Track intervention on  externalizing disorders across childhood was examined . Eight hundred-ninety-one early-starting children ( 69 % male ; 51 % African American ) were r and omly assigned by matched sets of schools to intervention or control conditions . The 10-year intervention addressed parent behavior-management , child social cognitive skills , reading , home visiting , mentoring , and classroom curricula . Outcomes included psychiatric diagnoses after grade s 3 , 6 , 9 , and 12 for conduct disorder , oppositional defiant disorder , attention deficit hyperactivity disorder , and any externalizing disorder . Significant interaction effects between intervention and initial risk level indicated that intervention prevented the lifetime prevalence of all diagnoses , but only among those at highest initial risk , suggesting that targeted intervention can prevent externalizing disorders to promote the raising of healthy children One of the least documented " known " effects of methylpheni date in hyperactive children is the suppression of peer aggression . In this study , 11 aggressive-hyperactive children received a low ( 0.3 mg/kg ) and moderate ( 0.6 mg/kg ) dose of methylpheni date and placebo for 2 weeks each under double-blind conditions . Children were observed in public school setting s during classroom seatwork activities , lunch , and recess . Results showed that methylpheni date suppressed nonphysical aggression ( p = 0.06 ) in the classroom , and a moderate dose decreased physical aggression ( p less than 0.01 ) and verbal aggression ( p = 0.07 ) on the playground . The effect on the rate of appropriate social interaction was variable . The majority of subjects exhibited either the same or higher levels of appropriate social interaction on the 0.6 mg/kg dose compared with placebo . In the classroom , both doses of methylpheni date also result ed in reduced levels of motor movement , off-task behavior , noncompliance , and disruptiveness . Teacher ratings of hyperactivity and conduct problem symptoms revealed drug effects , whereas parallel parent instruments did not Parent-report of  child homework problems was examined as a treatment outcome variable in the MTA – Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder ( ADHD ) . Five hundred seventy-nine children ages 7.0 to 9.9 were r and omly assigned to either medication management , behavioral treatment , combination treatment , or routine community care . Results showed that only participants who received behavioral treatment ( behavioral and combined treatment ) demonstrated sustained improvements in homework problems in comparison to routine community care . The magnitude of the sustained effect at the 10-month follow-up assessment was small to moderate for combined and behavioral treatment over routine community care ( d = .37 , .40 , respectively ) . Parent ratings of initial ADHD symptom severity was the only variable found to moderate these effects Background : Several parent training programmes and behavioural teacher training programmes built on learning theory have been developed for problem prevention and treatment of attention-deficit/hyperactivity disorder ( ADHD ) and /or oppositional defiant disorder ( ODD ) during the last few decades . Group format has often been used for parent training but single-subject design s are more common in teacher training . More studies have focussed on pre-school children than on older children , and a minority have been conducted in public mental health setting s. Aim : This study aim ed to evaluate a combined parent and teacher manual-based group training programme for children with ADHD conducted by the staff at a child and adolescent psychiatric clinic in Sweden . Method : The intervention was a modified version of Barkley 's programme .  Children were r and omized to an Intervention or a Control group .  Sixty-one parents and 68 teachers answered questions about ADHD and ODD symptoms , and about behavioural problems when the study started and at a 3-month follow-up . Results : Results showed that the intervention result ed in a reduction of the number of children who met DSM-IV criteria for ADHD and /or ODD . Effects were more pronounced in the home setting than in the school setting , and were further accentuated when both parents and teachers of the same child took part in the intervention . Teachers with more problematic classroom situations benefited most from the intervention . Conclusion : The programme , “ Strategies in Everyday Life ” , has , in a regular clinical setting , demonstrated promising effects on children 's disruptive behaviour , and a clinical implication was to recommend involving both parents and teachers in the programme Using a within-subject design and both high- and low-interest tasks , this study examined the effects of reward ( R ) , response cost ( RC ) , and no contingency ( NR ) on performance and motivation of 22 children with attention deficit-hyperactivity disorder ( ADHD ) and 22 controls . Dependent variables included performance measures , self-rated performance and motivation , and a new measure of behavioral motivation based on a 2-min postcontingency task .  Both contingencies benefited some aspects of the performance of ADHD children ; relative to R , RC showed stronger effects but at the expense of decreased self-rated motivation on the low-interest task . The performance of controls did not differ across tasks , whereas ADHD children performed relatively better on the high-interest task . Neither contingency decreased motivation measures relative to NR for either group . For ADHD children , motivational effects appeared to be influenced by self-perceptions of performance The effectiveness of brief social skills training ( SST ) was evaluated in a controlled outcome study with 27 children meeting criteria of the Diagnostic and Statistical Manual of Mental Disorders ( 3rd ed . , revised ; American Psychiatric Association , 1987 ) for an attention deficit disorder . Children were r and omly assigned to either SST with parent-mediated generalization ( SST-PG ) , child-only SST , or a wait-list control group . SST consisted of 8 group sessions in which skill modules were taught sequentially . Parents of children in the SST-PG group simultaneously participated in group generalization training design ed to support their children 's transfer of skills . Significant improvement in children 's skill knowledge and in parent reports of social skills and disruptive behavior occurred for both treatment groups relative to the wait-list control group and maintained at a 4-month follow-up . More modest evidence was found for generalization of SST to the school setting The objective of this study was to evaluate the efficacy of a multicomponent program for treating attention-deficit/hyperactivity disorder ( ADHD ) carried out by teachers in a classroom context . Dependent measures included neuropsychological tasks , behavioral rating scales for parents and teachers , direct observation of behavior in the classroom , and academic records of children with ADHD . Fifty children with ADHD participated in the study . The teachers of 29 of the 50 students  were trained in the use of behavior modification techniques , cognitive behavior strategies , and instructional management strategies . The other 21 students formed the  control group . Parents ' and teachers'ratings detected improvements in primary symptoms ( inattention — disorganization , hyperactivity — impulsivity ) and in behavioral difficulties usually associated with ADHD ( e.g. , antisocial behavior , psychopathological disorders , anxiety ) . Furthermore , the results showed increased academic scores , enhanced classroom behavioral observations , and improved teachers ' knowledge about the strategies directed toward responding to the children 's educational needs OBJECTIVE Numerous studies have examined the adolescent and young adult fate of children with attention deficit hyperactivity disorder ( ADHD ) .  In marked contrast , relatively little is known about the adult outcome of these children . There have been only two controlled , prospect i ve studies of psychiatric status into adulthood . The present study was conducted to gain further underst and ing of the natural course of this common childhood condition . METHOD This was a prospect i ve follow-up of clinical ly diagnosed , white boys of average intelligence who were referred by teachers to a child psychiatric research clinic at an average age of 7.3 years . At a mean age of 24.1 years , 85 prob and s ( 82 % of the childhood cohort ) and 73 comparison subjects ( 94 % of adolescent comparison subjects ) were directly interviewed by trained clinicians who were blind to group status . RESULTS Evaluations of the prob and s and comparison subjects indicated significantly higher prevalences of antisocial personality disorder ( 12 % versus 3 % ) and nonalcohol substance abuse ( 12 % versus 4 % ) in the prob and s , whereas mood disorders ( 4 % versus 4 % ) and anxiety disorders ( 2 % versus 7 % ) were not significantly different . At adult follow-up , ADHD was rare , occurring in only 4 % of the prob and s ( no comparison subjects ) . CONCLUSIONS The results of the present study are consistent with the authors ' previously reported major findings . They strongly suggest that children with ADHD are at significantly higher risk for a specific negative course marked by antisocial and substance-related disorders The objective of this study was to assess whether trials with a positive ( i.e. , statistically significant ) outcome are cited more often than negative trials . We review ed 530 r and omized clinical trials on hepato-biliary diseases published in 11 English- language journals indexed in MEDLINE from 1985 - 1996 . From each trial , we extracted the statistical significance of the primary study outcome ( positive or negative ) , the disease area , and method ological quality ( r and omization and double blinding ) . The number of citations during two calendar years after publication was obtained from Science Citation Index . There was a significant positive association between a statistically significant study outcome and the citation frequency ( beta , 0.55 , 95 % confidence interval , 0.39 - 0.72 ) . The disease area and adequate generation of the allocation sequence were also significant predictors of the citation frequency . We concluded that positive trials are cited significantly more often than negative trials . The association was not explained by disease area or method ological quality Objective : This pilot study tests the feasibility and preliminary efficacy of an after-school treatment program for middle schoolers with ADHD using a r and omized clinical trial design . Method : A total of 23 students with ADHD ( 25 % female , 48 % African American ) from a large public middle school were r and omly assigned to a 10-week program or to community comparison . Manualized treatment targeted educational , social , and recreational skills , homework completion , and school and home behavior . Parents participated . Results : Recruitment and r and omization targets were easily met ( 87 % completion ) . Parent and teacher satisfaction was positive . Small to medium treatment effects result ed despite greater medication use in the control group , with improvements in functioning for the program-treated youth or absence of deterioration relative to the comparison group . Conclusion : Despite testing an abbreviated version of the after-school program ( < 5 months ) , this study reveals feasibility and palatability for this intervention and modest beneficial effects on behavioral and academic outcomes . ( J. of Att . Dis . 2008 ; 12(3 ) 207 - 217 Eight hyperactive children were treated with a behavioral intervention focusing on teacher and parent training over a period of 5 months . Three times , before therapy and after 3 weeks and 13 weeks of intervention , children received methylpheni date during 3-week probe periods . Each week in a probe they received either a placebo , .25 mg/kg , or .75 mg/kg methylpheni date .  Classroom observation of on-task behavior suggested that effectiveness of the behavioral intervention was between that of the two dosages of medication before therapy . Both dosages result ed in higher levels of on-task behavior when administered after 13 weeks of behavioral intervention than when administered before therapy . Teacher rating data showed equivalent effects of therapy and the low dosage of methylpheni date alone but a stronger effect of the high dose alone ; only the high dose result ed in improved behavior after 13 weeks of behavioral intervention . As a group , only when they received the high dose of methylpheni date after 13 weeks of behavioral intervention did children reach the level of appropriate behavior shown by nonhyperactive controls . However , this level was also reached by two children with the low dose and by one child without medication , and it was not reached by one child . The results suggest that the combination of psychostimulant medication and behavior therapy may be more effective in the short-term than either treatment alone for hyperactive children in school setting s. In addition , parent ratings and clinic observation of parent-child interactions suggested that children had improved in the home setting , high-lighting the importance of behavioral parent training in the treatment of hyperactivity Objective The additional value of a short-term , clinical ly based , intensive multimodal behavior therapy to optimally titrated methylpheni date in children with attention-deficit hyperactivity disorder ( ADHD ) was investigated . Method Fifty children with ADHD ( ages 8–12 ) were r and omized to treatment of methylpheni date or treatment with methylpheni date combined with 10 weeks of multimodal behavior therapy . The multimodal behavior therapy consisted of a child and parent behavioral therapy and a teacher behavioral training . Assessment s included parent , teacher and child ratings of ADHD symptoms , oppositional and conduct behavior , social skills , parenting stress , anxiety and self-worth . Results Both treatment conditions yielded significant improvements on all outcome domains . No significant differences were found between both treatments . Conclusions No evidence was found for the additive effect of multimodal behavior therapy next to optimally titrated methylpheni date . Clinical implication sThis study does not support the expectation that optimally dosed stimulant treated children with ADHD should routinely receive psychosocial treatment to further reduce ADHD- and related symptoms Evaluated efficacy of social skills training ( SST ) on children with 2 subtypes of attention deficit hyperactivity disorder ( ADHD ) . Participants were 120 children ( 30 girls , 90 boys ) , ages 8 to 12 with ADHD-Inattentive type ( ADHD-I ; n = 59 ) or Combined type ( ADHD-C ; n = 61 ) . The children were r and omly assigned within diagnosis subtype to the treatment condition ( 8 weeks of SST ) or the no-intervention control condition . SST led to greater improvements in both parent- and child-perceived assertion skills in the children with ADHD , yet did not affect the other domains of social competence . Diagnostically heterogeneous groups led to greater improvements on parent-report of their child 's cooperation and assertion abilities as well as children 's report of their own empathy skills . Diagnostically homogeneous groups led to greater decreases in externalizing behaviors at posttreatment but not at follow-up . Children with comorbid oppositional defiant disorder ( ODD ) did not benefit as much from the intervention . Children with ADHD-I improved in assertion skills more than children with ADHD-C , yet the 2 diagnostic entities did not differ in improvement levels across all other social skills We evaluated whether , among hyperactive children who required maintenance stimulant treatment , cognitive training enhanced academic performance ; improved the functioning of  youngsters who had only a partial behavioral response to medication ; facilitated withdrawal of stimulant treatment ; and enhanced maintenance effects of academic gains following termination of stimulants . A 16-week cognitive training program that emphasized reflective problem-solving strategies and social problem-solving skills was compared with an attention control treatment and with no training . There was virtually no evidence of efficacy of cognitive training . No significant treatment effects were obtained on academic , behavioral , and cognitive measures .  Cognitive training did not improve behavior among children with residual problems , nor did it facilitate the withdrawal of medication . With placebo substitution , the overwhelming majority of children required remedication , regardless of previous exposure to cognitive training OBJECTIVE To determine the behavioral , situational , and temporal effects of 4 months of methylpheni date ( MPH ) treatment for attention-deficit hyperactivity disorder ( ADHD ) . METHOD Ninety-one children with ADHD were r and omly assigned to receive either MPH ( titrated to a target dose of 0.7 mg/kg twice a day ) or a placebo . Treatment effects were investigated with measures sensitive to various behaviors ( core and associated symptoms ) , situations ( home and school ) , time periods ( morning and afternoon , after reaching the target dose , and after 4 months of treatment ) , and side effects . RESULTS MPH treatment improved symptoms of ADHD and oppositional behavior at school , both in the morning and afternoon , but not at home . Side effects ( increase in physiological and effective symptoms , lack of weight gain ) were significantly more frequent with MPH than with placebo treatment . Benefit was evident after titration , but the onset of some side effects was delayed . Side effects were reported by parents but not by teachers . CONCLUSIONS Positive effects of MPH on behavior are evident in the classroom , but with MPH given twice daily , parents do not report that MPH improves behavior at home . Greater impact on home behavior may require three times daily MPH and combined treatments OBJECTIVE To test the hypothesis that intensive multimodal psychosocial intervention ( that includes academic assistance and psychotherapy ) combined with methylpheni date significantly enhances the academic performance and emotional status of children with attention-deficit/hyperactivity disorder ( ADHD ) compared with methylpheni date alone and with methylpheni date combined with nonspecific psychosocial treatment ( attention control ) . METHOD One hundred three children with ADHD ( ages 7 - 9 ) , free of conduct and learning disorders , who responded to short-term methylpheni date were r and omized for 2 years to receive one of three treatments : ( 1 ) methylpheni date alone , ( 2 ) methylpheni date plus psychosocial treatment that included academic remediation , organizational skills training , and psychotherapy as well as parent training and counseling and social skills training , or ( 3 ) methylpheni date plus attention control treatment . Children 's function was assessed through academic testing , parent ratings of homework problems , and self-ratings of depression and self-esteem . RESULTS No advantage was found on any measure of academic performance or emotional status for the combination treatment over methylpheni date alone and over methylpheni date plus attention control . Significant improvement occurred across all treatments and was maintained over 2 years . CONCLUSIONS In stimulant-responsive young children with ADHD without learning and conduct disorders , there is no support for academic assistance and psychotherapy to enhance academic achievement or emotional adjustment . Significant short-term improvements were maintained over 2 years We evaluated the efficacy of a manualized multimodal treatment program for young externalizing children . Families were assigned r and omly to an immediate 12-week parent and child treatment condition ( n = 24 ) or to a  delayed-treatment condition ( n = 23 ) . Parents had high attendance , high satisfaction with treatment , and increased knowledge of behavior management principles . Relative to the waitlist condition , treatment parents reported statistically and clinical ly significant reductions in child behavior problems , improved parenting practice s ( i.e. , increased consistency , decreased power assertive techniques ) , an increased sense of efficacy , and reduced parenting stress . There was a trend toward parents improving their attitudes toward their children . In considering the process of change , we found evidence that improved parenting practice s mediated reductions in child behavior problems and that child improvements mediated changes in parent attitudes and stress . Five months following treatment , teachers reported significant improvements in child behaviors , whereas parents reported that reductions in child behavior problems and parenting stress were maintained In 1992 , the National Institute of Mental Health and 6 teams of investigators began a multisite clinical trial , the Multimodal Treatment of Attention-Deficit Hyperactivity Disorder ( MTA ) study . Five hundred seventy-nine children were r and omly assigned to either routine community care ( CC ) or one of three study -delivered treatments , all lasting 14 months . The three MTA treatments-monthly medication management ( usually methylpheni date ) following weekly titration ( MedMgt ) , intensive behavioral treatment ( Beh ) , and the combination (Comb)-were design ed to reflect known best practice s within each treatment approach . Children were assessed at four time points in multiple outcome . Results indicated that Comb and MedMgt interventions were substantially superior to Beh and CC interventions for attention-deficit hyperactivity disorder symptoms . For other functioning domains ( social skills , academics , parent-child relations , oppositional behavior , anxiety/depression ) , results suggested slight advantages of Comb over single treatments ( MedMgt , Beh ) and community care . High quality medication treatment characterized by careful yet adequate dosing , three times daily methylpheni date administration , monthly follow-up visits , and communication with schools conveyed substantial benefits to those children that received it . In contrast to the overall study findings that showed the largest benefits for high quality medication management ( regardless of whether given in the MedMgt or Comb group ) , secondary analyses revealed that Comb had a significant incremental effect over MedMgt ( with a small effect size for this comparison ) when categorical indicators of excellent response and when composite outcome measures were used . In addition , children with parent-defined comorbid anxiety disorders , particularly those with overlapping disruptive disorder comorbidities , showed preferential benefits to the Beh and Comb interventions . Parental attitudes and disciplinary practice s appeared to mediate improved response to the Beh and Comb interventions Twenty hyperactive 6- to 9-year-old children of normal intelligence were studied in a half-day laboratory classroom in a 2-week period baseline-treatment-reversal design for behavior modification . Under double-blind conditions half the children were placed on .3 mg/kg of Ritalin and half on placebo for the entire program . The classroom program consisted of a group period with immediate reinforcement possible , and an individual time period without immediate reinforcement possible . Behavior modification caused a significant decrease in nonattending , out-of-seat , inappropriate vocalizing and inappropriate peer interaction behavior in the group period . Fidgeting , a nontargeted behavior , was not significantly decreased during this period but did signficantly decrease as a result of medication . No other drug effects occurred during this period . During the individual period , the results were essentially reversed . There were no significant behavior modification effects observed . Significant reductions result ed from medication in all behaviors except out-of-seat and fidgeting . Behavior modification alone significantly affected the two academic measures . No significant effects were seen on the Conners Abbreviated Teacher Rating Scale . No significant interactions were noted between medication and behavior modification 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 , methylpheni date ( 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 cm(2 ) , 25.0 cm(2 ) , 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 OBJECTIVE Intent-to-treat analyses of the Multimodal Treatment Study of ADHD ( MTA ) revealed group differences on attention-deficit/hyperactivity disorder symptoms ratings , with better outcome in groups of participants who were assigned the medication algorithm-medication alone ( MedMgt ) and combined (Comb)--than in those who were  not-behavior modification  ( Beh ) alone and community comparison ( CC ) . However , the effect size was reduced by 50 % from the end of treatment to the first follow-up . The convergence of outcomes suggests differential changes by treatment group beween 14 and 24 months , which this report explores , both for benefits of treatment and for side effects on growth . METHODS We documented reported medication use at 14- and 24-month assessment s and formed 4 naturalistic subgroups ( Med/Med , Med/NoMed , NoMed/Med , and NoMed/NoMed ) . Then we performed exploratory mediator analyses to evaluate effects of changes in medication use on 14- to 24-month change scores of effectiveness ( symptom ratings ) and growth ( height and weight measures ) . RESULTS The r and omly assigned groups with the greatest improvement at the end of the treatment phase ( Comb and MedMgt ) deteriorated during the follow-up phase , but the other 2 groups ( Beh and CC ) did not . There were no significant differences in the 14- to 24-month growth rates among the r and omly assigned groups , in contrast to significant growth suppression in the Comb and MedMgt at the end of the treatment phase . Changes in medication use mediated the 14- to 24-month change in attention-deficit/hyperactivity disorder symptom ratings : the subgroup that reported stopping medication ( Med/NoMed ) showed the largest deterioration , the subgroup that consistently reported ( Med/Med ) or never reported ( NoMed/NoMed ) medication use showed modest deterioration , and the subgroup that reported starting medication ( NoMed/Med ) showed improvement . Changes in medication use also mediated growth effects : the subgroup that consistently reported medication use ( Med/Med ) showed reduced height gain compared with the subgroup that never reported medication use ( NoMed/NoMed ) , which actually grew faster than predicted by population norms . CONCLUSION In the MTA follow-up , exploratory naturalistic analyses suggest that consistent use of stimulant medication was associated with maintenance of effectiveness but continued mild growth suppression OBJECTIVE In the Multimodal Treatment Study of ADHD ( MTA ) , the effects of medication management ( MedMgt ) and behavior modification therapy ( Beh ) and their combination ( Comb ) and usual community comparison ( CC ) in the treatment of attention-deficit/hyperactivity disorder ( ADHD ) differed at the 14-month assessment as a result of superiority of the MTA MedMgt strategy ( Comb or MedMgt ) over Beh and CC and modest additional benefits of Comb over MedMgt alone . Here we evaluate the persistence of these beneficial effects 10 months beyond the 14 months of intensive intervention . METHODS Of 579 children who entered the study , 540 ( 93 % ) participated in the first follow-up 10 months after the end of treatment . Mixed-effects regression models explored possible persisting effects of the MTA medication strategy , the incremental benefits of Comb over MedMgt alone , and the possible superiority of Beh over CC on 5 effectiveness and 4 service use domains . RESULTS The MTA medication strategy showed persisting significant superiority over Beh and CC for ADHD and oppositional-defiant symptoms at 24 months , although not as great as at 14 months . Significant additional benefits of Comb over MedMgt and of Beh over CC were not found . The groups differed significantly in mean dose ( methylpheni date equivalents 30.4 , 37.5 , 25.7 , and 24.0 mg/day , respectively ) . Continuing medication use partly mediated the persisting superiority of Comb and MedMgt . CONCLUSION The benefits of intensive MedMgt for ADHD extend 10 months beyond the intensive treatment phase only in symptom domains and diminish over time BACKGROUND We wanted to study the effects of amphetamine on symptoms of attention-deficit hyperactivity disorder ( ADHD ) over a longer period than has been reported in previous studies of central stimulants in this condition . METHODS Sixty-two children , aged 6 to 11 years , meeting DSM-III-R symptom criteria for ADHD participated in a parallel-group design , r and omized , double-blind , placebo-controlled study of amphetamine treatment . Treatment was not restricted to children with " pure " ADHD , ie , some had comorbid diagnoses . In the amphetamine group , children received active treatment for 15 months . RESULTS Amphetamine was clearly superior to placebo in reducing inattention , hyperactivity , and other disruptive behavior problems and tended to lead to improved results on the Wechsler Intelligence Scale for Children -- Revised . Treatment failure rate was considerably lower and time to treatment failure was longer in the amphetamine group . Adverse effects were few and relatively mild . CONCLUSION The results of this long-term , placebo-controlled study of the central stimulant amphetamine in the treatment of ADHD indicate that there are remaining positive effects of the drug 15 months after starting treatment OBJECTIVE To describe the rationale , methodology , and sample characteristics of a dual-site treatment study ( New York and Montreal ) of children with attention-deficit/hyperactivity disorder ( ADHD ) conducted between 1990 and 1995 . The hypotheses were that ( 1 ) methylpheni date combined with comprehensive multimodal psychosocial treatment was superior to methylpheni date alone in improving multiple functions and ( 2 ) the efficacy of the psychosocial intervention result ed from its specific components and not from nonspecific treatment effects . METHOD One hundred three children with ADHD ( ages 7 - 9 ) , free of conduct and learning disorders , who responded to methylpheni date , were r and omized for 2 years to ( 1 ) methylpheni date treatment alone ; ( 2 ) methylpheni date combined with multimodal psychosocial treatment that included parent training and counseling , academic assistance , psychotherapy , and social skills training ; or ( 3 ) methylpheni date plus attention control treatment that excluded specific aspects of the psychosocial intervention . Children were switched to single-blind placebo after 12 months ; methylpheni date was reinstituted when clinical ly indicated . Assessment s included ratings by parents , teachers , children , and psychiatrists ; school observations in academic and gym classes ; and academic performance tests . Almost 80 % of families completed the 2-year study . Companion papers present treatment effects . CONCLUSIONS A comprehensive 2-year psychosocial treatment was delivered successfully to children with ADHD and their families We examined 9-month data from the 14-month NIMH Multimodal Treatment Study of Children with ADHD ( the MTA ) as a further check on the relative effect of medication ( MedMgt ) and behavioral treatment ( Beh ) for attention – deficit/hyperactivity disorder ( ADHD ) while Beh was still being delivered at greater intensity than at 14-month endpoint , and conversely as a check on the efficacy of the MTA behavioral generalization/maintenance procedures . Intention-to-treat analysis at 9 months showed essentially the same results as at 14 months , after Beh had been completely faded ; MedMgt and the combination ( Comb ) of medication and Beh were significantly superior to Beh and community care ( CC ) for ADHD and oppositional – defiant ( ODD ) symptoms , with mixed results for social skills and internalizing symptoms . All treatment-group differences examined as changes in slopes from 9 to 14 months were nonsignificant ( we found general improvement for all groups ) . Slopes from baseline to 9 months correlated highly ( r > .74 , p < .0001 ) with slopes from baseline to 14 months for all groups . The time function from baseline to 14 months showed a significant linear , but not quadratic , trend for the main outcome measure ( a composite of parent- and teacher-rated ADHD and ODD symptoms ) for all groups . Findings suggest that in contrast to the hypothesized deterioration in the relative benefit of Beh between 9 and 14 months ( after completion of fading ) , the MTA Beh generalization and maintenance procedures implemented through 9 months apparently yielded continuing improvement through 14 months , with preservation of the relative position of Beh compared to other treatment strategies PROBLEM What is the effectiveness of a stress-management program on self-concept , locus of control , and acquisition of appropriate coping strategies in children with attention deficit hyperactivity disorder ( ADHD ) ? METHODS Forty-two children with ADHD ( age range 9 - 12 ) were r and omly assigned to a control group , a therapist-led group , or a group in which the stress-management techniques were taught by the parents . The subjects were pre- and posttested on self-concept , locus of control , and acquisition of coping skills . FINDINGS Although there were no significant changes in any of the three groups for acquisition of coping skills , the children in the therapist-led group reported more appropriate coping strategies . CONCLUSIONS Involving parents in a cognitive-behavioral approach could improve  parent-child relationships and further increase the opportunities for successful academic and social functioning To eluci date processes underlying therapeutic change in a large-scale r and omized clinical trial , we examined whether alterations in self-reported parenting practice s were associated with the effects of behavioral , medication , or combination treatments on teacher-reported outcomes ( disruptive behavior , social skills , internalizing symptoms ) in children with attention-deficit hyperactivity disorder ( ADHD ) . Participants were 579 children with Combined-type ADHD , aged 7–9.9 years , in the Multimodal Treatment Study of Children with ADHD ( MTA ) . We uncovered 2 second-order factors of parenting practice s , entitled Positive Involvement and Negative/Ineffective Discipline . Although Positive Involvement was not associated with amelioration of the school-based outcome measures , reductions in Negative/Ineffective Discipline mediated improvement in children 's social skills at school . For families showing the greatest reductions in Negative/Ineffective Discipline , effects of combined medication plus behavioral treatment were pronounced in relation to regular community care . Furthermore , only in combination treatment ( and not in behavioral treatment alone ) was decreased Negative/Ineffective Discipline associated with reduction in children 's disruptive behavior at school . Here , children in families receiving combination treatment who showed the greatest reductions in Negative/Ineffective Discipline had teacher-reported disruptive behavior that was essentially normalized . Overall , the success of combination treatment for important school-related outcomes appears related to reductions in negative and ineffective parenting practice s at home ; we discuss problems in interpreting the temporal sequencing of such process- outcome linkages and the means by which multimodal treatment may be mediated by psychosocial processes related to parenting To examine Swanson , Nolan , and Pelham — IV ( SNAP-IV ) psychometric properties , parent ( N = 1,613 ) and teacher ( N = 1,205 ) data were collected from a r and om elementary school student sample in a longitudinal attention deficit hyperactivity disorder ( ADHD ) detection study . SNAP-IV reliability was acceptable . Factor structure indicated two ADHD factors and an oppositional defiant disorder ( ODD ) factor . Parent and teacher scores varied by gender and poverty status ( d = .49-.56 ) but not age ; only teacher scores varied by race ( d = .25-.55 ) . Screening and diagnostic utility was evaluated with likelihood ratios ( LRs ) and posttest probabilities . Parent SNAP-IV scores above 1.2 increased probability of concern ( LR > 10 ) and above 1.8 , of ADHD diagnosis ( LR > 3 ) . Teacher hyperactivity/impulsivity scores above 1.2 and inattention scores above 1.8 increased probabilities of concern only ( LR = 4.2 and > 5 , respectively ) .  Higher teacher scores for African American children and race differences in measurement models require future study The Collaborative Multimodal Treatment Study of Children with Attention Deficit Hyperactivity Disorder ( ADHD ) , the MTA , is the first multisite , cooperative agreement treatment study of children , and the largest psychiatric/psychological treatment trial ever conducted by the National Institute of Mental Health . It examines the effectiveness of Medication vs. Psychosocial treatment vs. their combination for treatment of ADHD and compares these experimental arms to each other and to routine community care . In a parallel group design , 579 ( male and female ) ADHD children , aged 7–9 years , 11 months , were r and omly assigned to one of the four experimental arms , and then received 14 months of prescribed treatment ( or community care ) with periodic re assessment s. After delineating the theoretical and empirical rationale s for Psychosocial treatment of ADHD , we describe the MTA 's Psychosocial Treatment strategy applied to all children in two of the four experimental arms ( Psychosocial treatment alone ; Combined treatment ) . Psychosocial treatment consisted of three major components : a Parent Training component , a two-part School Intervention component , and a child treatment component anchored in an intensive Summer Treatment Program . Components were selected based on evidence of treatment efficacy and because they address comprehensive symptom targets , setting s , comorbidities , and functional domains . We delineate key conceptual and logistical issues faced by clinical research ers in design and implementation of Psychosocial research with examples of how these issues were addressed in the MTA study The present investigation examined the effects of methylpheni date on impulsivity in children with attention-deficit hyperactivity disorder ( ADHD ) . A task was design ed to measure empirically the ADHD child 's proclivity to blurt out incorrect answers before giving a final and /or correct response . Twenty-six ADHD children referred for double-blind placebo-controlled assessment of medication responsiveness and 14 non-ADHD controls were given a visual search word-matching task to assess impulsive responding . An analysis of covariance showed that ADHD children on methylpheni date made fewer impulsive errors than ADHD children on placebo . The control group made fewer impulsive errors than the ADHD children in the placebo condition , but the performance of the ADHD children on medication approximated the performance of the children without ADHD . These preliminary findings suggest that the word-matching task may be a useful tool for assessing impulsive responding and determining the benefits of stimulant medication on impulsivity . ( J Child Neurol 1993;8:157 - 163 ) OBJECTIVE Although the combination of methylpheni date ( MPH ) and behavior modification ( BMOD ) has been advocated to enhance clinical outcome for children with attention-deficit hyperactivity disorder ( ADHD ) and comorbid disruptive disorders , few group studies have been conducted . This study evaluates the separate and incremental effects of these modalities on rating scale and observational measures in multiple setting s. METHOD Sixteen of 22 children with ADHD and comorbid disruptive disorder completed a r and omized , placebo-controlled study examining the separate and incremental effects of 2 doses of MPH and BMOD during a partial hospitalization program . Of the 6 who did not complete the study , 2 children developed significant side effects . For the 16 who did complete the study , effects were examined on measures of symptom ratings , behavioral frequencies , and stimulant side effects across program activities . RESULTS Based on alpha-adjusted analyses of variance , there were several main effects of MPH and BMOD on ADHD symptoms , oppositional behavior , and positive social behavior , with certain effects unique to each intervention and setting . One incremental effect each was found for MPH ( positive mood/behavior ) and BMOD ( negative behavior ) . MPH and BMOD were associated with few side effects . Effect sizes for each intervention showed considerable variability in clinical response . CONCLUSIONS That MPH and BMOD had certain unique main and incremental effects extends findings supporting their combination and suggests that integrated studies evaluate multiple dimensions of functioning and in novel setting s ( e.g. , home , school ) . The incorporation of other intervention components in combined treatments may be warranted to enhance clinical efficacy From the Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder -- a r and omized clinical trial of 579 children ages 7 - 9 years receiving 14 months of medication management , behavioral treatment , combination , or community care --  the authors matched each African American and Latino participant with r and omly selected Caucasian participants of same sex , treatment group , and site . Although Caucasian children were significantly less symptomatic than African American and Latino children on some ratings , response to treatment did not differ significantly by ethnicity after controlling for public assistance . Ethnic minority families cooperated with and benefited significantly from combination ( multimodal ) treatment ( d = 0.36 , compared with medication ) . This incremental gain withstood statistical control for mother 's education , single-parent status , and public assistance . Treatment for lower socioeconomic status minority children , especially if comorbid , should combine medication and behavioral treatment OBJECTIVE To evaluate the effects of atomoxetine alone and in combination with behavior therapy on the school functioning of children with attention-deficit/hyperactivity disorder ( ADHD ) . Most atomoxetine studies have not assessed school functioning other than by measuring the change in ADHD symptoms . Combining behavior therapy with atomoxetine may be particularly beneficial for the academic domain as medication has not been found to produce sustained benefits in this realm . However , there is little research examining the effects of combining atomoxetine and behavior therapy . METHOD In an 8-week open-label trial , 56 children aged 6 - 12 years with ADHD diagnosed according to DSM-IV-TR were r and omly assigned to receive  atomoxetine and behavior therapy or atomoxetine alone . Behavior therapy consisted of an 8-week parenting course , a child social skills course , and a teacher-implemented daily report card of classroom behavior . The primary outcome was direct observation of the subject 's classroom behavior . Secondary outcomes included change in ADHD symptoms and functioning at home and school . All data were collected between March 2007 and May 2008 . RESULTS Classroom observations showed that atomoxetine decreased rule violations ( P < .0001 ) . Moreover , atomoxetine was associated with significant improvements in ADHD and oppositional defiant disorder symptoms at home and school and enhanced functioning in both domains ( Impairment Rating Scale : all P < .001 ) . Combined treatment led to greater improvements in parent-rated symptoms of inattention ( P < .01 ) , problem behaviors ( P < .001 ) , and academic impairment ( P < .05 ) . However , teachers did not report significant group differences . CONCLUSIONS Atomoxetine improved ADHD symptoms and classroom functioning as measured by parents , teachers , and direct observation . The addition of behavior therapy led to further improvements at home but not at school . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00918567 ABSTRACT . The objective of this study was to evaluate the effectiveness of an 8-week behavioral and social skill ( BSS ) class for children newly diagnosed with attention-deficit hyperactivity disorder ( ADHD ) and their parents , initiating stimulant treatment in primary care . The subjects were 100 children , aged 5 to 12 years , recently diagnosed with ADHD and treated with stimulant medication , and their parents or guardians . Eligible families were r and omly assigned to an intervention group ( IG : n = 59 ) or control group ( CG : n = 41 ) . The BSS function of each child was assessed using DuPaul ’s ADHD Parent Rating Scale ( 18-item ) and Child Attention Profile ( 12-item ) during blinded baseline and follow-up interviews . Parent discipline practice was assessed using a five-item inventory based on Likert-scale ratings during identical periods . Computerized pharmacy records were used to track psychostimulant use over time . IG children exhibited significantly lower parent-rated ADHD symptoms , whereas IG parents reported significantly better and more consistent discipline practice s compared with CG parents across time . No significant differences were found between groups in Child Attention Profile scores across time . Psychostimulant use did not significantly differ between groups across time .  BSS training  was well accepted and seemed to significantly improve BSS functioning among IG children in the home setting only Published evidence suggests that aspects of trial design lead to biased intervention effect estimates , but findings from different studies are inconsistent . This study combined data from 7 meta-epidemiologic studies and removed overlaps to derive a final data set of 234 unique meta-analyses containing 1973 trials . Outcome measures were classified as " mortality , " " other objective , " " or subjective , " and Bayesian hierarchical models were used to estimate associations of trial characteristics with average bias and between-trial heterogeneity . Intervention effect estimates seemed to be exaggerated in trials with inadequate or unclear ( vs. adequate ) r and om-sequence generation ( ratio of odds ratios , 0.89 [ 95 % credible interval { CrI } , 0.82 to 0.96 ] ) and with inadequate or unclear ( vs. adequate ) allocation concealment ( ratio of odds ratios , 0.93 [ CrI , 0.87 to 0.99 ] ) . Lack of or unclear double-blinding ( vs. double-blinding ) was associated with an average of 13 % exaggeration of intervention effects ( ratio of odds ratios , 0.87 [ CrI , 0.79 to 0.96 ] ) , and between-trial heterogeneity was increased for such studies ( SD increase in heterogeneity , 0.14 [ CrI , 0.02 to 0.30 ] ) . For each characteristic , average bias and increases in between-trial heterogeneity were driven primarily by trials with subjective outcomes , with little evidence of bias in trials with objective and mortality outcomes . This study is limited by incomplete trial reporting , and findings may be confounded by other study design characteristics . Bias associated with study design characteristics may lead to exaggeration of intervention effect estimates and increases in between-trial heterogeneity in trials reporting subjectively assessed outcomes
target: The content of the social skills interventions were comparable and based on a cognitive behavioural model .
  The review suggests that there is little evidence to support or refute social skills training for adolescents with ADHD .
background: BACKGROUND Attention Deficit Hyperactivity Disorder ( ADHD ) in children is associated with hyperactivity and impulsitivity , attention problems , and difficulties with social interactions .
  Pharmacological treatment may alleviate symptoms of ADHD but seldom solves difficulties with social interactions .
  Social skills training may benefit ADHD children in their social interactions .
  We examined the effects of social skills training on children 's  social competences , general behaviour , ADHD symptoms , and performance in school .
  OBJECTIVES To assess the effects of  social skills training in children and adolescents with ADHD .