PHOENIX -- Using behavioral interventions for attention-deficit/hyperactivity disorder delayed the start of medication and reduced the dose needed in a randomized, controlled study of 127 schoolchildren.
The study is the first to use behavioral modification before initiating medication for attention-deficit/hyperactivity disorder (ADHD), Erika K. Coles, Ph.D., said at a meeting of the New Clinical Drug Evaluation Unit sponsored by the National Institute of Mental Health.
The study also took the unusual approach of basing the need for medication on measures of impairment, not symptoms, and it separated treatment of the disorder at school from treatment at home.
The study enrolled children aged 5-12 years who had participated in a tightly controlled 9-week summer treatment program and research study of three intensities of behavior modification and four doses of medication for ADHD. All students started the school year unmedicated.
Dr. Coles and her associates randomized them to follow-up with or without behavioral consultation. The behavioral consultations started with three meetings with teachers and parents, often before school started, to set up behavioral intervention plans and daily report cards to track success and identify problems.
Children randomized to the behavioral modification group went longer into the school year before starting methylphenldate either in school or at home and were significantly less likely to use the drug at home (24%), compared with children who did not get behavioral consultations (53% of whom took methylphenidate at home).
By the end of the school year, the proportion of children who had started the drug did not differ significantly between groups (70% in the behavioral modification group and 80% in the control group), but the average weekly dose of methylphenidate was significantly lower in the behavioral intervention group (157 mg/day), compared with the control …