Effectiveness of an adaptive multimodal treatment in children with Attention-Deficit Hyperactivity Disorder -- global outcome.
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.


METHODS
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 methylphenidate 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 resulted 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.
Klinik und Poliklinik für Psychiatrie und Psychotherapie, des Kindes-- und Jugendalters am Klinikum der Universität zu Köln, Robert-Koch-Str. 10, 50931, Köln, Germany. manfred.doepfner@medizin.uni-koeln.de
Manfred
M
Döpfner
Dieter
D
Breuer
Stephanie
S
Schürmann
Tanja Wolff
TW
Metternich
Christiane
C
Rademacher
Gerd
G
Lehmkuhl
D000223:Adaptation, Psychological; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*; D001521:Behavior Therapy / Q000379:methods*; D000697:Central Nervous System Stimulants / Q000627:therapeutic use*; D002648:Child; D003131:Combined Modality Therapy; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D008774:Methylphenidate / Q000627:therapeutic use*
D000697:Central Nervous System Stimulants; D008774:Methylphenidate