Efficacy of methylphenidate, psychosocial treatments and their combination in school-aged children with ADHD: a meta-analysis.
BACKGROUND
This meta-analysis compares effect-sizes of methylphenidate and psychosocial treatments and their combination on ADHD, concurrent oppositional, conduct symptoms, social behaviors and academic functioning.


METHODS
Several databases (PubMed, PsycInfo, ISI Web of Science) were searched for articles published between 1985 and September 2006. Inclusion criteria were: a diagnosis of ADHD; age from 6-12 years; a randomized controlled treatment design; efficacy established with parent and teacher rating scales; psychosocial treatments used were described as behavioral or cognitive-behavioral; the methylphenidate treatment was short-acting; and finally, treatment was conducted in a clinical setting.


RESULTS
ADHD outcomes showed large mean weighted effect-sizes for both methylphenidate and combined treatments, psychosocial treatments had a moderate mean weighted effect-size; a similar pattern emerged for oppositional and conducted behavior symptoms. Social behavior outcomes showed comparable moderate mean weighted effect-sizes for all treatments, while on academic functioning, all treatments had low mean weighted effect-sizes. There was no correlation between duration of psychosocial treatment and effect-size.


CONCLUSIONS
Both methylphenidate and psychosocial treatments are effective in reducing ADHD symptoms. However, psychosocial treatment yields smaller effects than both other treatment conditions. Psychosocial treatment has no additional value to methylphenidate for the reduction of ADHD and teacher rated ODD symptoms. However, for social behavior and parent rated ODD the three treatments were equally effective. For improvement of academic functioning no treatment was effective.
Van der Oord
S
S
Department of Clinical Psychology, University of Amsterdam, Roeterstraat 15, 1018 WB Amsterdam, The Netherlands. s.vanderoord@uva.nl
Prins
P J M
PJ
Oosterlaan
J
J
Emmelkamp
P M G
PM
D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy* / Q000523:psychology; D019958:Attention Deficit and Disruptive Behavior Disorders / Q000188:drug therapy / Q000523:psychology; D000697:Central Nervous System Stimulants / Q000627:therapeutic use*; D002648:Child; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D006801:Humans; D008774:Methylphenidate / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
D000697:Central Nervous System Stimulants; D008774:Methylphenidate