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 Matt Barcellona

 Penn State College of Medicine


Goal of study: 3 Questions

1) How do long term and behavioral treatments compare with one another?

2) Are there additional benefits of combining medicinal and behavioral treatments?

3) How does careful systematic treatment compare to routine community care?


Study Design: 4 Groups (Strategies)

1)Medication management

2)Behavioral Treatment

3)Combined Treatment

4)Community Care

number of children = 579 over 14 month period


6 Major Outcome Domains

1) ADHD core symptoms (inattention, impulsivity, hyperactivity)

2) Oppositional/Aggressive symptoms

3) Social skills

4) Internalizing symptoms

5) Parent-Child relations

6) Academic achievement


Results & Conclusions

– All groups showed marked reductions in symptoms over time, with significant

differences in degrees of change.

– Med management superior to behavioral treatment in controlling core symptoms of

ADHD (parents/teachers). No significant difference on other domains.

– Combined treatment and med management were superior to behavioral treatment in

controlling core symptoms (parents/teachers) while Community Care was NOT.

– No significant advantage of combined therapy versus medications alone on any domain

-combined treatment consistently used lower doses than med management

– Combined treatment superior to behavioral treatment on 4 domains:

1) Inattention (parents/teachers), Hyperactivity-Impulsivity (parents)

2) Oppositional/Aggressive behaviors (parents)

3) Internalizing symptoms (parents)

4) Academic achievement (reading)

– Combined treatment was superior to Community Care on all 6 domains (parents).

– Treatment satisfaction scores for parents of combined and behavioral treatments were

superior to Med management parents.



Presentation References

1) Abukoff, HB, et al. “A 14-Month Randomized Clinical Trial of Treatment Strategies

for ADHD.” Archives of General Psychiatry. Vol 56. Dec. 1999. p1073-1085.

2) Brown, Ronald et al. “Prevalence and Assessment of ADHD in Primary Care

Settings.” Pediatrics. Vol 107. March 2001.

3) American Academy of Pediatrics. “Clinical Practice Guidelines: Treatment of School

aged Child with ADHD.” Pediatrics. Vol 108. No 4. October 2001. p1033-1044.

4) Stubbe, Dorothy et al. Child and Adolescent Psychiatric Clinics of North America.

W.B. Saunders Company. Vol 9. No 3. July 2001.

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