Medication + Behavior Management = Success!

AD/HD students given methylphenidate combined with psychosocial treatment showed significant improvement in classroom behavior and academic performance in what is being called the first large trial of the effects of multiple doses of methylphenidate on the behavior and performance of young teens in a classroom setting.

Methylphenidate is the generic version of the medication used in Ritalin. The psychosocial treatment used in this study included a behavior management program with individualized, negotiated behavioral contracts and other basic rules and contingencies. When students met the criteria of these contracts and basic rules they achieved increases in levels of privileges and weekly monetary payments.

The 40 adolescent males and 5 adolescent females who participated in the 8-week study were taught note-taking skills, social skills and problem solving in highly structured classrooms and intensive supervision by staff during a Summer Treatment Program for Adolescents (STP) conducted by the ADHD Program at the Western Psychiatric Institute and Clinic at the University of Pittsburgh Medical Center. All of the students had been diagnosed as having AD/HD, and all had chronic problems both at school and at home. In addition, 50% of the participants were diagnosed with comorbid oppositional defiant disorder, and 15% were diagnosed with comorbid conduct disorder.

After 2 weeks in the program, subjects were daily randomized to receive either no medication, or doses of methylphenidate. Medicated students were given 10 mg, 20 mg, or 30 mg of methylphenidate twice daily, with a third, halved dose in the afternoon. Eachsubject received each dose for about 6 days. Students who received no medication were given a placebo and were unaware that the medication dose had been changed.

Medication: How much is enough?

The 10-mg dose of methylphenidate was effective for most students, although some required higher doses for maximum improvement. The authors of the study concluded that doses of 10 mg to 20 mg of methylphenidate are effective in most cases, provided the medication is in conjunction with psychosocial treatment. (emphasis added). In fact, many of the students did not experience added benefit with increased dosages, and in some cases they experienced deterioration.

"We should emphasize the fact that the majority of the stimulant effects were positive," wrote the authors of the study. "As long as doses were at or below 20 mg, the benefits of medication clearly outweighed the risks." Very few side effects were reported at the average level, and none of the symptoms appeared to increase in frequency with increasing dose.

Some students did have better results with higher doses. However, most of the students who showed the best results at the 30-mg dose had demonstrated severely inappropriate social behavior and poor academic performance.

The complete study is available online at the web site of the American Psychological Association. (Note: this link will open a new browser window. Close the new window to return to additudemag.com)

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