Skip to main content
SpringerLink
Log in

Behavioral versus Behavioral and Pharmacological Treatment in ADHD Children Attending a Summer Treatment Program

  • Published:
Journal of Abnormal Child Psychology Aims and scope Submit manuscript

Abstract

As part of the behavioral treatment in the Multimodal Treatment Study of Children with ADHD (MTA), children participated in an intensive summer treatment program (STP). This study examined the differences between 57 children in the combined treatment (Comb) group, who were medicated, and 60 children in the behavioral treatment (Beh) group, who were unmedicated throughout the STP. Comb children were significantly better than Beh on 5 measures: rule following, good sportsmanship, peer negative nominations, and STP teacher posttreatment ratings of inattention/overactivity. Groups did not differ on any of the other 30 measures, and responded similarly to the STP over time. Comparisons to normative data revealed that Comb children were more likely to fall within the normative range on 6 measures. The differences between these results and the main MTA results, in which Comb was always superior to Beh, are discussed in terms of the relative intensity of combined treatments. The implications for future studies of pharmacological and behavioral treatment for ADHD are discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

REFERENCES

  • Abramowitz, A. J., Eckstrand, D., O'Leary, S. G., & Dulcan, M. K. (1992). ADHD children's responses to stimulant medication and two intensities of a behavioral intervention. Behavior Modification, 16, 193-203.

    Google Scholar 

  • American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.

    Google Scholar 

  • Atkins, M. S., Pelham, W. E., & Licht, M. H. (1985). A comparison of objective classroom measures and teacher ratings of Attention Deficit Disorder. Journal of Abnormal Child Psychology, 13, 155-167.

    Google Scholar 

  • Atkins, M. S., Pelham, W. E., & White, K. J. (1989). Hyperactivity and attention deficit disorders. In M. Hersen (Ed.), Psychological aspects of developmental and physical disabilities: A casebook (pp. 137-156). California: Sage Publications.

    Google Scholar 

  • Carlson, C. L., Pelham, W. E., Milich, R., & Dixon, M. J. (1992). Single and combined effects of methylphenidate and behavior therapy on the classroom behavior, academic performance and self-evaluations of children with attention deficit-hyperactivity disorder. Journal of Abnormal Child Psychology, 20, 213-232.

    Google Scholar 

  • Conners, C. K., MTA Cooperative Group. (in press). Multimodal treatment of ADHD (MTA): An alternative outcome analysis. Journal of the American Academy of Child and Adolescent Psychiatry.

  • Greenhill, L. L., Abikoff, H. B., Arnold, L. E., Cantwell, D. P., Conners, C. K., Elliott, G., Hechtman, L., Hinshaw, S. P., Hoza, B., Jensen, P. S., March, J., Newcorn, J., Pelham, W. E., Severe, J. B., Swanson, J. M., Vitiello, B., & Wells, K. (1996). Medication treatment strategies in the MTA study: Relevance to clinicians and researchers. Journal of the American Academy of child & Adolescent Psychiatry, 35, 1304-1313.

    Google Scholar 

  • Harter, S. (1985). Self-perception profile for children. Unpublished manuscript, University of Denver.

  • Hoza, B., Pelham, W. E., & Buursma, K. (1999, November). Factors affecting the impact of friendship on ADHD boys. Poster presented at the annual meeting of the Association for the Advancement of Behavior Therapy, Toronto.

  • Hoza, B., Pelham, W. E., Sams, S. E., & Carlson, C. L. (1992). An examination of the “dosage” effects of both behavior therapy and methylphenidate on the classroom performance of two ADHD children. Behavior Modification, 16, 164-192.

    Google Scholar 

  • Hoza, B., Waschbusch, D. A., Pelham, W. E., Molina, B. S. G., & Milich, R. (2000). ADHD and control boys' behavioral and self-evaluative responses to social success and failure in a novel get-acquainted task. Child Development, 71, 432-446.

    Google Scholar 

  • Jacobson, N. S., & Truax, P. (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12-19.

    Google Scholar 

  • Johnston, C., Pelham, W. E., & Murphy, H. A. (1985). Peer relationships in ADDH and normal children: A developmental analysis of peer and teacher ratings. Journal of Abnormal Child Psychology, 13, 89-100.

    Google Scholar 

  • Kelleher, K. J. (1998, November). Use of services and costs for youth with ADHD and related conditions. Paper presented at the NIH Consensus Development Conference on Diagnosis and Treatment of Attention Deficit Hyperactivity Disorder, Bethesda, MD.

  • Klein, R. G., & Abikoff, H. (1997). Behavior therapy and methylphenidate in the treatment of children with ADHD. Journal of Attention Disorders, 2, 89-114.

    Google Scholar 

  • Lochman, J. E., Burch, P. R., Curry, J. F., & Lampron, L. B. (1984). Treatment and generalization effects of cognitive-behavioral and goal-setting interventions with aggressive boys. Journal of Consulting and Clinical Psychology, 52, 915-916.

    Google Scholar 

  • Loney, J., & Milich, R. (1982). Hyperactivity, inattention, and aggression in clinical practice. In M. Wolraich & D. K. Routh (Eds.), Advances in behavioral pediatrics, (Vol. 2, pp. 113-147). Greenwich, Conn.: JAI Press.

    Google Scholar 

  • MTA Cooperative Group. (1999a). A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. Archives of General Psychiatry, 56, 1073-1086.

    Google Scholar 

  • MTA Cooperative Group. (1999b). Moderators and mediators of treatment response for children with attention-deficit/hyperactivity disorder. Archives of General Psychiatry, 56, 1088-1096.

    Google Scholar 

  • Northup, J., Fusilier, I., Swanson, V., Huete, J., Bruce, T., Freeland, J., Gulley, V., & Edwards, S. (1999). Further analysis of the separate and interactive effects of methylphenidate and common classroom contingencies. Journal of Applied Behavior Analysis, 32, 35-50.

    Google Scholar 

  • Oden, S., & Asher, S. R. (1977). Coaching children in social skills for friendship making. Child Development, 48, 495-506.

    Google Scholar 

  • Pelham, W. E. (1999a). The NIMH multimodal treatment study for attention-deficit hyperactivity disorder: Just say yes to drugs alone? Canadian Journal of Psychiatry, 44, 765-775.

    Google Scholar 

  • Pelham, W. E. (1999b, November). A summer treatment program for children with behavior problems: Efficacy, effectiveness, costs, and managed care. In T. H. Ollendick (Chair), Implementing empirically supported treatment for children in applied settings. Symposium conducted at the meeting of the Association for the Advancement of Behavior Therapy, Toronto.

  • Pelham, W. E., Aronoff, H. R., Midlam, J. K., Shapiro, C. J., Gnagy, E. M., Chronis, A. M., Onyango, A. N., Forehand, G., Nguyen, A., & Waxmonsky, J. (1999). A comparison of Ritalin and Adderall: Efficacy and time-course in children with attentiondeficit/hyperactivity disorder. Pediatrics [On-line], 103(4).

  • Pelham, W. E., & Bender, M. E. (1982). Peer relationships in hyperactive children: Description and treatment. In K. Gadow & I. Bailer (Eds.), Advances in learning and behavioral Disabilities (Vol. 1, pp. 365-436). Greenwich, CT: JAI Press.

    Google Scholar 

  • Pelham, W. E., Carlson, C., Sams, S. E., Vallano, G., Dixon, M. J., & Hoza, B. (1993). Separate and combined effects of methylphenidate and behavior modification on the classroom behavior and academic performance of ADHD boys: Group effects and individual differences. Journal of Consulting and Clinical Psychology, 61, 506-515.

    Google Scholar 

  • Pelham, W. E., Greenslade, K. E., Vodde-Hamilton, M. A., Murphy, D. A., Greenstein, J. J., Gnagy, E. M., & Dahl, R. E. (1990). Relative efficacy of long-acting CNS stimulants on children with attention deficit-hyperactivity disorder: A comparison of standard methylphenidate, sustained-release methylphenidate, sustainedrelease dextroamphetamine, and pemoline. Pediatrics, 86, 226-237.

    Google Scholar 

  • Pelham, W. E., Greiner, A. R., & Gnagy, E. M. (1997a). Summer treatment program manual. Buffalo, NY: Comprehensive Treatment for Attention Deficit Disorders, Inc.

    Google Scholar 

  • Pelham, W. E., Greiner, A. R., & Gnagy, E. M. (1997b). Summer treatment program supervisor binder. Buffalo, NY: Comprehensive Treatment for Attention Deficit Disorders, Inc.

    Google Scholar 

  • Pelham, W. E., Greiner, A., Gnagy, E., Hoza, B., Martin, L., Sams, S., & Wilson, T. (1996). Intensive treatment for ADHD: A model summer treatment program. In M. Roberts (Ed.), Model programs in child and family mental health (pp. 193-214). Mahwah, NJ: Erlbaum.

    Google Scholar 

  • Pelham, W. E., & Hinshaw, S. (1992). Behavioral intervention for attention deficit hyperactivity disorder. In S.M. Turner, K. S. Calhoun, & H. E. Adams (Eds.), Handbook of clinical behavior therapy (Vol. 2, pp. 259-283). New York: John Wiley & Sons.

    Google Scholar 

  • Pelham, W. E., & Hoza, B. (1996). Intensive treatment: A summer treatment program for children with ADHD. In E. Hibbs & P. Jensen (Eds.), Psychosocial treatments for child and adolescent disorders: Empirically based strategies for clinical practice (pp. 311-340). New York: APA Press.

    Google Scholar 

  • Pelham, W. E., Hoza, B., Kipp, H., Gnagy, E., Greiner, A., Trane, S., Pillow, D., Greenhouse, J., Wolfson, L., Fitzpatrick, E., Vallano, G., Bukstein, O., Baron-Myak, C., & Waschbusch, D. (1997, June). Effects of methylphenidate and expectancy on children with ADHD: Behavior, academic performance, and attributions in a summer treatment programand regular classroom settings. Poster presented at the annual meeting of the Society for Research in Child and Adolescent Psychopathology, Paris.

  • Pelham, W. E., & Hoza, J. (1987). Behavioral assessment of psychostimulant effects on ADD children in a summer day treatment program. In R. Prinz (Eds.), Advances in behavioral assessment of children and families (pp. 3-33). Greenwich, Connecticut: JAI Press.

    Google Scholar 

  • Pelham, W. E., Milich, R., Murphy, D. A., & Murphy, H. A. (1989). Normative data on the IOWA Conners teacher rating scale. Journal of Clinical Child Psychology, 18, 259-262.

    Google Scholar 

  • Pelham, W. E., Milich, R., & Walker, J. L. (1986). Effects of continuous and partial reinforcement and methylphenidate on learning in children with attention deficit disorder. Journal of Abnormal Psychology, 95, 319-325.

    Google Scholar 

  • Pelham, W. E., Murphy, D. A., Vannatta, K., Milich, R., Licht, B. G., Gnagy, E. M., Greenslade, K. E., Greiner, A. R., & Vodde-Hamilton, M. (1992). Methylphenidate and attributions in boys with attention deficit-hyperactivity disorder. Journal of Consulting and Clinical Psychology, 60, 282-292.

    Google Scholar 

  • Pelham, W. E., & Murphy, H. A. (1986). Attention deficit and conduct disorders. In M. Hersen (Ed.), Pharmacological and behavioral treatment: An integrative approach (pp. 108-148). New York: Wiley.

    Google Scholar 

  • Pelham, W. E., Schnedler, R. W., Bender, M. E., Miller, J., Nilsson, D., Budrow, M., Ronnei, M., Paluchowski, C., & Marks, D. (1988). The combination of behavior therapy and methylphenidate in the treatment of hyperactivity: A therapy outcome study. In L. Bloomingdale (Ed.), Attention deficit disorders (Vol. III, pp. 29-48). London: Pergamon.

    Google Scholar 

  • Pelham W. E., Schnedler, R. W., Bologna, N. C., Contreras, J. A. (1980). Behavioral and stimulant treatment of hyperactive children: A therapy study with methylphenidate probes in a within-subject design. Journal of Applied Behavioral Analysis, 13, 221-236.

    Google Scholar 

  • Pelham, W. E., & Smith, B. H. (2000). Prediction and measurement of individual responses to Ritalin by children and adolescents with ADHD. In L. Greenhill & B. P. Osman (Eds.), Ritalin: Theory and practice (2nd ed., pp. 193-217). New York: Mary Ann Liebert.

    Google Scholar 

  • Pelham, W. E., & Waschbusch, D. A. (1999). Behavioral intervention in ADHD. In H. C. Quay & A. Hogan (Eds.), Handbook of disruptive behavior disorders (pp. 255-278). New York: Plenum.

    Google Scholar 

  • Pelham, W. E., Wheeler, T., & Chronis, A. (1998). Empirically supported psychosocial treatments for ADHD. Journal of Clinical Child Psychology, 27, 190-205.

    Google Scholar 

  • Richters, J. E., Arnold, L. E., Jensen, P. S., Abikoff, H., Conners, K., Greenhill, L. L., Hechtman, L., Hinshaw, S. P., Pelham, W. E., & Swanson, J. M. (1995). NIMH collaborative multisite multimodal treatment study of children with ADHD: I. Background and rationale. Journal of the American Academy of Child and Adolescent Psychiatry, 34, 987-1000.

    Google Scholar 

  • Schachar, R., & Tannock, R. (1993). Childhood hyperactivity and psychostimulants: A review of extended treatment studies. Journal of Child and Adolescent Psychopharmacology, 3, 81-97.

    Google Scholar 

  • Schell, R. M., Pelham, W. E., Bender, M. E., Andree, J., Law, T., & Robbins, F. (1986). The concurrent assessment of behavioral and psychostimulant interventions: A controlled case study. Behavioral Assessment, 8, 373-384.

    Google Scholar 

  • Sherman, M., & Hertzig, M. E. (1991). Prescribing practices of Ritalin: The Suffolk County, New York study. In L. L. Greenhill & B. B. Osman (Eds.), Ritalin: Theory and patient management (pp. 187-193). New York: Mary Ann Liebert, Inc.

    Google Scholar 

  • Smoll, F. L., & Smith, R. E. (1987). Sports psychology for youth coaches. Washington, DC: National Federation for Catholic Ministry.

    Google Scholar 

  • Strakowski, S. M., Sax, K. W., Setters, M. J., & Keck, P. E. (1996). Enhanced response to repeated d-amphetamine challenge: evidence for behavioral sensitization in humans. Society of Biological Psychiatry, 40, 872-880.

    Google Scholar 

  • Swanson, J. M., McBurnett, K., Christian, D. L., & Wigal, T. (1995). Stimulant medication and treatment of children with ADHD. In T. H. Ollendick & R. J. Prinz (Eds.), Advances in clinical child psychology (Vol. 17, pp. 265-322). New York: Plenum Press.

    Google Scholar 

  • Wechsler, D. (1991). Wechsler Intelligence Scale for Children (3rd ed.). New York: Psychological Corporation.

    Google Scholar 

  • Weiss, G., & Hechtman, L. T. (1993). Hyperactive children grown up: ADHD in children, adolescents, and adults. New York: Guilford Press.

    Google Scholar 

  • Weisz, J. R, & Hawley, K. M. (1998). Finding, evaluating, refining, and applying empirically supported treatments for children and adolescents. Journal of Clinical Child Psychology, 27, 206-216.

    Google Scholar 

  • Wells, K. C., Pelham, W. E., Kotkin, R. A., Hoza, B., Abikoff, H. B., Abramowitz, A., Arnold, L. E., Cantwell, D. P., Conners, C. K., Del Carmen, R., Elliot, G., Greenhill, L. L., Hechtman, L., Hibbs, E., Hinshaw, S. P., Jensen, P. S., March, J. S., Swanson, J. B., & Schiller, E. (2000). Psychosocial treatment strategies in the MTA study: Rationale, methods, and critical issues in design and implementation. Journal of Abnormal Child Psychology, 28, 483-505.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychology, State University of New York at Buffalo, Park Hall, Buffalo, New York, 14260

    William E. Pelham Jr.

  2. State University of New York at Buffalo, Buffalo, New York

    Elizabeth M. Gnagy

  3. University of Pittsburgh, Pennsylvania

    Andrew R. Greiner, Cheri Shapiro, Oscar Bukstein & Carrie Baron-Myak

  4. Purdue University, West Lafayette, Indiana

    Betsy Hoza

  5. University of California at Berkeley, Berkeley, California

    Stephen P. Hinshaw

  6. University of California at Irvine, Irvine, California

    James M. Swanson & Steve Simpson

  7. University of Chicago, Illinois

    Keith McBurnett

Authors
  1. William E. Pelham Jr.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Elizabeth M. Gnagy
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Andrew R. Greiner
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Betsy Hoza
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Stephen P. Hinshaw
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. James M. Swanson
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Steve Simpson
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Cheri Shapiro
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Oscar Bukstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Carrie Baron-Myak
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Keith McBurnett
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pelham, W.E., Gnagy, E.M., Greiner, A.R. et al. Behavioral versus Behavioral and Pharmacological Treatment in ADHD Children Attending a Summer Treatment Program. J Abnorm Child Psychol 28, 507–525 (2000). https://doi.org/10.1023/A:1005127030251

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1005127030251

Search

Navigation