Abstract
Twenty-four boys with attention deficit-hyperactivity disorder (ADHD) participating in an intensive summer treatment program each received b.i.d. placebo and two doses of methylphenidate (MPH, 0.3 mg/kg and 0.6 mg/kg) crossed with two classroom settings: a behavior modification classroom including a token economy system, time out and daily home report card, and a “regular” classroom setting not using these procedures. Dependent variables included classroom observations of on-task and disruptive behavior, academic work completion and accuracy, and daily self-ratings of performance. Both MPH and behavior modification alone significantly improved children's classroom behavior, but only MPH improved children's academic productivity and accuracy. Singly, behavior therapy and 0.3 mg/kg PMH produced roughly equivalent improvements in classroom behavior. Further, the combination of behavior therapy and 0.3 mg/kg MPH resulted in maximal behavioral improvements, which were nearly identical to those obtained with 0.6 mg/kg MPH alone.
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References
Addison-Wesley, (1981).The mad minute. Reading, MA: Author.
Atkins, M. S., Pelham, W. E., & Licht, M. H. (1985). A comparison of obsjective classroom measures and teacher ratings of attention deficit disorder.Journal of Abnormal Child Psychology, 13, 155–167.
Atkins, M. S., Pelham, W. E., & Licht, M. (1988). The development and validation of objective classroom measures for the assessment of conduct and attention deficit disorders. In R. Prinz (Ed.),Advances in behavioral assessment of children and families (Vol. 4, pp. 3–33). Greenwich, CT: JAI Press.
Atkins, M. S., Pelham, W. E., & Licht, M. H. (1989a). The differential validity of teacher ratings of inattention/overactivity and aggression.Journal of Abnormal Child Psychology, 17, 423–435.
Atkins, M. S., Pelham, W. E., & White, K. J. (1989b). Hyperactivity and attention deficit disorders. In M. Hersen (Ed.),Psychological aspects of developmental and physical disabilities: A casebook (pp. 137–156). Beverly Hills, CA: Sage.
Ayllon, T., Layman, D., & Burke, S. (1972), Disruptive behavior and reinforcement of academic performance.Psychological Record, 22, 315–323.
Ayllon, T., Layman, D., & Kandel, H. J. (1975). A behavioral-educational alternative to drug control of hyperactive children.Journal of Applied Behavioral Analysis, 68, 137–146.
Bonig, R. (1978).Barnell Loft specific skills series. New York: Barnell Loft.
Carlson, C. L., & Lahey, B. B. (1988). Behavior classroom interventions with children exhibiting conduct disorders or attention deficit disorders with hyperactivity. In J. C. Witt, S. M. Elliott, & F. M. Gresham (Eds.),The handbook of behavior therapy in education (pp. 653–677). New York: Plenum Press.
Carlson, C. L., & Smith, M. (in press). Effects of methylphenidate on the academic performance of children with attention deficit hyperactivity disorder.School Psychology Review.
Douglas, V. I. Barr, R. G., O'Neill, M. E., & Britton, B. G. (1986). Short-term effects of methylphenidate on the cognitive, learning, and academic performance of children with attention deficit disorder in the laboratory and classroom.Journal of Child Psychology and Psychiatry, 27, 191–211.
Gittelman, R., Abikoff, H., Pollack, E., Klein, D. F., Katz, S., & Mattes, J. (1980). A controlled trial of behavior modification and methylphenidate in hyperactive children. In C. K. Whalen and B. Henker (Eds.),Hyperactive children: The social ecology of identification and treatment (pp. 221–243). New York: Academic Press.
Gittelman, R., & Kanner, A. (1986). Psychopharmacotherapy. In H. Quay and J. Werry (Eds.),Psychopathological disorders of childhood (3rd ed., pp. 455–495). New York: John Wiley and Sons.
Henker, B., & Whalen, C. K. (1989). Hyperactivity and attention deficits.American Psychologist, 44, 216–223.
Jacobvitz, D., Sroufe, L. A., Stewart, M., & Leffert, N. (1990). Treatment of attentional and hyperactive problems in children with sympathomimetic drugs: A followup review.Journal of the American Academy of Child and Adolescent Psychiatry, 29, 677–688.
O'Leary, S. G., & Pelham, W. E. (1978). Behavior therapy and withdrawal of stimulant medication with hyperactive children.Pediatrics, 61, 211–217.
Pelham, W. E. (1983). The effects of psychostimulants on academic achievement in hyperactive and learning-disabled children.Thalamus, 3, 1–47.
Pelham, W. E. (1986). The effects of stimulant drugs on learning and achievement in hyperactive and learning-disabled children. In J. K. Torgesen & B. Wong (Eds.),Psychological and educational perspectives on learning disabilities (pp. 259–295). New York: Academic Press.
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. (in Press). Methy' Phenidate and attributions in boys with Attention Deficit Hyperactivity disorder.Journal of Consulting and Clinical Psychology.
Pelham, W. E. (1990). Behavior therapy, behavioral assessment, and psychostimulant medication in treatment of attention deficit disorders: An interactive approach. In J. Swanson & L. Bloomingdale (Eds.).Attention deficit disorders IV: Current concepts and emerging trends in attentional and behavioral disorders of childhood (pp. 169–195). London: Pergamon Press.
Pelham, W. E., Bender, M. E., Caddell, J., Booth, S., & Moorer, S. (1985). The dose-response effects of methylphenidate on classroom academic and social behavior in children with attention deficit disorder.Archives of General Psychiatry, 42, 948–952.
Pelham, W. E., & Hoza, J. (1987). Behavioral assessment of psychostimulant effects on ADD children in a Summer Day Treatment Program. In R. Prinz (Ed.),Advances in behavioral assessment of children and families (Vol. 3, pp. 3–33). Greenwich, CT: JAI Press.
Pelham, W. E., Milich, R., & Walker, J. (1986). The effects of continuous and partial reinforcement and methylphenidate on learning in children with attention deficit disorder.Journal of Abnormal Psychology, 95, 319–325.
Pelham, W. E., & Murphy, H. A. (1986). Behavioral and pharmacological treatment of attention deficit and conduct disorders. In M. Hersen (Ed.),Pharmacological and behavioral treatment: An integrative approach (pp. 108–148). New York: Wiley.
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 and R. Klorman (Eds.),Attention deficit disorders (Vol. III, pp. 29–48). London: Pergamon Press.
Pelham, W. E., Schnedler, R. W., Bologna, N., & Contreras, A. (1980). Behavioral and stimulant treatment of hyperactive children: A therapy study with methylphenidate probes in a within-subject design.Journal of Applied Behavior Analysis, 13, 221–236.
Pelham, W. E., Sturges, J., Hoza, J., Schmidt, C., Bijlsma, J., Milich, R., & Moorer, S. (1987). Sustained release and standard methylphenidate effects on cognitive and social behavior in children with attention deficit disorder.Pediatrics, 80, 491–501.
Pelham, W. E., Walker, J. L., Sturges, J., & Hoza, J. (1989). The comparative effects of methylphenidate on ADD girls and boys.Journal of the American Academy of Child and Adolescent Psychiatry, 28, 773–776.
Pfiffner, L. J., & O'Leary, S. G. (in press). Educational placement and classroom management. In J. Matson (Ed.),Handbook of hyperactivity. Plenum Press.
Rapport, M. D., DuPaul, G. J., Stoner, G., & Jones, J. T. (1986). Comparing classroom and clinic measures of attention deficit disorder: Differential, idiosyncratic, and dose response effects of methylphenidate.Journal of Consulting and Clinical Psychology, 54, 334–341.
Rosen, L. A., O'Leary, S. G., Joyce, S. A., Conway, G., & Pfiffner, L. J. (1984). The importance of prudent negative consequences for maintaining the appropriate behavior of hyperactive students.Journal of Abnormal Child Psychology, 12, 581–604.
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.
Sullivan, M. A., & O'Leary, S. G. (1989). Differential maintenance following reward and cost token programs with children.Behavior Therapy, 21, 139–151.
Witt, J. C. Hannafin, M. J., & Martens, B. K. (1983). Home-based reinforcement: Behavioral covariation between academic performance and inappropriate behavior.Journal of School Psychology, 21, 337–348.
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The authors gratefully acknowledge the assistance of Patricia Donovan, Michelle Berry, Mary Ingram, Patricia Wells, Beth Gnagy, Karen Greenslade, Mary Hamilton, and the entire staff of the Western Psychiatric Institute and Clinic ADHD Summer Treatment Program.
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Carlson, C.L., Pelham, W.E., Milich, R. et al. Single and combined effects of methylphenidate and behavior therapy on the classroom performance of children with attention-deficit hyperactivity disorder. J Abnorm Child Psychol 20, 213–232 (1992). https://doi.org/10.1007/BF00916549
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DOI: https://doi.org/10.1007/BF00916549