Van der Oord S, Prins PJ, Oosterlaan J, Emmelkamp PM
journal
Clin Psychol Rev
Date Published
2008 Jun
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Study Summary
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What They Studied
They studied the effects of methylphenidate, psychosocial treatments, and their combination on ADHD symptoms, oppositional and conduct behaviors, social behaviors, and academic functioning.
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What They Found
They found that methylphenidate and combined treatments had large effects on ADHD and oppositional behaviors, while psychosocial treatments had moderate effects.
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What This Means
These findings show that both methylphenidate and psychosocial treatments are effective for reducing ADHD symptoms, but psychosocial treatments are less effective than methylphenidate alone or combined treatments.
Study Summary
Background
Abstract: 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.
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Primary FDA-Approved Use
Methylphenidate is FDA-approved for treating ADHD in children and adults.
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Mechanism of Action
Blocks reuptake of norepinephrine and dopamine, increasing their concentration in the synaptic cleft.
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Formulations and Dosage
Available in immediate, extended, and sustained-release forms; max daily dose is 72 mg for extended-release.
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Psychiatric Risks
May worsen symptoms of psychosis or bipolar disorder and cause new or increased aggressive behavior.
Study Summary
Methods
Researchers reviewed several databases, including PubMed and PsycInfo, for studies published between 1985 and 2006. The criteria for inclusion were a diagnosis of ADHD, children aged 6-12, randomized controlled trials, and assessments using parent and teacher rating scales. The psychosocial treatments included behavioral or cognitive-behavioral methods, and the methylphenidate used was short-acting. All treatments took place in clinical settings.
Abstract: 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 estab...more
Study Summary
Results
The results showed that both methylphenidate and combined treatments had large positive effects on ADHD symptoms, while psychosocial treatments had a moderate effect. This pattern was also seen in oppositional and conduct behaviors. Social behavior improvements were moderate across all treatments. However, academic performance showed low improvements for all methods. There was no link between the length of psychosocial treatment and its effectiveness.
Abstract: 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. Soci...more
Study Summary
Conclusions
Both methylphenidate and psychosocial treatments reduce ADHD symptoms, but psychosocial treatments are less effective than the other two. Adding psychosocial treatment to methylphenidate doesnβt provide extra benefits for ADHD and teacher-rated oppositional defiant disorder (ODD) symptoms. However, for social behavior and parent-rated ODD, all treatments were equally effective. None of the treatments significantly improved academic performance.
Abstract: 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 f...more
Professional Guide
Expert Opinion: Efficacy of ADHD Treatments in Children: A Meta-Analysis
The findings suggest that methylphenidate and psychosocial treatments, whether used individually or in combination, are effective for managing ADHD symptoms.
Stimulant medications, such as methylphenidate, exhibit a strong effect size for ADHD treatment, aligning with the observed outcomes.
For younger children with moderate-to-severe ADHD, methylphenidate is recommended when behavioral interventions are insufficient.
Combining behavioral therapy with stimulant medication shows positive results, particularly in pre-adolescent children.
The MTA study highlighted the additional benefits of combining these treatments based on parent and teacher ratings.
Behavioral therapy, which involves modifying the child's environment, enhances overall ADHD management, especially when coordinated between home and school.
Evidence Summary
Medication and Social Skills in Children with ADHD
Building upon the paper's finding that methylphenidate improves social behaviors, it's noteworthy that children with ADHD often struggle with social cues and relationships.
Medication alone helps these children better understand nonverbal cues.
However, adding social skills training to medication offers limited additional benefits for improving social skills.
Evidence Summary
Impact of ADHD on Organizational Skills and Treatment Approaches
Building upon the findings that both methylphenidate and combined treatments reduce ADHD symptoms,
this slide explores how ADHD impacts organizational skills in children and adults.
While medications like Ritalin can be effective, therapy and targeted interventions are also beneficial.
These approaches are especially promising for improving skills among college students.
Evidence Summary
ADHD Medications and Classroom Success
Building upon the discussion of treatment efficacy from the paper above, ADHD medications such as Vyvanse, Adderall, and Dexamphetamine show significant benefits.
These drugs enhance focus, maintain on-task behavior, and improve task completion.
The result is better academic performance and overall classroom success.