Effectiveness of an adaptive multimodal treatment in children with Attention-Deficit Hyperactivity Disorder -- global outcome.

Background: The meaning of different components within a multimodal treatment of ADHD remains to be further clarified.

Objective: To evaluate the effectiveness of behaviour therapy and drug treatment within an adaptive and individually tailored multimodal treatment for children with ADHD.

Method: After an initial psychoeducation n = 75 school-children aged 6-10 years with a diagnosis of ADHD/HKD were assigned to either behaviour therapy (including continued psychoeducation) or medical management with methylphenidate plus psychoeducation. Depending on the effectiveness, the treatment was either terminated (if totally effective) with long-term aftercare and continuation of medication if needed, or (if partially effective) the other treatment component was added (combined treatment), or (if ineffective) the treatment components were replaced. Thus a treatment rationale was applied which resulted in an adaptive and individually tailored therapy -- similar to a strategy that may be useful in clinical practice.

Results: Of the children who started with behaviour therapy after initial psychoeducation 26% received a combined treatment in later treatment stages. In most of the cases (82%) with initial medical management, behaviour therapy was added. ADHD symptoms, individually defined behaviour problems and comorbid symptoms were significantly reduced during the course of treatment. On core measures large pre-post effect sizes were found. On teacher ratings combined treatment was more effective than behaviour therapy.

Conclusions: Both, behaviour therapy and combined treatment are effective interventions within an adaptive and individually tailored multimodal treatment strategy.