Individual treatment response to behavior modification was examined in the context of a summer treatment program. Four children ages 11 to 12 and diagnosed with attention-deficit/hyperactivity disorder were examined in a BABAB design in which a comprehensive behavioral program was utilized and withdrawn across an 8-week period. Dependent measures included frequency counts of negative behaviors, rule violations in recreational and classroom settings, and academic seatwork completion and accuracy. Results documented the effectiveness of the behavioral intervention with all 4 children. Some children showed consistent responses regardless of setting,while others showed differential responses in classroom and recreational settings. In general, behavior worsened progressively over days during the withdrawal weeks.The second withdrawal of treatment produced deleterious effects for several children that persisted for a time even when behavior modification was reinstated.The individual response patterns of each of the 4 children are discussed.
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References
1.
AACAP Work Group on Quality Issues. (1997). Practice parameters for the assessment and treatment of children, adolescents, and adults with attention-deficit/hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry , 36(Suppl.), 85S— 121S.
2.
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.
3.
American Academy of Pediatrics, Committee on Quality Improvement and Subcommittee on Attention-Deficit/Hyperactivity Disorder. ( 2001). Clinical practice guidelines: Treatment of the school-aged child with attention-deficit/hyperactivity disorder. Pediatrics , 108(4), 1033—1044.
4.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author .
5.
Anastopoulos, A.D., Shelton, T.L., DuPaul, G.J., & Guevremont, D.C. (1993). Parent training for attention-deficit hyperactivity disorder: Its impact on parenting functioning. Journal of Abnormal Child Psychology, 21, 581—596.
6.
Barkley, R.A. (1994). Impaired delayed responding: a unified theory of attention-deficit hyperactivity disorder. In D. K. Routh (Ed.). Disruptive Behavior Disorders in Childhood (pp. 11—57). New York: Plenum Press.
7.
Barkley, R.A. (1998). Handbook of attention deficit hyperactivity disorder (2nd ed.). New York: Guilford.
8.
Carlson, C.L., Pelham, W.E., Milich, R., & Dixon, J. (1992). Single and combined effects of methylphenidate and behavior therapy on the classroom performance of children with ADHD. Journal of Abnormal Child Psychology, 20, 213—232.
9.
Chronis, A.M., Fabiano, G.A., Gnagy, E.M., Onyango, A.N., Pelham, W.E., Williams, A., et al. (in press). An evaluation of the summer treatment program for children with attention-deficit/ hyperactivity disorder using a treatment withdrawal design. Behavior Therapy.
10.
Dishion, T.J., McCord, J., & Poulin, F. (1999). When interventions harm: Peer groups and problem behavior. The American Psychologist, 54(9), 755—764.
11.
DuPaul, G.J., & Eckert, T.L. (1998). Academic interventions for students with attention-deficit/hyperactivity disorder: A review of the literature. Reading & Writing Quarterly: Overcoming Learning Difficulties, 14, 59—82.
12.
Fabiano, G.A., Pelham, W.E., Pisecco, S., Evans, S.W., Manos, M.J., Caserta, D., et al. (2002, November). A nationally representative survey of classroom-based, behavior modification treatment for ADHD. Poster presented at the annual meeting of The Association for Advancement ofBehavior Therapy, Reno, NV.
13.
Horn, W.F., Ialongo, N., Pascoe, J.M., Greenberg, G., Packard, T., Lopez, M., et al. (1991). Additive effects of psychostimulants, parent training, and self-control therapy with ADHD children: A 9-month follow-up . Journal of the American Academy of Child and Adolescent Psychiatry, 32, 164—192.
14.
Hoza, B., Pelham, W.E., Sams, S.E., & Carlson, C. (1992). An examination of the “dosage” effects of both behavior therapy and methylphenidate on the classroom performance of two ADHD children. Behavior Modification, 16(2), 164—192.
15.
Hupp, S.D.A., & Reitman, D. (1999). Improving sports skills and sportsmanship in children with attention-deficit/hyperactivity disorder. Child & FamilyBehavior Therapy, 21(3), 35—51.
16.
Hupp, S.D.A., Reitman, D., O'Callaghan, P., Gulley, V., Northup, J., Beazy, B., et al. (1999, November). The influence of a token economy and methylphenidate on attention during sports with children diagnosed with ADHD. Poster presented at the annual convention of the Association for the Advancement ofBehavior Therapy, Toronto .
17.
Jadad, A., Boyle, M., Cunningham, C., Kim, M., & Schachaar, R. (1999). Treatment of attention-deficit/hyperactivity disorder (Evidence Report/Technology Assessment No. 11. Prepared by McMaster University under contract No. 290-97-0017. AHRQ Publication No. 00-E005). Rockville, MD: Agency for Healthcare Research and Quality .
18.
Kendall, P.C., Nay, W.R., & Jeffers, J. (1975). Timeout duration and contrast effects: A systematic evaluation of a successive treatments design. Behavior Therapy , 6, 609—615.
19.
Klein, R.G., & Abikoff, H. (1997). Behavior therapy and methylphenidate in the treatment of children with ADHD. Journal of Attention Disorders, 2, 89—114.
20.
Kolko, D.J., Buistein, O.G., & Barron, J. (1999). Methylphenidate and behavior modification in children with ADHD and comorbid ODD or CD: Main and incremental effects across settings . Journal of the American Academy of Child and Adolescent Psychiatry, 38, 578—586.
21.
MTA Cooperative Group. (1999). 14-month randomized clinical trial of treatment strategies for attention deficit hyperactivity disorder. Archives of General Psychiatry, 56, 1073—1086.
22.
MTA Cooperative Group. (2000). Anxiety as a predictor and outcome variable in the multimodal treatment study of children with ADHD (MTA). Journal of Abnormal Child Psychology , 28(6), 527—541.
23.
Miller, A., Lee, S., Raina, P., Klassen, A., Zupancic, J., & Olsen, L. (1998). A review of therapies for attention-deficit/hyperactivity disorder. Ottawa: Canadian Coordinating Office for Health Technology Assessment (CCOHTA).
24.
Pelham, W.E., Burrows-MacLean, L., Massetti, G.M., Hoffman, M.T., Gnagy, E.M., & Coles, E.K. (2004, November). Behavioral and pharmacological treatment for children with ADHD: Replication and effects of time. Poster accepted for presentation at the annual convention of the Association for the Advancement of Behavior Therapy, New Orleans.
25.
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 boys with ADHD in the classroom. Journal of Consulting and Clinical Psychology, 61, 506—515.
26.
Pelham, W.E., Fabiano, G.A., Gnagy, E.M., Greiner, A.R., & Hoza, B. (2001). The role of summer treatment programs in the context of comprehensive treatment for ADHD. In E. D. Hibbs & P. S. Jensen (Eds.), Psychosocial treatment research of child and adolescent disorders (2nd ed.). New York: American Psychological Association Press.
27.
Pelham, W.E., Gnagy, E.M., Greenslade, K.E., & Milich, R. (1992). Teacher ratings of DSM-III-R symptoms of the disruptive behavior disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 210—218.
28.
Pelham, W.E., Gnagy, E.M., Greiner, A.R., Hoza, B., Hinshaw, S.P., Swanson, J.M., et al. (2000). Behavioral vs. behavioral and pharmacological treatment in ADHD children attending a summer treatment program. Journal of Abnormal Child Psychology, 28(6), 507—526.
29.
Pelham, W.W., Greiner, A.R., & Gnagy, E.M. (1997). Summer treatment program manual. Buffalo, NY: Comprehensive Treatment for Attention Deficit Disorders, Inc.
30.
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: American Psychological Association Press.
31.
Pelham, W.E., & Murphy, H.A. (1986). Attention deficit and conduct disorder. In M. Hersen (Ed.), Pharmacological and behavioral treatment: An integrative approach (pp. 108—148). New York: Wiley.
32.
Pelham, W.E., Schnedler, R.W., Bender, M.E., Miller, J., Nilsson, D., Budrow, M., et al. (1988). The combination of behavior theray and methylphenidate in the treatment of attention deficit disorders: A therapy outcome study. In L. Bloomindate (Ed.), Attention deficit disorders III: New research in attention, treatment, and psychopharmacology (pp. 29—48). London : Pergamon.
33.
Pelham, W.E., & Smith, B.H. (2002). Prediction and measurement of individual responses to Ritalin by children and adolescents with attention deficit hyperactivity disorder. In L. L. Greenhill & B. B. Osman (Eds.), Ritalin: Theory and practice (2nd ed., pp. 193—218). New York: Mary Ann Liebert.
34.
Pelham, W.E., & Waschbusch, D.A. (1999). A behavioral intervention in attention-deficit/hyperactivity disorder. In H. C. Quay & A. E. Hogan (Eds.), Handbook of disruptive behavior disorders (pp. 255—278). New York: Plenum Press.
35.
Pelham, W.E., Wheeler, T., & Chronis, A. (1998). Empirically supported psychosocial treatments for ADHD. Journal of Clinical Child Psychology, 27, 190—205.
36.
Pfiffner, L.J., O'Leary, S.G., Rosen, L.A., & Sanderson, W.C. (1985). A comparison of the effects of continuous and intermittent response cost and reprimands in the classroom . Journal of Clinical Child Psychology, 14(4), 348—352.
37.
Rapport, M., Murphy, H.A., & Bailey, J.S. (1980). The effects of a response treatment tactic on hyperactive children. Journal of School Psychology, 18, 98—111.
38.
Rapport, M., Murphy, H.A., & Bailey, J.S. (1982). Ritalin vs. response cost in the control of hyperactive children: A within-subjects comparison. Journal of Applied Behavior Analysis, 15, 205—216.
39.
Wechsler, D. (1991). Wechsler intelligence scale for children—Third edition: Manual. San Antonio: Psychological Corp.
40.
Wechsler, D. (1992). Wechsler individual achievement test: Manual. San Antonio: Psychological Corp.
