The effect of behavioral intervention on the need for adjunctive medication treatment in children with ADHD

The current study was designed to determine the impact of behavioral intervention on the need for medication in both the home and school setting, as well as to evaluate the dose of medication required as a function on ongoing behavioral treatments in the school and home setting in children with ADHD. Thus, 127 unmedicated children with ADHD were randomly assigned to either no, low, or high behavioral consultation procedures in their regular school setting following participation in a Summer Treatment Program study. Children were assessed weekly to determine if medication treatment with a CNS stimulant needed to be initiated, separately in the school and the home setting. When medication treatment was determined to be necessary, a medication assessment was conducted in either the school or home setting and the child began receiving medication. Several outcomes were assessed, including time to initiation of medication treatment, total daily dose of medication, and the child, parent, and teacher factors that may have influenced the above outcomes. Results indicate that children who received behavioral consultation both at home and at school initiated medication treatment later in the school year. Also, in the home setting, fewer children initiated medication in the behavioral consultation group than no behavior consultation. This result was not seen in the school setting. Of those children who did initiate medication treatment, there were differences in weekly doses of medication such that children who were receiving behavioral intervention received lower weekly doses of medication. A variety of predictors of propensity to receive medication were examined. Only previous use of medication predicted initiation of medication in both the home and school setting in the current study.