Behavior therapy and methylphenidate in the treatment of children with ADHD

Objective: To assess, in hyperactive children: 1) relative efficacy of behavior therapy, methylphenidate, and their combination; 2) effects of methylphenidate withdrawal after combined treatment; and 3) normalization effects of the combination. Method: Eighty-nine children were randomly assigned to treatment for eight weeks. Children on the combined treatments were switched to a placebo, double-blind. Ratings from parents, teachers and clinicians, and school observations were obtained. Results: Parents and teachers viewed children on behavior therapy as improved, but objective observations did not document behavioral change. In contrast, methylphenidate and the combined treatment induced significant improvement in all measures of outcome. Methylphenidate and the combination treatments were significantly superior to behavior therapy. In a few instances, the combination, which normalized behavior, was superior to methylphenidate. Children switched to placebo deteriorated significantly. Discussion: Behavior therapy delivered in school and home is not nearly as effective as methylphenidate for ADHD, but may be a useful adjunct to methylphenidate.