Methylphenidate and behavior modification in children with ADHD and comorbid ODD or CD: Main and incremental effects across settings

Objective: Although the combination of methylphenidate (MPH) and behavior m odification (BMOD) has been advocated to enhance clinical outcome for child ren with attention-deficit hyperactivity disorder (ADHD) and comorbid disru ptive disorders, few group studies have been conducted. This study evaluate s the separate and incremental effects of these modalities on rating scale and observational measures in multiple settings. Method: Sixteen of 22 chil dren with ADHD and comorbid disruptive disorder completed a randomized, pla cebo-controlled study examining the separate and incremental effects of 2 d oses of MPH and BMOD during a partial hospitalization program. Of the 6 who did not complete the study, 2 children developed significant side effects. For the 16 who did complete the study, effects were examined on measures o f symptom ratings, behavioral frequencies, and stimulant side effects acros s program activities. Results: Based on a-adjusted analyses of variance, th ere were several main effects of MPH and BMOD on ADHD symptoms, oppositiona l behavior, and positive social behavior, with certain effects unique to ea ch intervention and setting. One incremental effect each was found for MPH (positive mood/behavior) and BMOD (negative behavior). MPH and BMOD were as sociated with few side effects. Effect sizes for each intervention showed c onsiderable variability in clinical response. Conclusions: That MPH and BMO D had certain unique main and incremental effects extends findings supporti ng their combination and suggests that integrated studies evaluate multiple dimensions of functioning and in novel settings (e.g., home, school). The incorporation of other intervention components in combined treatments may b e warranted to enhance clinical efficacy.