Effectiveness of methylphenidate and combined treatment (methylphenidate and psychosocial treatment) for Chinese children with attention-deficit/hyperactivity disorder in a community mental health center.

摘要

Background. Numerous clinical trials demonstrate the efficacy of medication and behavioral treatment for Attention-Deficit/Hyperactivity Disorder (ADHD) in children, but provision of behavioral treatment for ADHD is limited in community clinics and only the pharmacological treatment is the standard care for children with ADHD.{09}The current study evaluated the treatment effectiveness of combining psychosocial treatment to methylphenidate and to compare this combined treatment with medication alone in treating ADHD in children of a community mental health center in Hong Kong. Psychosocial treatment consisted of parent training and child intervention. The treatment group for children was a 24-week problem solving, anger coping, and social skills training program. Parent training consisted of 18 weekly sessions, highlighting parenting as an integration of elements of cognition, emotion, and behavior, as well as introducing effective parenting techniques based on social learning principles. Method. A group of 146 consecutive child patients with ADHD symptoms attending Yaumatei Child Psychiatric Center were invited for screening their eligibility of participating in this study. A randomized group comparison design was used with two treatment conditions (medication-only; combined medication and psychosocial treatment) and four assessment time points. Ninety eligible child-parent dyads were randomly allocated to the combined treatment condition or medication-only condition. Treatment outcomes were assessed in multiple domains at pre-intervention and post-intervention, and at 6-month and 12-month follow-ups. Data was analyzed through intent-to-treat mixed-effects regression model.; Results. Regarding ADHD symptoms, children in combined treatment condition showed significantly greater improvement than those given medication alone at post-treatment assessment.{09}Combined treatment also proved better than medication alone in several other domains, such as oppositional behavior, a child's performance on computerized test, parenting behavior, and parental accurate knowledge of ADHD. Parental treatment-related attributions were also found to be changing over the course of treatment. Follow-up assessments revealed that children in the combined treatment condition maintained greater reduction in oppositional behavior one year after the completion of psychosocial treatment.; Conclusions. The combined treatment condition not only yielded significantly greater benefits than the medication-only condition on primary ADHD symptoms, but also other advantages in terms of conduct problem and adaptive functioning outcomes.