Assessing the Impact of Childhood Interventions on Subsequent Drug Use--Commissioned Papers

A review of the literature was conducted to identify empirical, peer-reviewed studies of psychosocial and pharmacological treatments of children with attention-deficit/hyperactivity disorder (ADHD). Due to the disproportionately large number of treatment outcome studies of childhood ADHD relative to other childhood mental health disorders, a more selective selection process was used to locate studies appropriate for this review. Systematic computerized literature searches were conducted on PsycINFO and Medline databases, with keywords "attention deficit disorder" (PsycINFO) and "attention deficit disorder with hyperactivity" (Medline). The large number of references that resulted from the keyword search was reduced to include only those studies that: (1) were identified in the electronic databases by one or more of the following study descriptors: treatment outcome study, controlled clinical trial, or randomized controlled trial; (2) included subjects between the ages of 6 and 12 as the primary treatment target population, although studies that included adolescents as well were not excluded; (3) were published between 1985 and 1999; and (4) were written in the English language. Reference lists from review articles and book chapters were not included in the search. This search strategy yielded 132 empirical peer-reviewed studies that focused on the treatment of children with ADHD. Of these 132 studies, 54 studies were excluded for the following reasons: ADHD was a secondary rather than a primary diagnosis (n = 12); the study focus was other than treatment outcome (e.g., predictors of treatment adherence, profile of medication side effects; n = 24); and finally, subjects were not randomly assigned to treatment conditions (n = 18). The remaining 78 studies were reduced further by excluding pharmacological studies in which the sample size was less than 30 children (n = 47). The "greater than 30" sample size criterion was not applied to psychosocial or adjunctive treatments due to the limited number of these studies. This process identified 31 peer-reviewed treatment outcome studies of children with ADHD. These 31 studies are presented and described in table 1. A reference list of the excluded small n psychopharmacological studies is included in the reference section.

Attention-deficit/hyperactivity disorder is perhaps the most researched disorder in child mental health, with pharmacological interventions, psychosocial interventions, and adjunctive or multimodal interventions widely investigated.

Pharmacological treatments for ADHD have been well documented. Psychostimulant medications, including methylphenidate (Ritalin), dextroamphetamine (Dexedrine and Adderal�), and pemoline (Cylert) have been found to be quite effective short-term treatments for symptoms of ADHD. Psychostimulant medications have been shown to have their greatest effect on core symptoms (e.g., hyperactivity, impulsivity, and inattention) and associated features (e.g., defiance, aggression, and oppositionality) of ADHD. Small treatment effects have been reported for learning, school achievement, and cognitive tasks. Side effects of stimulant medications are a common concern for children and parents, but findings indicate that most side effects are mild, decrease over time, and are dose-dependent.

Behavioral training for parents and teachers and classroom contingency management are the primary psychosocial treatments investigated with children with ADHD. Individual psychosocial treatments, including cognitive behavior therapy, cognitive training, and social skills training have been less efficacious. While psychosocial treatments do not appear to achieve improvements as substantial as those found with stimulant medication, they have been found useful in changing parenting and teaching practices.

Adjunctive interventions are treatments that include both pharmacological and psychosocial modalities across multiple settings. Studies assessing the combined impact of cognitive training and stimulant medication have found little incremental benefit over medication alone. The most recent and largest adjunctive study to date, the Multimodal Treatment Study of Children with ADHD (MTA) has shown that combined treatment was not superior to well-delivered and well-monitored psychostimulant medication at reducing the core symptoms of ADHD. However, combined treatment outcomes were achieved with lower medication doses. Combined treatment was also superior at reducing associated features of ADHD, including defiance, aggression, oppositionality, internalizing symptoms, and parent-child relationships.

Study Citation(s)	Study Design/ Description	Target Population	Demographic Characteristics	Outcomes	Notes
Table 1.2 Psychopharmacological Studies of Childhood Attention-Deficit/Hyperactivity Disorder
Biederman, Baldessarini, Wright, Knee, & Harmatz, 1989	Double-blind, placebo-controlled RCT; 6-week desipramine hydrochloride (n = 31) vs. placebo (n = 31)	Community-referred children with ADDH; subjects selected on the basis of structured parent clinical interview and parent ratings	Age: 6 – 17 Gender: 93% boys 7% girls Race/ Ethnicity: 93% White 7% Other	Significant improvement in symptoms characteristic of ADDH was obtained on clinician, parent, and teacher ratings; no between-group differences on cognitive measures	Findings were similar for adolescents; short-term efficacy only; medication was well tolerated; no followup
Buitelaar, van der Gaag, Swaab-Barneveld, & Kuiper, 1996	Double-blind, placebo-controlled, within-subject crossover experimental design; 4-week methylphenidate (n = 46)	Outpatient children with ADHD; subjects selected on the basis of parent clinical interview, parent ratings, teacher ratings, and psychometric testing	Age: 6 – 13 Gender: 89% boys 11% girls Race/ Ethnicity: DK	Positive treatment effect was obtained on ratings of behavior at school and at home; predictors of improvement were high IQ, severe inattentiveness, young age, low severity, and low anxiety; a positive response to a single dose predicted response at week 4	Treatment normalized behavior at school and home in 17% of subjects; treatment change measured by questionnaires only; no follow-up data
Buitelaar, van der Gaag, Swaab-Barneveld, & Kuiper, 1995	Double-blind, placebo-controlled, within-subject cross-over experimental design; 4-week pindolol vs. 4-week methylphenidate vs. 4-week placebo (n = 52)	Outpatient children with ADHD; subjects selected on the basis of parent clinical interview, parent ratings, teacher ratings, and psychometric testing	Age: 7 – 13 Gender: 88% boys 12% girls Race/ Ethnicity: DK	Overall, pindolol was moderately effective relative to methylphenidate; pindolol was equally effective on measures of hyperactivity and conduct problems at home and hyperactivity problems at school, but less effective on measures of conduct problems at school	Pindolol side effects caused significantly greater distress in children and parents relative to methylphenidate; used fixed dosing; no followup data
Conners, Casat, Gualtieri, Weller, Reader, Reiss, Weller, Khayrallah, & Ascher, 1996	Double-blind, placebo-controlled RCT; 6-week bupropion hydrochloride (n = 72) vs. placebo (n = 37)	Children with ADHD; subjects selected on the basis of unstructured parent clinical interview, parent ratings, and teacher ratings	Age: 6 – 12 Gender: 90% boys 10% girls Race/ Ethnicity: 75% White 24% Other	Positive treatment effect was obtained on teacher ratings of aggression and hyperactivity at school; parents also reported symptom reduction but of less magnitude; clinician ratings of global improvement varied greatly by site with no overall treatment effect when averaged	Positive treatment effect was obtained on short-term memory and continuous performance tests; no followup data
Gadow, Nolan, Sprafkin, & Sverd, 1995; Gadow, Sverd, Sprafkin, Nolan, & Grossman, 1999	Double-blind, placebo-controlled, within-subject crossover experimental design; 8-week methylphenidate (n = 34)	Schoolchildren with ADHD and comorbid tic disorder; subjects selected on the basis of parent clinical interview, parent ratings, and teacher ratings	Age: 6 – 11 Gender: 91% boys 9% girls Race/ Ethnicity: 86% White 10% African American 4% Other	Treatment resulted in significant reduction in hyperactive, disruptive, and aggressive behavior in school setting; treatment effect was observed across all three doses of methylphenidate (0.1, 0.3, and 0.5 mg/ kg); a clinically insignificant but statistically significant exacerbation of motor tics in classroom setting was observed	No nonresponders; followup data at 6-month intervals for 2 years revealed continuing overall improvement in symptoms characteristic of ADHD and no exacerbation of either motor or vocal tics
Gillberg, Melander, von Knorring, Janols, Thernlund, H�ggl�f, Eidevall-Wallin, Gustafsson, & Kopp, 1997	Double-blind, placebo-controlled RCT; 15-month amphetamine sulfate (n = 32) vs. placebo (n = 30)	Outpatient children with ADHD; subjects selected on the basis of parent clinical interview	Age: 6 – 11 Gender: 84% boys 16% girls Race/ Ethnicity: 100% White (Swedish)	Positive outcomes obtained on measures of behavioral abnormality by parents and teachers; trend for positive outcome on measures of learning	Significant attrition in placebo group (73%); adverse side effects were few and mild
Manos, Short, Findling, & 1999	Double-blind titration, placebo-controlled quasi-experimental design; 4-week two daily doses of methylphenidate (n = 42) vs. single dose of Adderall� (n = 42)	Outpatient children with ADHD; subjects selected on the basis of structured parent clinical interview, parent ratings, and teacher ratings	Age: 5 – 17 Gender: 79% boys 21% girls Race/ Ethnicity: 93% White 5% African American 2% Hispanic	Although a significant dose effect was observed for both medications, no between-treatment differences were observed on parent and teacher ratings	Subjects were not randomly assigned to treatment conditions; no followup data
Nolan & Gadow, 1997	Double-blind, placebo-controlled, within-subject crossover experimental design; evaluated the extent to which 8-week methylphenidate (n = 34) normalizes behavior and indirectly influences the behavior of peers	Community-referred children with ADHD and chronic tic disorder; subjects selected on the basis of parent clinical interview, parent ratings, and teacher ratings	Age: 6 – 11 Gender: 91% boys 9% girls Race/ Ethnicity: 86% White 10% African American 4% Other	Treatment result in significant behavioral improvement but complete behavioral normalization was not achieved in many of the children (68%)	Little evidence that peer behavior improved as a function of subject medication dose; treatment response of subjects with ADHD and tics is similar to samples of children with ADHD alone
Rapport, Denney, DuPaul, & Gardner, 1994	Double-blind, placebo-controlled, within-subject crossover experimental design; 6-week methylphenidate at four doses (5 mg, 10 mg, 15 mg, and 20 mg; n = 76)	Community-referred children with ADHD; subjects selected on the basis of semistructured parent interview, parent ratings, and teacher ratings	Age: 6 – 11 Gender: 86% boys 14% girls Race/ Ethnicity: 100% White	The dose-response effect on classroom behavior was predominately linear; a large proportion of children showed normalization of sustained attention (72%) and classroom functioning (78%), and a large proportion showed no improvement in academic functioning (47%)	None
Schachar, Tannock, Cunningham, & Corkum, 1997	RCT; 4-month methylphenidate (n = 46) vs. placebo (n = 45)	Outpatient children with ADHD; subjects selected on the basis of semi-structured parent clinical interview, parent ratings, and teacher ratings	Age: 6 – 12 Gender: DK Race/ Ethnicity: DK	Positive outcomes obtained on teacher ratings of core symptoms of ADHD (inattention, hyperactivity-impulsiveness); no between-group differences on measures of symptom improvement in parent ratings of home behavior	Treatment gains on teacher ratings were maintained over 4 months; no evidence of relapse during 4-month treatment; subjects in placebo condition also showed some improvement; 10% of the treatment group discontinued treatment due to negative side effects
Sprafkin & Gadow, 1996	Quasi-experimental between-group design; methylphenidate subjects in a controlled research protocol (n = 33) vs. methylphenidate subjects in a community-based clinic (n = 43); evaluated the extent to which assessment procedures influenced treatment response	Community-referred children with ADD/ADHD; subjects selected on the basis of unstructured parent clinical interview, parent ratings, and teacher ratings	Age: 4 – 13 Gender: 99% boys 1% girls Race/ Ethnicity: 84% White 8% African American 8% Other	Analyses of teacher ratings revealed no between-group differences; the pattern of treatment response was also similar within treatment groups	Subjects were not randomly assigned; groups were also not equivalent in age, special education status, level of aggression, and tic status
Swanson, Wigal, Greenhill, Browne, Waslik, Lerner, Williams, Flynn, Agler, Crowley, Fineberg, Baren, & Cantwell, 1998	Double-blind, placebo-controlled, within-subject crossover design; 7-week safety and efficacy study of Adderall� (n = 30)	Community-referred children with ADHD and positive treatment response to methylphenidate; subjects selected on the basis of a structured parent clinical interview, parent ratings, and psychometric testing	Age: 7 – 14 Gender: 79% boys 31% girls Race/ Ethnicity: DK	Objective (written schoolwork) and subjective (teacher ratings) measures revealed significant treatment effects; no unusual or serious side effects were noted	The use of an analogue classroom raises questions of ecological validity
Zeiner, Bryhn, Bjercke, Truyen, & Strand, 1999	Double-blind, placebo-controlled, within-subject crossover experimental design; 7-week methylphenidate (n = 36)	Outpatient children with ADHD; subjects selected on the basis of parent clinical interview, parent ratings, and neuropsychological testing	Age: 7 – 11 Gender: 100% boys Race/ Ethnicity: DK	Positive treatment effect was obtained on behavioral measures of hyperactivity and defiance at home and school; neuropsychological tests showed positive treatment effect for sustained attention, the ability to process complex information, and motor coordination	No followup data

Study Citation(s)	Study Design/ Description	Target Population	Demographic Characteristics	Outcomes	Notes
Table 1.3 Adjunctive Studies of Childhood Attention-Deficit/Hyperactivity Disorder
Abikoff, Ganeles, Reiter, Blum, Foley, & Klein, 1988	RCT; 16-week cognitive training plus medication (n = 11) vs. remedial tutoring plus medication (n = 10) vs. medication alone (n = 13)	Community-referred children with ADHD, with academic deficiency and positive treatment response to stimulant medication (methylphenidate or dextroamphetamine); subjects selected on the basis of unstructured parent clinical interview, parent ratings, and teacher ratings	Age: 7 – 12 Gender: 100% boys Race/ Ethnicity: 76% White 21% African American 3% Hispanic	Results showed no significant improvement in academic performance, self-esteem, or perceptions of academic functioning due to cognitive training	At 6-month followup, children in the cognitive training group were rated as more improved in math and reading by teachers; however, this finding did not coincide with changes in achievement tests; small sample size
Abikoff & Gittelman, 1985	RCT; 16-week cognitive training plus medication (n = 21) vs. attention control plus medication (n = 14) vs. medication alone (n = 15); at 4-week followup the medication-alone and attention-control groups were switched to placebo (n = 29), and cognitive-training group was randomized to continued medication (n = 10) or placebo (n = 10)	Community-referred children with ADHD, cross-situational hyperactivity who required maintenance methylphenidate, dextroamphetamine, or pemoline; subjects selected on the basis of referral, parent ratings, and psychometric testing	Age: 6 – 17 Gender: 90% boys 10% girls Race/ Ethnicity: DK	Cognitive training did not result in improved behavioral, academic, or cognitive functioning relative to the other two treatment groups; cognitive training did not facilitate withdrawal of medication	During placebo substitution phase, both cognitive training and attention control children were more disruptive than those children who had received medication alone; most children required remedication following placebo substitution
Brown, Borden, Wynne, Schleser, & Clingerman, 1986	2 x 2 double-blind, placebo-controlled RCT; methylphenidate and attention control (n = 8) vs. cognitive training and placebo (n = 10) vs. methylphenidate and cognitive training (n = 9) vs. attention control and placebo (n = 8)	Community-referred children with ADD; subjects selected on the basis of structured and unstructured parent clinical interviews	Age: 5 – 13 Gender: 80% boys 20% girls Race/ Ethnicity: DK	No significant improvement in characteristic symptoms of ADD across the four treatment groups	Medication was discontinued prior to posttesting; did not include dropouts in analyses; questionable power due to small sample size; no followup data
Brown, Wynne, Borden, Clingerman, Geniesse, & Spunt, 1986	2 x 2 double-blind, placebo-controlled RCT; 3-month methylphenidate and attention control (n = 7) vs. cognitive therapy and placebo (n = 10) vs. methylphenidate and cognitive therapy (n = 9) vs. attention control and placebo (n = 7)	Outpatient children with ADD; subjects selected on the basis of diagnosis by referring physician, parent ratings, and teacher ratings	Age: 5 – 13 Gender: 85% boys 15% girls Race/ Ethnicity: DK	The adjunctive use of cognitive therapy failed to help maintain treatment gains following discontinuation of medication	Questionable power due to small sample size; no followup data
Horn, Ialongo, Pascoe, Greenberg, Packard, Lopez, Wagner, & Puttler, 1991; Ialongo, Horn, Pascoe, Greenberg, Packard, Lopez, Wagner, & Puttler, 1993	2 x 3 double-blind, placebo-controlled RCT; three levels of medication: placebo, low-dose methylphenidate, or high-dose methylphenidate; levels of psychosocial intervention: 12-week behavioral parent training, 12-week self-control training, or no behavioral intervention; n = 16 subjects assigned to each of the six treatment conditions	Outpatient children with ADHD (50% comorbid with either CD or OD); subjects selected on the basis of unstructured parent clinical interview, parent ratings, teacher ratings, and psychometric testing	Age: 7 – 11 Gender: 77% boys 23% girls Race/ Ethnicity: 85% White 9% African American 4% Hispanic 2% Asian American	The combination of medication and behavioral intervention did not improve outcomes over high-dose medication alone; low-dose in combination with behavioral intervention was significantly more effective than low-dose alone and as effective as high-dose alone on teacher ratings	9-month followup failed to reveal positive outcomes for combined psychosocial intervention; results suggest that treatment benefits dissipate when medication is withdrawn
Klein & Abikoff, 1997	RCT; 8-week behavior therapy and placebo (n = 28) vs. methylphenidate alone (n = 29) vs. behavior therapy and methylphenidate (n = 29)	Outpatient children with ADHD; subjects selected on the basis of parent clinical interview and parent ratings	Age: 6 – 12 Gender: 94% boys 6% girls Race/ Ethnicity: 83% White 14% African American 2% Hispanic 1% Asian	The combination of behavior therapy and methylphenidate was the most effective treatment; methylphenidate alone was next most effective treatment; behavior therapy alone was least effective	The behavioral treatment program was comprehensive and intensive, which may limit its feasibility
Multimodal Treatment Study of Children with Attention-Deficit/ Hyperactivity Disorder Cooperative Group, 1999	RCT; 14-month medication management (n = 144) vs. behavioral treatment (n = 144) vs. combined treatment (n = 145) vs. 14-month community care (n = 146); the behavior treatment consisted of parent training (27 group and 8 individual sessions), child-focused treatment (8-week summer treatment program), and a school-based intervention (10-16 teacher consultation sessions and 12 weeks of a behaviorally trained aid working with the child)	Community-referred children with ADHD; subjects selected on the basis of a structured clinical interview, parent ratings, and teacher ratings	Age: 7 – 9 Gender: 80% boys 20% girls Race/ Ethnicity: 71% White 20% African American 8% Other	All treatments showed improvement in ADHD symptoms; combined treatment showed no added benefit to medication management alone in reducing core symptoms of ADHD; combined treatment was superior to other treatments in several non-ADHD domains (oppositional/ aggressive symptoms) and positive functioning outcomes (parent-child relations)	Largest and best designed study to date of treatments for children with ADHD; subjects were selected with a wide range of comorbid conditions and demographic characteristics representative of patients seen in clinical practice; improvements in combined treatment were achieved at lower doses
Pelham, Carlson, Sams, Vallano, Dixon, & Hoza, 1993	Within-subjects alternating treatments design; behavior modification vs. no behavior modification and high dose methylphenidate vs. low dose methylphenidate vs. placebo (n = 31)	Day treatment children with ADHD; subjects selected on the basis of parent structured interview, parent ratings, and teacher ratings	Age: 5 – 9 Gender: 100% boys Race/ Ethnicity: 94% White 6% African American	Significant main effect for both interventions alone, with the effect size of methylphenidate twice that of behavior modification; little was gained by the higher dose of methylphenidate or behavior modification over the effects of the low dose methylphenidate	No followup data; study limited to classroom behavior

Abikoff, H., Ganeles, D., Reiter, G., Blum, C., Foley, C., & Klein, R. (1988). Cognitive training in academically deficient ADDH boys receiving stimulant medication. Journal of Abnormal Child Psychology, 16, 411-432.

Abikoff, H., & Gittelman, R. (1985). Hyperactive children treated with stimulants: Is cognitive training a useful adjunct? Archives of General Psychiatry, 42, 953-961.

Biederman, J., Baldessarini, R. J., Wright, V., Knee, D., & Harmatz, J. S. (1989). A double-blind placebo controlled study of desipramine in the treatment of ADD: I. Efficacy. Journal of the American Academy of Child and Adolescent Psychiatry, 28, 777-784.

Brown, R. T., Borden, K. A., Wynne, M. E., Schleser, R., & Clingerman, S. (1986). Methylphenidate and cognitive therapy with ADD children: A methodological reconsideration. Journal of Abnormal Child Psychology, 14, 481-497.

Brown, R. T., Wynne, M. A., Borden, K. A., Clingerman, S. R., Geniesse, R., & Spunt, A. L. (1986). Methylphenidate and cognitive therapy in children with attention deficit disorder: A double-blind trial. Journal of Developmental and Behavioral Pediatrics, 7, 163-170.

Buitelaar, J. K., van der Gaag, R. J., Swaab-Barneveld, H., & Kuiper, M. (1996). Pindolol and methylphenidate in children with attention-deficit hyperactivity disorder. Clinical efficacy and side-effects. Journal of Child Psychology and Psychiatry and Allied Disciplines, 37, 587-595.

Buitelaar, J. K., van der Gaag, R. J., Swaab-Barneveld, H., & Kuiper, M. (1995). Prediction of clinical response to methylphenidate in children with attention-deficit hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 34, 1025-1032.

Conners, C. K., Casat, C. D., Gualtieri, C. T., Weller, E., Reader, M., Reiss, A., Weller, R. A., Khayrallah, M., & Ascher, J. (1996). Bupropion hydrochloride in attention deficit disorder with hyperactivity. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 1314-1321.

Fehlings, D. L., Roberts, W., Humphries, T., & Dawe, G. (1991). Attention deficit hyperactivity disorder: Does cognitive behavioral therapy improve home behavior? Journal of Developmental and Behavioral Pediatrics, 12, 223-228.

Gadow, K. D., Nolan, E., Sprafkin, J., & Sverd, J. (1995). School observations of children with attention-deficit hyperactivity disorder and comorbid tic disorder: Effects of methylphenidate treatment. Journal of Developmental and Behavioral Pediatrics, 16, 167-176.

Gadow, K.D., Sverd, J., Sprafkin, J., Nolan, E. E., & Ezor, S.N. (1995). Efficacy of methylphenidate for attention-deficit hyperactivity disorder in children with tic disorder. Archives of General Psychiatry, 52, 444-445.

Gadow, K. D., Sverd, J., Sprafkin, J., Nolan, E. E., & Grossman, S. (1999). Long-term methylphenidate therapy in children with comorbid attention-deficit hyperactivity disorder and chronic multiple tic disorder. Archives of General Psychiatry, 56, 330-336.

Gillberg, C., Melander, H., von Knorring, A. L., Janols, L. O., Thernlund, G., Hagglof, B., Eidevall-Wallin, L., Gustafsson, P., & Kopp, S. (1997). Long-term stimulant treatment of children with attention-deficit hyperactivity disorder symptoms: A randomized, double-blind, placebo-controlled trial. Archives of General Psychiatry, 54, 857-864.

Horn, W. F., Ialongo, N., Greenberg, G., Packard, T., & Smith-Winberry, C. (1990). Additive effects of behavioral parent training and self-control therapy with attention deficit hyperactivity disordered children. Journal of Clinical Child Psychology, 19, 98-110.

Horn, W. F., Ialongo, N. S., Pascoe, J. M., Greenberg, G., Packard, T., Lopez, M., Wagner, A., & Puttler, L. (1991). Additive effects of psychostimulants, parent training, and self-control therapy with ADHD children. Journal of the American Academy of Child and Adolescent Psychiatry, 30, 233-240.

Ialongo, N. S., Horn, W. F., Pascoe, J. M., Greenberg, G., Packard, T., Lozpe, M., Wagner, A., & Puttler, L. (1993). The effects of a multimodal intervention with attention-deficit hyperactivity disorder children: A 9-month follow-up. Journal of the American Academy of Child and Adolescent Psychiatry, 32, 182-189.

Klein, R.G., & Abikoff, H. (1997). Behavior therapy and methylphenidate in the treatment of children with ADHD. Journal of Attention Disorders, 2, 89-114.

Linden, M., Habib, T., & Radojevic, V. (1996). A controlled study of the effects of EEG biofeedback on cognition and behavior of children with attention deficit disorder and learning disabilities. Biofeedback and Self Regulation, 21, 35-49.

Long, N., Rickert, V. I., & Ashcraft, E. W. (1993). Bibliotherapy as an adjunct to stimulant medication in the treatment of attention-deficit hyperactivity disorder. Journal of Pediatric Health Care, 7, 82-88.

Manos, M. J., Short, E. J., & Findling, R. L. (1999). Differential effectiveness of methylphenidate and Adderall in school-age youths with attention-deficit/hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 813-819.

MTA Cooperative Group. (1999). A 14-month randomized trial of treatment strategies for attention-deficit/hyperactivity disorder. Archives of General Psychiatry, 56, 1073-1086.

Nolan, E. E., & Gadow, K. D. (1997). Children with ADHD and tic disorder and their classmates: Behavioral normalization with methylphenidate. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 597-604.

Pelham, W. E., Carlson, C. L., Sams, S. E., Vallano, G., Dixon, M. J., & Hoza, B. (1993). Separate and combined effects of methylphenidate and behavior modification on boys with attention deficit-hyperactivity disorder in the classroom. Journal of Consulting and Clinical Psychology, 61, 506-515.

Pfiffner, L. J., & McBurnett, K. (1997). Social skills training with parent generalization: Treatment effects for children with attention deficit disorder. Journal of Consulting and Clinical Psychology, 65, 749-757.

Pisterman, S., McGrath, P., Firestone, P., Goodman, J. T., Webster, I., & Mallory, R. (1989). Outcome of parent-mediated treatment of preschoolers with attention deficit disorder with hyperactivity. Journal of Consulting and Clinical Psychology, 57, 628-635.

Rapport, M. D., Denney, C., DuPaul, G. J., & Gardner, M. J. (1994). Attention deficit disorder and methylphenidate: normalization rates, clinical effectiveness, and response prediction in 76 children. Journal of the American Academy of Child and Adolescent Psychiatry, 33, 882-893.

Schachar, R. J., Tannock, R., Cunningham, C., & Corkum, P. V. (1997). Behavioral, situational, and temporal effects of treatment of ADHD with methylphenidate. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 754-763.

Schmidt, M.H., Mocks, P., Lay, B., Eisert, H.G., Fojkar, R., Fritz-Sigmund, D., Marcus, A., & Musaeus, B. (1997). Does oligoantigenic diet influence hyperactive/conduct-disordered children?: A controlled trial. European Child and Adolescent Psychiatry, 6, 88-95.

Sprafkin, J., & Gadow, K. D. (1996). Double-blind versus open evaluations of stimulant drug response in children with attention-deficit hyperactivity disorder. Journal of Child and Adolescent Psychopharmacology, 6, 215-228.

Swanson, J. M., Wigal, S., Greenhill, L. L., Browne, R., Waslik, B., Lerner, M., Williams, L., Flynn, D., Agler, D., Crowley, K., Fineberg, E., Baren, M., & Cantwell, D. P. (1998). Analog classroom assessment of Adderall in children with ADHD. Journal of the American Academy of Child and Adolescent Psychiatry, 37, 519-526.

Zeiner, P., Bryhn, G., Bjercke, C., Truyen, K., & Strand, G. (1999). Response to methylphenidate in boys with attention-deficit hyperactivity disorder. Acta Paediatrica, 88, 298-303.

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.

Ajibola, O., & Clement, P. W. (1995). Differential effects of methylphenidate and self-reinforcement on attention-deficit hyperactivity disorder. Behavior Modification, 19, 211-233.

Arnold, L. E., Kleykamp, D., Votolato, N. A., Taylor, W. A., Kontras, S. B., & Tobin, K. (1989). Gamma-linolenic acid for attention-deficit hyperactivity disorder: placebo-controlled comparison to D-amphetamine. Biological Psychiatry, 25, 222-228.

Barrickman, L. L., Perry, P. J., Allen, A. J., Kuperman, S., Arndt, S. V., Herrmann, K. J., & Schumacher, E. (1995). Bupropion versus methylphenidate in the treatment of attention-deficit hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 34, 649-657.

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 attention-deficit hyperactivity disorder. Journal of Abnormal Child Psychology, 20, 213-232.

Casat, C. D., Pleasants, D. Z., & Van Wyck Fleet, J. (1987). A double-blind trial of bupropion in children with attention deficit disorder. Psychopharmacology Bulletin, 23, 120-122.

Cotton, M. F., & Rothberg, A. D. (1988). Methylphenidate v. placebo--a randomised double-blind crossover study in children with the attention deficit disorder. South African Medical Journal, 74, 268-271.

Cunningham, C. E., Siegel, L. S., & Offord, D. R. (1991). A dose-response analysis of the effects of methylphenidate on the peer interactions and simulated classroom performance of ADD children with and without conduct problems. Journal of Child Psychology and Psychiatry and Allied Disciplines, 32, 439-452.

de Sonneville, L. M., Njiokiktjien, C., & Bos, H. (1994). Methylphenidate and information processing. Part 1: Differentiation between responders and nonresponders; Part 2: Efficacy in responders. Journal of Clinical and Experimental Neuropsychology, 16, 877-897.

de Sonneville, L. M., Njiokiktjien, C., & Hilhorst, R. C. (1991). Methylphenidate-induced changes in ADDH information processors. Journal of Child Psychology and Psychiatry and Allied Disciplines, 32, 285-295.

Donnelly, M., Rapoport, J. L., Potter, W. Z., Oliver, J., Keysor, C. S., & Murphy, D. L. (1989). Fenfluramine and dextroamphetamine treatment of childhood hyperactivity: Clinical and biochemical findings. Archives of General Psychiatry, 46, 205-212.

DuPaul, G. J., Barkley, R. A., & McMurray, M. B. (1994). Response of children with ADHD to methylphenidate: Interaction with internalizing symptoms. Journal of the American Academy of Child and Adolescent Psychiatry, 33, 894-903.

Fitzpatrick, P. A., Klorman, R., Brumaghim, J. T., & Borgstedt, A. D. (1992). Effects of sustained-release and standard preparations of methylphenidate on attention deficit disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 226-234.

Forness, S. R., Swanson, J. M., Cantwell, D. P., Youpa, D., & Hanna, G. L. (1992). Stimulant medication and reading performance: Follow-up on sustained dose in ADHD boys with and without conduct disorders. Journal of Learning Disabilities, 25, 115-123.

Gadow, K. D., Nolan, E. E., & Sverd, J. (1992). Methylphenidate in hyperactive boys with comorbid tic disorder: II. Short-term behavioral effects in school settings. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 462-471.

Gualtieri, C. T., Keenan, P. A., & Chandler, M. (1991). Clinical and neuropsychological effects of desipramine in children with attention deficit hyperactivity disorder. Journal of Clinical Psychopharmacology, 11, 155-159.

Hall, C. W., & Kataria, S. (1992). Effects of two treatment techniques on delay and vigilance tasks with attention deficit hyperactive disorder (ADHD) children. Journal of Psychology, 126, 17-25.

Hinshaw, S. P., Buhrmester, D., & Heller, T. (1989). Anger control in response to verbal provocation: Effects of stimulant medication for boys with ADHD. Journal of Abnormal Child Psychology, 17, 393-407.

Hinshaw, S. P., Henker, B., Whalen, C. K., Erhardt, D., & Dunnington, R. E., Jr. (1989). Aggressive, prosocial, and nonsocial behavior in hyperactive boys: Dose effects of methylphenidate in naturalistic settings. Journal of Consulting and Clinical Psychology, 57, 636-643.

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, 164-192.

Hunt, R. D., Minderaa, R. B., & Cohen, D. J. (1986). The therapeutic effect of clonidine in attention deficit disorder with hyperactivity: A comparison with placebo and methylphenidate. Psychopharmacology Bulletin, 22, 229-236.

Iaboni, F., Douglas, V. I., & Baker, A. G. (1995). Effects of reward and response costs on inhibition in ADHD children. Journal of Abnormal Psychology, 104, 232-240.

Kolko, D. J., Bukstein, 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.

Lubar, J. F., Swartwood, M. O., Swartwood, J. N., & O'Donnell, P. H. (1995). Evaluation of the effectiveness of EEG neurofeedback training for ADHD in a clinical setting as measured by changes in T.O.V.A. scores, behavioral ratings, and WISC-R performance. Biofeedback and Self Regulation, 20, 83-99.

Malone, M. A., & Swanson, J. M. (1993). Effects of methylphenidate on impulsive responding in children with attention-deficit hyperactivity disorder. Journal of Child Neurology, 8, 157-163.

Pelham, W. E., Aronoff, H. R., Midlam, J. K., Shapiro, C. J., Gnagy, E. M., Chronis, A. M., Onyango, A. N., Forehand, G., Nguyen, A., & Waxmonsky, J. (1999). A comparison of Ritalin and Adderall: Efficacy and time-course in children with attention-deficit/hyperactivity disorder. Pediatrics, 103, e43.

Pelham, W. E., Bender, M. E., Caddell, J., Booth, S., & Moorer, S. H. (1985). Methylphenidate and children with attention deficit disorder: Dose effects on classroom academic and social behavior. Archives of General Psychiatry, 42, 948-952.

Pelham, W. E., Jr., Greenslade, K. E., Vodde-Hamilton, M., Murphy, D. A., Greenstein, J. J., Gnagy, E. M., Guthrie, K. J., Hoover, M. D., & Dahl, R. E. (1990). Relative efficacy of long-acting stimulants on children with attention deficit-hyperactivity disorder: A comparison of standard methylphenidate, sustained-release methylphenidate, sustained-release dextroamphetamine, and pemoline. Pediatrics, 86, 226-237.

Pelham, W. E., Jr., McBurnett, K., Harper, G. W., Milich, R., Murphy, D. A., Clinton, J., & Thiele, C. (1990). Methylphenidate and baseball playing in ADHD children: Who's on first? Journal of Consulting and Clinical Psychology, 58, 130-133.

Pelham, W. E., Jr., Sturges, J., Hoza, J., Schmidt, C., Bijlsma, J. J., Milich, R., & Moorer, S. (1987). Sustained release and standard methylphenidate effects on cognitive and social behavior in children with attention deficit disorder. Pediatrics, 80, 491-501.

Rapport, M.D., Carlson, G.A., Kelly, K.L., & Pataki, C. (1993). Methylphenidate and desipramine in hospitalized children: I. Separate and combined effects on cognitive function. Journal of the American Academy of Child and Adolescent Psychiatry, 32, 333-342.

Rapport, M.D., & DuPaul, G.J. (1986). Methylphenidate: Rate-dependent effects on hyperactivity. Psychopharmacology Bulletin, 22, 223-228.

Rapport, M. D., Quinn, S. O., DuPaul, G. J., Quinn, E. P., & Kelly, K. L. (1989). Attention deficit disorder with hyperactivity and methylphenidate: The effects of dose and mastery level on children's learning performance. Journal of Abnormal Child Psychology, 17, 669-689.

Rapport, M. D., Stoner, G., DuPaul, G. J., Birmingham, B. K., & Tucker, S. (1985). Methylphenidate in hyperactive children: Differential effects of dose on academic, learning, and social behavior. Journal of Abnormal Child Psychology, 13, 227-243.

Sheridan, S. M., Dee, C. C., Morgan, J. C., McCormick, M. E., & Walker, D. (1996). A multimethod intervention for social skills deficits in children with ADHD and their parents. School Psychology Review, 25, 57-76.

Smith, B. H., Pelham, W. E., Gnagy, E., & Yudell, R. S. (1998). Equivalent effects of stimulant treatment for attention-deficit hyperactivity disorder during childhood and adolescence. Journal of the American Academy of Child and Adolescent Psychiatry, 37, 314-321.

Smithee, J. A., Klorman, R., Brumaghim, J. T., & Borgstedt, A. D. (1998). Methylphenidate does not modify the impact of response frequency or stimulus sequence on performance and event-related potentials of children with attention deficit hyperactivity disorder. Journal of Abnormal Child Psychology, 26, 233-245.

Tannock, R., & Schachar, R. (1992). Methylphenidate and cognitive perseveration in hyperactive children. Journal of Child Psychology and Psychiatry and Allied Disciplines, 33, 1217-1228.

Tannock, R., Schachar, R. J., Carr, R. P., Chajczyk, D., & Logan, G. D. (1989). Effects of methylphenidate on inhibitory control in hyperactive children. Journal of Abnormal Child Psychology, 17, 473-491.

Tannock, R., Schachar, R. J., Carr, R. P., & Logan, G. D. (1989). Dose-response effects of methylphenidate on academic performance and overt behavior in hyperactive children. Pediatrics, 84, 648-657.

Tannock, R., Schachar, R., & Logan, G. (1995). Methylphenidate and cognitive flexibility: Dissociated dose effects in hyperactive children. Journal of Abnormal Child Psychology, 23, 235-266.

Trommer, B. L., Hoeppner, J. A., & Zecker, S. G. (1991). The go-no test in attention deficit disorder is sensitive to methylphenidate. Journal of Child Neurology, 6, 128S-131S.

Verbaten, M. N., Overtoom, C. C., Koelega, H. S., Swaab-Barneveld, H., van der Gaag, R. J., Buitelaar, J., & van Engeland, H. (1994). Methylphenidate influences on both early and late ERP waves of ADHD children in a continuous performance test. Journal of Abnormal Child Psychology, 22, 561-578.

Vyse, S. A., & Rapport, M. D. (1989). The effects of methylphenidate on learning in children with ADDH: The stimulus equivalence paradigm. Journal of Consulting and Clinical Psychology, 57, 425-435.

Wigal, S. B., Swanson, J. M., Greenhill, L., Waslick, B., Cantwell, D., Clevenger, W., Davies, M., Lerner, M., Regino, R., Fineberg, E., Baren, M., & Browne, R. (1998). Evaluation of individual subjects in the analog classroom setting: II. Effects of dose of amphetamine (Adderal�). Psychopharmacology Bulletin, 34, 897-901.

Wilkison, P. C., Kircher, J. C., McMahon, W. M., & Sloane, H. N. (1995). Effects of methylphenidate on reward strength in boys with attention-deficit hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 34, 897-901.

Zametkin, A., Rapoport, J. L., Murphy, D. L., Linnoila, M., Karoum, F., Potter, W. Z., & Ismond, D. (1985). Treatment of hyperactive children with monoamine oxidase inhibitors: II. Plasma and urinary monoamine findings after treatment. Archives of General Psychiatry, 42, 969-973.