Skip to main content
SpringerLink
Log in

Adaptive Multimodal Treatment for Children with Attention-Deficit-/Hyperactivity Disorder: An 18 Month Follow-Up

  • Original Article
  • Published:
Child Psychiatry & Human Development Aims and scope Submit manuscript

Abstract

The Cologne Adaptive Multimodal Treatment (CAMT) study demonstrated that adaptive and individually tailored multimodal treatment for attention-deficit/hyperactivity disorder (ADHD) [consisting of behavior therapy (BT) and/or stimulant medication] is highly effective. This study reports findings of the 18 month follow-up assessment. Parents and teachers completed broad range behavior scales (Child Behavior Checklist/Teacher Report Form) and standardized ADHD and oppositional defiant disorder/conduct disorder symptom rating scales. Children that used medication to treat ADHD at follow-up (N = 32) and those that did not (N = 34) were analyzed separately. Parents did not report significant changes in child behavior from posttest to follow-up. Teacher ratings revealed some aggravation of ADHD symptoms in children that received medication, but this was not significant after Bonferroni correction. The initial advantage of combined treatment over BT was no longer evident. It can be concluded that treatment for ADHD that is tailored to the assessed needs of children results in large treatment effects that are maintained for at least 18 months.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Polanczyk G, de Lima MS, Horta BL, Biederman J, Rohde LA (2007) The worldwide prevalence of ADHD: a systematic review and metaregression analysis. Am J Psychiatry 164:942–948

    Article  PubMed  Google Scholar 

  2. Döpfner M, Breuer D, Wille N, Erhart M, Ravens-Sieberer U, Bella Study Group (2008) How often do children meet ICD-10/DSM-IV criteria of attention deficit-/hyperactivity disorder and hyperkinetic disorder? Parent based prevalence rates in a national sample—results of the BELLA study. Eur Child Adolesc Psychiatry 17(Suppl 1):59–70

    Article  PubMed  Google Scholar 

  3. American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders (DSM-5), 5th edn. American Psychiatric Association, Washington

    Google Scholar 

  4. Angold A, Costello E, Erkanli A (1999) Comorbidity. J Child Psychol Psychiatry 40:57–87

    Article  PubMed  Google Scholar 

  5. Sexton CC, Gelhorn H, Bell J, Classi P (2012) The co-occurrence of reading disorder and ADHD: epidemiology, treatment, psychosocial impact, and economic burden. J Learn Disabil 45:1–28

    Article  Google Scholar 

  6. Barkley RA, Fischer M, Smallish L, Fletcher K (2006) Young adult outcome of hyperactive children: adaptive functioning in major life activities. J Am Acad Child Adolesc Psychiatry 45:192–202

    Article  PubMed  Google Scholar 

  7. Gjervan B, Torgersen T, Nordahl HM, Rasmussen K (2012) Functional impairment and occupational outcome in adults with ADHD. J Atten Disord 16:544–552

    Article  PubMed  Google Scholar 

  8. Harpin V, Mazzone L, Raynaud JP, Kahle J, Hodgkins P (2013) Long-term outcomes of ADHD: a systematic review of self-esteem and social function. J Atten Disord. doi:10.1177/1087054713486516

    PubMed  Google Scholar 

  9. Biederman J, Monuteaux MC, Mick E, Spencer T, Wilens TE, Silva JM, Snyder LE, Faraone SV (2006) Young adult outcome of attention deficit hyperactivity disorder: a controlled 10-year follow-up study. Psychol Med 36:167–179

    Article  PubMed  Google Scholar 

  10. American Academy of Pediatrics (2011) ADHD: clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Subcommittee on attention-deficit/hyperactivity disorder, steering committee on quality improvement and management. Pediatrics 128:1007–1022

    Article  Google Scholar 

  11. Taylor E, Döpfner M, Sergeant J, Asherson P, Banaschewski T, Buitelaar J, Coghill D, Danckaerts M, Rothenberger A, Sonuga-Barke E, Steinhausen HC, Zuddas A (2004) European clinical guidelines for hyperkinetic disorder—first upgrade. Eur Child Adolesc Psychiatry 13(Suppl 1):17–30

    Google Scholar 

  12. Banaschewski T, Coghill D, Santosh P, Zuddas A, Asherson P, Buitelaar J, Danckaerts M, Döpfner M, Faraone SV, Rothenberger A, Sergeant J, Steinhausen HC, Sonuga-Barke EJ, Taylor E (2006) Long-acting medications for the hyperkinetic disorders. A systematic review and European treatment guideline. Eur Child Adolesc Psychiatry 15:476–495

    Article  PubMed  Google Scholar 

  13. Döpfner M, Ose C, Fischer R, Ammer R, Sherag A (2011) Comparison of the efficacy of two different modified release methylphenidate preparations for children and adolescents with attention-deficit/hyperactivity disorder in a natural setting: comparison of the efficacy of Medikinet® Retard and Concerta®—a randomized, controlled, double-blind multicenter clinical crossover trial. J Child Adolesc Psychopharmacol 21:445–454

    Article  PubMed Central  PubMed  Google Scholar 

  14. Hanwella R, Senanayake M, de Silva V (2011) Comparative efficacy and acceptability of methylphenidate and atomoxetine in treatment of attention deficit hyperactivity disorder in children and adolescents: a meta-analysis. BMC Psychiatry 11:176–184

    Article  PubMed Central  PubMed  Google Scholar 

  15. Abikoff H, Hechtman L, Klein RG, Weiss G, Fleiss K, Etcovitch J, Cousins L, Greenfield B, Martin D, Pollack S (2004) Symptomatic improvement in children with ADHD treated with long-term methylphenidate and multimodal psychosocial treatment. J Am Acad Child Adolesc Psychiatry 43:802–811

    Article  PubMed  Google Scholar 

  16. Buitelaar JK, Michelson D, Danckaerts M, Gillberg C, Spencer TJ, Zuddas A, Faries DE, Zhang S, Biederman J (2007) A randomized, double-blind study of continuation treatment for attention-deficit/hyperactivity disorder after 1 year. Biol Psychiatry 61:694–699

    Article  PubMed  Google Scholar 

  17. Charach A, Ickowicz A, Schachar R (2004) Stimulant treatment over five years: adherence, effectiveness, and adverse effects. J Am Acad Child Adolesc Psychiatry 43:559–567

    Article  PubMed  Google Scholar 

  18. Chronis AM, Jones HA, Raggi VL (2006) Evidence-based psychosocial treatments for children and adolescents with attention-deficit/hyperactivity disorder. Clin Psychol Rev 26:486–502

    Article  PubMed  Google Scholar 

  19. Fabiano GA, Pelham WE, Coles EK, Gnagy EM, Chronis-Tuscano A, O’Connor BC (2009) A meta-analysis of behavioral treatments for attention-deficit/hyperactivity disorder. Clin Psychol Rev 29:129–140

    Article  PubMed  Google Scholar 

  20. Pelham WE, Fabiano GA (2008) Evidence-based psychosocial treatments for attention-deficit/hyperactivity disorder. J Clin Child Adolesc Psychol 37:184–214

    Article  PubMed  Google Scholar 

  21. Sonuga-Barke EJS, Brandeis D, Cortese S, Daley D, Ferrin MT, Holtmann M, Stevenson J, Danckaerts M, van der Oord S, Döpfner M, Dittmann R, Simonoff E, Zuddas A, Banaschewski T, Buitelaar J, Coghill D, Hollis C, Konofal E, Lecendreux M, Wong I, Sergeant J on behalf of European ADHD Guidelines Group (2013) Nonpharmacological interventions for ADHD: systematic review and meta-analyses of randomized controlled trials of dietary and psychological treatments. Am J Psychiatry 170:275–289

    Google Scholar 

  22. Ercan ES, Ardic UA, Kutlu A, Durak S (2012) No beneficial effects of adding parent training to methylphenidate treatment for ADHD + ODD/CD children: a 1-year prospective follow-up study. J Atten Disord. doi:10.1177/1087054711432884

    PubMed  Google Scholar 

  23. Van der Oord S, Prins PJM, Oosterlaan J, Emmelkamp PMG (2008) Efficacy of methylphenidate, psychosocial treatments and their combination in school-aged children with ADHD: a meta-analysis. Clin Psychol Rev 28:783–800

    Article  PubMed  Google Scholar 

  24. Langberg JM, Arnold LE, Flowers AM, Epstein JN, Altaye M et al (2010) Parent-reported homework problems in the MTA study: evidence for sustained improvement with behavioral treatment. J Clin Child Adolesc Psychol 39:220–233

    Article  PubMed Central  PubMed  Google Scholar 

  25. Wells KC, Chi TC, Hinshaw SP, Epstein JN, Pfiffner L et al (2006) Treatment-related changes in objectively measured parenting behaviors in the multimodal treatment study of children with attention-deficit/hyperactivity disorder. J Consult Clin Psychol 74:649–657

    Article  PubMed  Google Scholar 

  26. Van den Hoofdakker BJ, Van der Veen-Meulen L, Sytema S, Emmelkamp PMG, Minderaa RB, Nauta MH (2007) Effectiveness of behavioral parent training for children with ADHD in routine clinical practice: a randomized controlled trial. J Am Acad Child Adolesc Psychiatry 46:1263–1271

    Article  PubMed  Google Scholar 

  27. Van der Oord S, Prins PJM, Oosterlaan J, Emmelkamp PMG (2012) The adolescent outcome of children with attention deficit hyperactivity disorder treated with methylphenidate or methylphenidate combined with multimodal behaviour therapy: results of a naturalistic follow-up study. Clin Psychol Psychother 19:270–278

    Article  PubMed  Google Scholar 

  28. MTA Cooperative Group (1999) A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. Arch Gen Psychiatry 56:1073–1086

    Article  Google Scholar 

  29. MTA Cooperative Group (2004) National Institute of Mental Health Multimodal Treatment Study of ADHD follow-up: 24-month outcomes of treatment strategies for attention-deficit/hyperactivity disorder. Pediatrics 113:754–761

    Article  Google Scholar 

  30. MTA Cooperative Group (2004) National Institute of Mental Health Multimodal Treatment Study of ADHD follow-up: changes in effectiveness and growth after end of treatment. Pediatrics 113:762–769

    Article  Google Scholar 

  31. Jensen PS, Arnold LE, Swanson JM, Vitiella B, Abikoff HB, Greenhill LL et al (2007) 3-Year follow-up of the NIMH MTA study. J Am Acad Child Adolesc Psychiatry 46:989–1002

    Article  PubMed  Google Scholar 

  32. Molina BSG, Hinshaw SP, Swanson JM, Arnold LE, Vitiello B, Jensen PS et al (2009) The MTA at 8 years: prospective follow-up of children treated for combined type ADHD in a multisite study. J Am Acad Child Adolesc Psychiatry 48:484–500

    Article  PubMed Central  PubMed  Google Scholar 

  33. Swanson JM, Hinshaw SP, Arnold LE, Gibbons RD, Marcus S, Hur K et al (2007) Secondary evaluations of MTA 36-month outcomes: propensity score and growth mixture model analyses. J Am Acad Child Adolesc Psychiatry 46:1003–1014

    Article  PubMed  Google Scholar 

  34. Pelham WE (1999) The NIMH multimodal treatment study for attention-deficit hyperactivity disorder: just say yes to drugs alone? Can J Psychiatry 44:981–990

    PubMed  Google Scholar 

  35. Greene RW, Ablon JS (2001) What does the MTA study tell us about effective psychosocial treatment for ADHD? J Clin Child Psychol 30:114–121

    Article  PubMed  Google Scholar 

  36. Weisz JR, Donenberg GR, Han SS, Weiss B (1995) Bridging the gap between lab and clinic in child and adolescent psychotherapy. J Consult Clin Psychol 63:688–701

    Article  PubMed  Google Scholar 

  37. Harrington RC, Cartwright-Hatton S, Stein A (2002) Annotation: randomised trials. J Child Psychol Psychiatry 43:695–704

    Article  PubMed  Google Scholar 

  38. Kazdin AE (2003) Psychotherapy for children and adolescents. Annu Rev Psychol 54:253–276

    Article  PubMed  Google Scholar 

  39. Kazdin AE (2008) Evidence-based treatment and practice. Am Psychol 63:146–159

    Article  PubMed  Google Scholar 

  40. Döpfner M, Breuer D, Schürmann S, Wolff Metternich T, Rademacher C, Lehmkuhl G (2004) Effectiveness of an adaptive multimodal treatment in children with attention-deficit hyperactivity disorder—global outcome. Eur Child Adolesc Psychiatry 13(Suppl 1):I/117–I/129

    Google Scholar 

  41. Jacobson NS, Truax P (1991) Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psychol 59:729–740

    Google Scholar 

  42. Döpfner M, Lehmkuhl G (2000) Diagnostik-System für Psychische Störungen im Kindes- und Jugendalter nach ICD-10 und DSM-IV (DISYPS-KJ) (2. korrigierte und ergänzte Auflage). Huber, Bern

    Google Scholar 

  43. Conners CK (1990) Corners’ Abbreviated Symptom Questionnaire: parent version, teacher version manual. Multi-Health Systems, Toronto

    Google Scholar 

  44. Döpfner M, Schürmann S, Frölich J (2013) Therapieprogramm für Kinder mit hyperkinetischem und oppositionellem Problemverhalten (THOP), 5th edn. Beltz, Weinheim

    Google Scholar 

  45. Salbach H, Lenz K, Huss M, Vogel R, Felsing D, Lehmkuhl U (2005) Die Wirksamkeit eines Gruppentrainings für Eltern hyperkinetischer Kinder [Treatment effects of parent management training for ADHD]. Z Kinder Jugendpsychiatr Psychother 33:59–68

    Article  PubMed  Google Scholar 

  46. Dreisörner T (2006) Wirksamkeit verhaltenstherapeutischer Gruppenprogramme bei Kindern mit Aufmerksamkeitsdefizit-und Hyperaktivitätsstörungen (ADHS) [The efficacy of training programs in children with attention deficit/hyperactivity disorder (ADHD)]. Kindh Entwickl 15:255–266

    Article  Google Scholar 

  47. Frölich J, Döpfner M, Lehmkuhl G (2002) Effects of combined cognitive behavioural treatment with parent management training in ADHD. Behav Cogn Psychother 30:111–115

    Google Scholar 

  48. Frölich J, Breuer D, Döpfner M, Amonn F (2012) Effects of a teacher training programme on symptoms of attention deficit hyperactivity disorder. Int J Educ 27:3

    Google Scholar 

  49. Döpfner M, Görtz-Dorten A, Lehmkuhl G, Breuer D, Goletz H (2008) Diagnostik-System für psychische Störungen nach ICD-10 und DSM-IV für Kinder und Jugendliche-II (DISYPS-II). Huber, Bern

    Google Scholar 

  50. Swanson JM, Kraemer HC, Hinshaw SP, Arnold LE, Conners CK, Abikoff HB et al (2001) Clinical relevance of the primary findings of the MTA: success rates based on severity of ADHD and ODD symptoms at the end of treatment. J Am Acad Child Adolesc Psychiatry 40:168–179

    Article  PubMed  Google Scholar 

  51. Brühl B, Döpfner M, Lehmkuhl G (2000) Der Fremdbeurteilungsbogen für hyperkinetische Störungen (FBB-HKS) - Prävalenz hyperkinetischer Störungen im Elternurteil und psychometrische Kriterien [The parent rating scale for ADHD (FBB-HKS)—prevalence of ADHD by the estimate of parents and psychometric criteria]. Kindh Entwickl 9:115–125

    Article  Google Scholar 

  52. Erhart M, Döpfner M, Ravens-Sieberer U, Bella Study Group (2008) Psychometric properties of two ADHD questionnaires: comparing the Conners’ scale and the FBB-HKS in the general population of German children and adolescents—results of the BELLA study. Eur Child Adolesc Psychiatry 17(Suppl 1):106–115

    Article  PubMed  Google Scholar 

  53. Görtz-Dorten A, Döpfner M (2009) Aufmerksamkeitsdefizit-/Hyperaktivitätsstörungen von Kindern und Jugendlichen im Elternurteil: Eine Analyse an einer Feldstichprobe mit dem Diagnostik-System DISYPS – II [Parent ratings of attention deficit/hyperactivity disorders in children and adolescents—an analysis in a field sample with the diagnostic system for mental disorders in childhood and adolescence (DISYPS-II)]. Z Kinder Jugendpsychiatr Psychother 37:183–194

    Article  PubMed  Google Scholar 

  54. Breuer D, Wolff Metternich T, Döpfner M (2009) Die Erfassung von Merkmalen von Aufmerksamkeitsdefizit/Hyperaktivitätsstörungen (ADHS) anhand von Lehrerurteilen. Zur Validität und Reliabilität des FBB-HKS [The assessment of attention deficit hyperactivity disorder (ADHD) by teacher ratings—validity and reliability of the FBB-HKS]. Z Kinder Jugendpsychiatr Psychother 37:431–440

    Article  PubMed  Google Scholar 

  55. Görtz-Dorten A, Ise E, Hautmann C, Walter D, Döpfner M (2013) Psychometric properties of a German parent rating scale for oppositional defiant and conduct disorder (FBB–SSV) in clinical and community samples. Child Psychiatry Hum Dev. doi:10.1007/s10578-013-0409-3

    Google Scholar 

  56. Ise E, Görtz-Dorten A, Döpfner M (submitted) Reliability and validity of teacher-rated symptoms of oppositional defiant and conduct disorders in a clinical sample

  57. Achenbach TM, Rescorla LA (2001) Manual for the ASEBA school-age forms and profiles. University of Vermont, Burlington

    Google Scholar 

  58. Döpfner M, Plück J, Kinnen C, Arbeitsgruppe Deutsche Child Behavior Checklist (2013) CBCL Handbuch-Schulalter. Manual zum Elternfragebogen über das Verhalten von Kindern und Jugendlichen (CBCL/6-18R), zum Lehrerfragebogen über das Verhalten von Kindern und Jugendlichen (TRF/6-18R) und zum Fragebogen für Jugendliche (YSR/11-18R). Hogrefe, Göttingen

  59. Döpfner M, Berner W, Schmeck K, Lehmkuhl G, Poustka F (1995) Internal consistency and validity of the CBCL and the TRF in a German sample—a cross cultural comparison. In: Sergeant J (ed) Eunethydis: European approaches to hyperkinetic disorder. Fotorotar Egg, Zurich, pp 51–81

    Google Scholar 

  60. Cohen J (1988) Power analysis for the behavioral sciences. Erlbaum, Hillsdale

    Google Scholar 

  61. Melchers P, Preuß U (2001) Kaufman-assessment battery for children (K-ABC). Deutschsprachige Fassung (5. Aufl.). PITS, Leiden

Download references

Acknowledgments

This work was supported by the German Research Foundation (Deutsche Forschungsgemeinschaft, DFG) [Grant Number LE 575/3-1]. We would like to thank all parents, teachers, and children who participated in this study and all co-workers engaged in this project.

Conflict of interest

M Döpfner served in an advisory or consultancy role for Lilly, Medice, Novartis, Shire, and Vifor Pharma. He received conference attendance support, conference support or speaker’s fee from Lilly, Medice, Novartis, and Shire. He is or has been involved in clinical trials conducted by Lilly, Shire, and Vifor. M Döpfner and S Schürmann are the authors of the behavioral treatment program that is investigated in this study and receive royalties from the publisher Hogrefe, Göttingen.

Author information

Authors and Affiliations

  1. Department of Child and Adolescent Psychiatry and Psychotherapy, Medical Faculty, University of Cologne, Robert-Koch-Str. 10, 50931, Cologne, Germany

    Manfred Döpfner, Elena Ise, Tanja Wolff Metternich-Kaizman, Stephanie Schürmann, Christiane Rademacher & Dieter Breuer

Authors
  1. Manfred Döpfner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Elena Ise
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tanja Wolff Metternich-Kaizman
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stephanie Schürmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Christiane Rademacher
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Dieter Breuer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Manfred Döpfner.

Additional information

Manfred Döpfner and Elena Ise have contributed equally to the manuscript and are considered joint first authors.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Döpfner, M., Ise, E., Wolff Metternich-Kaizman, T. et al. Adaptive Multimodal Treatment for Children with Attention-Deficit-/Hyperactivity Disorder: An 18 Month Follow-Up. Child Psychiatry Hum Dev 46, 44–56 (2015). https://doi.org/10.1007/s10578-014-0452-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10578-014-0452-8

Keywords

Search

Navigation