van der Veen-Mulders Lianne, van den Hoofdakker Barbara J, Nauta Maaike H, Emmelkamp Paul, Hoekstra Pieter J
1 Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen , Groningen, The Netherlands .
2 Department of Clinical Psychology and Experimental Psychopathology, University of Groningen , Groningen, The Netherlands .
J Child Adolesc Psychopharmacol. 2018 Feb;28(1):66-73. doi: 10.1089/cap.2017.0123. Epub 2017 Nov 13.
To compare the effectiveness between parent-child interaction therapy (PCIT) and methylphenidate in preschool children with attention-deficit/hyperactivity disorder (ADHD) symptoms and disruptive behaviors who had remaining significant behavior problems after previous behavioral parent training.
We included 35 preschool children, ranging in age between 3.4 and 6.0 years. Participants were randomized to PCIT (n = 18) or methylphenidate (n = 17). Outcome measures were maternal ratings of the intensity and number of behavior problems and severity of ADHD symptoms. Changes from pretreatment to directly posttreatment were compared between groups using two-way mixed analysis of variance. We also made comparisons of both treatments to a nonrandomized care as usual (CAU) group (n = 17) regarding intensity and number of behavior problems. All children who started one of the treatments were included in the analyses.
Mothers reported a significantly more decreased intensity of behavior problems after methylphenidate (pre-post effect size d = 1.50) compared with PCIT (d = 0.64). ADHD symptoms reduced significantly over time only after methylphenidate treatment (d = 0.48) and not after PCIT. Changes over time of children in the CAU treatment were nonsignificant.
Although methylphenidate was more effective than PCIT, both interventions may be effective in the treatment of preschool children with disruptive behaviors. Our findings are preliminary as our sample size was small and the use of methylphenidate in preschool children lacks profound safety data as reflected by its off-label status. More empirical support is needed from studies with larger sample sizes.
比较亲子互动疗法（PCIT）与哌甲酯对有注意力缺陷多动障碍（ADHD）症状和破坏性行为、且在先前行为家长培训后仍存在显著行为问题的学龄前儿童的疗效。
我们纳入了35名年龄在3.4至6.0岁之间的学龄前儿童。参与者被随机分为PCIT组（n = 18）或哌甲酯组（n = 17）。结果指标为母亲对行为问题的强度、数量以及ADHD症状严重程度的评分。使用双向混合方差分析比较两组从治疗前到治疗后即刻的变化。我们还将两种治疗方法与一个非随机的常规护理（CAU）组（n = 17）在行为问题的强度和数量方面进行了比较。所有开始其中一种治疗的儿童都纳入了分析。
母亲报告称，与PCIT组（效应量d = 0.64）相比，哌甲酯组治疗后行为问题强度的降低更为显著（治疗前后效应量d = 1.50）。仅在哌甲酯治疗后ADHD症状随时间显著减轻（d = 0.48），而PCIT治疗后未减轻。CAU治疗组儿童随时间的变化不显著。
尽管哌甲酯比PCIT更有效，但两种干预措施可能对治疗有破坏性行为的学龄前儿童均有效。由于我们的样本量较小，且哌甲酯在学龄前儿童中的使用缺乏如标签外使用状态所反映的深入安全数据，我们的研究结果是初步的。需要更大样本量的研究提供更多实证支持。
