Pelham W E, Schnedler R W, Bologna N C, Contreras J A
J Appl Behav Anal. 1980 Summer;13(2):221-36. doi: 10.1901/jaba.1980.13-221.
Eight hyperactive children were treated with a behavioral intervention focusing on teacher and parent training over a period of 5 months. Three times, before therapy and after 3 weeks and 13 weeks of intervention, children received methylphenidate during 3-week probe periods. Each week in a probe they received either a placebo, .25 mg/kg, or .75 mg/kg methylphenidate. Classroom observation of on-task behavior suggested that effectiveness of the behavioral intervention was between that of the two dosages of medication before therapy. Both dosages resulted in higher levels of on-task behavior when administered after 13 weeks of behavioral intervention than when administered before therapy. Teacher rating data showed equivalent effects of therapy and the low dosage of methylphenidate alone but a stronger effect of the high dose alone; only the high dose resulted in improved behavior after 13 weeks of behavioral intervention. As a group, only when they received the high dose of methylphenidate after 13 weeks of behavioral intervention did children reach the level of appropriate behavior shown by nonhyperactive controls. However, this level was also reached by two children with the low dose and by one child without medication, and it was not reached by one child. The results suggest that the combination of psychostimulant medication and behavior therapy may be more effective in the short-term than either treatment alone for hyperactive children in school settings. In addition, parent ratings and clinic observation of parent-child interactions suggested that children had improved in the home setting, high-lighting the importance of behavioral parent training in the treatment of hyperactivity.
八名多动症儿童接受了一项行为干预治疗，该治疗主要集中在教师和家长培训上，为期5个月。在治疗前、干预3周后和13周后，儿童在为期3周的探测期内三次接受哌甲酯治疗。在探测期的每周，他们分别接受安慰剂、0.25毫克/千克或0.75毫克/千克的哌甲酯。对课堂上专注行为的观察表明，行为干预的效果介于治疗前两种药物剂量的效果之间。与治疗前给药相比，在行为干预13周后给药时，两种剂量都导致了更高水平的专注行为。教师评分数据显示，治疗和单独使用低剂量哌甲酯的效果相当，但单独使用高剂量的效果更强；只有高剂量在行为干预13周后导致行为改善。作为一个群体，只有在行为干预13周后接受高剂量哌甲酯治疗时，儿童才达到非多动症对照组所表现出的适当行为水平。然而，两名接受低剂量治疗的儿童和一名未接受药物治疗的儿童也达到了这一水平，而一名儿童未达到。结果表明，在学校环境中，对于多动症儿童，精神兴奋剂药物和行为疗法相结合在短期内可能比单独使用任何一种治疗方法都更有效。此外，家长评分和对亲子互动的临床观察表明，儿童在家庭环境中有了改善，突出了行为家长培训在多动症治疗中的重要性。
