Multimodal Treatments for Childhood Attention-deficit/Hyperactivity Disorder: Interpreting Outcomes in the Context of Study Designs

Of course, intensive behavioral therapies, similarly to high doses of medication, have limitations. Specifically, aside from the limited availability and high cost of intensive, complex, direct contingency management programs (see Barkley 2000, for a discussion of this issue in regard to the MTA study), an added difficulty for psychosocial treatment generally is that gains are difficult to maintain outside the treatment setting (Richters et al. 1995). Indeed, generalization of gains and persistence of effects following participation in an intensive behavioral treatment program (e.g., Pelham and Hoza 1996; Pelham et al. 2005b) has not been adequately studied. In addition, follow-up studies into adolescence and young adulthood of children who participated in intensive behavioral treatments as children are rare, and have only recently begun to appear in the literature. Consistent with other long-term follow-up studies of ADHD samples (for a brief review, see Richters et al. 1995), these studies document continuing adjustment problems and risky behaviors into adolescence and adulthood relative to controls (e.g., Flory et al. 2006; Molina et al. 2007; Thompson et al. 2007). This suggests that short-term intensive behavioral treatment, like medication, has limitations.