Efficacy of a Stepped Care Approach for Adolescents and Adults with Attention-Deficit/Hyperactivity Disorder (ADHD): An Adaptive Intervention Study Including Randomized Controlled Trials (ESCAlate) -

5 hours ago

Study evaluated a stepped-care approach for treating ADHD in adolescents and adults (16-45 years).
Step1 involved randomization to Psychoeducation (PE), Telephone-assisted self-help (TASH), or waiting control (WC) for 3 months.
Step2 adjusted treatment based on Step1 response, offering counseling, neurofeedback (NF), or pharmacological treatment (with/without NF) for 6 months.
Primary outcome was clinician-rated ADHD symptom change; no significant between-group differences in Step1 (PE vs. TASH vs. WC).
Significant within-group symptom reductions observed in all Step1 treatments (PE: d=-0.60; TASH: d=-0.48; WC: d=-0.34).
Step2 also showed no between-group differences but significant within-group improvements (e.g., MPH: d=-0.59; MPH+NF: d=-0.76).
Step1 response influenced Step2 treatment success; intensified treatment for non-responders improved outcomes in MPH groups.
Limitations include study design complexity, limited psychosocial component details, and assumptions about missing data.
Findings support feasibility and partial effectiveness of stepped-care for ADHD, though specific effects of PE/TASH were questioned.

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