An examination of the "dosage" effects of both behavior therapy and methylphenidate on the classroom performance of two ADHD children.
Crank up your token economy before you crank up the pill dose—two ADHD kids proved the right behavioral ‘dosage’ can cut medication needs.
01Research in Context
What this study did
Two boys with ADHD were in a regular classroom.
The team gave each boy a token board.
They changed two things at once: how rich the token pay-off was and the milligrams of methylphenidate.
Each child got light, medium, and heavy versions of both tools.
Teachers counted math problems finished and rule breaks.
What they found
One boy needed the richest token board plus a low dose of pill to stay on task.
The other boy did fine with a light token board plus a medium dose.
When the token board was weak, raising the pill dose did not help much.
When the token board was strong, the lowest useful dose of pill could drop even lower.
How this fits with other research
Cudré-Mauroux (2010) warns that pills are given too quickly for behavior that is not psychotic.
Alsop et al. (1992) shows the same point: start with a strong behavior plan first, then add only the pill dose that is still needed.
Weyman et al. (2018) also played with reinforcement strength.
They swapped neutral praise for excited praise and saw small gains, proving the way you deliver a reinforcer matters as much as the reinforcer itself.
Dawson et al. (2000) found that mands only beat aggression when the payoff schedule was clearly better.
Alsop et al. (1992) mirrors this: the token schedule had to be clearly richer before pills could be trimmed.
Why it matters
Before you ask the doctor to raise the dose, raise your token economy first.
Add more tokens per answer, shorten the exchange time, or throw in a bonus item.
Track the child’s work and rule breaks each day.
If numbers jump, you just saved the child from extra medication and side effects.
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02At a glance
03Original abstract
Within the context of two case studies, the effects of two doses of methylphenidate (MPH) and behavioral interventions of varying potency are examined independently and jointly. Whereas studies of dose effects of MPH exist in the current literature, studies of different "doses" of behavior therapy-that is, interventions that vary in potency--are rare. This article uses a within-subjects design to demonstrate the importance of examining different doses of both types of treatments in determining the maximally effective treatment for a given child. The importance of considering individual differences is emphasized throughout this article as response to treatment among Attention-Deficit Hyperactivity Disorder children is quite variable. Case 1 illustrates the importance of evaluating medication response within the context of differing doses of behavior therapy; Case 2 demonstrates that difficult-to-manage cases are sometimes manageable using potent doses of both treatments simultaneously.
Behavior modification, 1992 · doi:10.1177/01454455920162002