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Background <p>This German multicenter study aimed to analyze the efficacy of telephone-assisted self-help (TASH) and changes during subsequent adaptive treatment in children with mild-to-moderate ADHD.</p> Methods <p>Participants were children (6;0–11;11&#xa0;years) with mild-to-moderate ADHD. Study Step 1 comprised a randomized waitlist-controlled trial on the efficacy of three-month, parent-directed TASH. Depending on their response to TASH, in Step 2, children were assigned to booster TASH (full response), behavior therapy (partial response), or pharmacotherapy plus behavior therapy or counseling (non-response) for six months. The primary outcome was the change in blinded-clinician-rated ADHD symptoms; for subsequent changes (Step 2), we considered semi-blinded ratings. The primary analyses were by intention-to-treat.</p> Results <p>Of the 163 included children (77.9% boys), 80 were randomized to TASH and 83 to the waitlist control group. Following TASH, 12 children (8.8%) were classified as full responders, 40 (29.2%) as partial responders, and 85 (62.0%) as non-responders. An analysis of covariance did not yield an effect of TASH on the primary outcome (mean between-group difference = 0.00 ± 0.07, 95% <i>CI</i>[− 0.14, 0.13]; <i>p</i> = 0.95; <i>d</i> = –0.01, 95% <i>CI</i>[− 0.37, 0.34]). During Step 2, full responders demonstrated a stable symptom level (piecewise mixed-effects model for repeated measures; <i>d</i> = − 0.07, 95% <i>CI</i>[− 0.61, 0.47], <i>p</i> = 0.80), partial responders a small increase in ADHD symptoms (<i>d</i> = 0.29, 95% <i>CI</i>[0.00, 0.59], <i>p</i> = 0.05), and non-responders a large decrease (<i>d</i> = − 1.00, 95% <i>CI</i>[− 1.27, − 0.73], <i>p</i> &lt; 0.001).</p> Conclusions <p>TASH is not effective in reducing blinded-clinician-rated ADHD symptoms in children with mild-to-moderate ADHD. Based on the changes within the response groups during Step 2, hypotheses are generated for adaptive treatment after TASH.</p> <p><i>Trial registration</i> German Clinical Trials Register (DRKS): DRKS0000897; URL: <a href="https://drks.de/search/de/trial/DRKS00008973/details">https://drks.de/search/de/trial/DRKS00008973/details</a>; registered on December 18th 2015.</p>

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Efficacy of a stepped-care approach for school-age children with mild to moderate ADHD (ESCAschool-moderate): an adaptive intervention study including a randomized controlled trial

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  • 发表日期：

    2026年7月23日

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  • Manfred Döpfner,
  • Christina Dose,
  • Christopher Hautmann,
  • Martin Hellmich,
  • Lea Teresa Kohl,
  • Anne-Katrin Treier,
  • Elena von Wirth,
  • Katja Becker,
  • Daniel Brandeis,
  • Ute Dürrwächter,
  • Julia Geissler,
  • Sarah Hohmann,
  • Martin Holtmann,
  • Michael Huss,
  • Thomas Jans,
  • Anna Kaiser,
  • Johanna Ketter,
  • Tanja Legenbauer,
  • Sabina Millenet,
  • Luise Poustka,
  • Tobias J. Renner,
  • Jasmin Wenning,
  • Nina Christmann,
  • Brigitta Gehrig,
  • Monja Groh,
  • Christine Igel,
  • Karina Janson,
  • Marie-Therese Steiner,
  • Matthias Winkler,
  • Mirjam Ziegler,
  • Nicole Grau,
  • Wiebke Haberhausen,
  • Alisa Hiery,
  • Katja John,
  • Daria Kasperzack,
  • Jennifer Krämer,
  • Christopher Mann,
  • Tanja Mingebach,
  • Anna Maria Paulus,
  • Bastian Schrott,
  • Linda Weber,
  • Anne-Kathrin Ohlsen,
  • Julia Kellner,
  • Katrin Krugmann,
  • Karen Schulze-Husmann,
  • Ann-Katrin Thöne,
  • Paula Vetter,
  • Marcel Romanos,
  • Tobias Johann Renner,
  • Ute Dürrwächer,
  • Lena Flik,
  • Melinda Mross,
  • Anja Pascher,
  • Natalie Richardt,
  • Priska Schneider,
  • Ida Steinacker,
  • Inken Kirschbaum-Lesch,
  • Franziska Martin,
  • Michael Kölch,
  • Stefanie Bienioschek,
  • Henrik Uebel von Sandersleben,
  • Fatmeh Al-Deb’i,
  • Kerstin Konrad,
  • Vanessa Reindl,
  • Jochen Seitz,
  • Tamara Novak,
  • Miriam Remy,
  • Christine Margarete Freitag,
  • Nadine Friedrich,
  • Michael Rösler,
  • Steffen Barra,
  • Petra Retz-Junginger,
  • Birgit Leipnitz,
  • Florence Philipp,
  • Toivo Zinnow,
  • Esther Sobanski,
  • Barbara Alm,
  • Melanie Bleich,
  • Oliver Hennig,
  • Peter Praus,
  • Barbara Scharnholz,
  • Andreas Jochen Fallgatter,
  • Julia Becker-Sadzio,
  • Saskia Deppermann,
  • Thomas Ethofer,
  • Lydia Weber,
  • Michael Erb,
  • Alexandra Phillipsen,
  • Marcel Schulze,
  • Behrem Aslan,
  • Meike Lingen,
  • Maria Steffens,
  • Sina Klüver,
  • Samira Groß,
  • Vivien Groß,
  • Johannes Thome,
  • Beate Krecklow,
  • Wolfgang Retz,
  • Lea Bensing,
  • Sergiy Davydenko,
  • Priscilla Gregório-Hertz,
  • Daniel Turner,
  • Tobias Banaschewski

摘要

Background

This German multicenter study aimed to analyze the efficacy of telephone-assisted self-help (TASH) and changes during subsequent adaptive treatment in children with mild-to-moderate ADHD.

Methods

Participants were children (6;0–11;11 years) with mild-to-moderate ADHD. Study Step 1 comprised a randomized waitlist-controlled trial on the efficacy of three-month, parent-directed TASH. Depending on their response to TASH, in Step 2, children were assigned to booster TASH (full response), behavior therapy (partial response), or pharmacotherapy plus behavior therapy or counseling (non-response) for six months. The primary outcome was the change in blinded-clinician-rated ADHD symptoms; for subsequent changes (Step 2), we considered semi-blinded ratings. The primary analyses were by intention-to-treat.

Results

Of the 163 included children (77.9% boys), 80 were randomized to TASH and 83 to the waitlist control group. Following TASH, 12 children (8.8%) were classified as full responders, 40 (29.2%) as partial responders, and 85 (62.0%) as non-responders. An analysis of covariance did not yield an effect of TASH on the primary outcome (mean between-group difference = 0.00 ± 0.07, 95% CI[− 0.14, 0.13]; p = 0.95; d = –0.01, 95% CI[− 0.37, 0.34]). During Step 2, full responders demonstrated a stable symptom level (piecewise mixed-effects model for repeated measures; d = − 0.07, 95% CI[− 0.61, 0.47], p = 0.80), partial responders a small increase in ADHD symptoms (d = 0.29, 95% CI[0.00, 0.59], p = 0.05), and non-responders a large decrease (d = − 1.00, 95% CI[− 1.27, − 0.73], p < 0.001).

Conclusions

TASH is not effective in reducing blinded-clinician-rated ADHD symptoms in children with mild-to-moderate ADHD. Based on the changes within the response groups during Step 2, hypotheses are generated for adaptive treatment after TASH.

Trial registration German Clinical Trials Register (DRKS): DRKS0000897; URL: https://drks.de/search/de/trial/DRKS00008973/details; registered on December 18th 2015.