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This study evaluates the effectiveness of a telephone-assisted self-help approach for children diagnosed with mild to moderate ADHD.

July 24, 2026Child and Adolescent Psychiatry and Mental Health0 citationsOpen Access

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

MDManfred Döpfner CDChristina Dose CHChristopher Hautmann

Key Points

This study evaluates the effectiveness of a telephone-assisted self-help approach for children diagnosed with mild to moderate ADHD.
Randomized waitlist-controlled trial involving 163 children with mild to moderate ADHD.
Step 1 assessed the efficacy of parent-directed telephone-assisted self-help (TASH) over three months.
Step 2 focused on further treatment based on initial response: booster TASH, behavior therapy, or pharmacotherapy with counseling.
8.8% of participants were full responders to TASH after three months, while 62.0% were categorized as non-responders.
No significant difference in ADHD symptom reduction was found (p=0.95).
Non-responders exhibited a large decrease in symptoms in Step 2 (d=−1.00, p<0.001) compared to partial responders (d=0.29, p=0.05).

Abstract

Abstract 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.

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Cite This Study

Döpfner et al. (Thu,) studied this question.

synapsesocial.com/papers/6a6300c2395161722cd15990 https://doi.org/https://doi.org/10.1186/s13034-026-01115-3

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