Discussion
oppositional defiant behaviors, ODD behaviors, non-ADHD, ADHD
This series of replicated single-case experiments was conducted to examine the added efficacy of consequent-based techniques to antecedent-based techniques on parent-reported behaviors of six medicated children with ADHD. Because consequent-based techniques were introduced subsequent to antecedent-based techniques, we can only draw conclusions about the added efficacy of the consequent-based techniques. To our knowledge, this is the first single-case experimental study that evaluated components of BPT in children with ADHD. We randomized the moment of phase change (i.e., introduction of the different types of techniques) to determine whether potential changes in behavior could be attributed to training parents in the behavioral techniques. In the current study, we could not demonstrate the added efficacy of the consequent-based techniques in decreasing selected problem behaviors and improving overall behavior of children with ADHD. Although the improvement in behavior (selected problem behaviors and overall behavior) was in the expected direction for most children, differences between the phases were not statistically significant at an individual level. When individual Despite the fact that the added efficacy of training parents in consequent-based techniques has been demonstrated in less stringent studies with non-ADHD samples or with other comparisons (First, in contrast to the above mentioned studies, the children in the single-case experiments already used medication for ADHD, therefore possibly leaving less room for improvement. Moreover, stimulant medication could have impacted the oppositional defiant behaviors as well, as stimulant medication may significantly reduce ODD behaviors (moderate to large effects) (Second, behaviors selected by the parents participating in our previous microtrial (Third, another factor that may have had an influence on the efficacy of the components is the time in between the sessions, inherent to this type of single-case experiment with randomization. Normally, as described in various BPT treatment manuals (e.g., Although it was not a specific aim of this study, an interesting finding was that most children showed high variability of behavior in all phases (both in the overall behavior scores and the selected problem behavior scores), even after medication. This was not only the case in the baseline phase, but also after the introduction of the sessions in which parents were trained in the behavioral techniques. High variability in behavior may interfere with drawing clear conclusions about the effects of components (