Tailored psychosocial treatments for ADHD: the search for a good fit

Commented on the article "What Does the MTA Study Tell Us About Effective Psychosocial Treatment for ADHD?" by Greene and Ablon (this issue). In this article, these authors note that the Multimodal Treatment Study (MTA) did not focus on or provide information about how to match treatment to the needs of the individual child. They contend that cognitive-behavioral treatment (CBT), which was not included in the MTA, can facilitate treatment tailoring if delivered appropriately. The authors offer several suggestions regarding how CBT can be structured to meet the needs of each child. This commentary points out that the MTA included psychosocial treatments with established rather than potential efficacy. Systematic studies are needed to determine whether the suggestions offered by Greene and Ablon have clinical utility. Matching treatment to the needs of individual patients remains the overarching goal of those interested in idiographic approaches to treatment. However, efforts to inform on treatment tailoring involve complex design and needs assessment methodologies. Several suggestions are offered regarding the technology of treatment tailoring. These include the use of goal attainment scaling to identify and evaluate individualized outcome measures and the use of hybrid efficacy-effectiveness designs to assess the impact of treatment preference on outcome.