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Case Study: Adderall vs. Response Cost

A six year-old boy in the T.L.C. program was seen by the consulting psychiatrist who recommended tapering the child off of his psycho-stimulant medication (Adderall) due to his small stature, observable tics, and ongoing difficulties with inattention, impulsivity, and hyperactivity despite the use of the stimulant medication.  Prior to tapering the medication, observations were made of this child’s behavior in the school and cottage settings.  Frequencies of off-task, inattentive, and impulsive behaviors were counted in each setting over the course of one week.  After this data was collected and the child was tapered off the Adderall, a response cost program was implemented in the school and cottage settings to specifically target these behaviors.  Frequencies of off-task, inattentive, and impulsive behaviors were again collected in the cottage and school settings after the implementation of the response cost program.

The average rate of off-task, inattentive, and impulsive behaviors per hour were determined from these frequency counts.  Comparisons were made between the child’s average hourly frequency of displaying each behavior while on Adderall to the child’s average hourly frequency of displaying each behavior while off Adderall and utilizing a response cost program.  In all cases the rates of behaviors were lower during the response cost program than they were during the Adderall regimen (see graph below).  It is important to note that the decrease in the average hourly rate of off-task behavior (t(2)=1.104, p=.38) and impulsive behavior (t(2)=.949, p=.443) was not statistically significant.  This finding is not surprising, rather it is to be expected given the limited statistical power to find real differences that comes from using such a small data set (with only two degrees of freedom). 

Average hourly frequency of behaviors


The truly impressive finding in this single-sample case study is that the average rate of inattentive behavior did significantly decrease (t(2)=4.062, p=.05).  This is particularly noteworthy given the limited amount of statistical power to find real differences with a small data set, as mentioned above.  This indicates that, for this child, the intended effect of the response cost program is rather potent when compared to the intended effect of the Adderall.  Furthermore, the response cost program does not have the negative side effects of diminished stature or tics that were associated with the Adderall. 

The current study should be viewed only as intended, as a single-sample case study to assess the effects of the change in program for one child, with all the inherent threats to validity that are associated with a single case study or any study with limited data points.  The significant findings of this study do indicate however, that these positive effects might be expected to generalize to other children.  Further assessment should therefore be conducted whenever similar changes are indicated in other children’s treatment programs in an attempt to replicate these findings.