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

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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Journal
Child and Adolescent Psychiatry and Mental Health
Published
2026-07-23
DOI
https://doi.org/10.1186/s13034-026-01115-3
Primary Topic
Attention Deficit Hyperactivity Disorder
Type
article
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article

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

Barbara Alm, Saskia Deppermann, Karen Schulze-Husmann, Christopher Hautmann et al.
Child and Adolescent Psychiatry and Mental Health
Attention Deficit Hyperactivity Disorder
article

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

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

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.

Child and Adolescent Psychiatry and Mental Health
Universität Hamburg (DE), Philipps University of Marburg (DE), University of Cologne (DE), Johannes Gutenberg University Mainz (DE), University of Zurich (CH), Heidelberg University (DE), Universitätsklinikum Gießen und Marburg (DE), University Hospital Heidelberg (DE), ETH Zurich (CH), University Medical Center of the Johannes Gutenberg University Mainz (DE), Universitätsklinikum Tübingen (DE), University Hospital of Zurich (CH), Central Institute of Mental Health (DE), University Medical Center Hamburg-Eppendorf (DE), Universitätsmedizin Göttingen (DE), Essen University Hospital (DE), Universitätsklinikum Würzburg (DE), LWL-Universitätsklinik Hamm (DE), University Hospital Cologne (DE), German Center for Diabetes Research (DE), University of Duisburg-Essen (DE), University of Tübingen (DE), Universität Trier (DE), Ruhr University Bochum (DE)
Universitätsklinikum Köln
Openalex Percentile: Top 9%
Attention Deficit Hyperactivity Disorder
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