Fabiano’s ADHD research continues with latest $3.3 million grant

A UB expert on treating and educating ADHD children will collaborate on a $3.3 million U.S. Department of Education grant to study how best to treat these children for the full school year.

Gregory Fabiano, associate dean for interdisciplinary research in the Graduate School of Education who is nationally known for his innovative work treating ADHD children, will partner with Florida International University to investigate the best way to help support and treat children with ADHD and their families.

Their study hopes to follow up previous research that showed that positive behavioral supports used by parents and teachers produced better results in ADHD children than using medication first. A key practical question for educators is what treatment should be used first, for what length of time and with what level of intensity. Fabiano’s study will directly tackle that key question faced by educators and parents each school year.

One hundred children with ADHD will be recruited each year, for three years, in hopes of finding the best approach for supporting students’ learning and behavioral outcomes.

“The long-term educational outcomes of individuals with ADHD are not where we would like them to be,” says Fabiano, whose scholarly work has focused on improving the relationship between ADHD children and their parents, including working with a driving simulator, as well as organizing interactive athletic activities for children and their parents.

“Even though children with ADHD have the same ability as their peers to learn and achieve, they unfortunately do not go as far in higher education, and they make less money when they get employed.

“This is something we need to start addressing early, in school, with effective treatments before it is too late,” he says. “It is our hope that this study can add to the knowledge base of best practices to help children with ADHD be successful in school.”

Fabiano says ADHD affects one to two children per classroom across the country.

The $3.3 million grant from the Department of Education’s Institute of Education Sciences will support Fabiano’s work and that of his colleague, William Pelham, director of the Center for Children and Families, and Distinguished Service Professor at Florida International University. Pelham served on the UB psychology faculty for 13 years, and this research will follow up studies he and Fabiano did at UB.

The researchers concluded in a previous study that the sequence used for ADHD treatment is very important. There are two treatments that work for children with ADHD, Fabiano explains: behavior therapy, which includes positive behavior supports that parents and teachers implement in the home and classroom, and stimulant medication used at home and at school.

“Although it is clear that these treatments can be helpful, there is almost no study of the right sequence to use them — medication first or behavior therapy first — and what combination of doses works the best,” he says.

“This is a problem because that is the first question a parent confronts when the child is diagnosed with ADHD: What should we do? And unfortunately, there is not clear guidance on what the right answer to that question should be.”

This study will explore how sequencing of treatments improves school outcomes when implemented entirely in a school setting with 300 elementary school students with ADHD, Fabiano says.

“Because all children are different and will be in a variety of different classrooms and grade levels, with 300 kids we’ll have a reasonable group to study to find out what type of child responds to low-intensity behavior therapy,” he says. “And for those that need more, does it work better to increase the intensity of the behavior therapy, or add medication?”

This newest study will randomly assign some ADHD children to receive business-as-usual treatment — that is, all the treatments their school and parents would typically provide — or a stepped-up intensity of treatments over time, if needed. 

“Because ADHD is a chronic condition, the study needs to last the entire school year so that we can continually monitor progress and adapt our approach as needed,” Fabiano says. “This better reflects the situation parents and teachers deal with in typical educational settings, and we hope this means our results will be more meaningful.”

The study begins with positive behavioral supports because researchers expect this to adequately treat a considerable number of children.

“If a child continues to show impaired functioning, they will then be randomly assigned to receive more intensive positive behavioral supports, or medication,” says Fabiano. “In this way, our study is similar to what happens naturally over the school year — treatment is continued if it is working and more treatment is added when a child is struggling.

“But because we are measuring progress and adding in treatment systematically, we can learn which sequence and combination of treatments works the best,” he says.

Anyone interested in learning more about the study, can call (716) 829-2024.