{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T17:01:00Z","timestamp":1780419660101,"version":"3.54.1"},"reference-count":50,"publisher":"S. Karger AG","license":[{"start":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T00:00:00Z","timestamp":1773964800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/karger.com\/pages\/terms-and-conditions"},{"start":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T00:00:00Z","timestamp":1773964800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/karger.com\/pages\/terms-and-conditions"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Psychother Psychosom"],"abstract":"<jats:p>Introduction: This study evaluated the effectiveness of a stepped-care approach \u2013 a staged model that escalates from lower- to higher-intensity treatments according to clinical response \u2013 for the treatment of adolescents and adults with ADHD, taking into account symptom severity and prior treatment response. Methods: In a multicenter study, adolescents and adults with ADHD (16\u201345 years) participated in a two-step treatment program including randomized controlled trials (RCTs). In step 1, patients were (block-)randomized to 3 months of psychoeducation (PE), telephone-assisted self-help (TASH), or waiting control (WC). In step 2 based on step 1 response (full, partial, none), patients either received counseling or were randomized to counseling with\/without neurofeedback (NF) or pharmacological treatment (with\/without NF) for 6 months. The primary outcome was change in clinician-rated ADHD symptoms, analyzed using linear (mixed-)effects models for repeated measures to account for correlations within participants over time. Results: Between January 2015, and September 2020, N = 299 (mean age = 28 years, 55.2% male) patients were randomized in step 1. The primary outcome showed no significant between-group differences (PE vs. TASH: d = \u22120.12, 95% CI: \u22123.18, 1.19, p = 0.64; PE vs. control: d = \u22120.26, 95% CI: \u22124.25, 0.05, p = 0.13; TASH vs. control: d = \u22120.14, 95% CI: \u22123.24, 1.04, p = 0.57). However, significant within-group effects emerged (PE: d = \u22120.60; TASH: d = \u22120.48; WC: d = \u22120.34; p &lt; 0.001). Step 2 also showed no between-group differences but significant within-group effects (MPH: d = \u22120.59; MPH+NF: d = \u22120.76; counseling: d = \u22120.57\/\u22121.35, p = 0.01\/p &lt; 0.001). Mixed models revealed symptom reduction in all step 1 responders and step 1 non-responders in step 2. Conclusions: The lack of step 1 RCT differences questions the specific effects of PE\/TASH. Similar patterns emerged in step 2, but intensified treatment for step 1 non-responders improved outcomes in MPH groups. Step 1 response influenced later treatment success. Some stepped-care combinations did not further reduce symptoms, but no rebound effects occurred. The main limitations of this study are the two-step design complexity, limited information on certain (additional) psychosocial components, and the need to make assumptions about missing data. Nevertheless, findings support the feasibility and partial effectiveness of a stepped-care approach.<\/jats:p>","DOI":"10.1159\/000551307","type":"journal-article","created":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T17:01:05Z","timestamp":1774026065000},"page":"1-20","source":"Crossref","is-referenced-by-count":0,"title":["Efficacy of a Stepped-Care Approach for Adolescents and Adults with Attention-Deficit\/Hyperactivity Disorder: An Adaptive Intervention Study Including Randomized Controlled Trials 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