Projects Using SMARTs | The Methodology Center

Projects Using SMARTs

Sequential, multiple assignment, randomized trial (SMART) designs are being used to construct adaptive interventions across a broad array of topics. This list of current or completed projects is meant to allow researchers to learn more about SMART designs similar to ones they may wish to employ. If you know of projects that should be included in our list, please email

Click on an image to enlarge and show detail. To see a subset of the designs that relate to a specific health problem or design type, select from the dropdown list. 

Adaptive Treatment for Pregnant Women Who Abuse Drugs
Researchers have developed an intensive relapse-prevention program for pregnant women who abuse drugs. A SMART design is being used to develop an adaptive intervention where the intensity and scope of the relapse-prevention program is adjusted based on the evolving status of the woman.
  • PIs: Hendrée Jones, Margaret Chisolm
  • Funding: NIDA Project R01DA014979
  • Related Article: 
    Jones, H. E., O'Grady, K. E., & Tuten, M. (2011). Reinforcement-based treatment improves the maternal treatment and neonatal outcomes of pregnant patients enrolled in comprehensive care treatment. The American Journal on Addictions, 20(3), 196-204.
Adaptive Treatment for Growth Suppression in Children with ADHD
Studies show that the use of stimulants for the control of ADHD in youth leads to a reduction in height gain. This study uses a SMART design to examine the effectiveness of temporary breaks in medicinal treatments and caloric supplementation for the treatment of stimulant-induced weight and growth suppression.
    • PI: James G. Waxmonsky
    • Funding: NIMH Project R01MH083692
    • Related Article: Study in progress
    Adaptive Intervention for Adolescent Marijuana Use
    Researchers in this study are developing an adaptive treatment for adolescent marijuana users. They are studying the use and combination of several efficacious treatments, including behavioral therapy, contingency management, behavioral parent training, and working memory training via a SMART trial.
    • PI: Alan J. Budney
    • Funding: NIDA Project R01DA015186
    • Related Article:  
      Brown, P.C., Budney, A.J., Thostenson, J.D., & Stanger, C. (2013). Initiation of abstinence in adolescents treated for marijuana use disorders. Journal of Substance Abuse Treatment, 44(4), 384-390. PMCID: PMC3556197
    Adaptive Interventions for Children with ADHD
    The aim of this SMART is to understand whether to begin with medication or behavioral therapy for children with ADHD, and whether to intensify or augment initial treatment for children who do not respond to treatment.
    • PI: William Pelham
    • Funding: US Dept. of Education-funded completed project
    • Related Article:  
      Pelham, W. E., & Fabiano, G.A. (2008). Evidence-based psychosocial treatment for ADHD: An update. Journal of Clinical Child and Adolescent Psychology, 31, 184-214.
    Adaptive Treatment for Cocaine Dependence
    A SMART design is being implemented to develop an adaptive intervention to increase treatment engagement and decrease cocaine use for patients who are cocaine dependent. The study also examines whether patient choice of care affects patient outcomes.
    • PI: James R. McKay
    • Funding: NIDA Project P01AA016821 
    • Related Articles: 
      McKay, J. R. (2009). Treating substance use disorders with adaptive continuing care. Washington, D.C.: American Psychological Association.
      McKay, J. R., Van Horn, D. H., Lynch, K. G., Ivey, M., Cary, M. S., Drapkin, M. L., ... & Plebani, J. G. (2013). An adaptive approach for identifying cocaine dependent patients who benefit from extended continuing care. Journal of consulting and clinical psychology, 81(6), 1063.
    Adaptive Approach to Naltrexone Treatment for Alcoholism
    Naltrexone (NTX) is an opioid receptor antagonist used to prevent alcoholism relapse. This trial examines how to define "non-response" to treatment with NTX and what treatments are most effective for those who do or do not respond to the initial treatment.
    • PI: David Oslin
    • Funding: NIAAA Project R01AA017164
    • Related Articles: 
      Murphy, S. A., Lynch, K. G., Oslin, D. W., McKay, J. R., & Ten Have, T. R. (2007). Developing adaptive treatment strategies in substance abuse research. Drug Alcohol Dependence, 88(2), S24–30. PMCID: PMC1922034
      Lei, H., Nahum-Shani, I., Lynch, K., Oslin, D., & Murphy, S. A. (2012). A "SMART" design for building individualized treatment sequences. The Annual Review of Clinical Psychology, 8, 21-48. PMC Journal- In Process
    Adaptive Treatment for Adolescent Obesity
    This project targets African American adolescents with obesity and their parents. SMARTs are used to develop an adaptive intervention that increases skills in changing dietary, exercise, and sedentary behaviors.
    • PI: Sylvie Naar-King
    • Funding: NHLBI Project U01HL097889
    • Related Articles: Study in progress
    Adaptive Treatment Strategies for Children and Adolescents With Obsessive-Compulsive Disorder (OCD)
    For youth with OCD, the most common treatments are cognitive-behavioral therapy (CBT), pharmacological treatment, or both. Up to 30% of patients may not benefit from their initial treatments. Researchers will employ a SMART to determine the optimal treatment sequence for participants dependent on whether or not they respond to their initial treatment.
    • PI: Roseli Shavitt
    • Related Article: Study in progress
    Pilot SMART for Adolescent Depression
    Adolescents suffering from depression begin treatment with interpersonal psychotherapy. This pilot project employs SMART to help establish treatment rules regarding when and in what way to intensify treatment.
    • PI: Meredith L. Gunlicks-Stoessel
    • Funding: NIMH Project K23MH090216
    • Related Articles: 
      Almirall, D., Compton, S. N., Gunlicks-Stoessel, M., Duan, N., & Murphy, S. A. (2012). Designing a pilot sequential multiple assignment randomized trial for developing an adaptive treatment strategy. Statistics in Medicine, 17, 1887-1902. PMCID: PMC3399974
    Adaptive Treatment for Persistent Insomnia
    This project aims to develop an adaptive intervention for persistent insomnia. Researchers are using SMART to determine the best sequencing of cognitive behavioral therapy and medication for persistent insomnia.
      • PI: Charles Morin
      • Funding: NIMH Project R01MH091053
      • Related Article: 
        Morin, C., Vallieres, A., Guay, B., Ivers, H., Savard, J., Merette, C., Bastien, C. & Baillargeon, L. (2009). Cognitive and behavioral therapy singly or combined with medication for persistent insomnia: A randomized controlled trial. Journal of the American Medical Association, 301(19), 2005-2015.
      Adaptive Treatment for Bipolar Disorder
      Patients suffering from bipolar disorder are assigned to one of two mood stabilizers. A SMART design is used to determine the appropriate treatment for patients who develop depression.
      • PIs: Charles Lee Bowden, Joseph Calabres
      • Funding: NIMH Project P30MH086045
      • Related Article: Study in progress
      Pilot SMART for Personalizing Treatment for Child Depression
      This pilot project uses a SMART design to develop an adaptive intervention for children with depression. Dr. Eckshtain aims to develop decision rules regarding the use of cognitive behavioral treatment, caregiver–child treatment, or both. The goal is to develop an adaptive treatment protocol for depressed children.
      • PI: Dikla Eckshtain
      • Funding: NIMH Project K23MH093491
      • Related Article: Study in progress
      Characterizing Cognition in Nonverbal Individuals With Autism
      In order to develop communication skills among school-aged children who are nonverbal, this project employs a SMART design to test a novel intervention. The intervention includes components that focus on spoken language and the use of a speech-generating device (e.g., iPad). The SMART design provides the data needed to define response and nonresponse to the intervention and identify the best treatment sequence.
      • PI: Connie Kasari
      • Funding: Funded by Autism Speaks
      • Related Article:
        Lei, H., Nahum-Shani, I., Lynch, K., Oslin, D., & Murphy, S. A. (2012). A "SMART" design for building individualized treatment sequences. The Annual Review of Clinical Psychology, 8, 21-48. PMC Journal - In Process


         Kasari, C., Kaiser, A., Goods, K., Nietfeld, J., Mathy, P., Landa, R., ... & Almirall, D. (2014). Communication Interventions for   Minimally Verbal Children With Autism: A Sequential Multiple Assignment Randomized Trial. Journal of the American Academy of Child & Adolescent Psychiatry, 53(6), 635-646.

      Adaptive Interventions for Minimally Verbal Children With Autism Spectrum Disorder in the Community
      This study will compare two types of intensive, daily instruction for children with autism spectrum disorder (ASD) who use only minimal verbal communication. Earlier research has shown that even after early language-skills training, about one-third of school-aged children with ASD remain minimally verbal. Researchers plan to enroll 200 children in four cities: Los Angeles, Nashville, New York City, and Rochester, N.Y.
      • PI: Connie Kasari
      • Funding: NICHD Project R01HD073975
      • Research Article: 
        Study in progress
      Adaptive Intervention Strategies in Conduct Problem Prevention: Pilot Study
      This study compares two types of interventions for youth (ages 10-15) with conduct disorders. Participants received either a teen-focused or parent-focused intervention. The appropriate intensity of the interventions was also studied.
      • PI: Gerald August
      • Funding: NIMH Project R34MH097832
      • Related Article: August, Gerald J., Timothy F. Piehler, and Michael L. Bloomquist. "Being 'SMART' about adolescent conduct problems prevention: Executing a SMART pilot study in a juvenile diversion agency." Journal of Clinical Child & Adolescent Psychology ahead-of-print (2014): 1-15.
      SMART Design for Attendance-Based Prize Contingency Management (CM) for Cocaine Abuse
      Contingency management (CM) is a treatment used in substance abuse where patients are rewarded for following treatment guidelines. In this study, researchers are comparing CM to treatment without incentives using a SMART design. They are also testing the timing and the length of the CM.
      • PI: Nancy Petry
      • Funding: NIDA Project R01AA021446
      • Related Article:
        Petry, N. M., Barry, D., Alessi, S. M., Rounsaville, B. J., & Carroll, K. M. (2012). A randomized trial adapting contingency management targets based on initial abstinence status of cocaine-dependent patients. Journal of Consulting and Clinical Psychology, 80(2), 276-285. PMCID: PMC3668312
      Adaptive Treatment for Smoking Among People With HIV
      Between 50% and 70% of people living with HIV are nicotine dependent. This SMART examines how and when to apply contingency management and standard treatment to promote smoking cessation in this population.
      • PI: David Ledgerwood
      • Funding: NIMH Project R01DA034537
      • Related article: Study in progress
      Pilot SMART for Treating ADHD in Families
      This project aims to develop an adaptive intervention for families where the mother has ADHD and the child is at genetic and environmental risk for ADHD. Researchers are using SMART to determine how to use behavioral training or medication for mothers separately, in sequence, or in combination, to improve the quality of parenting and prevent the progression of ADHD in children.
      • PIs: Mark Stein and Andrea Chronis-Tuscano
      • Funding: NIMH Project R34MH99208
      • Related Article: Study in progress
      Improving Mental Health Outcomes: Building an Adaptive Implementation Strategy
      This SMART is cluster-randomized. Randomization occurs at the clinic level. The aim of the study is to develop an adaptive quality improvement strategy designed to enhance the implementation of an evidence-based mental health intervention. Outcomes are measured at the patient level.
      • PI: Amy Kilbourne
      • Funding: NIMH Project R01MH099898
      • Related Article: Study in progress
      Adolescent Substance Abuse: Progressive Treatment for Adolescent Who Use Drugs
      Because the history of adolescent substance abuse interventions shows that individuals respond differently to treatment, this study uses a pair of SMART designs to examine when and how to treat adolescent drug users.
      • PI: Holly Barrett Waldron
      • Funding: NIDA-funded completed project
      • Related Article: 
        Waldron, H. B., & Turner, C. W. (2008). Evidence-based psychosocial treatments for adolescent substance abuse. Journal of Clinical Child & Adolescent Psychology, 37(1), 238-261.

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