ADHD Treatment Study update.

A three-year follow-up to the 1999 Multimodal Treatment Study of Children with Attention Deficit Hyperactivity Disorder (MTA) reports that "children continue to experience improvement in their symptoms regardless of which treatment they use" (my emphasis). In the original 1999 randomized study, 579 children, aged seven to ten years, received stimulant medication (e.g., Ritalin), intensive behavior therapy, a combination of medication and behavior therapy, or community care ("whatever the parents could find"). The researchers evaluated attention deficit hyperactivity disorder (ADHD) symptoms, Oppositional Defiant Disorder symptoms, reading achievement scores, functional impairment, and social skills, using parent, teacher, and clinical evaluations. Children in the stimulant group and in the stimulant-plus behavioral therapy group had significantly better evaluations than those receiving community care or behavioral therapy alone. At the end of the 14-month study period, families were free to use whatever treatment they wished or to stop treatment altogether.

At 36 months, 485 children from the initial study (now ten to 13 years) were re-evaluated (Jensen PS, et al. Three-year follow-up of the NIMH MTA study. J Am Acad Child Adolesc Psychiatry. 2007;46:988-1001). In this follow-up, 71% of children who took stimulants in the original study were still taking ADHD medication at a "high level." Also, 62% of those in the community care group and 45% of the behavioral therapy-alone group were on high levels of medication. Overall, however, the advantage of taking ADHD medication for an extended period had disappeared. The researchers even looked at the number of days the children were on medication and found "no significant difference in ADHD symptoms." The researchers were reportedly "struck by the remarkable degree of improvement found in all of the subjects over time." Even though the children, on average, had some symptoms, the symptoms were no longer severe. "The benefit for patients may be related to the extra attention brought by participation in the study or may reflect 'a natural waning of symptoms,'" the researchers say. Without a control group of children who received no treatment, these researchers could not be sure if ADHD symptoms decline without treatment as a child matures.

Doheny K. After 3 years on Ritalin, kids are shorter, lighter than peers. WebMD Medical News. July 20, 2007. Available at: www.medicinenet.com/script/main/art.asp?articlekey=82704&pf=3&page=1. Accessed January 9, 2008.

Elias M. Kids treated for attention deficit get better in a few years. USA Today. July 19, 2007. Available at: www.usatoday.com/news/health/2007-07-19-adhd_N.thm?POE=click-refer. Accessed December 27, 2007.

Phend C. ADHD therapies hold roughly uniform benefit in the long run. Medpage Today. July 20, 2007. Available at: www.medpagetoday.com/Pediatrics/ADHDADD/tb/6205. Accessed January 9, 2008.