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Monitored Medication More Beneficial in ADHD.

NEW YORK -- An analysis of 10-month follow-up data from a multicenter study of attention-deficit hyperactivity disorder suggests that closely monitored medication management continues to be more beneficial than any lasting effects of intensive behavioral treatment, and there may be some advantages in combining the two.

These findings were reported at the annual meeting of the American Academy of Child and Adolescent Psychiatry by speakers for the Multimodal Treatment Study of Children With Attention-Deficit Hyperactivity Disorder Cooperative group, which includes 24 investigators at 15 universities and the National Institute of Mental Health.

Dr. L. Eugene Arnold of Ohio State University, Columbus, reported early findings from the follow-up study of the original group of 579 children who were actively treated for 14 months. Ten months after the end of the formal trial, patients assigned to medication management alone or a combination of medication and behavioral therapy continued to show greater improvement in symptoms of attention-deficit hyperactivity disorder (ADHD) or oppositional defiant disorder (ODD) than those originally in behavioral therapy alone or those in community care. This is at least partly explained by the continued use of medication during the follow-up by those who received it during the 14-month active treatment period.

After correcting for use of medication during the follow-up, continued improvement was seen only in regards to ADHD symptoms, not ODD symptoms.

The type of treatment sought during the 10-month follow-up period--when patients were free to pursue any or no treatment with their own physician--differed according to the patients' original treatment group. Those assigned to behavioral treatment were significantly less likely to use medication during this period than were those in the combined or medical management-only groups: 44% vs. 88%. "Fourteen months of exposure to behavioral treatment seems to reduce the propensity to reach out for medication," he said.

Dr. Peter S. Jensen of Columbia University and the New York State Psychiatric Institute, New York, summarized findings from the original trial in which the 579 children with ADHD or ODD were randomized into roughly equal groups to receive medication management only, behavioral therapy only, a combination of the two, or community care (assessment and referral back to community providers).

Medication management alone was significantly superior to community care in terms of symptoms, aggression, and social skills, he said. Combined treatment showed superiority in these areas as well as in the areas of anxiety, academic skills, and the parent-child relationship. The group who received behavioral treatment alone was superior to the community-treated group only in terms of the parent-child relationship. Those who received the combination of medication and behavioral therapy did significantly better in ADHD and ODD symptoms than those receiving medication management alone in secondary analyses--and at a lower dose.

Children in the medication management group did significantly better in ADHD and ODD symptoms than those in community care, even though two-thirds of the latter also were medicated, Dr. Jensen said. One possible reason was differences in regimen: Total dosage was not only higher in the medication management group, but it was divided over three, rather than two, daily doses. Children in the medication management group also were seen monthly by a pharmacotherapist for 30 minutes; children in community care saw a physician just twice during the entire period for a mean of 18 minutes per visit.

Dr. Jensen noted that the good response in the medication management group during the initial trial may have occurred because we weren't just testing a pill but a pattern of management. ... There was a support system built into treatment with the protocol." The treating clinician contacted the patients' schools to get information and to make adjustments in the medication protocol,

"Well-delivered medication treatments may be sufficient for most children for the treatment of ADHD symptoms, while combination treatments may yield optimum benefits in [children who also have problems in] non-ADHD areas of functioning," Dr. Jensen commented.

Dr. Lily Hechtman of Montreal Children's Hospital also presented results from the 10-month follow-up data that suggested some superiority for the combination approach--both among those who received medication during the follow-up period and among those who did not. Children originally in the medication management group experienced a worsening of ADHD and/or ODD symptoms after the end of the formal trial, while the combination and behavioral groups maintained their gains despite having stopped behavioral treatment at 14 months.

A similar pattern was seen in measures of social skills: Those who had received behavioral treatment in addition to medication deteriorated less than those who had received drugs alone, although the difference was not great, she said. Children who received medication, with or without behavioral treatment, still did better than those who had received behavioral treatment alone or community care.

In terms of responder status, the same overall pattern seen at 14 months persisted 10 months later: The highest proportion of responders were in the combination group, followed by medication only, behavioral treatment only, and community care.
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Title Annotation:attention-deficit hyperactivity disorder
Comment:Monitored Medication More Beneficial in ADHD.(attention-deficit hyperactivity disorder)
Author:SHERMAN, CARL
Publication:Family Practice News
Geographic Code:1USA
Date:Feb 15, 2001
Words:817
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