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Medication More Effective Than Therapy Alone in Treating ADHD

WebMD Health News

Dec. 14, 1999 (New York) -- Reporting data from the largest clinical trial comparing treatments for attention deficit hyperactivity disorder (ADHD), researchers said Tuesday that they have answered the "two major questions that have burdened the field" of ADHD. In the largest treatment study of children with ADHD, carefully managed medication was shown to be better than behavioral therapy in alleviating the symptoms of ADHD.

However, approximately two-thirds of children in the study had other psychological or social problems. These symptoms were best treated with a combination of well-monitored medication and behavioral therapy (summer day camps, school interventions, and family interventions).

"We really need to educate consumers about the need for a very comprehensive assessment and follow-up protocol," says Beth Kaplaneck, president-elect of the Washington-based group Children and Adults With Attention Deficit Hyperactivity Disorder. She spoke to WebMD following the announcement of the trial results. "We have to continue to demand that treatments be available that are multimodal."

In the study, which was conducted at six research sites in the U.S. and Canada, nearly 600 children between the ages of 7 and 10 with ADHD and other social problems were randomly assigned to one of four treatment approaches: a carefully managed medication approach; behavioral therapy alone; combination treatment; or routine community care.

While the researchers looked at four times as many boys as girls, they recruited the largest treatment group of girls to date, said Stephen P. Hinshaw, PhD, the study's principal investigator and a psychologist at the University of California, Berkeley. Children were treated for 14 months.

The study, which is published in the December issue of the Archives of General Psychiatry, was conducted in conjunction with Columbia University.

"A well-managed medical strategy may get you most of the way home," said the study's principal collaborator, Peter S. Jensen, MD, from the National Institutes of Mental Health. "Combination treatment may allow some children to be treated with less medicine, the study revealed."

According to Hinshaw, for children from "highly stressed families" -- for example, those with parents on public assistance -- combination therapy yields added benefit in enhancing social skills, peer interaction, and parent-child relations.

The medication treatment arm of the study was far more intensive than that found in conventional practice, stressed Hinshaw. In the first month of medical treatment, a far more aggressive effort was made to find an optimal dose of medication (between 32 and 38 mg per day). All children were put on three-times-a-day dosing. After the first month, monthly half-hour visits with the family were held to address medication and other ADHD-related problems.

Children who came in frequently had a better response than those seen less frequently in the community, said Hinshaw, who added that the more frequent interaction appears to bolster quality of care.

And while behavioral therapy alone did not match the effectiveness of well-monitored medication, investigators stressed that behavioral therapies evaluated in the study did improve social skills, parent-child relations, and school performance, and reduced anxiety.

Researchers took pains to stress that treatments should not be of the 'one-size-fits-all' variety and that careful diagnostic evaluation is needed to assess related problems.

The study suggested that the 15-minute medication check done once every four months in community practice is not optimal. "Only by families and consumers pressing for better care" will this standard change, said Jensen.

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