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Treating ADHD: Drugs or Therapy Work

Study Shows Improvement in ADHD Symptoms With Medication or Behavior Therapy
WebMD Health News
Reviewed by Louise Chang, MD

July 20, 2007 -- Three years after starting treatment for attention deficit hyperactivity disorder (ADHD), children continue to experience improvement in their symptoms regardless of which treatment they use, a major follow-up study shows. But the advantage of medication, shown to be superior to other treatments in previous follow-ups, seems to wear off. And some improvement in symptoms may occur naturally, independently of treatment.

At the three-year follow-up mark, "the kids by and large had improved a great deal," says Peter S. Jensen, MD, author of one of four reports issued on the study. Called the Multimodal Treatment Study of Children with Attention Deficit Hyperactivity Disorder (MTA), the study first enrolled children with ADHD when they were ages 7 to 10. These reports, the third follow-up on the study, are published in the August issue of the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP).

But the news isn't all great. In a surprise finding, the effect of ADHD medications, initially shown to be superior to other treatments such as behavior therapy, was found to provide no better results at the three-year mark than the other approaches. And the risk of behavioral problems in ADHD children, including their tendency to experiment with drugs and alcohol and to display delinquent behavior, was found higher than in other children, which the researchers expected.

About 2 million U.S. children are diagnosed with ADHD, a condition in which children have trouble focusing on tasks, sitting still, and paying attention.

Medication and Behavior Therapy for ADHD

The latest follow-up study on which treatments worked best evaluated 485 of the original 579 children when they were ages 10 to 13. The original study, which continued for 14 months, evaluated four approaches: behavior therapy, medication, medication plus behavior therapy, or routine community care. After the 14 months, families could choose from treatments available in their communities, and the original groups may have added or eliminated the treatments they first took in the study.

By the three-year mark, the percentage of children taking ADHD medication more than half the time had changed across the initial treatment groups, with 45% of the initial behavior therapy group, for instance, taking medication. Overall, 45% to 71% of children were taking ADHD medication at the three-year follow-up. But the medication was no longer associated with better outcomes -- such as symptom control -- than the other approaches, as it had been in the previous reports, issued at 14 months and two years.

In fact, all four groups had similar improvement in ADHD symptoms at the three-year mark. On average, all still had some symptoms, but not in the severe category.

Some of that "lost ground" with medication "is due to less intense treatment," says Jensen, director of The Reach Institute, a nonprofit organization in New York focused on children's emotional and behavioral health. "It's the only thing that changed [after the 14-month study]."

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