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ADHD in Children Health Center

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Treating ADHD: Drugs or Therapy Work

Study Shows Improvement in ADHD Symptoms With Medication or Behavior Therapy

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]."

ADHD Medications Wear Off

In a second report, the researchers tried to figure out why the ADHD medication's effect seems to wear off at the three-year mark, at least for some children. "We analyzed symptoms based on whether or not they were on medication, regardless of what [study] group they were in," says James M. Swanson, PhD, professor of pediatrics at the University of California, Irvine, and a co-author on all four papers.

Still, he tells WebMD, they found at the three-year mark that "all the kids looked better, but the ones taking medication were no better [than the others]."

However, the researchers did find that for a subset of the children, the medication effect seems to kick in at the three-year mark, Swanson says. "These are the kids who initially didn't show a good response [to medication]. They only got a little better the first year but continued to get better over three years."

Of all the children studied, he says, about 34% of them fall into this category, those who do seem to be helped long-term by the drugs. While it's not possible to describe exactly who these children are, Swanson says they tend to be more likely to have other conduct disorders along with the ADHD diagnosis.

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