ADHD Study Follow-Up Sheds Light on Treatment Efficacy
> 7/20/2007 11:40:54 AM

Back in December of 1999 the publication of the Mulitmodal Treatment Study (MTS) of Children with Attention Defecit Hyperactivity Disorder raised some eyebrows when it concluded that ADHD treatments that combined therapy and medication or used medication alone were superior to other treatments—specifically behavioral treatments. This week information on the three year follow-up to the MTA study has been released, and it too is set to raise eyebrows when several new reports appear in next month's edition of the Journal of the American Academy of Child & Adolescent Psychiatry.

The MTA follow-up, which was sponsored by the National Institute on Mental Health and lead by Dr. Peter Jensen of the Center for the Advancement of Children's Mental Health at Columbia University, has produced four distinct conclusions, which were described in an NIMH press release:
  1. The most notable result of this follow-up was that the clinical advantages observed previously from combination or medication treatment in comparison to behavioral treatments appeared to disappear in the years following the original 14-month study.
  2. A second team examining follow-up data found variability in the responses of participants to medication. Some showed gradual improvement on medication, others showed more immediate improvement that then tapered off, and another smaller group showed immediate improvement followed by deterioration and a return of symptoms.
  3. A third report confirmed the somewhat disturbing data that showed children who took ADHD stimulant medications such as Ritalin had slowed growth, and ended up being slightly smaller than their non-medication taking counterparts. In the follow-up, growth rates for the medication children had normalized, but the damage had been done, they did not catch up, on average, to those who didn't take medications.
  4. Finally, delinquency continued to be an issue after the follow up: The children with ADHD showed significantly higher-than-normal rates of delinquency (27.1 percent vs. 7.4 percent) and substance use (17.4 percent vs. 7.8 percent) after three years."
The message that some might take home from this new data is that ADHD treatment isn't necessary, but Dr. Jensen warned, in speaking with USA Today, that that would be an incorrect assumption:

"This doesn't mean that medication didn't help children because we're not seeing effects now," Jensen says. "Some may have given it up because they got better." Others who didn't take medicine at the start may have started taking it because they became much worse, he says.

What this data may show is that with treatment, no matter which type of treatment that may be, children can learn to live and indeed thrive with their symptoms. The other outcome, one that should be viewed even more favorably, is that children between the ages of 7 and 10 who display symptoms will eventually grow out of them. This message should be incredibly encouraging for parents as well as practitioners who despair at placing children on powerful and potentially addictive substances like Ritalin or Adderall. The MTA follow-up illustrates that choosing a behavioral treatment route early on, should in fact lead to the same result as medication based therapy. Every child and family is different, and therefore each case needs to be judged on its own merit, nevertheless, this new information shows the light at the end of the tunnell, and should offer new hope to those who have felt exasperated with ADHD's symptoms.

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