ADHD Treatment: What The NIMH Has To Say

    A girl sits in bed, holding her teddy bearChildren with attention deficit hyperactivity disorder (ADHD), the most common of the psychiatric disorders that appear in childhood, are often the subject of great concern on the part of parents and teachers. Children with ADHD are unable to stay focused on a task, cannot sit still, act without thinking, and rarely finish anything. If untreated, the disorder can have long-term effects on a child’s ability to make friends or do well at school or in other activities. Over time, children with ADHD may develop depression, lack of self-esteem, and other emotional problems.

    Experts estimate that ADHD affects 3 to 5 percent of school-age children and two to three times as many boys as girls. Children with untreated ADHD have higher than normal rates of injury. ADHD frequently co-occurs with other problems, such as depression and anxiety disorders, conduct disorder, drug abuse, or antisocial behavior.

    Although ADHD is relatively common, our knowledge of the problem is incomplete. Current ADHD treatment includes a mix of approaches, such as drug therapy, counseling, supportive services in schools and communities, and various combinations of the three. The medical literature offers many studies carried out over brief treatment periods (3 months or less), but a pressing question remains: what is the best kind of help we can offer children with ADHD over a longer term?

    To answer this question, NIMH is sponsoring an ongoing, multisite, cooperative agreement treatment study of children with ADHD entitled The Multimodal Treatment Study of Children with Attention Deficit Hyperactivity Disorder. The first findings from this study, which were published in December 1999, provide important guidance for physicians and parents of children with ADHD and are discussed below. Ongoing follow-up reports will be published, with an additional 10-15 papers expected to be released in calendar year 2000.

    Questions and Answers

    Q. What is the Multimodal Treatment Study of Children with ADHD?

    A. The Multimodal Treatment Study of Children with ADHD–“MTA” for short–brought together 18 nationally recognized authorities in ADHD at 6 different university medical centers and hospitals to evaluate the leading treatments for ADHD, including various forms of behavior therapy and medications. The study has included nearly 600 elementary school children, ages 7-9, randomly assigned to one of four treatment modes: (1) medication alone; (2) psychosocial/behavioral treatment alone; (3) a combination of both; or (4) routine community care.

    Q. Why is this study important?

    A. ADHD is a major public health problem of great interest to many parents, teachers, and health care providers. Up-to-date information concerning the long-term safety and comparative effectiveness of its treatments is urgently needed. While previous studies have examined the safety and compared the effectiveness of the two major forms of treatment, medication and behavior therapy, these studies generally have been limited to periods up to 4 months. The MTA study demonstrates for the first time the safety and relative effectiveness of these two treatments (including a behavioral therapy-only group), alone and in combination, for a time period up to 14 months, and compares these treatments to routine community care. The children involved in the study will be tracked into adolescence to document and evaluate long-term outcomes.

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