Using medication to treat children with attention-deficit/hyperactivity disorder offers no long-term advantage over other treatment methods, according to a follow-up study.
Dr. Peter S. Jensen and his colleagues at Columbia University, New York, found that children with ADHD who were treated with medication (including stimulants, bupropion, and tricyclics) showed greater improvements in symptoms, compared with children who had been treated with behavior therapy after 14 months of treatment. But those on the medication algorithm lost that advantage after 3 years, based on data from the Multimodal Treatment Study of Children With ADHD (J. Am. Acad. Child Adolesc. Psychiatry 2007;46:989-1002).
The original study included 579 children aged 7–10 years who had been diagnosed with “ADHD combined type.” The children were randomized into one of four treatment groups—intensive multicomponent behavior therapy, intensive medication management, the combination, and routine community care—and they were followed for 14 months.
Of those, 485 children, now aged 10–13 years, took part in a long-term follow-up study. All of the children showed some ADHD and oppositional defiant disorder symptom (ODD) improvement, compared with baseline after 14 months, although the differences were significantly greater in the children in the medication and combination groups after 14 months and 24 months.
But none of the randomized treatment groups showed significant differences on any of five measures of clinical and functional outcomes by 36 months' follow-up. The clinical and functional outcomes were parent reports and teacher reports of ADHD and ODD symptoms, reading achievement scores, social skills, and functional impairment.
Intensive medication management of ADHD in children may have a long-term impact only if the intensity of the medication use is maintained over time, the researchers wrote.
The study was supported in part by the National Institute of Mental Health.