Findings from this landmark ADHD study include a surprise or two, and confirm a long-time suspicion.
Three years into the Multimodal Treatment Study of Children with ADHD (MTA), researchers noted that all of the children had improved a great deal. They were surprised to find, however, that medication didn’t remain effective in the long term. These findings underscore the fact that ADHD is a chronic condition, and that treatment, though not necessarily one specific approach, is crucial.
The MTA is the largest ADHD treatment study ever conducted. When the study began, 579 seven- to 10-year-old children diagnosed with ADHD were assigned to one of four treatment conditions: medication only, behavior therapy only, medication and behavior therapy (combined treatment), or community care (the course of treatment parents arranged on their own). Community care often included medication prescribed by the child’s pediatrician, but treatment was generally not rigorously maintained.
Treatment within the MTA Study ended after 14 months. At this point, children continued to be assessed, while parents made their own treatment arrangements.
Recently, the MTA Study Group published a three-year follow-up, based on 485 of the original 579 participants. It is important to note that children in all groups were doing substantially better than they had been when the study began.
Medications Lose Effectiveness. At both the 14- and 24-month marks, children taking medication had significantly better outcomes than children in the behavior therapy or community care groups. At the three-year mark, however, this clear advantage had disappeared.
Stimulants Slow Growth. It’s long been suspected that consistent use of stimulant medications slows a child’s growth. With three years of data from the MTA Study, researchers were able to confirm this theory. On average, kids taking stimulants lagged behind peers on their growth curves by 3/4 of an inch in height and six pounds in weight.
Treatment Doesn’t Decrease Risky Behavior. One team of researchers compared rates of delinquent behavior, such as getting in fights or stealing, and substance abuse for 487 children from the MTA with 272 non-ADHD kids in the same age range. Despite the years of treatment, the ADHD children remained at much higher risk for delinquency (27% vs. 7%) and experimentation with illegal substances (17% vs. 8%) than the control group.
Children Stop Taking Meds. At the 14-month assessment, 90 percent of the children in the medication and combined groups carefully adhered to their medication regimens. At the 36-month assessment, the rate had dropped to 70 percent. High medication compliance in the community care group remained steady at roughly 60 percent, and about 45 percent of children originally assigned to behavior therapy began taking ADHD medication after the 14-month assessment.
One possible explanation for the similar outcomes at 36 months is that all four groups were, by then, quite similar in their use of medication. Had children continued intensive medication treatment, the clear benefits seen at 14 and 28 months may have continued. What is clear, however, is that any of these four approaches is better than providing no treatment to ADHD kids. The researchers implore parents to be sure their children are receiving adequate treatment, and to avoid going on “cruise control” if the child seems to be improving.
-as reported in the October/November 2007 issue