As the results of the five-year, multicenter, and multimodal treatment study of ADHD (MTA)26 become available, it is becoming more and clearer that medications are the treatment of choice. The initial reports indicate that medication alone and medication plus intensive behavioral treatment were nearly identical and that both were significantly superior to intensive behavioral treatment alone on 18 out of 19 outcome measures. The community treatment arm of the MTA also showed that 1/3 of these children with clearly documented “screaming” ADHD received no treatment whatsoever and that those who did get treatment of some sort were almost always under-dosed on their medication. The MTA is just the most recent evidence that ADHD remains grossly under-treated.
The results of the MTA do not mean that adjunctive behavioral management is not helpful. Because ADHD often inhibits development of social awareness and self-control at the critical times it may be important to work on these issues through therapy. The MTA clearly demonstrates that behavior management and “trying harder” do not treat the major impairment domains of inattention, impulsivity and motor restlessness.
The MTA does show that ADHD is not the result of bad parenting skills. These were good, involved parents who received even more training and assistance. It just didn’t make any difference. It also proved that ADHD is not the result of a defect in character or laziness. Trying harder even with intensive support of specialists in the field was ineffective.
In children referred to clinics for learning or behavior problems, the number of ear infections correlated significantly both with a diagnosis of ADHD and with the severity of the ADHD.27 Studies have not so far implicated diet, allergies or asthma as having any connection to ADHD.
Although there have been more than 40 medications that have been shown to have some effect on ADHD there are really only two first line medications for the disorder:
- METHYLPHENIDATE (RITALIN, METHYLIN, METADATE, CONCERTA)
- AMPHETAMINE (ADDERALL, DEXEDRINE, DEXTROSTAT)
(Continued on next page)