ADHD - It's not just about attention
Scott R. Pekrul, M.D.
Child Grand Rounds
Pekrul describes the Multimodal Treatment Study (MTA) in which participants with ADHD were assigned to four treatment groups (medication management, intensive behavioral treatment, combined medication and behavioral, and standard community care). Children’s core symptoms were assessed at baseline, 3, 9, and 14 months of treatment. Results showed improvement over baseline in all treatment groups; however, the combination and medication management groups were clinically and statistically superior to the other two groups in reducing ADHD and oppositional defiant disorder symptoms. A six and eight year follow-up study revealed that group differences in medication use were no longer significant, and there were no statistically significant effects of original treatment group assignment on any of the 24 outcome variables tested. Pekrul also presents evidence suggesting that children with ADHD tend to fare less well academically as compared to typically developing children and are more likely to suffer from a co-occurring learning disorder in the areas of reading or arithmetic. Medication treatments such as stimulants are generally reported to improve academic performance, but there are mixed results. Behavioral treatments are not as effective, but are important nonetheless. Children with ADHD also suffer socialization deficits and are at risk of facing social exclusion or suffering from conduct disorders, delinquency offenses, and substance use disorders. Although mixed findings have been reported regarding socialization treatment, pharmacotherapy is generally regarded as the most effective method of improving social deficits. Pekrul suggests a combination of medication and behavioral interventions is most conducive to successful outcomes in school and socialization.