Tuesday, July 31, 2007
Most kids with attention-deficit hyperactivity disorder benefit from long-term treatment, whether or not that treatment includes drugs, according to a study funded by the National Institute of Mental Health.
The study, published in the August issue of the Journal of the American Academy of Child and Adolescent Psychiatry, is a follow-up to a landmark NIMH study published in 1999.
In the earlier phase of the study, nearly 600 children ages 7 to 9 with ADHD were randomly assigned to one of four treatments for 14 months. Those whose medication was managed by an ADHD specialist and those whose treatment involved both drugs and behavioral therapy did far better than those treated by a family physician or with behavior therapy alone.
But in the next two-year phase, when parents decided whether and how to treat their children, the advantages of medication began to wane. At the three-year mark, kids from all four groups showed the same amount of improvement.
"It's quite clear that each of these treatments is better than no treatment at all," said lead study author Peter Jensen, director of Columbia University's Center for the Advancement of Children's Mental Health.
Does that mean you should pitch your child's Ritalin? No, says Jensen; instead, it's good evidence that treatments should change over time, as the severity of symptoms dictates. "Many of these kids do better over time," Jensen said, "and they should start it [medication] and stop it as they need it."
Children's National Medical Center psychiatrist Jay Salpekar agrees. "This study clearly indicates that treatments need to change" from time to time, said Salpekar, who was not involved with the study. "No one has great info on the best treatment over time. We reevaluate our patients' needs each time they visit so that they don't get stuck in a rut."
-- Matt McMillen