Improvement Following ADHD Treatment Sustained in Most Children, but Behavioral Problems Were Found to Persist Into Adolescence
The good news is that most children treated from an interdisciplinary treatment approach for Attention Deficit Hyperactivity Disorder (ADHD) showed sustained improvement after three years in a major follow-up study funded by the National Institute of Mental Health (NIMH). However, the bad news is that increased risk for behavioral problems, including delinquency and substance use, remained higher than normal.
The report, published in the August, 2007 issue of the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP), stated that after three years, 45-71 percent of the youth in the original treatment groups were taking medication; however, continuing medication treatment was no longer associated with better outcomes by the third year. More specifically, they identified three groups of children with different patterns of response. One group, about a third of the children, showed a gradual, moderate improvement; a second group, about half of the children, showed larger initial improvement, which was sustained through the third year; and a third group, about 14 percent of the children, responded well initially, but then deteriorated as symptoms returned during the second and third years. Swanson and colleagues suggested “trial withdrawals” for some children to determine if they still need to take medications.
In a follow-up study of 485 children ages 10-13, the study found that intensive medication management alone or in combination with behavioral therapy produced better outcomes than just behavioral therapy. Furthermore, ratings from families and teachers favored the combination treatment, which allowed for lower medication doses. Of particular concern was that found by Brooke Molina, Ph.D., University of Pittsburgh, and his colleagues. They reported that, despite treatment, the children with ADHD showed significantly higher-than-normal rates of delinquency (27.1 percent vs. 7.4 percent) and substance use (17.4 percent vs. 7.8 percent) after three years. Earlier evidence of lower substance use rates among children who had received intensive behavioral therapy had lessened by the third year. “These findings underscore the point that ADHD treatment for one year does not prevent serious problems from emerging later,” noted Molina.
September 13th, 2007 at 4:51 pm
Perhaps when the multi-module aproach is introduced/embraced more and more throught the country adn the world, the patients in treatment will take other guidelines like basic nutrition along with the medical interventions and coaching/therapy, when needed.