Symptomatic improvement in children with ADHD treated with long-term methylphenidate and multimodal psychosocial treatment.
OBJECTIVE
To test the hypotheses that in children with attention-deficit/hyperactivity disorder (ADHD) (1) symptoms of ADHD, oppositional defiant disorder, and overall functioning are significantly improved by methylphenidate combined with intensive multimodal psychosocial treatment compared with methylphenidate alone and with methylphenidate plus attention control and (2) more children receiving combined treatment can be taken off methylphenidate.


METHODS
One hundred three children with ADHD (ages 7-9), free of conduct and learning disorders, who responded to short-term methylphenidate were randomized for 2 years to (1) methylphenidate alone; (2) methylphenidate plus psychosocial treatment that included parent training and counseling, social skills training, psychotherapy, and academic assistance, or (3) methylphenidate plus attention psychosocial control treatment. Assessments included parent, teacher, and psychiatrist ratings, and observations in academic and gym classes.


RESULTS
Combination treatment did not lead to superior functioning and did not facilitate methylphenidate discontinuation. Significant improvement occurred across all treatments and continued over 2 years.


CONCLUSIONS
In stimulant-responsive children with ADHD, there is no support for adding ambitious long-term psychosocial intervention to improve ADHD and oppositional defiant disorder symptoms. Significant benefits from methylphenidate were stable over 2 years.
Abikoff
Howard
H
NYU Child Study Center, New York University School of Medicine, New York, NY 10016, USA. abikoh01@med.nyu.edu
Hechtman
Lily
L
Klein
Rachel G
RG
Weiss
Gabrielle
G
Fleiss
Karen
K
Etcovitch
Joy
J
Cousins
Lorne
L
Greenfield
Brian
B
Martin
Diane
D
Pollack
Simcha
S
D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000188:drug therapy*; D000697:Central Nervous System Stimulants / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D008774:Methylphenidate / Q000008:administration & dosage / Q000627:therapeutic use*; D017063:Outcome Assessment, Health Care
D000697:Central Nervous System Stimulants; D008774:Methylphenidate