It has been suggested that children with attention deficit hyperactivity disorder (ADHD) generally require multimodal treatment, combining environmental interventions and medication. The expectation is that a carefully tailored approach that deals with the core symptoms and with a youngster's secondary and comorbid symptoms would provide increased benefits.
Satterfield et al.62 treated 117 youngsters with hyperactivity who were assigned to a multimodal treatment study that individualized treatment for each subject. Youngsters were assigned a combination of therapeutic interventions, including methylphenidate (MPH), individual therapy, family therapy, educational remediation, and group therapies. Children receiving the combined treatments showed major improvements in the form of increased academic performance and decreased antisocial behaviors.
The limitations of earlier multimodal studies led to the National Institute of Mental Health Collaborative Multisite Multimodal Treatment Study of Children with ADHD (MTA).63 In the MTA, 576 children, ages 7 to 9 years, were randomly assigned to one of four treatment groups:
This study demonstrated the clear-cut superiority of medication over behavior therapy. Behavior therapy applied in conjunction with medication did not augment the robust effects of medication alone on the core symptoms of ADHD. Nonetheless, behavioral treatments may provide some improvements for non-ADHD and anxiety symptoms.
The medication-only group was also superior to the community treatment group. This superiority appeared to be related to three factors:
Reviewed and revised June 2004 by Steven C. Schachter, MD, epilepsy.com Editorial Board.
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