Study Suggests Tailoring ADHD Treatment

Purdue University psychology professor Betsy Hoza was part of the team of researchers that conducted the study for the National Institute of Mental Health. She says the results point to individually tailored doses of medicine together with behavior therapy as the most effective treatment for school-age children and their families.

"We found that when given alone, carefully monitored medication treatment performed as well as medication combined with behavior therapy for reducing ADHD symptoms" says Hoza, who was co-investigator at one of six sites where the study was conducted. "Even though medication reduced symptoms when taken alone, it was necessary to add behavior therapy to maximize improvements when problems with parent-child relations, disruptive behavior, poor academic performance, anxiety and social skills were part of the picture."

The most commonly diagnosed disorder in children, ADHD is estimated to affect between 3 percent and 5 percent of all school-age youngsters. Mental health experts estimate that on average, at least one child in every U.S. classroom needs help for ADHD. The most common symptoms are inability to sustain attention and concentration, developmentally inappropriate levels of activity, distractibility and inability to control impulsive behavior.

The nearly 600 7- to 9-year-old patients involved in the study were randomly assigned one of four treatment programs: medication management; behavioral treatment; a combination of both; or routine care by their own community practitioners.

Hoza assisted principal investigator William E. Pelham Jr. at the Western Psychiatric Institute in Pittsburgh, Pa. Other sites were Columbia University in New York; Duke University Medical Center in Durham, N.C.; Long Island Jewish Medical Center in New Hyde Park, N.Y.; University of California, Berkeley; University of California, Irvine; and Montreal Children's Hospital, Canada.

Participants who received medication treatments were individually assessed to find the optimal dose needed, and the prescribing clinicians met with the families monthly for half-hour visits. The physicians also sought input from teachers on a monthly basis and used all of this information to make necessary adjustments to treatment. Researchers also noted that this system of treatment delivery was significantly different from that provided by community physicians, who generally saw their patients one or two times a year and for shorter periods of time.

"I think the message for doctors is that medication treatment can be made dramatically more effective for children when the stimulants are prescribed at an optimal dose, and patients are monitored closely and regularly," Hoza says. "Monthly office visits with the family and monthly contacts with the child's teachers seem to be indicated. And referral for behavior therapy is necessary when problems extend beyond ADHD symptoms themselves."

Two papers detailing the results of the study were published in the December issue of the American Medical Associations' Archives of General Psychiatry.