ADHD Medication: Can Your Child Go Without?

Video: ADHD

In the 1990s, the National Institute of Mental Health tried to weigh the relative benefits of the two most common treatments for ADHD: stimulant drugs and behavioral treatments, including parent training. The Multimodal Treatment Study of Children with ADHD followed 579 grade-schoolers for 14 months. Some got stimulants, and some got behavioral therapy that included parent training, teacher training, and a summer camp that taught the kids social skills. A third group got both medication and the behavioral intervention. A fourth group had treatments chosen by their parents in the community. At the end, the children in all four groups were doing better. Parents and teachers rated the medication-only group as having many fewer symptoms of inattention and hyperactivity/impulsivity. But they rated the children who got behavioral treatment as doing better on aggressive behavior, peer relations, parent-child relations, and academic achievement. Since the first results were published in 1999, researchers have been arguing strenuously over whether the study proves that medication or treatment without medication is best.

"What the MTA really showed is that it's not the medication per se but the intensive monitoring," says Benedetto Vitiello, chief of the child and adolescent treatment and preventive interventions branch for the National Institute of Mental Health. "Having a visit each month, putting together all the information for the school and the parent, tailoring the treatment." Indeed, when the study ended and the extra monitoring stopped, the benefits faded for all groups, medicated or not.

The take-home message for parents: There are other good treatments besides the pills, but no treatment's going to work without sustained effort from the whole family.