Optimal Treatments for ADHD

Data from the NIMH collaborative Multimodal Treatment Study of Children with ADHD (MTA) suggests that the optimal treatment of the wide range of problems associated with ADHD, especially those extending beyond ADHD symptoms (e.g., oppositional/aggression behavior, parent-child conflict, academic problems), are best addressed by combining medication with behavioral interventions (MTA Cooperative Group, 1999). Project Co-Investigator Dr. Hoza has shown a dose-response relationship between the intensity of behavior therapy and improvements in functional deficits associated with ADHD—indeed, in some cases, increasing the intensity of behavior therapy can eliminate the need for pharmacotherapy (Hoza et al., 1992). Furthermore, use of behavior therapy concurrently with medication substantially reduces the required dosage of medication, presumably also reducing the associated risks of side effects (MTA Cooperative Group, 1999). The issue of side effects has received renewed attention given recent findings of constitutive changes in gene expression following administration of methylphenidate in rats (Chase et al., 2005).

Reference cited:
1.MTA Cooperative Group. (1999). 14-month randomized clinical trial of treatment strategies for attention deficit hyperactivity disorder. Arch Gen Psychiatry, 56:1073-1086.1.
2. Hoza, B. Pelham, W. E., Sams, S. E., & Carlson, C. (1992). An examination of the “dosage” effects of both behavior therapy and methylphenidate on the classroom performance of two ADHD children. Behav Modif, 16(2):164-92.
3.MTA Cooperative Group. (1999). Moderators and mediators of treatment response for children with attention-deficit/hyperactivity disorder: The multimodal treatment study of children with attention-deficit/hyperactivity disorder. Arch Gen Psychiatry, 56:1088-1096.
4. Chase, T. D., Carrey, N., Brown, R. E., & Wilkinson, M (2005) Methylphenidate differentially regulates c-fos and fosB expression in the developing rat striatum Brain Res Dev Brain Res, Jun 30;157(2):181-91.