Posted by Mark Probert

The NIH and DOEd have done a study which shows that the first line
treatment for ADHD is medication which is agressively managed and
therapy.

URL: http://www.nimh.nih.gov/events/prmta.cfm

For the lazy, here's the press relase:

The National Institute of Mental Health (NIMH) will join Columbia
University to present the results of the collaborative NIMH Multimodal
Treatment Study of Children with Attention Deficit Hyperactivity
Disorder (MTA). The press conference will be held on December 14, 1999
at 10:00 A.M. at the Columbia University College of Physicians and
Surgeons, Conference Center, Columbia Presbyterian, East Side, 16 East
60th Street, New York City. Two papers detailing the results of the MTA
study will be published in the December issue of the American Medical
Association's Archives of General Psychiatry.

Attention deficit hyperactivity disorder (ADHD) is the most
commonly diagnosed disorder of children, estimated to effect 3-5% of
school age children. On average, at least one child in every classroom
in the United States needs help for the disorder. The core symptoms of
ADHD include an inability to sustain attention and concentration,
developmentally inappropriate levels of activity, distractibility and
impulsivity.

"ADHD is a major public health problem of great interest to many
parents, teachers, health care providers, and researchers. Up-to-date
information concerning the safety and efficacy of treatments over a
significant period of time is critical," said Steven E. Hyman, M.D.,
Director of NIMH. In this landmark study, the first major clinical
trial to look at childhood mental illness and the largest NIMH clinical
trial to date, the NIMH and the Department of Education tested the
leading treatments for ADHD for long-term efficacy at multiple research
sites in the U.S. and Canada.

Including nearly 600 elementary school children, ages 7-9, the MTA
study randomly assigned them to one of four treatment programs: (1)
medication management alone; (2) behavioral treatment alone; (3) a
combination of both; or (4) routine community care. "All children
tended to improve over the course of the study, but they differed in
the relative amount of improvement," said Peter Jensen, M.D., one of
the primary NIMH collaborators for the study and Senior Advisor to the
Director of the NIMH, on assignment to Columbia
University. "Nonetheless, determining what treatment will be most
effective for a particular child is an important question that needs to
be answered by each family in consultation with their health care
professional."

The MTA study has demonstrated, on average, that carefully
monitored medication management with monthly follow-up, with input from
teachers, is more effective than intensive behavioral treatment for
ADHD. The combination of medication management and intensive behavioral
treatments was also significantly superior to psychosocial treatments
alone in reducing ADHD symptoms. For some outcomes that are important
in the daily functioning of these children (e.g., academic performance,
familial relations), the combination of behavioral therapy and
medication was necessary to produce improvements, and families and
teachers reported somewhat higher levels of consumer satisfaction for
those treatments that included the behavioral therapy components.
Furthermore, the combination program allowed children to be treated
over the course of the study with somewhat lower doses of medication.

The study also found substantial differences between the study-
provided medication treatments and those provided in the community,
differences mostly related to the quality and intensity of the
medication management treatment. During the first month of treatment,
special care was taken to find an optimal dose of medication for each
child receiving the MTA medication treatment. After this period, the
MTA prescribing therapist met with the family for monthly, one-half
hour visits with the parent and the child, to assess any concerns that
the family might have regarding the medication or the child's ADHD-
related difficulties. In addition, the MTA physicians sought input from
the teacher on a monthly basis, and used this information to make any
necessary adjustments in the child's treatment. If the child was
experiencing any difficulties, the MTA physician was encouraged to
consider adjustments in the child's medication. In comparison, the
community-treatment physician generally saw the children face-to-face
only 1-2 times per year, and for shorter periods of time each visit.
Furthermore, they did not have any interaction with the teachers, and
generally prescribed lower doses of stimulant medication.

"As the first major randomized treatment study, one of the most
important results is that these same findings were replicated across 6
sites, located at diverse but representative geographical areas in this
country and in Canada, despite substantial differences among sites in
their samples' socio-demographic characteristics. This means that the
study's overall results are probably applicable and generalizable for
the many and diverse children and families in need of treatment
services for ADHD," said Laurence Greenhill, M.D., a research
psychiatrist at Columbia University, one of the research sites. Other
sites include Duke University Medical Center, Durham, N.C.; Western
Psychiatric Institute, Pittsburgh, PA; Long Island Jewish Medical
Center, New Hyde Park, N.Y.; University of California at Berkeley; and
University of California at Irvine; Montreal Children's Hospital,
Canada.

The news conference will include presentations by Peter Jensen,
M.D. and Stephen P. Hinshaw, Ph.D., the primary investigator for the
research site at University of California, Berkeley. Other study
investigators will be available for questions, including Howard B.
Abikoff, Ph.D., New York University, Jeffrey Newcorn, M.D., Mount Sinai
Medical Center, and Lily Hechtman, M.D., McGill University, Canada.
Kimberly Hoagwood, Ph.D., Associate Director for Child and Adolescent
Research, and Benedetto Vitiello, M.D., Chief of the Child and
Adolescent Treatment and Preventive Intervention Branch, both of the
NIMH, will also be present.

Other NIMH researchers participating in the study were: Laurence
L. Greenhill, M.D., Glen Elliot, M.D., Ph.D., C. Keith Conners, Ph.D.,
Karen Wells, Ph.D., John S. March, M.D., M.P.H., James Swanson, Ph.D.,
Dennis P. Cantwell, M.D., William E. Pelham, Ph.D., Betsy Hoza, Ph.D.,
Helena C. Kraemer, Ph.D. The principal collaborator from the Office of
Special Education Programs in the Department of Education (OSEP/DOE)
was Ellen Schiller, Ph.D.; the current OSEP/DOE contact is Tom V.
Hanley, Ed.D.

The National Institute of Mental Health (NIMH) is part of the
National Institutes of Health (NIH), the Federal Government's primary
agency for biomedical and behavioral research. NIH is a component of
the U.S. Department of Health and Human Services. The Office of Special
Education Programs (OSEP) is part of the Office of Special Education
and Rehabilitative Services (OSERS), a component of the U.S. Department
of Education.

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No more of this try everything before medication bullshit.

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