The treatment of ADHD and the MTA Trials
Author: Deane G. Baldwin, M.D., FAAP

“Stimulant” medications have been around for many years and are generally regarded as first line medical treatment for Attention Deficit Hyperactivity Disorder (ADHD).

Methylphenidate and dextroamphetamine compounds are the leaders in this group of medications with a variety of delivery systems that have emerged to offer the patient a more effective clinical response with a better chance for compliance.

So effective have been these medications that one, a “short acting” methylphenidate, was chosen to be used in a recent landmark study that was sanctioned by the National Institute of Health and performed by major university mental health groups in multiple locations across the country. The study trials were termed Multimodal Treatment for ADHD (MTA) and were unique in that a variety of treatment regimes were compared for effectiveness when subjected to standard behavioral measurements.

For comparison, four groups were randomly chosen from students who were diagnosed with ADHD. Many in each group had other developmental and emotional disorders as well. The first group was treated by expert physicians with medication alone. A second group was treated with behavioral therapy that involved numerous sessions with parents and teachers where experts instructed them on the state of the art behavioral management of ADHD. A third group included those students who received both medication and behavioral management. A fourth group was comprised of students who were treated by community physicians.

The goal of the therapy was to achieve optimum results where normalization was the desired end point. Treatment results were analyzed for improvement by standardized behavioral rating scales.

On the average normalization in the group treated (by experts) with medication alone and the group treated with both medication and behavioral management were quite similar (60% + or -) with only a slight edge going to the latter group. Behavioral therapy alone normalized about one third of that student group and the students treated by community physicians reached the optimum goal about one fourth of the time.

The groups treated by mental health experts were treated much more aggressively than the community medical treatment group. Frequent follow up with parent and teacher input was the norm. Student compliance in taking the medication was achieved and higher doses of medication were administered (three doses of medication rather than two and at a higher overall dose). Therefore, where possible, the treatment of ADHD should be aimed at a high level of improvement (normalization) and include intensive medication management.

Further, behavioral management adds “icing on the cake” in the treatment for ADHD and the methodology used in the study design might well become an example for educators. Behavioral management appeared to be most effective when the students with ADHD had other developmental and emotional disorders.

The study has been in progress for two years now and will be completed in another three years. Perhaps much will be learned about multimodal interventions for a variety of students with ADHD alone and ADHD with other developmental and emotional disorders. Future studies will likely include the medications with the improved and longer acting delivery systems.

For more information about ADHD and co morbidities see www.ABLEDEV.COM .








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Dr. Deane G. Baldwin, M.D., FAAP, is a Board Certified Pediatrician in private practice for 39years. Specializing in developmental disorders and school health. For more information go to www.ABLEDEV.COM

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