Experts reassess treatment of attention deficit hyperactivity disorder

Twenty years ago, more than a dozen leaders in child psychiatry received US$11 million from the US National Institute of Mental Health to study an important question facing families with children with attention deficit hyperactivity disorder: is the best long-term treatment medication, behavioural therapy or both?

The widely publicised result was not only that medication like Ritalin or Adderall trounced behavioural therapy, but that combining the two did little beyond what medication could do alone. The finding has become a pillar of pharmaceutical companies' campaigns to market ADHD drugs.

But in retrospect, even some authors of the study - widely considered the most influential study on ADHD - worry that the results oversold the benefits of drugs. They fear the results discouraged important therapy focused on the home and school, and ultimately distorted the debate over the most effective (and cost-effective) treatments.

The study was structured to emphasise the reduction of impulsiveness and inattention symptoms, for which medication is designed to deliver quick results, several of the researchers said in recent interviews. Less emphasis was placed on improving children's longer-term academic and social skills, which behavioural therapy addresses.

Recent papers have also cast doubt on whether the benefits of medication last as long as those from therapy.

"There was lost opportunity to give kids the advantage of both and develop more resources in schools to support the child. That value was dismissed," said Dr Gene Arnold, a child psychiatrist and professor at Ohio State University and one of the principal researchers on the study, known as the Multimodal Treatment Study of Children With ADHD.