A recent follow-up of the Multisite Treatment Study of Children with ADHD (MTA) study investigated the long-term course of ADHD and the impact of short- term treatment on long-term outcomes.A decade ago, children with ADHD were randomly assigned to one of four treat- ments for 14 months: stimulant medication, behavioral treatment, combined medica- tion and behavioral treatment, or usual care in the community. At the endpoint, medication and combined treatment showed significantly greater improvement than behavioral treatment or usual care, though all groups showed improvement over the initial study period (MTA Cooperative Group. Arch Gen Psychiatry 1999;56:1073-1086), After 14 months, all participants’ families were free to seek treatment in the community as they deemed appropriate, and researchers monitored the children’s ADHD symptoms periodically. By the end of three years, the initial advantage of medication treatment over behavioral treatment disappeared (Jensen PS et al., J Am Acad Child Adolesc Psychiatry 2007;46:989-1002). The present study, which is the eight-year fol- low-up of the same patients, again found that having been in one of the medication groups for the initial study did not influ- ence long-term outcomes. In general, children in the MTA study continued to lag behind non-ADHD children on aca- demic and mental health measures (Molina SG et al., 2008 J Am Acad Child Adolesc Psychiatry 2009;48:484-500).

TCPR’s Take: While some commenta- tors believe these long term data indicate that stimulants have little long term efficacy, such a conclusion does not necessarily follow from the data. Since patients’ treatment was no longer randomized after 14 months, over the ensuing years some children originally assigned to medication discontinued stimulants, while some origi- nally assigned to therapy started medication. Unfortunately, the long-term physical impact of stimulants has received little study, though three year follow-up of MTA participants found that newly medicated patients grew an average 0.9 inches less and gained 5.95 fewer pounds than the non-medicated children in the study (Swanson JM et al., J Am Acad Child Adolesc Psychiatry 2007;46:1015-1027).