title: Psychotic Side Effects of Psychostimulants: A 5-Year Review Treatment effectiveness of combined medication/behavioural treatment with chinese ADHD children in routine practice. Symptomatic improvement in children with ADHD treated with long-term methylphenidate and multimodal psychosocial treatment. 3-year follow-up of the NIMH MTA study. Long-Term Follow-Up of Children with Mental Retardation/Borderline Intellectual Functioning and ADHD Hyperactive boys almost grown up. I. Psychiatric status. Social functioning in children with ADHD treated with long-term methylphenidate and multimodal psychosocial treatment. Clinical and functional outcome of childhood attention-deficit/hyperactivity disorder 33 years later. Children with ADHD treated with long-term methylphenidate and multimodal psychosocial treatment: impact on parental practices. The MTA at 8 years: prospective follow-up of children treated for combined-type ADHD in a multisite study. A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. The MTA Cooperative Group. Multimodal Treatment Study of Children with ADHD. Consultation-based Academic Interventions for Children with ADHD: Effects on Reading and Mathematics Achievement Delinquent behavior and emerging substance use in the MTA at 36 months: prevalence, course, and treatment effects. Adult psychiatric status of hyperactive boys grown up. Predictors of persistence and remission of ADHD into adolescence: results from a four-year prospective follow-up study. Young adult outcome of attention deficit hyperactivity disorder: a controlled 10-year follow-up study. The adolescent outcome of hyperactive children diagnosed by research criteria: I. An 8-year prospective follow-up study. Academic achievement and emotional status of children with ADHD treated with long-term methylphenidate and multimodal psychosocial treatment. Impact of early school-based screening and intervention programs for ADHD on children's outcomes and access to services: follow-up of a school-based trial at age 10 years. Stimulant treatment over five years: adherence, effectiveness, and adverse effects. Hyperactive boys almost grown up. III. Methylphenidate effects on ultimate height. National Institute of Mental Health Multimodal Treatment Study of ADHD follow-up: changes in effectiveness and growth after the end of treatment. National Institute of Mental Health Multimodal Treatment Study of ADHD follow-up: 24-month outcomes of treatment strategies for attention-deficit/hyperactivity disorder. Long-term stimulant treatment of children with attention-deficit hyperactivity disorder symptoms. A randomized, double-blind, placebo-controlled trial. Developmental course of attention deficit hyperactivity disorder and its predictors. Adult outcome of hyperactive boys. Educational achievement, occupational rank, and psychiatric status.
abstract: Objective : To examine the rate of psychotic and mood-congruent psychotic side effects of stimulant medications in children treated for attention-deficit hyperactivity disorder ( ADHD ) . Method : A chart review was completed of all children diagnosed with ADHD in an outpatient clinic from January 1989 to March 1995 . Results : Over 5 years , 192 children were diagnosed with ADHD . Ninety-eight children received treatment at the clinic with stimulants .  Six children developed psychotic or mood-congruent psychotic symptoms during treatment . Children on medication were followed for an average of 1 year and 9 months . Conclusions : Awareness of the potential for psychotic side effects from stimulant medications is important when prescribing for children . A large prospect i ve study would be useful to predict the frequency and classification of the side effects in children BACKGROUND The effectiveness of a combined methylpheni date /behavioural treatment ( BT ) versus methylpheni date -only for Chinese children with Attention-Deficit/Hyperactivity Disorder ( ADHD ) was tested in routine clinical practice in Hong Kong . METHODS A r and omized group comparison design was adopted with two treatment conditions ( methylpheni date -only ; methylpheni date /BT ) , which lasted for 6 months . There were four assessment time points ( pre-treatment , post-treatment , and 6-month and 12-month follow-ups ) , using the Strengths and Weaknesses of ADHD Symptoms and Normal Behaviours ( SWAN ) Rating Scale . Parental attitude toward different treatment options of ADHD was also assessed at pre-treatment and post-treatment . Participants included 90 Chinese ADHD children ( mean age=8 years , SD=.95 ) . RESULTS The combination of BT and a low-dose methylpheni date was significantly more effective than methylpheni date -only in reducing ADHD and ODD symptoms at post-treatment . At follow-ups , the benefits of the combined treatment were maintained , while the methylpheni date -only group caught up in improvement in ADHD symptoms . Parents in both treatment conditions showed improved attitude toward medication after the 6-month treatment phase , while their attitude toward BT was positive all along . CONCLUSIONS This study supported the added benefits of BT , on top of medication , for Chinese ADHD children in routine practice with treatments conducted by regular medical and paramedical staffs OBJECTIVE To test the hypotheses that in children with attention-deficit/hyperactivity disorder ( ADHD ) ( 1 ) symptoms of ADHD , oppositional defiant disorder , and overall functioning are significantly improved by methylpheni date combined with intensive multimodal psychosocial treatment compared with methylpheni date alone and with methylpheni date plus attention control and ( 2 ) more children receiving combined treatment can be taken off methylpheni date . METHOD One hundred three children with ADHD ( ages 7 - 9 ) , free of conduct and learning disorders , who responded to short-term methylpheni date were r and omized for 2 years to ( 1 ) methylpheni date alone ; ( 2 ) methylpheni date plus psychosocial treatment that included parent training and counseling , social skills training , psychotherapy , and academic assistance , or ( 3 ) methylpheni date plus attention psychosocial control treatment . Assessment s included parent , teacher , and psychiatrist ratings , and observations in academic and gym classes . RESULTS Combination treatment did not lead to superior functioning and did not facilitate methylpheni date discontinuation . Significant improvement occurred across all treatments and continued over 2 years . CONCLUSIONS In stimulant-responsive children with ADHD , there is no support for adding ambitious long-term psychosocial intervention to improve ADHD and oppositional defiant disorder symptoms . Significant benefits from methylpheni date were stable over 2 years OBJECTIVE In the intent-to-treat analysis of the Multimodal Treatment Study of Children With ADHD ( MTA ) , the effects of medication management ( MedMgt ) , behavior therapy ( Beh ) , their combination ( Comb ) , and usual community care ( CC ) differed at 14 and 24 months due to superiority of treatments that used the MTA medication algorithm ( Comb+MedMgt ) over those that did not ( Beh+CC ) . This report examines 36-month outcomes , 2 years after treatment by the study ended . METHOD For primary outcome measures ( attention-deficit/hyperactivity disorder [ ADHD ] and oppositional defiant disorder [ ODD ] symptoms , social skills , reading scores , impairment , and diagnostic status ) , mixed-effects regression models and orthogonal contrasts examined 36-month outcomes . RESULTS At 3 years , 485 of the original 579 subjects ( 83.8 % ) participated in the follow-up , now at ages 10 to 13 years , ( mean 11.9 years ) . In contrast to the significant advantage of MedMgt+Comb over Beh+CC for ADHD symptoms at 14 and 24 months , treatment groups did not differ significantly on any measure at 36 months . The percentage of children taking medication > 50 % of the time changed between 14 and 36 months across the initial treatment groups : Beh significantly increased ( 14 % to 45 % ) , MedMed+Comb significantly decreased ( 91 % to 71 % ) , and CC remained constant ( 60%-62 % ) . Regardless of their treatment use changes , all of the groups showed symptom improvement over baseline . Notably , initial symptom severity , sex ( male ) , comorbidity , public assistance , and parental psychopathology ( ADHD ) did not moderate children 's 36-month treatment responses , but these factors predicted worse outcomes over 36 months , regardless of original treatment assignment . CONCLUSIONS By 36 months , the earlier advantage of having had 14 months of the medication algorithm was no longer apparent , possibly due to age-related decline in ADHD symptoms , changes in medication management intensity , starting or stopping medications altogether , or other factors not yet evaluated Fifty-two children ( ages 7 to 14 years ) with moderate mental retardation to borderline intellectual functioning were recontacted 12 to 65 months following participation in a double-blind , placebo-controlled trial of methylpheni date ( MPH ) . Sixty-nine percent of subjects continued to be prescribed medication for behavior control at follow-up . While 72 % of the sample evidence d improvement , over two-thirds continued to be rated at or above the 98th percentile on the Hyperactivity Index of the Parent Conners . In fact , 22 % of subjects had received inpatient psychiatric treatment between the time of the initial MPH trial and follow-up . Finally , subjects with high initial ratings on the Parent Conners Conduct Problems scale were more likely to be suspended from school or receive inpatient psychiatric treatment than subjects with low initial ratings . The results suggested that children with ADHD and mental retardation or borderline intellectual functioning continued to exhibit significant symptoms associated with attention deficit hyperactivity disorder ( ADHD ) at follow-up and that early conduct problems were predictive of continuing behavioral difficulties We report a prospect i ve longitudinal study of 101 male adolescents ( ages 16 to 23 years ) who had been diagnosed hyperactive in childhood ( ages 6 to 12 years ) , compared with 100 normal controls . The DSM-III diagnoses were made blind to group membership . Information was obtained for 98 % of the original cohort . The full attention deficit disorder with hyperactivity ( ADDH ) syndrome persisted in 31 % of the prob and s vs in 3 % of the controls . The only other two conditions that distinguished the groups significantly were conduct and substance use disorders . These disorders aggregated significantly among the prob and s with continued ADDH . The results indicate that the greatest risk factor for the development of antisocial behavior and drug abuse is the maintenance of ADDH symptoms . Substance use disorders followed the onset of conduct disorder in the overwhelming majority of the cases OBJECTIVE To test that methylpheni date combined with intensive multimodal psychosocial intervention , which includes social skills training , significantly enhances social functioning in children with attention-deficit/hyperactivity disorder ( ADHD ) compared with methylpheni date alone and methylpheni date plus nonspecific psychosocial treatment ( attention control ) . METHOD One hundred three children with ADHD ( ages 7 - 9 ) , free of conduct and learning disorders , who responded to short-term methylpheni date were r and omized for 2 years to receive ( 1 ) methylpheni date alone , ( 2 ) methylpheni date plus multimodal psychosocial treatment that included social skills training , or ( 3 ) methylpheni date plus attention control treatment . Assessment s included parent , child , and teacher ratings of social function and direct school observations in gym . RESULTS No advantage was found on any measure of social functioning for the combination treatment over methylpheni date alone or methylpheni date plus attention control . Significant improvement occurred across all treatments and continued over 2 years . CONCLUSIONS In young children with ADHD , there is no support for clinic-based social skills training as part of a long-term psychosocial intervention to improve social behavior . Significant benefits from methylpheni date were stable over 2 years CONTEXT Prospect i ve studies of childhood attention-deficit/hyperactivity disorder ( ADHD ) have not extended beyond early adulthood . OBJECTIVE To examine whether children diagnosed as having ADHD at a mean age of 8 years ( prob and s ) have worse educational , occupational , economic , social , and marital outcomes and higher rates of ongoing ADHD , antisocial personality disorder ( ASPD ) , substance use disorders ( SUDs ) , adult-onset psychiatric disorders , psychiatric hospitalizations , and incarcerations than non-ADHD comparison participants at a mean age of 41 years . DESIGN Prospect i ve , 33-year follow-up study , with masked clinical assessment s. SETTING Research clinic . PARTICIPANTS A total of 135 white men with ADHD in childhood , free of conduct disorder , and 136 men without childhood ADHD ( 65.2 % and 76.4 % of original cohort , respectively ) . MAIN OUTCOME MEASURES Occupational , economic , and educational attainment ; marital history ; occupational and social functioning ; ongoing and lifetime psychiatric disorders ; psychiatric hospitalizations ; and incarcerations . RESULTS Prob and s had significantly worse educational , occupational , economic , and social outcomes ; more divorces ; and higher rates of ongoing ADHD ( 22.2 % vs 5.1 % , P < .001 ) , ASPD ( 16.3 % vs 0 % , P < .001 ) , and SUDs ( 14.1 % vs 5.1 % , P = .01 ) but not more mood or anxiety disorders ( P = .36 and .33 ) than did comparison participants . Ongoing ADHD was weakly related to ongoing SUDs ( ϕ = 0.19 , P = .04 ) , as well as ASPD with SUDs ( ϕ = 0.20 , P = .04 ) . During their lifetime , prob and s had significantly more ASPD and SUDs but not mood or anxiety disorders and more psychiatric hospitalizations and incarcerations than comparison participants . Relative to comparisons , psychiatric disorders with onsets at 21 years or older were not significantly elevated in prob and s. Prob and s without ongoing psychiatric disorders had worse social , but not occupational , functioning . CONCLUSIONS The multiple disadvantages predicted by childhood ADHD well into adulthood began in adolescence , without increased onsets of new disorders after 20 years of age . Findings highlight the importance of extended monitoring and treatment of children with ADHD OBJECTIVE To test the hypothesis that multimodal psychosocial intervention , which includes parent training , combined with methylpheni date significantly enhances the behavior of parents of children with attention-deficit/hyperactivity disorder ( ADHD ) , compared with methylpheni date alone and compared with methylpheni date and nonspecific psychosocial treatment ( attention control ) . METHOD One hundred three children with ADHD ( ages 7 - 9 ) , free of conduct and learning disorders , who responded to short-term methylpheni date therapy were r and omized for 2 years to receive either ( 1 ) methylpheni date treatment alone ; ( 2 ) methylpheni date plus psychosocial treatment that included parent training and counseling , social skills training , academic assistance , and psychotherapy ; or ( 3 ) methylpheni date plus attention control treatment . Parents rated their knowledge of parenting principles and negative and positive parenting behavior . Children rated their parents ' behavior . RESULTS Psychosocial treatment led to significantly better knowledge of parenting principles but did not enhance parenting practice s , as rated by parents and children . Significant improvement in mothers ' negative parenting occurred across all treatments and was maintained . CONCLUSIONS In nonconduct-disordered , stimulant-treated children with ADHD , parent training does not improve self-rated parental behavior . The benefits of brief stimulant treatment for negative parental behavior are sustained with extended treatment OBJECTIVES To determine any long-term effects , 6 and 8 years after childhood enrollment , of the r and omly assigned 14-month treatments in the NIMH Collaborative Multisite Multimodal Treatment Study of Children With Attention-Deficit/Hyperactivity Disorder ( MTA ; N = 436 ) ; to test whether attention-deficit/hyperactivity disorder ( ADHD ) symptom trajectory through 3 years predicts outcome in subsequent years ; and to examine functioning level of the MTA adolescents relative to their non-ADHD peers ( local normative comparison group ; N = 261 ) . METHOD Mixed-effects regression models with planned contrasts at 6 and 8 years tested a wide range of symptom and impairment variables assessed by  parent , teacher , and youth report . RESULTS In nearly every analysis , the originally r and omized treatment groups did not differ significantly on repeated measures or newly analyzed variables ( e.g. , grade s earned in school , arrests , psychiatric hospitalizations , other clinical ly relevant outcomes ) . Medication use decreased by 62 % after the 14-month controlled trial , but adjusting for this did not change the results . ADHD symptom trajectory in the first 3 years predicted 55 % of the outcomes . The MTA participants fared worse than the local normative comparison group on 91 % of the variables tested . CONCLUSIONS Type or intensity of 14 months of treatment for ADHD in childhood ( at age 7.0 - 9.9 years ) does not predict functioning 6 to 8 years later . Rather , early ADHD symptom trajectory regardless of treatment type is prognostic . This finding implies that children with behavioral and sociodemographic advantage , with the best response to any treatment , will have the best long-term prognosis . As a group , however , despite initial symptom improvement during treatment that is largely maintained after treatment , children with combined-type ADHD exhibit significant impairment in adolescence . Innovative treatment approaches targeting specific areas of adolescent impairment are needed BACKGROUND Previous studies have demonstrated the short-term efficacy of pharmacotherapy and behavior therapy for attention-deficit/hyperactivity disorder ( ADHD ) , but no longer-term ( i.e. , > 4 months ) investigations have compared these 2 treatments or their combination . METHODS A group of 579 children with ADHD Combined Type , aged 7 to 9.9 years , were assigned to 14 months of medication management ( titration followed by monthly visits ) ; intensive behavioral treatment ( parent , school , and child components , with therapist involvement gradually reduced over time ) ; the two combined ; or st and ard community care ( treatments by community providers ) . Outcomes were assessed in multiple domains before and during treatment and at treatment end point ( with the combined treatment and medication management groups continuing medication at all assessment points ) . Data were analyzed through intent-to-treat r and om-effects regression procedures . RESULTS All 4 groups showed sizable reductions in symptoms over time , with significant differences among them in degrees of change . For most ADHD symptoms , children in the combined treatment and medication management groups showed significantly greater improvement than those given intensive behavioral treatment and community care . Combined and medication management treatments did not differ significantly on any direct comparisons , but in several instances ( oppositional/aggressive symptoms , internalizing symptoms , teacher-rated social skills , parent-child relations , and reading achievement )  combined treatment proved superior to intensive behavioral treatment and /or community care while medication management did not . Study medication strategies were superior to community care treatments , despite the fact that two thirds of community-treated subjects received medication during the study period . CONCLUSIONS For ADHD symptoms , our carefully crafted medication management was superior to behavioral treatment and to routine community care that included medication . Our combined treatment did not yield significantly greater benefits than medication management for core ADHD symptoms , but may have provided modest advantages for non-ADHD symptom and positive functioning outcomes The purpose of this investigation was to evaluate the relative efficacy of two consultation-based models for design ing academic interventions to enhance the educational functioning of children with attention-deficit/hyperactivity disorder ( ADHD ) . Children ( N=167 ) meeting DSM-IV criteria for ADHD were r and omly assigned to one of two consultation groups : Individualized Academic Intervention ( IAI ; interventions design ed using a data -based decision-making model that involved ongoing feedback to teachers ) and Generic Academic Intervention ( GAI ; interventions design ed based on consultant-teacher collaboration , representing “ consultation as usual ” ) . Teachers implemented academic interventions over 15 months . Academic outcomes ( e.g. , st and ardized achievement test , and teacher ratings of academic skills ) were assessed on four occasions ( baseline , 3 months , 12 months , 15 months ) . Hierarchical linear modeling analyses indicated significant positive growth for 8 of the 14 dependent variables ; however , trajectories did not differ significantly across consultation groups . Interventions in the IAI group were delivered with significantly greater integrity ; however , groups did not differ with respect to teacher ratings of treatment acceptability . The results of this study provide partial support for the effectiveness of consultation-based academic interventions in enhancing educational functioning in children with ADHD ; however , the relative advantages of an individualized model over “ consultation as usual ” have yet to be established OBJECTIVE To compare delinquent behavior and early substance use between the children in the Multimodal Treatment Study of Children With ADHD ( MTA ; N = 487 ) and those in a local normative comparison group ( n = 272 ) at 24 and 36 months postr and omization and to test whether these outcomes were predicted by the r and omly assigned treatments and subsequent self-selected prescribed medications . METHOD Most MTA children were 11 to 13 years old by 36 months .  Delinquency seriousness was coded ordinally from multiple measures /reporters ; child-reported substance use was binary . RESULTS Relative to local normative comparison group , MTA children had significantly higher rates of delinquency ( e.g. , 27.1 % vs. 7.4 % at 36 months ; p = .000 ) and substance use ( e.g. , 17.4 % vs. 7.8 % at 36 months ; p = .001 ) . Children r and omized to intensive behavior therapy reported less 24-month substance use than other MTA children ( p = .02 ) . R and om effects ordinal growth models revealed no other effects of initial treatment assignment on delinquency seriousness or substance use . By 24 and 36 months , more days of prescribed medication were associated with more serious delinquency but not substance use . CONCLUSIONS Cause- and -effect relationships between medication treatment and delinquency are unclear ; the absence of associations between medication treatment and substance use needs to be re-evaluated at older ages . Findings underscore the need for continuous monitoring of these outcomes as children with attention-deficit/hyperactivity disorder enter adolescence OBJECTIVE Numerous studies have examined the adolescent and young adult fate of children with attention deficit hyperactivity disorder ( ADHD ) .  In marked contrast , relatively little is known about the adult outcome of these children . There have been only two controlled , prospect i ve studies of psychiatric status into adulthood . The present study was conducted to gain further underst and ing of the natural course of this common childhood condition . METHOD This was a prospect i ve follow-up of clinical ly diagnosed , white boys of average intelligence who were referred by teachers to a child psychiatric research clinic at an average age of 7.3 years . At a mean age of 24.1 years , 85 prob and s ( 82 % of the childhood cohort ) and 73 comparison subjects ( 94 % of adolescent comparison subjects ) were directly interviewed by trained clinicians who were blind to group status . RESULTS Evaluations of the prob and s and comparison subjects indicated significantly higher prevalences of antisocial personality disorder ( 12 % versus 3 % ) and nonalcohol substance abuse ( 12 % versus 4 % ) in the prob and s , whereas mood disorders ( 4 % versus 4 % ) and anxiety disorders ( 2 % versus 7 % ) were not significantly different . At adult follow-up , ADHD was rare , occurring in only 4 % of the prob and s ( no comparison subjects ) . CONCLUSIONS The results of the present study are consistent with the authors ' previously reported major findings . They strongly suggest that children with ADHD are at significantly higher risk for a specific negative course marked by antisocial and substance-related disorders OBJECTIVE To evaluate the predictors of persistence and the timing of remission of attention-deficit hyperactivity disorder ( ADHD ) . METHOD Subjects were 6- to 17-year old Caucasian , non-Hispanic boys with and without ADHD . DSM-III-R structured diagnostic interviews and blind raters were used to examine psychiatric diagnoses , cognitive achievement , social , school , and family functioning at a 4-year follow-up assessment . RESULTS At the 4-year follow-up assessment , 85 % of children with ADHD continued to have the disorder and 15 % remitted . Of those who remitted , half did so in childhood and the other half in adolescence . Predictors of persistence were familiality of ADHD , psychosocial adversity , and comorbidity with conduct , mood , and anxiety disorders . CONCLUSIONS The findings prospect ively confirm that the majority of children with ADHD will continue to express the disorder 4 years later . For a minority of children , ADHD was a transient disorder that remits early in development . In addition , we have shown that persistence of ADHD is predictable . Familiality , adversity , and psychiatric comorbidity may be clinical ly useful predictors of which children with ADHD are at risk for a persistent disorder BACKGROUND Our objective was to estimate the lifetime prevalence of psychopathology in a sample of youth with and without attention deficit hyperactivity disorder ( ADHD ) through young adulthood using contemporaneous diagnostic and analytic techniques . METHOD We conducted a case-control , 10-year prospect i ve study of ADHD youth . At baseline , we assessed consecutively referred male , Caucasian children with ( n=140 ) and without ( n=120 ) DSM-III-R ADHD , aged 6 - 18 years , ascertained from psychiatric and pediatric sources to allow for generalizability of results . At the 10-year follow-up , 112 ( 80 % ) and 105 ( 88 % ) of the ADHD and control children , respectively , were reassessed ( mean age 22 years ) . We created the following categories of psychiatric disorders : Major Psychopathology ( mood disorders and psychosis ) , Anxiety Disorders , Antisocial Disorders ( conduct , oppositional-defiant , and antisocial personality disorder ) , Developmental Disorders ( elimination , language , and tics disorder ) , and Substance Dependence Disorders ( alcohol , drug , and nicotine dependence ) , as measured by blinded structured diagnostic interview . RESULTS The lifetime prevalence for all categories of psychopathology were significantly greater in ADHD young adults compared to controls , with hazard ratios and 95 % confidence intervals of 6.1 ( 3.5 - 10.7 ) , 2.2 ( 1.5 - 3.2 ) , 5.9 ( 3.9 - 8.8 ) , 2.5 ( 1.7 - 3.6 ) , and 2.0 ( 1.3 - 3.0 ) , respectively , for the categories described above . CONCLUSIONS By their young adult years , ADHD youth were at high risk for a wide range of adverse psychiatric outcomes including markedly elevated rates of antisocial , addictive , mood and anxiety disorders . These prospect i ve findings provide further evidence for the high morbidity associated with ADHD across the life-cycle and stress the importance of early recognition of this disorder for prevention and intervention strategies The psychiatric outcome is reported for a large sample of hyperactive children ( N = 123 ) , meeting research diagnostic criteria , and normal control children ( N = 66 ) followed prospect ively over an 8-year period into adolescence . Over 80 % of the hyperactives were attention deficit hyperactivity disorder ( ADHD ) and 60 % had either oppositional defiant disorder and /or conduct disorder at outcome . Rates of antisocial acts were considerably higher among hyperactives than normals , as were cigarette and marijuana use and negative academic outcomes . The presence of conduct disorder accounted for much though not all of these outcomes . Family status of hyperactives was much less stable over time than in the normal subjects . The use of research criteria for diagnosing children as hyperactive identifies a pattern of behavioral symptoms that is highly stable over time and associated with considerably greater risk for family disturbance and negative academic and social outcomes in adolescence than has been previously reported OBJECTIVE To test the hypothesis that intensive multimodal psychosocial intervention ( that includes academic assistance and psychotherapy ) combined with methylpheni date significantly enhances the academic performance and emotional status of children with attention-deficit/hyperactivity disorder ( ADHD ) compared with methylpheni date alone and with methylpheni date combined with nonspecific psychosocial treatment ( attention control ) . METHOD One hundred three children with ADHD ( ages 7 - 9 ) , free of conduct and learning disorders , who responded to short-term methylpheni date were r and omized for 2 years to receive one of three treatments : ( 1 ) methylpheni date alone , ( 2 ) methylpheni date plus psychosocial treatment that included academic remediation , organizational skills training , and psychotherapy as well as parent training and counseling and social skills training , or ( 3 ) methylpheni date plus attention control treatment . Children 's function was assessed through academic testing , parent ratings of homework problems , and self-ratings of depression and self-esteem . RESULTS No advantage was found on any measure of academic performance or emotional status for the combination treatment over methylpheni date alone and over methylpheni date plus attention control . Significant improvement occurred across all treatments and was maintained over 2 years . CONCLUSIONS In stimulant-responsive young children with ADHD without learning and conduct disorders , there is no support for academic assistance and psychotherapy to enhance academic achievement or emotional adjustment . Significant short-term improvements were maintained over 2 years OBJECTIVES To investigate the impact of early school-based screening and educational interventions on longer-term outcomes for children at risk for attention-deficit/hyperactivity disorder ( ADHD ) and the predictive utility of teacher ratings . DESIGN A population -based 5-year follow-up of a r and omized , school-based intervention . SETTING Schools in Engl and . PARTICIPANTS Children between 4 and 5 years of age with high teacher-rated hyperactivity/inattention scores . Follow-up data were collected on 487 children in 308 schools . INTERVENTIONS Following screening , using a 2 x 2 factorial design , schools r and omly received an educational intervention ( books about ADHD for teachers ) , the names of children with high hyperactivity/inattention scores between ages 4 and 5 years ( identification ) , both educational intervention and identification , or no intervention . OUTCOME MEASURES Parent-rated hyperactivity/inattention , impairment in classroom learning , and access to specialist health services for mental health or behavioral problems . RESULTS None of the interventions were associated with improved outcomes . However , children receiving the identification -only intervention were twice as likely as children in the no-intervention group to have high hyperactivity/inattention scores at follow-up ( adjusted odds ratio , 2.11 ; 95 % confidence interval , 1.12 - 4.00 ) . Regardless of intervention , high baseline hyperactivity/inattention scores were associated with high hyperactivity/inattention and specialist health service use at follow-up . CONCLUSIONS We did not find evidence of long-term , generalizable benefits following a school-based universal screening program for ADHD . There may be adverse effects associated with labeling children at a young age OBJECTIVE To evaluate the impact of adherence and medication status on effectiveness and adverse effects of stimulant use in children with attention-deficit/hyperactivity disorder ( ADHD ) over 5 years . METHOD Seventy-nine of 91 participants in a 12-month r and omized controlled trial of methylpheni date and parent groups enrolled in a follow-up study . Adherence to stimulants , treatment response , and adverse effects were evaluated annually for 5 years . Changes in teacher-reported symptoms and parent-reported adverse effects were compared at 2 , 3 , 4 , and 5 years for 3 groups : adherents , nonadherents on medication , or nonadherents off medication . Controlling for age , gender , and baseline severity , adherence status and medication status were evaluated as correlates of teacher-reported ADHD symptom scores at each year using multiple regression analyses . RESULTS At 2 years , adherents ( n = 41 ) showed greater improvement in teacher-reported symptoms than those off medication ( n = 16 ) and equivalent response to nonadherents on stimulants ( n = 16 ) ( p = .02 ) . At 5 years , adherents ( n = 16 ) showed greater improvement in teacher-reported symptoms than nonadherents on stimulants ( n = 15 ) and those off medication ( n = 14 ) ( p = .04 ) . At year 2 medication status ( beta = 4.67 [ 0.40 - 8.95 , p = .033 ] ) and at year 5 adherence status ( beta = 7.23 [ 3.01 - 11.44 , p = .001 ] ) correlated with higher teacher-reported symptom scores . Clinical ly significant adverse effects were present for 5 years , most commonly loss of appetite . CONCLUSIONS Psychostimulants improve ADHD symptoms for up to 5 years , but adverse effects persist The height of young adults who were treated with methylpheni date hydrochloride in childhood because of hyperactivity ( average daily dose , 45 mg ; duration of treatment , six months to five years ) was studied . There was no significant difference in height between the treated patients ( n = 61 ) and controls ( n = 99 ) ; both groups were at the national US norm in stature . The findings indicated that methylpheni date therapy does not compromise final height , even when it has an adverse impact on children 's growth rate during the active treatment phase . A compensatory growth rate , or growth rebound , appears to occur following discontinuation of stimulant therapy OBJECTIVE Intent-to-treat analyses of the Multimodal Treatment Study of ADHD ( MTA ) revealed group differences on attention-deficit/hyperactivity disorder symptoms ratings , with better outcome in groups of participants who were assigned the medication algorithm-medication alone ( MedMgt ) and combined (Comb)--than in those who were  not-behavior modification  ( Beh ) alone and community comparison ( CC ) . However , the effect size was reduced by 50 % from the end of treatment to the first follow-up . The convergence of outcomes suggests differential changes by treatment group beween 14 and 24 months , which this report explores , both for benefits of treatment and for side effects on growth . METHODS We documented reported medication use at 14- and 24-month assessment s and formed 4 naturalistic subgroups ( Med/Med , Med/NoMed , NoMed/Med , and NoMed/NoMed ) . Then we performed exploratory mediator analyses to evaluate effects of changes in medication use on 14- to 24-month change scores of effectiveness ( symptom ratings ) and growth ( height and weight measures ) . RESULTS The r and omly assigned groups with the greatest improvement at the end of the treatment phase ( Comb and MedMgt ) deteriorated during the follow-up phase , but the other 2 groups ( Beh and CC ) did not . There were no significant differences in the 14- to 24-month growth rates among the r and omly assigned groups , in contrast to significant growth suppression in the Comb and MedMgt at the end of the treatment phase . Changes in medication use mediated the 14- to 24-month change in attention-deficit/hyperactivity disorder symptom ratings : the subgroup that reported stopping medication ( Med/NoMed ) showed the largest deterioration , the subgroup that consistently reported ( Med/Med ) or never reported ( NoMed/NoMed ) medication use showed modest deterioration , and the subgroup that reported starting medication ( NoMed/Med ) showed improvement . Changes in medication use also mediated growth effects : the subgroup that consistently reported medication use ( Med/Med ) showed reduced height gain compared with the subgroup that never reported medication use ( NoMed/NoMed ) , which actually grew faster than predicted by population norms . CONCLUSION In the MTA follow-up , exploratory naturalistic analyses suggest that consistent use of stimulant medication was associated with maintenance of effectiveness but continued mild growth suppression OBJECTIVE In the Multimodal Treatment Study of ADHD ( MTA ) , the effects of medication management ( MedMgt ) and behavior modification therapy ( Beh ) and their combination ( Comb ) and usual community comparison ( CC ) in the treatment of attention-deficit/hyperactivity disorder ( ADHD ) differed at the 14-month assessment as a result of superiority of the MTA MedMgt strategy ( Comb or MedMgt ) over Beh and CC and modest additional benefits of Comb over MedMgt alone . Here we evaluate the persistence of these beneficial effects 10 months beyond the 14 months of intensive intervention . METHODS Of 579 children who entered the study , 540 ( 93 % ) participated in the first follow-up 10 months after the end of treatment . Mixed-effects regression models explored possible persisting effects of the MTA medication strategy , the incremental benefits of Comb over MedMgt alone , and the possible superiority of Beh over CC on 5 effectiveness and 4 service use domains . RESULTS The MTA medication strategy showed persisting significant superiority over Beh and CC for ADHD and oppositional-defiant symptoms at 24 months , although not as great as at 14 months . Significant additional benefits of Comb over MedMgt and of Beh over CC were not found . The groups differed significantly in mean dose ( methylpheni date equivalents 30.4 , 37.5 , 25.7 , and 24.0 mg/day , respectively ) . Continuing medication use partly mediated the persisting superiority of Comb and MedMgt . CONCLUSION The benefits of intensive MedMgt for ADHD extend 10 months beyond the intensive treatment phase only in symptom domains and diminish over time BACKGROUND We wanted to study the effects of amphetamine on symptoms of attention-deficit hyperactivity disorder ( ADHD ) over a longer period than has been reported in previous studies of central stimulants in this condition . METHODS Sixty-two children , aged 6 to 11 years , meeting DSM-III-R symptom criteria for ADHD participated in a parallel-group design , r and omized , double-blind , placebo-controlled study of amphetamine treatment . Treatment was not restricted to children with " pure " ADHD , ie , some had comorbid diagnoses . In the amphetamine group , children received active treatment for 15 months . RESULTS Amphetamine was clearly superior to placebo in reducing inattention , hyperactivity , and other disruptive behavior problems and tended to lead to improved results on the Wechsler Intelligence Scale for Children -- Revised . Treatment failure rate was considerably lower and time to treatment failure was longer in the amphetamine group . Adverse effects were few and relatively mild . CONCLUSION The results of this long-term , placebo-controlled study of the central stimulant amphetamine in the treatment of ADHD indicate that there are remaining positive effects of the drug 15 months after starting treatment OBJECTIVE To outline the key features of the developmental progression of ADHD and to consider the most prominent influences on its developmental course and outcomes . METHODS This is a selective review focusing primarily on prospect i ve follow-up studies . Relevant publications were selected by search ing the MEDLINE and PubMed data bases using keywords : ADHD , development , preschool , adolescent , adult , follow up , outcome , long-term , predictors , and treatment . Reference lists of the result ing articles were then review ed for additional publications . RESULTS Presentation of ADHD and associated impairments evolve across development , as do outcome predictors . In early development , in addition to genetics , some forms of prenatal adversity increase the risk for ADHD . In preschool years , symptom severity , cognitive function , and family factors become significant predictors of school age outcomes . These continue to predict long-term outcomes in school aged children , and comorbidity emerges as another significant long-term outcome predictor at this stage . CONCLUSIONS Presentation of ADHD and risk factors for later adversity evolve across development , which calls for developmentally-informed clinical practice OBJECTIVE The paucity of data concerning the long-term natural history of attention-deficit hyperactivity disorder ( ADHD ) , a common childhood psychiatric disorder , prompted a longitudinal study to investigate the adult sequelae of the childhood disorder . DESIGN Prospect i ve study , follow-up intervals ranging from 13 to 19 years ( mean , 16 years ) , with blind systematic clinical assessment s. SUBJECTS Ninety-one white males ( mean age , 26 years ) , representing 88 % of a cohort systematic ally diagnosed as hyperactive in childhood , and 95 ( 95 % ) of comparison cases of similar race , gender , age , whose teachers had voiced no complaints about their school behavior in childhood . RESULTS Prob and s had significantly higher rates than comparisons of ADHD symptoms ( 11 % vs 1 % ) , antisocial personality disorders ( 18 % vs 2 % ) , and drug abuse disorders ( 16 % vs 4 % ) . Significant comorbidity occurred between antisocial and drug disorders . Educational and occupational achievements were significantly compromised in the prob and s. These disadvantages were independent of psychiatric status . We did not find increased rates of affective or anxiety disorders in the prob and s. CONCLUSIONS Childhood ADHD predicts specific adult psychiatric disorders , namely antisocial and drug abuse disorders . In the adolescent outcome of this cohort , we found that these disturbances were dependent on the continuation of ADHD symptoms . In contrast , in adulthood , antisocial and drug disorders appeared , in part , independent of sustained ADHD . In addition , regardless of psychiatric status , ADHD placed children at relative risk for educational and vocational disadvantage . The results do not support a relationship between childhood ADHD and adult mood or anxiety disorders
target: Results suggest there is moderate-to-high-level evidence that combined pharmacological and behavioral interventions , and pharmacological interventions alone can be effective in managing the core ADHD symptoms and academic performance at 14 months .
  However , the effect size may decrease beyond this period .
  This review has highlighted the paucity and limitations of the evidence investigating the long-term outcomes of recommended interventions for managing ADHD symptoms .
  There is little evidence to suggest that the effects observed over the relatively short term are maintained throughout longer periods of impairment .
background: PURPOSE To systematic ally identify and review the currently available evidence on the long-term outcomes of recommended attention-deficit hyperactivity disorder ( ADHD ) interventions following r and omized controlled trials with children and young people .