SPECIAL SECTION: METHYLPHENIDATE AND MULTIMODAL PSYCHOSOCIAL TREATMENT IN ADHD
Academic Achievement and Emotional Status of Children With ADHD Treated With Long-Term Methylphenidate and Multimodal Psychosocial Treatment

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ABSTRACT

Objective

To test the hypothesis that intensive multimodal psychosocial intervention (that includes academic assistance and psychotherapy) combined with methylphenidate significantly enhances the academic performance and emotional status of children with attention-deficit/hyperactivity disorder (ADHD) compared with methylphenidate alone and with methylphenidate 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 methylphenidate were randomized for 2 years to receive one of three treatments: (1) methylphenidate alone, (2) methylphenidate 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) methylphenidate 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 methylphenidate alone and over methylphenidate 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.

Section snippets

METHOD

Details of the design and its rationale are presented in Klein et al. (2004). Briefly, the study was conducted at two large medical centers (New York and Montreal) between 1990 and 1995. Medication-free boys and girls, 7.0–9.9 years of age, met diagnostic and severity criteria for ADHD. Because treatment included 2 years of methylphenidate, children had to exhibit meaningful benefit in a 5-week open clinical trial of the medication.

RESULTS

As Table 1 indicates, mean standard scores on the reading and mathematics of the Kaufman Test of Educational Achievement reflect average academic achievement, but approximately 20% of children had low reading scores and 15% had low mathematics scores (i.e., standard scores of ≤90). The groups did not differ in the proportion with academic difficulties or in mean scores.

The children's emotional status, as indexed by self-ratings on the Piers-Harris Self-Concept and CDI, were not worse than

DISCUSSION

This study was designed in part to ameliorate academic performance as well as the emotional functioning of children with ADHD treated with stimulants and maintained during a second year. Treatments were carefully designed to be relevant to problems typically encountered by children with ADHD and were systematically delivered.

The expectation was that academic training and individual psychotherapy would complement and enhance the effect of ongoing methylphenidate. Contrary to predictions, we did

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    The study was supported NIMH grants RO1 MH44848 (H.A.) and RO1 MH44842 (L.H.) .

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    Copyright © 2004 The American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.