young boyContrary to popular belief, not all children who have been diagnosed with attention deficit hyperactivity disorder (ADHD) are treated with medications. And according to a study released on Friday, most children treated for ADHD show significant improvement within a few years, regardless of treatment (medication only, behavioral therapy only, standard “community care”, or a combined approach).

Medication, behavioral therapy, a combination of the two, and usual community care all produced significant ADHD symptom improvement at three years with no difference between groups, found Peter Jensen, M.D., of Columbia University here, and colleagues.

The new report, published in the August Journal of the American Academy of Child and Adolescent Psychiatry, tracked 485 children who were still participating three years after the study began.

At the end of the random controlled clinical trial at 14 months, the children given medication alone or stimulants plus behavior therapy were doing much better than those who got just therapy or other care in the community.

The children in the community care group did not receive study treatments, but their personal physicians were given their study assessments and a list of community mental health resources. Treatment was at the personal physicians’ discretion and most of the children did get medication during the 14 month treatment phase.

The researchers then assessed outcomes of the children two years after the 14-month randomized treatment phase. During those two years, families resumed control over treatment choice.

At the end of the two years, there were no discernible or significant differences among all treatment groups.

Whatever the reason for the lack of difference between groups, the researchers said they were “struck by the remarkable degree of improvement found in all of the subjects over time.”

The benefit for patients may be related to the extra attention brought by participation in the study or may reflect “a natural waning of symptoms,” they said. However, “without an untreated control group, no firm conclusions about the possibility of more positive ADHD outcomes can be drawn with confidence.”

Source: Jensen P.S., et al. (2007). Three-year Follow-up of the NIMH MTA Study. J Am Acad Child Adolesc Psychiatry, 46:988-1001.