Letters
Child health
Volume 189 - Issue 5

In the long run, skills are as good as pills for attention deficit hyperactivity disorder

Authors:  Alison Poulton and Ralph K H Nanan

Med J Aust 2008; 189 (5): 295-296. || doi: 10.5694/j.1326-5377.2008.tb02038.x
Published online: 1 September 2008
Download PDF (464 KB)
Share: Share on Blue Sky Share on Facebook Share on LinkedIn Share by email

To the Editor: We read with interest Rey’s interpretation of the Multimodal Treatment Study of Children with Attention Deficit Hyperactivity Disorder (MTA).1 The MTA was a large randomised study comparing the impact of stimulant medication, behavioural treatment, a combination of the two, and standard community care on attention deficit hyperactivity disorder (ADHD).2 The treatment phase lasted 14 months, during which the children taking medication showed more improvement than the other groups. Participants were then allowed to change their treatment and, at 36-month follow-up, the outcomes in all groups were similar. Rey concluded that, if stimulant medication is not associated with sustained improvement, its place in the treatment of ADHD is limited.

This conclusion overlooks two important points. First, the greater initial improvement in symptoms of ADHD associated with stimulant medication might be important both clinically and socially. The second point is the expected impact of a relatively brief intervention: is it really plausible that an independent effect of 14 months of controlled treatment will be detectable after a further 22 months of self-selected management? The observation that the 14-month treatment phase becomes progressively less relevant as time passes is perhaps not altogether unexpected.

In the unmedicated group, the 23% non-compliance rate during the 14-month treatment phase indicated greater dissatisfaction with treatment than the 10% non-compliance in the medication groups (P < 0.005, χ2 test). This could imply a parental preference for more immediate relief of symptoms, even if it involves their child taking medication. Parental preference can be accommodated if the family and treating physician discuss and agree on a treatment plan, adjusted to optimise functioning. Far from indicating a diminished role for medication, the evidence from the MTA study suggests that the clinical approach would involve most individuals with ADHD being treated with stimulant medication at some stage.

Stimulant medication treats symptoms; it is not curative. It is likely that the role of stimulant medication in the treatment of ADHD decreases as children mature. However, temporary relief of symptoms can be highly valuable for affected children and their families.

View this article on Wiley Online Library

More like this

Child health Research 13 August 2026 Open Access

Watchful Waiting Compared With Immediate Antibiotics for Urban Aboriginal and Torres Strait Islander Children With Uncomplicated Acute Otitis Media (WATCH): A Non-Inferiority Randomised Controlled Trial

Jennifer S. Reath, Hasantha Gunasekera, Sanja Lujic, Amanda J. Leach, Letitia Campbell, Robyn Walsh, Tim Usherwood, Geoffrey K. Spurling, Claudette A. Tyson, Deborah A. Askew, Kelvin Kong, Chelsea J. Watego, Peter Morris, Wendy Hu, Penelope A. Abbott

Child health Consensus statement 1 July 2026 Open Access

Progressing Cross-Sector Collaboration for People With Eating Disorders and Higher Weight: Priority Actions From an Expert Roundtable Using a Modified Nominal Group Technique

Hiba Jebeile, Leah Brennan, Tracy Burrows, Xochitl de la Piedad Garcia, Angelique F. Ralph, Supreet Saluja, Evan Atlantis, Sarah P. Garnett, Carmel J. Harrison, Eve T. House, Natalie B. Lister, Lisa Moran, Milan K. Piya, Elizabeth Rieger, Evelyn Smith, Phillipa Hay, Sarah Trobe

View more