By Sam Goldstein, Ph.D.
Despite optimism by professionals and researchers years ago that treating AD/HD in childhood would lead to improved outcome in adulthood, current research has not supported this perception. In fact, relieving the symptoms of AD/HD may not necessarily contribute to increasing the likelihood of positive outcome in the adult years. Why not? What should parents and professionals be doing to ensure positive future outcomes? In this article, Sam Goldstein, Ph.D., answers these questions.
We all accomplish our goals and successes in life through our strengths and abilities. Happy, successful adults frequently comment that their success lay, in part, to finding something in life they were good at, having the opportunity to develop the skill or ability, and being appreciated for it. This speaks to an important issue relative to your question. Is symptom relief for AD/HD equivalent to positively changing long-term outcome? Unfortunately, as far as we are currently aware, the answer is no.
First, let's focus on symptom relief. Longitudinal studies, including the recent multi-site study of over 300 kids with AD/HD funded by the National Institute of Mental Health, have unequivocally demonstrated the impairment caused by symptoms of AD/HD is dramatically reduced through a combination of education about the condition, medication, parent training in behavior management, and support from the classroom teacher. Although initial data analysis of this research demonstrated medication alone to be the most powerful intervention, recent re-analysis of data leaves no doubt that the combination of interventions is superior to medication only.
This finding has been further reinforced in a study of adolescents with AD/HD published in the May issue of Experimental and Clinical Psychopharmacology (Volume 9, Number 2). Medication in combination with behavior modification intervention improved students' performance on a range of academic measures , including note taking, daily assignments, and quiz scores. Consistently and conscientiously applied parenting strategies involving behavior management, as well as educational support in the classroom, are very effective in reducing the impairing problems caused by the symptoms of AD/HD.
Specific medications, particularly those that affect certain neurotransmitters in the brain, are also very effective in increasing self-control and thereby reducing symptoms and impairment. In particular, stimulant and antidepressant medications that affect the neurotransmitters, dopamine and norepinephrine, appear quite beneficial for AD/HD. In contrast, the currently popular antidepressant medications that impact serotonin, such as Prozac® and Zoloft®, have not been found to be beneficial for AD/HD.
Unfortunately, as we follow children with AD/HD growing up, those who responded best to our symptom-focused interventions were not necessarily those who turned out to be most functional as adults. Thus, although we once believed that relieving the immediate symptoms of AD/HD led to better life outcome, treatment alone doesn't predict outcome. From a common sense perspective, if every day of a child's life is better, certainly the sum total of his life should be better. Yet, we have had difficulty demonstrating this fact. What we have demonstrated, however, is the factors that contribute to good life outcome for all kids are particularly important for children with disabling conditions, such as AD/HD.
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