Concern about increasing prescription rates for stimulant and related medications for young children continue to dominate public concern despite the fact that such findings in original research reports are considerably less sensational than popularly reported. The point has recently been made that even professionals in special education seem to be relatively uninformed, if not outright skeptical, about psychopharmacologic treatment, despite the fact that considerable evidence exists for its efficacy and favorable risk-benefit ratio.
Evidence both from a recent meta-analysis of 115 studies and from the MTA study referred to earlier suggests that, for ADHD, psychopharmacologic treatment is both statistically and clinically more effective than comprehensive behavioral intervention. The meta-analytic findings, for example, indicate not only that stimulant medication is more effective than placebo by an average effect size of two thirds of a standard deviation, across a number of outcomes such as behavioral and academic measures in the classroom, but that stimulant treatment also has an effect-size advantage over behavioral or psychosocial treatments of nearly half a standard deviation (Crenshaw, Kavale, Forness, & Reeve, 1999).
The MTA study, as noted above, involved 579 children carefully diagnosed for ADHD who were treated for 14 months (MTA Cooperative Group, 1999 a,b). There were 14 outcome measures including inattentive, impulsive, hyperactive, and aggressive behaviors; internalizing symptoms; parental interactions; social skills as rated by teachers and parents; and individual measures of academic achievement. Not only were there both statistically and clinically significant gains in children treated with medication and behavioral interventions (the combined treatment group) and in children treated with medication (medication only group); but there were also no differences in gains between these two groups. In other words, adding a comprehensive behavioral intervention to careful medication management did not significantly improve gains made from just using medication management alone. On eight of the 14 outcome measures, including teacher-rated social skills and reading achievement among others, children in the combined group performed significantly better than children in the behavioral treatment only group.............
