An 8-year follow-up study of adolescents and young adults conducted in Germany has shown that individualised, multimodal treatment of childhood ADHD can lead to long-term behavioural improvements, although educational and social outcomes were still poorer after this approach compared with the general population. Childhood use of ADHD medication did not lead to better long-term outcomes compared with behavioural interventions alone.
In the initial Cologne Adaptive Multimodal Treatment Study (CAMT), 75 children with ADHD received psychoeducation followed by either behavioural interventions (n=45) or immediate-release methylphenidate (n=28) during an intensive treatment phase. Treatment could be stopped if it was completely effective, switched if it was ineffective, or combined in the case of a partial response.
The follow-up study re-evaluated the CAMT participants 6–12 years after the intensive treatment phase, to examine the long-term course of their behaviour and to assess educational and social outcomes relative to the general population. All of the original participants (mean age at follow-up 15–22 years) were contacted and provided information on their educational and social functioning, but only the parents of 62 participants responded on symptom and behavioural rating scales; half of the participants had received no medication or had taken medication for <1 year.
The effect size for improvement in parent-rated ADHD symptoms was large (d=1.2); 68% of participants fell within the normal range for symptoms at follow-up. Participants who had not used medication or had a history of medication use for less than 1 year demonstrated higher improvements on several long-term behavioural outcomes relative to those who had received medication for more than 1 year.
Relative to the general population, participants demonstrated poorer educational outcomes and higher conviction rates, but lower rates of unemployment.
CAMT was limited by the absence of an untreated control group. In addition, the only medication trialled was immediate-release methylphenidate. However, this study indicated that long-term behavioural (but not educational or social) benefits resulted from intensive multimodal treatment, and that continued use of medication did not improve outcomes compared with behavioural interventions alone.
Read more about the long-term benefits of multimodal treatment here
Döpfner M, Ise E, Breuer D, et al. Long-term course after adaptive multimodal treatment for children with ADHD: an 8-year follow-up. J Atten Disord 2016 [Epub ahead of print].