Medications and ADD without Hyperactivity


From a note posted on the ADD Forum on CompuServe by Mind Forum leader Carla Nelson, republished with her permission.

Below is part of a post I recently contributed on another forum where there's been a heated debate going on about whether Attention Deficits should be treated medically or psychologically or both. Needless to say, integrationist-me, says that what we are calling "ADD" consists of a mix of inborn neurobiology reinforced by life experience which may exacerbate those traits even more, and thus needs to be approached BOTH biologically and behaviorally.

Some psychologists on the thread have contended that "ADD" is not a medical problem at all, and should not be treated with medication because, among other things, there is "no evidence" meds make a difference for those who suffer inattention without hyperactivity.

This note is my response to the "no evidence" claim, recapping results of a recent study. I am sharing it here too, FYI:



Peter Jensen, Chief of the Child & Adolescent Disorders Research Branch, Division of Clinical & Treatment Research at NIMH recently gave a talk previewing some about-to-be-published research. Below a recap of what he said, including some quotes:

"We know that children [with AD/HD] are going to develop oppositional disorders, conduct disorders, anxiety disorders, substance abuse, depression... if we can provide appropriate treatments early on that are intensive and appropriate.. we can prevent some of these other adverse outcomes... [we wanted to know] how did our treatments basically work in the long run? We knew they worked in the short term, but how did they work in the long run... in preventing these secondary disorders?"

... We know what treatments work in the short term... [including] behavior therapies [and] medication.. [but] we don't know for which child, under which conditions, for how long, for what symptoms and in what combination of treatments."

Where one child might need a "good multimodal treatment" another might not need "the whole shooting match" he continues. Accordingly, his team decided to compare medication versus a very intensive behavioral treatment so clinicians and parents could see if there are conditions under which children would benefit from one or the other alone. Is the additional cost of combining them both always justified, he asks.

This study took 600 children over 24 months, investigating what he calls "four treatment arms".. meds only versus behavior therapies only versus the two combined versus no intervention. This is the only trial, he points out, where they have actually "delivered the treatment into the real world" where the children are. They also tried on purpose to get especially complex cases, including kids with tics. They also strove for a good ethnic mix.

They found that comorbidities were extensive in the group: 40% had features of ODD; 15% had conduct disorder; plus a "substantial minority" met criteria for depressive and/or anxiety disorders. More than 10% (of these 7-9 year olds) had used alcohol. All those given medication were rated as improved in behavior during the course of the trial, and the impact increased as dosage increase in teacher's observation reports.

"Regardless of the kind of symptom, whether it be inattention, over-activity, aggression or defiance, we see a close to one standard deviation in effect size in terms of benefit [for that] symptom... this trial showed that, depending on the dose you could get clear responses..."

There will soon be a detailed article about the comparative effectiveness of all four modalities this study examined.

(paraphrased from the Winter Issue of the CHADD magazine, "Attention" p. 31)


Posted 1/16/98

Thank you for sharing this Carla.

Carla is also publisher of an ezine about ADD, Hyperthink/Ink, that can be seen at her web site,"