Symptom Relief And Long-Term Outcome For ADHD

Dr. Sam Goldstein

Despite optimism by professionals and researchers years ago that treating ADHD in childhood led to improved outcome in adulthood, current research has not supported this perception. In fact, the research suggests that relieving the symptoms of ADHD may not necessarily contribute to increasing the likelihood of positive outcome in the adult years. In this month’s article I’ll address this issue and suggest a dual focus for the treatment of ADHD in childhood.

We all accomplish our goals and successes in life through out strengths and abilities. Happy, successful adults frequently comment that in part their success lay in finding something in life they were good at, having the opportunity to develop that skill or ability, and being appreciated for that activity. This speaks to an important issue relative to the treatment of ADHD. Is symptom relief for ADHD 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. A number of longitudinal studies over multiple years, including the recently completed multi-site study involving over 300 children with ADHD funded by the National Institute of Mental Health has unequivocally demonstrated that the symptoms and immediate impairment caused by the symptoms of ADHD are dramatically reduced through a combination of education about the condition, medication, parent behavior management training and in classroom teacher support. Although initial data analysis of this research demonstrated that medication alone appeared to be the most powerful intervention, recent re-analysis of these data leaves no doubt that the combination of interventions is superior to medication alone. 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 in classroom educational support are very effective in reducing the impairing problems caused by the symptoms of ADHD. The use of some classes of 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 ADHD. In contrast, the currently popular antidepressant medications that impact serotonin, such as Prozac and Zoloft, have not been found to be beneficial for ADHD.

As we follow children with ADHD growing up, unfortunately, 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 ADHD 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 or her life should be better. Yet, we have had difficulty demonstrating this fact. What we have demonstrated, however, is that the factors that contribute to good life outcome for all children are particularly important for children with handicapping conditions such as ADHD.

Our current treatment for ADHD is now dual focused. First, we focus on research proven interventions involving medication, education, parent training and classroom intervention to reduce the symptoms of and impairment caused by ADHD. By making tasks interesting and payoffs valuable, we have discovered that children with ADHD function dramatically better. Our treatment for ADHD, however, has now taken on a second, equally important component. Providing children with ADHD with opportunities to develop a resilient mindset. Children with such a mindset are empathic. They communicate effectively. They learn to problem solve, develop a social conscience and most importantly are self-disciplined. Parents engaged in the process of raising resilient youngsters possess an understanding that is sometimes explicit, at other times implicit or intuitive of what they can to do nurture this mindset in their children. To do this requires parents to appreciate the components of resilience so that their interactions with their children are guided by an important set of principles, ideas, and actions. Although each child’s road to adulthood is shaped by a variety of factors, these guideposts provide principles applicable for all roads and thus can direct all parents in raising resilient children. Dr. Robert Brooks and I elaborate the guideposts, principles and strategies of this model in our book, Raising Resilient Children (Contemporary, 2001).

Just as some children require more support, effort and instruction to learn to ride a bicycle or swim, we now believe that it is critically important for us to provide support for children with ADHD to assist them in developing self-control. Day in and day out modeling of the behaviors necessary to become self-disciplined may assist children with ADHD in developing the internal skills necessary to function more effectively in future life.