Preliminary results from the study showed that stimulant medication alone and treatment with combined medication/behavioral therapy were of equal efficacy and, furthermore, that both of these modalities were superior to behavioral therapy alone and to the typical treatment afforded by clinicians in their community.  A major professional controversy has arisen because of the study's arguable implication that behavioral therapy is an unnecessary addition to medication management.  Ongoing analysis of the data and numerous follow-up studies continue.  These efforts have indicated that combined treatment had a statistically significant and clinically meaningful advantage over medication management and all other therapy conditions.  For example, combined treatment resulted in 12% more successes than medication management alone.  The combined treatment group ended the study on 20% lower doses of medication than did the medication management group.  Also, combined treatment showed modest superiority in treating non-core ADHD symptoms. Despite the sometimes conflicting conclusions from this work, some very useful practice pearls are notable.?

Medication Pearls: Medication should be the first intervention but certainly not the only one. The addition of medication to psychosocial interventions more than doubles the number of cases that are successfully treated (from 30% to 62%).  Girls and boys respond equally well.?ØOnce on medication, other interventions and accommodations are much more likely to be effective.  When the basic deficits in behavioral and emotional inhibition and working memory have been corrected or improved with medication, behavioral techniques can be utilized to teach enduring coping strategies. Doses should be titrated to achieve maximum benefit, not merely adequate benefit. Pediatric patients' return visits should occur every month during the initial treatment phase to allow active reassessment and titration of dose as well as early identification of problems as they arise.  (Thereafter, until the patient has demonstrated at least two years of stable functioning with maximum control of residual ADHD symptoms, we recommend that the patient be followed with rating scales and visits a minimum of every two to three months.)