Treatment for ADHD: Is more complex treatment cost-effective for more complex cases?

A combination of medication and behavioral therapy is the most cost-effective treatment for children with attention problems complicated by other mental health issues such as depression, anxiety or aggression, according to a new analysis.

For youngsters with "pure" attention-deficit/hyperactivity disorder (ADHD), medication alone seems to be the most cost-effective treatment.

"Providing these [simpler] cases with high-quality medication management may free resources needed to provide more costly treatment to more complex cases," say the study authors, led by E. Michael Foster, Ph.D., an economist specializing in child health at the University of North Carolina in Chapel Hill.

Attention problems are among the most common behavioral disorders in American children. Youth with ADHD are more likely than others to require special education services, develop substance abuse problems and commit crimes.

Improving treatments for ADHD "may produce substantial benefits for society over time," according to the study published online in Health Services Research.

The new study is based on data from the influential 1999 Multimodal Treatment Study of Children with ADHD. This randomized clinical trial compared the effectiveness of four treatment approaches over 14 months: routine care, medication, behavioral therapy or combination therapy.

Earlier analyses focused on changes in symptoms, which reflect how patients felt. Foster and colleagues reviewed the data for 579 children ages 7 to 9 to see how they actually functioned at home and at school. This broader scope confirmed that the combination therapy was "modestly superior" to medication alone for children with dual diagnoses.

"As an economist, I'm more interested in functioning because those are the things that really affect your productivity," Foster said.

The study authors acknowledge that the kind of high-quality, intensive behavioral therapy provided during the study is rare in most communities. In fact, the ability of most parents to access that level of treatment for their children is "essentially nil," according to David Rabiner, Ph.D., a child psychologist at Duke University who was not involved with the study.

"We know that good behavior therapy can be quite effective," Rabiner said. But these findings don't necessarily convey to "realistically available" therapies.

Rabiner also said that although children in the study improved in some ways, many still faced significant challenges. This points to the need to continue searching for safe and effective treatments to complement existing therapies. Rabiner said that some alternative approaches - such as neurofeedback, computerized attention training and working memory exercises - have shown promise.

By Laura Kennedy

http://www.hbns.org