Multimodal treatment

Recently, a large multisite treatment study in the United States compared drug treatment (mostly methylphenidate), drug treatment combined with an intensive psychosocial intervention (a combination of family therapy, social skills training, and classroom management), psychosocial intervention alone, and a typical community-based intervention in 576 school-aged children with AD-HKD. (160) All subjects received the same assessment, but those in the community-based intervention were referred to their family physicians for appropriate treatment. The results of this study demonstrated little evidence of an incremental effect of combined treatment over medication alone. The effects of psychosocial treatment, when administered without medication, were generally equivalent to those of a community-based treatment. Many children in the community-based intervention received medication, but they did not seem to progress as well as those who received medication managed by the study personnel. This finding suggests that medication management that is intensive and coupled with supportive counselling is superior to the medication treatment most children receive in the community.

In summary, non-drug interventions are an important treatment option, particularly for families who do not wish to use medication, but these interventions have only modest effects. Moreover, the psychosocial treatments that have been evaluated to date do not seem to potentiate the effects of medication on the core symptoms of AD-HKD, such as hyperactivity, but may reduce associated impairments, and improve social skills and self-esteem.

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