To evaluate if the Norwegian guide to diagnosis and treatment of ADHD has included the results form the MTA-study. To find out what the results of the MTA-study can tell us about how we should perform treatment of ADHD today.
We have been wondering about what the best treatment for ADHD is for a long time. We have in particular wanted to look at the empery on behaviour treatment vs medication, and if the combination of these has advantages over the two alone. MTA was the only long term study of this theme, and therefore we chose to focus our work on articles published by the MTA-cooperative group.
We chose to do a literature study. We used Pubmed and performed the search for ADHD, MTA-study and NIMH. We found that the MTA-cooperative group had published so many studies that we had to make some exclusion criteria to adjust the material to our capacity. We read the articles we chose and also read the Norwegian guide to diagnosis and treatment of ADHD.
After 14 months the MTA-study showed statistically significant superior effect of treatments which included intensive, monitored medication versus the treatments that did not include this. The difference in improvement of ADHD-symptoms between the groups that received intensive, monitored medication and the groups that did not, had diminished by 50 percent after 24 months but was still statistically significant. The 3 year follow up-studies showed that everyone that received treatment improved from baseline on ADHD-symptoms and there were no statistically significant differences between the groups.
Some of the additional studies give a more nuanced view on these results. The most important finding is that there is additional improvement when a multimodal approach is used, especially for some subgroups.
The authors of the Norwegian guide to diagnosis and treatment of ADHD only used one small study from the MTA-group. The reference list did not contain the main MTA-studies at all. We found that the Norwegian guide was broad and not precise. It leaves the decision on how to treat ADHD up to the clinician. We conclude that the Norwegian guide would benefit from including a more precise strategy on use of medication in the treatment of ADHD. When, how and who shall try medication and/or multimodal treatment?