Evidence, Interpretation, and Qualification From Multiple Reports of Long-Term Outcomes in the Multimodal Treatment Study of Children With ADHD (MTA) Improving attention-deficit/hyperactivity disorder treatment outcomes through use of a collaborative consultation treatment service by community-based pediatricians: a cluster randomized trial. Long-term stimulant treatment of children with attention-deficit hyperactivity disorder symptoms. A randomized, double-blind, placebo-controlled trial. Evidence, Interpretation, and Qualification From Multiple Reports of Long-Term Outcomes in the Multimodal Treatment Study of Children With ADHD (MTA) Erratum to: Long-acting methylphenidate formulations in the treatment of attention-deficit/hyperactivity disorder: a systematic review of head-to-head studies A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. The MTA Cooperative Group. Multimodal Treatment Study of Children with ADHD. Long-term methylphenidate therapy in children with comorbid attention-deficit hyperactivity disorder and chronic multiple tic disorder. Enhancing Behavioral and Social Skill Functioning in Children Newly Diagnosed with Attention-Deficit Hyperactivity Disorder in a Pediatric Setting Young adult outcomes in the follow‐up of the multimodal treatment study of attention‐deficit/hyperactivity disorder: symptom persistence, source discrepancy, and height suppression A randomized, controlled trial of integrated home-school behavioral treatment for ADHD, predominantly inattentive type. Preliminary data suggesting the efficacy of attention training for school-aged children with ADHD Randomized, placebo-controlled, crossover study of methylphenidate for attention-deficit/hyperactivity disorder symptoms in preschoolers with developmental disorders. Parent-Reported Homework Problems in the MTA Study: Evidence for Sustained Improvement with Behavioral Treatment Clinical evaluation of subjective and objective changes in motor activity and attention in children with attention-deficit/hyperactivity disorder in a double-blind methylphenidate trial. Childhood hyperactivity and psychostimulants: a review of extended treatment studies. Combined ω3 and ω6 Supplementation in Children With Attention-Deficit Hyperactivity Disorder (ADHD) Refractory to Methylphenidate Treatment Homeopathic treatment of children with attention deficit hyperactivity disorder: a randomised, double blind, placebo controlled crossover trial
Objective : To review and provide details about the primary and secondary findings from the Multimodal Treatment study of ADHD ( MTA ) published during the past decade as three sets of articles . Method : In the second of a two part article , we provide additional background and detail required by the complexity of the MTA to address confusion and controversy about the findings outlined in part I ( the Executive Summary ) . Results : We present details about the gold st and ard used to produce scientific evidence , the r and omized clinical trial ( RCT ) , which we applied to evaluate the long-term effects of two well-established unimodal treatments , Medication Management ( MedMGT ) and behavior therapy ( Beh ) , the multimodal combination ( Comb ) , and treatment “ as usual ” in the community ( CC ) . For each of the first three assessment points defined by RCT methods and included in intent-to-treat analyses , we discuss our definition of evidence from the MTA , interpretation of the serial presentations of findings at each assessment point with a different definition of long-term varying from weeks to years , and qualification of the interim conclusions about long-term effects of treatments for ADHD based on many exploratory analyses described in additional published articles . Conclusions : Using a question and answer format , we discuss the possible clinical relevance of the MTA and present some practical suggestions based on current knowledge and uncertainties facing families , clinicians , and investigators regarding the long-term use of stimulant medication and behavioral therapy in the treatment of children with ADHD . ( J. of Att . Dis . 2008 ; 12(1 ) 15 - 43 OBJECTIVE To test whether adoption of a collaborative consultative service model results in improved patient outcomes . DESIGN Twelve pediatric practice s were r and omly assigned to receive access to collaborative consultative services or to a control group . SETTING Community-based pediatric offices . PARTICIPANTS Fifty-two pediatricians and their 377 patients with attention-deficit/hyperactivity disorder ( ADHD ) . Intervention A collaborative consultative service promoting the use of titration trials and periodic monitoring during medication maintenance . Main Outcome Measure Physician practice behaviors and child ADHD symptomatology . RESULTS Using self-report of pediatricians , the collaborative consultative service increased the use of evidence -based practice s by pediatricians , but no difference in children 's ADHD symptomatology was observed between the groups . However , many pediatricians did not fully use the collaborative consultative services . Those children who actually received collaborative consultative services showed significant behavioral improvement compared with children not receiving these services . CONCLUSIONS When actually implemented by pediatricians , the collaborative consultative service appears to be an effective method for facilitating evidence -based treatment procedures for ADHD and use of these procedures appear to improve children 's outcomes . Barriers to implementation of collaborative consultative service in pediatric practice need to be further understood BACKGROUND We wanted to study the effects of amphetamine on symptoms of attention-deficit hyperactivity disorder ( ADHD ) over a longer period than has been reported in previous studies of central stimulants in this condition . METHODS Sixty-two children , aged 6 to 11 years , meeting DSM-III-R symptom criteria for ADHD participated in a parallel-group design , r and omized , double-blind , placebo-controlled study of amphetamine treatment . Treatment was not restricted to children with " pure " ADHD , ie , some had comorbid diagnoses . In the amphetamine group , children received active treatment for 15 months . RESULTS Amphetamine was clearly superior to placebo in reducing inattention , hyperactivity , and other disruptive behavior problems and tended to lead to improved results on the Wechsler Intelligence Scale for Children -- Revised . Treatment failure rate was considerably lower and time to treatment failure was longer in the amphetamine group . Adverse effects were few and relatively mild . CONCLUSION The results of this long-term , placebo-controlled study of the central stimulant amphetamine in the treatment of ADHD indicate that there are remaining positive effects of the drug 15 months after starting treatment Objective : To review the primary and secondary findings from the Multimodal Treatment study of ADHD ( MTA ) published over the past decade as three sets of articles . Method : In a two-part article — Part I : Executive Summary ( without distracting details ) and Part II : Supporting Details ( with additional background and detail required by the complexity of the MTA)—we address confusion and controversy about the findings . Results : We discuss the basic features of the gold st and ard used to produce scientific evidence , the r and omized clinical trial , for which was used to contrast four treatment conditions : medication management alone ( MedMgt ) , behavior therapy alone ( Beh ) , the combination of these two ( Comb ) , and a community comparison of treatment “ as usual ” ( CC ) . For each of the three assessment points we review three areas that we believe are important for appreciation of the findings : definition of evidence from the MTA , interpretation of the serial presentations of findings at each assessment point with a different definition of long-term , and qualification of the interim conclusions about long-term effects of treatments for ADHD . Conclusion : We discuss the possible clinical relevance of the MTA and present some practical suggestions based on current knowledge and uncertainties facing families , clinicians , and investigators regarding the long-term use of stimulant medication and behavioral therapy in the treatment of children with ADHD . ( J. of Att . Dis . 2008 ; 12(1 ) 4 - 14 Background : The stimulant methylpheni date ( MPH ) has been a mainstay of treatment for attention-deficit/hyperactivity disorder ( ADHD ) for many years . Owing to the short half-life and the issues associated with multiple daily dosing of immediate-release MPH formulations , a new generation of long-acting MPH formulations has emerged . Direct head-to-head studies of these long-acting MPH formulations are important to facilitate an evaluation of their comparative pharmacokinetics and efficacy ; however , to date , relatively few head-to-head studies have been performed . The objective of this systematic review was to compare the evidence available from head-to-head studies of long-acting MPH formulations and provide information that can guide treatment selection . Methods : A systematic literature search was conducted in MEDLINE and PsycINFO in March 2012 using the MeSH terms : attention deficit disorder with hyperactivity/drug therapy ; methylpheni date /therapeutic use and All Fields : Concerta ; Ritalin LA ; OROS and ADHD ; Medikinet ; Equasym XL and ADHD ; long-acting methylpheni date ; Diffucaps and ADHD ; SODAS and methylpheni date . No filters were applied and no language , publication date or publication status limitations were imposed . Articles were selected if the title indicated a comparison of two or more long-acting MPH preparations in human subjects of any age ; non- systematic review articles and unpublished data were not included . Results : Of 15,295 references returned in the literature search and screened by title , 34 articles were identified for inclusion : nine articles from pharmacokinetic studies ( nine studies ) ; nine articles from laboratory school studies ( six studies ) ; two articles from r and omized controlled trials ( two studies ) ; three articles from switching studies ( two studies ) and three articles from one observational study . Conclusions : Emerging head-to-head studies provide important data on the comparative efficacy of the formulations available . At a group level , efficacy across the day generally follows the pharmacokinetic profile of the MPH formulation . No formulation is clearly superior to another ; careful consideration of patient needs and subtle differences between formulations is required to optimize treatment . For patients achieving suboptimal symptom control , switching long-acting MPH formulations may be beneficial . When switching formulations , it is usually appropriate to titrate the immediate-release component of the formulation ; a limitation of current studies is a focus on total daily dose rather than equivalent immediate-release components . Further studies are necessary to provide guidance in clinical practice , particularly in the treatment of adults and pre-school children and the impact of comorbidities and symptom severity on treatment response BACKGROUND Previous studies have demonstrated the short-term efficacy of pharmacotherapy and behavior therapy for attention-deficit/hyperactivity disorder ( ADHD ) , but no longer-term ( i.e. , > 4 months ) investigations have compared these 2 treatments or their combination . METHODS A group of 579 children with ADHD Combined Type , aged 7 to 9.9 years , were assigned to 14 months of medication management ( titration followed by monthly visits ) ; intensive behavioral treatment ( parent , school , and child components , with therapist involvement gradually reduced over time ) ; the two combined ; or st and ard community care ( treatments by community providers ) . Outcomes were assessed in multiple domains before and during treatment and at treatment end point ( with the combined treatment and medication management groups continuing medication at all assessment points ) . Data were analyzed through intent-to-treat r and om-effects regression procedures . RESULTS All 4 groups showed sizable reductions in symptoms over time , with significant differences among them in degrees of change . For most ADHD symptoms , children in the combined treatment and medication management groups showed significantly greater improvement than those given intensive behavioral treatment and community care . Combined and medication management treatments did not differ significantly on any direct comparisons , but in several instances ( oppositional/aggressive symptoms , internalizing symptoms , teacher-rated social skills , parent-child relations , and reading achievement )  combined treatment proved superior to intensive behavioral treatment and /or community care while medication management did not . Study medication strategies were superior to community care treatments , despite the fact that two thirds of community-treated subjects received medication during the study period . CONCLUSIONS For ADHD symptoms , our carefully crafted medication management was superior to behavioral treatment and to routine community care that included medication . Our combined treatment did not yield significantly greater benefits than medication management for core ADHD symptoms , but may have provided modest advantages for non-ADHD symptom and positive functioning outcomes BACKGROUND This study examined changes in attention-deficit hyperactivity ( ADHD ) behaviors and motor and vocal tics during long-term treatment with methylpheni date . METHODS Thirty-four prepubertal children with ADHD and chronic multiple tic disorder ( who had participated in an 8-week , double-blind , placebo-controlled methylpheni date evaluation ) were evaluated at 6-month intervals for 2 years as part of a prospect i ve , nonblind , follow-up study . Treatment effects were assessed using direct observations of child behavior in a simulated ( clinic-based ) classroom and behavior rating scales completed by parents and physician . Videotapes of the simulated classroom were scored by coders who were blind to treatment status . RESULTS There was no evidence ( group data ) that motor tics or vocal tics changed in frequency or severity during maintenance therapy compared with diagnostic or initial double-blind placebo evaluations . Behavioral improvements demonstrated during the acute drug trial were maintained during follow-up . There was no evidence ( group data ) of clinical ly significant adverse drug effects on cardiovascular function or growth at the end of 2 years of treatment . CONCLUSIONS Long-term treatment with methylpheni date seems to be safe and effective for the management of ADHD behaviors in many ( but not necessarily all ) children with mild to moderate tic disorder . Nevertheless , careful clinical monitoring is m and atory to rule out the possibility of drug-induced tic exacerbation in individual patients ABSTRACT . The objective of this study was to evaluate the effectiveness of an 8-week behavioral and social skill ( BSS ) class for children newly diagnosed with attention-deficit hyperactivity disorder ( ADHD ) and their parents , initiating stimulant treatment in primary care . The subjects were 100 children , aged 5 to 12 years , recently diagnosed with ADHD and treated with stimulant medication , and their parents or guardians . Eligible families were r and omly assigned to an intervention group ( IG : n = 59 ) or control group ( CG : n = 41 ) . The BSS function of each child was assessed using DuPaul ’s ADHD Parent Rating Scale ( 18-item ) and Child Attention Profile ( 12-item ) during blinded baseline and follow-up interviews . Parent discipline practice was assessed using a five-item inventory based on Likert-scale ratings during identical periods . Computerized pharmacy records were used to track psychostimulant use over time . IG children exhibited significantly lower parent-rated ADHD symptoms , whereas IG parents reported significantly better and more consistent discipline practice s compared with CG parents across time . No significant differences were found between groups in Child Attention Profile scores across time . Psychostimulant use did not significantly differ between groups across time .  BSS training  was well accepted and seemed to significantly improve BSS functioning among IG children in the home setting only BACKGROUND The Multimodal Treatment Study ( MTA ) began as a 14-month r and omized clinical trial of behavioral and pharmacological treatments of 579 children ( 7 - 10 years of age ) diagnosed with attention-deficit/hyperactivity disorder (ADHD)-combined type . It transitioned into an observational long-term follow-up of 515 cases consented for continuation and 289 classmates ( 258 without ADHD ) added as a local normative comparison group ( LNCG ) , with assessment s 2 - 16 years after baseline . METHODS Primary ( symptom severity ) and secondary ( adult height ) outcomes in adulthood were specified . Treatment was monitored to age 18 , and naturalistic subgroups were formed based on three patterns of long-term use of stimulant medication ( Consistent , Inconsistent , and Negligible ) . For the follow-up , hypothesis-generating analyses were performed on outcomes in early adulthood ( at 25 years of age ) . Planned comparisons were used to estimate ADHD-LNCG differences reflecting persistence of symptoms and naturalistic subgroup differences reflecting benefit ( symptom reduction ) and cost ( height suppression ) associated with extended use of medication . RESULTS For ratings of symptom severity , the ADHD-LNCG comparison was statistically significant for the parent/self-report average ( 0.51 ± 0.04 , p < .0001 , d = 1.11 ) , documenting symptom persistence , and for the parent/self-report difference ( 0.21 ± 0.04 , p < .0001 , d = .60 ) , documenting source discrepancy , but the comparisons of naturalistic subgroups reflecting medication effects were not significant . For adult height , the ADHD group was 1.29 ± 0.55 cm shorter than the LNCG ( p < .01 , d = .21 ) , and the comparisons of the naturalistic subgroups were significant : the treated group with the Consistent or Inconsistent pattern was 2.55 ± 0.73 cm shorter than the subgroup with the Negligible pattern ( p < .0005 , d = .42 ) , and within the treated group , the subgroup with the Consistent pattern was 2.36 ± 1.13 cm shorter than the subgroup with the Inconsistent pattern ( p < .04 , d = .38 ) . CONCLUSIONS In the MTA follow-up into adulthood , the ADHD group showed symptom persistence compared to local norms from the LNCG . Within naturalistic subgroups of ADHD cases , extended use of medication was associated with suppression of adult height but not with reduction of symptom severity OBJECTIVE To evaluate the efficacy of a behavioral psychosocial treatment integrated across home and school ( Child Life and Attention Skills Program ) with attention-deficit/hyperactivity disorder ( ADHD ) predominantly inattentive type ( ADHD-I ) . METHOD Sixty-nine children ages 7 to 11 years were r and omized to the Child Life and Attention Skills Program or a control group who did not receive the intervention .  We compared groups posttreatment and at 3- to 5-month follow-up on parent and teacher ratings of inattention , sluggish cognitive tempo , and functional impairment . RESULTS Children r and omized to the Child Life and Attention Skills Program were reported to have significantly fewer inattention and sluggish cognitive tempo symptoms , and significantly improved social and organizational skills , relative to the control group . Gains were maintained at follow-up . CONCLUSIONS Behavioral psychosocial treatment , when specifically adapted for ADHD-I and coordinated among parents , teachers , and children , appears efficacious in reducing symptoms and impairment associated with A pilot r and omized clinical trial was conducted to examine the initial efficacy of Pay Attention ! , an intervention training sustained , selective , alternating , and divided attention , in children diagnosed with Attention-Deficit/Hyperactivity Disorder ( ADHD ) . After a diagnostic and baseline evaluation , school-aged children with ADHD were r and omized to receive 16 bi-weekly sessions of Pay Attention ! ( n=54 ) or to a waitlist control group ( n=51 ) . Participants completed an outcome evaluation approximately 12 weeks after their baseline evaluation . Results showed significant treatment effects for parent and clinician ratings of ADHD symptoms , child self-report of ability to focus , and parent ratings of executive functioning . Child performance on neuropsychological tests showed significant treatment-related improvement on strategic planning efficiency , but no treatment effects were observed on other neuropsychological outcomes . Treatment effects were also not observed for teacher ratings of ADHD . These data add to a growing body of literature supporting effects of cognitive training on attention and behavior , however , additional research is warranted OBJECTIVE The aim of this study was to investigate the short-term efficacy and safety of methylpheni date ( MPH ) to treat attention-deficit/hyperactivity disorder ( ADHD ) symptoms in an understudied population of preschoolers with pervasive developmental disorder ( PDD ) or intellectual disability ( ID ) . METHODS Fourteen preschoolers with developmental disorders ( DD , n = 14 ; PDD , n = 12 ; ID , n = 2 ) underwent MPH titration in a single-blind manner followed by a 4-week double-blind crossover phase . Each child was administered placebo for 2 weeks and " optimal dose " for 2 weeks . The primary outcome measure was the Diagnostic and Statistical Manual of Mental Disorders , 4(th ) edition ( DSM-IV ) ADHD subscale of the Conners ' Parent Rating Scale-Revised ( CPRS-R-DSM-IV-ADHD ) . RESULTS MPH improved parent-rated ADHD symptoms of the preschoolers ; 50 % were rated as responders . The CPRS-R-DSM-IV-ADHD subscale was significant for the PDD subgroup ( p = 0.005 , Cohen d = 0.97 ) and marginally significant for the entire DD sample ( p = 0.08 , Cohen d = 0.50 ) . Half of the preschoolers experienced side effects with MPH , including reports of increased stereotypic behavior , upset stomach , sleep-related difficulties , and emotional lability . One child discontinued during titration due to side effects . CONCLUSION The predominant direction of response in these preschoolers with both ADHD and PDD/ID favored MPH , even though the response was more subtle and variable than in older and typically developing children . Due to high rates of adverse effects , preschoolers should be monitored closely Parent-report of  child homework problems was examined as a treatment outcome variable in the MTA – Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder ( ADHD ) . Five hundred seventy-nine children ages 7.0 to 9.9 were r and omly assigned to either medication management , behavioral treatment , combination treatment , or routine community care . Results showed that only participants who received behavioral treatment ( behavioral and combined treatment ) demonstrated sustained improvements in homework problems in comparison to routine community care . The magnitude of the sustained effect at the 10-month follow-up assessment was small to moderate for combined and behavioral treatment over routine community care ( d = .37 , .40 , respectively ) . Parent ratings of initial ADHD symptom severity was the only variable found to moderate these effects The aim of this study was to determine drug-dependent effects on attention and motor activity in children with attention-deficit/hyperactivity disorder ( ADHD ) in a double-blind methylpheni date ( MPH ) trial using both subjective behavior ratings and objective measures of function . In particular , we were interested in the relationship between changes of those subjective and objective measures . A total of 44 ADHD children with the combined subtype completed a r and omized , double-blind , placebo-controlled , crossover trial with 2 doses of MPH ( 0.25 ; 0.5 mg/kg body weight ) and placebo . In each condition , computerized attention tasks were performed , teacher-behavior ratings were obtained , and actigraph data were collected in both clinical and naturalistic setting s. Trend tests revealed linear effects of MPH dose on actigraph data in the test session ( p = 0.02 ) and at school ( p = 0.001 ) , as well as on sustained attention ( p < 0.001 ) , while inhibitory control showed a quadratic dose-response curve ( p < 0.001 ) . Multivariate regression analyses revealed that changes of both , hyperactive-impulsive symptoms ( 28 % ) and inattentive symptoms ( 23 % ) could be explained by objective changes of motor activity . Thus , for clinical practice , it should be taken into account that behavior ratings of ADHD symptoms seemed to be predominantly influenced by changes of motor activity ABSTRACT Clinical trials with a treatment duration of at least 3 months were review ed to determine the effect of psychostimulants on the core symptoms of attention-deficit hyperactivity disorder ( ADHD ) and on its commonly associated features . Eighteen studies were identified : 17 were studies of  methylpheni date  , 1 was a study of dextroamphetamine , and none involved  pemoline  or  slow-release stimulants . Eleven of these studies were r and omized controlled trials , whereas seven employed quasi-experimental design s without r and omization . The results of r and omized controlled trials showed that psychostimulants provided greater benefit than did the nonr and omized trials , suggesting that the efficacy of extended treatment may have been underestimated because more seriously disturbed children were assigned to medication treatment than to control treatments in nonr and omized trials . Evidence from the more definitive r and omized controlled trials indicates that stimulants are more effective in ameliorating the core behavioral symptoms of ADHD ( restlessness , inattentiveness , impulsiveness ) than placebos , nonpharmacological therapies , or no treatment-at least in 3 - 7-month trials . During extended psychostimulant treatment , few children become symptom-free , clinical effects may diminish with time , and improvement dissipates rapidly upon discontinuation of medication . There is minimal evidence that extended stimulant treatment improves cognitive deficits or associated problems such as conduct disturbance , low self-esteem , poor peer relationships , or academic underachievement . The belief that stimulants do not improve the long-term prognosis of  children with ADHD  may be based on weakly design ed studies that focus on associated rather than core symptoms . A failure to assign patients of similar clinical severity to different treatment conditions may also have contributed to obscuring the efficacy of extended psychostimulant treatments Children ( 6 - 12 years ) with attention-deficit hyperactivity disorder ( ADHD ) being treated with methylpheni date and st and ard behavior therapy for more than 6 months , whose parents reported no improvement in behavior and academic learning , were r and omly assigned to receive supplementation with a combined ω3 and ω6 preparation or a placebo . Outcome was measured at 3 and 6 months after treatment using a self- assessment checklist completed by the parents . Statistically significant improvement was found in the treatment group compared with the placebo group ( P < .01 ) in the following measures : restlessness , aggressiveness , completing work , and academic performance . Statistically significant improvement was not found at 3 months of treatment between groups but was evident at 6 months of treatment ( P < .05 ) with inattention , impulsiveness , and cooperation with parents and teachers . Distractibility failed to show improvement . Effect sizes ranged from 0.3 to 1.1 at 3 months and 0.2 to 1.4 at 6 months for individual symptom variables An increasing number of parents turn to homeopathy for treatment of their hyperactive child . Two publications , a r and omised , partially blinded trial and a clinical observation study , conclude that homeopathy has positive effects in patients with attention deficit hyperactivity disorder ( ADHD ) . The aim of this study was to obtain scientific evidence of the effectiveness of homeopathy in ADHD . A total of 83 children aged 6–16 years , with ADHD diagnosed using the Diagnostic and Statistical Manual of Mental Disorders-IV criteria , were recruited . Prior to the r and omised , double blind , placebo controlled crossover study , they were treated with individually prescribed homeopathic medications .  62 patients , who achieved an improvement of 50 % in the Conners ’ Global Index ( CGI )  , participated in the trial . Thirteen patients did not fulfill this eligibility criterion ( CGI ) . The responders were split into two groups and received either verum for 6 weeks followed by placebo for 6 weeks ( arm A ) , or vice-versa ( arm B ) . At the beginning of the trial and after each crossover period , parents reported the CGI and patients underwent neuropsychological testing . The CGI rating was evaluated again at the end of each crossover period and twice in long-term follow-up . At entry to the crossover trial , cognitive performance such as visual global perception , impulsivity and divided attention , had improved significantly under open label treatment ( P<0.0001 ) . During the crossover trial , CGI parent – ratings were significantly lower under verum ( average 1.67 points ) than under placebo ( P = 0.0479 ) . Long-term CGI improvement reached 12 points ( 63 % , P < 0.0001 ) . Conclusion : The trial suggests scientific evidence of the effectiveness of homeopathy in the treatment of attention deficit hyperactivity disorder , particularly in the areas of behavioural and cognitive functions
Results suggest there is moderate-to-high-level evidence that combined pharmacological and behavioral interventions , and pharmacological interventions alone can be effective in managing the core ADHD symptoms and academic performance at 14 months .
However , the effect size may decrease beyond this period .
This review has highlighted the paucity and limitations of the evidence investigating the long-term outcomes of recommended interventions for managing ADHD symptoms .
There is little evidence to suggest that the effects observed over the relatively short term are maintained throughout longer periods of impairment .
PURPOSE To systematic ally identify and review the currently available evidence on the long-term outcomes of recommended attention-deficit hyperactivity disorder ( ADHD ) interventions following r and omized controlled trials with children and young people .