U.S. Department of Justice

Office of Justice Programs

Office of Juvenile Justice and Delinquency Prevention 

only a few minutes. They often initiate a number of tasks but fail

to complete them. Hyperactive children seem to be constantly in

motion. They have difficulty sitting still, may wander around the

room, squirm in their seats, or repeatedly tap a pencil. Impulsive

children tend to act without thinking and often seem unable to

control their immediate reactions to people, events, or even their

own thoughts and feelings. As a result, they may speak without

thinking or dash into the street without looking for traffic.

Most children (and adults) experience transient episodes of these

symptoms, perhaps due to stress or in response to certain medications. Younger children tend to be more active and have shorter

attention spans than older ones. These symptoms indicate ADHD

only if they occur over an extended period of time, typically for at

least 6 months; begin before age 7; appear in different settings;

and occur at a level that is both performance impairing and developmentally inappropriate. A thorough and comprehensive evaluation for ADHD should include input from both parents and

teachers.

ADHD and Juvenile Delinquency

Children with ADHD may appear functionally impaired in many

areas and may engage in a broad array of problem behaviors that

frustrate and disrupt family, school, and peer relationships. Their

inability to sit still and pay attention in class may lead to school

failure, truancy, and dropping out. For many individuals, the

effects of untreated ADHD continue into adolescence and adulthood. As they grow older, children with untreated ADHD—often

in combination with oppositional-defiant and conduct disorders—

may abuse drugs or alcohol, engage in antisocial behavior, and

suffer physical injury at higher rates than the general population.

Later impairment can include vocational and social problems, low

self-esteem, and a higher incidence of automobile accidents. Boys

with ADHD are at increased risk for engaging in delinquent and

antisocial behavior. Researchers know less about the long-term

consequences of ADHD in girls because of a lack of relevant longitudinal research; however, current studies suggest that ADHD

can also have long-term negative effects on girls.

A Treatment Study of Children With

Attention Deficit Hyperactivity Disorder

by Karen R. Stern

The National Institute of Mental Health (NIMH) is sponsoring

the Multimodal Treatment Study of Children With Attention

Deficit Hyperactivity Disorder (ADHD) to assess the effectiveness of different treatment protocols for children with ADHD.

The U.S. Department of Education (ED) and the Office of

Juvenile Justice and Delinquency Prevention (OJJDP) are also

supporting this research because the results will have important

implications for improving educational outcomes and reducing

delinquent behavior in children who have this disorder.

This is the first major NIMH collaborative clinical trial to focus

on a childhood mental disorder and the largest clinical trial ever

conducted by NIMH. Nearly 600 children ages 7–9 years have

been randomly assigned to 1 of 4 treatment groups: (1) medication management only, (2) behavioral treatment only, (3) a combination of medication and behavioral treatment, and (4) routine

community care (the control group). The primary study sites

include Columbia University in New York City; Duke University

Medical Center in Durham, NC; Western Psychiatric Institute in

Pittsburgh, PA; Long Island Jewish Medical Center in New Hyde

Park, NY; the University of California at Berkeley; and the

University of California at Irvine. Additional subcontractor sites

include Montreal Children’s Hospital in Quebec, Canada; Mount

Sinai School of Medicine in New York City; and the University

of California at San Francisco.

Diagnosing ADHD

ADHD is the most commonly diagnosed childhood disorder,

affecting an estimated 3 to 5 percent of school-age children. It

occurs more often in boys than girls, in some studies by a 5:1

ratio. Research suggests that the condition may have a genetic

component because ADHD is diagnosed more frequently in children who have close biological relatives with ADHD than in the

general population.

The core symptoms of ADHD include inattention, hyperactivity,

and impulsivity. Children who are inattentive and easily distracted have difficulty focusing on a task and may become bored after

May 2001 #20
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DOJ/OJJDP

PERMIT NO. G–91

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U.S. Department of Justice

Office of Justice Programs

Office of Juvenile Justice and Delinquency Prevention

Washington, DC 20531

Official Business

Penalty for Private Use $300

Current Study Findings

Study results indicate that two forms of treatment—carefully

administered medication alone or in conjunction with an intensive

behavioral treatment program, including a therapeutic summer

camp, parent training, and teacher consultation/classroom management—were significantly more effective in reducing the symptoms of ADHD than either behavioral treatment alone or routine

community care. In addition, children in the combined treatment

group (medication plus behavioral treatment) received, on average, significantly lower doses of medication than those receiving

medication only—yet children in both these groups showed similar reductions in ADHD symptoms. To date, these differential

effects have extended for at least 14 months.

In general, in other areas of functioning (oppositional/aggressive

behaviors, internalizing symptoms, social skills, parent-child relations, and academic achievement), few differences among the

three study treatments were found with three exceptions: combined treatment was superior to behavioral treatment for parents’

reports of their children’s anxiety symptoms, oppositional/

aggressive symptoms, and reading achievement. Only the combined treatment fared significantly better than community care for

all five areas of functioning and a composite measure of overall

functioning. In contrast, medication and the behavioral program

alone were each superior to community care in one functioning

area (social skills and parent-child relations, respectively). However, parents expressed greater satisfaction with treatment quality

and children’s progress and children were less likely to drop out

of the program when they received the combination and behavioral treatments than when they received medication only.

Significantly, all of these findings were replicated across all six

study sites. Because the sites served populations with widely

varying sociodemographic characteristics, the study’s results

appear to apply to a broad range of children and families affected

by ADHD.

Future Directions

With continued funding from NIMH, ED, and OJJDP, researchers

plan to follow study subjects into adolescence, conducting repeated assessments that explore multiple variables for variations in

outcomes associated with the four treatment strategies. Researchers will also provide information to ED and OJJDP on the subjects’ rates of aggressive and violent behavior, school problems,

substance abuse, delinquent and criminal activity, and contact

with the juvenile justice system.

For Further Information

For more information on the Multimodal Treatment Study of

Children With Attention Deficit Hyperactivity Disorder, contact:

Benedetto Vitiello, M.D.

Child and Adolescent Treatment and Preventive Interventions

Research Branch

National Institute of Mental Health, Room 7147

6001 Executive Boulevard, MSC 9633

Bethesda, MD 20892–9633

Fax: 301–443–4045

E-mail: bvitiell@nih.gov 

Kimberly Hoagwood, Ph.D.

Associate Director, Child and Adolescent Translational Research

Division of Services and Intervention Research

National Institute of Mental Health, Room 7146

6001 Executive Boulevard, MSC 9631

Bethesda, MD 20892–9631

Fax: 301–443–4045

E-mail: khoagwood@nih.gov

Karen R. Stern, Ph.D., is a Program Manager in OJJDP’s Research and

Program Development Division.

The Office of Juvenile Justice and Delinquency Prevention is a component 

of the Office of Justice Programs, which also includes the Bureau of Justice

Assistance, the Bureau of Justice Statistics, the National Institute of Justice,

and the Office for Victims of Crime.

FS–200120