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 .
National Institute of Mental Health Multimodal Treatment Study of ADHD follow-up: changes in effectiveness and growth after the end of treatment.
OBJECTIVE Intent-to-treat analyses of the Multimodal Treatment Study of ADHD ( MTA ) revealed group differences on attention-deficit/hyperactivity disorder symptoms ratings , with better outcome in groups of participants who were assigned the medication algorithm-medication alone ( MedMgt ) and combined (Comb)--than in those who were  not-behavior modification  ( Beh ) alone and community comparison ( CC ) . However , the effect size was reduced by 50 % from the end of treatment to the first follow-up . The convergence of outcomes suggests differential changes by treatment group beween 14 and 24 months , which this report explores , both for benefits of treatment and for side effects on growth . METHODS We documented reported medication use at 14- and 24-month assessment s and formed 4 naturalistic subgroups ( Med/Med , Med/NoMed , NoMed/Med , and NoMed/NoMed ) . Then we performed exploratory mediator analyses to evaluate effects of changes in medication use on 14- to 24-month change scores of effectiveness ( symptom ratings ) and growth ( height and weight measures ) . RESULTS The r and omly assigned groups with the greatest improvement at the end of the treatment phase ( Comb and MedMgt ) deteriorated during the follow-up phase , but the other 2 groups ( Beh and CC ) did not . There were no significant differences in the 14- to 24-month growth rates among the r and omly assigned groups , in contrast to significant growth suppression in the Comb and MedMgt at the end of the treatment phase . Changes in medication use mediated the 14- to 24-month change in attention-deficit/hyperactivity disorder symptom ratings : the subgroup that reported stopping medication ( Med/NoMed ) showed the largest deterioration , the subgroup that consistently reported ( Med/Med ) or never reported ( NoMed/NoMed ) medication use showed modest deterioration , and the subgroup that reported starting medication ( NoMed/Med ) showed improvement . Changes in medication use also mediated growth effects : the subgroup that consistently reported medication use ( Med/Med ) showed reduced height gain compared with the subgroup that never reported medication use ( NoMed/NoMed ) , which actually grew faster than predicted by population norms . CONCLUSION In the MTA follow-up , exploratory naturalistic analyses suggest that consistent use of stimulant medication was associated with maintenance of effectiveness but continued mild growth suppression
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 .