There should in due course be relevant information forthcoming from this trial. Even with current knowledge, an important conclusion is that combined treatment offers greater power than behavioral treatment. Children with suboptimal responses to behavioral approaches should therefore be offered medication as well. This is quite often not done or done only after a long delay, perhaps years. The superiority of the combined treatment emphasizes that it is not normally acceptable for psychosocial interventions to be prolonged as the sole intervention in the face of lack of improvement.
Medication is available as an effective supplement.
It follows that one aspect of a clinical service that should be audited is its efficiency in progressing to medical management when indicated. This means that effects of behavioral approaches may be underestimated in the outcome measures of combined treatment. Improvements because of behavioral treatment may be reflected in a reduction in the dose of medication, while if 2 fixed-dose treatments had been compared, the outcome might have been better with combined treatment than with medication management. Psychological interventions were tapered prior to outcome assessment, while medication was continued at full dosage. Certainly it reflects differences in what would be done in conventional practice but this is not a strong argument.