The study examined four approaches to treating ADHD: intensive medication management, intensive behavioral treatment, a combination of both medication management and behavioral treatment, and routine community care. Initial results found that, on average, behavioral therapy coupled with closely managed medication produced 'significantly superior' results than either community care or behavioral treatment alone for reducing ADHD symptoms over a 14-month period.

In March 2009 the study authors presented an important follow-up to the initial study. They found that regardless of treatment, children with ADHD still had a much greater degree of difficulty in school and in social settings, more conduct issues, and higher instances of depression and psychiatric hospitalizations than children without ADHD. Most notably, the success of short-term ADHD treatment -- whether medication, therapy, or a combination of both -- didn't necessarily improve long-term outcomes; in fact, children no longer taking Ritalin at the eight-year follow up were functioning as well as those who were still taking it.

"The reality is that you can't draw too many firm conclusions from the extension of the MTA about the efficacy of treatment," Vitiello cautioned. "What we can say is that, on average, attention deficit disorder is a very impairing condition and even if you treat it intensively for 14 months you are not going to probably change some of the negative outcomes that are related to ADD. There are different patterns and paths within attention deficit disorder. It's very difficult to make a statement that covers them all. That's one of the conclusions that come from this; there's a lot of diversity, heterogeneity in this group that we call attention deficit disorder, and we can't just have one treatment for every group." One striking statistic remains: of the roughly 15% of the country's children prescribed behavioral medication, nine out of ten are given ADHD drugs.

In 2000, testifying before a House of Representatives hearing on "Behavioral Drugs in Schools: Questions and Concerns," child psychiatrist David Fassler, M.D. pointed out that Ritalin was generally well-tolerated by children with minimal side effects, but added this caveat: "Nonetheless, I share the concern that some children may be placed on medication without a comprehensive evaluation, accurate and specific diagnosis or an individualized treatment plan. Let me also be very clear I am similarly deeply concerned about the many children with ADHD and other psychiatric disorders who would benefit from treatment, including treatment with medication, who go unrecognized and undiagnosed, and who are not receiving the help that they need."

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