Multimodality treatment. A one-year follow-up of 84 hyperactive boys.

This study reports findings at the end of the first year of a three-year prospective study of 84 hyperactive boys. A multidimensional approach to evaluation and an individualized multimodality treatment plan commensurate with each child's disabilities was used. Treatment plans were implemented by members of the research staff working together as a coordinated therapeutic team. Measures of the child's behavior at home and at school, academic performance, delinquent behavior, and emotional adjustment were obtained initially and at one year. Results suggest that the combination of a clinically useful medication with appropriate psychological treatments simultaneously directed to each of the child's many disabilities is associated with an unexpectedly good outcome. Whether this will continue to be true when these children are followed up over a longer period of time awaits further investigation.

Multimodality treatment. A two-year evaluation of 61 hyperactive boys.

This study reports findings at the end of the second year of a three-year prospective study of 61 hyperactive boys. Individualized multimodality treatment plans commensurate with each child's disabilities were implemented by the research staff. Measures of the child's behavior at home and at school, academic performance, delinquent behavior, and emotional adjustment were obtained initially and at the end of each treatment year. The combination of a clinically useful medication in appropriate dosage schedules with relevant psychological treatments simultaneously directed to each of the child's many disabilities were associated with an unexpectedly good outcome at the end of one and two years. Whether this improvement will be maintained over a longer period of time and whether young adult outcome will be affected await further investigation.

Ontogeny of selective attention effects on event-related potentials in attention-deficit hyperactivity disorder and normal boys.

A longitudinal study of young attention-deficit hyperactivity disorder (ADHD) boys has found clear evidence for developmental abnormalities in event-related potential (ERP) waves that reflect cognitive processes associated with selective attentional tasks. Boys alternated attention to auditory or visual modalities in a train of stimuli, in an attempt to detect target stimuli in the attended modality. Results suggest that ADHD boys' attentional difficulties are due to insufficient facilitation of responses to the attended stimuli and not to an inability to block ignored stimuli. Abnormalities in ERPs reflecting cognitive processes associated with both interchannel selection mechanisms (processing negativity) and intrachannel selection mechanisms (P3b) were found. The degree of abnormality in the P3b responses to target stimuli in ADHD boys (lower than normal boys) was found to increase with age. It is suggested that the abnormally low P36 response to attended target stimuli found in ADHD boys may be due in part to insufficient LC noradrenergic activity normally triggered by attended task-relevant or novel stimuli.

Three-year multimodality treatment study of 100 hyperactive boys.

We conducted a prospective study of 100 hyperactive boys admitted to a multimodality treatment program. After a comprehensive evaluation, an individualized psychotherapy plan commensurate with the child's disabilities was developed. In addition to medication, each child was enrolled in one or more indicated psychotherapeutic modalities. Since approximately 50% of our patients dropped out of treatment, groups receiving less and more treatment were compared on outcome measures. At three-year follow-up the group receiving more treatment was found to be further ahead educationally, to demonstrate less antisocial behavior, to be more attentive (as rated by their teachers), to have better adjustment at school and at home (as reported by their parents), and to be more globally improved (as rated by psychiatrists and by parents) than children in the group receiving less treatment. Outcome for the group receiving more treatment was found also to be unusually good as compared to that in other studies of hyperactive children treated for varying lengths of time and evaluated after one to five years.