Treatment effectiveness and limitations
A fairly broad choice of stimulant medications exists, as well as a nonstimulant, atomoxetine, for the treatment of ADHD. Increasingly, these medications are being prescribed for adults, but work is needed to optimize doses for this age group. In any case, treatment declines in adolescence, and compliance and adherence are significant issues in adolescents and adults. While symptomatic improvements are necessary for functional improvements, they may be insufficient for improving functioning. Greater emphasis on measurement of functioning, including social functioning, is needed. Many individuals with ADHD lack social and organizational skills, which may require adjunctive psychosocial treatments.
The best supported psychosocial treatments for children have involved contingency management/reinforcement approaches, parent training, and the integration of home- and school-based approaches. Limitations include the failure to maintain benefits post-treatment and to generalize to broader areas of life functioning. These may result from cognitive deficits, skill deficits, or performance deficits tied to the failures to self-organize and self-motivate behavior toward a later goal. Combined pharmacologic and psychological, i.e., multimodal treatments, can impact functioning over time, but follow up periods have been limited to childhood. Little research is available concerning the effects of psychosocial treatments on adolescent or adult outcomes.
