Does multimodal treatment of ADHD decrease other diagnoses?

Comorbid conditions in children with attention deficit hyperactivity disorder (ADHD) are frequent and can affect treatment response and life course. From the multimodal treatment study of ADHD (MTA), we examined the persistence or development of conditions other than ADHD, e.g. oppositional defiant disorder (ODD), conduct disorder (CD), anxiety, depression, and learning disorder (LD) in 576 children, age 7-9 years, diagnosed rigorously with ADHD, who were randomly assigned to four different treatments for 14 months. The treatment groups were medication management alone (MedMgt), behavioral treatment alone (Beh), the combination (Comb), and community comparison routine care (CC). For the sample as a whole, we found significant decreases from baseline to 14 months in diagnoses of ODD, CD, and anxiety disorder but not LD or mood disorder. The CC group developed significantly more new ODD and retained more baseline ODD than the Comb or MedMgt groups. There were no significant treatment group differences for specific other conditions. Only the Comb group was significantly better than the CC group in reducing total number of disorders and impairment at 14 months in subjects with multiple conditions at baseline. Well-titrated and monitored stimulant medication can decrease ODD and possibly prevent future CD. Combined treatment may be required for the most disturbed children with ADHD who have multiple disorders and severe impairment.