The relative merits of medication versus behavioral treatment of ADHD continues to be an focus of concern for parents and researchers. It has been nearly 12 years since the publication of the classic study titled: Multimodal Treatment Study of Children with ADHD (MTA). This study compared children with ADHD assigned randomly to one of four treatment arms:
stimulant drug treatment alone (titrated to response),
intensive behavioral treatment alone, combined stimulant and behavioral therapy, community care treatment by community providers
The key finding from the MTA study was that stimulant therapy alone proved superior to behavior therapy alone. Adding behavior therapy did not appear to provide additional improvement in key ADHD symptom measures. Combined therapy did appear to provide some incremental improvement in oppositional and aggressive behaviors as well as social skills--deficits commonly found in children with ADHD.
A recent study from the Netherlands provides some additional insight in to the issue of training attention functions in children with ADHD. Although stimulant treatment appears to improve attention in ADHD, it does not typically normalize this cognitive function domain. So the question remains whether adding attention training to children on stimulant therapy provides additional benefit.
In the Netherlands study, attention training consisted of use of a computerized training program called AixTent. This training program taps into the fact that attention is multiple aspects or domains. Children may have selective impairment in some but not all areas of attention. The areas of attention studied included:
- Tonic alertness
- Phasic alertness
- Vigilance
- Selective attention
- Divided attention
- Flexibility
Attention training consisted of eight one hour training sessions with 45 minutes of the hour computer based and the rest preparation and setup. A control group of children received a control exposure to visual perception--a method not targeted at improving attention.
The study found attention training effective in improving vigilance, divided attention and flexibility. No elements of attention were improved by the control condition. So this study lends some support for the potential to augment the effects of stimulant on attention with specific attention computer-based training tasks.
The durability of this attention improvement was not addressed in the study. However, it appears that assessing the multiple components of attention and providing specific training in attention holds some promise in ADHD. It appears this type of training may augment response to stimulants. Whether it is effective without stimulants on board in unknown. Developing and improving engaging video games that target improvement in real-world translatable attentional skills may provide further treatment options for teachers, parents and clinicians.
This study differs from the MTA study in that it focused more on attention cognitive skill training rather than a primary behavioral approach. Maybe it's not that stimulants work better than therapy, but that with better cognitive training methods, combined treatment may get attentional skills in children with ADHD closer to that found in there peers.
Tucha O, Tucha L, Kaumann G, König S, Lange KM, Stasik D, Streather Z, Engelschalk T, & Lange KW (2011). Training of attention functions in children with attention deficit hyperactivity disorder. Attention deficit and hyperactivity disorders PMID: 21597880
Photo of Birds of Paradise Flower from Maui Courtesy of Yates Photography
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