ADHD treatment in the 21st century: pushing the envelope

Required for optimal intervention for attention deficit hyperactivity disorder (ADHD) is evidence-based matching of child, treatment, and situation. The landmark Multimodal Treatment Study (MTA) of Children with ADHD documented the superiority of pharmacotherapy for the vast majority of children with ADHD. Although this study could not address the problem of the match directly, it is generating important leads for research on the use of psychosocial strategies to enhance the scope and durability of treatment gains while decreasing the risks attendant upon long-term use of medication. Given the inherent distinctions between pharmacological and psychosocial treatments, conclusive answers to questions about comparative efficacy will continue to elude scientist-practitioners. Needed next is research examining ways to improve outcomes beyond the effects of medication, using systematically tailored and sequenced psychosocial approaches and exploring new treatment targets, agents, and modalities. To illustrate, some emerging findings from an ongoing experience sampling study and implications for online therapy are discussed.