Impact of Comorbidity on Treatment
Studies of stimulant treatment have shown that ADHD
chil-dren with and without aggression respond equally well to MPH treatment in
terms of ADHD symptoms. Research examining whether aggression in ADHD children
can be treated with psy-chostimulants has mainly yielded positive findings.
Finally, one study found that some covert, nonaggressive symptoms (e.g.,
stealing) were also decreased in ADHD children (independent of comorbidity)
following treatment with MPH (Hinshaw et
al., 1992). Treatment of comorbid ADHD and CD/ODD in the MTA study was
superior when medication was used, although the best outcome was seen with
combined treatment (Jensen et al.,
2001).
While it is now clear that stimulant treatment can
improve performance on a wide array of cognitive measures, treatment of
comorbid learning disabilities requires direct, nonpharmaco-logical, academic
interventions. There has been some concern regarding the possible dissociation
of cognitive and behavioral effects of stimulant medication. One landmark study
found that optimal cognitive performance was achieved at low doses (i.e., 0.3
mg/kg) while optimal behavioral function was achieved at high doses (i.e., 1.0
mg/kg), with an accompanying decline in cognitive function at the higher dose
(Sprague and Sleator, 1977). However, other investigators have reported a
linear rather than a curvilinear dose–response curve for both behavioral and
cognitive functions and have therefore not supported the previ-ously
hypothesized “cognitive toxicity”.
In contrast to studies in children with ADHD who
are ag-gressive, studies of stimulant response in ADHD children with comorbid
anxiety have produced somewhat inconsistent find-ings.Recent studies have found
that medication is equally ef-fective in comorbid ADHD and anxiety disorders.
Other stud-ies have found that children with ADHD and anxiety respond as well
as those without comorbid anxiety to the antidepressant DMI (Biederman et al., 1993).
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