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The study compares the effectiveness of long-term psychoanalytic psychotherapy without medication with behavioral therapy and/or medication treatment. Seventy-three children with attention-deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) participated in a controlled trial. The primary outcome was symptom reduction 38 months after the pre-treatment assessment. Secondary outcomes were significantly lower scores for Conners Parent and Teacher Rating Scale, Child Behavior Checklist and Teacher Report Form scores. Both treatment groups demonstrated significant symptom reduction, with no significant differences in effectiveness between the two groups. Teacher ratings as well as parent ratings showed a significant decline over time on the ADHD index scores, on oppositional behavior and hyperactivity/impulsivity levels and on internalizing and externalizing problem scores. Both groups demonstrated similar main effects of time. There were no significant interactions between group and time. The findings of this study support psychoanalytic psychotherapy without medication as being as effective as behavioral treatment with methylphenidate in symptom reduction and problem reduction on ADHD/ODD related rating scales.