A 2-yr, prospective follow-up of 72 hyperactive boys (94% of the initial sample) examined classroom and home behavior, academic achievement, peer status and depressive symptomatology for patients and a matched control group. Of the sample, 65% was still on medication at follow-up. The patient group continued to manifest behavioral and academic difficulty. Off-drug classroom behavior showed considerable stability from baseline to 2-yr follow-up which did not appear to be significantly influenced by change of school or interim stimulant drug treatment. Academic difficulties, low peer status, and depressive symptoms exceeded that of the control group. Low peer status at 2 yr was predicted for the patient group by baseline (but not current) classroom hyperactivity. The continued difficulties for this middle-class sample, in spite of faithful stimulant drug intake, ancillary educational and psychiatric support, are disappointing. As no untreated comparison group was available, the relative benefit of continued drug treatment could not be directly examined. Some indirect evidence indicates that although drugs may continue to have a suppressant effect on impulsive and hyperactive behavior, peer status and academic achievement may not be improved. An optimally medicated group (86% of responders from an initially randomly assigned group) had almost identical academic achievement and social acceptance as did a group of dropouts from drug treatment, or the sample as a whole.