Aim: This study aimed to compare the cognitive and behavioral outcomes in children with ADHD receiving pharmacological treatment versus behavioral therapy over a 12-month period. Materials and Methods: A total of 80 children, aged 6-12 years, diagnosed with ADHD based on DSM-5 criteria, were randomly assigned to either a pharmacological treatment group (n=40) or a behavioral therapy group (n=40). Cognitive and behavioral outcomes were assessed at baseline, 6-month, and 12-month follow-ups using a variety of standardized measures including the Wechsler Intelligence Scale for Children (WISC-V), Continuous Performance Test (CPT), Conners' Rating Scales, and the Clinical Global Impression (CGI) scale. Results: There were no significant differences between the two groups in cognitive outcomes, including WISC-V scores, CPT performance, and executive function tasks at both 6-month and 12-month follow-ups. Behavioral outcomes also showed no significant differences between the groups in terms of hyperactivity, inattention, and externalizing behaviors at both follow-up points. However, the pharmacological treatment group showed a more significant reduction in the severity of ADHD symptoms (p=0.04), though there were no significant differences in symptom improvement (p=0.10) or functional outcomes (p=0.25) between the groups. Conclusion: Both pharmacological treatment and behavioral therapy were effective in improving cognitive and behavioral outcomes in children with ADHD. The pharmacological treatment group exhibited a more substantial reduction in symptom severity, while both treatments led to similar improvements in attention, hyperactivity, and overall functioning. These findings highlight the efficacy of both approaches, suggesting that medication may offer more immediate symptom relief, while behavioral therapy can also provide long-term benefits.