Abstract
We examined 9-month data from the 14-month NIMH Multimodal Treatment Study of Children with ADHD (the MTA) as a further check on the relative effect of medication (MedMgt) and behavioral treatment (Beh) for attention–deficit/hyperactivity disorder (ADHD) while Beh was still being delivered at greater intensity than at 14-month endpoint, and conversely as a check on the efficacy of the MTA behavioral generalization/maintenance procedures. Intention-to-treat analysis at 9 months showed essentially the same results as at 14 months, after Beh had been completely faded; MedMgt and the combination (Comb) of medication and Beh were significantly superior to Beh and community care (CC) for ADHD and oppositional–defiant (ODD) symptoms, with mixed results for social skills and internalizing symptoms. All treatment-group differences examined as changes in slopes from 9 to 14 months were nonsignificant (we found general improvement for all groups). Slopes from baseline to 9 months correlated highly (r > .74, p <.0001) with slopes from baseline to 14 months for all groups. The time function from baseline to 14 months showed a significant linear, but not quadratic, trend for the main outcome measure (a composite of parent- and teacher-rated ADHD and ODD symptoms) for all groups. Findings suggest that in contrast to the hypothesized deterioration in the relative benefit of Beh between 9 and 14 months (after completion of fading), the MTA Beh generalization and maintenance procedures implemented through 9 months apparently yielded continuing improvement through 14 months, with preservation of the relative position of Beh compared to other treatment strategies.
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REFERENCES
Arnold, L. E., Abikoff, H. B., Cantwell, D. P., Conners, C. K., Elliott, G. R., Greenhill, L. L., et al. (1997a). NIMH collaborative multimodal treatment study of children with ADHD (MTA): Design challenges and choices. Archives of General Psychiatry, 54, 865-870.
Arnold, L. E., Abikoff, H. B., Cantwell, D. P., Conners, C. K., Elliott, G. R., Greenhill, L. L., et al. (1997b). NIMH collaborative multimodal treatment study of children with ADHD (MTA): Design, methodology, and protocol evolution. Journal of Attention Disorders, 2, 1419-158.
Arnold, L. E., Elliott, M., Sachs, L., Bird, H., Kraemer, H. C., Wells, K. C., et al. (2003). Effects of ethnicity on treatment attendance, stimulant response/dose, and 14-month outcome in ADHD. Journal of Consulting and Clinical Psychology, 71, 713-727.
Conners, C. K., Epstein, J. N., March, J., Angold., A., Wells, K. C., Klaric, J., et al. (2001). Multimodal treatment of ADHD in the MTA: an alternative outcome analysis. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 159-167.
Greenhill, L. L., Abikoff, H. B., Arnold, L. E., Cantwell, D. P., Conners, C. K., Elliott, G., et al. (1996). Medication treatment strategies in the MTA: Relevance to clinicians and researchers. Journal of American Academy of Child and Adolescent Psychiatry, 35, 1304-1313.
Gresham, F. M., & Elliott, S. N. (1990). Social skills rating svstem manual. Circle Pines, MN: American Guidance Systems.
Hinshaw, S. P., March, J. S., Abikoff, H., Arnold, L. E., Cantwell, D. P., Conners, C. K., et al. (1997). Comprehensive assessment of childhood attentiondeficit hyperactivity disorder in the context of a multisite, multimodal clinical trial. Journal of Attention Disorders, 1, 217-234.
Hinshaw, S. P., Owens, E. B., Wells, K. C., Kraemer, H. C., Abikoff, H. B., Arnold, L. E., et al. (2000). Family processes and treatment outcome in the MTA: Negative/ineffective parenting practices in relation to multimodal treatment. Journal of Abnormal Child Psychology, 28, 555-568.
Jensen, P. S., Hinshaw, S. P., Kraemer, H. C., Lenora, N., Newcorn, J. H., Abikoff, H. B., et al. (2001). ADHD comorbidity findings from the MTA study: Comparing comorbid subgroups. Journal of the American Academy of Child and Adolescent. Psychiatry, 40, 147-158.
March, J. S., Swanson, J. M., Arnold, L. E., Hoza, B., Conners, C. K., Hinshaw, S., et al. (2000). Anxiety as a predictor and outcome variable in the Multimodal Treatment Study of children with ADHD. Journal of Abnormal Child Psychology, 28, 527-541.
Marcus, S. M., & Gibbons, R. D. (2001). Estimating the efficacy of receiving treatment in randomized clinical trials with noncompliance. Health Services and Outcomes Research Methodology (Special Issue on Causal Inference), 2, 247-258.
MTA Cooperative Group. (1999a). A 14-Month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. Archives of General Psychiatry, 56, 1073-1086.
MTA Cooperative Group. (1999b). Moderators and mediators of treatment response for children with attention-deficit/hyperactivity disorder. Archives of General Psychiatry, 56, 1088-1096.
Owens, E. B., Hinshaw, S. P., Kraemer, H. C., Arnold, L. E., Abikoff, H. B., Cantwell, D. P., et al. (2003). What treatment for whom for ADHD: Moderators of treatment response in the MTA. Journal of Consulting and Clinical Psychology, 71, 540-552.
Pelham, W. E., Jr. (1999a). President's message: the NIMH Multimodal Treatment Study for ADHD: Just say yes to drugs? Clinical Child Psychology Newsletter, 14(2), 1-5.
Pelham, W. E., Jr. (1999b). The NIMH Multimodal Treatment Study for attention-deficit/Hyperactivity Disorder: Just say yes to drugs alone? Canadian Journal of Psychiatry, 44, 981-990.
Pelham, W. E., Jr. (2000). Implications of the MTA study for behavioral and combined treatments. The ADHD Report, 8, 9-16.
Pelham, W. E., Jr., Gnagy, E. M., Greiner, A. R., Hoza, B., Hinshaw, S. P., Swanson, J. M., et al. (2000). Behavioral vs. behavioral and pharmacological treatment in ADHD children attending a summer treatment program. Journal of Abnormal Child Psychology, 28, 507-525.
Pelham, W. E., & Hoza, B. (1996). Intensive treatment: A summer treatment program for children with ADHD. In E. D. Hibbs & P. S. Jensen (Eds.), Psychosocial treatments for child and adolescent disorders: Empirically-based strategies for clinical practice (pp. 311-340). Washington, DC: American Psychological Association.
Rieppi, R., Greenhill, L. L., Ford, R. E., Chuang, S., Wu, M., Davies, M., et al. (2002). Socioeconomic status as a moderator of ADHD treatment outcomes. Journal of American Academy of Child and Adolescent Psychiatry, 41, 269-277.
Swanson, J. M. (1992). School-based assessments and interventions for ADD students. Irvine, CA: K. C. Publishing. SNAP-IV also available for download from WWW.ADHD. net.
Swanson, J. M., Kraemer, H. C., Hinshaw, S. P., Arnold, L. E., Conners, C. K., Abikoff, H. B., et al. (2001). Clinical relevance of the primary findings of the MTA: Success rates based on severity of ADHD and ODD symptoms at the end of treatment. Journal of the American Academy of Child and Adolescent. Psychiatry, 40, 168-179.
Vitiello, B., Severe, J. B., Greenhill, L. L., Arnold, L. E., Abikoff, H. B., Bukstein, O., et al. (2001). Methylphenidate dosage for children with ADHD over time under controlled conditions: Lessons from the MTA. Journal of the American Academy of Child and Adolescent. Psychiatry, 40, 188-196.
Wells, K. C., Pelham, W. E., Kotkin, R. A., Hoza, B., Abikoff, H. B., Abramowitz, A., et al. (2000). Psychosocial treatment strategies in the MTA study: Rationale, methods, and critical issues in design and implementation. Journal of Abnormal Child Psychology, 28, 483-505.
Wells, K. C., Epstein, J. N., Hinshaw, S. P., Conners, C. K., Klaric, J., Abikoff, H., et al. (2000). Parenting and family stress treatment outcomes in attention deficit hyperactivity disorder (ADHD): An empirical analysis in the MTA study. Journal of Abnormal Child Psychology, 28, 543-553.
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Arnold, L.E., Chuang, S., Davies, M. et al. Nine Months of Multicomponent Behavioral Treatment for ADHD and Effectiveness of MTA Fading Procedures. J Abnorm Child Psychol 32, 39–51 (2004). https://doi.org/10.1023/B:JACP.0000007579.61289.31
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DOI: https://doi.org/10.1023/B:JACP.0000007579.61289.31