Empirical Evaluation of the Generalizability of the Sample from the Multimodal Treatment Study for ADHD

Randomized controlled trials (RCTs) are criticized for the questionable generalizability of their patient samples to real world populations. This study compared the demographic and clinical characteristics of children from the Multimodal Treatment Study of Children with ADHD (MTA) to those from the NIMH Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study and the National Health and Nutrition Examination Survey (NHANES). On the whole, we found no compelling evidence against the representativeness of the MTA sample, but the limited power from MECA and NHANES may have lead to noteworthy differences between datasets being statistically nonsignificant.

[1]  M. Posternak,et al.  Generalizability of antidepressant efficacy trials. , 2004, Essential psychopharmacology.

[2]  Elizabeth B. Owens,et al.  Clinical relevance of the primary findings of the MTA: success rates based on severity of ADHD and ODD symptoms at the end of treatment. , 2001, Journal of the American Academy of Child and Adolescent Psychiatry.

[3]  C. Hoven,et al.  Mental health service use in the community and schools: Results from the four-community MECA study , 1996 .

[4]  R. DeRubeis,et al.  Are samples in randomized controlled trials of psychotherapy representative of community outpatients? A new methodology and initial findings. , 2003, Journal of consulting and clinical psychology.

[5]  Stephen P. Hinshaw,et al.  A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. The MTA Cooperative Group. Multimodal Treatment Study of Children with ADHD. , 1999, Archives of general psychiatry.

[6]  R. DeRubeis,et al.  Are Research Patients and Clinical Trials Representative of Clinical Practice , 2006 .

[7]  Colin B. Begg 1. Cross design synthesis: A new strategy for medical effectiveness research. United States General Accounting Office, (GA0/PEMD‐92‐18), Washington, Dc, 1992. no. of pages: 121. Price: Free/(Available from US General Accounting Office, P.O. Box 6015, Gaithersburg, Md 20877, U.S.A.) , 1992 .

[8]  H. Kraemer,et al.  Effects of ethnicity on treatment attendance, stimulant response/dose, and 14-month outcome in ADHD. , 2003, Journal of consulting and clinical psychology.

[9]  H. Kraemer,et al.  National Institute of Mental Health Collaborative Multimodal Treatment Study of Children with ADHD (the MTA). Design challenges and choices. , 1997, Archives of general psychiatry.

[10]  K. Kelleher,et al.  Race/ethnicity and insurance status as factors associated with ADHD treatment patterns. , 2005, Journal of child and adolescent psychopharmacology.

[11]  H. Kraemer,et al.  Impairment and deportment responses to different methylphenidate doses in children with ADHD: the MTA titration trial. , 2001, Journal of the American Academy of Child and Adolescent Psychiatry.

[12]  P. Rothwell,et al.  External validity of randomised controlled trials: “To whom do the results of this trial apply?” , 2005, The Lancet.

[13]  R. Barkley Commentary on the Multimodal Treatment Study of Children with ADHD , 2000, Journal of abnormal child psychology.

[14]  E. Costello,et al.  Use, Persistence, and Intensity: Patterns of Care for Children's Mental Health Across One Year , 1999, Community Mental Health Journal.

[15]  J. Norcross,et al.  Evidence-based practices in mental health : debate and dialogue on the fundamental questions , 2006 .

[16]  J. Persons,et al.  Are results of randomized controlled trials useful to psychotherapists? , 1998, Journal of consulting and clinical psychology.

[17]  H. Kraemer,et al.  Socioeconomic status as a moderator of ADHD treatment outcomes. , 2002, Journal of the American Academy of Child and Adolescent Psychiatry.

[18]  M. Gould,et al.  Patterns of diagnostic comorbidity in a community sample of children aged 9 through 16 years. , 1993, Journal of the American Academy of Child and Adolescent Psychiatry.

[19]  J. Swanson,et al.  Moderators and mediators of treatment response for children with attention-deficit/hyperactivity disorder: the Multimodal Treatment Study of children with Attention-deficit/hyperactivity disorder. , 1999, Archives of general psychiatry.

[20]  M Davies,et al.  The NIMH Diagnostic Interview Schedule for Children Version 2.3 (DISC-2.3): description, acceptability, prevalence rates, and performance in the MECA Study. Methods for the Epidemiology of Child and Adolescent Mental Disorders Study. , 1996, Journal of the American Academy of Child and Adolescent Psychiatry.

[21]  E. Korn,et al.  Analysis of Health Surveys: Korn/Analysis , 1999 .

[22]  M. Weissman,et al.  The NIMH Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study: background and methodology. , 1996, Journal of the American Academy of Child and Adolescent Psychiatry.

[23]  M. Posternak,et al.  Are subjects in pharmacological treatment trials of depression representative of patients in routine clinical practice? , 2002, The American journal of psychiatry.

[24]  J. E. Stone,et al.  Peabody Picture Vocabulary Test-Revised (PPVT–R) , 1989, Diagnostique.

[25]  Dc Washington Diagnostic and Statistical Manual of Mental Disorders, 4th Ed. , 1994 .

[26]  H. Kraemer,et al.  ADHD comorbidity findings from the MTA study: comparing comorbid subgroups. , 2001, Journal of the American Academy of Child and Adolescent Psychiatry.

[27]  H. Kraemer,et al.  Multimodal treatment of ADHD in the MTA: an alternative outcome analysis. , 2001, Journal of the American Academy of Child and Adolescent Psychiatry.

[28]  A. Beck,et al.  An inventory for measuring depression. , 1961, Archives of general psychiatry.

[29]  Elizabeth B. Owens,et al.  Which treatment for whom for ADHD? Moderators of treatment response in the MTA. , 2003, Journal of consulting and clinical psychology.