The MTA at 8 years: prospective follow-up of children treated for combined-type ADHD in a multisite study.

OBJECTIVES To determine any long-term effects, 6 and 8 years after childhood enrollment, of the randomly assigned 14-month treatments in the NIMH Collaborative Multisite Multimodal Treatment Study of Children With Attention-Deficit/Hyperactivity Disorder (MTA; N = 436); to test whether attention-deficit/hyperactivity disorder (ADHD) symptom trajectory through 3 years predicts outcome in subsequent years; and to examine functioning level of the MTA adolescents relative to their non-ADHD peers (local normative comparison group; N = 261). METHOD Mixed-effects regression models with planned contrasts at 6 and 8 years tested a wide range of symptom and impairment variables assessed by parent, teacher, and youth report. RESULTS In nearly every analysis, the originally randomized treatment groups did not differ significantly on repeated measures or newly analyzed variables (e.g., grades earned in school, arrests, psychiatric hospitalizations, other clinically relevant outcomes). Medication use decreased by 62% after the 14-month controlled trial, but adjusting for this did not change the results. ADHD symptom trajectory in the first 3 years predicted 55% of the outcomes. The MTA participants fared worse than the local normative comparison group on 91% of the variables tested. CONCLUSIONS Type or intensity of 14 months of treatment for ADHD in childhood (at age 7.0-9.9 years) does not predict functioning 6 to 8 years later. Rather, early ADHD symptom trajectory regardless of treatment type is prognostic. This finding implies that children with behavioral and sociodemographic advantage, with the best response to any treatment, will have the best long-term prognosis. As a group, however, despite initial symptom improvement during treatment that is largely maintained after treatment, children with combined-type ADHD exhibit significant impairment in adolescence. Innovative treatment approaches targeting specific areas of adolescent impairment are needed.

[1]  G. Salmon,et al.  Attention deficit hyperactivity disorder. , 2018, British journal of hospital medicine.

[2]  Daniel L. Segal,et al.  Diagnostic Interview Schedule for DSM-IV (DIS-IV) , 2010 .

[3]  George Mendelson,et al.  Book Reviews , 1995 .

[4]  Nora D Volkow,et al.  Psychopharmacology: concepts and opinions about the use of stimulant medications. , 2009, Journal of child psychology and psychiatry, and allied disciplines.

[5]  H. Kraemer,et al.  Evidence, Interpretation, and Qualification From Multiple Reports of Long-Term Outcomes in the Multimodal Treatment Study of Children With ADHD (MTA) , 2008, Journal of attention disorders.

[6]  G. DuPaul,et al.  Improving School Outcomes for Students With ADHD , 2008, Journal of attention disorders.

[7]  K. Dodge,et al.  Fast track randomized controlled trial to prevent externalizing psychiatric disorders: findings from grades 3 to 9. , 2007, Journal of the American Academy of Child and Adolescent Psychiatry.

[8]  Robert D Gibbons,et al.  3-year follow-up of the NIMH MTA study. , 2007, Journal of the American Academy of Child and Adolescent Psychiatry.

[9]  Kimberly Hoagwood,et al.  Secondary evaluations of MTA 36-month outcomes: propensity score and growth mixture model analyses. , 2007, Journal of the American Academy of Child and Adolescent Psychiatry.

[10]  J. Swanson,et al.  Delinquent behavior and emerging substance use in the MTA at 36 months: prevalence, course, and treatment effects. , 2007, Journal of the American Academy of Child and Adolescent Psychiatry.

[11]  R. Perou,et al.  National Estimates and Factors Associated With Medication Treatment for Childhood Attention-Deficit/Hyperactivity Disorder , 2007, Pediatrics.

[12]  L. Leslie,et al.  ADHD service use patterns in youth. , 2007, Ambulatory pediatrics : the official journal of the Ambulatory Pediatric Association.

[13]  R. Ross,et al.  Psychotic and manic-like symptoms during stimulant treatment of attention deficit hyperactivity disorder. , 2006, The American journal of psychiatry.

[14]  Elizabeth B. Owens,et al.  Prospective follow-up of girls with attention-deficit/hyperactivity disorder into adolescence: Evidence for continuing cross-domain impairment. , 2006, Journal of consulting and clinical psychology.

[15]  Donald Hedeker,et al.  Longitudinal Data Analysis , 2006 .

[16]  S. Faraone,et al.  Symptoms versus impairment: the case for respecting DSM-IV's Criterion D. , 2005, Journal of attention disorders.

[17]  Russell A. Barkley,et al.  Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment, 3rd ed. , 2006 .

[18]  Greta M. Massetti,et al.  Evidence-Based Assessment of Attention Deficit Hyperactivity Disorder in Children and Adolescents , 2005, Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53.

[19]  J. Severe,et al.  Reliability of the services for children and adolescents-parent interview. , 2004, Journal of the American Academy of Child and Adolescent Psychiatry.

[20]  J. Swanson,et al.  The services for children and adolescents-parent interview: development and performance characteristics. , 2004, Journal of the American Academy of Child and Adolescent Psychiatry.

[21]  G. Weiss,et al.  Symptomatic improvement in children with ADHD treated with long-term methylphenidate and multimodal psychosocial treatment. , 2004, Journal of the American Academy of Child and Adolescent Psychiatry.

[22]  S. Faraone,et al.  Age-dependent expression of attention-deficit/hyperactivity disorder symptoms. , 2004, The Psychiatric clinics of North America.

[23]  J. Swanson,et al.  National Institute of Mental Health Multimodal Treatment Study of ADHD follow-up: 24-month outcomes of treatment strategies for attention-deficit/hyperactivity disorder. , 2004, Pediatrics.

[24]  J. Swanson,et al.  National Institute of Mental Health Multimodal Treatment Study of ADHD follow-up: changes in effectiveness and growth after the end of treatment. , 2004, Pediatrics.

[25]  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.

[26]  R. Barkley,et al.  Does the treatment of attention‐deficit/hyperactivity disorder with stimulants contribute to drug use/abuse? , 2003, Pediatrics.

[27]  W. Pelham,et al.  Attention-deficit hyperactivity disorder and problems in peer relations: predictions from childhood to adolescence. , 2001, Journal of the American Academy of Child and Adolescent Psychiatry.

[28]  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.

[29]  D. R. Smith,et al.  CHAPTER 6 – Wechsler Individual Achievement Test , 2001 .

[30]  J. Swanson,et al.  Psychosocial Treatment Strategies in the MTA Study: Rationale, Methods, and Critical Issues in Design and Implementation , 2000, Journal of abnormal child psychology.

[31]  D. Shaffer,et al.  NIMH Diagnostic Interview Schedule for Children Version IV (NIMH DISC-IV): description, differences from previous versions, and reliability of some common diagnoses. , 2000, Journal of the American Academy of Child and Adolescent Psychiatry.

[32]  B. Roberts,et al.  The rank-order consistency of personality traits from childhood to old age: a quantitative review of longitudinal studies. , 2000, Psychological bulletin.

[33]  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.

[34]  S. Hinshaw,et al.  The Multidimensional Anxiety Scale for Children (MASC): Confirmatory factor analysis in a pediatric ADHD sample , 1999 .

[35]  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.

[36]  R. Barkley,et al.  Treatment of childhood disorders , 1998 .

[37]  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.

[38]  J. Swanson,et al.  Comprehensive assessment of childhood Attention-Deficit Hyperactivity Disorder in the context of a multisite, multimodal clinical trial , 1997 .

[39]  J. Swanson,et al.  Medication treatment strategies in the MTA Study: relevance to clinicians and researchers. , 1996, Journal of the American Academy of Child and Adolescent Psychiatry.

[40]  Brooks Applegate,et al.  Developmental change in attention-deficit hyperactivity disorder in boys: A four-year longitudinal study , 1995, Journal of abnormal child psychology.

[41]  J. Swanson,et al.  NIMH collaborative multisite multimodal treatment study of children with ADHD: I. Background and rationale. , 1995, Journal of the American Academy of Child and Adolescent Psychiatry.

[42]  D. Shaffer,et al.  The Columbia Impairment Scale (CIS): Pilot findings on a measure of global impairment for children and adolescents. , 1993 .

[43]  Jacob Cohen,et al.  A power primer. , 1992, Psychological bulletin.

[44]  Larry B. Silver,et al.  Attention Deficit Hyperactivity Disorder. A Handbook for Diagnosis and Treatment , 1991 .

[45]  R. Barkley,et al.  The adolescent outcome of hyperactive children diagnosed by research criteria: I. An 8-year prospective follow-up study. , 1990, Journal of the American Academy of Child and Adolescent Psychiatry.

[46]  A. Beck,et al.  An inventory for measuring clinical anxiety: psychometric properties. , 1988, Journal of consulting and clinical psychology.

[47]  Michael J. Kovacs.  Children’s Depression Inventory , 2014 .

[48]  M. Kovacs.  The Children's Depression, Inventory (CDI). , 1985, Psychopharmacology bulletin.

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