multimodal study of children with adhd followup
- From: sprattJill@xxxxxxxxx
- Date: Tue, 21 Aug 2007 18:36:56 -0000
The 3-year followup of the Multimodal Treatment Study of Children with
Attention Deficit Hyperactivity Disorder (MTA) showed that the initial
advantages of medication management alone or in combination with
behavioral treatment over purely behavioral or routine community care
waned in the years after 14 months of controlled treatment ended. In
addition, the effects of stimulant medication effect on physical
growth in the follow-up phase of MTA confirmed an earlier finding that
taking medication slowed growth.
Also, by 24 and 36 months, more days of prescribed medication were
associated with more serious delinquency but not substance use.
Overall, the study concluded "cause-and-effect relationships between
medication treatment and delinquency are unclear; the absence of
associations between medication treatment and substance use needs to
be re-evaluated at older ages. Findings underscore the need for
continuous monitoring of these outcomes as children with ADHD enter
adolescence.
The follow-up of the MTA sample will continue as the participating
children go through adolescence and enter adulthood.
for more information see:
August, 2007 Journal of the American Academy of Child and Adolescent
Psychiatry (JAACAP)
1: J Am Acad Child Adolesc Psychiatry. 2007 Aug;46(8):989-1002. Links
3-year follow-up of the NIMH MTA study.Jensen PS, Arnold LE, Swanson
JM, Vitiello B, Abikoff HB, Greenhill LL, Hechtman L, Hinshaw SP,
Pelham WE, Wells KC, Conners CK, Elliott GR, Epstein JN, Hoza B, March
JS, Molina BS, Newcorn JH, Severe JB, Wigal T, Gibbons RD, Hur K.
Center for the Advancement of Children's Mental Health, Unit #78,
Columbia University/NYSPI, 1051 Riverside Drive, New York, NY 10027,
USA. pj131@xxxxxxxxxxxx
OBJECTIVE: In the intent-to-treat analysis of the Multimodal Treatment
Study of Children With ADHD (MTA), the effects of medication
management (MedMgt), behavior therapy (Beh), their combination (Comb),
and usual community care (CC) differed at 14 and 24 months due to
superiority of treatments that used the MTA medication algorithm (Comb
+MedMgt) over those that did not (Beh+CC). This report examines 36-
month outcomes, 2 years after treatment by the study ended. METHOD:
For primary outcome measures (attention-deficit/hyperactivity disorder
[ADHD] and oppositional defiant disorder [ODD] symptoms, social
skills, reading scores, impairment, and diagnostic status), mixed-
effects regression models and orthogonal contrasts examined 36-month
outcomes. RESULTS: At 3 years, 485 of the original 579 subjects
(83.8%) participated in the follow-up, now at ages 10 to 13 years,
(mean 11.9 years). In contrast to the significant advantage of MedMgt
+Comb over Beh+CC for ADHD symptoms at 14 and 24 months, treatment
groups did not differ significantly on any measure at 36 months. The
percentage of children taking medication >50% of the time changed
between 14 and 36 months across the initial treatment groups: Beh
significantly increased (14% to 45%), MedMed+Comb significantly
decreased (91% to 71%), and CC remained constant (60%-62%). Regardless
of their treatment use changes, all of the groups showed symptom
improvement over baseline. Notably, initial symptom severity, sex
(male), comorbidity, public assistance, and parental psychopathology
(ADHD) did not moderate children's 36-month treatment responses, but
these factors predicted worse outcomes over 36 months, regardless of
original treatment assignment. CONCLUSIONS: By 36 months, the earlier
advantage of having had 14 months of the medication algorithm was no
longer apparent, possibly due to age-related decline in ADHD symptoms,
changes in medication management intensity, starting or stopping
medications altogether, or other factors not yet evaluated.
PMID: 17667478 [PubMed - in process]
Related LinksNational Institute of Mental Health Multimodal Treatment
Study of ADHD follow-up: 24-month outcomes of treatment strategies for
attention-deficit/hyperactivity disorder. [Pediatrics. 2004]Nine
months of multicomponent behavioral treatment for ADHD and
effectiveness of MTA fading procedures. [J Abnorm Child Psychol.
2004]Clinical relevance of the primary findings of the MTA: success
rates based on severity of ADHD and ODD symptoms at the end of
treatment. [J Am Acad Child Adolesc Psychiatry. 2001]Findings from the
NIMH Multimodal Treatment Study of ADHD (MTA): implications and
applications for primary care providers. [J Dev Behav Pediatr.
2001]National Institute of Mental Health Multimodal Treatment Study of
ADHD follow-up: changes in effectiveness and growth after the end of
treatment. [Pediatrics. 2004]See all Related Articles...
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Clinical relevance of the primary findings of the MTA: success rates
based on severity of ADHD and ODD symptoms at the end of treatment.
J Am Acad Child Adolesc Psychiatry. 2001 Feb; 40(2):168-79.
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