Evidence, Interpretation, and Qualification From Multiple Reports of Long-Term Outcomes in the Multimodal Treatment Study of Children With ADHD (MTA) Part I: Executive Summary

UCI Child Development Center, University of California, Irvine, Irvine, CA 92612, USA.
Journal of Attention Disorders (Impact Factor: 3.78). 08/2008; 12(1):4-14. DOI: 10.1177/1087054708319345
Source: PubMed


To review the primary and secondary findings from the Multimodal Treatment study of ADHD (MTA) published over the past decade as three sets of articles.
In a two-part article-Part I: Executive Summary (without distracting details) and Part II: Supporting Details (with additional background and detail required by the complexity of the MTA)-we address confusion and controversy about the findings.
We discuss the basic features of the gold standard used to produce scientific evidence, the randomized clinical trial, for which was used to contrast four treatment conditions: medication management alone (MedMgt), behavior therapy alone (Beh), the combination of these two (Comb), and a community comparison of treatment "as usual" (CC). For each of the three assessment points we review three areas that we believe are important for appreciation of the findings: definition of evidence from the MTA, interpretation of the serial presentations of findings at each assessment point with a different definition of long-term, and qualification of the interim conclusions about long-term effects of treatments for ADHD.
We discuss the possible clinical relevance of the MTA and present some practical suggestions based on current knowledge and uncertainties facing families, clinicians, and investigators regarding the long-term use of stimulant medication and behavioral therapy in the treatment of children with ADHD.

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    • "In contrast to the studies using self-selected naturalistic settings, a well-known MTA study was conducted using a randomized-controlled design in the first 14 months. The series reports of the MTA study indicated that all dimensions of neurocognitive performance among medicated patients were superior to those among unmedicated patients at the 24 month assessment point (Epstein et al. 2006); nevertheless, the residual relative benefit of the medication treatment did not remain after 36 months (Swanson et al. 2008). Nevertheless, the participants in the MTA study were tested while they received treatment, as was routine procedure. "
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    ABSTRACT: Objective: This study investigated the trends in neurocognitive function and behavioral symptoms among patients with attention-deficit/hyperactivity disorder (ADHD) during 24 months of treatment with methylphenidate in a clinical setting. Methods: Study participants consisted of 181 ADHD patients with a mean age of 13.4±2.5 years (ages ranged from 8 to 18 years; 151 boys and 30 girls) who were prescribed oral short-acting methylphenidate two or three times daily, with each dose ranging between 0.3 and 1.0 mg/kg. At baseline and 6, 12, 18, and 24 months from baseline, neurocognitive function was assessed using the Test of Variables of Attention (TOVA) on the day the patient was off medication, and behavioral symptoms were evaluated using the Swanson, Nolan, and Pelham Version IV Scale for ADHD (SNAP-IV) parent form, the SNAP-IV teacher form, and the ADHD-Rating Scale (completed by a child psychiatrist). Results: Of the 181 ADHD patients at the initial visit, 103 (56.9%) completed the study. During the 24-month methylphenidate treatment, only the commission errors in TOVA significantly improved; however, the omission errors, response time, response time variability, response sensitivity, and ADHD score did not. The behavioral symptoms of ADHD, observed by various informants, all declined substantially, and were significantly correlated with each other during the long-term follow-up. The severity of teacher ratings was lower than that of parent and psychiatrist ratings. However, the teacher-rated inattention symptoms showed the strongest correlations with TOVA performance. Conclusions: Findings suggest that neurocognitive deficits in ADHD patients, except inhibition ability, might be long lasting in realistic settings. In addition, obtaining behavior profile assessments from multiple informants, especially from teachers, is vital for establishing a complete understanding of ADHD patients.
    Journal of Child and Adolescent Psychopharmacology 01/2015; 25(3). DOI:10.1089/cap.2014.0015 · 2.93 Impact Factor
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    • "The SNAP-IV was originally developed to assess ADHD symptoms according the DSM-III. Bussing et al [59] evaluated the short 26-item MTA version, named after its use in the Multimodal Treatment Study for ADHD [60], [61]. The questionnaire makes use of both teacher and parent ratings. "
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    ABSTRACT: Little is known about reliability and validity of instruments measuring externalizing mental health problems in immigrant ethnic minority youths. To provide an overview of studies on measurement properties of instruments measuring these problems in immigrant ethnic minority youths, their methodological quality and results. A systematic review of the literature in MEDLINE, EMbase, PsycINFO and Cochrane Library was performed. Evaluation of methodological quality of studies found was done by using the 'COSMIN-checklist'. Full text, original articles, published in English after 1990 were included. Articles had to concern the development or evaluation of the measurement properties of self-reported, parent-reported and/or teacher- or clinician-reported questionnaires assessing or screening externalizing mental health problems in immigrant ethnic minority youths. Specific results of analyses on (an) immigrant ethnic minority group had to be given. Twenty-nine studies evaluating 18 instruments met our criteria. Most studies concerned instruments with known validity in Western populations, tested mainly in African Americans. Considering methodological quality, inequivalences between ethnicities were found, self-reports seemed to perform better, and administration of an instrument influenced reliability and validity. It seems that the majority of instruments for assessing externalizing problems in immigrant ethnic minority youths is currently not sufficiently validated. Further evaluating existing instruments is crucial to accurately assess and interpreted externalizing problems in immigrant ethnic minority youths.
    PLoS ONE 05/2013; 8(5):e63109. DOI:10.1371/journal.pone.0063109 · 3.23 Impact Factor
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    • "Thus the transfer between child and adult services occurs at a time of increased vulnerability, when young people with ADHD may require guidance and support from trusted carers, including health care professionals. Data from the Multimodal Treatment of ADHD (MTA) study clearly suggests that well thought through and organized evidence based treatment protocols can improve outcomes for those with ADHD [11,12]. However, as ADHD has not yet been widely embraced by adult mental health services in the UK, many are untreated [13] and there are limited established clinical services offering planned transition to adult teams for young people with ADHD. "
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    ABSTRACT: Attention deficit hyperactivity disorder (ADHD) is a common childhood disorder that frequently persists into adulthood. However, in the UK, there is a paucity of adult services available for the increasing number of young people with ADHD who are now graduating from child services. Furthermore, there is limited research investigating the transition of young people with ADHD from child to adult services and a lack of guidance on how to achieve this effectively. This paper reviews the difficulties of young people with ADHD and their families who are transitioning between services; we review transition from the child and adult health teams' perspectives and identify barriers to the transition process. We conclude with recommendations on how to develop transition services for young people with ADHD.
    BMC Psychiatry 11/2011; 11(1):174. DOI:10.1186/1471-244X-11-174 · 2.21 Impact Factor
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