Psychosocial Treatment Strategies in the MTA Study: Rationale, Methods, and Critical Issues in Design and Implementation

ArticleinJournal of Abnormal Child Psychology 28(6):483-505 · January 2000with24 Reads
DOI: 10.1023/A:1005174913412
The Collaborative Multimodal Treatment Study of Children with Attention Deficit Hyperactivity Disorder (ADHD), the MTA, is the first multisite, cooperative agreement treatment study of children, and the largest psychiatric/psychological treatment trial ever conducted by the National Institute of Mental Health. It examines the effectiveness of Medication vs. Psychosocial treatment vs. their combination for treatment of ADHD and compares these experimental arms to each other and to routine community care. In a parallel group design, 579 (male and female) ADHD children, aged 7–9 years, 11 months, were randomly assigned to one of the four experimental arms, and then received 14 months of prescribed treatment (or community care) with periodic reassessments. After delineating the theoretical and empirical rationales for Psychosocial treatment of ADHD, we describe the MTA's Psychosocial Treatment strategy applied to all children in two of the four experimental arms (Psychosocial treatment alone; Combined treatment). Psychosocial treatment consisted of three major components: a Parent Training component, a two-part School Intervention component, and a child treatment component anchored in an intensive Summer Treatment Program. Components were selected based on evidence of treatment efficacy and because they address comprehensive symptom targets, settings, comorbidities, and functional domains. We delineate key conceptual and logistical issues faced by clinical researchers in design and implementation of Psychosocial research with examples of how these issues were addressed in the MTA study.


    • "ven that the APQ's five original scales could be reduced to a lower number as in previous studies (Clerkin et al. 2007; Molinuevo et al. 2011; Randolph and Radey 2011; Wells et al. 2000 ). In fact, a threefactor solution, in a way similar to previous studies, was found. However, it should be noted that three factors are not the same in all studies. Wells et al. (2000) found one factor of positive parenting (Parental Involvement) and two of negative parenting (Ineffective/Negative Discipline and Poor Monitoring), whereas Randolph and Radey (2011) obtained two factors of positive parenting (Positive Reinforcement and Positive Discipline) and only one of negative parenting (Negative Discipline). Moreove"
    [Show abstract] [Hide abstract] ABSTRACT: Despite difficulties measuring parenting styles, many studies have demonstrated a significant relationship between disruptive children and certain parenting practices. One of the most frequently used scales to measure parenting styles is the Alabama Parenting Questionnaire (APQ). This scale was originally defined based on theoretical dimensions and using samples from the USA. Therefore, both factor analysis studies and its adaptation to other countries have been proposed to improve and widen its use. The aim of this study was to adapt the APQ to the Italian population. A community sample of 258 mothers and children (94 %) and 192 fathers (70 %) from 274 families with children from 10- to 14-years-old who agreed to participate and met the inclusion criteria completed the APQ. Principal components and exploratory factor analyses resulted in a unique 19-item version of the APQ for mothers, fathers, and children. This unified version has resulted in two factor categories: positive (12 items) and negative parenting (7 items). The internal consistency and goodness of fit of the model were satisfactory. Moderate and significant convergent validity were found for mothers and fathers but not for children. In fact, we found differences in validity rates among the participants. Children perceived less positive and more negative parenting than did fathers and mothers, and mothers believed that they provided more positive parenting than did other parents. In conclusion, the APQ Italian version of the parents and children global report forms are considered a suitable measure for positive and negative parenting styles with acceptable validity and reliability indices.
    Full-text · Article · Sep 2015
    • "The ADHD group treatment program used in this study is an 8-session manualized BPT program, based on the 10-session program originally developed by Barkley (1997) and the 35-session program used in the MTA study (Wells et al., 2000). It specifically focused on issues related to children with ADHD. "
    [Show abstract] [Hide abstract] ABSTRACT: Objective: This study examined the feasibility and effectiveness of a behavioral parent training (BPT) group intervention implemented in an outpatient mental health setting in reducing child impairments and increasing parenting confidence in managing child behavior. Method: Parents of 241 children with ADHD participated in the eight-session parent group program, completing the Impairment Rating Scale (IRS) and a measure of parenting confidence at the first and last session. Results: Parents reported improvements in child behavior across all domains of the IRS, with the largest improvements in terms of overall impairment, parent-child relationship, and impact of child behavior on the family. Parents also reported increased confidence in managing their child's behavior. Conclusion: These findings suggest that brief BPT group programs administered to a diverse range of attendees in a typical outpatient setting result in improvements in functional impairments comparable with those produced in controlled studies, as well as improved parenting confidence.
    Full-text · Article · Apr 2013
    • "paraprofessional, and behavioral interventions in a summer camp (Wells et al., 2000). In addition, several other investigative teams have developed and evaluated programs involving classroom interventions and parent training (e.g., Abikoff et al., 2004; Kern et al., 2007; Owens, Murphy, Richerson, Girio, & Himawan, 2008; Pfiffner, Mikami, Huang- Pollock, Easterlin, Zalecki, & MvBurnett, 2007). "
    [Show abstract] [Hide abstract] ABSTRACT: Although numerous studies have evaluated the effectiveness of multi-modal psychosocial interventions for children with attention deficit hyperactivity disorder, these programs are limited in that there has not beeti an explicit focus on the connection between fatnily and school. This study was designed to develop and pilot test a family-school ititervention, Family-School Success-Early Elementary (FSS-EE), for kindergarten and first-grade studetits with attention deficit hyperactivity disorder. Key components of FSS-EE were family-school behavioral consultatioti, daily report cards, and strategies to improve parent-child relationships atid family involvement in educatioti. FSS-EE was developed using a multistep iterative process. The piloted version consisted of 12 weekly sessions including 6 group meetings, 4 individualized family sessions, and 2 school-based consultations. Families participating in the study were given the choice of placing their childreti on medication; 25% of children were on medication at the time of random assignmetit. Childreti (n = 61) were randomly assigned to FSS-EE or a comparison group controlling for nonspecific treatment effects. Outcomes were assessed at post interventioti and 2-month follow-up. Study findings indicated that FSS-EE was feasible to implement and acceptable to paretits atid teachers. In addition, the findings provided preliminary evidence that FSS-EE is effective in improving parenting practices, child behavior at school, and the student-teacher relationship.
    Full-text · Article · Dec 2012
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