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Findings from the NIMH Multimodal Treatment Study of ADHD (MTA): Implications and Applications for Primary Care Providers

 

作者: PETER JENSEN,   STEPHEN HINSHAW,   JAMES SWANSON,   LAURENCE GREENHILL,   C. CONNERS,   L. ARNOLD,   HOWARD ABIKOFF,   GLEN ELLIOTT,   LILY HECHTMAN,   BETSY HOZA,   JOHN MARCH,   JEFFREY NEWCORN,   JOANNE SEVERE,   BENEDETTO VITIELLO,   KAREN WELLS,   TIMOTHY WIGAL,  

 

期刊: Journal of Developmental & Behavioral Pediatrics  (OVID Available online 2001)
卷期: Volume 22, issue 1  

页码: 60-73

 

ISSN:0196-206X

 

年代: 2001

 

出版商: OVID

 

关键词: ADHD;stimulants;behavior therapy;attention deficit;treatment;outcomes

 

数据来源: OVID

 

摘要:

In 1992, the National Institute of Mental Health and 6 teams of investigators began a multisite clinical trial, the Multimodal Treatment of Attention-Deficit Hyperactivity Disorder (MTA) study. Five hundred seventy-nine children were randomly assigned to either routine community care (CC) or one of three study-delivered treatments, all lasting 14 months. The three MTA treatments-monthly medication management (usually methylphenidate) following weekly titration (MedMgt), intensive behavioral treatment (Beh), and the combination (Comb)-were designed to reflect known best practices within each treatment approach. Children were assessed at four time points in multiple outcome. Results indicated that Comb and MedMgt interventions were substantially superior to Beh and CC interventions for attention-deficit hyperactivity disorder symptoms. For other functioning domains (social skills, academics, parent-child relations, oppositional behavior, anxiety/depression), results suggested slight advantages of Comb over single treatments (MedMgt, Beh) and community care. High quality medication treatment characterized by careful yet adequate dosing, three times daily methylphenidate administration, monthly follow-up visits, and communication with schools conveyed substantial benefits to those children that received it. In contrast to the overall study findings that showed the largest benefits for high quality medication management (regardless of whether given in the MedMgt or Comb group), secondary analyses revealed that Comb had a significant incremental effect over MedMgt (with a small effect size for this comparison) when categorical indicators of excellent response and when composite outcome measures were used. In addition, children with parent-defined comorbid anxiety disorders, particularly those with overlapping disruptive disorder comorbidities, showed preferential benefits to the Beh and Comb interventions. Parental attitudes and disciplinary practices appeared to mediate improved response to the Beh and Comb interventions.

 

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