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

J Am Acad Child Adolesc Psychiatry. 2009 May;48(5):484-500. doi: 10.1097/CHI.0b013e31819c23d0.

Abstract

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.

Trial registration: ClinicalTrials.gov NCT00000388.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adolescent
  • Attention Deficit Disorder with Hyperactivity / drug therapy
  • Attention Deficit Disorder with Hyperactivity / psychology
  • Attention Deficit Disorder with Hyperactivity / therapy*
  • Attention Deficit and Disruptive Behavior Disorders / drug therapy
  • Attention Deficit and Disruptive Behavior Disorders / psychology
  • Attention Deficit and Disruptive Behavior Disorders / therapy*
  • Behavior Therapy / methods*
  • Behavioral Symptoms
  • Case-Control Studies
  • Child
  • Combined Modality Therapy
  • Community Mental Health Services
  • Diagnostic and Statistical Manual of Mental Disorders
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Psychiatric Status Rating Scales
  • Psychotropic Drugs / administration & dosage
  • Psychotropic Drugs / therapeutic use
  • Reference Values
  • Regression Analysis
  • Treatment Outcome

Substances

  • Psychotropic Drugs

Associated data

  • ClinicalTrials.gov/NCT00000388

Grant support