Young adult outcomes in the follow-up of the multimodal treatment study of attention-deficit/hyperactivity disorder: symptom persistence, source discrepancy, and height suppression

James M Swanson; L Eugene Arnold; Brooke S G Molina; Margaret H Sibley; Lily T Hechtman; Stephen P Hinshaw; Howard B Abikoff; Annamarie Stehli; Elizabeth B Owens; John T Mitchell; Quyen Nichols; Andrea Howard; Laurence L Greenhill; Betsy Hoza; Jeffrey H Newcorn; Peter S Jensen; Benedetto Vitiello; Timothy Wigal; Jeffery N Epstein; Leanne Tamm; Kimberly D Lakes; James Waxmonsky; Marc Lerner; Joy Etcovitch; Desiree W Murray; Maximilian Muenke; Maria T Acosta; Mauricio Arcos-Burgos; William E Pelham; Helena C Kraemer; MTA Cooperative Group

doi:10.1111/jcpp.12684

Young adult outcomes in the follow-up of the multimodal treatment study of attention-deficit/hyperactivity disorder: symptom persistence, source discrepancy, and height suppression

J Child Psychol Psychiatry. 2017 Jun;58(6):663-678. doi: 10.1111/jcpp.12684. Epub 2017 Mar 10.

Authors

James M Swanson¹, L Eugene Arnold², Brooke S G Molina³, Margaret H Sibley⁴, Lily T Hechtman⁵, Stephen P Hinshaw⁶, Howard B Abikoff⁷, Annamarie Stehli¹, Elizabeth B Owens⁸, John T Mitchell⁹, Quyen Nichols¹⁰, Andrea Howard¹¹, Laurence L Greenhill¹², Betsy Hoza¹⁰, Jeffrey H Newcorn¹³, Peter S Jensen¹⁴, Benedetto Vitiello¹⁵, Timothy Wigal¹⁶, Jeffery N Epstein¹⁷, Leanne Tamm¹⁷, Kimberly D Lakes¹, James Waxmonsky¹⁸, Marc Lerner¹, Joy Etcovitch¹⁹, Desiree W Murray²⁰, Maximilian Muenke²¹, Maria T Acosta²¹, Mauricio Arcos-Burgos²², William E Pelham²³, Helena C Kraemer²⁴; MTA Cooperative Group

Collaborators

MTA Cooperative Group:
Joanne B Severe, John Richters, Donald Vereen, Glen R Elliott, Karen C Wells, C Keith Conners, John March, Dennis P Cantwell, Robert D Gibbons, Sue Marcus, Kwan Hur, Thomas Hanley, Karen Stern

Affiliations

¹ Department of Pediatrics, School of Medicine, University of California, Irvine, CA, USA.
² Department of Psychiatry, Nisonger Center, Ohio State University, Columbus, OH, USA.
³ Departments of Psychiatry and Psychology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
⁴ Department of Psychiatry, Florida International University, Miami, FL, USA.
⁵ Division of Child Psychiatry, McGill University, Montreal Children's Hospital, Montreal, QC, Canada.
⁶ Department of Psychology, University of California, Berkeley, CA, USA.
⁷ Child Study Center at New York University Langone Medical Center, New York, NY, USA.
⁸ Institute of Human Development, University of California, Berkeley, CA, USA.
⁹ Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.
¹⁰ Department of Psychological Science, University of Vermont, Burlington, VT, USA.
¹¹ Department of Psychology, Carleton University, Ottawa, ON, Canada.
¹² Department of Psychiatry, Columbia University, New York, NY, USA.
¹³ Department of Psychiatry, Mount Sinai Medical School, New York, NY, USA.
¹⁴ Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
¹⁵ National Institute of Mental Health, Bethesda, MD, USA.
¹⁶ Avida, Inc., Newport Beach, CA, USA.
¹⁷ Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
¹⁸ Penn State University, College of Medicine, Hershey, PA, USA.
¹⁹ Montreal Children's Hospital, Montreal, QC, Canada.
²⁰ Frank Porter Graham Child Development Institute, University of North Carolina, Chapel Hill, NC, USA.
²¹ National Human Genome Research Institute, Bethesda, MD, USA.
²² Institute of Translational Medicine, Universidad del Rosario, Bogata, Colombia.
²³ Department of Psychology, Florida International University, Miami, FL, USA.
²⁴ Department of Psychiatry, Stanford University, Stanford, CA, USA.

Abstract

Background: The Multimodal Treatment Study (MTA) began as a 14-month randomized clinical trial of behavioral and pharmacological treatments of 579 children (7-10 years of age) diagnosed with attention-deficit/hyperactivity disorder (ADHD)-combined type. It transitioned into an observational long-term follow-up of 515 cases consented for continuation and 289 classmates (258 without ADHD) added as a local normative comparison group (LNCG), with assessments 2-16 years after baseline.

Methods: Primary (symptom severity) and secondary (adult height) outcomes in adulthood were specified. Treatment was monitored to age 18, and naturalistic subgroups were formed based on three patterns of long-term use of stimulant medication (Consistent, Inconsistent, and Negligible). For the follow-up, hypothesis-generating analyses were performed on outcomes in early adulthood (at 25 years of age). Planned comparisons were used to estimate ADHD-LNCG differences reflecting persistence of symptoms and naturalistic subgroup differences reflecting benefit (symptom reduction) and cost (height suppression) associated with extended use of medication.

Results: For ratings of symptom severity, the ADHD-LNCG comparison was statistically significant for the parent/self-report average (0.51 ± 0.04, p < .0001, d = 1.11), documenting symptom persistence, and for the parent/self-report difference (0.21 ± 0.04, p < .0001, d = .60), documenting source discrepancy, but the comparisons of naturalistic subgroups reflecting medication effects were not significant. For adult height, the ADHD group was 1.29 ± 0.55 cm shorter than the LNCG (p < .01, d = .21), and the comparisons of the naturalistic subgroups were significant: the treated group with the Consistent or Inconsistent pattern was 2.55 ± 0.73 cm shorter than the subgroup with the Negligible pattern (p < .0005, d = .42), and within the treated group, the subgroup with the Consistent pattern was 2.36 ± 1.13 cm shorter than the subgroup with the Inconsistent pattern (p < .04, d = .38).

Conclusions: In the MTA follow-up into adulthood, the ADHD group showed symptom persistence compared to local norms from the LNCG. Within naturalistic subgroups of ADHD cases, extended use of medication was associated with suppression of adult height but not with reduction of symptom severity.

Keywords: Attention-deficit/hyperactivity disorder; follow-up studies; growth; longitudinal studies; medication effects; treatment trials.

Publication types

Observational Study
Randomized Controlled Trial

MeSH terms

Adolescent
Adult
Aftercare
Attention Deficit Disorder with Hyperactivity / drug therapy
Attention Deficit Disorder with Hyperactivity / physiopathology*
Attention Deficit Disorder with Hyperactivity / therapy*
Body Height / physiology*
Child
Combined Modality Therapy
Female
Follow-Up Studies
Humans
Male
Outcome Assessment, Health Care*
Severity of Illness Index*
Young Adult

Abstract

Publication types

MeSH terms

Grants and funding