Indeed, arguments have been put forth that the symptom count thresholds developed for the diagnosis of ADHD in children may be overly stringent for adolescents and adults. Our results also lend some support to the idea that indicators of functioning beyond symptoms may be crucial, if not more important than measurement of symptoms, in the design and study of treatments for ADHD.
Given the wide-ranging differences between the MTA and LNCG samples in variables that transcend the symptoms of ADHD, and their potential importance as treatment targets, future clinical trials may be forced to broaden narrow definitions of primary outcome variables.
Taken together, these 8-year findings point to a crucial need for development of treatments that are efficacious, accessible, and lasting for high school-aged youth with ADHD and their parents. The available literature on this topic is quite small and in need of innovation. There is the temptation, despite our failure to find long-term advantage of medication treatment, to somehow improve adherence to medication treatment.
However, an under-recognized problem in the treatment of adolescent ADHD is the dramatic decline in medication adherence with the onset of adolescence. This decline is important in the larger context of studies finding poor adherence, more generally, with stimulant treatment regimens. Overall, the findings of this 6- and 8-year follow-up of the children in the MTA indicate that 1 treatment-related improvements for the children in the MTA are generally maintained, but differential treatment efficacy continues to be lost at and beyond months; 2 initial patient characteristics and demographics and improved ADHD symptom response to any of the MTA treatments or to community care predicts high-school-aged functioning for a range of outcomes; 3 on average, children with Combined Type ADHD, despite having received months of intensive, state-of-the-art behavior therapy or medication management, are functioning less well than their nonADHD age-mates across most indices of functioning.
Some children were lost to follow-up, and their families were demographically disadvantaged. These findings apply to a range of symptom and functioning indices including delinquency, arrests, grade retentions and letter grades earned in school, and psychiatric hospitalizations that occur for an important minority of the sample.
Hence, there is a practical need to pursue further research to develop and deliver more effective sustainable interventions, and to shift the emphasis in the field from reliance on ADHD symptoms as the key outcome of treatment to include measurement of impairments that bring families in for treatment and that are likely to mediate adulthood functioning. Jensen has received research funding from McNeil; has received unrestricted grants from Pfizer; has consulted to Best Practice, Inc.
Hoza has received research funding from MediaBalance, Inc. The opinions and assertions contained in this report are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of Health and Human Services, the National Institutes of Health, or the National Institute of Mental Health. The other authors report no conflicts of interest.
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Author manuscript; available in PMC Mar Brooke S. Molina , PhD, Stephen P. Hinshaw , PhD, James M. Swanson , PhD, L. Eugene Arnold , MD, M. Jensen , MD, Jeffery N. Abikoff , PhD, Glen R. Greenhill , MD, Jeffrey H. Newcorn , MD, Karen C. Author information Copyright and License information Disclaimer. Jensen, M. Eugene Arnold, M. Hinshaw, Ph. Berkeley , Glen R. Elliott, Ph. San Francisco ; Duke University: C. Keith Conners, Ph. Wells, Ph.
Irvine , Dennis P. Cantwell, M. Abikoff, Ph. Greenhill, M. Columbia , Jeffrey H. Newcorn, M. Pelham, Ph. D, Patricia R. Houck, MS. Original statistical and trial design consultant: Helena C.
Kraemer, Ph. Stanford University. Follow-up phase statistical collaborators: Robert D. Gibbons, Ph. University of Illinois, Chicago. Corresponding Author: Brooke S. Molina O'Hara St. Pittsburgh, PA ude.
Copyright notice. See other articles in PMC that cite the published article. 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. Keywords: ADHD , adolescence , clinical trial , longitudinal. Open in a separate window. DOI: Open Access. Open Journal of Statistics Vol. Open Journal of Pediatrics Vol. Open Journal of Psychiatry Vol. What is the role of behavioral therapy in treating ADHD? Which treatment is right for my child? Why do many social skills improve with medication?
Why were the MTA medication treatments more effective than community treatments that also usually included medication? How were children selected for this study? What are the main limitations of the MTA, and what happened after it concluded?
Where did this study take place? Where can I find more information about the MTA study? Arch Gen Psychiatry ; J Consult Clin Psychol ; This website uses cookies to improve your experience. We'll assume you're ok with this, but you can opt-out if you wish. Accept Reject Read More. Close Privacy Overview This website uses cookies to improve your experience while you navigate through the website.
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