The MTA at 8 Years: Prospective Follow-Up of Children Treated for Combined Type ADHD in a Multisite Study

By Brooke S. G. Molina, Stephen P. Hinshaw, James M. Swanson, L. E. Arnold, B. Vitiello, Peter S. Jensen, Jeffery N. Epstein, B. Hoza, L. Hechtman, H. Abikoff and 8 more. Journal of the American Academy of Child and Adolescent Psychiatry, 2009

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Objectives To determine any long-term effects, 6 and 8 years after childhood enrollment, of the randomly assigned 14-month treatments in the Multimodal Treatment Study of Children with ADHD (MTA; N=436); to test whether Attention-Deficit/Hyperactivity Disorder (ADHD) symptom trajectory through 3-years predicts outcome in subsequent years; to examine functioning level of the MTA adolescents relative to their non-ADHD peers (Local Normative Comparison Group or LNCG; 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, or 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. MTA participants fared worse than LNCG 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 old) does not predict functioning six-to-eight 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 longterm prognosis. As a group, however, despite initial symptom improvement during treatment that is largely maintained post-treatment, children with Combined-Type ADHD exhibit significant impairment in adolescence. Innovative treatment approaches targeting specific areas of adolescent impairment are needed.

Subfields: Cognitive Neuroscience, Epidemiology, Psychiatry and Mental health

View Paper: https://www.semanticscholar.org/paper/6e9dd62deacc97a6fa07182323d1d9bc560e1ea2

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Citations in the corpus

Prospective Association of Childhood Attention-deficit/hyperactivity Disorder (ADHD) and Substance Use and Abuse/Dependence: A Meta-Analytic Review (2011, background): “…(Bédard et al., 2010; Ray et al., 2010; Volkow, Fowler, Wang, Baler, & Telang, 2009; Volkow et al., 2009) and methylphenidate (MPH) is a highly efficacious treatment for the core symptoms of ADHD, although recent evidence suggests that therapeutic response may be time-limited (Molina et al., 2008).”
Special Education Implications of Point and Cumulative Prevalence for Children With Emotional or Behavioral Disorders (2012, background): “Likewise, in a review of recent carefully controlled studies of intensive psychiatric treatment for ADHD, depression, or anxiety disorders, anywhere from half to nearly three quarters of affected children or adolescents responded to such treatment and thus no longer currently met diagnostic criteria”
ADHD in children and young people: prevalence, care pathways, and service provision. (2017, background): “Longer term naturalistic follow-up of these children highlighted continued effects for all groups but that the additional benefits seen in the medication groups were not sustained over time.(118) Whilst some authorities have argued that these findings suggest that medications do not work in the long”
Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents (2019, neutral): “As individuals with ADHD enter adolescence, their overt hyperactive and impulsive symptoms tend to decline, whereas their inattentive symptoms tend to persist.(13,14) Learning and language problems are common comorbid conditions with ADHD.”
A systematic review and analysis of long-term outcomes in attention deficit hyperactivity disorder: effects of treatment and non-treatment (2012, background): “The results of four studies included in this analysis that used both types of comparators within the same study ((1) non-ADHD controls and (2) untreated ADHD participants or ADHD participant’s pretreatment baseline) were consistent with the present overall observations that there was clear improveme”
Adaptive Interventions in Child and Adolescent Mental Health (2016, background): “For example, analysis of participants in the Multimodal Treatment of ADHD study demonstrated that (a) children who showed the most favorable clinical presentation at baseline and the best acute treatment response (approximately 52% of the sample) fared better over time, yet the majority of adolescen”
The roles of dopamine and noradrenaline in the pathophysiology and treatment of attention-deficit/hyperactivity disorder. (2011, background): “Prospective follow-up studies estimate that in about 50% of children with ADHD, symptoms carry on into adulthood and are associated with substance abuse, depression, unemployment, and criminal offenses when left untreated (3,4).”
Academic and Social Impairments of Elementary School Children With Attention Deficit Hyperactivity Disorder (2011, result): “…than controls on all 12 dependent measures, consistent with previous studies (Barkley et al., 1990; DuPaul et al., 2004; Greene et al., 1996; Faraone et al., 1998; Frazier et al., 2004; Frazier et al., 2007; McConaughy et al., 2009; Molina et al., 2009; Nigg et al., 2002; Solanto et al., 2007).”
Efficacy of Neurofeedback Treatment in ADHD: The Effects on Inattention, Impulsivity and Hyperactivity: A Meta-Analysis (2009, result): “This, in contrast to stimulant medication where it is known that when the medication is stopped often the initial complaints will come back again and recent evidence showing that temporary treatment with stimulant medication is not likely to improve long-term outcomes.(42)”