Multimodal treatment of ADHD in the MTA: an alternative outcome analysis.
OBJECTIVE
To conduct a post hoc investigation of the utility of a single composite measure of treatment outcome for the NIMH Collaborative Multisite Multimodal Treatment Study of Children With Attention-Deficit/Hyperactivity Disorder (MTA) at 14 months postbaseline.


BACKGROUND
Examination of multiple measures one at a time in the main MTA intent-to-treat outcome analyses failed to detect a statistically significant advantage of combined treatment (Comb) over medication management (MedMgt). A measure that increases power and precision using a single outcome score may be a useful alternative to multiple outcome measures.


METHODS
Factor analysis of baseline scores yielded two "source factors" (parent and teacher) and one "instrument factor" (parent-child interactions). A composite score was created from the average of standardized parent and teacher measures.


RESULTS
The composite was internally consistent (alpha = .83), reliable (test-retest over 3 months = 0.86), and correlated 0.61 with clinician global judgments. In an intent-to-treat analysis, Comb was statistically significantly better than all other treatments, with effect sizes ranging from small (0.28) versus MedMgt, to moderately large (0.70) versus a community comparison group.


CONCLUSIONS
A composite of ADHD variables may be an important tool in future treatment trials with ADHD and may avoid some of the statistical limitations of multiple measures.
Conners
C K
CK
Attention Deficit Disorder Program, DUMC, 2200 West Main Street, Suite 230B, Durham, NC 27715, USA. conne011@mc.duke.edu
Epstein
J N
JN
March
J S
JS
Angold
A
A
Wells
K C
KC
Klaric
J
J
Swanson
J M
JM
Arnold
L E
LE
Abikoff
H B
HB
Elliott
G R
GR
Greenhill
L L
LL
Hechtman
L
L
Hinshaw
S P
SP
Hoza
B
B
Jensen
P S
PS
Kraemer
H C
HC
Newcorn
J H
JH
Pelham
W E
WE
Severe
J B
JB
Vitiello
B
B
Wigal
T
T
D000704:Analysis of Variance; D001289:Attention Deficit Disorder with Hyperactivity / Q000628:therapy*; D002648:Child; D003131:Combined Modality Therapy; D015987:Effect Modifier, Epidemiologic; D005163:Factor Analysis, Statistical; D006801:Humans; D011594:Psychometrics / Q000706:statistics & numerical data*; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D016896:Treatment Outcome