Clinical relevance of the primary findings of the MTA: success rates based on severity of ADHD and ODD symptoms at the end of treatment.
OBJECTIVE
To develop a categorical outcome measure related to clinical decisions and to perform secondary analyses to supplement the primary analyses of the NIMH Collaborative Multisite Multimodal Treatment Study of Children With Attention-Deficit/Hyperactivity Disorder (MTA).


METHODS
End-of-treatment status was summarized by averaging the parent and teacher ratings of attention-deficit/hyperactivity disorder and oppositional defiant disorder symptoms on the Swanson, Nolan, and Pelham, version IV (SNAP-IV) scale, and low symptom-severity ("Just a Little") on this continuous measure was set as a clinical cutoff to form a categorical outcome measure reflecting successful treatment. Three orthogonal comparisons of the treatment groups (combined treatment [Comb], medication management [MedMgt], behavioral treatment [Beh], and community comparison [CC]) evaluated hypotheses about the MTA medication algorithm ("Comb + MedMgt versus Beh + CC"), multimodality superiority ("Comb versus MedMgt"), and psychosocial substitution ("Beh versus CC").


RESULTS
The summary of SNAP-IV ratings across sources and domains increased the precision of measurement by 30%. The secondary analyses of group differences in success rates (Comb = 68%; MedMgt = 56%; Beh = 34%; CC = 25%) confirmed the large effect of the MTA medication algorithm and a smaller effect of multimodality superiority, which was now statistically significant (p < .05). The psychosocial substitution effect remained negligible and nonsignificant.


CONCLUSIONS
These secondary analyses confirm the primary findings and clarify clinical decisions about the choice between multimodal and unimodal treatment with medication.
Swanson
J M
JM
University of California at Irvine, Child Development Center, 19722 MacArthur Blvd., Irvine, CA 92612, USA. jmswanso@uci.edu
Kraemer
H C
HC
Hinshaw
S P
SP
Arnold
L E
LE
Conners
C K
CK
Abikoff
H B
HB
Clevenger
W
W
Davies
M
M
Elliott
G R
GR
Greenhill
L L
LL
Hechtman
L
L
Hoza
B
B
Jensen
P S
PS
March
J S
JS
Newcorn
J H
JH
Owens
E B
EB
Pelham
W E
WE
Schiller
E
E
Severe
J B
JB
Simpson
S
S
Vitiello
B
B
Wells
K
K
Wigal
T
T
Wu
M
M
D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis* / Q000628:therapy; D019958:Attention Deficit and Disruptive Behavior Disorders / Q000175:diagnosis* / Q000628:therapy; D002648:Child; D003131:Combined Modality Therapy; D006801:Humans; D015233:Models, Statistical; D011594:Psychometrics / Q000706:statistics & numerical data*; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data*; D012720:Severity of Illness Index; D016896:Treatment Outcome