title: Multimodal treatment of ADHD in the MTA: an alternative outcome analysis.
abstract: 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.
authors.affiliation: Attention Deficit Disorder Program, DUMC, 2200 West Main Street, Suite 230B, Durham, NC 27715, USA. conne011@mc.duke.edu
authors.forename: C K
authors.initials: CK
authors.lastname: Conners
authors.forename: J N
authors.initials: JN
authors.lastname: Epstein
authors.forename: J S
authors.initials: JS
authors.lastname: March
authors.forename: A
authors.initials: A
authors.lastname: Angold
authors.forename: K C
authors.initials: KC
authors.lastname: Wells
authors.forename: J
authors.initials: J
authors.lastname: Klaric
authors.forename: J M
authors.initials: JM
authors.lastname: Swanson
authors.forename: L E
authors.initials: LE
authors.lastname: Arnold
authors.forename: H B
authors.initials: HB
authors.lastname: Abikoff
authors.forename: G R
authors.initials: GR
authors.lastname: Elliott
authors.forename: L L
authors.initials: LL
authors.lastname: Greenhill
authors.forename: L
authors.initials: L
authors.lastname: Hechtman
authors.forename: S P
authors.initials: SP
authors.lastname: Hinshaw
authors.forename: B
authors.initials: B
authors.lastname: Hoza
authors.forename: P S
authors.initials: PS
authors.lastname: Jensen
authors.forename: H C
authors.initials: HC
authors.lastname: Kraemer
authors.forename: J H
authors.initials: JH
authors.lastname: Newcorn
authors.forename: W E
authors.initials: WE
authors.lastname: Pelham
authors.forename: J B
authors.initials: JB
authors.lastname: Severe
authors.forename: B
authors.initials: B
authors.lastname: Vitiello
authors.forename: T
authors.initials: T
authors.lastname: Wigal
mesh_terms: 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