Socioeconomic status as a moderator of ADHD treatment outcomes.
OBJECTIVE
To explore whether socioeconomic status (SES) variables moderate treatment response of attention-deficit/hyperactivity disorder (ADHD) to medication management (MedMgt), behavioral treatment (Beh), combined intervention (Comb), and routine community care (CC).


METHODS
The MTA Cooperative Group's intent-to-treat (ITT) analyses were repeated, covarying for composite Hollingshead SES, education, occupation, income, and marital status.


RESULTS
Individual SES variables were more informative than the composite Hollingshead Index. Treatment response of children from less educated households paralleled ITT outcomes: no significant difference was found between Comb and MedMgt (both better than Beh and CC) for core ADHD symptoms. However, children from more educated families showed superior reduction of ADHD symptoms with Comb. For oppositional-aggressive symptoms, children from blue-collar, lower SES households benefited most from Comb, whereas those from white-collar, higher SES homes generally showed no differential treatment response. Household income and marital status failed to influence outcomes. Controlling for treatment attendance attenuated the moderating effects of the SES variables only for MedMgt.


CONCLUSIONS
Investigators are encouraged to use independent SES variables for maximal explanation of SES effects. Clinicians should prioritize target symptoms and consider the mediating role of treatment adherence when determining an ADHD patient's optimal intervention plan.
Rieppi
Ricardo
R
Department of Psychology, St. Johns University, Jamaica, NY 11439, USA. rriep477@stjohns.edu
Greenhill
Laurence L
LL
Ford
Rebecca E
RE
Chuang
Shirley
S
Wu
Min
M
Davies
Mark
M
Abikoff
Howard B
HB
Arnold
L Eugene
LE
Conners
C Keith
CK
Elliott
Glen R
GR
Hechtman
Lily
L
Hinshaw
Stephen P
SP
Hoza
Betsy
B
Jensen
Peter S
PS
Kraemer
Helena C
HC
March
John S
JS
Newcorn
Jeffrey H
JH
Pelham
William E
WE
Severe
Joanne B
JB
Swanson
James M
JM
Vitiello
Benedetto
B
Wells
Karen C
KC
Wigal
Timothy
T
D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000628:therapy*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D011569:Psychiatric Status Rating Scales; D011897:Random Allocation; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome