Nine months of multicomponent behavioral treatment for ADHD and effectiveness of MTA fading procedures.
We examined 9-month data from the 14-month NIMH Multimodal Treatment Study of Children with ADHD (the MTA) as a further check on the relative effect of medication (MedMgt) and behavioral treatment (Beh) for attention-deficit/hyperactivity disorder (ADHD) while Beh was still being delivered at greater intensity than at 14-month endpoint, and conversely as a check on the efficacy of the MTA behavioral generalization/maintenance procedures. Intention-to-treat analysis at 9 months showed essentially the same results as at 14 months, after Beh had been completely faded; MedMgt and the combination (Comb) of medication and Beh were significantly superior to Beh and community care (CC) for ADHD and oppositional-defiant (ODD) symptoms, with mixed results for social skills and internalizing symptoms. All treatment-group differences examined as changes in slopes from 9 to 14 months were nonsignificant (we found general improvement for all groups). Slopes from baseline to 9 months correlated highly (r > .74, p < .0001) with slopes from baseline to 14 months for all groups. The time function from baseline to 14 months showed a significant linear, but not quadratic, trend for the main outcome measure (a composite of parent- and teacher-rated ADHD and ODD symptoms) for all groups. Findings suggest that in contrast to the hypothesized deterioration in the relative benefit of Beh between 9 and 14 months (after completion of fading), the MTA Beh generalization and maintenance procedures implemented through 9 months apparently yielded continuing improvement through 14 months, with preservation of the relative position of Beh compared to other treatment strategies.
The Ohio State University, Columbus, Ohio, USA. arnold.6@osu.edu
L Eugene
LE
Arnold
Shirley
S
Chuang
Mark
M
Davies
Howard B
HB
Abikoff
C Keith
CK
Conners
Glen R
GR
Elliott
Laurence L
LL
Greenhill
Lily
L
Hechtman
Stephen P
SP
Hinshaw
Betsy
B
Hoza
Peter S
PS
Jensen
Helena C
HC
Kraemer
Kristen S
KS
Langworthy-Lam
John S
JS
March
Jeffrey H
JH
Newcorn
William E
WE
Pelham
Joanne B
JB
Severe
James M
JM
Swanson
Benedetto
B
Vitiello
Karen C
KC
Wells
Timothy
T
Wigal
D000704:Analysis of Variance; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy / Q000628:therapy*; D019958:Attention Deficit and Disruptive Behavior Disorders / Q000188:drug therapy / Q000628:therapy; D001521:Behavior Therapy / Q000379:methods*; D002648:Child; D003131:Combined Modality Therapy; D005260:Female; D005793:Generalization, Psychological; D006801:Humans; D008297:Male; D013997:Time Factors