title: Treatment of children with attention-deficit/hyperactivity disorder (ADHD) and irritability: results from the multimodal treatment study of children with ADHD (MTA).
abstract: OBJECTIVE
  Clinically impairing irritability affects 25% to 45% of children with attention-deficit/hyperactivity disorder (ADHD); yet, we know little about what interventions are effective in treating children with ADHD and co-occurring irritability. We used data from the Multimodal Treatment Study of Children With ADHD (MTA) to address 3 aims: to establish whether irritability in children with ADHD can be distinguished from other symptoms of oppositional defiant disorder (ODD); to examine whether ADHD treatment is effective in treating irritability; and to examine how irritability influences ADHD treatment outcomes.
  
  
  METHODS
  Secondary analyses of data from the MTA included multivariate analyses, and intent-to-treat random-effects regression models were used.
  
  
  RESULTS
  Irritability was separable from other ODD symptoms. For treating irritability, systematic stimulant treatment was superior to behavioral management but not to routine community care; a combination of stimulants and behavioral treatment was superior to community care and to behavioral treatment alone, but not to medication alone. Irritability did not moderate the impact of treatment on parent- and teacher-reported ADHD symptoms in any of the 4 treatment groups.
  
  
  CONCLUSIONS
  Treatments targeting ADHD symptoms are helpful for improving irritability in children with ADHD. Moreover, irritability does not appear to influence the response to treatment of ADHD.
  
  
  BACKGROUND
  Multimodal Treatment Study of Children With Attention Deficit and Hyperactivity Disorder (MTA); http://www.clinicaltrials.gov; NCT00000388.
authors.affiliation: Institute of Psychiatry, King's College London, UK. Electronic address: lorena.fernandez_de_la_cruz@kcl.ac.uk.
authors.forename: Lorena
authors.initials: L
authors.lastname: Fernández de la Cruz
authors.affiliation: Institute of Psychiatry, King's College London, UK.
authors.forename: Emily
authors.initials: E
authors.lastname: Simonoff
authors.affiliation: Semel Institute for Neuroscience and Human Behavior at the University of California, Los Angeles, USA.
authors.forename: James J
authors.initials: JJ
authors.lastname: McGough
authors.affiliation: Queens College, City University of New York, New York City, USA.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Halperin
authors.affiliation: Nisonger Center, The Ohio State University, Columbus, OH, USA.
authors.forename: L Eugene
authors.initials: LE
authors.lastname: Arnold
authors.affiliation: Institute of Psychiatry, King's College London, UK.
authors.forename: Argyris
authors.initials: A
authors.lastname: Stringaris
mesh_terms: D018759:Adrenergic Uptake Inhibitors / Q000627:therapeutic use; D001289:Attention Deficit Disorder with Hyperactivity / Q000150:complications / Q000188:drug therapy / Q000628:therapy*; D001521:Behavior Therapy / Q000379:methods*; D000697:Central Nervous System Stimulants / Q000627:therapeutic use*; D002648:Child; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007508:Irritable Mood / Q000187:drug effects / Q000502:physiology*; D008297:Male; D016896:Treatment Outcome
chemical_list: D018759:Adrenergic Uptake Inhibitors; D000697:Central Nervous System Stimulants
keywords: attention-deficit/hyperactivity disorder; irritability; oppositional defiant disorder; treatment outcomes