title: Young adult outcomes in the follow-up of the multimodal treatment study of attention-deficit/hyperactivity disorder: symptom persistence, source discrepancy, and height suppression.
abstract: BACKGROUND
  The Multimodal Treatment Study (MTA) began as a 14-month randomized clinical trial of behavioral and pharmacological treatments of 579 children (7-10 years of age) diagnosed with attention-deficit/hyperactivity disorder (ADHD)-combined type. It transitioned into an observational long-term follow-up of 515 cases consented for continuation and 289 classmates (258 without ADHD) added as a local normative comparison group (LNCG), with assessments 2-16 years after baseline.
  
  
  METHODS
  Primary (symptom severity) and secondary (adult height) outcomes in adulthood were specified. Treatment was monitored to age 18, and naturalistic subgroups were formed based on three patterns of long-term use of stimulant medication (Consistent, Inconsistent, and Negligible). For the follow-up, hypothesis-generating analyses were performed on outcomes in early adulthood (at 25 years of age). Planned comparisons were used to estimate ADHD-LNCG differences reflecting persistence of symptoms and naturalistic subgroup differences reflecting benefit (symptom reduction) and cost (height suppression) associated with extended use of medication.
  
  
  RESULTS
  For ratings of symptom severity, the ADHD-LNCG comparison was statistically significant for the parent/self-report average (0.51 ± 0.04, p < .0001, d = 1.11), documenting symptom persistence, and for the parent/self-report difference (0.21 ± 0.04, p < .0001, d = .60), documenting source discrepancy, but the comparisons of naturalistic subgroups reflecting medication effects were not significant. For adult height, the ADHD group was 1.29 ± 0.55 cm shorter than the LNCG (p < .01, d = .21), and the comparisons of the naturalistic subgroups were significant: the treated group with the Consistent or Inconsistent pattern was 2.55 ± 0.73 cm shorter than the subgroup with the Negligible pattern (p < .0005, d = .42), and within the treated group, the subgroup with the Consistent pattern was 2.36 ± 1.13 cm shorter than the subgroup with the Inconsistent pattern (p < .04, d = .38).
  
  
  CONCLUSIONS
  In the MTA follow-up into adulthood, the ADHD group showed symptom persistence compared to local norms from the LNCG. Within naturalistic subgroups of ADHD cases, extended use of medication was associated with suppression of adult height but not with reduction of symptom severity.
authors.affiliation: Department of Pediatrics, School of Medicine, University of California, Irvine, CA, USA.
authors.forename: James M
authors.initials: JM
authors.lastname: Swanson
authors.affiliation: Department of Psychiatry, Nisonger Center, Ohio State University, Columbus, OH, USA.
authors.forename: L Eugene
authors.initials: LE
authors.lastname: Arnold
authors.affiliation: Departments of Psychiatry and Psychology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Brooke S G
authors.initials: BSG
authors.lastname: Molina
authors.affiliation: Department of Psychiatry, Florida International University, Miami, FL, USA.
authors.forename: Margaret H
authors.initials: MH
authors.lastname: Sibley
authors.affiliation: Division of Child Psychiatry, McGill University, Montreal Children's Hospital, Montreal, QC, Canada.
authors.forename: Lily T
authors.initials: LT
authors.lastname: Hechtman
authors.affiliation: Department of Psychology, University of California, Berkeley, CA, USA.
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Hinshaw
authors.affiliation: Child Study Center at New York University Langone Medical Center, New York, NY, USA.
authors.forename: Howard B
authors.initials: HB
authors.lastname: Abikoff
authors.affiliation: Department of Pediatrics, School of Medicine, University of California, Irvine, CA, USA.
authors.forename: Annamarie
authors.initials: A
authors.lastname: Stehli
authors.affiliation: Institute of Human Development, University of California, Berkeley, CA, USA.
authors.forename: Elizabeth B
authors.initials: EB
authors.lastname: Owens
authors.affiliation: Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.
authors.forename: John T
authors.initials: JT
authors.lastname: Mitchell
authors.affiliation: Department of Psychological Science, University of Vermont, Burlington, VT, USA.
authors.forename: Quyen
authors.initials: Q
authors.lastname: Nichols
authors.affiliation: Department of Psychology, Carleton University, Ottawa, ON, Canada.
authors.forename: Andrea
authors.initials: A
authors.lastname: Howard
authors.affiliation: Department of Psychiatry, Columbia University, New York, NY, USA.
authors.forename: Laurence L
authors.initials: LL
authors.lastname: Greenhill
authors.affiliation: Department of Psychological Science, University of Vermont, Burlington, VT, USA.
authors.forename: Betsy
authors.initials: B
authors.lastname: Hoza
authors.affiliation: Department of Psychiatry, Mount Sinai Medical School, New York, NY, USA.
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Newcorn
authors.affiliation: Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
authors.forename: Peter S
authors.initials: PS
authors.lastname: Jensen
authors.affiliation: National Institute of Mental Health, Bethesda, MD, USA.
authors.forename: Benedetto
authors.initials: B
authors.lastname: Vitiello
authors.affiliation: Avida, Inc., Newport Beach, CA, USA.
authors.forename: Timothy
authors.initials: T
authors.lastname: Wigal
authors.affiliation: Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Jeffery N
authors.initials: JN
authors.lastname: Epstein
authors.affiliation: Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Leanne
authors.initials: L
authors.lastname: Tamm
authors.affiliation: Department of Pediatrics, School of Medicine, University of California, Irvine, CA, USA.
authors.forename: Kimberly D
authors.initials: KD
authors.lastname: Lakes
authors.affiliation: Penn State University, College of Medicine, Hershey, PA, USA.
authors.forename: James
authors.initials: J
authors.lastname: Waxmonsky
authors.affiliation: Department of Pediatrics, School of Medicine, University of California, Irvine, CA, USA.
authors.forename: Marc
authors.initials: M
authors.lastname: Lerner
authors.affiliation: Montreal Children's Hospital, Montreal, QC, Canada.
authors.forename: Joy
authors.initials: J
authors.lastname: Etcovitch
authors.affiliation: Frank Porter Graham Child Development Institute, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Desiree W
authors.initials: DW
authors.lastname: Murray
authors.affiliation: National Human Genome Research Institute, Bethesda, MD, USA.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Muenke
authors.affiliation: National Human Genome Research Institute, Bethesda, MD, USA.
authors.forename: Maria T
authors.initials: MT
authors.lastname: Acosta
authors.affiliation: Institute of Translational Medicine, Universidad del Rosario, Bogata, Colombia.
authors.forename: Mauricio
authors.initials: M
authors.lastname: Arcos-Burgos
authors.affiliation: Department of Psychology, Florida International University, Miami, FL, USA.
authors.forename: William E
authors.initials: WE
authors.lastname: Pelham
authors.affiliation: Department of Psychiatry, Stanford University, Stanford, CA, USA.
authors.forename: Helena C
authors.initials: HC
authors.lastname: Kraemer
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D055815:Young Adult; D000359:Aftercare; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy; D001827:Body Height / Q000502:physiology; D003131:Combined Modality Therapy; D005500:Follow-Up Studies; D017063:Outcome Assessment, Health Care; D012720:Severity of Illness Index
keywords: Attention-deficit/hyperactivity disorder; follow-up studies; growth; longitudinal studies; medication effects; treatment trials