• DOI:10.1001/ARCHPSYC.56.12.1073
• Corpus ID: 11056506

A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. The MTA Cooperative Group. Multimodal Treatment Study of Children with ADHD.

@article{Jensen1999A1R,
  title={A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. The MTA Cooperative Group. Multimodal Treatment Study of Children with ADHD.},
  author={Pj Jensen and L. Eugene Arnold and John E. Richters and J B Severe and Donald R. Vereen and Benedetto Vitiello and Edler Schiller and Stephen P. Hinshaw and Gr Elliott and C. Keith Conners and K C Wells and John S. March and James M. Swanson and Timothy L. Wigal and Dennis P. Cantwell and H B Abikoff and J Hechtman and Ll Greeenhill and J H Newcorn and W. E. Pelham and Betsy Hoza and Hk Kraemer},
  journal={Archives of general psychiatry},
  year={1999},
  volume={56 12},
  pages={
          1073-86
        }
}

• P. Jensen, L. E. Arnold, +19 authors H. Kraemer
• Published 1 December 1999
• Psychology, Medicine
• Archives of general psychiatry

BACKGROUND
Previous studies have demonstrated the short-term efficacy of pharmacotherapy and behavior therapy for attention-deficit/hyperactivity disorder (ADHD), but no longer-term (i.e., >4 months) investigations have compared these 2 treatments or their combination.

METHODS
A group of 579 children with ADHD Combined Type, aged 7 to 9.9 years, were assigned to 14 months of medication management (titration followed by monthly visits); intensive behavioral treatment (parent, school, and child components, with therapist involvement gradually reduced over time); the two combined; or standard community care (treatments by community providers). Outcomes were assessed in multiple domains before and during treatment and at treatment end point (with the combined treatment and medication management groups continuing medication at all assessment points). Data were analyzed through intent-to-treat random-effects regression procedures.

RESULTS
All 4 groups showed sizable reductions in symptoms over time, with significant differences among them in degrees of change. For most ADHD symptoms, children in the combined treatment and medication management groups showed significantly greater improvement than those given intensive behavioral treatment and community care. Combined and medication management treatments did not differ significantly on any direct comparisons, but in several instances (oppositional/aggressive symptoms, internalizing symptoms, teacher-rated social skills, parent-child relations, and reading achievement) combined treatment proved superior to intensive behavioral treatment and/or community care while medication management did not. Study medication strategies were superior to community care treatments, despite the fact that two thirds of community-treated subjects received medication during the study period.

CONCLUSIONS
For ADHD symptoms, our carefully crafted medication management was superior to behavioral treatment and to routine community care that included medication. Our combined treatment did not yield significantly greater benefits than medication management for core ADHD symptoms, but may have provided modest advantages for non-ADHD symptom and positive functioning outcomes.