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Evidence, Interpretation, and Qualification From Multiple Reports of Long-Term Outcomes in the Multimodal Treatment Study of Children With ADHD (MTA)

Part I: Executive Summary

University of California, Irvine, jmswanso{at}uci.edu

L. Eugene Arnold

Ohio State University

Helena Kraemer

Stanford University

Lily Hechtman

McGill University

Brooke Molina

University of Pittsburgh School of Medicine

Stephen Hinshaw

University of California, Berkeley

Benedetto Vitiello

NIMH

Peter Jensen

REACH Institute (Resources for Advancing Children's Healthcare)

Ken Steinhoff

UCI

Marc Lerner

UCI

Laurence Greenhill

Columbia University

Howard Abikoff

New York University

Karen Wells

Duke University

Jeffery Epstein

Univeristy of Cincinnati

Glen Elliott

Children's Health Council

Jeffrey Newcorn

Mount Sinai School of Medicine and Co-PI of the Columbia/Mt. Sinai MTA site

Betsy Hoza

University of Vermont

Timothy Wigal

University of California, Irvine

Objective: To review the primary and secondary findings from the Multimodal Treatment study of ADHD (MTA) published over the past decade as three sets of articles. Method: In a two-part article—Part I: Executive Summary (without distracting details) and Part II: Supporting Details (with additional background and detail required by the complexity of the MTA)—we address confusion and controversy about the findings. Results: We discuss the basic features of the gold standard used to produce scientific evidence, the randomized clinical trial, for which was used to contrast four treatment conditions: medication management alone (MedMgt), behavior therapy alone (Beh), the combination of these two (Comb), and a community comparison of treatment "as usual" (CC). For each of the three assessment points we review three areas that we believe are important for appreciation of the findings: definition of evidence from the MTA, interpretation of the serial presentations of findings at each assessment point with a different definition of long-term, and qualification of the interim conclusions about long-term effects of treatments for ADHD. Conclusion: We discuss the possible clinical relevance of the MTA and present some practical suggestions based on current knowledge and uncertainties facing families, clinicians, and investigators regarding the long-term use of stimulant medication and behavioral therapy in the treatment of children with ADHD. (J. of Att. Dis. 2008; 12(1) 4-14)

Key Words: attention deficit/hyperactivity disorder • multimodal treatment • randomized clinical trial • stimulant medication • behavior modification

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