Treatment of children with attention-deficit/hyperactivity disorder (ADHD) and irritability: results from the multimodal treatment study of children with ADHD (MTA)

Lorena Fernández de la Cruz, Emily Simonoff, James J McGough, Jeffrey M Halperin, L Eugene Arnold, Argyris Stringaris, Lorena Fernández de la Cruz, Emily Simonoff, James J McGough, Jeffrey M Halperin, L Eugene Arnold, Argyris Stringaris

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.

Method: 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.

Conclusion: 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.

Clinical trial registration information: Multimodal Treatment Study of Children With Attention Deficit and Hyperactivity Disorder (MTA); http://www.clinicaltrials.gov; NCT00000388.

Keywords: attention-deficit/hyperactivity disorder; irritability; oppositional defiant disorder; treatment outcomes.

Copyright © 2015 American Academy of Child & Adolescent Psychaitry. Published by Elsevier Inc. All rights reserved.

Figures

Figure S1
Figure S1
Path analyses of the relation between irritability and headstrong dimensions across time.
Figure 1
Figure 1
Parent-reported irritability response to multimodal treatment in the 4 treatment groups. Note: Beh = Behavioral treatment; CC = Community Comparison; Comb = Combined treatment; MedMgt = Medication management.
Figure 2
Figure 2
Changes in parent-reported attention-deficit/hyperactivity disorder (ADHD) scores in the 4 treatment groups in individuals with high (a) and low (b) irritability. Note: The categorical outcome was generated using a median split into high and low irritability and is used in this figure for purposes of illustration. However, a dimensional irritability variable is used in the statistical models presented in the text. Beh = behavioral treatment; CC = community comparison; Comb = combined treatment; MedMgt = Medication management.

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