The MTA at 8 years: prospective follow-up of children treated for combined-type ADHD in a multisite study

Abstract

Objectives: To determine any long-term effects, 6 and 8 years after childhood enrollment, of the randomly assigned 14-month treatments in the NIMH Collaborative Multisite Multimodal Treatment Study of Children With Attention-Deficit/Hyperactivity Disorder (MTA; N = 436); to test whether attention-deficit/hyperactivity disorder (ADHD) symptom trajectory through 3 years predicts outcome in subsequent years; and to examine functioning level of the MTA adolescents relative to their non-ADHD peers (local normative comparison group; N = 261).

Method: Mixed-effects regression models with planned contrasts at 6 and 8 years tested a wide range of symptom and impairment variables assessed by parent, teacher, and youth report.

Results: In nearly every analysis, the originally randomized treatment groups did not differ significantly on repeated measures or newly analyzed variables (e.g., grades earned in school, arrests, psychiatric hospitalizations, other clinically relevant outcomes). Medication use decreased by 62% after the 14-month controlled trial, but adjusting for this did not change the results. ADHD symptom trajectory in the first 3 years predicted 55% of the outcomes. The MTA participants fared worse than the local normative comparison group on 91% of the variables tested.

Conclusions: Type or intensity of 14 months of treatment for ADHD in childhood (at age 7.0-9.9 years) does not predict functioning 6 to 8 years later. Rather, early ADHD symptom trajectory regardless of treatment type is prognostic. This finding implies that children with behavioral and sociodemographic advantage, with the best response to any treatment, will have the best long-term prognosis. As a group, however, despite initial symptom improvement during treatment that is largely maintained after treatment, children with combined-type ADHD exhibit significant impairment in adolescence. Innovative treatment approaches targeting specific areas of adolescent impairment are needed.

Trial registration: ClinicalTrials.gov NCT00000388.

Figures

Figure 1

Average ADHD Symptom Score Over Time by Latent Class. LNCG = Local Normative Comparison Group. Figure reproduced with Permission from Wolters Kluwer Health, August 14, 2008). Originally published in Swanson JM, Hinshaw SP, Arnold LE, et al. Secondary evaluations of MTA 36-month outcomes: propensity score and growth mixture model analyses. J Am Acad Child Adolesc Psychiatry. 2007;46(8):1003–1014.

Figure 2

Selected outcome variables for MTA children, graphed by originally randomized treatment group assignment, and LNCG. CC = Community Care; MedMgt = Medication Management; Comb = Combined; Beh = Behavior Therapy; LNCG = Local Normative Comparison Group; SNAP = Swanson, Nolan, Pelham Rating Scale; CIS = Columbia Impairment Rating Scale; ODD = Oppositional Defiant Disorder.

Figure 3

Selected outcome variables for MTA children, graphed by 36 month ADHD symptom latent class, and LNCG (Local Normative Comparison Group). SNAP = Swanson, Nolan, Pelham Rating Scale; CIS = Columbia Impairment Rating Scale; ODD = Oppositional Defiant Disorder.