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Cited by 3,372Attention Deficit Hyperactivity DisorderBehavioral and Psychological StudiesChild and Adolescent Psychosocial and Emotional Development

A 14-Month Randomized Clinical Trial of Treatment Strategies for Attention-Deficit/Hyperactivity Disorder

The MTA Cooperative Group·1999·Archives of General Psychiatry
DOI 10.1001/archpsyc.56.12.1073
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Abstract

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.

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  • In the MTA study, the combination of behavioral therapy and stimulant medication was not significantly more effective than medication alone for ADHD's core symptoms after correcting for multiple tests in the primary analysis.

    “In the MTA study, researchers found that although the combination of behavioral therapy and stimulant medication was not significantly more effective than treatment with medication alone for ADHD’s core symptoms, after correcting for multiple tests in the primary analysis,139”

    From Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents (2019) · cites this paper as [139]

  • Behavioral therapy has positive effects when combined with medication for preadolescent children.

    “Studies indicate that behavioral therapy has positive effects when it is combined with medication for preadolescent children.139”

    From Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents (2019) · cites this paper as [139]

  • Clinical experience has long suggested that stimulants can have positive, favorable effects on emotional lability.

    “Though debate persists over the neural mechanisms by which stimulants improve emotional lability, clinical experience has long suggested that stimulants can have positive, favorable effects on emotional lability.”

    From Using Stimulants to Treat ADHD-Related Emotional Lability (2014) · cites this paper as [31]

  • Behavioral interventions are harder to maintain over long periods, cost more, and may be less effective than stimulants, especially for core ADHD symptoms.

    “Behavioral interventions, in contrast, are often more difficult to sustain over long durations, are generally more costly, and, arguably, may be less effective than stimulant medications—particularly for the core symptoms of ADHD”

    From Improving Outcomes for Youth with ADHD: A Conceptual Framework for Combined Neurocognitive and Skill-Based Treatment Approaches (2014) · cites this paper as MTA Cooperative Group, 1999

  • Pharmacological and psychosocial treatments for ADHD that have evidence support produce only short-term effects, usually do not transfer to untreated settings, seldom persist, and do not adequately improve functional impairment or executive functioning.

    “Although evidence-based pharmacological and psychosocial treatments exist for ADHD, effects of these treatments are acute, do not typically generalize into non-treated settings, rarely sustain over time, and insufficiently affect key areas of functional impairment (i.e., family, social, and academic functioning) and executive functioning.”

    From Improving Outcomes for Youth with ADHD: A Conceptual Framework for Combined Neurocognitive and Skill-Based Treatment Approaches (2014) · cites this paper as MTA Cooperative Group, 1999

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Authors
The MTA Cooperative Group
Corresponding author
The MTA Cooperative Group
Venue
Archives of General Psychiatry
Publisher
American Medical Association (AMA)
Published
1999-12-01
Volume
56
Issue
12
Pages
1073
ISSN
0003-990X (ISSN-L)
DOI
10.1001/archpsyc.56.12.1073
OpenAlex
W2601578636
Cited by
3,372
References
35
Citations by year
2026: 32 · 2025: 50 · 2024: 49 · 2023: 47 · 2022: 71 · 2021: 97 · 2020: 125 · 2019: 113 · 2018: 99 · 2017: 134 · 2016: 147 · 2015: 136 · 2014: 156 · 2013: 146 · 2012: 164
FWCI
74.27
Type
journal article
Language
en
Open access
closed
Locations
  • Archives of General Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Institutional Research Information System University of Turin (University of Turin) (submittedVersion)
Funders
National Institute of Mental Health (UO1 MH50461, UO1 MH50440, U01MH050447, U01MH050440, UO1 MH50447, U01MH050461)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
  • Social Sciences › Psychology › Developmental and Educational Psychology › Behavioral and Psychological Studies
  • Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
Keywords
attention deficit hyperactivity disorder, combined type ADHD, medication management, community-based care, children, long-term treatment efficacy, parent training, school-based intervention, reading achievement, social skills, parent-child relationship, internalizing problems
MeSH terms
Central Nervous System Stimulants, Anxiety Disorders, Attention Deficit Disorder with Hyperactivity, Behavior Therapy, Child, Combined Modality Therapy, Community Mental Health Services, Double-Blind Method, Drug Administration Schedule, Female, Humans, Male, Methylphenidate, Patient Acceptance of Health Care, Patient Compliance, Referral and Consultation, Regression Analysis, Comorbidity, Treatment Outcome

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