Clinical Relevance of the Primary Findings of the MTA: Success Rates Based on Severity of ADHD and ODD Symptoms at the End of Treatment

SWANSON, JAMES M.; KRAEMER, HELENA C.; HINSHAW, STEPHEN P.; ARNOLD, L. EUGENE; CONNERS, C. KEITH; ABIKOFF, HOWARD B.; CLEVENGER, WALTER; DAVIES, MARK; ELLIOTT, GLEN R.; GREENHILL, LAURENCE L.; HECHTMAN, LILY; HOZA, BETSY; JENSEN, PETER S.; MARCH, JOHN S.; NEWCORN, JEFFREY H.; OWENS, ELIZABETH B.; PELHAM, WILLIAM E.; SCHILLER, ELLEN; SEVERE, JOANNE B.; SIMPSON, STEVE; VITIELLO, BENEDETTO; WELLS, KAREN; WIGAL, TIMOTHY; WU, MIN

doi:10.1097/00004583-200102000-00011

Cited by 1,157Attention Deficit Hyperactivity DisorderBehavioral and Psychological StudiesChild and Adolescent Psychosocial and Emotional Development

Clinical Relevance of the Primary Findings of the MTA: Success Rates Based on Severity of ADHD and ODD Symptoms at the End of Treatment

SWANSON, JAMES M., KRAEMER, HELENA C., HINSHAW, STEPHEN P., ARNOLD, L. EUGENE, CONNERS, C. KEITH, ABIKOFF, HOWARD B., CLEVENGER, WALTER, DAVIES, MARK +16 more·2001·Journal of the American Academy of Child & Adolescent Psychiatry

DOI 10.1097/00004583-200102000-00011

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Abstract

Objectives To develop a categorical outcome measure related to clinical decisions and to perform secondary analyses to supplement the primary analyses of the NIMH Collaborative Multisite Multimodal Treatment Study of Children With Attention-Deficit/Hyperactivity Disorder (MTA).Method End-of-treatment status was summarized by averaging the parent and teacher ratings of attention-deficit/hyperactivity disorder and oppositional defiant disorder symptoms on the Swanson, Nolan, and Pelham, version IV (SNAP-IV) scale, and low symptom-severity ("Just a Little") on this continuous measure was set as a clinical cutoff to form a categorical outcome measure reflecting successful treatment. Three orthogonal comparisons of the treatment groups (combined treatment [Comb], medication management [MedMgt], behavioral treatment [Beh], and community comparison [CC]) evaluated hypotheses about the MTA medication algorithm ("Comb + MedMgt versus Beh + CC"), multimodality superiority ("Comb versus MedMgt"), and psychosocial substitution ("Beh versus CC").Results The summary of SNAP-IV ratings across sources and domains increased the precision of measurement by 30%. The secondary analyses of group differences in success rates (Comb = 68%; MedMgt = 56%; Beh = 34%; CC = 25%) confirmed the large effect of the MTA medication algorithm and a smaller effect of multimodality superiority, which was now statistically significant (p < .05). The psychosocial substitution effect remained negligible and nonsignificant.Conclusion These secondary analyses confirm the primary findings and clarify clinical decisions about the choice between multimodal and unimodal treatment with medication.

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Scores of 2-3 indicated symptom presence, as is standard practice.
“Scores of 2–3 indicated symptom presence, as is standard practice.”
From Variable Patterns of Remission From ADHD in the Multimodal Treatment Study of ADHD (2022) · cites this paper as [20]
Even though these treatments help behavioral symptoms, they do not normalize behavior for a substantial portion of youth with ADHD; in the MTA study, one-third to two-thirds did not show clinically significant improvement.
“these interventions do not normalize behavior for a significant number of youth with ADHD. As an example, Swanson and colleagues (2001) found that despite intensive, relatively long-term stimulant medication and behavioral treatment, one-third to two-thirds of youth with ADHD did not evince clinically significant improvements in the Multimodal Treatment of ADHD Study (MTA, 1999).”
From Improving Outcomes for Youth with ADHD: A Conceptual Framework for Combined Neurocognitive and Skill-Based Treatment Approaches (2014) · cites this paper as Swanson et al., 2001
Swanson et al. found that 32-64% of children continued to exhibit clinically significant levels of ADHD despite intensive stimulant medication and behavioral treatment regimens.
“Swanson and colleagues (Swanson et al., 2001) found that 32–64% of children continued to exhibit clinically significant levels of ADHD despite intensive stimulant medication and behavioral treatment regimens.”
From The influences of environmental enrichment, cognitive enhancement, and physical exercise on brain development: Can we alter the developmental trajectory of ADHD? (2011) · cites this paper as Swanson et al., 2001
A significant number of children with ADHD are not normalized by stimulant medication and/or behavioral interventions.
“the behavior of a significant number of children with ADHD is not normalized by the use of these interventions (Hoza et al., 2005; Swanson et al., 2001).”
From The influences of environmental enrichment, cognitive enhancement, and physical exercise on brain development: Can we alter the developmental trajectory of ADHD? (2011) · cites this paper as Swanson et al., 2001

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Authors: SWANSON, J. M., KRAEMER, H. C., HINSHAW, S. P., ARNOLD, L. E., CONNERS, C. K., ABIKOFF, H. B., CLEVENGER, W., DAVIES, M., ELLIOTT, G. R., GREENHILL, L. L., HECHTMAN, L., HOZA, B., JENSEN, P. S., MARCH, J. S., NEWCORN, J. H., OWENS, E. B., PELHAM, W. E., SCHILLER, E., SEVERE, J. B., SIMPSON, S., VITIELLO, B., WELLS, K., WIGAL, T., & WU, M.
Affiliations: University of California, Irvine (US)
Corresponding author: SWANSON, JAMES M.
ORCID: SWANSON, JAMES M.
KRAEMER, HELENA C.
HINSHAW, STEPHEN P.
ARNOLD, L. EUGENE
ABIKOFF, HOWARD B.
DAVIES, MARK
ELLIOTT, GLEN R.
GREENHILL, LAURENCE L.
HECHTMAN, LILY
HOZA, BETSY
JENSEN, PETER S.
NEWCORN, JEFFREY H.
OWENS, ELIZABETH B.
PELHAM, WILLIAM E.
SIMPSON, STEVE
VITIELLO, BENEDETTO
WELLS, KAREN
Venue: Journal of the American Academy of Child & Adolescent Psychiatry
Publisher: Elsevier BV
Published: 2001-02
Volume: 40
Issue: 2
Pages: 168-179
ISSN: 0890-8567 (ISSN-L)
DOI: 10.1097/00004583-200102000-00011
OpenAlex: W2071199156
Cited by: 1,157
References: 4
Citations by year: 2026: 37 · 2025: 67 · 2024: 44 · 2023: 43 · 2022: 58 · 2021: 69 · 2020: 57 · 2019: 36 · 2018: 38 · 2017: 47 · 2016: 55 · 2015: 40 · 2014: 65 · 2013: 44 · 2012: 63
FWCI: 15.09
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
PubMed (publishedVersion)
Institutional Research Information System University of Turin (University of Turin) (submittedVersion)
Funders: National Institute of Mental Health (UO1 MH50453, UO1 MH50461, UO1 MH-50454, UO1 MH50440, U01MH050467, U01MH050447, U01MH050440, UO1MH50467, U01MH050453, UO1 MH50447, U01MH050461, U01MH050454)
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, oppositional defiant disorder, treatment outcomes, treatment success rate, multimodal therapy, medication management, behavior therapy, psychosocial interventions, SNAP-IV, symptom severity, treatment algorithm
MeSH terms: Attention Deficit Disorder with Hyperactivity, Child, Combined Modality Therapy, Humans, Psychometrics, Severity of Illness Index, Models, Statistical, Randomized Controlled Trials as Topic, Treatment Outcome, Attention Deficit and Disruptive Behavior Disorders

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Clinical Relevance of the Primary Findings of the MTA: Success Rates Based on Severity of ADHD and ODD Symptoms at the End of Treatment

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