The MTA at 8 years: prospective follow-up of children treated for combined-type ADHD in a multisite study
Open accessAbstract
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.
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Long-term follow-up studies suggest that hyperactive and impulsive behaviors tend to decrease with age, while inattentive symptoms show greater persistence and may stay life-long.
“Long-term follow-up studies suggest that hyperactive and impulsive behaviors tend to decrease with age, while inattentive symptoms show greater persistence and may stay life-long (Biederman et al., 2000; Molina et al., 2009).”
From A Review of Heterogeneity in Attention Deficit/Hyperactivity Disorder (ADHD) (2019) · cites this paper as Molina et al., 2009
The Discussion reports a decrease in parent- and teacher-rated hyperactivity and impulsivity through adolescence. It also says ADHD symptom scores remained higher than classmates’, but does not establish that inattention persists more than hyperactivity or that it may last a lifetime; the follow-up ended in adolescence. (LLM, conf=0.88)
Experimental — accuracy not yet measuredPotential longer-term efficacy could be the real advantage of tDCS over stimulant medication, whose effects are discontinued with discontinued drug administration and appear to wane in long-term continuous administration, presumably due to brain adaptation to the drug.
“potential longer-term efficacy could be the real advantage of tDCS over stimulant medication where effects are discontinued with discontinued drug administration and where effects appear to even wane in long-term continuous administration (Molina et al., 2009), presumably due to brain adaptation to the drug (Fusar-Poli et al., 2012).”
From Cognitive Neuroscience of Attention Deficit Hyperactivity Disorder (ADHD) and Its Clinical Translation (2018) · cites this paper as Molina et al., 2009
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredSuch delayed consolidation effects reinforce the notion that brain self-regulation via NF affects neuroplasticity and may hence have unique longer-term efficacy compared to stimulant medication which does not affect neuroplasticity and may even lose efficacy over time, due to potential brain adaptation.
“Such delayed consolidation effects reinforce the notion that brain self-regulation via NF affects neuroplasticity and may hence have unique longer-term efficacy compared to stimulant medication which does not affect neuroplasticity and may even loose efficacy over time (Molina et al., 2009), due to potential brain adaptation (Fusar-Poli et al., 2012).”
From Cognitive Neuroscience of Attention Deficit Hyperactivity Disorder (ADHD) and Its Clinical Translation (2018) · cites this paper as Molina et al., 2009
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredFor many individuals, ADHD causes symptoms and dysfunction over long periods of time, even into adulthood.
“As in the 2 previous guidelines, this recommendation is based on the evidence that for many individuals, ADHD causes symptoms and dysfunction over long periods of time, even into adulthood.”
From Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents (2019) · cites this paper as [13]
The Discussion reports that, eight years after childhood treatment, the MTA group still had substantially higher ADHD symptom scores and poorer functioning than former classmates in adolescence. It mentions evidence concerning early adulthood, but this study's follow-up does not establish that its participants' symptoms and dysfunction persisted into adulthood. (LLM, conf=0.86)
Experimental — accuracy not yet measuredIn the MTA Study, despite large differences in medication use, there were no appreciable between-group differences in long-term academic achievement in reading or mathematics.
“Despite this large difference in medication use, there were no appreciable between-group differences in long-term academic achievement in reading or mathematics (Molina et al., 2009).”
From The effect of stimulant medication on the learning of academic curricula in children with ADHD: A randomized crossover study. (2022) · cites this paper as Molina et al., 2009
The Results section on 6- and 8-year outcomes reports no significant differences between the originally randomized treatment groups on the outcomes tested, supporting the claim about long-term reading and mathematics achievement. But the Results section on medication use says the large differences between those groups occurred earlier and were no longer significant at 6 or 8 years. The paper also reports a positive association between continued medication use and math achievement, distinct from the randomized-group comparison. Page numbers are unavailable in our copy. (LLM, conf=0.86)
Experimental — accuracy not yet measured
Results are consistent with other randomized evidence with less controlled designs in failing to support the expectation that taking stimulant medication during childhood will impact children with ADHD's long-term academic achievement.
“This is the first study of its kind, and results are consistent with other randomized evidence with less controlled designs (Molina et al., 2009; Tamm et al., 2017) in failing to support the expectation that taking stimulant medication during childhood will impact children with ADHD’s long-term academic achievement.”
From The effect of stimulant medication on the learning of academic curricula in children with ADHD: A randomized crossover study. (2022) · cites this paper as Molina et al., 2009
The Results (Effects of Randomized Treatment on 6- and 8-year Outcomes) report no significant effect of original randomized treatment assignment on eight-year outcomes, including no treatment-group gains in math achievement. But they also report a positive association between continued medication use and math achievement at six and eight years, which may suggest a benefit; the Discussion notes that follow-up after the 14-month trial was uncontrolled. The broad claim needs those qualifications. (LLM, conf=0.84)
Experimental — accuracy not yet measuredChildhood risk factors associated with a more persistent course of ADHD include higher levels of symptoms, comorbid oppositional-defiant disorder (ODD), lower IQ, and family socioeconomic disadvantage.
“These studies have identified childhood risk factors associated with a more persistent course, including higher levels of symptoms, comorbid oppositional-defiant disorder (ODD), lower IQ, and family socioeconomic disadvantage.”
From Evaluation of the persistence, remission, and emergence of attention-deficit/hyperactivity disorder in young adulthood (2016) · cites this paper as [11]
The Discussion (page unavailable) links greater childhood ADHD symptom severity, lower IQ, conduct problems, and less socioeconomic advantage with poorer adolescent functioning; it also describes the more favorable baseline profile of children whose ADHD symptoms improved most durably. It does not specifically identify comorbid ODD as a childhood predictor, and its stated prediction concerns later functioning rather than ADHD persistence alone. (LLM, conf=0.85)
Experimental — accuracy not yet measuredAs individuals with ADHD enter adolescence, their overt hyperactive and impulsive symptoms tend to decline, whereas their inattentive symptoms tend to persist.
“As individuals with ADHD enter adolescence, their overt hyperactive and impulsive symptoms tend to decline, whereas their inattentive symptoms tend to persist.13,14”
From Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents (2019) · cites this paper as [13]
ADHD is a chronic condition.
“ADHD is a chronic condition; therefore, the PCC should manage children and adolescents with ADHD in the same manner that they would children and youth with special health care needs, following the principles of the chronic care model and the medical home (Table 5).”
From Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents (2019) · cites this paper as [13]
ADHD treatments are frequently not maintained over time.
“Authors of longitudinal studies have found that ADHD treatments are frequently not maintained over time13 and impairments persist into adulthood.70”
From Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents (2019) · cites this paper as [13]
Only two randomized studies have induced variability in medication use and measured subsequent acquisition of academic skills and knowledge taught in classroom settings.
“We are aware of only two such studies (Molina et al., 2009; Tamm et al., 2017).”
From The effect of stimulant medication on the learning of academic curricula in children with ADHD: A randomized crossover study. (2022) · cites this paper as Molina et al., 2009
Stimulant and behavioral interventions show limited longer-term benefits even when delivered intensively to school-age and preschool children.
“data suggest limited longer-term benefits of stimulant and behavioral interventions, even when applied intensively for both school-age and preschool children (Molina et al., 2009; Riddle et al., 2013).”
From Improving Outcomes for Youth with ADHD: A Conceptual Framework for Combined Neurocognitive and Skill-Based Treatment Approaches (2014) · cites this paper as Molina et al., 2009
The relative benefits of childhood treatment with stimulant medication compared with non-pharmacological treatments-improvement in cognitive deficits as well as reductions in symptom severity-may dissipate after a 2- to 3-year period, whether or not the medication component is continued or withdrawn.
“This suggests that the relative benefits of childhood treatment with stimulant medication, compared with non-pharmacological treatmentsFimprovement in cognitive deficits as well as reductions in symptom severityFmay dissipate after a 2-to 3-year period, whether or not the medication component of treatment is continued or withdrawn (Molina et al, 2009;Swanson et al, 2008a, b).”
From Understanding the Effects of Stimulant Medications on Cognition in Individuals with Attention-Deficit Hyperactivity Disorder: A Decade of Progress (2011) · cites this paper as Molina et al, 2009
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“Published findings on the girls include an absence of sex-by-treatment interactions for key outcomes (MTA Cooperative Group, 1999b; Owens et al., 2003) or a lack of explicit consideration of sex effects (Molina et al., 2009).”
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- Authors
- Molina, B. S. G., Hinshaw, S. P., Swanson, J. M., Arnold, L. E., Vitiello, B., Jensen, P. S., Epstein, J. N., Hoza, B., Hechtman, L., Abikoff, H. B., Elliott, G. R., Greenhill, L. L., Newcorn, J. H., Wells, K. C., Wigal, T., Gibbons, R. D., Hur, K., & Houck, P. R.
- Affiliations
- University of Pittsburgh (US)
- University of California, Berkeley (US)
- University of California, Irvine (US)
- National Institute of Mental Health (US)
- Duke University (US)
- Long Island Jewish Medical Center (US)
- New York State Psychiatric Institute (US)
- University of Illinois Chicago (US)
- Corresponding author
- Molina, Brooke S.G.
- ORCID
- Venue
- Journal of the American Academy of Child & Adolescent Psychiatry
- Publisher
- Elsevier BV
- Published
- 2009-05
- Volume
- 48
- Issue
- 5
- Pages
- 484-500
- ISSN
- 0890-8567 (ISSN-L)
- PMC
- PMC3063150
- OpenAlex
- W2144385879
- Cited by
- 1,182
- References
- 55
- Citations by year
- 2026: 24 · 2025: 41 · 2024: 37 · 2023: 39 · 2022: 53 · 2021: 44 · 2020: 69 · 2019: 79 · 2018: 59 · 2017: 85 · 2016: 108 · 2015: 92 · 2014: 109 · 2013: 76 · 2012: 94
- FWCI
- 53.43
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Institutional Research Information System University of Turin (University of Turin) (submittedVersion)
- Funders
- U.S. Department of Health and Human Services
- U.S. Department of Justice
- U.S. Department of Education
- Abbott Laboratories
- Eli Lilly and Company
- Pfizer
- Sanofi
- Purdue University
- Celgene
- University of Pittsburgh (HHSN271200800008-C, U01 MH50467, N01MH 12010)
- McGill University (N01MH12008, HHSN271200800003-C)
- Purdue Pharma
- York University
- National Institutes of Health (n01mh12011-0-0-1, n01mh012009-007, n01mh12008-0-0-1, n01mh12010-0-0-1, n01mh12004-0-0-0, n01mh12007-0-0-0, n01mh012012-001)
- Medical Center, University of Pittsburgh
- University of California, Irvine (HHSN271200800006-C, N01MH 12004)
- National Institute of Mental Health (U01MH50461, N01 MH12007, N01MH-12012, N01 MH012007, U01MH50440, N01MH12008,, U01MH050467, MH-50467, N01 MH012009, U01 MH50477, N01 MH012011, U01MH050447, U01MH050440, N01 MH012012, N01 MH12009, U01MH050453, N01 MH012010, U01MH50467, U01MH050461, N01MH 12004, U01MH50453, N01MH 12010, U01MH050454, N01 MH012004, N01 MH012008)
- National Institute on Drug Abuse (HHSN271200800003C, HHSN271200800006C, N01 DA085550, N01 DA085552, HHSN271200800008C, N01 DA085549, HHSN271200800005C, N01 DA085551, N01 DA085548, HHSN271200800007C, HHSN271200800009C, N01 DA085553, N01 DA085554, R01DA012414, HHSN271200800004C)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Social Sciences › Psychology › Developmental and Educational Psychology › Behavioral and Psychological Studies
- Keywords
- attention deficit hyperactivity disorder, combined type ADHD, long-term outcomes, symptom trajectories, prognostic factors, treatment effects, medication use, adolescent functioning, academic performance, arrests, psychiatric hospitalization
- MeSH terms
- Adolescent, Attention Deficit Disorder with Hyperactivity, Behavior Therapy, Behavioral Symptoms, Child, Combined Modality Therapy, Community Mental Health Services, Female, Follow-Up Studies, Humans, Male, Psychiatric Status Rating Scales, Psychotropic Drugs, Reference Values, Regression Analysis, Case-Control Studies, Treatment Outcome, Attention Deficit and Disruptive Behavior Disorders, Diagnostic and Statistical Manual of Mental Disorders
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