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Cited by 384Attention Deficit Hyperactivity DisorderBehavioral and Psychological StudiesChild and Adolescent Psychosocial and Emotional Development

National Institute of Mental Health Multimodal Treatment Study of ADHD Follow-up: Changes in Effectiveness and Growth After the End of Treatment

MTA Cooperative Group·2004·PEDIATRICS
DOI 10.1542/peds.113.4.762
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Abstract

OBJECTIVE: Intent-to-treat analyses of the Multimodal Treatment Study of ADHD (MTA) revealed group differences on attention-deficit/hyperactivity disorder symptoms ratings, with better outcome in groups of participants who were assigned the medication algorithm-medication alone (MedMgt) and combined (Comb)--than in those who were not-behavior modification (Beh) alone and community comparison (CC). However, the effect size was reduced by 50% from the end of treatment to the first follow-up. The convergence of outcomes suggests differential changes by treatment group beween 14 and 24 months, which this report explores, both for benefits of treatment and for side effects on growth. METHODS: We documented reported medication use at 14- and 24-month assessments and formed 4 naturalistic subgroups (Med/Med, Med/NoMed, NoMed/Med, and NoMed/NoMed). Then we performed exploratory mediator analyses to evaluate effects of changes in medication use on 14- to 24-month change scores of effectiveness (symptom ratings) and growth (height and weight measures). RESULTS: The randomly assigned groups with the greatest improvement at the end of the treatment phase (Comb and MedMgt) deteriorated during the follow-up phase, but the other 2 groups (Beh and CC) did not. There were no significant differences in the 14- to 24-month growth rates among the randomly assigned groups, in contrast to significant growth suppression in the Comb and MedMgt at the end of the treatment phase. Changes in medication use mediated the 14- to 24-month change in attention-deficit/hyperactivity disorder symptom ratings: the subgroup that reported stopping medication (Med/NoMed) showed the largest deterioration, the subgroup that consistently reported (Med/Med) or never reported (NoMed/NoMed) medication use showed modest deterioration, and the subgroup that reported starting medication (NoMed/Med) showed improvement. Changes in medication use also mediated growth effects: the subgroup that consistently reported medication use (Med/Med) showed reduced height gain compared with the subgroup that never reported medication use (NoMed/NoMed), which actually grew faster than predicted by population norms. CONCLUSION: In the MTA follow-up, exploratory naturalistic analyses suggest that consistent use of stimulant medication was associated with maintenance of effectiveness but continued mild growth suppression.

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Authors
MTA Cooperative Group
Corresponding author
MTA Cooperative Group
Venue
PEDIATRICS
Publisher
American Academy of Pediatrics (AAP)
Published
2004-04-01
Volume
113
Issue
4
Pages
762-769
ISSN
  • 0031-4005 (ISSN-L)
  • 1098-4275
DOI
10.1542/peds.113.4.762
OpenAlex
W2744661960
Cited by
384
References
24
Citations by year
2026: 2 · 2025: 3 · 2024: 5 · 2023: 5 · 2022: 3 · 2021: 9 · 2020: 5 · 2019: 8 · 2018: 13 · 2017: 10 · 2016: 17 · 2015: 15 · 2014: 15 · 2013: 12 · 2012: 28
FWCI
22.58
Type
journal article
Language
en
Open access
closed
Locations
  • PEDIATRICS (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Institute of Mental Health (UO1 MH50453, UO1 MH50461, UO1 MH-50454, UO1 MH50440, U01MH050467, U01MH050440, UO1 MH50477, UO1MH50467, U01MH050453, 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, stimulant medication, medication adherence, maintenance therapy, symptom deterioration, growth inhibition, height and weight, behavior modification, drug discontinuation, mediation analysis
MeSH terms
Adolescent, Attention Deficit Disorder with Hyperactivity, Behavior Therapy, Body Height, Body Weight, Child, Combined Modality Therapy, Follow-Up Studies, Growth, Humans, National Institutes of Health (U.S.), Regression Analysis, United States, Randomized Controlled Trials as Topic, Treatment Outcome

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