DOI QR코드

DOI QR Code

Major Lessons from the MTA in Treatment of Attention-Deficit Hyperactivity Disorder

주의력결핍 과잉행동장애 치료에서 MTA의 주요 교훈

  • Hwang, Jun-Won (Department of Psychiatry, College of Medicine, Eulji University)
  • 황준원 (을지대학교 의과대학 정신과학교실)
  • Received : 2009.10.05
  • Accepted : 2009.12.22
  • Published : 2010.03.30

Abstract

Objectives : The current review aimed to describe the major findings of the NIMH Collaborative Multisite Multimodal Treatment Study of Children with Attention-Deficit Hyperactivity Disorder (MTA) with regard to the treatment of children with attention-deficit hyperactivity disorder (ADHD). Methods : We performed a general review of the literature regarding the efficacy of the MTA's proposed treatments. Results : There is a large and still increasing body of evidence regarding the MTA's treatment outcomes. We present and discuss details of the findings at each follow-up point. Conclusion : Currently, findings regarding the MTA's treatments suggest children with combined-type ADHD exhibit significant impairment in adolescence, despite their initial symptom improvement. Further studies, using innovative treatment approaches and targeting specific areas of adolescent impairment, are needed in order to enhance ADHD treatment outcomes.

Keywords

References

  1. Spetie L, Arnold EL. Attention-deficit/hyperactivity disorder. In: Martins A, Volkmar FR, editors. Lewis's child and adolescent psychiatry: a comprehensive textbook, Fourth Edition. Philadelphia: Lippincott Williams & Wilkins;2007. p.430-454.
  2. Swanson J, Arnold LE, Kraemer H, Hechtman L, Molina B, Hinshaw S, et al. Evidence, interpretation, and qualification from multiple reports of long-term outcomes in the Multimodal Treatment study of Children With ADHD (MTA): part I: executive summary. J Atten Disord 2008;12:4-14. https://doi.org/10.1177/1087054708319345
  3. Richters JE, Arnold LE, Jensen PS, Abikoff H, Conners CK, Greenhill LL, et al. NIMH collaborative multisite multimodal treatment study of children with ADHD: I. Background and rationale. J Am Acad Child Adolesc Psychiatry 1995;34:987-1000. https://doi.org/10.1097/00004583-199508000-00008
  4. Institute of Medicine. Research on Children and Adolescents with Mental, Behavioral, and Developmental Disorders. Washington DC: National Academy Press;1989.
  5. National Advisory Mental Health Council. National Plan for Research on Child and Adolescent Mental Disorders. Rockville: National Institute of Mental Health;1990.
  6. Swanson J, Arnold LE, Kraemer H, Hechtman L, Molina B, Hinshaw S, et al. Evidence, interpretation, and qualification from multiple reports of long-term outcomes in the Multimodal Treatment Study of children with ADHD (MTA): Part II: supporting details. J Atten Disord 2008;12:15-43. https://doi.org/10.1177/1087054708319525
  7. Greenhill LL, Abikoff HB, Arnold LE, Cantwell DP, Conners CK, Elliott G, et al. Medication treatment strategies in the MTA Study: relevance to clinicians and researchers. J Am Acad Child Adolesc Psychiatry 1996;35:1304-1313. https://doi.org/10.1097/00004583-199610000-00017
  8. Arnold LE, Abikoff HB, Cantwell DP, Conners CK, Elliott G, Greenhill LL, et al. National Institute of Mental Health Collaborative Multimodal Treatment Study of Children with ADHD (the MTA). Design challenges and choices. Arch Gen Psychiatry 1997;54:865-870. https://doi.org/10.1001/archpsyc.1997.01830210113015
  9. MTA Cooperative Group. A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. The MTA Cooperative Group. Multimodal Treatment Study of Children with ADHD. Arch Gen Psychiatry 1999;56:1073-1086. https://doi.org/10.1001/archpsyc.56.12.1073
  10. MTA Cooperative Group. Moderators and mediators of treatment response for children with attention-deficit/hyperactivity disorder: the Multimodal Treatment Study of children with Attention- deficit/hyperactivity disorder. Arch Gen Psychiatry 1999; 56:1088-1096. https://doi.org/10.1001/archpsyc.56.12.1088
  11. MTA Cooperative Group. National Institute of Mental Health Multimodal Treatment Study of ADHD follow-up: 24-month outcomes of treatment strategies for attention-deficit/hyperactivity disorder. Pediatrics 2004;113:754-761. https://doi.org/10.1542/peds.113.4.754
  12. MTA Cooperative Group. National Institute of Mental Health Multimodal Treatment Study of ADHD follow-up: changes in effectiveness and growth after the end of treatment. Pediatrics 2004;113:762-769. https://doi.org/10.1542/peds.113.4.762
  13. Jensen PS, Arnold LE, Swanson JM, Vitiello B, Abikoff HB, Greenhill LL, et al. 3-year follow-up of the NIMH MTA study. J Am Acad Child Adolesc Psychiatry 2007;46:989-1002. https://doi.org/10.1097/CHI.0b013e3180686d48
  14. Swanson JM, Hinshaw SP, Arnold LE, Gibbons RD, Marcus S, Hur K, et al. Secondary evaluations of MTA 36-month outcomes: propensity score and growth mixture model analyses. J Am Acad Child Adolesc Psychiatry 2007;46:1003-1014. https://doi.org/10.1097/CHI.0b013e3180686d63
  15. Swanson JM, Elliott GR, Greenhill LL, Wigal T, Arnold LE, Vitiello B, et al. Effects of stimulant medication on growth rates across 3 years in the MTA follow-up. J Am Acad Child Adolesc Psychiatry 2007;46:1015-1027. https://doi.org/10.1097/chi.0b013e3180686d7e
  16. Molina BS, Flory K, Hinshaw SP, Greiner AR, Arnold LE, Swanson JM, et al. Delinquent behavior and emerging substance use in the MTA at 36 months: prevalence, course, and treatment effects. J Am Acad Child Adolesc Psychiatry 2007; 46:1028-1040. https://doi.org/10.1097/chi.0b013e3180686d96
  17. Molina BS, Hinshaw SP, Swanson JM, Arnold LE, Vitiello B, Jensen PS, et al. The MTA at 8 years: prospective follow-up of children treated for combined-type ADHD in a multisite study. J Am Acad Child Adolesc Psychiatry 2009;48:484-500. https://doi.org/10.1097/CHI.0b013e31819c23d0
  18. Shaffer D, Fisher P, Dulcan M, Davies M, Piacentini J, Schwab-Stone M, et al. The second version of the NIMH Diagnostic Interview Schedule for Children (DISC-2). J Am Acad Child Adolesc Psychiatry 1996;35:865-877. https://doi.org/10.1097/00004583-199607000-00012
  19. Wells KC, Pelham WE, Kotkin RA, Hoza B, Abikoff HB, Abramowitz A, et al. Psychosocial treatment strategies in the MTA study: rationale, methods, and critical issues in design and implementation. J Abnorm Child Psychol 2000;28:483-505. https://doi.org/10.1023/A:1005174913412
  20. Pelham WE, Gnagy EM, Greiner AR, Hoza B, Hinshaw SP, Swanson JM, et al. Behavioral versus behavioral and pharmacological treatment in ADHD children attending a summer treatment program. J Abnorm Child Psychol 2000;28:507-525. https://doi.org/10.1023/A:1005127030251
  21. Vitiello B, Severe JB, Greenhill LL, Arnold LE, Abikoff HB, Bukstein OG, et al. Methylphenidate dosage for children with ADHD over time under controlled conditions: lessons from the MTA. J Am Acad Child Adolesc Psychiatry 2001;40:188-196. https://doi.org/10.1097/00004583-200102000-00013
  22. Conners CK, Epstein JN, March JS, Angold A, Wells KC, Klaric J, et al. Multimodal treatment of ADHD in the MTA: an alternative outcome analysis. J Am Acad Child Adolesc Psychiatry 2001;40:159-167. https://doi.org/10.1097/00004583-200102000-00010
  23. Newcorn JH, Halperin JM, Jensen PS, Abikoff HB, Arnold LE, Cantwell DP, et al. Symptom profiles in children with ADHD: effects of comorbidity and gender. J Am Acad Child Adolesc Psychiatry 2001;40:137-146. https://doi.org/10.1097/00004583-200102000-00008
  24. Jensen PS, Hinshaw SP, Kraemer HC, Lenora N, Newcorn JH, Abikoff HB, et al. ADHD comorbidity findings from the MTA study: comparing comorbid subgroups. J Am Acad Child Adolesc Psychiatry 2001;40:147-158. https://doi.org/10.1097/00004583-200102000-00009
  25. Hechtman L, Etcovitch J, Platt R, Arnold LE, Abikoff HB, Newcorn JH, et al. Does multimodal treatment of ADHD decrease other diagnoses? Clin Neurosci Res 2005;5:273-282. https://doi.org/10.1016/j.cnr.2005.09.007
  26. Pappadopulos E, Jensen PS, Chait AR, Arnold LE, Swanson JM, Greenhill LL, et al. Medication adherence in the MTA: saliva methylphenidate samples versus parent report and mediating effect of concomitant behavioral treatment. J Am Acad Child Adolesc Psychiatry 2009;48:501-510. https://doi.org/10.1097/CHI.0b013e31819c23ed
  27. Santosh PJ, Taylor E, Swanson J, Wigal T, Chuang S, Davies M, et al. Reanalysis of the multimodal treatment study of attention- deficit/hyperactivity disorder (ADHD) based on ICD- 10 criteria for hyperkinetic disorder (HD). Clin Neurosci Res 2005;5:307-314. https://doi.org/10.1016/j.cnr.2005.09.010
  28. Owens EB, Hinshaw SP, Kraemer HC, Arnold LE, Abikoff HB, Cantwell DP, et al. Which treatment for whom for ADHD? Moderators of treatment response in the MTA. J Consult Clin Psychol 2003;71:540-552. https://doi.org/10.1037/0022-006X.71.3.540
  29. Swanson JM, Kraemer HC, Hinshaw SP, Arnold LE, Conners CK, Abikoff HB, et al. Clinical relevance of the primary findings of the MTA: success rates based on severity of ADHD and ODD symptoms at the end of treatment. J Am Acad Child Adolesc Psychiatry 2001;40:168-179. https://doi.org/10.1097/00004583-200102000-00011
  30. Jensen PS, Garcia JA, Glied S, Crowe M, Foster M, Schlander M, et al. Cost-effectiveness of ADHD treatments: findings from the multimodal treatment study of children with ADHD. Am J Psychiatry 2005;162:1628-1636. https://doi.org/10.1176/appi.ajp.162.9.1628
  31. Boyle MH, Jadad AR, Allnut DR. Lesson from large trials: The MTA study as a model for evaluating the treatment of childhood psychiatric disorder. Can J Psychiatry 1999;44:991-998. https://doi.org/10.1177/070674379904401005
  32. Breggin PR. MTA study has flaws. Arch Gen Psychiatry 2001; 58:1184. https://doi.org/10.1001/archpsyc.58.12.1184
  33. Barkley RA. Commentary on the multimodal treatment study of children with ADHD. J Abnorm Child Psychol 2000;28:595-599. https://doi.org/10.1023/A:1005139300209
  34. Pelham WE. The NIMH multimodal treatment study for ADHD: Just say yes to drugs alone? Can J Psychiatry 1999;44:981-990. https://doi.org/10.1177/070674379904401004
  35. Epstein JN, Conners CK, Hervey AS, Tonev ST, Arnold LE, Abikoff HB, et al. Assessing medication effects in the MTA study using neuropsychological outcomes. J Child Psychol Psychiatry 2006;47:446-456. https://doi.org/10.1111/j.1469-7610.2005.01469.x
  36. Yoo HJ, Yang SJ, Shin DW, Kang HY, Kim BN, Kim JH, et al. The Korean practice parameter for the treatment of attentiondeficit hyperactivity disorder (III). Pharmacologic Treatment. J Kor Acad Child Adolesc Psychiatry 2007;18:16-25.

Cited by

  1. Differences in Utilization Patterns among Medications in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder: a 36-Month Retrospective Study Using the Korean Health Insurance Review and Assessment Claims Database vol.31, pp.8, 2016, https://doi.org/10.3346/jkms.2016.31.8.1284