Findings from the NIMH Multimodal Treatment Study of ADHD (MTA): Implications and applications for primary care providers.

摘要: In 1992, the National Institute of Mental Health and 6 teams investigators began a multisite clinical trial, Multimodal Treatment Attention-Deficit Hyperactivity Disorder (MTA) study. Five hundred seventy-nine children were randomly assigned to either routine community care (CC) or one three study-delivered treatments, all lasting 14 months. The MTA treatments-monthly medication management (usually methylphenidate) following weekly titration (MedMgt), intensive behavioral treatment (Beh), combination (Comb)-were designed reflect known best practices within each approach. Children assessed at four time points in multiple outcome. Results indicated that Comb MedMgt interventions substantially superior Beh CC for attention-deficit hyperactivity disorder symptoms. For other functioning domains (social skills, academics, parent-child relations, oppositional behavior, anxiety/depression), results suggested slight advantages over single treatments (MedMgt, Beh) care. High quality characterized by careful yet adequate dosing, times daily methylphenidate administration, monthly follow-up visits, communication with schools conveyed substantial benefits those received it. contrast overall study findings showed largest high (regardless whether given group), secondary analyses revealed had significant incremental effect (with small size this comparison) when categorical indicators excellent response composite outcome measures used. addition, parent-defined comorbid anxiety disorders, particularly overlapping disruptive comorbidities, preferential interventions. Parental attitudes disciplinary appeared mediate improved