The MTA Study - Attention-deficit and Disruptive Behavior Disorders

The MTA Study

The multimodal treatment study of children with ADHD (MTA) was a landmark multisite clinical trial, conducted at six perfor-mance sites across the USA and Canada, that examined the com-parative response to 14 months of medication and psychosocial treatments, administered alone or together, in 579 7- to 9-year-old children with combined subtype ADHD. The principal objec-tives of the study were to determine the relative effectiveness of the three active treatments in comparison to one another, and in comparison with community standard care.

The treatment arms were not individual treatments but rather combinations of treatments, or treatment algorithms. Chil-dren treated in the medication arm began with a controlled trial of MPH given three times a day, and, if this was not effective, could go on to receive other treatments, such as DEX or other stimulant or nonstimulant medications. The psychosocial arm consisted of a variety of interventions, including an intense parent behavior management training program which trained parents to use be-havioral techniques such as contingency management, ongoing consultation to the classroom teacher, a summer treatment pro-gram and a paraprofessional program. In the latter program, an aide was placed in each child’s classroom for half day each day for 3 months. The combined treatment was the combination of all medication and psychosocial interventions. Finally, the com-munity standard group received evaluations as part of the study, but was treated by community providers of their own choosing outside the study.

Results of the 14-month intent-to-treat analyses indicated that, for ADHD symptoms, treatments that included medication performed better than other treatments in reducing ADHD symp-toms (MTA Cooperative Group, 1999). For nonADHD symp-toms, only combined treatment was statistically superior to the community standard care, although it was not different from the medication group. Children with comorbid ADHD and anxiety disorders tended to have a relatively better response to the psy-chosocial treatment administered alone as compared with those without comorbid anxiety. Medication was as effective in treating comorbid ADHD and anxiety as it was in the group with ADHD only. Lower effectiveness was seen in the community standard group, despite the fact that two-thirds of the community-treated children received medication at some time over the 14-month pe-riod of the study.