MEDICATION TREATMENT STRATEGIES IN THE MTA STUDY - RELEVANCE TO CLINICIAN AND RESEARCHERS

Objective: Clinicians have difficulty applying drug research findings to clinical practice, because research protocols use methods different from those used in daily office practice settings. Method: To design a medication protocol for a multisite clinical trial involving 576 chi ldren with attention-deficit hyperactivity disorder (ADHD) while maint aining relevance to clinical practice, investigators from the NIMH Col laborative Multisite Multimodal Treatment Study of Children with Atten tion-Deficit/Hyperactivity Disorder (MTA study) developed novel medica tion strategies. These were designed to work either in a monomodal or multimodal format and to ensure standard approaches are used across di verse sites. Each child randomized to medication (projected N = 288) i s individually titrated to his or her ''best'' methylphenidate dose an d has individual ADHD symptoms monitored. Decision rules were develope d to guide ''best dose'' selection, dose changes, medication changes, the management of side effects, and integration with psychosocial trea tments. Conclusions: The MTA study uses a controlled method to standar dize the identification of each child's ''best'' methylphenidate dose in a national, multisite cooperative treatment program. Although the t itration protocol is complex, the study's individual dosing approach a nd algorithms for openly managing ADHD children's medication over time will be of interest to clinicians in office practice.