Moderators and mediators of treatment response for children with attention-deficit/hyperactivity disorder - The multimodal treatment study of children with attention-deficit/hyperactivity disorder

Background: Intent-to-treat analyses of the study revealed that medication management, alone or combined with intensive behavioral treatment, was supe rior to behavioral treatment and community care in reducing attention-defic it/hyperactivity disorder (ADHD) symptoms; but only combined treatment show ed consistently greater benefit than community care across other outcome do mains (disruptive and internalizing symptoms, achievement, parent-child rel ations and social skills). We examine response patterns in subgroups define d by baseline variables (moderators) or variables related to treatment impl ementation (mediators). Methods: We reconducted random-effects regression (RR) analyses, adding fac tors defined by moderators (ses, prior medication use, comorbid disruptive or anxiety disorder, and public assistance) and a mediator (treatment accep tance/attendance). Results: Study outcomes (N = 579) were upheld in most moderator subgroups ( boys and girls, children with and without prior medication, children with a nd without co-morbid disruptive disorders). Comorbid anxiety disorder did m oderate outcome. in participants without anxiety, results paralleled intent -to-treat findings. For those with anxiety disorders, however, behavioral t reatment yielded significantly better outcomes than community care (and was no longer statistically different from medication management and combined treatment) regarding ADHD-related and internalizing symptoms. In families r eceiving public assistance, medication management yielded decreased closene ss in parent-child interactions, and combined treatment yielded relatively greater benefits for teacher-reported social skills. In families with high treatment acceptance/attendance, intent-to-treat results were upheld. Accep tance/attendance was particularly important for medication treatments. Fina lly, two thirds of children given community care received stimulants. Behav ioral treatment did not significantly differ from, but medication managemen t was superior to, this subgroup. Conclusions: Exploratory analyses revealed that our study (the Multimodal T reatment Study of Children With Attention-Deficit/Hyperactivity Disorder [M TA]) re suits were confirmed across most baseline variables and treatment a cceptance/attendance. Tn children with ADHD plus anxiety, behavioral treatm ent surpassed community. care and approached medication-based treatments re garding parent-reported ADHD symptoms.