Fact versus fancy concerning the multimodal treatment study for attention-deficit hyperactivity disorder

Findings from the Multimodal Treatment Study of Children With Attention-Def icit Hyperactivity Disorder (ADHD), the MTA, have been much discussed but f requently misinterpreted or mischaracterized. Misinterpretations regarding the specific nature of and rationale for the study design, the effectivenes s of the behavioural treatment arm, the possible advantages of combined tre atments over single-component (medication management or behavioural therapy ) interventions, and the feasibility and applicability of MTA treatments fo r "real-world" practitioners are addressed. Careful interpretation of the MTA findings suggests that for ADHD symptoms, carefully crafted medication-management approaches are superior to behavio ural treatment and to routine community care that includes medication. For non-ADHD areas of functioning (for example, social skills, academic perform ance), combined treatments may offer modest advantages over single-componen t approaches. Longer-term outcomes past 14 months of intensive MTA treatmen ts las well as their relative effectiveness with respect to each other) rem ain unknown, pending further MTA analyses. The MTA treatments by and large consisted of evidence-based "best practices ." Thus, rather than characterizing these treatments as infeasible, the sub stantially superior outcomes of these treatments (versus routine clinical c are) across diverse settings should help set the standard for future treatm ent practices in real-would settings. Despite important study limitations, the MTA study, by virtue of its size, scope, and length; parallel-groups de sign,. explicit use of manualized, evidence-based treatments; and comprehen sive range of outcome assessments sets an important benchmark for future tr ials testing new treatments for childhood ADHD and defines a new standard f or optimal outcomes that can be achieved with the best of clinical care.