Psychosocial treatment strategies in the MTA study: Rationale, methods, and critical issues in design and implementation

The Collaborative Multimodal Treatment Study of Children with Attention Def icit Hyperactivity Disorder (ADHD), the MTA, is the first multisite, cooper ative agreement treatment study of children, and the largest psychiatric/ps ychological treatment trial ever conducted by the National Institute of Men tal Health. It examines the effectiveness of Medication vs. Psychosocial tr eatment vs. their combination for treatment of ADHD and compares these expe rimental arms to each other and to routine community care. In a parallel gr oup design, 579 (male and female) ADHD children, aged 7-9 years, Il months, were randomly assigned to one of the four experimental arms, and then rece ived 14 months of prescribed treatment (or community care) with periodic re assessments. After delineating the theoretical and empirical rationales for Psychosocial treatment of ADHD, we describe the MTA's Psychosocial Treatme nt strategy applied to all children in two of the four experimental arms (P sychosocial treatment alone; Combined treatment). Psychosocial treatment co nsisted of three major components: a Parent Training component, a two-part School Intervention component, and a child treatment component anchored in an intensive Summer Treatment Program. Components were selected based on ev idence of treatment efficacy and because they address comprehensive symptom targets, settings, comorbidities, and functional domains. We delineate key conceptual and logistical issues faced by clinical researchers in design a nd implementation of Psychosocial research with examples of how these issue s were addressed in the MTA study.