Findings from the NIMH multimodal treatment study of ADHD (MPA): Implications and applications for primary care providers

In 1992, the National Institute of Mental Health and 6 teams of investigato rs began a multisite clinical trial, the Multimodal Treatment of Attention- Deficit Hyperactivity Disorder (MTA) study. Five hundred seventy-nine child ren were randomly assigned to either routine community care (CC) or one of three study-delivered treatments, ail lasting 14 months. The three MTA trea tments-monthly medication management (usually methylphenidate) following we ekly titration (MedMgt), intensive behavioral treatment (Beh), and the comb ination (Comb)-were designed to reflect known best practices within each tr eatment approach. Children were assessed at four time points in multiple ou tcome. Results indicated that Comb and MedMgt interventions were substantia lly superior to Beh and CC interventions for attention-deficit hyperactivit y disorder symptoms. Far other functioning domains (social skills, academic s, parent-child relations, oppositional behavior, anxiety/depression), resu lts suggested slight advantages of Comb over single treatments (MedMgt, Beh ) and community care. High quality medication treatment characterized by ca reful yet adequate dosing, three times daily methylphenidate administration , monthly follow-up visits, and communication with schools conveyed substan tial benefits to those children that received it. In contrast to the overal l study findings that showed the largest benefits for high quality medicati on management (regardless of whether given in the MedMgt or Comb group), se condary analyses revealed that Comb had a significant incremental effect ov er MedMgt (with a small effect size for this comparison) when categorical i ndicators of excellent response and when composite outcome measures were us ed. In addition, children with parent-defined comorbid anxiety disorders, p articularly those with overlapping disruptive disorder comorbidities, showe d preferential benefits to the Beh and Comb interventions. Parental attitud es and disciplinary practices appeared to mediate improved response to the Beh and Comb interventions.