In the Wake of the MTA: Charting a New Course for the Study and Treatment of Children with Attention-Deficit Hyperactivity Disorder

This paper considers 3 questions addressed by the National Institute of Mental Health's Collaborative Multimodal Treatment Study of Children With Attention-Deficit Hyperactivity Disorder (ADHD), the MTA study, of pharmacological and behavioural interventions for 7- to 9-year-old ADHD children. First, do behavioural interventions represent a viable treatment option for families of children with ADHD? Second, what are the relative benefits of behavioural and pharmacological interventions? Finally, are there advantages to combining behavioural and pharmacological interventions for children with ADHD? In the absence of secondary analyses, the MTA's primary intent-to-treat analyses released to date are difficult to interpret. While behavioural interventions represented a viable option for many families, the doses achieved via systematic titration and follow-up medication-management protocols yielded larger effect sizes on unblinded primary symptom reports than did behavioural treatments or the medication management used by most families in the community control conditions. Finally, while combined medication and behavioural management demonstrates some benefits, a more definitive conclusion awaits a detailed presentation of secondary analyses and follow-up data.