To date an effective treatment approach which results in short and long term positive outcome for children with Attention Deficit Hyperactive Disorder (ADHD) has not been established. The proposed study addresses major therapeutic issues in the management of children with ADHD. These include 1) determination of the relative short-term efficacy of different stimulant medications and of each subject's 'best' medication regimen; 2) comparisons of conventional stimulant treatment alone and in combination with full multimodal or single-modality psychosocial treatment; 3) how particular treatments affect the feasibility of discontinuing medication; 4) an assessment of the characteristics of medication (and other treatment) refusers, and of the efficacy of psychosocial treatment in this group; and 5) predictors of treatment outcome, including child, parent, family and demographic characteristics, and comorbid diagnoses. The study will treat a total of 720 ADHD/ADD children aged 7 to 9 at 4 different sites. Children with a variety of comorbid conditions such as oppositional disorder (ODD), conduct disorder (CD), specific academic skills disorders, anxiety or affective disorders, will all be included. The design includes an initial 16 week random crossover double-blind trial which will involve 4 weeks each of placebo, methylphenidate, dextroamphetamine and pemoline. In this way the optimal drug and dose for each individual child will be determined. Children on this optimal medication will then be assigned randomly to 5 different treatment groups: (1) A conventional stimulant treatment group; (2) A multimodal treatment group which will receive social and academic skills training and remedial tutoring for the child, a school based behavioral treatment program and parent training and counselling; (3) A school domain intervention group which will receive the school based behavioral program; (4) A child domain intervention group that will receive social and academic skills training and remedial tutoring; 5) A parent domain intervention group where the parents will receive parent training and counselling. Families who refuse medication will be randomly assigned to either a multimodal or an attentional control group. Intensive treatment will occur weekly for 19 months. This will be followed by a placebo challenge to determine if stimulant treatment can be discontinued, and how this is affected by the particular treatment received. We will thus be able to evaluate the efficacy of optimal medication plus either full multimodal or single domain (school, child, or parent) psychosocial treatments or conventional stimulant treatment. The effect of comorbidity and other psychosocial factors on outcome of various treatment approaches will be explored.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project--Cooperative Agreements (U01)
Project #
5U01MH050453-02
Application #
3553981
Study Section
Special Emphasis Panel (SRCM (01))
Project Start
1992-09-30
Project End
1997-08-31
Budget Start
1993-09-30
Budget End
1994-08-31
Support Year
2
Fiscal Year
1993
Total Cost
Indirect Cost
Name
Long Island Jewish Medical Center
Department
Type
DUNS #
City
New Hyde Park
State
NY
Country
United States
Zip Code
11040
Brinkman, William B; Simon, John O; Epstein, Jeffery N (2018) Reasons Why Children and Adolescents With Attention-Deficit/Hyperactivity Disorder Stop and Restart Taking Medicine. Acad Pediatr 18:273-280
Mitchell, John T; Weisner, Thomas S; Jensen, Peter S et al. (2018) How Substance Users With ADHD Perceive the Relationship Between Substance Use and Emotional Functioning. J Atten Disord 22:49S-60S
Jensen, Peter S; Yuki, Kumi; Murray, Desiree et al. (2018) Turning Points in the Lives of Youth of With/Without ADHD: Are They Linked to Changes in Substance Use? J Atten Disord 22:38S-48S
Molina, Brooke S G; Howard, Andrea L; Swanson, James M et al. (2018) Substance use through adolescence into early adulthood after childhood-diagnosed ADHD: findings from the MTA longitudinal study. J Child Psychol Psychiatry 59:692-702
Sibley, Margaret H; Rohde, Luis A; Swanson, James M et al. (2018) Late-Onset ADHD Reconsidered With Comprehensive Repeated Assessments Between Ages 10 and 25. Am J Psychiatry 175:140-149
Perez Algorta, Guillermo; Kragh, Carolyn A; Arnold, L Eugene et al. (2018) Maternal ADHD Symptoms, Personality, and Parenting Stress: Differences Between Mothers of Children With ADHD and Mothers of Comparison Children. J Atten Disord 22:1266-1277
Vitiello, Benedetto; Perez Algorta, Guillermo; Arnold, L Eugene et al. (2017) Psychotic Symptoms in Attention-Deficit/Hyperactivity Disorder: An Analysis of the MTA Database. J Am Acad Child Adolesc Psychiatry 56:336-343
Swanson, James M; Arnold, L Eugene; Molina, Brooke S G et al. (2017) Young adult outcomes in the follow-up of the multimodal treatment study of attention-deficit/hyperactivity disorder: symptom persistence, source discrepancy, and height suppression. J Child Psychol Psychiatry 58:663-678
Roy, Arunima; Hechtman, Lily; Arnold, L Eugene et al. (2017) Childhood Predictors of Adult Functional Outcomes in the Multimodal Treatment Study of Attention-Deficit/Hyperactivity Disorder (MTA). J Am Acad Child Adolesc Psychiatry 56:687-695.e7
Kelly, Clare; Castellanos, F Xavier; Tomaselli, Olivia et al. (2017) Distinct effects of childhood ADHD and cannabis use on brain functional architecture in young adults. Neuroimage Clin 13:188-200

Showing the most recent 10 out of 69 publications