multimodal treatment study of children with adhd (mta) james h. johnson, ph.d. university of florida...

Multimodal Treatment Study of Multimodal Treatment Study of Children With ADHD (MTA)Children With ADHD (MTA)

James H. Johnson, Ph.D.

University of Florida

This presentation draws heavily on an excellent critique of the MTA study by Rabiner (2000)

The Multimodal Treatment The Multimodal Treatment Study: BackgroundStudy: Background

Until fairly recently there were no well controlled long-term treatment studies in the area of ADHD.

There were many double-blind/placebo controlled studies, designed to assess the effects of various stimulant medications.

Results of these studies often supported the use of these medications.

However, these studies were typically short duration studies, usually lasting only three to four months.


While such studies often provided support for the effectiveness of stimulant medications in treating ADHD, they provided little information regarding their long term effectiveness.

Likewise, there were few published studies on the relative effectiveness of different approaches to treatment of children with ADHD.

And, little information was available regarding the long term effectiveness of combined treatment approaches (e.g., stimulants and psychosocial interventions) in ADHD treatment.


To fill these gaps in our knowledge of ADHD treatment, in the late 1990’s, the National Institute of Mental Health sponsored a large multi-site, 14-month, investigation of the multimodal treatment of ADHD..

This Multimodal Treatment Study of Children with ADHD – "MTA" for short – brought together 18 nationally recognized authorities in ADHD at a number of different university medical centers and hospitals to evaluate the effectiveness of leading treatments for ADHD – notably stimulant drug and behavioral treatment.

Multimodal Treatment Study: Multimodal Treatment Study: BackgroundBackground

Research sites included: – New York State Psychiatric Institute at Columbia

University, New York, N.Y. – Mount Sinai Medical Center, New York, N.Y. – Duke University Medical Center, Durham, N.C. – University of Pittsburgh, Pittsburgh, PA. – Long Island Jewish Medical Center, New Hyde Park,

N.Y. – Montreal Children's Hospital, Montreal, Canada – University of California at Berkeley, CA. – University of California at Irvine, CA.

Multimodal Treatment Study:Multimodal Treatment Study:Subject RecruitmentSubject Recruitment

Children became involved in the MTA as a result of parents contacting investigators for more information, after learning about the study through local pediatricians, other health care providers, elementary school teachers, or radio/newspaper announcements.

Children and parents were then carefully interviewed to learn more about the nature of the child's symptoms, and to rule out the presence of other conditions that might contribute to the child's difficulties.

Multimodal Treatment Study: Multimodal Treatment Study: Subject RecruitmentSubject Recruitment

In addition, extensive historical information was gathered and diagnostic interviews were conducted to determine if the child met basic criteria for a diagnosis of ADHD.

If children met full criteria for ADHD and study entry (and many did not), informed parental consent with child assent and school permission were obtained; the children and families then were eligible for study entry and randomized assignment to treatments.

Children who had behavior problems but not ADHD were not eligible for study participation.

Multimodal Treatment Study: Multimodal Treatment Study: Subject RecruitmentSubject Recruitment

Only children determined to have Combined Type ADHD were included in the MTA study.

Children diagnosed with the hyperactive/impulsive subtype and inattentive subtype were excluded (Note. This makes it difficult to generalize any study findings to children with these types of ADHD).

This decision was made because the combined type is the most frequently diagnosed type of ADHD.

All in all, the study included 579 children ages 7 to 9.9 years

Approximately 20% were female and approximately the same percentage was African American.

The Multimodal Treatment Study: The Multimodal Treatment Study: OverviewOverview

After participants were identified, were determined to have met study criteria, and pre-treatment assessment measures were obtained, they were assigned at random to 1 of 4 treatment conditions.– medication alone;– psychosocial/behavioral treatment alone;– Combined treatment; or – routine community care.

Fourteen months later, the participants were again assessed so that the impact of the different treatments could be evaluated.

The Multimodal Treatment The Multimodal Treatment Study: Assessment MeasuresStudy: Assessment Measures

Primary ADHD symptoms - ratings provided by parents and teachers;

Aggressive and oppositional behavior - ratings provided by parents, teachers, and classroom observers;

Internalizing symptoms (e.g. anxiety and sadness) - ratings provided by parents, teachers, and children;

Social skills - ratings provided by parents, teachers, and children;

Parent-child relations - rated by parent; Academic achievement - assessed by standardized tests

The Multimodal Treatment The Multimodal Treatment Study: OverviewStudy: Overview

The MTA Study was designed to answer three basic questions regarding the treatment of ADHD;

How do long-term treatments with medication and psychosocial (behavioral) interventions compare with one another?

Are there additional benefits of combining these two treatments in treating individual children?

What is the effectiveness of systematic, carefully delivered treatments vs. the way these treatments are usually applied in routine community care?

MTA: Medication Alone GroupMTA: Medication Alone Group Children assigned to the medication management

condition received drug treatment only. Treatment began with a 28-day, double-blind

placebo-controlled trial in which the effects of 4 different doses of methylphenidate (a generic formulation of Ritalin) were evaluated.

The doses tested were 5, 10, 15, and 20 mg. Children received a full dose at breakfast and

lunch, and a half-dose in the afternoon. Parent and teacher ratings of children's behavior on

each dose were compared by a team of experienced clinicians, and the best dose for each child was selected by consensus.

MTA: Medication Alone GroupMTA: Medication Alone Group

In this double-blind placebo-controlled trial, the child was administered actual medication on some days and a placebo during other days.

Neither the child, the teacher, nor the parent knew when the real medication was being received and when placebo was being given.

This was designed to insure that parent and teacher ratings of the child's behavior were not biased by the knowledge that the child was on medication.


For children not obtaining an adequate response to methylphenidate in the initial trial, alternate medications were tested using a non-double-blind procedures in the following order until a satisfactory medication and dose for the child was found:– dextroamphetamine (the generic version of

dexedrine),– pemoline (the generic version of Cylert), and– imipramine (a tricyclic antidepressant).

MTA: Medication Alone GroupMTA: Medication Alone Group A total of 289 participants were initially assigned to

receive medication in either the medication only condition or the combined condition.

A total of 256 (88.6%) successfully completed this initial titration period used to select an effective medication.

In the case of the remaining children, parents either– refused to try their child on medication,– there were intolerable side effects, or– parents could not cooperate with the careful titration

procedures.

MTA: Medication Alone GroupMTA: Medication Alone Group An adequate response with at least one of the doses

of methylphenidate was obtained for about 69% of the children completing the initial medication trial, and they began treatment on this dose.

Twenty-six children who did not respond to methylphenidate were found to do well on dextroamphetamine and began on this medication.

A final 32 did not begin on any medication because they had such a strong placebo response that no clear benefits of medication could be demonstrated.

MTA: Medication Alone GroupMTA: Medication Alone Group In addition to this carefully monitored approach to

determine the optimal medication and dose, half-hour monthly visits were scheduled during which time the provider for the child reviewed information about the child's behavior over the past month that had been provided by parent and teacher.

After reviewing this information, any needed dosage adjustments were made using predetermined guidelines.

Adjustments that involved increases or decreases of more than 10 mg/dose needed to be approved by a cross-site panel of experts.

MTA: Medication Alone GroupMTA: Medication Alone Group At the end of the study, some 14 months later,

approximately 74% of participants in the medication or combined treatment groups were being successfully maintained on methylphenidate.

10% were being successfully maintained on dextroamphetamine.

Just over 1% were being successfully maintained on pemoline.

Only two children were on any other type of medication.


As already noted, some children who were assigned to one of the medication groups never received medication, either because their parents refused or could not follow the initial trial procedures.

Side effects were also monitored monthly for all children who were on medication.

Over 85% of the sample reported either no or mild side effects.

MTA: Medication Alone GroupMTA: Medication Alone Group As Rabiner (2000) has indicated, it is important to note

how different this approach to pharmacological treatment was from what often occurs in community treatment.

He notes that the primary differences are– the use of a double-blind trial to establish the best initial

dose and type of medication for each child; and,– regular follow-up visits to evaluate ongoing medication

effectiveness based on parent and teacher reports with systematic adjustments made as needed.

MTA: Medication Alone GroupMTA: Medication Alone GroupHe indicates that it is also important to note

that almost all children were effectively managed on one of the standard stimulants.

And, and none were judged to require a combination of medications to effectively manage their ADHD symptoms.

This seems to underscore how rarely medications need to be combined to treat ADHD, if a careful procedure is used to test out the different types of stimulants that are available.

MTA: Behavioral TreatmentMTA: Behavioral Treatment

Behavioral treatment included parent training, child-focused treatment, and a school-based intervention program.

Parent training involved a total of 27 group sessions and 8 individual sessions per family.

The focus was on teaching parents specific behavioral strategies to deal with the challenges that children with ADHD often present.

MTA: Behavioral TreatmentMTA: Behavioral Treatment The child-focused treatment was a summer treatment

program that children attended for 8 weeks, 5 days a week, during the summer.

This program employed intensive behavioral interventions that were administered by counselors/aides who were supervised by the therapists conducting the parent training.

The basic model was one in which children were able to earn various rewards based on their ability to follow well-defined rules and meet certain behavioral expectations.

Social skills training and specialized academic instruction was also provided.

MTA: Behavioral TreatmentMTA: Behavioral Treatment The school-based treatment had 2 components:

– 10 to16 sessions of biweekly teacher consultation focused on classroom behavior management strategies, and 12 weeks of a part-time paraprofessional aide who worked directly in the classroom with the child.

– During the school year, a Daily Report Card was used to link the child's behavior at school to consequences at home.

The Daily Report Card was a 1-page teacher-completed ratings of the the child's success on specific behaviors.

This was brought home daily by the child to be reviewed by parents with rewards for a successful day provided as indicated.

MTA: Behavioral TreatmentMTA: Behavioral Treatment Consistent with what occurs in actual clinical practice,

the family and child's involvement in behavioral treatment was gradually tapered over the 14 month period.

In most cases, contact had been reduced to once monthly or stopped altogether by the end of this period.

As Rabiner (2000) has noted, the behavioral treatment received here, reflects state-of-the-art practice that would be almost impossible for most children to get.

Thus, one would assume that the benefits of behavioral treatment seen here would likely be much greater than which would typically be obtained.

MTA: Combined TreatmentMTA: Combined Treatment Children in the combined treatment group received all

of the treatments received by children in the Medication and Behavioral Treatment conditions.

Individuals supervising the child's behavioral and medical treatments conferred regularly, and this information guided overall treatment decisions.

Consistent with prior studies, by the end of the study, children in the combined group were being maintained on lower daily doses of methylphenidate than children who received medication alone.

Here, average doses were 31.2 mg/day for the Combined group and 37.7 mg/day for the Medication Only group.

MTA: Community TreatmentMTA: Community Treatment

As it would clearly be unethical to assign children with ADHD to a no-treatment control group for 14 months, some children were randomly assigned to a group that received "community care".

In this condition, following the child's diagnosis of ADHD, parents were provided with a list of community mental health resources and made whatever treatment arrangements they preferred for their child.

MTA: Community TreatmentMTA: Community Treatment Most of the 97 children in this group (over 2/3)

received medication from their own provider sometime during the 14 months.

Several things are interesting about the medication these children received compared to children who received medication as part of the study.– Community care children received less medication each day.– For those treated with methylphenidate, the average daily

dose was 22.6 mg/day compared to the average daily doses of 31.2 mg and 37.7 mg for children in the other groups receiving medication.

– Community care children received an average of 2.3 doses per day compared to 3 times/day dosing for children in the study groups.

MTA: Community TreatmentMTA: Community Treatment Finally, although none of the children receiving

medication in the study groups were maintained on either clonidine or a combination of medications, 4 children seen by community physicians were treated with clonidine and 10 children received more than one medication.

Thus, it appears that physicians in these communities were in some ways more conservative in their use of medication, using lower doses of methylphenidate.

In some ways they were less conservative, being more likely to use medications other than the stimulants for treating ADHD.

MTA: Research QuestionsMTA: Research Questions

As noted earlier, the MTA study was designed to address 3 fundamental questions about ADHD treatment: – How do long-term medication and behavioral

treatments compare with one another in treatment effectiveness in children with ADHD?

– Are there additional benefits when these two treatments are used together?

– What is the effectiveness of systematic, carefully delivered treatments vs. routine community care in the management of ADHD?

MTA: Overall FindingsMTA: Overall Findings Children in all groups (i.e. medication only, behavioral

treatment only, combined treatment, and treatment in the community) showed significant reductions in their level of symptoms over time in most areas.

Thus, even though some treatments were clearly superior to others in certain domains, overall, even children receiving the "least effective" treatment tended to show important improvements.

Thus, these data should not be interpreted in a framework of "what worked" and "what did not work".

Rather, it is a matter of what was the most effective among treatments that showed positive effects.

Long-term Medication vs Long-term Medication vs Behavioral TreatmentBehavioral Treatment

For both parent and teacher ratings of ADHDcore symptoms (i.e. inattention, hyperactivity and impulsivity) medication management alone was clearly superior to behavioral treatment alone.

Medication management and behavioral treatment did not typically differ significantly on other outcome measures.

While medication was found to be superior to behavioral treatment in managing core symptoms, these findings did not hold for other problems such as oppositional behavior, peer relations, internalizing behavior and academic achievement.

Combined vs Single TreatmentsCombined vs Single Treatments

Combined Treatment & Medication Management treatment did not differ significantly on any of the 6 domains assessed in this study.

This suggests that for most children with ADHD, adding behavioral intervention on top of well-conducted medication management is not likely to yield substantial incremental gains.

As Rabiner (2000) has suggested, however, conclusions sometimes change depending on how one looks at the data.

Combined vs Single TreatmentsCombined vs Single Treatments For example, when one looks at the rank ordering

on different outcomes for children in the different groups, children in the combined treatment group did best on 12 of 19 outcome measures.

Those in the Medication Management group were best on only 4.

In addition, when the individual outcome measures were combined into composite measures, or when children's outcomes were grouped into “Excellent Response” vs. “Less Dramatic Response” categories, children receiving combined treatment did modestly, but significantly, better.

Combined vs Single TreatmentsCombined vs Single Treatments Compared to Behavioral Treatment alone,

Combined Treatment was found to be superior;– on parent and teacher ratings of ADHD core

symptoms,– on parent ratings of aggressive/oppositional behavior,– on parent ratings of children's internalizing symptoms,– and on results of the standardized reading assessment.

Thus, adding medication to the treatment of a child already receiving behavioral intervention is likely to yield additional benefits for most children.

MTA Treatments vs Community MTA Treatments vs Community CareCare

Both Combined Treatment and Medication Treatment were superior to community care for parent and teacher reports of ADHD core symptoms,

Behavioral treatment was not. In general, parents and teachers tended to report a

decline of approximately 50% in inattentive and hyperactive/impulsive symptoms for children in the medication and combined treatment groups.

For children receiving community care, the declines reported were in the 25% range.

These were comparable to those reported for children receiving behavioral treatment.


In the non-ADHD domains, with children displaying oppositional behavior, internalizing symptoms, social skills deficits and reading problems, Combined Treatment was always superior to Community Based Treatment.

Here there were particularly dramatic differences in parent reports of oppositional and aggressive behavior.


These data indicate that, although children treated in the community made modest gains, those receiving medication treatment in the MTA study (either alone or in combination with behavioral treatment) did significantly better.

This was especially true for children receiving the combined treatments.

MTA: Follow Up AnalysesMTA: Follow Up Analyses

The MTA research group also considered whether the effects of the different treatments may have varied depending on child characteristics.

Thus, they also looked at whether similar results were obtained:– for boys vs. girls – for children with and without an additional diagnosis of

either Oppositional Defiant Disorder (ODD) or Conduct Disorder (CD);

– for children with and without a co-occurring Anxiety Disorder;

MTA: Follow Up AnalysesMTA: Follow Up AnalysesIn general, there were no substantial differences

in the effectiveness of the different treatments depending on these variables.

Similar treatment results were found for boys and girls and for children with and without a co-occurring behavior disorder.

There was some indication, however, that for children with a co-occurring anxiety disorder, behavioral intervention alone was as effective as both medication management and the combined treatment.

MTA: Follow Up AnalysesMTA: Follow Up Analyses

It is also worth noting, however, that children with anxiety disorders, who received medication only, did not have a poorer response to medication than other children with ADHD.

Thus, findings from previous studies suggesting that children with ADHD and an anxiety disorder do not do as well on stimulant medication are contradicted by these results.

Impact of Treatment AdherenceImpact of Treatment Adherence In a final set of follow up analyses, the researchers also

analyzed the results according to how children and parents were able to adhere to the prescribed treatments.

Here, children assigned to the Medication Management condition were divided into 2 groups depending on whether or not medication treatment was implemented as recommended and whether the family attended at least 80% of the scheduled follow-up visits where the effects of the medication could be monitored.

Impact of Treatment AdherenceImpact of Treatment Adherence

For behavioral treatment, children were divided into 2 groups depending on whether or not – parents attended at least 75% of the scheduled parent group

meetings,– the child attended at least 75% of the summer treatment

program, and– whether the child and paraprofessional working with the child

in the classroom were both present for 75% of the intended days.

If any one of these 3 conditions were not met, the behavioral treatment was not considered to have been implemented as intended.

Impact of Treatment AdherenceImpact of Treatment Adherence

For the Combined Treatment group, families had to adhere to the guidelines for both Medication Management and Behavioral Treatment to be placed in the "as intended" group.

Otherwise, they were placed in a group that was judged to not have adhered to treatment as recommended

Adherence to Treatment Adherence to Treatment RecommendationsRecommendations

One major item of interest is the percentage of families in the 3 MTA treatment conditions that were able/willing to adhere to treatment recommendations.

Acceptance/attendance was higher for the Medication Management treatment (78% of families completing treatment as intended) than in Behavioral Treatment (63%) or Combined Treatment (61%) groups.

Here it is noteworthy that, even when state of the art behavioral treatment is provided to families FREE, almost 40% of families were unable and/or unwilling to fully take advantage of it.

Treatment Adherence and Treatment Adherence and OutcomeOutcome

Regarding treatment adherence and child outcome, significant effects were found only for the Medication Management group.

Outcomes were significantly better for children where the recommended medication management procedure was followed more closely.

For the Behavioral and Combined Treatment conditions, outcome was not found to be related to degree of adherence.

Treatment Adherence and Treatment Adherence and OutcomeOutcome

Here, it has been suggested that the absence of an effect of adherence for the Combined Treatment group was likely due to the fact that parents and children failed to comply with the Behavioral treatment procedure.

And, that these children likely did as well as the "adherers" because of the benefits they derived from the medication.

MTA: SummaryMTA: Summary What are some of the important conclusions to be

drawn from these findings? What do these results mean for parents and health

care providers who are concerned about doing the best they can for their child and their patients?

Rabiner (2000) suggests a number of these: First, he suggests that “For many children with

ADHD, Combined Type, medication alone is likely to be an effective and perhaps even sufficient treatment when care is taken to determine the optimal medication/dose for each child and when the ongoing effectiveness of medication is carefully monitored.”

MTA: SummaryMTA: SummaryAlthough there was some indication for a mild

to modest superiority for combined treatment on some outcomes, children who received medication alone tended to do about as well as children who received the combined treatment.

This was true even though the behavioral treatment provided in this study was far more intensive than would be routinely available in any non-research community setting.

MTA: SummaryMTA: Summary Rabiner notes that this does not mean that there is no

place for behavioral treatment with ADHD. Here, he suggests that a reasonable approach may be to

begin with carefully conducted medication trial to be certain that the maximum possible benefits from medication are being attained.

If the child still has difficulties in behavioral, emotional, academic, and/or social functioning, adding behavioral or other psychosocial interventions that specifically target these residual problems should be considered.

These interventions can make an important difference for an individual child, even though the benefits at a group level are apparently not so dramatic.

MTA: SummaryMTA: Summary

He notes that, it should also be considered that combining behavioral treatment with medication management did enable children to be maintained on a somewhat lower dose of medication.

So, if maintaining a child on the minimum dose of medication is seen as important, one might want to consider combining medication treatment with carefully executed behavioral interventions.

MTA: SummaryMTA: SummaryIntensive and well-conducted behavioral

treatment can also be an effective option for treating children with ADHD.

Rabiner suggests, however, that for most children it will probably be less effective than careful medication treatment and it may be hard for parents to implement as directed.

MTA: SummaryMTA: Summary How medication is prescribed makes a difference. An inescapable conclusion from this study is that

children who received medication from the MTA staff did significantly better than children who received medication from community physicians.

Although the reasons for this can not be determined with certainty, it seems quite likely that this was because of the care that was taken initially to determine the optimum dose for each child, and to then carefully monitor how the child was doing and to make adjustments as needed.

Parents need to insist that this be done for their child.

MTA: SummaryMTA: Summary There are also differences in medication treatment in

the MTA group and the community care group that are clear from this study. – Children treated by community physicians may be routinely

under-medicated.– Children treated by community physicians are often put on

non-stimulant medications and/or combinations of medications that are probably not necessary.

– When stimulant medication is prescribed carefully, there will be very few cases where another class of medication needs to be used and almost no cases where multiple medications are needed.

MTA: Critical Reviews and MTA: Critical Reviews and CommentaryCommentary

As with any major study, the MTA investigation has been the subject of both criticism and praise.

Some have suggested that this study provides clear evidence that medication is better than psychosocial treatments.

Others have suggested that the effects of psychosocial treatment have been understated.

Other critiques have simply focused on methodological and conceptual issues that make the findings more difficult to interpret,

Green & Ablon (2001)Green & Ablon (2001)Medication used for duration of study –

Behavioral treatment often ended months before post-treatment assessment.

Failure of matching study treatments to needs of the child: Medication vs Behavioral Treatments.

Lack of focus on cognitive-behavioral interventions.

Emphasis on “Core Symptoms” versus other functional domains (e.g., social functioning).

Hoza (2001)Hoza (2001) Several of the Green and Ablon criticisms have been

countered in an article by Hoza (2001). Behavioral arm of study was highly individualized

(treatment targets, nature of rewards, treatment tailored to child’s progress).

Cognitive-behavioral issues were addressed (STP dealt with social skills training daily, those with anger problems had individualized anger management program).

Noted that the focus on operant factors is appropriate as training in the above areas is only effective if skills that are taught are maintained by contingency management methods (as adjuncts to other effective treatments)

Hoza (2001)Hoza (2001) Critique that measures of functional domains other

than “Core Symptoms” were inadequately focused on. Acknowledges that it would be good to focus on these

more but that peer relationships were included as a major element of the STP.

Notes that other findings of MTA treatment outcome, involving peer nominations and videotaped parent-child interactions, will be forthcoming.

Focus was on Core Symptoms, but these other domains were not, in fact, neglected.

Hoza (2001)Hoza (2001) Hoza also raised a new and more general issue -

Participant motivation in Medication Only and Behavioral Groups.– Parents enter into randomize treatment trials with preferences

regarding treatment.– Some do not get preferences.– Not getting your preference for behavioral treatment may not

be such a problem as meds may still work.– Not getting your preference for meds may be an issue as

parents may not implement intensive behavioral programs as well as parents motivated for behavioral treatments.

– Could have an overall impact of effectiveness of behavior treatments compared to medication treatment.

Focusing on “Minor” MTA Focusing on “Minor” MTA Findings (Whalen, 2001)Findings (Whalen, 2001)

Outcomes of the combined treatment, which were not detectably different from those of the Medication Only condition, were achieved at significantly lower medication doses.

Given that side effects are often dose related, a question is whether the higher doses required in the Medication Only condition have differential long term effects on psychological or physiological functioning.


Only Combined Treatment was superior to Community Care in problem domains beyond Core Symptoms ( e.g., internalizing symptoms, social skills, academic achievement, parent child relationships).

Given that a reduction of core symptoms may not be the most powerful predictor of long-term outcomes (although important), these findings suggest that psychosocial treatments must add something important to the treatment mix in dealing with these important areas of functioning – over and beyond medication.


Improvement on 12 of the 19 outcome variables was greatest following Combined Treatment; The Medication Only group resulted in the highest level of improvement on only 4 outcome variables.

Many of these improvements may have had positive impacts of families who experienced them.


Parents were more satisfied with treatment when it included a behavioral component that when it involved Medication Only.

What is the contribution of psychosocial treatment that makes for more satisfied parents?

Are there ways to enhance satisfaction associated with pharmacological approaches?


For children with comorbid ADHD and Anxiety Disorders, the behavioral treatment was superior to community care and did not differ from medical management.

Given that 1/3 had anxiety disorders, and that behavioral treatment was not designed to deal with anxiety related problems, might the behavioral treatment be enhanced to make them more effective it this arena?

This might be the area that would benefit most from cognitive behavioral components.


Medication Management in the MTA proved superior to the use of medication in the Community Care Condition.

What exactly are the differences between the two? Was it that doses in the Medication Management

group were higher? What role did the careful titration of medication play? Were the findings due to more careful monitoring of

drug effects or more frequent clinician contacts?


Positive parent-child interchanges, as reported by parents, decreased for those in the medication arm but either increased or remained the same in all other conditions.

Are there inadvertent yet undesirable effects of drug therapy that can be prevented or offset when psychosocial components are added to a medication regimen?

Does medication modify attributions and expectations or suggest that problem solutions are no longer under parent or child control and thereby influence parent-child interactions?

That’s It ! Questions?That’s It ! Questions?

multimodal treatment study of children with adhd (mta) james h. johnson, ph.d. university of florida...

Documents

multimodal treatment

treatment of children

knowledge of adhd treatment

mta study

behavioral treatment

study entry

area of adhd

diagnosis of adhd