The MTA at 8 years: prospective follow-up of children treated for combined-type ADHD in a multisite study.
The MTA at 8 years: prospective follow-up of children treated for combined-type ADHD in a multisite study.
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DOI：
10.1097/chi.0b013e31819c23d0
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发表时间：
2009-05
影响因子：
13.3
通讯作者：
MTA Cooperative Group
中科院分区：
文献类型：
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作者：
Molina BSG;Hinshaw SP;Swanson JM;Arnold LE;Vitiello B;Jensen PS;Epstein JN;Hoza B;Hechtman L;Abikoff HB;Elliott GR;Greenhill LL;Newcorn JH;Wells KC;Wigal T;Gibbons RD;Hur K;Houck PR;MTA Cooperative Group
确定ADHD儿童多模式治疗研究中随机分配的14个月治疗在儿童入组后6年和8年的任何长期效果（MTA; N=436）;测试3年内注意力缺陷/多动障碍（ADHD）症状轨迹是否可预测随后几年的结果;检查MTA青少年相对于非ADHD同龄人的功能水平（当地规范性比较组或LNCG; N=261）。混合效应回归模型与计划的对比，在6年和8年测试了广泛的症状和障碍变量评估的家长，教师和青年报告。在几乎每项分析中，最初随机化的治疗组在重复测量或新分析的变量（例如，在学校获得的成绩、被捕、精神病住院或其他临床相关结果）。在14个月的对照试验后，药物使用减少了62%，但对此进行调整并没有改变结果。前3年的ADHD症状轨迹预测了55%的结果。MTA参与者在91%的测试变量上比LNCG表现更差。儿童时期（7.0-9.9岁）ADHD治疗的类型或强度不能预测6 - 8年后的功能。相反，无论治疗类型如何，早期ADHD症状轨迹都是预后性的。这一发现意味着具有行为和社会人口优势的儿童，对任何治疗的反应最好，将具有最好的长期预后。然而，作为一个群体，尽管在治疗期间最初的症状改善在很大程度上保持治疗后，合并型ADHD儿童在青春期表现出显着的损害。需要针对青少年障碍的具体领域采取创新的治疗方法。
To determine any long-term effects, 6 and 8 years after childhood enrollment, of the randomly assigned 14-month treatments in the Multimodal Treatment Study of Children with ADHD (MTA; N=436); to test whether Attention-Deficit/Hyperactivity Disorder (ADHD) symptom trajectory through 3-years predicts outcome in subsequent years; to examine functioning level of the MTA adolescents relative to their non-ADHD peers (Local Normative Comparison Group or LNCG; N=261). Mixed effects regression models with planned contrasts at 6- and 8-years tested a wide range of symptom and impairment variables assessed by parent, teacher, and youth report. In nearly every analysis, the originally randomized treatment groups did not differ significantly on repeated measures or newly-analyzed variables (e.g., grades earned in school, arrests, psychiatric hospitalizations, or other clinically relevant outcomes). Medication use decreased by 62% after the 14-month controlled trial, but adjusting for this did not change the results. ADHD symptom trajectory in the first 3 years predicted 55% of the outcomes. MTA participants fared worse than LNCG on 91% of the variables tested. Type or intensity of 14 months of treatment for ADHD in childhood (at age 7.0–9.9 years old) does not predict functioning six-to-eight years later. Rather, early ADHD symptom trajectory regardless of treatment type is prognostic. This finding implies that children with behavioral and sociodemographic advantage, with the best response to any treatment, will have the best longterm prognosis. As a group, however, despite initial symptom improvement during treatment that is largely maintained post-treatment, children with Combined-Type ADHD exhibit significant impairment in adolescence. Innovative treatment approaches targeting specific areas of adolescent impairment are needed.