Moderators and mediators of treatment response for children with attention-deficit/hyperactivity disorder -: The multimodal treatment study of children with attention-deficit/hyperactivity disorder
Moderators and mediators of treatment response for children with attention-deficit/hyperactivity disorder -: The multimodal treatment study of children with attention-deficit/hyperactivity disorder
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DOI：
10.1001/archpsyc.56.12.1088
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发表时间：
1999-12-01
影响因子：
--
通讯作者：
Kraemer, HC
中科院分区：
文献类型：
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作者：
Jensen, PS;Arnold, LE;Kraemer, HC
工作背景：该研究的意向治疗分析显示，单独或与强化行为治疗相结合的药物管理在减少注意力缺陷/多动障碍（ADHD）症状方面上级行为治疗和社区护理;但只有联合治疗在其他结果领域（破坏性和内化症状，成就，亲子关系和社交技能）中显示出比社区护理更大的益处。我们检查了由基线变量定义的亚组的反应模式（调节因子）或与治疗实施相关的变量方法：我们重新进行随机效应回归（RR）分析，增加调节因子定义的因素（SES、既往用药、共病破坏性或焦虑性障碍和公共援助）和调解人结果：研究结果（N = 579）在大多数调节剂亚组（男孩和女孩、有和没有先前药物的儿童、有和没有共病破坏性障碍的儿童）中得到维持。共病焦虑障碍的结局为中度。在没有焦虑的参与者中，结果与意向治疗结果一致。然而，对于那些焦虑症患者，行为治疗在ADHD相关和内化症状方面的结果明显优于社区护理（并且与药物管理和联合治疗不再有统计学差异）。在接受公共援助的家庭中，药物管理降低了亲子互动的亲密度，联合治疗对教师报告的社交技能产生了相对较大的益处。在治疗接受度/出勤率高的家庭中，维持意向治疗结果。接受/出席对于药物治疗特别重要。最后，三分之二接受社区护理的儿童接受兴奋剂。行为治疗并没有显着差异，但药物管理是上级，这个subgroup.Conclusions：探索性分析显示，我们的研究（多模式治疗研究的儿童注意力缺陷/多动障碍[MTA]）的结果证实了在大多数基线变量和治疗接受/出勤。对于患有多动症和焦虑症的儿童，行为治疗超过了社区。护理和接近药物为基础的治疗父母报告的ADHD症状。
Background: Intent-to-treat analyses of the study revealed that medication management, alone or combined with intensive behavioral treatment, was superior to behavioral treatment and community care in reducing attention-deficit/hyperactivity disorder (ADHD) symptoms; but only combined treatment showed consistently greater benefit than community care across other outcome domains (disruptive and internalizing symptoms, achievement, parent-child relations and social skills). We examine response patterns in subgroups defined by baseline variables (moderators) or variables related to treatment implementation (mediators).Methods: We reconducted random-effects regression (RR) analyses, adding factors defined by moderators (ses, prior medication use, comorbid disruptive or anxiety disorder, and public assistance) and a mediator (treatment acceptance/attendance).Results: Study outcomes (N = 579) were upheld in most moderator subgroups (boys and girls, children with and without prior medication, children with and without co-morbid disruptive disorders). Comorbid anxiety disorder did moderate outcome. in participants without anxiety, results paralleled intent-to-treat findings. For those with anxiety disorders, however, behavioral treatment yielded significantly better outcomes than community care (and was no longer statistically different from medication management and combined treatment) regarding ADHD-related and internalizing symptoms. In families receiving public assistance, medication management yielded decreased closeness in parent-child interactions, and combined treatment yielded relatively greater benefits for teacher-reported social skills. In families with high treatment acceptance/attendance, intent-to-treat results were upheld. Acceptance/attendance was particularly important for medication treatments. Finally, two thirds of children given community care received stimulants. Behavioral treatment did not significantly differ from, but medication management was superior to, this subgroup.Conclusions: Exploratory analyses revealed that our study (the Multimodal Treatment Study of Children With Attention-Deficit/Hyperactivity Disorder [MTA]) re suits were confirmed across most baseline variables and treatment acceptance/attendance. Tn children with ADHD plus anxiety, behavioral treatment surpassed community. care and approached medication-based treatments regarding parent-reported ADHD symptoms.