Abstract
OBJECTIVE: To evaluate two hypotheses: that self-selection bias contributed to lack of medication advantage at the 36-month assessment of the Multimodal Treatment Study of Children With ADHD (MTA) and that overall improvement over time obscured treatment effects in subgroups with different outcome trajectories. METHOD: Propensity score analyses, using baseline characteristics and severity of attention-deficit/hyperactivity disorder symptoms at follow-up, established five subgroups (quintiles) based on tendency to take medication at the 36-month assessment. Growth mixture model (GMM) analyses were performed to identify subgroups (classes) with different patterns of outcome over time. RESULTS: All five propensity subgroups showed initial advantage of medication that disappeared by the 36-month assessment. GMM analyses identified heterogeneity of trajectories over time and three classes: class 1 (34% of the MTA sample) with initial small improvement followed by gradual improvement that produced significant medication effects; class 2 (52%) with initial large improvement maintained for 3 years and overrepresentation of cases treated with the MTA Medication Algorithm; and class 3 (14%) with initial large improvement followed by deterioration. CONCLUSIONS: We failed to confirm the self-selection hypothesis. We found suggestive evidence of residual but not current benefits of assigned medication in class 2 and small current benefits of actual treatment with medication in class 1. Copyright 2007
Original language | English (US) |
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Pages (from-to) | 1003-1014 |
Number of pages | 12 |
Journal | Journal of the American Academy of Child and Adolescent Psychiatry |
Volume | 46 |
Issue number | 8 |
DOIs | |
State | Published - Aug 2007 |
Keywords
- Attention-deficit/hyperactivity disorder
- Behavior therapy
- Clinical trial
- Multimodal treatment
- Stimulant
ASJC Scopus subject areas
- Developmental and Educational Psychology
- Psychiatry and Mental health