Secondary evaluations of MTA 36-month outcomes

Propensity score and growth mixture model analyses

James M. Swanson, Stephen P. Hinshaw, L. Eugene Arnold, Robert D. Gibbons, Sue Marcus, Kwan Hur, Peter S. Jensen, Benedetto Vitiello, Howard B. Abikoff, Laurence L. Greenhill, Lily Hechtman, William E. Pelham, Karen C. Wells, C. Keith Conners, John S. March, Glen R. Elliott, Jeffery N. Epstein, Kimberly Hoagwood, Betsy Hoza, Brooke S G Molina & 3 others Jeffrey H. Newcorn, Joanne B. Severe, Timothy Wigal

Research output: Contribution to journalArticle

100 Citations (Scopus)

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 languageEnglish (US)
Pages (from-to)1003-1014
Number of pages12
JournalJournal of the American Academy of Child and Adolescent Psychiatry
Volume46
Issue number8
DOIs
StatePublished - Aug 2007
Externally publishedYes

Fingerprint

Pemetrexed
Propensity Score
Growth
Combined Modality Therapy
Selection Bias
Attention Deficit Disorder with Hyperactivity
Therapeutics

Keywords

  • Attention-deficit/hyperactivity disorder
  • Behavior therapy
  • Clinical trial
  • Multimodal treatment
  • Stimulant

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Developmental and Educational Psychology

Cite this

Secondary evaluations of MTA 36-month outcomes : Propensity score and growth mixture model analyses. / Swanson, James M.; Hinshaw, Stephen P.; Arnold, L. Eugene; Gibbons, Robert D.; Marcus, Sue; Hur, Kwan; Jensen, Peter S.; Vitiello, Benedetto; Abikoff, Howard B.; Greenhill, Laurence L.; Hechtman, Lily; Pelham, William E.; Wells, Karen C.; Conners, C. Keith; March, John S.; Elliott, Glen R.; Epstein, Jeffery N.; Hoagwood, Kimberly; Hoza, Betsy; Molina, Brooke S G; Newcorn, Jeffrey H.; Severe, Joanne B.; Wigal, Timothy.

In: Journal of the American Academy of Child and Adolescent Psychiatry, Vol. 46, No. 8, 08.2007, p. 1003-1014.

Research output: Contribution to journalArticle

Swanson, JM, Hinshaw, SP, Arnold, LE, Gibbons, RD, Marcus, S, Hur, K, Jensen, PS, Vitiello, B, Abikoff, HB, Greenhill, LL, Hechtman, L, Pelham, WE, Wells, KC, Conners, CK, March, JS, Elliott, GR, Epstein, JN, Hoagwood, K, Hoza, B, Molina, BSG, Newcorn, JH, Severe, JB & Wigal, T 2007, 'Secondary evaluations of MTA 36-month outcomes: Propensity score and growth mixture model analyses', Journal of the American Academy of Child and Adolescent Psychiatry, vol. 46, no. 8, pp. 1003-1014. https://doi.org/10.1097/CHI.0b013e3180686d63
Swanson, James M. ; Hinshaw, Stephen P. ; Arnold, L. Eugene ; Gibbons, Robert D. ; Marcus, Sue ; Hur, Kwan ; Jensen, Peter S. ; Vitiello, Benedetto ; Abikoff, Howard B. ; Greenhill, Laurence L. ; Hechtman, Lily ; Pelham, William E. ; Wells, Karen C. ; Conners, C. Keith ; March, John S. ; Elliott, Glen R. ; Epstein, Jeffery N. ; Hoagwood, Kimberly ; Hoza, Betsy ; Molina, Brooke S G ; Newcorn, Jeffrey H. ; Severe, Joanne B. ; Wigal, Timothy. / Secondary evaluations of MTA 36-month outcomes : Propensity score and growth mixture model analyses. In: Journal of the American Academy of Child and Adolescent Psychiatry. 2007 ; Vol. 46, No. 8. pp. 1003-1014.
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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",
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T1 - Secondary evaluations of MTA 36-month outcomes

T2 - Propensity score and growth mixture model analyses

AU - Swanson, James M.

AU - Hinshaw, Stephen P.

AU - Arnold, L. Eugene

AU - Gibbons, Robert D.

AU - Marcus, Sue

AU - Hur, Kwan

AU - Jensen, Peter S.

AU - Vitiello, Benedetto

AU - Abikoff, Howard B.

AU - Greenhill, Laurence L.

AU - Hechtman, Lily

AU - Pelham, William E.

AU - Wells, Karen C.

AU - Conners, C. Keith

AU - March, John S.

AU - Elliott, Glen R.

AU - Epstein, Jeffery N.

AU - Hoagwood, Kimberly

AU - Hoza, Betsy

AU - Molina, Brooke S G

AU - Newcorn, Jeffrey H.

AU - Severe, Joanne B.

AU - Wigal, Timothy

PY - 2007/8

Y1 - 2007/8

N2 - 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

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KW - Attention-deficit/hyperactivity disorder

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KW - Clinical trial

KW - Multimodal treatment

KW - Stimulant

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