Young adult outcomes in the follow‐up of the multimodal treatment study of attention‐deficit/hyperactivity disorder: symptom persistence, source discrepancy, and height suppression

Young adult outcomes in the follow‐up of the multimodal treatment study of attention‐deficit/hyperactivity disorder: symptom persistence, source discrepancy, and height suppression · SciRah

^aDepartment of Pediatrics School of Medicine University of California Irvine CA USA
^bDepartment of Pediatrics, School of Medicine, University of California, Irvine, CA, USA
^cDepartment of Psychiatry Nisonger Center Ohio State University Columbus OH USA
^dDepartment of Psychiatry, Nisonger Center, Ohio State University, Columbus, OH, USA
^eDepartments of Psychiatry and Psychology University of Pittsburgh School of Medicine Pittsburgh PA USA
^fDepartments of Psychiatry and Psychology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
^gDepartment of Psychiatry Florida International University Miami FL USA
^hDepartment of Psychiatry, Florida International University, Miami, FL, USA
ⁱDivision of Child Psychiatry McGill University Montreal Children's Hospital Montreal QC Canada
^jDivision of Child Psychiatry, McGill University, Montreal Children's Hospital, Montreal, QC, Canada
^kDepartment of Psychology University of California Berkeley CA USA
^lDepartment of Psychology, University of California, Berkeley, CA, USA
^mChild Study Center at New York University Langone Medical Center New York NY USA
ⁿChild Study Center at New York University Langone Medical Center, New York, NY, USA
^oInstitute of Human Development University of California Berkeley CA USA
^pInstitute of Human Development, University of California, Berkeley, CA, USA
^qDepartment of Psychiatry &amp
^rBehavioral Sciences Duke University Medical Center Durham NC USA
^sDepartment of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
^tDepartment of Psychological Science University of Vermont Burlington VT USA
^uDepartment of Psychological Science, University of Vermont, Burlington, VT, USA
^vDepartment of Psychology Carleton University Ottawa ON Canada
^wDepartment of Psychology, Carleton University, Ottawa, ON, Canada
^xDepartment of Psychiatry Columbia University New York NY USA
^yDepartment of Psychiatry, Columbia University, New York, NY, USA
^zDepartment of Psychiatry Mount Sinai Medical School New York NY USA
^aaDepartment of Psychiatry, Mount Sinai Medical School, New York, NY, USA
^abDepartment of Psychiatry University of Arkansas for Medical Sciences Little Rock AR USA
^acDepartment of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
^adNational Institute of Mental Health Bethesda MD USA
^aeNational Institute of Mental Health, Bethesda, MD, USA
^afAvida, Inc. Newport Beach CA USA
^agAvida, Inc., Newport Beach, CA, USA
^ahDepartment of Pediatrics Cincinnati Children's Hospital Medical Center Cincinnati OH USA
^aiDepartment of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
^ajPenn State University, College of Medicine Hershey PA USA
^akPenn State University, College of Medicine, Hershey, PA, USA
^alMontreal Children's Hospital Montreal QC Canada
^amMontreal Children's Hospital, Montreal, QC, Canada
^anFrank Porter Graham Child Development Institute University of North Carolina Chapel Hill NC USA
^aoFrank Porter Graham Child Development Institute, University of North Carolina, Chapel Hill, NC, USA
^apNational Human Genome Research Institute Bethesda MD USA
^aqNational Human Genome Research Institute, Bethesda, MD, USA
^arInstitute of Translational Medicine, Universidad del Rosario Bogata Colombia
^asInstitute of Translational Medicine, Universidad del Rosario, Bogata, Colombia
^atDepartment of Psychology Florida International University Miami FL USA
^auDepartment of Psychology, Florida International University, Miami, FL, USA
^avDepartment of Psychiatry Stanford University Stanford CA USA
^awDepartment of Psychiatry, Stanford University, Stanford, CA, USA
✉Corresponding author

Abstract

BACKGROUND: The Multimodal Treatment Study (MTA) began as a 14-month randomized clinical trial of behavioral and pharmacological treatments of 579 children (7-10 years of age) diagnosed with attention-deficit/hyperactivity disorder (ADHD)-combined type. It transitioned into an observational long-term follow-up of 515 cases consented for continuation and 289 classmates (258 without ADHD) added as a local normative comparison group (LNCG), with assessments 2-16 years after baseline. METHODS: Primary (symptom severity) and secondary (adult height) outcomes in adulthood were specified. Treatment was monitored to age 18, and naturalistic subgroups were formed based on three patterns of long-term use of stimulant medication (Consistent, Inconsistent, and Negligible). For the follow-up, hypothesis-generating analyses were performed on outcomes in early adulthood (at 25 years of age). Planned comparisons were used to estimate ADHD-LNCG differences reflecting persistence of symptoms and naturalistic subgroup differences reflecting benefit (symptom reduction) and cost (height suppression) associated with extended use of medication. RESULTS: For ratings of symptom severity, the ADHD-LNCG comparison was statistically significant for the parent/self-report average (0.51 ± 0.04, p < .0001, d = 1.11), documenting symptom persistence, and for the parent/self-report difference (0.21 ± 0.04, p < .0001, d = .60), documenting source discrepancy, but the comparisons of naturalistic subgroups reflecting medication effects were not significant. For adult height, the ADHD group was 1.29 ± 0.55 cm shorter than the LNCG (p < .01, d = .21), and the comparisons of the naturalistic subgroups were significant: the treated group with the Consistent or Inconsistent pattern was 2.55 ± 0.73 cm shorter than the subgroup with the Negligible pattern (p < .0005, d = .42), and within the treated group, the subgroup with the Consistent pattern was 2.36 ± 1.13 cm shorter than the subgroup with the Inconsistent pattern (p < .04, d = .38). CONCLUSIONS: In the MTA follow-up into adulthood, the ADHD group showed symptom persistence compared to local norms from the LNCG. Within naturalistic subgroups of ADHD cases, extended use of medication was associated with suppression of adult height but not with reduction of symptom severity.

Young adult outcomes in the follow‐up of the multimodal treatment study of attention‐deficit/hyperactivity disorder: symptom persistence, source discrepancy, and height suppression

Abstract

Plain-language summary

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