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Delinquent Behavior and Emerging Substance Use in the MTA at 36 Months: Prevalence, Course, and Treatment Effects.

Author(s): Molina BS, Flory K, Hinshaw SP, Greiner AR, Arnold LE, Swanson JM, Hechtman L, Jensen PS, Vitiello B, Hoza B, Pelham WE, Elliott GR, Wells KC, Abikoff HB, Gibbons RD, Marcus S, Conners CK, Epstein JN, Greenhill LL, March JS, Newcorn JH, Severe JB, Wigal T

Affiliation(s): The Multimodal Treatment Study of Children with ADHD (MTA) was a National Institute of Mental health (NIMH) cooperative agreement randomized clinical trial involving six clinical sites. Collaborators from the National Institute of Mental Health: Peter S. Jensen, M.D. (currently at Columbia University, New York), L. Eugene Arnold, M.D., M.Ed. (currently at Ohio State University), Joanne B. Severe, M.S. (Clinical Trials Operations and Biostatistics Unit, Division of Services and Intervention Research), Benedetto Vitiello, M.D. (Child & Adolescent Treatment and Preventive Interventions Research Branch), Kimberly Hoagwood, Ph.D. (currently at Columbia University); previous contributors from NIMH to the early phase: John Richters, Ph.D. (currently at National Institute of Nursing Research); Donald Vereen, M.D. (currently at National Institute on Drug Abuse). Principal investigators and co-investigators from the clinical sites are University of California, Berkeley/San Francisco: Stephen P. Hinshaw, Ph.D. (Berkeley), Glen R. Elliott, M.D., Ph.D. (San Francisco); Duke University: C. Keith Conners, Ph.D., Karen C. Wells, Ph.D., John March, M.D., M.P.H., Jeffery Epstein, Ph.D.; University of California, Irvine/Los Angeles: James Swanson, Ph.D. (Irvine), Dennis P. Cantwell, M.D. (deceased, Los Angeles), Timothy Wigal, Ph.D. (Irvine); Long Island Jewish Medical Center/Montreal Children's Hospital: Howard B. Abikoff, Ph.D. (currently at New York University School of Medicine), Lily Hechtman, M.D. (McGill University, Montreal); New York State Psychiatric Institute/Columbia University/Mount Sinai Medical Center, New York: Laurence L. Greenhill, M.D. (Columbia University), Jeffrey H. Newcorn, M.D. (Mount Sinai School of Medicine); University of Pittsburgh: William E. Pelham, Ph.D. (currently at State University of New York, Buffalo), Betsy Hoza, Ph.D. (currently at University of Vermont, Burlington), Brooke Molina, Ph.D. Original statistical and trial design consultant: Helena C. Kraemer, Ph.D. (Stanford University). Follow-up phase statistical collaborators: Robert D. Gibbons, Ph.D. (University of Illinois, Chicago), Sue Marcus, Ph.D. (Mt. Sinai School of Medicine), Kwan Hur, Ph.D. (University of Illinois, Chicago). Kate Flory, Ph.D. (University of South Carolina at Columbia). Andrew Greiner, B.S. (State University of New York at Buffalo). Collaborator from the Office of Special Education Programs/U.S. Department of Education: Thomas Hanley, Ed.D. Collaborator from Office of Juvenile Justice and Delinquency Prevention/Department of Justice: Karen Stern, Ph.D.

Publication date & source: 2007-08, J Am Acad Child Adolesc Psychiatry., 46(8):1028-1040.

OBJECTIVE:: To compare delinquent behavior and early substance use between the children in the Multimodal Treatment Study of Children With ADHD (MTA; N = 487) and those in a local normative comparison group (n = 272) at 24 and 36 months postrandomization and to test whether these outcomes were predicted by the randomly assigned treatments and subsequent self-selected prescribed medications. METHOD:: Most MTA children were 11 to 13 years old by 36 months. Delinquency seriousness was coded ordinally from multiple measures/reporters; child-reported substance use was binary. RESULTS:: Relative to local normative comparison group, MTA children had significantly higher rates of delinquency (e.g., 27.1% vs. 7.4% at 36 months; p = .000) and substance use (e.g., 17.4% vs. 7.8% at 36 months; p = .001). Children randomized to intensive behavior therapy reported less 24-month substance use than other MTA children (p = .02). Random effects ordinal growth models revealed no other effects of initial treatment assignment on delinquency seriousness or substance use. By 24 and 36 months, more days of prescribed medication were associated with more serious delinquency but not substance use. CONCLUSIONS:: Cause-and-effect relationships between medication treatment and delinquency are unclear; the absence of associations between medication treatment and substance use needs to be re-evaluated at older ages. Findings underscore the need for continuous monitoring of these outcomes as children with attention-deficit/hyperactivity disorder enter adolescence.

Page last updated: 2007-08-04

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