Clinical relevance of the primary findings of the MTA: Success rates based on severity of ADHD and ODD symptoms at the end of treatment

James M. Swanson, Helena C. Kraemer, Stephen P. Hinshaw, L. Eugene Arnold, C. Keith Conners, Howard B. Abikoff, Walter Clevenger, Mark Davies, Glen R. Elliott, Laurence L. Greenhill, Lily Hechtman, Betsy Hoza, Peter S. Jensen, John S. March, Jeffrey H. Newcorn, Elizabeth B. Owens, William E. Pelham, Ellen Schiller, Joanne B. Severe, Steve SimpsonBenedetto Vitiello, Karen Wells, Timothy Wigal, Min Wu

Research output: Contribution to journalArticlepeer-review

688 Scopus citations


Objectives: To develop a categorical outcome measure related to clinical decisions and to perform secondary analyses to supplement the primary analyses of the NIMH Collaborative Multisite Multimodal Treatment Study of Children With Attention-Deficit/Hyperactivity Disorder (MTA). Method: End-of-treatment status was summarized by averaging the parent and teacher ratings of attention-deficit/hyperactivity disorder and oppositional defiant disorder symptoms on the Swanson, Nolan, and Pelham, version IV (SNAP-IV) scale, and low symptom-severity ("Just a Little") on this continuous measure was set as a clinical cutoff to form a categorical outcome measure reflecting successful treatment. Three orthogonal comparisons of the treatment groups (combined treatment [Comb], medication management [MedMgt], behavioral treatment [Beh], and community comparison [CC]) evaluated hypotheses about the MTA medication algorithm ("Comb + MedMgt versus Beh + CC"), multimodality superiority ("Comb versus MedMgt"), and psychosocial substitution ("Beh versus CC"). Results: The summary of SNAP-IV ratings across sources and domains increased the precision of measurement by 30%. The secondary analyses of group differences in success rates (Comb = 68%; MedMgt = 56%; Beh = 34%; CC = 25%) confirmed the large effect of the MTA medication algorithm and a smaller effect of multimodality superiority, which was now statistically significant (p < .05). The psychosocial substitution effect remained negligible and nonsignificant. Conclusion: These secondary analyses confirm the primary findings and clarify clinical decisions about the choice between multimodal and unimodal treatment with medication.

Original languageEnglish (US)
Pages (from-to)168-179
Number of pages12
JournalJournal of the American Academy of Child and Adolescent Psychiatry
Issue number2
StatePublished - 2001


  • Clinical relevance
  • Logistic regression
  • Multimodal superiority
  • Orthogonal comparisons
  • SNAP-IV ratings

ASJC Scopus subject areas

  • Developmental and Educational Psychology
  • Psychiatry and Mental health


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