Treatment-related changes in objectively measured parenting behaviors in the multimodal treatment study of children with attention-deficit/hyperactivity disorder.
Journal of Consulting and Clinical PsychologyPublished 1 January 2006
Karen C. Wells, Christian Terry, Stephen P. Hinshaw, Jeffery N. Epstein, Linda J. Pfiffner, Marie Nebel-Schwalm
Citations99
SJR quartileQ1
SJR score2.23
SNIP2.00
Generate an AI Snapshot to get a quick, structured summary of this paper.
Study Snapshot
ObjectiveStudy objective
MethodsResearch methodology
PopulationPopulation studied
Sample sizeSample sizes
OutcomesStudy outcomes here
ResultsStudy results comes here
LimitationsResearch study limitations comes here
A concise AI-generated summary of the paper will appear here once you click Generate AI Snapshot.
TL;DR
Comb produced significantly greater improvements in constructive parenting than did medication management, intensive behavior therapy, combination of the 2, or community-treated comparison, with effect sizes approaching medium for these contrasts.
Abstract
The present study examined treatment outcomes for objectively measured parenting behavior in the Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder (ADHD). Five hundred seventy-nine ethnically and socioeconomically diverse children with ADHD-combined type (ages 7.0-9.9 years) and their parent(s) were recruited at 6 sites in the United States and Canada and randomly assigned to 1 of 4 treatment groups for 14 months of active intervention: medication management (MedMgt), intensive behavior therapy, combination of the 2 (Comb), or a community-treated comparison (CC). Baseline and posttreatment laboratory observations of parent-child interactions were coded by observers blind to treatment condition. Comb produced significantly greater improvements in constructive parenting than did MedMgt or CC, with effect sizes approaching medium for these contrasts. Treatment effects on child behaviors were not significant. The authors discuss the importance of changes in parenting behavior for families of children with ADHD and the need for reliable and objective measures in evaluating treatment outcome.
Keywords
PsychologyMedicine
Encyclopedia of Social WorkDiagnostic and Statistical Manual of Mental Disorders
109,983 Citations2013Janet B. W. Williams, Michael B. First
Behavioral DisordersAttention Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment
4,655 Citations1994Russell A. Barkley, Mary Jo Poillion
Barkley, A Theory of ADHD, ADHD in Adults: Developmental Course and Outcome of Children with ADHD, and ADHD in Clinic-referred Adults; and Cunningham, Cunningham, Student-mediated Conflict Resolution Programs.
Journal of the American Statistical AssociationMultiple Comparisons among Means
4,477 Citations1961Olive Jean Dunn
Archives of General PsychiatryA 14-Month Randomized Clinical Trial of Treatment Strategies for Attention-Deficit/Hyperactivity Disorder
3,365 Citations1999
The authors' carefully crafted medication management was superior to behavioral treatment and to routine community care that included medication for ADHD symptoms, and may have provided modest advantages for non-ADHD symptom and positive functioning outcomes.
Clinical Child and Family Psychology ReviewFamilies of Children With Attention-Deficit/Hyperactivity Disorder: Review and Recommendations for Future Research
1,143 Citations2001Charlotte Johnston, Eric J. Mash
Evidence suggests that the presence of ADHD in children is associated to varying degrees with disturbances in family and marital functioning, disrupted parent–child relationships, specific patterns of parental cognitions about child behavior and reduced parenting self-efficacy, and increased levels of parenting stress and parental psychopathology.
Journal of the American Academy of Child & Adolescent PsychiatryClinical Relevance of the Primary Findings of the MTA: Success Rates Based on Severity of ADHD and ODD Symptoms at the End of Treatment
1,130 Citations2001James M. Swanson, Helena C. Kraemer +22 more
These secondary analyses confirm the primary findings and clarify clinical decisions about the choice between multimodal and unimodal treatment with medication.
Journal of the American Statistical AssociationMultiple Comparisons Among Means
692 Citations1961Olive Jean Dunn
Archives of General PsychiatryModerators and Mediators of Treatment Response for Children With Attention-Deficit/Hyperactivity Disorder
652 Citations1999The MTA Cooperative Group
In children with ADHD plus anxiety, behavioral treatment surpassed community care and approached medication-based treatments regarding parent-reported ADHD symptoms, and results were upheld across most baseline variables and treatment acceptance/attendance.
American Psychological Association eBooksPsychosocial treatments for child and adolescent disorders: Empirically based strategies for clinical practice.
610 Citations1996
Medical Entomology and ZoologyHyperactive Children Grown Up: ADHD in Children, Adolescents, and Adults
596 Citations1993Gabrielle Weiss, Lily Hechtman
This second edition of a classic volume demonstrates that fifty percent of hyperactive children continue to face problems of impulsivity, restlessness, low self-esteem, and social skill deficits when they become adults.
BiometricsMeasuring Agreement between Two Judges on the Presence or Absence of a Trait
504 Citations1975Joseph L. Fleiss
Using the binary (positive-negative) case as a model, some of the proposed indexes for measuring agreement between two judges on a categorical scale are presented and critically evaluates.
Journal of the American Academy of Child & Adolescent PsychiatryParent-Based Therapies for Preschool Attention-Deficit/Hyperactivity Disorder: A Randomized, Controlled Trial With a Community Sample
415 Citations2001Edmund Sonuga‐Barke, David Daley +3 more
PT is a valuable treatment for preschool ADHD and constructive training in parenting strategies is an important element in the success of parent-based interventions.
Journal of the American Academy of Child & Adolescent PsychiatryLong-Term Outcome of Hyperactive Children: A Review
406 Citations1991Rachel G. Klein, Salvatore Mannuzza
The little existing information on girls with attention deficit hyperactivity disorder does not suggest a worse outcome than for boys, and attempts to identify the children most likely to have a poor outcome have been largely unsuccessful.
Journal of Child Psychology and PsychiatryThe Adolescent Outcome of Hyperactive Children Diagnosed By Research Criteria—III. Mother–Child Interactions, Family Conflicts and Maternal Psychopathology
373 Citations1991Russell A. Barkley, Mariellen Fischer +2 more
Results suggest that the development and maintenance of ODD into adolescence in hyperactive children is strongly associated with aggression and negative parent-child interactions in childhood.
Journal of the American Academy of Child & Adolescent PsychiatryStimulant Treatment for Children: A Community Perspective
358 Citations2000Adrian Angold, ALAATTIN ERKANLI +2 more
In this area of the Great Smoky Mountains, stimulant treatment was being used in ways substantially inconsistent with current diagnostic guidelines.
Cambridge University Press eBooksCoercion and Punishment in Long-Term Perspectives
324 Citations1995Joan McCord
Journal of Abnormal Child PsychologyParent characteristics and parent-child interactions in families of nonproblem children and ADHD children with higher and lower levels of oppositional-defiant behavior
320 Citations1996Charlotte Johnston
The results support the LOD and HOD distinction, but also suggest that, although certain difficulties are more common in the families of ADHD-HOD children, families ofADHD-LOD children also differ from controls on a number of dimensions.
Journal of Clinical Child & Adolescent PsychologyParent Stress and Coping in Relation to Child ADHD Severity and Associated Child Disruptive Behavior Problems
311 Citations2001Cheryl-Lynn Podolski, Joel T. Nigg
Mothers and fathers of children with ADHD combined and inattentive subtypes expressed more role dissatisfaction than parents of control children and parenting role distress was associated uniquely with child oppositional or aggressive behaviors but not with ADHD symptom severity.
Journal of the American Academy of Child & Adolescent PsychiatryAre Stimulants Overprescribed? Treatment of ADHD in Four U.S. Communities
308 Citations1999Peter S. Jensen, LORI KETTLE +7 more
Medication treatments are often not used in treating ADHD children identified in the community, suggesting the need for better education of parents, physicians, and mental health professionals about the effectiveness of these treatments.
Journal of the American Academy of Child & Adolescent PsychiatryMedication Treatment Strategies in the MTA Study: Relevance to Clinicians and Researchers
297 Citations1996LAURENCE L. GREENHILL, Howard Abikoff +15 more
Although the titration protocol is complex, the study's individual dosing approach and algorithms for openly managing ADHD children's medication over time will be of interest to clinicians in office practice.
Journal of Abnormal Child PsychologyAdolescents with attention deficit hyperactivity disorder: Mother-adolescent interactions, family beliefs and conflicts, and maternal psychopathology
290 Citations1992Russell A. Barkley, Arthur D. Anastopoulos +2 more
Results imply that it is the combination of ODD symptoms with those of ADHD that is associated with the greater-than-normal conflicts, anger, poor communications, unreasonable beliefs, and negative interactive styles seen in ADHD adolescents.
Journal of the American Academy of Child & Adolescent PsychiatryMultimodal Treatment of ADHD in the MTA: An Alternative Outcome Analysis
285 Citations2001C. Keith Conners, Jeffrey N. Epstein +19 more
A composite of ADHD variables may be an important tool in future treatment trials with ADHD and may avoid some of the statistical limitations of multiple measures.
Journal of Abnormal Child PsychologyFamily Processes and Treatment Outcome in the MTA: Negative/Ineffective Parenting Practices in Relation to Multimodal Treatment
269 Citations2000Stephen P. Hinshaw, Elizabeth B. Owens +16 more
Overall, the success of combination treatment for important school-related outcomes appears related to reductions in negative and ineffective parenting practices at home, and problems in interpreting the temporal sequencing of such process-outcome linkages are discussed.
Journal of Clinical Child & Adolescent PsychologyPeer-Assessed Outcomes in the Multimodal Treatment Study of Children With Attention Deficit Hyperactivity Disorder
268 Citations2005Betsy Hoza, Alyson C. Gerdes +19 more
There was little evidence of superiority of any of the treatments for the peer-assessed outcomes studied, although the limited evidence that emerged favored treatments involving medication management.
Child DevelopmentThe Interactions of Normal and Hyperactive Children with Their Mothers in Free Play and Structured Tasks
252 Citations1979Charles E. Cunningham, Russell A. Barkley
It is suggested that the controlling intrusive style observed among the mothers of hyperactive boys, while initially a response to the child's overactive, impulsive, inattentive style, may further contribute to theChild's behavioral difficulties.
Journal of Consulting and Clinical PsychologyOutcome of parent-mediated treatment of preschoolers with attention deficit disorder with hyperactivity.
236 Citations1989Susan Pisterman, Patrick J. McGrath +4 more
Evaluation of treatment effects on nontargeted child behaviors indicated no generalization and positive treatment effect was obtained on measures of compliance, parental style of interaction, and management skills.
Handbook of clinical family therapy.
226 Citations2005Jay L. Lebow
Journal of Abnormal Child PsychologyParenting and Family Stress Treatment Outcomes in Attention Deficit Hyperactivity Disorder (ADHD): An Empirical Analysis in the MTA Study
217 Citations2000Karen C. Wells, Jeffery N. Epstein +18 more
Results showed that Beh alone, MedMgt alone, and Comb produced significantly greater decreases in a parent-rated measure of negative parenting, Negative/Ineffective Discipline, than did standard community treatment.
Journal of Abnormal Child PsychologyHard-to-manage preschool boys: Externalizing behavior, social competence, and family context at two-year followup
211 Citations1994Susan B. Campbell
Boys, identified as hard to manage in preschool, were followed up 2 years after initial assessment and continued to rate hard-to-manage boys as having more problems with attention and impulse control and as more oppositional, than comparison boys who had been problem-free at intake.
Journal of Abnormal Child PsychologyParent–Adolescent Conflict in Teenagers with ADHD and ODD
199 Citations2001Gwenyth H. Edwards, Russell A. Barkley +3 more
Past studies of mother–child interactions in ADHD/ODD children, extended to teens with these disorders, showed that greater conflict also occurs in father–teen interactions, and found that degree of parental hostility, but not ADHD symptoms, further contributed to levels of parent–teen conflict beyond the contribution made by severity of teen ADHD and ODD symptoms.
Journal of Child Psychology and PsychiatryHYPERACTIVE AND NORMAL GIRLS AND BOYS: MOTHER‐CHILD INTERACTION, PARENT PSYCHIATRIC STATUS AND CHILD PSYCHOPATHOLOGY*
195 Citations1985Marilyn schulte Befera, Russell A. Barkley
Hyperactive children were less compliant and more negative, and their mothers responded more negatively to their compliance than mothers of normal children.
Journal of Abnormal Child PsychologyPsychosocial Treatment Strategies in the MTA Study: Rationale, Methods, and Critical Issues in Design and Implementation
194 Citations2000Karen C. Wells, William E. Pelham +17 more
The MTA's Psychosocial Treatment strategy applied to all children in two of the four experimental arms, and consisted of three major components: a Parent Training component, a two-part School Intervention component, and a child treatment component anchored in an intensive Summer Treatment Program.
Child DevelopmentA Comparison of the Mother-Child Interactions of Younger and Older Hyperactive and Normal Children
179 Citations1982Eric J. Mash, Charlotte Johnston
Between-group differences in mother-child interactions were greatest when comparing dyads with a younger hyperactive child with the other 3 groups, especially during the structured-task situation.
Child DevelopmentA Developmental Investigation of Inattentiveness and Hyperactivity
170 Citations1995Elizabeth A. Carlson, Deborah Jacobvitz +1 more
The findings support a developmental view of the origins and course of hyperactivity in childhood, that is, that the emergence and persistence of AD/HD symptoms depend on developmental history along with current circumstances.
Journal of Attention DisordersComprehensive assessment of childhood Attention-Deficit Hyperactivity Disorder in the context of a multisite, multimodal clinical trial
166 Citations1997Stephen P. Hinshaw, John S. March +20 more
The MTA's multiple-gating procedures for recruitment, screening, and diagnosis of a diverse sample, and the cross-domain assessment battery for tracking the sample before, during, and after 14 months of active intervention are described.
Cambridge University Press eBooksCoercion as a basis for early age of onset for arrest
161 Citations1995Gerald R. Patterson
Journal of Clinical Child PsychologyDiagnostic Status and Symptomatic Behavior of Hard-to-Manage Preschool Children in Middle Childhood and Early Adolescence
150 Citations1999Elizabeth W. Pierce, Linda J. Ewing +1 more
Across cohorts, children with persistent problems had higher levels of symptoms and more varied symptoms at ages 3 and 4 and over the course of development.
Griffith Research Online (Griffith University, Queensland, Australia)Handbook of Interventions that Work With Children and Adolescents: From Prevention to Treatment
146 Citations2004Paula M. Barrett, Thomas H. Ollendick
Journal of Child Psychology and PsychiatryDEVELOPMENTAL CHANGES IN THE MOTHER‐CHILD INTERACTIONS OF HYPERACTIVE BOYS: EFFECTS OF TWO DOSE LEVELS OF RITALIN*
137 Citations1985Russell A. Barkley, Jennifer Karlsson +2 more
The mother-child interactions of 60 hyperactive children subdivided equally into five age levels were studied during free play and task periods in a double-blind drug-placebo evaluation of two dose levels of Ritalin, apparently reflecting a chronic lag in this pattern inhyperactive children that may be improved with stimulant medication.
American Journal of OrthopsychiatryThe role of parent training in treatment of preschoolers with ADDH.
134 Citations1992Susan Pisterman, Philip Firestone +5 more
The efficacy of group parent training was assessed in improving compliance and time on task in preschoolers with attention-deficit disorder with hyperactivity and positive effects were obtained on measures of child compliance.
Journal of Abnormal Child PsychologyThe interactions of hyperactive and normal boys with their fathers and mothers
116 Citations1983James Tallmadge, Russell A. Barkley
American Journal of OrthopsychiatryLong-term outcome of hyperactive children.
115 Citations1983Lily Hechtman, Gabrielle Weiss
A review of outcome studies of hyperactive children suggests that they experience significant academic, social, and conduct difficulties during adolescence, and that social, emotional, and impulse problems persist into young adulthood for the majority.
Journal of Abnormal Child PsychologyMother-child interactions in ADHD and comparison boys: Relationships with overt and covert externalizing behavior
108 Citations1994Carolyn A. Anderson, Stephen P. Hinshaw +1 more
Hierarchical multiple-regression analyses revealed that, even with maternal psychopathology and child negativity with the mother partialed, maternal negative behaviors predicted both observed noncompliance exhibited in class and play settings and laboratory stealing.
Journal of Child Psychology and PsychiatrySTIMULANT EFFECTS ON COOPERATION AND SOCIAL INTERACTION BETWEEN HYPERACTIVEE CHILDREN AND THEIR MOTHERS
100 Citations1978Thomas W. Humphries, Marcel Kinsbohrne +1 more
Journal of Consulting and Clinical PsychologyDoes Maternal Warmth Moderate the Effects of Birth Weight on Twins' Attention-Deficit/Hyperactivity Disorder (ADHD) Symptoms and Low IQ?
95 Citations2004Lucy A. Tully, Louise Arseneault +3 more
The findings suggest that the effect of children's birth weight on their ADHD symptoms can be moderated by maternal warmth and that enhancing maternal warmth may prevent behavior problems among the increasing population of low-birth- weight children.
Journal of Attention DisordersNIMH collaborative multimodal treatment study of children with ADHD (MTA): Design, methodology, and protocol evolution
82 Citations1997L. Eugene Arnold, Howard Abikoff +18 more
The steering committee of the collaborative six-site Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder had to develop a common protocol consistent with public health goals and with scientific and clinical state of the art.
Journal of Abnormal Child PsychologyEffects of age on the mother-child interactions of ADD-H and normal boys
80 Citations1985Russell A. Barkley, Jennifer Karlsson +1 more
Several age effects were noted suggesting that older boys in both groups were more compliant while their mothers gave fewer commands and controlled their compliance less than the motherchild dyads of younger boys.
Journal of Abnormal Child PsychologyA sequential analysis of the mother-adolescent interactions of ADHD, ADHD/ODD, and normal teenagers during neutral and conflict discussions
79 Citations1996Kenneth E. Fletcher, Mariellen Fischer +2 more
The majority of conflict between ADHD children and their parents seemed due to comorbid ODD and such ODD is a family, not just a teen, characteristic.
Child & Family Behavior TherapyThe Effects of Parent Training and Ritalin on the Parent-Child Interactions of Hyperactive Boys
67 Citations1984Susan Pollard, Eric M. Ward +1 more
PsychoneuroendocrinologyReporting the size of effects in research studies to facilitate assessment of practical or clinical significance
64 Citations1992H KRAEMER
One method of presentation of results is proposed that not only encompasses all the others, but enhances the scope of useful information conveyed in a research report.
Journal of the American Academy of Child & Adolescent PsychiatryTraditional and Alternative Research Designs and Methods in Clinical Pediatric Psychopharmacology
56 Citations1996Maurizio Fava
It appears that pediatric psychopharmacology trials require a relatively greater flexibility in design to avoid significant study biases.
Evaluation & the Health ProfessionsEvaluating How Placebos Produce Change
55 Citations2002Opher Caspi, Richard R. Bootzin
The article challenges the premise that placebo effects can be measured precisely enough that variance attributed to “nonspecific” placebo effectsCan be hierarchically partitioned from variance attributing to other “more specific” elements of therapy.
Psychological BulletinEnsemble-adjusted p values.
42 Citations1983Robert Rosenthal, Donald B. Rubin
In many data analyses, multiple tests of significance are performed, and in many contexts it is more informative to report p values than the significant-nonsignificant dichotomy for some fixed a, so it is believed that the ensemble-adjusted p value, Cpj, should be reported.
Child & Family Behavior TherapyDevelopment of Listening Skills in Retarded Children:
25 Citations1983Deborah Keogh, Louis D. Burgio +2 more
Treatment of Adhd in Children and Adolescents
13 Citations2004Karen C. Wells
Journal of Psychotherapy & The FamilyChild and Family Therapy
8 Citations1989Sharon Gordetsky, Joan J. Zilbach