注意缺陷多动障碍多模式治疗研究随访中的青年成人结局：症状持续、来源差异和身高抑制

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

作者信息

Swanson James M, Arnold L Eugene, Molina Brooke S G, Sibley Margaret H, Hechtman Lily T, Hinshaw Stephen P, Abikoff Howard B, Stehli Annamarie, Owens Elizabeth B, Mitchell John T, Nichols Quyen, Howard Andrea, Greenhill Laurence L, Hoza Betsy, Newcorn Jeffrey H, Jensen Peter S, Vitiello Benedetto, Wigal Timothy, Epstein Jeffery N, Tamm Leanne, Lakes Kimberly D, Waxmonsky James, Lerner Marc, Etcovitch Joy, Murray Desiree W, Muenke Maximilian, Acosta Maria T, Arcos-Burgos Mauricio, Pelham William E, Kraemer Helena C

机构信息

Department of Pediatrics, School of Medicine, University of California, Irvine, CA, USA.

Department of Psychiatry, Nisonger Center, Ohio State University, Columbus, OH, USA.

出版信息

J Child Psychol Psychiatry. 2017 Jun;58(6):663-678. doi: 10.1111/jcpp.12684. Epub 2017 Mar 10.

DOI:10.1111/jcpp.12684

PMID:28295312

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6168061/

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.

摘要

背景

多模式治疗研究（MTA）最初是一项针对579名被诊断为注意力缺陷多动障碍（ADHD）合并型的7至10岁儿童进行的为期14个月的行为和药物治疗随机临床试验。它转变为对515例同意继续参与研究的病例以及作为当地正常对照组（LNCG）加入的289名同学（258名无ADHD）进行的观察性长期随访，在基线后2至16年进行评估。

方法

确定了成年期的主要（症状严重程度）和次要（成人身高）结局。对治疗进行监测直至18岁，并根据三种长期使用兴奋剂药物的模式（持续、不持续和极少使用）形成自然分组。对于随访，对成年早期（25岁时）的结局进行了产生假设的分析。采用计划比较来估计反映症状持续存在的ADHD-LNCG差异以及反映与长期用药相关的获益（症状减轻）和代价（身高抑制）的自然分组差异。

结果

对于症状严重程度评分，ADHD-LNCG在父母/自我报告平均值方面的比较具有统计学意义（0.51±0.04，p<.0001，d=1.11），证明了症状的持续存在，在父母/自我报告差异方面也具有统计学意义（0.21±0.04，p<.0001，d=.60），证明了来源差异，但反映药物作用的自然分组比较不显著。对于成人身高，ADHD组比LNCG组矮1.29±0.55厘米（p<.01，d=.21），自然分组的比较具有统计学意义：持续或不持续用药模式的治疗组比极少用药模式的组矮2.55±0.73厘米（p<.0005，d=.42），在治疗组内，持续用药模式的组比不持续用药模式的组矮2.36±1.13厘米（p<.04，d=.38）。