Follow-up study of children with ADHD followed until adulthood: the ‘Multimodal Treatment Study’

The ‘Multimodal Treatment Study of Children with ADHD’ (MTA) has shown that the amelioration of ADHD behaviours during the first two years of therapy was greatest among the group of children undergoing intensive drug treatment. Follow-up studies of the MTA found that the differences in the reduction of ADHD behaviours disappeared over time. Even after long-term follow-up, the groups did not differ in terms of academic achievement, delinquency or incipient drug abuse. The article discussed here adds to this the adverse effect of growth retardation, while a further side-effect, that of cardiac arrhythmias, was revealed in 2016.8 9

Prescribers and suppliers should remember that drugs to treat ADHD should be prescribed by a doctor with expertise of behavioural disorders among children, and that according to the authorised indication, these drugs should only be prescribed when non-medicinal therapies have no or insufficient effect. In view of the lack of evidence for the long-term efficacy of methylphenidate and the risks of more or less serious adverse effects, it is clear that considerable caution  must be exercised when deciding to prescribe medicinal therapy to children diagnosed with ADHD, as was previously also recommended in Gebu 2012; 46: 121-129.

  1. MTA Cooperative Group. A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. Arch Gen Psychiatry 1999; 56: 1073-1086.
  2. Jensen PS, et al. 3-Year follow-up of the NIMH MTA Study. J Am Acad Child Adolesc Psychiatry 2007; 46: 989-1002.
  3. Molina BSG, et al. MTA Cooperative Group. The MTA at 8 years: Prospective follow-up of children treated for combined-type ADHD in a multisite study. J Am Acad Child Adolesc Psychiat 2009; 48: 484-500.
  4. MTA Cooperative Group. National Institute of Mental Health multimodal treatment study of ADHD follow-up: 24-month outcomes of treatment strategies for attention-deficit/hyperactivity disorder. Pediatrics 2004; 113: 754-761.
  5. Nieweg EH. Is ADHD-medicatie na 2-3 jaar uitgewerkt? Over de verrassende, maar weinig bekende follow-up van het MTA-onderzoek. Tijdschr Psychiatrie 2010; 52: 245-254.
  6. Buitelaar JK. Follow-up van de MTA-studie bij kinderen met ADHD: wat vertellen de data wel, en wat niet? [commentaar]. Tijdschr Psychiatrie 2010; 52: 255-257.
  7. Swanson JM, et al. Young adult outcomes in the follow-up of the multimodal treatment study of attention-deficit/hyperactivity disorder: symptom persistence, source discrepancy, and height suppression. J Child Psychology Psychiatry 2017; 58: 663-678.
  8. Shin JY, et al. Cardiovascular safety of methylphenidate among children and young people with attention-deficit/hyperactivity disorder (ADHD): nationwide self controlled case series study. BMJ 2016; 353: i2550.
  9. Montastruc F,et al. Cardiovascular safety of methylphenidate should also be considered in adults. BMJ 2016; 353: i3418.

*The literature refers to the Dutch text.