Medication treatment strategies in the MTA study: Relevance to clinicians and researchers

Objective: Clinicians have difficulty applying drug research findings to clinical practice, because research protocols use methods different from those used in daily office practice settings. Method: To design a medication protocol for a multisite clinical trial involving 576 children with attention-deficit hyperactivity disorder (ADHD) while maintaining relevance to clinical practice, investigators from the NIMH Collaborative Multisite Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder (MTA study) developed novel medication strategies. These were designed to work either in a monomodal or multimodal format and to ensure standard approaches are used across diverse sites. Each child randomized to medication (projected N = 288) is individually titrated to his or her ''best'' methylphenidate dose and has individual ADHD symptoms monitored. Decision rules were developed to guide ''best dose'' selection, dose changes, medication changes, the management of side effects, and integration with psychosocial treatments. Conclusions: The MTA study uses a controlled method to standardize the identification of each child's ''best'' methylphenidate dose in a national, multisite cooperative treatment program. 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.