RESUMEN
The Collaborative Multimodal Treatment Study of Children with Attention Deficit Hyperactivity Disorder (ADHD), the MTA, is the first child multisite cooperative agreement treatment study of children conducted by the National Institute of Mental Health, Rockville, Md. It examines the long-term effectiveness of medication vs behavioral treatment vs both for treatment of ADHD and compares state-of-the-art treatment with routine community care. In a parallel-groups design, 576 children (age, 7-9 years) with ADHD (96 at each site) are thoroughly assessed and randomized to 4 conditions: (1) medication alone, (2) psychosocial treatment alone, (3) the combination of both, (4) or community comparison. The first 3 groups are treated for 14 months and all are reassessed periodically for 24 months. Designers met the following challenges: framing clinically relevant primary questions; defining the target population; choice, intensity, and integration and combination of treatments for fair comparisons; combining scientific controls and standardization with clinical flexibility; and implementing a controlled clinical trial in a nonclinical setting (school) controlled by others. Innovative solutions included extensive decision algorithms and manualized adaptations of treatments to specific needs.
Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad/tratamiento farmacológico , Trastorno por Déficit de Atención con Hiperactividad/terapia , Investigación sobre Servicios de Salud , Proyectos de Investigación/normas , Trastorno por Déficit de Atención con Hiperactividad/psicología , Terapia Conductista , Niño , Protocolos Clínicos , Terapia Combinada , Toma de Decisiones , Dextroanfetamina/uso terapéutico , Femenino , Política de Salud , Humanos , Imipramina/uso terapéutico , Masculino , Metilfenidato/uso terapéutico , National Institute of Mental Health (U.S.) , Selección de Paciente , Pemolina/uso terapéutico , Estados UnidosRESUMEN
The physical, economic, and mental toll caused by violence in the United States has put tremendous pressure on American medical, political, religious, and social institutions. The impact in urban neighborhoods has been especially harrowing, forcing African-American organizations to address this domestic problem with ideas and suggestions unique to their philosophies and collective talents. This article contains general perspectives and commentary from physicians and social science experts who participated in a workshop sponsored by the National Medical Association, the National Institute of Drug Abuse, and the National Institute of Mental Health to discuss topics on violence, its health consequences, and the conduct of research in the African-American community.