The M.T.A. Study of Attention Deficit Hyperactivity Disorder: Where are we heading? What do we really know? How doctors and scientists are concerned about the outcome of the multimodal treatment
He was in charge of the site in Orange County. He recruited and selected 100 children who had A.D.H.D. symptoms. Some were given regular Ritalin, some were given high-quality behavioral training, and the rest were left to figure out their own treatment when they were split into treatment groups. The same thing happened at five other sites across the continent. Known as the Multimodal Treatment of Attention Deficit Hyperactivity Disorder Study, or M.T.A., it was one of the largest studies ever undertaken of the long-term effects of any psychiatric medication.
At a moment of national concern about our shrinking attention spans, this science suggests that there may be some new and more effective ways to help the millions of young people who are struggling to focus.
I’ve spent the last year speaking with some of the leading A.D.H.D. researchers in the United States and abroad, and many of them, like Swanson, express concern over what they see as a disconnect between the emerging scientific understanding of A.D.H.D. and the way the condition is being treated in clinics and doctors’ offices. Edmund Sonuga-Barke is a researcher in neuroscience and Psychiatry at King’s College London. “I’ve invested 35 years of my life trying to identify the causes of A.D.H.D., and somehow we seem to be farther away from our goal than we were when we started,” he told me. There is a clinical definition of A.D.H.D. that is unanchored from what we find in our science.
Normally, when a diagnosis booms like this, it’s because of some novel scientific breakthrough — a newly discovered treatment or a fresh understanding of what causes the underlying symptoms. I spent the last year interviewing A.D.H.D. scientists around the world for my magazine article, and what I heard from them was, in fact, the opposite: In many ways, we now understand A.D.H.D. less well than we thought we did a couple of decades ago. Recent studies have shaken some of the field’s previous assumptions about A.D.H.D. At the same time, scientists have made important discoveries, including some that are leading to a new understanding of the role of a child’s environment in the progression of his symptoms.