The Transition to Middle School is Associated with Changes in the Developmental Trajectory of ADHD Symptomatology in Young Adolescents with ADHD

Abstract

The attention deficit hyperactivity disorder (ADHD) symptom presentation of young adolescents with ADHD was examined in association with the transition to middle school. This study used data collected in the Multimodal Treatment Study of ADHD, which included children between 7 and 9 years of age with a diagnosis of ADHD (n = 258) and grade- and sex-matched controls (n = 112). The trajectory of ADHD symptoms before, during, and after the transition to middle school was modeled using hierarchical linear modeling. A clear developmental reduction in ADHD symptomatology was observed for all three ADHD symptom domains. For young adolescents with ADHD, the transition to middle school was associated with a disruption in the developmental decline of inattention, hyperactivity, and impulsivity symptoms as measured by parent ratings. This effect was also observed for teacher ratings of inattention and hyperactivity. These results support the assertion that the environmental changes associated with transitioning to middle school coincide with a transient reversal in ADHD symptom decline among children with ADHD.

Notes

Note: (1) = Unconditional mean model; (2) = (1) + fixed age; (3) = (2) + random effect for age; (4) = (2) + fixed age²; (5) = (4) + random effect for age²; A = age.

Note: Random effects are italicized. Comb = combined treatment; MedMgt = medication management only; Beh = behavioral only; CC = community comparison.

∗p < .05; ∗∗p < .01; ∗∗∗p < .001.

Note: Random effects are italicized. Comb = combined treatment; MedMgt = medication management only; Beh = behavioral only; CC = community comparison.

∗p < .05; ∗∗p < .01; ∗∗∗p < .001.

Note: Time point 0 designates the transition to middle school. Negative numbers are the elementary school years leading to middle school. Positive numbers are the years following the transition year.

Note: Pooled SD used to calculate ES. ES = effect size; pooled SD = average of SD Transition and SD No Transition.

Note: (1) = Unconditional mean; (2) = Linear age (fixed); (3) = Linear age (random); (4) = Quadratic age (Fixed); (5) = Quadratic age (random); (6) = (4) + med use (Fixed); (7) = (6) + med use (random); (8) = (6) + treatment group; (9) = (8) + transition (fixed); (10) = (9) + transition (random); (11) = 10 + post transition (fixed); (12) = 11 + post transition (random); (13) = final model after dropping quadratic age and non significant interaction terms. A = age; M = medication use; TG = treatment group; T = transition year; PT = posttransition slope.

The Multimodal Treatment Study of Children with ADHD (MTA) was a National Institute of Mental Health (NIMH) cooperative agreement randomized clinical trial, and then continued under an NIMH contract as a follow-up study. Collaborators from the National Institute of Mental Health: Benedetto Vitiello, M.D. (Child & Adolescent Treatment and Preventive Interventions Research Branch), Joanne B. Severe, M.S. (Clinical Trials Operations and Biostatistics Unit, Division of Services and Intervention Research), Peter S. Jensen, M.D. (currently at Columbia University), L. Eugene Arnold, M.D., M.Ed. (currently at Ohio State University), Kimberly Hoagwood, Ph.D. (currently at Columbia); previous contributors from NIMH to the early phases: John Richters, Ph.D. (currently at National Institute of Nursing Research); Donald Vereen, M.D. (currently at National Institute on Drug Abuse). Principal investigators and co-investigators from the sites are: University of California, Berkeley/San Francisco: Stephen P. Hinshaw, Ph.D. (Berkeley), Glen R. Elliott, M.D., Ph.D. (San Francisco); Duke University: Karen C. Wells, Ph.D., Jeffery Epstein, Ph.D.; previous Duke contributors to early phases: C. Keith Conners, Ph.D. (former PI); John March, M.D., M.P.H.; University of California, Irvine: James Swanson, Ph.D., Timothy Wigal, Ph.D.; previous contributor from UCLA to the early phases: Dennis P. Cantwell, M.D. (deceased); Long Island Jewish Medical Center/New York University: Howard, B. Abikoff, Ph.D.; Montreal Children's Hospital/McGill University: Lily Hechtman, M.D.; New York State Psychiatric Institute/Columbia University/Mount Sinai Medical Center: Laurence L. Greenhill, M.D. (Columbia), Jeffrey H. Newcorn, M.D. (Mount Sinai School of Medicine). University of Pittsburgh: Brooke Molina, Ph.D., Betsy Hoza, Ph.D. (currently at Purdue University), William E. Pelham, Ph.D. (PI for early phases, currently at State University of New York, Buffalo). Follow-up phase statistical collaborators: Robert D. Gibbons, Ph.D. (University of Illinois, Chicago); Sue Marcus, Ph.D (Mt. Sinai College of Medicine) Kwan Hur, Ph.D. (University of Illinois, Chicago). Original study statistical and design consultant: Helena C. Kraemer, Ph.D. (Stanford University). Collaborator from the Office of Special Education Programs/US Department of Education: Thomas Hanley, Ed.D. Collaborator from Office of Juvenile Justice and Delinquency Prevention/Department of Justice: Karen Stern, Ph.D.