Delinquent Behavior and Emerging Substance Use

in the MTA at 36 Months: Prevalence, Course,

and Treatment Effects

BROOKE S.G. MOLINA, PH.D., KATE FLORY, PH.D., STEPHEN P. HINSHAW, PH.D.,

ANDREW R. GREINER, B.S., L. EUGENE ARNOLD, M.D., JAMES M. SWANSON, PH.D.,

LILY HECHTMAN, M.D., PETER S. JENSEN, M.D., BENEDETTO VITIELLO, M.D.,

BETSY HOZA, PH.D., WILLIAM E. PELHAM, PH.D., GLEN R. ELLIOTT, PH.D., M.D.,

KAREN C. WELLS, PH.D., HOWARD B. ABIKOFF, PH.D., ROBERT D. GIBBONS, PH.D.,

SUE MARCUS, PH.D., C. KEITH CONNERS, PH.D., JEFFERY N. EPSTEIN, PH.D.,

LAURENCE L. GREENHILL, M.D., JOHN S. MARCH, M.D., M.P.H.,

JEFFREY H. NEWCORN, M.D., JOANNE B. SEVERE, M.S., AND TIMOTHY WIGAL, PH.D.

ABSTRACT

Objective: To compare delinquent behavior and early substance use between the children in the Multimodal Treatment

Study of Children With ADHD (MTA; N = 487) and those in a local normative comparison group (n = 272) at 24 and 36

months postrandomization and to test whether these outcomes were predicted by the randomly assigned treatments and

subsequent self-selected prescribed medications. Method: Most MTA children were 11 to 13 years old by 36 months.

Delinquency seriousness was coded ordinally from multiple measures/reporters; child-reported substance use was binary.

Results: Relative to local normative comparison group, MTA children had significantly higher rates of delinquency (e.g.,

27.1% vs. 7.4% at 36 months; p = .000) and substance use (e.g., 17.4% vs. 7.8% at 36 months; p = .001). Children

randomized to intensive behavior therapy reported less 24-month substance use than other MTA children (p = .02).

Random effects ordinal growth models revealed no other effects of initial treatment assignment on delinquency

seriousness or substance use. By 24 and 36 months, more days of prescribed medication were associated with more

serious delinquency but not substance use. Conclusions: Cause-and-effect relationships between medication treatment

and delinquency are unclear; the absence of associations between medication treatment and substance use needs to be

re-evaluated at older ages. Findingsunderscore the need for continuousmonitoring of these outcomes as childrenwith attentiondeficit/hyperactivity disorder enter adolescence. J. Am. Acad. Child Adolesc. Psychiatry, 2007;46(8):1027Y1039. Key Words:

attention-deficit/hyperactivity disorder, treatment,multimodal,medication, substance use, delinquency.

Accepted January 4, 2007.

Please see end of text for author affiliations.

The work reported was supported by cooperative agreement grants and contracts

from the National Institute of Mental Health to the following: University of

California, Berkeley: U01 MH50461 and N01MH12009; Duke University:

U01 MH50477 and N01MH12012; University of California, Irvine: U01

MH50440 and N01MH 12011; Research Foundation for Mental Hygiene

(New York State Psychiatric Institute/Columbia University): U01 MH50467

and N01MH12007; Long Island-JewishMedical Center U01MH50453; New

York University: N01MH 12004; University of Pittsburgh: U01 MH50467

and N01 MH 12010; and McGill University N01MH12008.- The Office of

Special Education Programs of the U.S. Department of Education, the Office of

Juvenile Justice and Delinquency Prevention of the Justice Department, and the

National Institute on Drug Abuse also participated in funding.

Appreciation is extended to Dr. Patrick C
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