Socioeconomic Status as a Moderator of ADHD Treatment Outcomes

Ricardo Rieppi; Laurence L. Greenhill; Rebecca E. Ford; Shirley Chuang; Min Wu; Mark Davies; Howard B. Abikoff; L. Eugene Arnold; C. Keith Conners; Glen R. Elliott; Lily Hechtman; Stephen P. Hinshaw; Betsy Hoza; Peter S. Jensen; Helena C. Kraemer; John S. March; Jeffrey H. Newcorn; William E. Pelham; Joanne B. Severe; James M. Swanson; Benedetto Vitiello; Karen C. Wells; Timothy Wigal

doi:10.1097/00004583-200203000-00006

Socioeconomic Status as a Moderator of ADHD Treatment Outcomes

Ricardo Rieppi^*, Laurence L. Greenhill, Rebecca E. Ford, Shirley Chuang, Min Wu, Mark Davies, Howard B. Abikoff, L. Eugene Arnold, C. Keith Conners, Glen R. Elliott, Lily Hechtman, Stephen P. Hinshaw, Betsy Hoza, Peter S. Jensen, Helena C. Kraemer, John S. March, Jeffrey H. Newcorn, William E. Pelham, Joanne B. Severe, James M. SwansonBenedetto Vitiello, Karen C. Wells, Timothy Wigal

^*Corresponding author for this work

Psychiatry and Behavioral Sciences

Research output: Contribution to journal › Article › peer-review

104 Scopus citations

Abstract

Objective: To explore whether socioeconomic status (SES) variables moderate treatment response of attention-deficit/hyperactivity disorder (ADHD) to medication management (MedMgt), behavioral treatment (Beh), combined intervention (Comb), and routine community care (CC). Method: The MTA Cooperative Group's intent-to-treat (ITT) analyses were repeated, covarying for composite Hollingshead SES, education, occupation, income, and marital status. Results: Individual SES variables were more informative than the composite Hollingshead Index. Treatment response of children from less educated households paralleled ITT outcomes: no significant difference was found between Comb and MedMgt (both better than Beh and CC) for core ADHD symptoms. However, children from more educated families showed superior reduction of ADHD symptoms with Comb. For oppositional-aggressive symptoms, children from blue-collar, lower SES households benefited most from Comb, whereas those from white-collar, higher SES homes generally showed no differential treatment response. Household income and marital status failed to influence outcomes. Controlling for treatment attendance attenuated the moderating effects of the SES variables only for MedMgt. Conclusions: Investigators are encouraged to use independent SES variables for maximal explanation of SES effects. Clinicians should prioritize target symptoms and consider the mediating role of treatment adherence when determining an ADHD patient's optimal intervention plan.

Original language	English (US)
Pages (from-to)	269-277
Number of pages	9
Journal	Journal of the American Academy of Child and Adolescent Psychiatry
Volume	41
Issue number	3
DOIs	https://doi.org/10.1097/00004583-200203000-00006
State	Published - Mar 2002

Funding

This work was supported by NIMH grant 5 UO1-MH50454-02 . The opinions and assertions contained in this report are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of Health and Human Services or the National Institutes of Health.

Keywords

Attention-deficit/hyperactivity disorder
Clinical trial
Moderator
Socioeconomic status

ASJC Scopus subject areas

Psychiatry and Mental health
Developmental and Educational Psychology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1097/00004583-200203000-00006

Cite this

Rieppi, R., Greenhill, L. L., Ford, R. E., Chuang, S., Wu, M., Davies, M., Abikoff, H. B., Arnold, L. E., Conners, C. K., Elliott, G. R., Hechtman, L., Hinshaw, S. P., Hoza, B., Jensen, P. S., Kraemer, H. C., March, J. S., Newcorn, J. H., Pelham, W. E., Severe, J. B., ... Wigal, T. (2002). Socioeconomic Status as a Moderator of ADHD Treatment Outcomes. Journal of the American Academy of Child and Adolescent Psychiatry, 41(3), 269-277. https://doi.org/10.1097/00004583-200203000-00006

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abstract = "Objective: To explore whether socioeconomic status (SES) variables moderate treatment response of attention-deficit/hyperactivity disorder (ADHD) to medication management (MedMgt), behavioral treatment (Beh), combined intervention (Comb), and routine community care (CC). Method: The MTA Cooperative Group's intent-to-treat (ITT) analyses were repeated, covarying for composite Hollingshead SES, education, occupation, income, and marital status. Results: Individual SES variables were more informative than the composite Hollingshead Index. Treatment response of children from less educated households paralleled ITT outcomes: no significant difference was found between Comb and MedMgt (both better than Beh and CC) for core ADHD symptoms. However, children from more educated families showed superior reduction of ADHD symptoms with Comb. For oppositional-aggressive symptoms, children from blue-collar, lower SES households benefited most from Comb, whereas those from white-collar, higher SES homes generally showed no differential treatment response. Household income and marital status failed to influence outcomes. Controlling for treatment attendance attenuated the moderating effects of the SES variables only for MedMgt. Conclusions: Investigators are encouraged to use independent SES variables for maximal explanation of SES effects. Clinicians should prioritize target symptoms and consider the mediating role of treatment adherence when determining an ADHD patient's optimal intervention plan.",

keywords = "Attention-deficit/hyperactivity disorder, Clinical trial, Moderator, Socioeconomic status",

author = "Ricardo Rieppi and Greenhill, {Laurence L.} and Ford, {Rebecca E.} and Shirley Chuang and Min Wu and Mark Davies and Abikoff, {Howard B.} and Arnold, {L. Eugene} and Conners, {C. Keith} and Elliott, {Glen R.} and Lily Hechtman and Hinshaw, {Stephen P.} and Betsy Hoza and Jensen, {Peter S.} and Kraemer, {Helena C.} and March, {John S.} and Newcorn, {Jeffrey H.} and Pelham, {William E.} and Severe, {Joanne B.} and Swanson, {James M.} and Benedetto Vitiello and Wells, {Karen C.} and Timothy Wigal",

note = "Funding Information: This work was supported by NIMH grant 5 UO1-MH50454-02 . The opinions and assertions contained in this report are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of Health and Human Services or the National Institutes of Health. ",

year = "2002",

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doi = "10.1097/00004583-200203000-00006",

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Rieppi, R, Greenhill, LL, Ford, RE, Chuang, S, Wu, M, Davies, M, Abikoff, HB, Arnold, LE, Conners, CK, Elliott, GR, Hechtman, L, Hinshaw, SP, Hoza, B, Jensen, PS, Kraemer, HC, March, JS, Newcorn, JH, Pelham, WE, Severe, JB, Swanson, JM, Vitiello, B, Wells, KC & Wigal, T 2002, 'Socioeconomic Status as a Moderator of ADHD Treatment Outcomes', Journal of the American Academy of Child and Adolescent Psychiatry, vol. 41, no. 3, pp. 269-277. https://doi.org/10.1097/00004583-200203000-00006

TY - JOUR

T1 - Socioeconomic Status as a Moderator of ADHD Treatment Outcomes

AU - Rieppi, Ricardo

AU - Greenhill, Laurence L.

AU - Ford, Rebecca E.

AU - Chuang, Shirley

AU - Wu, Min

AU - Davies, Mark

AU - Abikoff, Howard B.

AU - Arnold, L. Eugene

AU - Conners, C. Keith

AU - Elliott, Glen R.

AU - Hechtman, Lily

AU - Hinshaw, Stephen P.

AU - Hoza, Betsy

AU - Jensen, Peter S.

AU - Kraemer, Helena C.

AU - March, John S.

AU - Newcorn, Jeffrey H.

AU - Pelham, William E.

AU - Severe, Joanne B.

AU - Swanson, James M.

AU - Vitiello, Benedetto

AU - Wells, Karen C.

AU - Wigal, Timothy

N1 - Funding Information: This work was supported by NIMH grant 5 UO1-MH50454-02 . The opinions and assertions contained in this report are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of Health and Human Services or the National Institutes of Health.

PY - 2002/3

Y1 - 2002/3

N2 - Objective: To explore whether socioeconomic status (SES) variables moderate treatment response of attention-deficit/hyperactivity disorder (ADHD) to medication management (MedMgt), behavioral treatment (Beh), combined intervention (Comb), and routine community care (CC). Method: The MTA Cooperative Group's intent-to-treat (ITT) analyses were repeated, covarying for composite Hollingshead SES, education, occupation, income, and marital status. Results: Individual SES variables were more informative than the composite Hollingshead Index. Treatment response of children from less educated households paralleled ITT outcomes: no significant difference was found between Comb and MedMgt (both better than Beh and CC) for core ADHD symptoms. However, children from more educated families showed superior reduction of ADHD symptoms with Comb. For oppositional-aggressive symptoms, children from blue-collar, lower SES households benefited most from Comb, whereas those from white-collar, higher SES homes generally showed no differential treatment response. Household income and marital status failed to influence outcomes. Controlling for treatment attendance attenuated the moderating effects of the SES variables only for MedMgt. Conclusions: Investigators are encouraged to use independent SES variables for maximal explanation of SES effects. Clinicians should prioritize target symptoms and consider the mediating role of treatment adherence when determining an ADHD patient's optimal intervention plan.

AB - Objective: To explore whether socioeconomic status (SES) variables moderate treatment response of attention-deficit/hyperactivity disorder (ADHD) to medication management (MedMgt), behavioral treatment (Beh), combined intervention (Comb), and routine community care (CC). Method: The MTA Cooperative Group's intent-to-treat (ITT) analyses were repeated, covarying for composite Hollingshead SES, education, occupation, income, and marital status. Results: Individual SES variables were more informative than the composite Hollingshead Index. Treatment response of children from less educated households paralleled ITT outcomes: no significant difference was found between Comb and MedMgt (both better than Beh and CC) for core ADHD symptoms. However, children from more educated families showed superior reduction of ADHD symptoms with Comb. For oppositional-aggressive symptoms, children from blue-collar, lower SES households benefited most from Comb, whereas those from white-collar, higher SES homes generally showed no differential treatment response. Household income and marital status failed to influence outcomes. Controlling for treatment attendance attenuated the moderating effects of the SES variables only for MedMgt. Conclusions: Investigators are encouraged to use independent SES variables for maximal explanation of SES effects. Clinicians should prioritize target symptoms and consider the mediating role of treatment adherence when determining an ADHD patient's optimal intervention plan.

KW - Attention-deficit/hyperactivity disorder

KW - Clinical trial

KW - Moderator

KW - Socioeconomic status

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JO - Journal of the American Academy of Child and Adolescent Psychiatry

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Socioeconomic Status as a Moderator of ADHD Treatment Outcomes

Abstract

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Keywords

ASJC Scopus subject areas

UN SDGs

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