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Journal of Pediatric Psychology Advance Access published online on January 29, 2007
Journal of Pediatric Psychology, doi:10.1093/jpepsy/jsl055
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© The Author 2007. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org

Moderators and Mediators of Treatment Outcome for Youth with ADHD: Understanding for Whom and How Interventions Work

Stephen P. Hinshaw, PhD

University of California, Berkeley

All correspondence concerning this article should be addressed to Stephen Hinshaw, Department of Psychology, Tolman Hall #1650, University of California, Berkeley, CA 94720-1650. E-mail: hinshaw{at}berkeley.edu


  Abstract

Objective Although treatment research and clinical trials have a primary goal of uncovering the efficacy and effectiveness of intervention strategies, understanding subpopulations with greater versus lesser treatment response and understanding the processes through which treatments exert their effects are essential to further both conceptual and clinical aims. The objective herein is to present data on moderators and mediators of treatment response from the Multimodal Treatment Study of Children with attention-deficit/hyperactivity disorder (ADHD), MTA. Method The article describes moderator variables (baseline factors that define subgroups with greater vs. lesser intervention response) and mediator variables (factors occurring during treatment that explain how interventions ‘work’), with specific application to the outcomes of the MTA Study. Results Key moderator variables (comorbid anxiety disorder, public assistance, severity of ADHD, parental depressive symptomatology, IQ) and mediator processes (negative/ineffective parental discipline) are reviewed. Conclusion Treatment research in the future should explicitly consider the exploration of moderator and mediator variables, which can greatly aid the explanatory power of clinical trials and specify the critical next steps for intervention research.

Key words: ADHD; clinical trials; moderator; mediator; intervention.


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