Public Slides from the NIMH MTA Study

1. Peter S. Jensen, M.D. ~Putting Science to Work~ Center for the Advancement of Children’s Mental Health Columbia University Beyond DSM-IV: New Models for Understanding and Diagnosis of Children’s Emotional and Behavioral Problems

3. Myths Surrounding The Causes Of Childhood Psychiatric Disorders Bad parenting They'll grow out of it food additives cause these disorders bad diet

4. Family Environment The Child’s Inner Environment Social Environment Physical Environment Child Health Child’s Health Policy

5. Behavior Biology Physical Environment Child Health Policy Birth Early Adult Time Development Child’s Health Health Services Social Environment (Culture Family Community)

7. Synaptic density/mm 3 x 10 6

8. Greenough, et al., 1998

9. ADHD as a Case Example

10. ADHD Historical Timeline 1900 1937 1955 1960 1966 1980 1987 1994 Bradley; Benzedrine MPH created Clements listed attention as a deficit in children Attention Deficit Hyperactivity Disorder (DSM-III-R) DSM-IV updated criteria Attention Deficit Disorder + or – Hyperactivity (DSM-III) Minimal Brain Dysfunction George Still described ADHD symptoms Bradley (1937)—original conceptualization of ADHD involved testing of response to stimulant.

12. Scientific American , September 1998 ADHD: Suggested Pathophysiology

13. ADHD Adult vs. Normal Controls (fMRI During Perceptual Task)* ADHD *Stroop task utilized MGH-NIMR Center & Harvard-MIT CITP, Bush G et al. Biol Psychiatry. 1999 ADHD brain uses less efficient pathway to process data NORMAL

14. Twin Studies Show ADHD Is a Genetic Disorder Faraone. J Am Acad Child Adolesc Psychiatry. 2000;39:1455-1457. Hemminki. Mutat Res. 2001;25:11-21. Palmer. Eur Resp J. 2001;17:696-702. Willerman, 1973 Goodman, 1989 Gillis, 1992 Edelbrock, 1992 Schmitz, 1995 Thapar, 1995 Gjone, 1996 Silberg, 1996 Sherman, 1997 Levy, 1997 Nadder, 1998 Hudziak, 2000 Average genetic contribution of ADHD based on twin studies Height Breast cancer Asthma Schizophrenia ADHD Mean 0 0.2 0.4 0.6 0.8 1

16. Are Children Just Being “Labeled?” Attention Problems in Classroom Children

17. Assessment Points Baseline Early Treatment (3 m) Mid- treatment (9 m) End Treatment (14 m) Follow-up (24 m) Follow-up (36 m) 14-m Treatment Stage 10-m Follow- up After Treatment 22-m Follow- up After Treatment 0 36 24 14 Month Recruitment Screening Diagnosis Random Assignment 579 ADHD Subjects Medication Only 144 Subjects Psychosocial (Behavioral) Treatment Only 144 Subjects Combined Medication and Psychosocial Treatment 145 Subjects Assessment and Referral (Community Control) No Treatment from Study; Assessed for 24 mo. 146 Subjects Recruitment of LNCG Cohort

18. Class 1 Over Time

19. Class 2 Over Time

20. Class 3 Over Time

21. Treatment Effectiveness at 24 Months by Class and Med Status

27. ADHD symptoms as an Adaptive Problem

28. Genetic Roots

33. Extent of Mental & SU Disorders In U.S. Children and Adolescents 7.8% 8.0% 5.6% 5.0% 7.7% 0.5% Source: Office of the Surgeon General, and National Institute of Mental Health, 1999

34. To Diagnose or to Not Diagnose? “labeling?”

44. MISLEADING DICHOTOMIES Brain vs. Behavior? Nature vs. Nurture?