31.2 MINING THE MEANING OF THE MULTISITE MULTIMODAL TREATMENT STUDY OF ADHD (MTA) STUDY: NOVEL FINDINGS FROM QUALITATIVE STUDY METHODS

Abstract

Most psychiatric research uses rigorously structured mental health interviews of DSM-based mental health disorders as well as paper-and-pencil questionnaires about study variables. Although these so-called “quantitative” study methods have generated important research findings, they have limitations. For example, although a given variable may be a causal factor for illness in some, the same variable can operate in the opposite manner in others; for example, taking a stimulant medication for ADHD might prevent substance abuse (SU) in some but precipitate it in others. Even diametrically opposed findings can be hidden in a study’s quantitative findings. In clinical practice, practitioners operate differently than quantitative researchers to understand illness. Like detectives who assemble clues after an event has occurred, clinicians seek to obtain a comprehensive history from various informants, gather clues regarding the patient’s beliefs and assumptions about the illness, and determine the most plausible explanation for the illness. Like clinical practitioners, qualitative researchers also use historical methods to understand patients’ beliefs and assumptions, in order to generate new hypotheses that can be verified by quantitative methods. We review a qualitative study of 183 patients’ interviews about their ADHD experiences via participation in the MTA and their beliefs and assumptions about ADHD, its causes, consequences, and optimal treatments. Despite over 150 quantitative research reports from the MTA study, questions persist. What explains the good vs poor outcomes of so many subjects? Why do some risk factors portend bad outcomes, but have no effect in others? How do “turning points” differentially affect the lives of youth, and how are these turning points linked to subsequent life decisions? Comparison of the MTA study’s quantitative vs qualitative findings reveals important new areas for study: some factors appear to convey “risk” in some but “benefit” in others. Some adults with ADHD cite the importance of turning points that led them to major life changes. For many, ADHD is seen as “no big deal,” and stimulants are seen as unnecessary. For some young adults, family factors are protective but are illness-producing for others.