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A Review of Clinical Practice Guidelines in the Diagnosis and Treatment of Attention-Deficit/Hyperactivity Disorder. Child Adolesc Psychiatr Clin N Am 2022; 31:569-581. [PMID: 35697402 DOI: 10.1016/j.chc.2022.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Clinical practice guidelines (CPGs) are systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances. CPGs have evolved during the last 2 decades from general consensus statements by prominent practitioners in the field to highly structured instruments. The Institute of Medicine has laid out specific standards for selecting the experts who develop a CPG and the process by which CPGs are developed. Attention-deficit/hyperactivity disorder (ADHD) has been the focus of more than 20 CPGs created by governments and professional societies, both in the United States and internationally. There is a good deal of consensus across these CPGs regarding the principles of the diagnosis and treatment of ADHD. Drawing on the rich research base in ADHD, all CPGs emphasize the need for screening, a diagnosis based on history and standardized rating scales, as well as the use of evidence-based psychosocial and pharmacologic treatments. They vary in terms of their emphasis on the role of psychosocial treatment and the degree to which they address comorbid disorders in ADHD. Although limited research has shown ADHG CPGs do change provider practice, there is no research examining if the changes in practice brought about by CPGs impact patient outcomes.
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Nobel E, Hoekstra PJ, Agnes Brunnekreef J, Messink-de Vries DEH, Fischer B, Emmelkamp PMG, van den Hoofdakker BJ. Home-based parent training for school-aged children with attention-deficit/hyperactivity disorder and behavior problems with remaining impairing disruptive behaviors after routine treatment: a randomized controlled trial. Eur Child Adolesc Psychiatry 2020; 29:395-408. [PMID: 31332524 PMCID: PMC7056677 DOI: 10.1007/s00787-019-01375-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 07/11/2019] [Indexed: 11/28/2022]
Abstract
The objective is to investigate the effectiveness of home-based behavioral parent training for school-aged children with attention-deficit/hyperactivity disorder (ADHD) and behavior problems with remaining impairing disruptive behaviors after routinely offered treatments in clinical practice. In a randomized controlled study including 73 referred children with ADHD and impairing disruptive symptoms after routine clinical pharmacotherapy and/or clinic-based parent training had been tried or, at least, offered, home-based behavioral parent training (n = 26) was compared to a waiting list (n = 23) and a care-as-usual home-based treatment (n = 24). It was unknown to families which of the home-based treatments that they received. Using mixed models for repeated measures, we examined the effectiveness on the primary outcome measure of children's severity of disruptive behaviors and on a number of secondary outcome measures [the degree to which parents experienced the disruptive behaviors as troublesome, ADHD symptoms, oppositional-defiant disorder (ODD) symptoms, and internalizing problems]. Compared to the waiting list, children receiving home-based parent training improved significantly more regarding severity of disruptive behaviors (ES = 0.75), ADHD symptoms (ES = 0.89), ODD symptoms (ES = 0.65), and internalizing problems (ES = 0.60). Compared to care-as-usual, home-based parent training was more effective in reducing disruptive behaviors (ES = 0.57), ADHD symptoms (ES = 0.89), and ODD symptoms (ES = 0.88). Significantly more reduction of children's internalizing problems was not found. In conclusion, children with ADHD and residual behavioral problems after routine treatment may benefit from home-based behavioral parent training.
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Affiliation(s)
- Ellen Nobel
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Hanzeplein 1 XA10, NL-9713 GZ, Groningen, The Netherlands
| | - Pieter J Hoekstra
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Hanzeplein 1 XA10, NL-9713 GZ, Groningen, The Netherlands
| | - J Agnes Brunnekreef
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Hanzeplein 1 XA10, NL-9713 GZ, Groningen, The Netherlands
| | | | - Barbara Fischer
- Jonx, Department of Youth Mental Health and Autism, Lentis Psychiatric Institute, Groningen, The Netherlands
| | - Paul M G Emmelkamp
- Department of Clinical Psychology, Netherlands Institute for Advanced Study, University of Amsterdam, Amsterdam, The Netherlands
| | - Barbara J van den Hoofdakker
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Hanzeplein 1 XA10, NL-9713 GZ, Groningen, The Netherlands.
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands.
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Nobel E, Brunnekreef JA, Schachar RJ, van den Hoofdakker BJ, Hoekstra PJ. Parent-clinician agreement in rating the presence and severity of attention-deficit/hyperactivity disorder symptoms. ACTA ACUST UNITED AC 2019; 11:21-29. [PMID: 30927229 DOI: 10.1007/s12402-018-0267-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 08/16/2018] [Indexed: 11/28/2022]
Abstract
We determined the validity of a parent-report questionnaire as a research tool for rating attention-deficit/hyperactivity disorder (ADHD) symptoms in children. Using Cohen's kappa and Pearson correlation, we examined the agreement between parent reports of ADHD symptoms (using the Swanson, Nolan and Pelham Questionnaire-IV; SNAP-IV) and clinical judgment (using a semi-structured parent interview). Also, we explored factors that may be associated with the level of agreement, using regression analyses. We found moderate levels of agreement for severity of overall ADHD (r = 0.43) and for hyperactive-impulsive symptoms (r = 0.54), but no significant agreement for inattentive symptoms. On individual symptom level (range kappa = - 0.05-0.22) and for the presence/absence of ADHD (kappa = 0.14), agreement was poor. Therefore, we conclude that parent-report questionnaires may be acceptable to rate the overall severity of ADHD symptoms in treatment effect studies, but not to detect the presence of ADHD in epidemiological studies.
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Affiliation(s)
- Ellen Nobel
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Hanzeplein 1 XA10, 9713 GZ, Groningen, The Netherlands.
| | - J Agnes Brunnekreef
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Hanzeplein 1 XA10, 9713 GZ, Groningen, The Netherlands
| | | | - Barbara J van den Hoofdakker
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Hanzeplein 1 XA10, 9713 GZ, Groningen, The Netherlands.,Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
| | - Pieter J Hoekstra
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Hanzeplein 1 XA10, 9713 GZ, Groningen, The Netherlands
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Vierhile AE, Palumbo D, Belden H. Diagnosis and treatment of attention deficit hyperactivity disorder. Nurse Pract 2017; 42:48-54. [PMID: 28926497 DOI: 10.1097/01.npr.0000521995.38311.e7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Attention-deficit hyperactivity disorder (ADHD) is a neurobehavioral disorder characterized by signs and symptoms of inattention, hyperactivity, and impulsivity that typically begin in childhood. ADHD can persist into adulthood, causing impairments in occupational performance and peer and family relationships. This article reviews the epidemiology, diagnosis, and treatment of ADHD.
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Affiliation(s)
- Amy E Vierhile
- Amy E. Vierhile is a senior NP at the University of Rochester Medical Center and assistant professor at the University of Rochester, School of Nursing, Rochester, N.Y. Donna Palumbo is a medical director, ADHD franchise at Pfizer, Inc., New York, N.Y. Heidi Belden is a medical director at Tris Pharma, Inc., Monmouth Junction, N.J
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Rockhill CM, Tse YJ, Fesinmeyer MD, Garcia J, Myers K. Telepsychiatrists' Medication Treatment Strategies in the Children's Attention-Deficit/Hyperactivity Disorder Telemental Health Treatment Study. J Child Adolesc Psychopharmacol 2016; 26:662-671. [PMID: 26258927 PMCID: PMC5069727 DOI: 10.1089/cap.2015.0017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The purpose of this study was to examine the prescribing strategies that telepsychiatrists used to provide pharmacologic treatment in the Children's Attention-Deficit/Hyperactivity Disorder (ADHD) Telemental Health Treatment Study (CATTS). METHODS CATTS was a randomized controlled trial that demonstrated the superiority of a telehealth service delivery model for the treatment of ADHD with combined pharmacotherapy and behavior training (n=111), compared with management in primary care augmented with a telepsychiatry consultation (n=112). A diagnosis of ADHD was established with the Computerized Diagnostic Interview Schedule for Children (CDISC), and comorbidity for oppositional defiant disorder (ODD) and anxiety disorders (AD) was established using the CDISC and the Child Behavior Checklist. Telepsychiatrists used the Texas Children's Medication Algorithm Project (TCMAP) for ADHD to guide pharmacotherapy and the treat-to-target model to encourage their assertive medication management to a predetermined goal of 50% reduction in ADHD-related symptoms. We assessed whether telepsychiatrists' decision making about making medication changes was associated with baseline ADHD symptom severity, comorbidity, and attainment of the treat-to-target goal. RESULTS Telepsychiatrists showed high fidelity (91%) to their chosen algorithms in medication management. At the end of the trial, the CATTS intervention showed 46.0% attainment of the treat-to-target goal compared with 13.6% for the augmented primary care condition, and significantly greater attainment of the goal by comorbidity status for the ADHD with one and ADHD with two comorbidities groups. Telepsychiatrists' were more likely to decide to make medication adjustments for youth with higher baseline ADHD severity and the presence of disorders comorbid with ADHD. Multiple mixed methods regression analyses controlling for baseline ADHD severity and comorbidity status indicated that the telepsychiatrists also based their decision making session to session on attainment of the treat-to-target goal. CONCLUSIONS Telepsychiatry is an effective service delivery model for providing pharmacotherapy for ADHD, and the CATTS telepsychiatrists showed high fidelity to evidence-based protocols.
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Affiliation(s)
- Carol M. Rockhill
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Yuet Juhn Tse
- Department of Education, University of Washington, Seattle, Washington
| | - Megan D. Fesinmeyer
- Child Health, Behavior and Development Center, Seattle Children's Research Institute, Seattle, Washington
| | - Jessica Garcia
- Child Health, Behavior and Development Center, Seattle Children's Research Institute, Seattle, Washington
| | - Kathleen Myers
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington.,Child Health, Behavior and Development Center, Seattle Children's Research Institute, Seattle, Washington
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Treuer T, Méndez L, Montgomery W, Wu S. Factors affecting treatment adherence to atomoxetine in ADHD: a systematic review. Neuropsychiatr Dis Treat 2016; 12:1061-83. [PMID: 27217754 PMCID: PMC4862343 DOI: 10.2147/ndt.s97724] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The purpose of this paper was to systematically review the literature related to research about the factors affecting treatment adherence and discontinuation of atomoxetine in pediatric, adolescent, and adult patients with attention-deficit/hyperactivity disorder (ADHD). Medline was systematically searched using the following prespecified terms: "ADHD", "Adherence", "Compliance", "Discontinuation", and "Atomoxetine". We identified 31 articles that met all inclusion and exclusion criteria. The findings from this review indicate that persistence and adherence to atomoxetine treatment were generally high. Factors found to influence adherence and nonadherence to atomoxetine treatment in ADHD in this review include age, sex, the definition of response used, length of treatment, initial dose of treatment, comorbid conditions, and reimbursement. Tolerability was cited as an important reason for treatment discontinuation. More research is needed to understand those factors that can help to identify patients at risk for poor adherence and interventions that could improve treatment adherence early in the stage of this illness to secure a better long-term prognosis.
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Affiliation(s)
- Tamás Treuer
- Neuroscience Research, Eli Lilly and Company, Budapest, Hungary
| | | | - William Montgomery
- Global Patient Outcomes and Real World Evidence, Eli Lilly Australia Pty Ltd, West Ryde, NSW, Australia
| | - Shenghu Wu
- Neuroscience Research, Eli Lilly Asia, Inc, Shanghai, People's Republic of China
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Wagner DJ, McLennan JD. An Alternative Approach to Scoring the MTA-SNAP-IV to Guide Attention-Deficit/Hyperactivity Disorder Medication Treatment Titration towards Symptom Remission: A Preliminary Consideration. J Child Adolesc Psychopharmacol 2015; 25:749-53. [PMID: 26682996 DOI: 10.1089/cap.2015.0081] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The Multimodal Treatment Study for Attention-Deficit/Hyperactivity Disorder Swanson, Nolan, and Pelham, Version IV (MTA-SNAP-IV) is a common rating scale to measure attention-deficit/hyperactivity disorder (ADHD) symptoms during medication treatment. Relying on the traditional scoring approach for this instrument to identify symptom remission, however, may leave a child with significant residual symptoms. The objective of this study was to examine an alternative scoring approach for this instrument to identify the extent of residual symptoms for children completing ADHD medication treatment. METHODS Parent and teacher ratings on the ADHD symptom component of the MTA-SNAP-IV were extracted from medical records of 80 children completing medication treatment at a specialty clinic in Canada. Data were scored in two ways. 1) Traditional scoring based on assigning a value ranging from 0 to 3 for response options: "Not at all," "Just a little," "Pretty much," or "Very much," for each symptom and then determining a mean across items, and 2) alternative scoring based on assigning values of 0, 0, 0.5, and 1 across the same response options and summing the total across items. Symptom remission based on the former is defined as a mean value ≤ 1, and for the latter it is defined as a summed value equal to 0. RESULTS Children were significantly less likely to be classified as symptom remitted under the alternative scoring method based on parent, teacher, and combined parent-teacher ratings. Using the alternative scoring approach, residual symptoms were identified for 25%, 39%, and 70% of children classified as symptom remitted (under traditional scoring rules) by parents, teachers, and parents/teachers combined, respectively. CONCLUSIONS Potential "residual" ADHD symptoms were identified in many children attaining symptom remission using the traditional scoring approach; however, further scrutiny of this alternative scoring approach is required. Although it may improve the ability to detect residual symptoms that could signal the need for further intervention to achieve symptom remission, it may increase the risk of over treatment.
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Affiliation(s)
- Daniel J Wagner
- 1 Institute of Health Policy, Management and Evaluation, University of Toronto , Toronto, Ontario, Canada
| | - John D McLennan
- 2 Department of Pediatrics, Psychiatry and Community Health Sciences, Cumming School of Medicine. University of Calgary , Calgary, Alberta, Canada
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