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Fredriksen M, Egeland J, Haavik J, Fasmer OB. Individual Variability in Reaction Time and Prediction of Clinical Response to Methylphenidate in Adult ADHD: A Prospective Open Label Study Using Conners' Continuous Performance Test II. J Atten Disord 2021; 25:657-671. [PMID: 30762452 DOI: 10.1177/1087054719829822] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: The aim of this study was to examine whether reaction time parameters in adult patients with ADHD could predict their response to methylphenidate (MPH). Method: Previously unmedicated patients (N = 123) were administered the Conners' Continuous Performance Test II (CPT II) at baseline and after 6 weeks of treatment with immediate-release MPH. In addition to traditional CPT measures, we extracted intraindividual raw data and analyzed time series using linear and nonlinear mathematical models. Results: Clinical responders, assessed with the Clinical Global Impression-Improvement scale, showed significant normalization of target failures, reduced variability and skewness, and increased complexity of reaction time series after 6 weeks of treatment, while nonresponders showed no significant changes. Prior to treatment, responders had significantly higher variability and skewness, combined with lower complexity, compared with nonresponders. Conclusion: These results show that the CPT test is useful in the evaluation of treatment response to MPH.
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Affiliation(s)
| | - Jens Egeland
- Vestfold Hospital Trust, Tønsberg, Norway.,University of Oslo, Norway
| | - Jan Haavik
- University of Bergen, Norway.,Haukeland University Hospital, Bergen, Norway.,K.G. Jebsen Center for Research on Neuropsychiatric Disorders, Bergen, Norway
| | - Ole Bernt Fasmer
- University of Bergen, Norway.,Haukeland University Hospital, Bergen, Norway.,K.G. Jebsen Center for Research on Neuropsychiatric Disorders, Bergen, Norway
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Schoenfelder EN, Chronis-Tuscano A, Strickland J, Almirall D, Stein MA. Piloting a Sequential, Multiple Assignment, Randomized Trial for Mothers with Attention-Deficit/Hyperactivity Disorder and Their At-Risk Young Children. J Child Adolesc Psychopharmacol 2019; 29:256-267. [PMID: 30950637 PMCID: PMC6534090 DOI: 10.1089/cap.2018.0136] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objective: Parental attention-deficit/hyperactivity disorder (ADHD) is associated with suboptimal parenting and reduces the effectiveness of child ADHD treatments. We conducted a Pilot Sequential, Multiple Assignment, Randomized Trial (SMART Pilot) to evaluate the feasibility and acceptability of sequencing medication and behavioral treatments for mothers with ADHD to target outcomes, including maternal ADHD, parenting, and child ADHD symptoms/impairment in multiplex ADHD families. Methods: Thirty-five mothers with ADHD and their 5- to 8-year-old child with ADHD symptoms were enrolled. Mothers were randomized to 8 weeks of individually titrated stimulant medication (MSM) or behavioral parent training (BPT), followed by rerandomization to 8 weeks of continued first-line treatment (with as-needed modifications) or combined treatment, leading to four treatment sequences (MSM-MSM, MSM-BPT, BPT-MSM, and BPT-BPT). Results: Recruitment of multiplex ADHD families came primarily from child providers. Mothers were adherent to medication and had high therapy session attendance. Mothers and clinicians found both treatments to be acceptable and preferred combination treatment, especially receiving medication before BPT. Monotherapy treatment visits were viewed as more burdensome (MSM-MSM, BPT-BPT). Conclusions: Maternal stimulant medication and BPT are acceptable and feasible interventions for families in which both the mother and child have ADHD symptoms. Mothers with concerns about their children's ADHD symptoms are receptive to receiving treatment themselves as an initial strategy for improving their children's health and functioning. Fully powered SMART designs show promise in evaluating the sequencing of interventions and helping clinicians develop algorithms for treating multiplex families in real-world practice settings.
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Affiliation(s)
- Erin N. Schoenfelder
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington
| | | | - Jennifer Strickland
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington
| | - Daniel Almirall
- Department of Statistics, University of Michigan, Ann Arbor, Michigan
| | - Mark A. Stein
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington
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Reinhardt MC, Reinhardt CA. Attention deficit-hyperactivity disorder, comorbidities, and risk situations. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2013. [DOI: 10.1016/j.jpedp.2012.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Reinhardt MC, Reinhardt CAU. Attention deficit-hyperactivity disorder, comorbidities, and risk situations. J Pediatr (Rio J) 2013; 89:124-30. [PMID: 23642421 DOI: 10.1016/j.jped.2013.03.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 10/31/2012] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE Attention deficit/hyperactivity disorder (ADHD) is highly prevalent, and its symptoms often represent a significant public health problem; thus, the aim of this study was to verify emergency situations caused by certain comorbidities, or by exposing the patient to a higher risk of accidents. DATA SOURCE A literature search was carried out in the PubMed database between the years 1992 and 2012, using the key words "adhd", "urgency", "comorbidity", "substance disorder", "alcohol", "eating disorder", "suicide", "trauma", "abuse", "crime", "internet", "videogame", "bullying", and their combinations. The selection considered the most relevant articles according to the scope of the proposed topic, performed in a non-systematic way. DATA SYNTHESIS Several situations were observed in which ADHD is the most relevant psychiatric diagnosis in relation to its urgency, such as the risk of accidents, suicide risk and addition, exposure to violence, or risk of internet abuse or sexual abuse; or when ADHD is the most prevalent comorbidity and is also correlated with emergency situations, such as in bipolar and eating disorders. CONCLUSIONS The results show several comorbidities and risk situations involving the diagnosis of ADHD, thus reinforcing the importance of their identification for the adequate treatment of this disorder.
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Schlander M, Trott GE, Schwarz O. [The health economics of attention deficit hyperactivity disorder in Germany. Part 2: Therapeutic options and their cost-effectiveness]. DER NERVENARZT 2010; 81:301-14. [PMID: 19936695 DOI: 10.1007/s00115-009-2889-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Attention deficit hyperactivity disorder (ADHD) has been associated with a continuous increase of health care utilization and thus expenditures. This raises the issue of cost-effectiveness of health care provided for patients with ADHD. Comparative health economic evaluations generate relevant insights and typically report incremental cost-effectiveness ratios (ICERs) of alternatives versus an established standard. Typically, results of cost-effectiveness analyses (CEAs) are reported in terms of incremental cost-effectiveness ratios (ICERs). International evaluations, as well specific adaptations to Germany, indicate an acceptable to attractive cost-effectiveness--according to currently used international benchmarks--of an intense medication management strategy based on stimulants, primarily methylphenidate, with ICERs ranging from 20,000 EUR to 37,000 EUR per quality-adjusted life year (QALY) gained. Economic modeling studies also suggest cost-effectiveness of long-acting modified-release preparations of methylphenidate, owing to improved treatment compliance associated with simplified once daily administration schemes. Atomoxetine, in contrast, appears economically inferior compared to long-acting stimulants, given its higher acquisition costs and at best equal clinical effectiveness. There are currently no data supporting the cost-effectiveness of psychotherapeutic or behavioral interventions. Economic evaluations, which have been published to date, are generally limited by time horizons of up to 1 year and by their prevailing focus on ADHD core symptom improvement only. Therefore, further research into the cost-effectiveness of ADHD treatment strategies seems warranted.
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Affiliation(s)
- M Schlander
- Institute for Innovation & Valuation in Health Care (InnoValHC), An der Ringkirche 4, 65197 Wiesbaden.
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Freeman JB, Choate-Summers ML, Garcia AM, Moore PS, Sapyta JJ, Khanna MS, March JS, Foa EB, Franklin ME. The Pediatric Obsessive-Compulsive Disorder Treatment Study II: rationale, design and methods. Child Adolesc Psychiatry Ment Health 2009; 3:4. [PMID: 19183470 PMCID: PMC2646688 DOI: 10.1186/1753-2000-3-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2008] [Accepted: 01/30/2009] [Indexed: 11/10/2022] Open
Abstract
UNLABELLED This paper presents the rationale, design, and methods of the Pediatric Obsessive-Compulsive Disorder Treatment Study II (POTS II), which investigates two different cognitive-behavior therapy (CBT) augmentation approaches in children and adolescents who have experienced a partial response to pharmacotherapy with a serotonin reuptake inhibitor for OCD. The two CBT approaches test a "single doctor" versus "dual doctor" model of service delivery. A specific goal was to develop and test an easily disseminated protocol whereby child psychiatrists would provide instructions in core CBT procedures recommended for pediatric OCD (e.g., hierarchy development, in vivo exposure homework) during routine medical management of OCD (I-CBT). The conventional "dual doctor" CBT protocol consists of 14 visits over 12 weeks involving: (1) psychoeducation, (2), cognitive training, (3) mapping OCD, and (4) exposure with response prevention (EX/RP). I-CBT is a 7-session version of CBT that does not include imaginal exposure or therapist-assisted EX/RP. In this study, we compared 12 weeks of medication management (MM) provided by a study psychiatrist (MM only) with two types of CBT augmentation: (1) the dual doctor model (MM+CBT); and (2) the single doctor model (MM+I-CBT). The design balanced elements of an efficacy study (e.g., random assignment, independent ratings) with effectiveness research aims (e.g., differences in specific SRI medications, dosages, treatment providers). The study is wrapping up recruitment of 140 youth ages 7-17 with a primary diagnosis of OCD. Independent evaluators (IEs) rated participants at weeks 0,4,8, and 12 during acute treatment and at 3,6, and 12 month follow-up visits. TRIAL REGISTRATION NCT00074815.
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Affiliation(s)
- Jennifer B Freeman
- Department of Psychiatry and Human Behavior, Brown University School of Medicine, Providence, RI USA
| | - Molly L Choate-Summers
- Department of Psychiatry and Human Behavior, Brown University School of Medicine, Providence, RI USA
| | - Abbe M Garcia
- Department of Psychiatry and Human Behavior, Brown University School of Medicine, Providence, RI USA
| | - Phoebe S Moore
- Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA USA
| | - Jeffrey J Sapyta
- Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA USA
| | - Muniya S Khanna
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC USA
| | - John S March
- Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA USA
| | - Edna B Foa
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC USA
| | - Martin E Franklin
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC USA
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May DE, Kratochvil CJ, Puumala SE, Silva SG, Rezac AJ, Hallin MJ, Reinecke MA, Vitiello B, Weller EB, Pathak S, Simons AD, March JS. A manual-based intervention to address clinical crises and retain patients in the Treatment of Adolescents With Depression Study (TADS). J Am Acad Child Adolesc Psychiatry 2007; 46:573-581. [PMID: 17450048 DOI: 10.1097/chi.0b013e3180323342] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To describe a manual-based intervention to address clinical crises and retain participants in the Treatment for Adolescents With Depression Study (TADS). METHOD The use of adjunct services for attrition prevention (ASAP) is described for adolescents (ages 12-17 years) during the 12-week acute treatment in TADS, from 2000 to 2003. Logistic regression, controlling for site, was used to predict use. RESULTS Of 439 enrolled participants, 17.8% (n = 78) used ASAP primarily for suicidality or worsening of depression. Of these, 46.2% continued in their assigned treatment through week 12, 47.4% received out-of-protocol treatment but continued participating in assessments, and 10.3% withdrew consent, including 3 who terminated treatment and withdrew consent on the same date. ASAP use did not differ between treatments (p =.97) and typically occurred early in treatment. At the end of the 12 weeks, 37.2% of participants using ASAP remained in their assigned treatment, although 80.8% continued participating in assessments. ASAP was associated with, at baseline, a higher severity of depression (p <.01), substance use (p <.01), and precontemplation level of change (p <.02). CONCLUSIONS ASAP may be useful to retain adolescent participants and as a safety intervention in placebo-controlled trials. In clinical practice ASAP-like procedures may be useful to encourage adherence in patients engaging in long-term treatment. Clinical trial registration information-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00006286.
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Affiliation(s)
- Diane E May
- Ms. Puumala, Ms. Rezac and Ms. Hallin are with the University of Nebraska Medical Center, Omaha.
| | | | - Susan E Puumala
- Ms. Puumala, Ms. Rezac and Ms. Hallin are with the University of Nebraska Medical Center, Omaha
| | - Susan G Silva
- Ms. Puumala, Ms. Rezac and Ms. Hallin are with the University of Nebraska Medical Center, Omaha
| | - Amy J Rezac
- Ms. Puumala, Ms. Rezac and Ms. Hallin are with the University of Nebraska Medical Center, Omaha
| | - Mary J Hallin
- Ms. Puumala, Ms. Rezac and Ms. Hallin are with the University of Nebraska Medical Center, Omaha
| | - Mark A Reinecke
- Ms. Puumala, Ms. Rezac and Ms. Hallin are with the University of Nebraska Medical Center, Omaha
| | - Benedetto Vitiello
- Ms. Puumala, Ms. Rezac and Ms. Hallin are with the University of Nebraska Medical Center, Omaha
| | - Elizabeth B Weller
- Ms. Puumala, Ms. Rezac and Ms. Hallin are with the University of Nebraska Medical Center, Omaha
| | - Sanjeev Pathak
- Ms. Puumala, Ms. Rezac and Ms. Hallin are with the University of Nebraska Medical Center, Omaha
| | - Anne D Simons
- Ms. Puumala, Ms. Rezac and Ms. Hallin are with the University of Nebraska Medical Center, Omaha
| | - John S March
- Ms. Puumala, Ms. Rezac and Ms. Hallin are with the University of Nebraska Medical Center, Omaha
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Curry JF, Wells KC. Striving for effectiveness in the treatment of adolescent depression: Cognitive behavior therapy for multisite community intervention. COGNITIVE AND BEHAVIORAL PRACTICE 2005. [DOI: 10.1016/s1077-7229(05)80023-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hinshaw SP, Hoagwood K, Jensen PS, Kratochvil C, Bickman L, Clarke G, Abikoff HB, Atkins M, Vitiello B. AACAP 2001 research forum: challenges and recommendations regarding recruitment and retention of participants in research investigations. J Am Acad Child Adolesc Psychiatry 2004; 43:1037-45. [PMID: 15266200 DOI: 10.1097/01.chi.0000129222.89433.3d] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Clinical research depends on the participation of representative samples. At the 2001 Annual Meeting of the American Academy of Child and Adolescent Psychiatry, the Workgroup on Research conducted a research forum with the purpose of improving recruitment and retention of children and adolescents in research protocols. METHOD An interdisciplinary group of participants focused on (1) consumers and families, (2) communities, (3) professionals and health care delivery systems, (4) regulatory bodies, and (5) alternative research designs. Obstacles and challenges were identified and solutions were discussed. RESULTS Key recommendations include the following: Investigators must become involved with community stakeholders and more explicitly communicate with families about research procedures, risks, and benefits; budgets should include explicit items for case management and referrals to families who do not meet entry criteria; the culture of clinical settings must incorporate research conducted by clinicians; regulatory bodies must streamline and coordinate protocols and procedures; designs emphasizing flexible treatment strategies and adaptive treatments should be encouraged; and health care systems should consider changing incentives for research participation, including the radical notion that reimbursement be made in terms of improvement rather than service units. CONCLUSIONS An integrated approach is recommended, requiring direct involvement of investigators in communities where research is to be conducted.
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Affiliation(s)
- Stephen P Hinshaw
- Department of Psychology, University of California, Berkeley, CA 94720-1650, USA.
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March J, Kratochvil C, Clarke G, Beardslee W, Derivan A, Emslie G, Green EP, Heiligenstein J, Hinshaw S, Hoagwood K, Jensen P, Lavori P, Leonard H, McNulty J, Michaels MA, Mossholder A, Osher T, Petti T, Prentice E, Vitiello B, Wells K. AACAP 2002 research forum: placebo and alternatives to placebo in randomized controlled trials in pediatric psychopharmacology. J Am Acad Child Adolesc Psychiatry 2004; 43:1046-56. [PMID: 15266201 DOI: 10.1097/01.chi.0000129606.83206.77] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The use of placebo in the pediatric age group has come under increasing scrutiny. At the 2002 Annual Meeting of the American Academy of Child and Adolescent Psychiatry, the Academy's Workgroup on Research conducted a research forum. The purpose was to identify challenges and their solutions regarding the use of placebo in randomized controlled trials in pediatric psychopharmacology. METHOD Workgroups focused on problems and solutions in five areas: ethics and human subjects, research design and statistics, partnering with consumers, U.S. Food and Drug Administration and pharmaceutical industry perspectives, and psychosocial treatments. RESULTS In many but not all circumstances, inclusion of a placebo control is essential to meet the scientific goals of treatment outcome research. Innovative research designs; involvement of consumers in planning and implementing research; flexibility by industry, academia, the National Institutes of Health, and regulatory agencies acting in partnership; and concomitant use of evidence-based psychosocial services can and should assist in making placebo-controlled trials acceptable. CONCLUSIONS Properly designed placebo-controlled trials remain necessary, ethical, and feasible.
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Affiliation(s)
- John March
- Duke University Medical Center, Durham, NC 27705, USA.
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Franklin M, Foa E, March JS. The pediatric obsessive-compulsive disorder treatment study: rationale, design, and methods. J Child Adolesc Psychopharmacol 2003; 13 Suppl 1:S39-51. [PMID: 12880499 DOI: 10.1089/104454603322126331] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Obsessive-compulsive disorder (OCD), which has a prevalence of 1 in 200 in children and adolescents, carries with it significant functional morbidity. A growing empirical literature supports the efficacy of short-term treatment with OCD-specific cognitive-behavior therapy (CBT) or medication management with a selective serotonin reuptake inhibitor. These and other studies also identify a substantial probability of partial response and, possibly, differences in durability when treatment is discontinued between medication and CBT. The Pediatric OCD Treatment Study is a multicenter, randomized, masked clinical trial designed to evaluate the relative benefit and durability of four treatments for children and adolescents with OCD: sertraline, CBT, combination of sertraline and CBT, and pill placebo. Stage 1 (12 weeks) is a balanced randomized comparison of these four treatments. Responders at the end of stage 1 advance to 4 months of open follow-up in their assigned arm during which all treatment is discontinued. At the end of stage 2 (if not before), nonresponders to any treatment at the end of stage 1, any patient relapsing in stage 2, and all stage 1 placebo patients receive open treatment that is tailored to the patient's needs. A volunteer sample of 120 subjects between the ages of 7 and 17 inclusive with a primary Diagnostic and Statistical Manual of Mental Disorders (fourth edition) diagnosis of OCD enters the study. All patients, regardless of responder status, return for all scheduled assessments. This report describes the design of the trial, the rationale for the design choices made, and the methods used to carry out the trial.
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Affiliation(s)
- Martin Franklin
- Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
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Abstract
OBJECTIVES A rapidly growing empirical literature on the treatment of major depressive disorder (MDD) in youth supports the efficacy of short-term treatment with depression-specific cognitive-behavioral therapy or medication management with a selective serotonin reuptake inhibitor. These studies also identify a substantial probability of partial response and of relapse, which might be addressed by more intensive, longer-term treatments. METHOD Funded by the National Institute of Mental Health, the Treatment for Adolescents With Depression Study (TADS) is a multicenter, randomized, masked effectiveness trial designed to evaluate the short-term (12-week) and long-term (36-week) effectiveness of four treatments for adolescents with MDD: fluoxetine, cognitive-behavioral therapy, their combination, and, acutely, pill placebo. A volunteer sample of 432 subjects aged 12-17 years (inclusive) with a primary DSM-IV diagnosis of MDD who are broadly representative of patients seen in clinical practice will enter the study. The primary dependent measures rated blindly by an independent evaluator are the Children's Depression Rating Scale and, for responder analysis, a dichotomized Clinical Global Impressions-Improvement score. Consistent with an intent-to-treat analysis, all patients, regardless of treatment status, return for all scheduled assessments. RESULTS This report describes the design of the trial, the rationale for the design choices made, and the methods used to carry out the trial. CONCLUSION When completed, TADS will improve our understanding of how best to initiate treatment for adolescents with MDD.
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Greenhill LL, Jensen PS, Abikoff H, Blumer JL, Deveaugh-Geiss J, Fisher C, Hoagwood K, Kratochvil CJ, Lahey BB, Laughren T, Leckman J, Petti TA, Pope K, Shaffer D, Vitiello B, Zeanah C. Developing strategies for psychopharmacological studies in preschool children. J Am Acad Child Adolesc Psychiatry 2003; 42:406-14. [PMID: 12649627 DOI: 10.1097/01.chi.0000046812.95464.fa] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify the obstacles and special challenges-ethical, practical, scientific, and regulatory-faced by investigators who attempt to conduct psychopharmacological studies in preschoolers. METHOD In a workshop held at the 47th Annual Meeting of the American Academy of Child and Adolescent Psychiatry, featuring interactive sessions designed to elicit discussion of the theory and feasibility of research in this young population, several key domains were identified: diagnosis and assessment, ethics, research design, special considerations for preschoolers, regulatory/industry issues, and education/training. RESULTS A Pediatric Psychopharmacology Initiative is needed to consolidate recommendations from this and other workshops and current federal, research, and regulatory committees. A scholarly review and a guide for institutional review boards and investigators should be prepared on issues related to preschoolers. Developmental specialists provide valuable expertise that can strengthen studies of pediatric psychopharmacology. "N of 1" case studies can provide valuable information to clinicians. Only preschoolers with severe symptoms that occur in several interpersonal contexts should be entered into trials. Indications for the study of symptom complexes (e.g., aggression) rather than specific diagnoses should be examined and considered for regulatory activities. Psychopharmacology practice parameters for preschoolers are needed. CONCLUSIONS With preschoolers being increasingly treated with psychopharmacological agents, the need for investigations to address the safety and efficacy of these medications is becoming a central issue for researchers from many disciplines.
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Affiliation(s)
- Laurence L Greenhill
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA.
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