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Vertessen K, Oosterlaan J, Bet P, Bottelier M, Stoffelsen R, Swanson JM, Wisse A, Twisk J, Luman M. Placebo-related improvement with methylphenidate treatment in children with ADHD. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02550-3. [PMID: 39126498 DOI: 10.1007/s00787-024-02550-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 07/30/2024] [Indexed: 08/12/2024]
Abstract
Non-specific effects of methylphenidate treatment, including expectancy and regression to the mean effects, contribute to the overall effect of methylphenidate on attention-deficit/hyperactivity disorder (ADHD) symptoms. Knowledge on the extent to which non-specific effects contribute to the overall effect and whether regression to the mean explains part of the non-specific effects, is currently lacking. A double-blind, randomized, placebo-controlled, cross-over trial was used to compare parent and teacher ratings of child ADHD symptoms at baseline and during treatment with placebo and 5, 10, 15 and 20 mg of methylphenidate, twice daily. Participants were 5-13-year-old children with a DSM-5 diagnosis of ADHD (N = 45). The extent to which non-specific effects contributed to the effects of methylphenidate was determined by ADHD symptom reductions observed with placebo versus reductions observed with active doses of methylphenidate. The influence of regression to the mean was examined by estimating the contribution of baseline ADHD symptom severity to the effects observed with placebo treatment. Data were analyzed using multilevel analyses. We observed significant non-specific effects of methylphenidate for parent-rated ADHD symptoms, but not for teacher-rated symptoms. For parent reported hyperactive/impulsive symptoms, higher baseline symptoms predicted larger effects with placebo, indicating regression to the mean effects. For parent-reports, a significant part of the overall effect of methylphenidate treatment is explained by non-specific effects. Our findings stress the importance of taking non-specific effects into account when evaluating methylphenidate treatment, by including teacher-reports and using a double baseline assessment during titration. Comparing active medication with a placebo in the titration trial has the potential to identify non-specific effects.
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Affiliation(s)
- Karen Vertessen
- VU Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
- University Psychiatric Centre, Katholieke Universiteit Leuven, Leuven, Belgium.
| | - Jaap Oosterlaan
- VU Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
- Department of Pediatrics, Emma Children's Hospital, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Pierre Bet
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, VU Medical Center, Amsterdam, The Netherlands
| | - Marco Bottelier
- Child Study Center Accare, UMC Groningen, Groningen, The Netherlands
| | - Reino Stoffelsen
- Levvel Specialists in Youth and Family Care, Amsterdam, The Netherlands
| | - James M Swanson
- Department of Pediatrics, University of California, Irvine, USA
| | | | - Jos Twisk
- Department of Epidemiology and Biostatistics, VU Medical Center, Amsterdam, The Netherlands
| | - Marjolein Luman
- VU Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
- Levvel Specialists in Youth and Family Care, Amsterdam, The Netherlands
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Mulraney M, de Silva U, Joseph A, Sousa Fialho MDL, Dutia I, Munro N, Payne JM, Banaschewski T, de Lima CB, Bellgrove MA, Chamberlain SR, Chan P, Chong I, Clink A, Cortese S, Daly E, Faraone SV, Gladstone M, Guastella AJ, Järvdike J, Kaleem S, Lovell MG, Meller T, Nagy P, Newcorn JH, Polanczyk GV, Simonoff E, Szatmari P, Tehan C, Walsh K, Wamithi S, Coghill D. International Consensus on Standard Outcome Measures for Neurodevelopmental Disorders: A Consensus Statement. JAMA Netw Open 2024; 7:e2416760. [PMID: 38869906 DOI: 10.1001/jamanetworkopen.2024.16760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2024] Open
Abstract
Importance The use of evidence-based standardized outcome measures is increasingly recognized as key to guiding clinical decision-making in mental health. Implementation of these measures into clinical practice has been hampered by lack of clarity on what to measure and how to do this in a reliable and standardized way. Objective To develop a core set of outcome measures for specific neurodevelopmental disorders (NDDs), such as attention-deficit/hyperactivity disorder (ADHD), communication disorders, specific learning disorders, and motor disorders, that may be used across a range of geographic and cultural settings. Evidence Review An international working group composed of clinical and research experts and service users (n = 27) was convened to develop a standard core set of accessible, valid, and reliable outcome measures for children and adolescents with NDDs. The working group participated in 9 video conference calls and 8 surveys between March 1, 2021, and June 30, 2022. A modified Delphi approach defined the scope, outcomes, included measures, case-mix variables, and measurement time points. After development, the NDD set was distributed to professionals and service users for open review, feedback, and external validation. Findings The final set recommends measuring 12 outcomes across 3 key domains: (1) core symptoms related to the diagnosis; (2) impact, functioning, and quality of life; and (3) common coexisting problems. The following 14 measures should be administered at least every 6 months to monitor these outcomes: ADHD Rating Scale 5, Vanderbilt ADHD Diagnostic Rating Scale, or Swanson, Nolan, and Pelham Rating Scale IV; Affective Reactivity Index; Children's Communication Checklist 2; Colorado Learning Disabilities Questionnaire; Children's Sleep Habits Questionnaire; Developmental-Disability Children's Global Assessment Scale; Developmental Coordination Disorder Questionnaire; Family Strain Index; Intelligibility in Context Scale; Vineland Adaptive Behavior Scale or Repetitive Behavior Scale-Revised and Social Responsiveness Scale; Revised Child Anxiety and Depression Scales; and Yale Global Tic Severity Scale. The external review survey was completed by 32 professionals and 40 service users. The NDD set items were endorsed by more than 70% of professionals and service users in the open review survey. Conclusions and Relevance The NDD set covers outcomes of most concern to patients and caregivers. Use of the NDD set has the potential to improve clinical practice and research.
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Affiliation(s)
- Melissa Mulraney
- Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Umanga de Silva
- International Consortium of Health Outcome Measures, Boston, Massachusetts
| | - Andria Joseph
- International Consortium of Health Outcome Measures, Boston, Massachusetts
| | | | - Iain Dutia
- School of Allied Health, Australian Catholic University, Brisbane, Australia
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
| | - Natalie Munro
- Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
| | | | - Tobias Banaschewski
- Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Cláudia Bandeira de Lima
- Institute for Evidence Based Healthcare at University of Lisbon School and Medicine, Lisbon, Portugal
| | - Mark A Bellgrove
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Samuel R Chamberlain
- Department of Psychiatry, Faculty of Medicine, University of Southampton, Southampton, UK
- Department of Neuroscience and Physiology, Norton College of Medicine at SUNY Upstate Medical University, Syracuse, New York
| | - Phyllis Chan
- Department of Psychiatry, Queen Mary Hospital, Hong Kong
| | - Ivy Chong
- May Institute Inc, Randolph, Massachusetts
| | | | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- Tees, Esk, and Wear Valleys NHS Foundation Trust, Middlesbrough, UK
- Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York City, New York
- Department of Precision and Regenerative Medicine and Ionian Area, University of Studies of Bari Aldo Moro, Bari, Italy
| | - Eileen Daly
- Department of Forensic and Neurodevelopmental Sciences, King's College London, London, UK
| | - Stephen V Faraone
- Department of Neuroscience and Physiology, Norton College of Medicine at SUNY Upstate Medical University, Syracuse, New York
- Department of Psychiatry and Behavioral Sciences, Norton College of Medicine at SUNY Upstate Medical University, Syracuse, New York
| | - Melissa Gladstone
- Department of Women and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Adam J Guastella
- Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | | | - Sidra Kaleem
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Mark G Lovell
- Tees, Esk, and Wear Valleys NHS Foundation Trust, Middlesbrough, UK
- Royal College of Psychiatrists, London, UK
| | - Tamasin Meller
- Northern Beaches Child and Family Health Service, Sydney, Australia
| | - Peter Nagy
- Division of Neurodevelopmental Disorders, Bethesda Children's Hospital, Budapest, Hungary
| | - Jeffrey H Newcorn
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Guilherme V Polanczyk
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Emily Simonoff
- Department of Child and Adolescent Psychiatry, King's College London, London, UK
| | - Peter Szatmari
- Centre for Addiction and Mental Health University of Toronto, Toronto, Ontario, Canada
| | | | - Karin Walsh
- Division of Neuropsychology, Children's National Hospital and The George Washington University School of Medicine, Washington, DC
| | - Susan Wamithi
- Department of Paediatrics, Child & Adolescent Health, Aga Khan University Medical College, Nairobi, Kenya
| | - David Coghill
- Department of Paediatrics, University of Melbourne, Parkville, Australia
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McGrath J. The clinical pathway in ADMiRE, Ireland's first public specialist service for children and adolescents with attention deficit hyperactivity disorder. Ir J Psychol Med 2024:1-8. [PMID: 38825868 DOI: 10.1017/ipm.2024.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Abstract
Attention deficit hyperactivity disorder (ADHD) is a highly prevalent neurodevelopmental disorder occurring in approximately one in twenty young people in Ireland, and in one-third of those attending Irish Child and Adolescent Mental Health Services (CAMHS). It is important to treat ADHD, as un/poorly treated ADHD is associated with a raft of negative health and socio-economic outcomes. Effective interventions for ADHD are available, and the use of standardised, evidence-based pathways for assessment and management of ADHD optimises outcomes. Despite this, there is no national standardised clinical pathway for assessment and treatment of ADHD in Ireland. ADMiRE, the first public healthcare specialist service for children and adolescents in Ireland, has developed a strongly evidence-based, efficient, effective and safe clinical pathway for assessment and management of ADHD. This paper describes the ADMiRE Clinical Pathway and references ADMiRE resources that are available to other services.
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Affiliation(s)
- Jane McGrath
- Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
- Linn Dara Child and Adolescent Mental Health Services, Cherry Orchard Hospital, Dublin, Ireland
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Vertessen K, Luman M, Bet P, Bergwerff CE, Bottelier M, Stoffelsen R, Swanson JM, Wisse A, Twisk J, Oosterlaan J. Improving Methylphenidate Titration in Children with Attention-Deficit/Hyperactivity Disorder (ADHD): A Randomized Controlled Trial Using Placebo-Controlled Titration Implemented in Clinical Practice. Paediatr Drugs 2024; 26:319-330. [PMID: 38280943 DOI: 10.1007/s40272-023-00604-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2023] [Indexed: 01/29/2024]
Abstract
BACKGROUND AND OBJECTIVES Concerns exist regarding the rising use of methylphenidate. A double-blind, placebo-controlled methylphenidate titration (PCT) for children with attention-deficit/hyperactivity disorder (ADHD) has shown potential to improve titration (i.e., detection of placebo responders and larger ADHD symptom improvement) in experimental settings. This study aims to determine if these advantages can be transferred to clinical settings. METHOD Children (aged 5-13 years) with an ADHD diagnosis and an indication to start methylphenidate (MPH) treatment were recruited. Participants were randomized to PCT or care as usual (CAU) in a 1:1 ratio followed by a 7-week randomized controlled trial (T1) and 6-month, naturalistic, open-label follow-up (T2). Parents, teachers, and physicians rated ADHD symptoms, ADHD medication use, MPH dosing, and treatment satisfaction using questionnaires. RESULTS A total of 100 children were enrolled and randomized to PCT (n = 49) or CAU (n = 51). In the PCT group, we found 8.2% placebo responders, 16.3% non-responders, and 65.3% responders to MPH. With PCT compared with CAU, a significantly larger number of children discontinued MPH (T1: 24.5 vs 5.9%, p = 0.009; T2: 41.7 vs 10.4%, p < 0.001) and refrained from using other pharmacological treatment (T1: 20.4 vs 3.9%, p = 0.013; T2: 20.83 vs 6.25%, p = 0.002). At both timepoints, there were no significant differences between the groups in the average dose of MPH, ADHD symptoms, or treatment satisfaction. CONCLUSIONS PCT can be used to improve detection of children who do not benefit from MPH, and may therefore potentially reduce overtreatment of ADHD with MPH.
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Affiliation(s)
- Karen Vertessen
- Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
- University Psychiatric Centre, Katholieke Universiteit Leuven, Leuven, Belgium.
| | - Marjolein Luman
- Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
- Levvel Specialists in Youth and Family Care, Amsterdam, The Netherlands
| | - Pierre Bet
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, VU Medical Center, Amsterdam, The Netherlands
| | - Catharina E Bergwerff
- Institute of Education and Child Studies, Leiden University, Leiden, The Netherlands
| | - Marco Bottelier
- Child Study Center Accare, UMC Groningen, Groningen, The Netherlands
| | - Reino Stoffelsen
- Levvel Specialists in Youth and Family Care, Amsterdam, The Netherlands
| | - James M Swanson
- Department of Pediatrics, University of California, Irvine, USA
| | - Annemiek Wisse
- Youz, Center for Youth Mental Healthcare, Velsen-Noord, The Netherlands
| | - Jos Twisk
- Department of Epidemiology and Biostatistics, VU Medical Center, Amsterdam, Amsterdam, The Netherlands
| | - Jaap Oosterlaan
- Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
- Department of Pediatrics, Emma Children's Hospital, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
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Willig TN, Blanc JP, Assathiany R, Bilbault C, Raffier L, Werner A. Ambulatory pediatricians: how to bridge the gaps in diagnosis and care coordination for neurodevelopmental disorders in France. Front Pediatr 2024; 12:1269198. [PMID: 38725981 PMCID: PMC11079306 DOI: 10.3389/fped.2024.1269198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 01/10/2024] [Indexed: 05/12/2024] Open
Abstract
Introduction and aims The organization of healthcare pathways for neurodevelopmental disorders (NDD) relies on different levels of expertise depending on the complexity of these disorders. NDDs affect between 8% and 15% of children. Historically, national recommendations and healthcare planning measures were initially devoted to autism spectrum disorders and were gradually extended to Attention deficit hyperactivity disorder (ADHD) and specific learning and development disorders. Private doctors play an increasing role in these pathways at different levels of care due to difficulties in organization, particularly in the health and social sector. The aim of this work was to evaluate the contribution of second-line private doctors in the diagnosis and care of children affected by NDD. Methods A first series of surveys in 2016 evaluated the level of commitment of primary care pediatricians; this online national survey was repeated in 2023 among 1,430 members of the French Association of Ambulatory Pediatrics (Association Française de Pédiatrie Ambulatoire: AFPA) to assess their training, current and future involvement, and activity in NDD care. Analysis was performed by the main author using Epi-Info software. Results The study identified in 2023 214 second-line private doctors (14% of all pediatricians in activity), of which 185 agreed to appear in a directory published the same year by the AFPA to facilitate referrals from other professionals. Sex ratio of responders is usual for paediatricians: 79.5%/20.5% (F/M), with a distribution among ages showing a slight increase of the age range between age 51-60 (30.5%). Our data indicate that in France in 2022, second-line private doctors made 48%-53% of NDD diagnoses, 24%-26.4% of follow-up consultations and declare to be accountable for 21% of initial prescriptions for Methylphenidate. Among these second-line doctors, 40% had completed a post-university degree on NDD, 74.3% had completed professional development training (PDT) and 85.2% had completed either or both types of training. Most doctors participating in the survey wanted to improve their level of practice, suggesting that in five years, the number of second-line private doctors will increase by 20% to 244 despite 24 planned retirements within the same period. This data probably underestimates the role of private doctors in NDD diagnosis, follow-up, and initial Methylphenidate prescriptions given the unfavourable working conditions (no financial compensation for long appointments, difficulty accessing paramedical and psychological assessments). Conclusions Our data confirms that diagnosis and care coordination in the various presentations of NDD may rely on different types of practices and specializations: medical and social professionals, mental health professionals, but also a growing body of medical doctors involved in developmental and behavioural pediatrics. This data and reflection will be helpful for organizing healthcare in France or in other countries. Main study limitation relies in the self-declaration of MD's involvement in NDD and could not evaluate the activity of employed MD's from the social and medico social sector, nor be based on the national databases for prescription. It remains however the first attempt of characterization of medical activity at the national level in France for NDD.
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Affiliation(s)
- Thiébaut-Noël Willig
- Clinique Ambroise Paré, ELSAN Group, & Eventail 31, Toulouse, France
- Occitadys, Toulouse, France
- Association Française de Pédiatrie Ambulatoire (AFPA), Ancenis Saint-Géréon, France
| | - Jean-Paul Blanc
- Association Française de Pédiatrie Ambulatoire (AFPA), Ancenis Saint-Géréon, France
| | - Rémy Assathiany
- Association Française de Pédiatrie Ambulatoire (AFPA), Ancenis Saint-Géréon, France
| | - Claire Bilbault
- Association Française de Pédiatrie Ambulatoire (AFPA), Ancenis Saint-Géréon, France
- Association Française des Neuropédiatres Libéraux (AFNL), Chatenay Malabry, France
- CHR Metz Thionville, Ars Laquenexy, France
| | | | - Andreas Werner
- Association Française de Pédiatrie Ambulatoire (AFPA), Ancenis Saint-Géréon, France
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Andersen AC, Sund AM, Thomsen PH, Lydersen S, Young S, Nøvik TS. One year follow-up of participants in a randomised controlled trial of a CBT-based group therapy programme for adolescents diagnosed with ADHD. Nord J Psychiatry 2024; 78:189-197. [PMID: 38353423 DOI: 10.1080/08039488.2024.2301774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/01/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Adolescents with ADHD often struggle on many areas of their lives and have a high risk of adverse outcomes and negative life trajectories. Multimodal treatment including psychosocial interventions is recommended but evidence regarding effect of such interventions is still limited. MATERIALS AND METHODS This study was a follow-up study of adolescents participating in a randomised controlled trial (RCT) of a group intervention based on cognitive behavioural therapy (CBT). Participants were adolescents diagnosed with ADHD and still impaired by their symptoms after standard treatment including psychoeducation and medication. All participants were interviewed by telephone one year after inclusion, and outcome measures included both quantitative and qualitative measures. RESULTS There were 100 adolescents included in the study. We found no significant differences between treatment and control group on measures of ADHD-symptoms, self-efficacy, overall problems, global psychosocial functioning, or symptom severity at one-year follow-up. Still, participants in the intervention group reported on positive gains and that they learned a lot about ADHD and themselves. CONCLUSIONS The intervention delivered in this trial failed to show a treatment effect on symptom level when added to standard care. Participants did however report on positive gains and felt they learned a lot. More research is needed to explore how the programme and delivery of treatment might be improved, and which patients might benefit the most from this type of interventions.
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Affiliation(s)
- Ann Christin Andersen
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Anne Mari Sund
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Child and Adolescent Psychiatry, St. Olav University Hospital, Trondheim, Norway
| | - Per Hove Thomsen
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department for Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark
| | - Stian Lydersen
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Susan Young
- Psychology Services Limited, London, UK
- Department of Psychology, Reykjavik University, Reykjavik, Iceland
| | - Torunn Stene Nøvik
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Child and Adolescent Psychiatry, St. Olav University Hospital, Trondheim, Norway
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Vertessen K, Luman M, Oosterlaan J. ADHD medication adherence: the importance of adequate prescribing. Lancet Psychiatry 2024; 11:2-3. [PMID: 38035875 DOI: 10.1016/s2215-0366(23)00393-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 11/13/2023] [Indexed: 12/02/2023]
Affiliation(s)
- Karen Vertessen
- University Psychiatric Center, Catholic University of Leuven, 3000 Leuven, Belgium; Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
| | - Marjolein Luman
- Vrije Universiteit Amsterdam, Amsterdam, Netherlands; Levvel Specialists in Youth and Family Care, Amsterdam, Netherlands
| | - Jaap Oosterlaan
- Vrije Universiteit Amsterdam, Amsterdam, Netherlands; Department of Pediatrics, Emma Children's Hospital, University of Amsterdam, Amsterdam, Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
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Botha JJ, Schoeman R. Attention deficit hyperactivity disorder: Insights into underfunding in the private healthcare sector in South Africa. S Afr J Psychiatr 2023; 29:2050. [PMID: 37928936 PMCID: PMC10623611 DOI: 10.4102/sajpsychiatry.v29i0.2050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 09/08/2023] [Indexed: 11/07/2023] Open
Abstract
Background Although the prevalence of attention deficit hyperactivity disorder (ADHD) has remained stable, the number of patients diagnosed with ADHD has increased in recent years owing to increased awareness. Despite this increase, medical schemes in South Africa have not improved their funding models for this condition. Aim The study aimed to provide an account of the funding that medical schemes provisioned for treating ADHD in South Africa during 2022. Setting All the South African medical schemes that were registered with the Council of Medical Schemes during 2022 (n = 72) and all their listed options were evaluated (n = 279). Methods The study analysed secondary data published on the medical schemes' websites in the public domain. Statistical minimum, average, maximum and correlation analyses were performed using Excel version 16.58. Results Attention deficit hyperactivity disorder is not regarded as a prescribed minimum benefit (PMB) condition and therefore each medical scheme used its own approach to providing its beneficiaries with some or no benefits for ADHD. It was evident that ADHD was underfunded and lacked structured or standardised funding approaches. Conclusion Attention deficit hyperactivity disorder is underfunded in the private healthcare sector in South Africa. Better funding models are needed or ADHD needs to be registered as a PMB condition. Contribution Findings from this study highlight the urgency for structured and sufficient ADHD-specific funding by medical schemes. Considerations based on these findings may be applied in the National Health Insurance and in other countries around the world.
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Affiliation(s)
- Johan J Botha
- Department MBA, Faculty of Economic and Management Sciences, University of Stellenbosch Business School, Stellenbosch University, Bellville, South Africa
| | - Renata Schoeman
- Department of Leadership, Faculty Healthcare Leadership, University of Stellenbosch Business School, Stellenbosch University, Bellville, South Africa
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Suetani S, Hull J, Zeniou L, Chong L, Stimming A, Nelson C, Panagoda G. A model of care for attention deficit and hyperactivity disorder among adults in the community. Australas Psychiatry 2023; 31:616-618. [PMID: 37358370 DOI: 10.1177/10398562231186237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
OBJECTIVE To describe the process of collaborative, contextualised development and implementation of a model of care for adults with symptoms suggestive of attention deficit and hyperactivity disorder in an Aboriginal community-controlled health service. CONCLUSION The current article describes an attempt to reduce unmet mental health needs through a systemic approach within a well-established Indigenous community-controlled organisation.
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Affiliation(s)
- Shuichi Suetani
- Institute for Urban Indigenous Health, Windsor, QLD, Australia
- Physical health and mental health stream, Queensland Centre for Mental Health Research, Wacol, QLD, Australia
- Queensland Brain Institute, The University of Queensland, St Lucia, QLD, Australia
- School of Medicine and Dentistry, Griffith University, Southport, QLD, Australia
| | - Jaimie Hull
- Institute for Urban Indigenous Health, Windsor, QLD, Australia
| | - Lakis Zeniou
- Institute for Urban Indigenous Health, Windsor, QLD, Australia
| | - Leshay Chong
- Institute for Urban Indigenous Health, Windsor, QLD, Australia
| | - Andrea Stimming
- Institute for Urban Indigenous Health, Windsor, QLD, Australia
| | - Carmel Nelson
- Institute for Urban Indigenous Health, Windsor, QLD, Australia
| | - Gaj Panagoda
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD, Australia
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Bisset M, Brown LE, Bhide S, Patel P, Zendarski N, Coghill D, Payne L, Bellgrove MA, Middeldorp CM, Sciberras E. Practitioner Review: It's time to bridge the gap - understanding the unmet needs of consumers with attention-deficit/hyperactivity disorder - a systematic review and recommendations. J Child Psychol Psychiatry 2023; 64:848-858. [PMID: 36651107 PMCID: PMC10952204 DOI: 10.1111/jcpp.13752] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/15/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Understanding the unmet needs of healthcare consumers with attention-deficit/hyperactivity disorder (ADHD) (individuals with ADHD and their caregivers) provides critical insight into gaps in services, education and research that require focus and funding to improve outcomes. This review examines the unmet needs of ADHD consumers from a consumer perspective. METHODS A standardised search protocol identified peer-reviewed studies published between December 2011 and December 2021 focusing on consumer-identified needs relating to ADHD clinical care or research priorities. RESULTS 1,624 articles were screened with 23 studies that reviewed examining the needs of ADHD consumers from Europe, the U.K., Hong Kong, Iran, Australia, the U.S.A. and Canada. Consumer-identified needs related to: treatment that goes beyond medication (12 studies); improved ADHD-related education/training (17 studies); improved access to clinical services, carer support and financial assistance (14 studies); school accommodations/support (6 studies); and ongoing treatment efficacy research (1 study). CONCLUSION ADHD consumers have substantial unmet needs in clinical, psychosocial and research contexts. Recommendations to address these needs include: improving access to and quality of multimodal care provision; incorporating recovery principles into care provision; fostering ADHD health literacy; and increasing consumer participation in research, service development and ADHD-related training/education.
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Affiliation(s)
- Matthew Bisset
- School of PsychologyDeakin UniversityMelbourneVICAustralia
- The Royal Children's HospitalParkvilleVICAustralia
- Murdoch Children's Research InsitituteMelbourneVICAustralia
| | | | - Sampada Bhide
- School of PsychologyDeakin UniversityMelbourneVICAustralia
- Murdoch Children's Research InsitituteMelbourneVICAustralia
- The Royal Melbourne HospitalParkvilleVICAustralia
| | - Pooja Patel
- School of PsychologyDeakin UniversityMelbourneVICAustralia
| | - Nardia Zendarski
- Department of PaediatricsUniversity of MelbourneParkvilleVICAustralia
| | - David Coghill
- The Royal Children's HospitalParkvilleVICAustralia
- Murdoch Children's Research InsitituteMelbourneVICAustralia
- Department of PaediatricsUniversity of MelbourneParkvilleVICAustralia
| | - Leanne Payne
- Child Health Research CentreUniversity of QueenslandBrisbaneQLDAustralia
- Child and Youth Mental Health ServiceChildren's Health Queensland Hospital and Health ServiceBrisbaneQLDAustralia
| | - Mark A. Bellgrove
- Turner Institute for Brain and Mental Health and School of Psychological SciencesMonash UniversityMelbourneVICAustralia
| | - Christel M. Middeldorp
- Child Health Research CentreUniversity of QueenslandBrisbaneQLDAustralia
- Child and Youth Mental Health ServiceChildren's Health Queensland Hospital and Health ServiceBrisbaneQLDAustralia
| | - Emma Sciberras
- School of PsychologyDeakin UniversityMelbourneVICAustralia
- Murdoch Children's Research InsitituteMelbourneVICAustralia
- Department of PaediatricsUniversity of MelbourneParkvilleVICAustralia
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11
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Payne L, Roest SL, Lu ZQ, Zendarski N, Bisset M, Sciberras E, Stathis S, Siebelink BM, Vermeiren RRJM, Bellgrove MA, Coghill D, Middeldorp CM. Comparing Treatment Outcomes in Children and Adolescents With ADHD to Other Disorders Within an Australian and Dutch Outpatient Cohort. J Atten Disord 2022; 26:1914-1924. [PMID: 35861495 DOI: 10.1177/10870547221112941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Previous studies at child and youth mental health services (CYMHS) suggest that children with ADHD have poorer outcomes compared to those with other diagnoses. This study investigates this in more detail. METHODS Children with ADHD were compared to those with ASD and those with emotional disorders, on routinely collected outcomes at CYMHS in Australia (N = 2,513) and the Netherlands (N = 844). RESULTS Where the emotional disorders group reached a similar level of emotional symptoms at the end-of-treatment as the ADHD and ASD groups, the latter two groups still had higher scores on ADHD and ASD symptoms (attention and peer problems). The poorer outcomes were mainly explained by higher severity at baseline. In Australia, an ADHD and/or ASD diagnosis also independently contributed to worse outcomes. CONCLUSION Those with neurodevelopmental disorders within both countries had poorer outcomes than those with emotional disorders. Services should aim to optimize treatment to ensure best possible outcomes.
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Affiliation(s)
| | | | - Zhen Qi Lu
- University of Queensland, St Lucia, Australia
| | | | | | - Emma Sciberras
- University of Melbourne, Parkville, VIC, Australia.,Deakin University, Burwood, VIC, Australia.,Murdoch Children's Research Institute, Parkville, Australia
| | - Stephen Stathis
- University of Queensland, St Lucia, Australia.,Children's Health Queensland Hospital and Health Service, South Brisbane, Australia
| | | | | | | | | | - Christel M Middeldorp
- University of Queensland, St Lucia, Australia.,Children's Health Queensland Hospital and Health Service, South Brisbane, Australia
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12
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Haugan ALJ, Sund AM, Young S, Thomsen PH, Lydersen S, Nøvik TS. Cognitive behavioural group therapy as addition to psychoeducation and pharmacological treatment for adolescents with ADHD symptoms and related impairments: a randomised controlled trial. BMC Psychiatry 2022; 22:375. [PMID: 35655149 PMCID: PMC9164353 DOI: 10.1186/s12888-022-04019-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 05/25/2022] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Cognitive behavioural therapy (CBT) is recommended for attention-deficit/hyperactivity-disorder (ADHD) in adolescents. However, all CBTs are not created equal, and the guidelines do not specify which CBT interventions are the most effective for this patient group. This study examines the efficacy of a group CBT without parent involvement as follow-up treatment compared to no additional CBT in adolescents with persistent and impairing ADHD symptoms after a short psychoeducational intervention and medical treatment. METHODS The authors conducted a two-arm parallel randomized controlled trial in two child and adolescent mental health outpatient clinics in Norway. One hundred patients aged 14-18 years with a diagnosis of ADHD (66%) or subthreshold ADHD (34%) were randomized to either a 12-week group CBT program (N = 50) or a non-CBT control condition (N = 50). Assessments were made at admission to the clinic, two weeks before and two weeks after treatment. The primary outcomes were parent-, teacher- and self-ratings of ADHD symptoms (ADHD Rating Scale-IV), and the secondary outcomes were ratings of ADHD symptom severity, executive function, functional impairment, and emotional problems. Evaluators blinded to group allocation rated ADHD symptom severity with the Clinical Global Impression Scale for Severity (CGI-S) at baseline and post-treatment. RESULTS Analyses using mixed-effects models showed no difference between the treatment arms from baseline to post treatment in primary and secondary outcomes. CONCLUSIONS Contrary to our hypothesis, we found no incremental treatment effect on the part of a group CBT as follow-up to psychoeducation and pharmacological treatment on ADHD symptoms and accompanying impairments. Limitations with the CBT was the large number and low dosage of treatment components, causing restricted time for practice. Unlike evidence-based, individualized targeted CBTs with parent involvement, a group CBT directed solely at the adolescents with no parent involvement does not appear effective for treating ADHD. TRIAL REGISTRATION NCT02937142 , 18/10/2016.
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Affiliation(s)
- Anne-Lise Juul Haugan
- Department of Mental Health, Faculty of Medicine and Health Sciences, Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), NTNU- Norwegian University of Science and Technology, Trondheim, Norway.
| | - Anne Mari Sund
- Department of Mental Health, Faculty of Medicine and Health Sciences, Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), NTNU- Norwegian University of Science and Technology, Trondheim, Norway
- Department of Child and Adolescent Psychiatry, St. Olav University Hospital, Trondheim, Norway
| | - Susan Young
- Psychology Services Limited, London, UK
- Department of Psychology, University of Reykjavik, Reykjavik, Iceland
| | - Per Hove Thomsen
- Department of Mental Health, Faculty of Medicine and Health Sciences, Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), NTNU- Norwegian University of Science and Technology, Trondheim, Norway
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark
| | - Stian Lydersen
- Department of Mental Health, Faculty of Medicine and Health Sciences, Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), NTNU- Norwegian University of Science and Technology, Trondheim, Norway
| | - Torunn Stene Nøvik
- Department of Mental Health, Faculty of Medicine and Health Sciences, Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), NTNU- Norwegian University of Science and Technology, Trondheim, Norway
- Department of Child and Adolescent Psychiatry, St. Olav University Hospital, Trondheim, Norway
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13
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A novel school-based approach to screening for attention deficit hyperactivity disorder. Eur Child Adolesc Psychiatry 2022; 31:909-917. [PMID: 33515089 DOI: 10.1007/s00787-021-01721-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 01/11/2021] [Indexed: 10/22/2022]
Abstract
Current approaches to screening for ADHD result in high rates of false positives. A proof of concept study to investigate the added benefits in the school-based detection of ADHD of adding a standardised teacher to teacher interview to traditional parent and teacher report questionnaires. A school-based study of diagnostic accuracy of ADHD using a novel 2-stage screening process. Participants were all 1026 pupils enrolled in grades 1 to 6 (ages 6-12 years) of a school in Hunan Province, China. The primary outcome was a diagnosis of ADHD on the Kiddie Schedule for Affective Disorders and Schizophrenia Present Lifetime version. 230 (22.4%) of the 1026 students screened positive at Stage 1 (parent and teacher questionnaires) (Sensitivity 0.86 [95% CI, 0.75 to 0.96], specificity 0.80 [95% CI, 0.78-0.83], false positive rate 0.20 (95% CI, 0.18 to 0.23), false negative rate was 0.14 (95% CI, 0.12 to 0.16). 65 remained screen-positive at the Stage 2 screen (teacher to teacher SNAP-IV interview). 36/65 (55.4%) of these Stage 2 screen positive participants and 1/144 (0.7%) of the screen negative subjects met DSM-IV criteria for ADHD (sensitivity 0.83 [95% CI, 0.71-0.95]; specificity of 0.97 [95% CI, 0.96-0.98]; false positive rate 0.03 [95% CI, 0.01 to 0.04], false negative rate 0.16 [95% CI, 0.15 to 0.19]. Adding teacher to teacher interviews to traditional questionnaire-based screening has the potential to improve the clinical utility of school-based screening for ADHD reducing the proportion of false positives, without a negative impact on sensitivity.
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14
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Yao A, Shimada K, Kasaba R, Tomoda A. Beneficial Effects of Behavioral Parent Training on Inhibitory Control in Children With Attention-Deficit/Hyperactivity Disorder: A Small-Scale Randomized Controlled Trial. Front Psychiatry 2022; 13:859249. [PMID: 35573335 PMCID: PMC9094443 DOI: 10.3389/fpsyt.2022.859249] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/17/2022] [Indexed: 11/28/2022] Open
Abstract
The purpose of this study was to examine whether the beneficial effects of behavioral parent training (BPT), as an indirect type of psychosocial treatment, are extended to cognitive manifestations beyond behavioral symptoms of attention-deficit/hyperactivity disorder (ADHD). Although previous studies of community families have shown an association between parenting quality and a child's cognitive functions, little is known about the effects of BPT on cognitive manifestations in children with ADHD. In this study, we focused on inhibitory control among cognitive domains, which is considered to be the most malleable to direct types of psychosocial treatment for ADHD. We hypothesized that inhibitory control is affected by BPT, which uses parents as the primary agents of change to help their children. Thirty school-age children (6-12 years old) with ADHD and their parents (mothers) participated and were randomly assigned to either the standard BPT or waitlist control group. Using two objective laboratory-based tasks of inhibitory control (i.e., go/no-go and single response selection tasks), we assessed baseline and post-treatment response inhibition to suppress task-irrelevant responses and response selection to select task-relevant responses. In addition to decreased ADHD symptoms and negative parenting, the BPT group exhibited significantly improved performance in the single response selection task, but not in the go/no-go task, compared with the waitlist control group. Although tentative, these findings partially support our hypothesis that BPT has beneficial effects on the cognitive inhibitory control of ADHD, highlighting the potential for supportive environmental modifications to advance cognitive development in children with ADHD.
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Affiliation(s)
- Akiko Yao
- Research Center for Child Mental Development, University of Fukui, Fukui, Japan
- Department of Child Development, United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University, and University of Fukui, Fukui, Japan
| | - Koji Shimada
- Research Center for Child Mental Development, University of Fukui, Fukui, Japan
- Department of Child Development, United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University, and University of Fukui, Fukui, Japan
- Biomedical Imaging Research Center, University of Fukui, Fukui, Japan
| | - Ryoko Kasaba
- Department of Child Development, United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University, and University of Fukui, Fukui, Japan
| | - Akemi Tomoda
- Research Center for Child Mental Development, University of Fukui, Fukui, Japan
- Department of Child Development, United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University, and University of Fukui, Fukui, Japan
- Department of Child and Adolescent Psychological Medicine, University of Fukui Hospital, Fukui, Japan
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15
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Abstract
This chapter focusses on the benefits and limitations of stimulant medications in the treatment of ADHD. We highlight the key similarities and differences between the different stimulants used to treat ADHD and briefly discuss mechanisms of action, pharmacokinetics, and pharmacodynamics. We will discuss some of the political, ethical, and moral discussions about the use of stimulants including a consideration of the treatment of subsyndromal ADHD and the use of stimulants as cognitive enhancers. We review the comparative efficacy and effectiveness between stimulants and non-pharmacological treatments for ADHD, between stimulant classes and formulations and between stimulant and non-stimulant medications. We discuss the effects on core symptoms, common associated symptoms, cognition, and more distal outcomes including quality of life and functioning and issues related to tolerance, tolerability and adverse effects. Looking at the clinical implications of these findings, we discuss the importance of measurement-based care in the treatment of ADHD. Finally, we will look at the benefits and limitations of stimulants across several different populations and clinical subgroups.
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Affiliation(s)
- David Coghill
- Financial Markets Foundation Chair of Developmental Mental Health, Departments of Paediatrics and Psychiatry, School of Medicine, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia.
- Murdoch Children's Research Institute, Parkville, VIC, Australia.
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16
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Kleve L, Vårdal L, Elgen IB. The Nurse Role in the Management of ADHD in Children and Adolescent: A Literature Review. Front Psychiatry 2022; 13:676528. [PMID: 35273525 PMCID: PMC8902137 DOI: 10.3389/fpsyt.2022.676528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 01/10/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To review literature regarding existing and recommended roles for nurses in the management of children with ADHD. METHODS MEDLINE and CINAHL were searched from 2010 to the end of 2019 with the following keywords: ADHD, nurse, child, and inclusion criteria published in an English journal. RESULTS Forty-three records were found. However, only five articles scientifically evaluated the nurse role. The nurse role in ADHD management seemed to vary across countries with nurses working independently or as part of a team with delegated responsibility. CONCLUSION The literature review gave information to suggest that nurses can have a significant role in providing a range of medical and non-medical management.
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Affiliation(s)
- Liv Kleve
- Division of Mental Health, Department of Child and Adolescent Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Lisa Vårdal
- Division of Mental Health, Department of Child and Adolescent Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Irene Bircow Elgen
- Division of Mental Health, Department of Child and Adolescent Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
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17
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Baweja R, Soutullo CA, Waxmonsky JG. Review of barriers and interventions to promote treatment engagement for pediatric attention deficit hyperactivity disorder care. World J Psychiatry 2021; 11:1206-1227. [PMID: 35070771 PMCID: PMC8717033 DOI: 10.5498/wjp.v11.i12.1206] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/20/2021] [Accepted: 10/25/2021] [Indexed: 02/06/2023] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) is a common and impairing behavioral health disorder, impacting over 5% of children worldwide. There are multiple evidence-based pharmacological and psychosocial treatments for ADHD, and greater service utilization is associated with improved acute and long-term outcomes. However, long-term outcomes are suboptimal as multimodal treatments are often not accessed and most care ends prematurely. This narrative review discusses barriers to engagement for children and adolescents with ADHD and their families as well as interventions to overcome these barriers. Families face a variety of structural and attitudinal barriers, ranging from cost and access to stigma and low self-efficacy to successfully implement change. There are multiple interventions that may enhance engagement with ADHD care including psychoeducation, integration of behavioral services in general medical settings, telehealth as well as specific adaptations to existing ADHD treatments, such as the use of motivational interviewing or shared decision making. Integration of behavioral health into general medical settings and telehealth have been found in controlled studies to increase access by reducing both structural and attitudinal barriers. Adding motivational interviewing, shared decision making and other engagement interventions to evidence-based ADHD treatments has been found to reduce attitudinal barriers that translates into improved participation and satisfaction while enhancing outcomes. However, little is known about how to promote extended engagement with ADHD services even though a chronic care model for ADHD is recommended.
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Affiliation(s)
- Raman Baweja
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, PA 17033, United States
| | - Cesar A Soutullo
- Louis A. Faillace, MD Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX 77054, United States
| | - James G Waxmonsky
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, PA 17033, United States
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18
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Rocco I, Corso B, Bonati M, Minicuci N. Time of onset and/or diagnosis of ADHD in European children: a systematic review. BMC Psychiatry 2021; 21:575. [PMID: 34784913 PMCID: PMC8594188 DOI: 10.1186/s12888-021-03547-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/17/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Attention-Deficit/ Hyperactivity Disorder (ADHD) is one of the most common childhood neurobehavioral conditions. Symptoms related to this disorder cause a significant impairment in school tasks and in the activities of children's daily lives; an early diagnosis and appropriate treatment could almost certainly help improve their outcomes. The current study, part of the Models Of Child Health Appraised (MOCHA) project, aims to explore the age at which children experience the onset or diagnosis of ADHD in European countries. METHODS A systematic review was done examining the studies reporting the age of onset/diagnosis (AO/AD) of ADHD in European countries (28 European Member States plus 2 European Economic Area countries), published between January 1, 2010 and December 31, 2019. Of the 2276 identified studies, 44 met all the predefined criteria and were included in the review. RESULTS The lowest mean AO in the children diagnosed with ADHD alone was 2.25 years and the highest was 7.5 years. It was 15.3 years in the children with ADHD and disruptive behaviour disorder. The mean AD ranges between 6.2 and 18.1 years. CONCLUSIONS Our findings indicate that there is a wide variability in both the AO and AD of ADHD, and a too large distance between AO and AD. Since studies in the literature suggest that an early identification of ADHD symptoms may facilitate early referral and treatment, it would be important to understand the underlying reasons behind the wide variability found. TRIAL REGISTRATION PROSPERO registration: CRD42017070631 .
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Affiliation(s)
- Ilaria Rocco
- grid.5326.20000 0001 1940 4177Neuroscience Institute, National Research Council, Padova, Italy
| | - Barbara Corso
- Neuroscience Institute, National Research Council, Padova, Italy.
| | - Maurizio Bonati
- grid.4527.40000000106678902Laboratory for Mother and Child Health, Department of Public Health, Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - Nadia Minicuci
- grid.5326.20000 0001 1940 4177Neuroscience Institute, National Research Council, Padova, Italy
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19
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Kanevski M, Booth JN, Oldridge J, McDougal E, Stewart TM, McGeown S, Rhodes SM. The relationship between cognition and mathematics in children with attention-deficit/hyperactivity disorder: a systematic review. Child Neuropsychol 2021; 28:394-426. [PMID: 34724883 DOI: 10.1080/09297049.2021.1985444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Cognitive processes play an imperative role in children's mathematics learning. Difficulties in cognitive functioning are a core feature of Attention Deficit Hyperactivity Disorder (ADHD) in children, who also tend to show lower levels of mathematics attainment than their typically developing peers. This review (registration number: CRD42020169708) sought to aggregate findings from studies assessing the relationship between cognition and mathematics in children with a clinical ADHD diagnosis aged 4-12 years. A total of 11,799 studies published between 1992 and August 2020 were screened for eligibility using various database (PsycINFO, PubMed, SCOPUS, EMBASE, ERIC, Web of Science, and additional sources), from which four studies met inclusion criteria. A narrative synthesis was conducted on the correlations between mathematics and cognitive domains, including an evaluation of the risk of bias within the studies. Across four studies meeting inclusion criteria, memory, inhibitory control, and processing speed were assessed. The results showed a positive association between cognition and mathematics performance in this population. The strength of associations across these studies varied as a function of the cognitive domain in question, means by which mathematics performance was assessed, as well as whether confounding factors such as age and IQ were controlled for. Collectively, this review demonstrates a lack of research in this area and points to various methodological considerations for identifying the association between cognition and mathematics performance in ADHD.
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Affiliation(s)
- Margarita Kanevski
- Child Life and Health, Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Josephine N Booth
- Institute of Education, Community and Society, Moray House School of Education and Sport, University of Edinburgh, Edinburgh, UK
| | - Jessica Oldridge
- Child Life and Health, Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Emily McDougal
- Child Life and Health, Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Tracy M Stewart
- Institute of Education, Community and Society, Moray House School of Education and Sport, University of Edinburgh, Edinburgh, UK
| | - Sarah McGeown
- Institute of Education, Community and Society, Moray House School of Education and Sport, University of Edinburgh, Edinburgh, UK
| | - Sinead M Rhodes
- Child Life and Health, Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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20
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The management of ADHD in children and adolescents: bringing evidence to the clinic: perspective from the European ADHD Guidelines Group (EAGG). Eur Child Adolesc Psychiatry 2021:10.1007/s00787-021-01871-x. [PMID: 34677682 PMCID: PMC8532460 DOI: 10.1007/s00787-021-01871-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 09/01/2021] [Indexed: 11/24/2022]
Abstract
ADHD is the most common neurodevelopmental disorder presenting to child and adolescent mental health, paediatric, and primary care services. Timely and effective interventions to address core ADHD symptoms and co-occurring problems are a high priority for healthcare and society more widely. While much research has reported on the benefits and adverse effects of different interventions for ADHD, these individual research reports and the reviews, meta-analyses and guidelines summarizing their findings are sometimes inconsistent and difficult to interpret. We have summarized the current evidence and identified several methodological issues and gaps in the current evidence that we believe are important for clinicians to consider when evaluating the evidence and making treatment decisions. These include understanding potential impact of bias such as inadequate blinding and selection bias on study outcomes; the relative lack of high-quality data comparing different treatments and assessing long-term effectiveness, adverse effects and safety for both pharmacological and non-pharmacological treatments; and the problems associated with observational studies, including those based on large national registries and comparing treatments with each other. We highlight key similarities across current international clinical guidelines and discuss the reasons for divergence where these occur. We discuss the integration of these different perspective into a framework for person/family-centered evidence-based practice approach to care that aims to achieve optimal outcomes that prioritize individual strengths and impairments, as well as the personal treatment targets of children and their families. Finally, we consider how access to care for this common and impairing disorder can be improved in different healthcare systems.
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21
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Cortese S, Newcorn JH, Coghill D. A Practical, Evidence-informed Approach to Managing Stimulant-Refractory Attention Deficit Hyperactivity Disorder (ADHD). CNS Drugs 2021; 35:1035-1051. [PMID: 34403134 DOI: 10.1007/s40263-021-00848-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/16/2021] [Indexed: 10/20/2022]
Abstract
Stimulants (methylphenidate or amphetamines) are the recommended first-line option for the pharmacological treatment of individuals with attention deficit hyperactivity disorder (ADHD). However, some patients with ADHD will not respond optimally to stimulants. Here, we discuss strategies to manage stimulant-refractory ADHD, based on the recommendations advanced in clinical guidelines, knowledge of expert practice in the field, and our own clinical recommendations, informed by a comprehensive literature search in PubMed, PsycInfo, EMBASE + EMBASE classic, OVID Medline, and Web of Science (up to 30 March 2021). We first highlight the importance of stimulant optimization as an effective strategy to increase response. We then discuss a series of factors that should be considered before using alternative pharmacological strategies for ADHD, including poor adherence, time action properties of stimulants (and wearing-off of effects), poor tolerability (that prevents the use of higher, more effective doses), excessive focus on or confounding from presence of comorbid non-ADHD symptoms, and tolerance. Finally, we consider the role of non-stimulants and combined pharmacological approaches. While the choice of medication for ADHD is still to a large extent based on a trial-and-error process, there are reasonably accepted data and guidelines to aid in clinical decision-making. It is hoped that advances in precision psychiatry in the years ahead will further guide prescribers to tailor medication choice to the specific characteristics of the patient.
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Affiliation(s)
- Samuele Cortese
- School of Psychology, Centre for Innovation in Mental Health (CIMH), Faculty of Environmental and Life Sciences, University of Southampton, Highfield Campus, Building 44, Southampton, SO17 1BJ, UK. .,Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK. .,Solent NHS Trust, Southampton, UK. .,Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York, NY, USA. .,Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK.
| | - Jeffrey H Newcorn
- Division of ADHD and Learning Disorders, Departments of Psychiatry and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David Coghill
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia.,The Royal Children's Hospital, Melbourne, VIC, Australia
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22
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Jaeschke RR, Sujkowska E, Sowa-Kućma M. Methylphenidate for attention-deficit/hyperactivity disorder in adults: a narrative review. Psychopharmacology (Berl) 2021; 238:2667-2691. [PMID: 34436651 PMCID: PMC8455398 DOI: 10.1007/s00213-021-05946-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 07/31/2021] [Indexed: 12/12/2022]
Abstract
RATIONALE Psychostimulants, including methylphenidate (MPH), are the mainstay of pharmacotherapy for attention-deficit/hyperactivity disorder (ADHD) in adults. Even though MPH is the most commonly used medication for ADHD these days, there are relatively few resources available that provide comprehensive insight into the pharmacological and clinical features of the compound. OBJECTIVE The aim of this paper is to provide an up-to-date outline of the pharmacology and clinical utility of MPH for ADHD in adult patients. METHODS While conducting the narrative review, we applied structured search strategies covering the two major online databases (MEDLINE and Cochrane Central Register of Controlled Trials). In addition, we performed handsearching of reference lists of relevant papers. RESULTS Methylphenidate exhibits multimodal mechanism of action, working primarily as a dopamine and noradrenaline reuptake inhibitor. It also protects the dopaminergic system against the ongoing 'wearing off' (by securing a substantial reserve pool of the neurotransmitter, stored in the presynaptic vesicles). In placebo-controlled trials, MPH was shown to be moderately effective both against the core ADHD symptoms (standardized mean difference [SMD], 0.49; 95% confidence interval [CI], 0.35-0.64), and the accompanying emotion regulation deficits (SMD, 0.34; 95% CI, 0.23-0.45). The most common adverse events related to long-term treatment with MPH are decreased appetite (~ 20%), dry mouth (15%), heart palpitations (13%), gastrointestinal infections (~ 10%), and agitation/feeling restless (~ 10%). CONCLUSIONS There is substantial body of evidence to suggest that MPH is an effective and safe treatment option for adults with ADHD.
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Affiliation(s)
- Rafał R Jaeschke
- Section of Affective Disorders, Department of Psychiatry, Jagiellonian University Medical College, ul. Kopernika 21a, 31-501, Kraków, Poland.
| | - Ewelina Sujkowska
- Department of Human Physiology, Institute of Medical Sciences, Medical College of Rzeszów University, ul. Kopisto 2a, 35-315, Rzeszów, Poland
| | - Magdalena Sowa-Kućma
- Department of Human Physiology, Institute of Medical Sciences, Medical College of Rzeszów University, ul. Kopisto 2a, 35-315, Rzeszów, Poland
- Centre for Innovative Research in Medical and Natural Sciences, Medical College of Rzeszów University, ul. Warzywna 1a, 35-310, Rzeszów, Poland
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23
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Assessing the needs of caregivers of children and adolescents with fetal alcohol spectrum disorders: Results from a survey among families and professionals in Germany. Eur J Paediatr Neurol 2021; 33:1-8. [PMID: 33971449 DOI: 10.1016/j.ejpn.2021.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/15/2021] [Accepted: 04/27/2021] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Caring for individuals with fetal alcohol spectrum disorders (FASD) puts a substantial and often life-long burden on affected families. Caregivers' specific needs and demands are, however, not well understood so far. We thus aimed at systematically collecting data on the needs of individuals caring for children and adolescents with FASD. MATERIALS AND METHODS Between May 2019 and November 2020, a quantitative survey among caregivers and professionals from across Germany was performed. Participants completed a questionnaire collecting information on the perceived support caregivers receive from various sources as well as the current fulfilment of caregivers' needs. Specifically, the fulfilment of a variety of specific needs summarised in five categories was rated by the participants on a scale ranging from 1 (very good) to 6 (insufficient). RESULTS Both caregivers and professionals rated the overall fulfilment of needs rather poorly (mean: 3.94 and 4.27, respectively). Caregivers indicated needs concerning coordination of support (4.74) and relief services (4.44) to be fulfilled the least while needs in the relief services category also received the lowest average grade among professionals (4.57). The needs that the caregivers regarded as most sufficiently fulfilled were their own knowledge about FASD (mean: 1.95) and their knowledge about the causes of their child's problems (mean: 1.87). CONCLUSIONS The results of the present study indicate that FASD caregivers are supported insufficiently, while most of their needs remain unmet. Health care planners and providers thus urgently need to identify and implement measures to better address FASD caregivers' needs and demands.
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Balan-Moshe L, Gothelf D. Minding the gap between clinical guidelines and real-life clinical work. Eur Child Adolesc Psychiatry 2021; 30:681-683. [PMID: 33796938 DOI: 10.1007/s00787-021-01765-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Livia Balan-Moshe
- The Child & Adolescent Psychiatry Division, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 5262000, Tel Hashmoer, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Doron Gothelf
- The Child & Adolescent Psychiatry Division, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 5262000, Tel Hashmoer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
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25
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Janssens A, Eke H, Price A, Newlove-Delgado T, Blake S, Ani C, Asherson P, Beresford B, Emmens T, Hollis C, Logan S, Paul M, Sayal K, Young S, Ford T. The transition from children’s services to adult services for young people with attention deficit hyperactivity disorder: the CATCh-uS mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08420] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Attention deficit hyperactivity disorder was previously seen as a childhood developmental disorder, so adult mental health services were not set up to support attention deficit hyperactivity disorder patients who became too old for child services. To our knowledge, this is the first in-depth study of the transition of attention deficit hyperactivity disorder patients from child to adult health services in the UK.
Objectives
Our objectives were to explore how many young people with attention deficit hyperactivity disorder are in need of services as an adult, what adult attention deficit hyperactivity disorder services are available and how attention deficit hyperactivity disorder stakeholders experience transition from child to adult services.
Design
An interactive mixed-method design was adopted with three study streams: (1) a 12-month surveillance study with 9-month follow-up to find out how many young people required ongoing medication when they were too old for child services (929 surveys completed by children’s clinicians); (2) a mapping study to identify and describe services for young adults with attention deficit hyperactivity disorder (2686 respondents to online surveys for patients and health workers and freedom of information requests to service providers and commissioners); and (3) a qualitative study to explore key stakeholders’ experiences of transition from child to adult services (144 interviews with 64 attention deficit hyperactivity disorder patients, 28 parents and 52 health clinicians; 38 working in child or adult secondary health services and 14 general practitioners). Members of the public advised at each stage of the study.
Results
When corrected for non-response and case ascertainment, the annual number of young people with an ongoing need for medication for attention deficit hyperactivity disorder lies between 270 and 599 per 100,000 people aged 17–19 years. Among 315 individuals eligible for transition, 64% were accepted, but only 22% attended their first adult services appointment. Our interactive map describes 294 unique services for adults with attention deficit hyperactivity disorder across the UK, of which 44 are ‘dedicated’ attention deficit hyperactivity disorder services. Few services provide the full range of recommended provision; most focus on diagnosis and medication. Services are unevenly distributed across the UK, with nearly all ‘dedicated’ services being in England. Exploring stakeholders’ experiences revealed how invested the stakeholders are in continuing attention deficit hyperactivity disorder treatment and how the architecture of services affects transition. An association between attention deficit hyperactivity disorder, education and continuance of medication into young adulthood, plus parent involvement and feeling prepared for transition and adult life with attention deficit hyperactivity disorder, influenced investment. However, even with investment, how accessible adult services are, how patient needs fit with the remit of the adult service and the level of patient information available affect transition outcomes. The results also highlight how general practitioners can end up as care co-ordinators during transition by default.
Limitations
Transition estimates were based on those who want medication, so these indicate a minimum level of need.
Conclusions
Few of those who need ongoing support for attention deficit hyperactivity disorder successfully transfer to adult services, and a small proportion of those who transfer experience optimal transitional care. Adult attention deficit hyperactivity disorder service provision is patchy. Even among ‘dedicated’ services, few provide the whole range of National Institute for Health and Care Excellence-recommended treatments.
Future work
We need to evaluate various models of transitional care and adult attention deficit hyperactivity disorder provision, as well as develop and evaluate psychosocial interventions for young people and adults with attention deficit hyperactivity disorder.
Trial registration
Current Controlled Trials ISRCTN12492022.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 42. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Astrid Janssens
- Child Health Research Group, University of Exeter Medical School, University of Exeter, Exeter, UK
- User Perspectives, University of Southern Denmark, Odense, Denmark
| | - Helen Eke
- Child Health Research Group, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Anna Price
- Child Health Research Group, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Tamsin Newlove-Delgado
- Child Health Research Group, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Sharon Blake
- Child Health Research Group, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Cornelius Ani
- Division of Psychiatry, Faculty of Medicine, Imperial College London, London, UK
- Surrey and Borders Partnership NHS Foundation Trust, Chertsey, UK
| | - Philip Asherson
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | | | - Chris Hollis
- School of Medicine, University of Nottingham, Nottingham, UK
- Institute of Mental Health, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
- National Institute for Health Research MindTech MedTech Co-operative and National Institute for Health Research Biomedical Research Centre, Mental Health Theme, Institute of Mental Health, Nottingham, UK
| | - Stuart Logan
- Child Health Research Group, University of Exeter Medical School, University of Exeter, Exeter, UK
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South West Peninsula, Exeter, UK
| | - Moli Paul
- Warwick Medical School, University of Warwick, Coventry, UK
- Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
| | - Kapil Sayal
- School of Medicine, University of Nottingham, Nottingham, UK
- Institute of Mental Health, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | | | - Tamsin Ford
- Child Health Research Group, University of Exeter Medical School, University of Exeter, Exeter, UK
- University of Cambridge, Cambridge, UK
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Coghill DR, Newcorn JH, Chen J, Werner-Kiechle T, Banaschewski T. Post hoc analyses of response rates to pharmacological treatments in children and adolescents with attention-deficit/hyperactivity disorder. J Psychopharmacol 2020; 34:874-882. [PMID: 32043417 PMCID: PMC7376623 DOI: 10.1177/0269881120904949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION AND OBJECTIVES Lack of consensus regarding how best to define treatment response hinders translation from trials to the clinic. These post hoc analyses examine three commonly used response criteria in six trials of lisdexamfetamine dimesylate (LDX) in children and adolescents with attention-deficit/hyperactivity disorder (ADHD). METHODS Data from four short-term randomised controlled trials (RCTs) and two long-term open-label studies were analysed. Children and adolescents with ADHD received either dose-optimised (30-70 mg/day) or fixed-dose (70 mg/day) LDX. The RCTs included osmotic-release oral system methylphenidate (OROS-MPH) or atomoxetine (ATX) as a head-to-head comparator or as a reference treatment. Three definitions of response were used in these analyses: reductions of ⩾30% or ⩾50% in ADHD Rating Scale IV (ADHD-RS-IV) total score plus a Clinical Global Impressions - Improvement (CGI-I) score of 1 or 2, or an ADHD-RS-IV total score of ⩽18. RESULTS At the end point, LDX response rates for the least stringent criterion of ⩾30% reduction in ADHD-RS-IV total score plus a CGI-I score of 1 or 2 ranged from 69.6% to 82.6%. The proportion achieving the more stringent criterion of a reduction in ADHD-RS-IV total score of ⩾50% plus a CGI-I score of 1 or 2 at the end point ranged from 59.8% to 74.8%. An ADHD-RS-IV total score of ⩽18 at the end point was achieved by 56.7-79.9% of participants. Response rates remained stable throughout the long-term open-label studies. CONCLUSIONS Response rates were similar for the two more stringent response criteria. The less stringent criterion resulted in higher response rates and may include partial responders.
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Affiliation(s)
- David R Coghill
- Departments of Paediatrics and Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia,Murdoch Children’s Research Institute, Melbourne, Australia,David R Coghill, Departments of Paediatrics and Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Level 2 West, Royal Children’s Hospital, Melbourne, VIC 3052, Australia.
| | - Jeffrey H Newcorn
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jie Chen
- Shire, a member of the Takeda group of companies, Lexington, MA, USA
| | | | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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Markowitz JT, Oberdhan D, Ciesluk A, Rams A, Wigal SB. Review of Clinical Outcome Assessments in Pediatric Attention-Deficit/Hyperactivity Disorder. Neuropsychiatr Dis Treat 2020; 16:1619-1643. [PMID: 32669845 PMCID: PMC7335865 DOI: 10.2147/ndt.s248685] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 05/28/2020] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Various clinical outcome assessments (COAs) are used in clinical research to assess and monitor treatment efficacy in pediatric attention-deficit/hyperactivity disorder (ADHD) trials. It is unclear whether the concepts assessed are those that are important to patients and their caregivers. The concepts measured by commonly used COAs in this population have not been explicitly compared. METHODS We conducted reviews of the qualitative literature to extract information on pediatric ADHD-related concepts reported by pediatric patients, parents, and teachers. Using these concepts, we developed a conceptual framework of pediatric ADHD using both the Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria and the additional symptoms and behavioral impacts identified in the literature. We searched for COAs that have been used in pediatric ADHD research and mapped their items based on their conceptual underpinning. RESULTS Of the 27 COAs found in the empirical literature, 4 COAs assessed only DSM symptoms. The most comprehensive coverage of our conceptual framework was seen in the Swanson, Nolan, and Pelham Rating Scale-DSM-IV (SNAP-IV). Eighteen COAs were used in at least 1 clinical trial: ADHD-Rating Scale-IV (ADHD-RS-IV) was used most often (n=77), followed by SNAP-IV (n=50), Swanson, Kotkin, Agler, M-Flynn, and Pelham Scale (SKAMP; n=31), Weiss Functional Impairment Rating Scale (WFIRS; n=24), and Vanderbilt ADHD Diagnostic Rating Scale (VADRS; n=15). CONCLUSION We identified symptoms and behavioral impacts from qualitative studies in pediatric ADHD that are not included in DSM-based criteria. Most COAs used in pediatric ADHD clinical trials measure only those symptoms listed in the DSM. While these COAs can measure symptom severity, they may not assess the full range of symptoms and impacts important to patients and their caregivers. Future research is needed to measure all concepts important to patients and caregivers within ADHD clinical trials.
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Affiliation(s)
| | - Dorothee Oberdhan
- HEOR and Outcomes Management, Otsuka America Pharmaceutical, Inc, Rockville, MD20850, USA
| | - Anna Ciesluk
- Research Department, Modus Outcomes, Cambridge, MA02142, USA
| | - Alissa Rams
- Research Department, Modus Outcomes, Cambridge, MA02142, USA
| | - Sharon B Wigal
- Department of Pediatrics, University of California School of Medicine, Irvine, CA92697–4089, USA
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Abstract
Attention deficit hyperactivity disorder (ADHD) is the commonest disorder presenting to Child and Adolescent Mental Health Services in Ireland. This article considers the impact of the Covid-19 pandemic on the provision of mental health services for young people with ADHD with specific reference to the difficulties that have been experienced in ADMiRE, a specialist ADHD service in Dublin, since the outbreak of Covid-19 in Ireland. Current guidelines and alternative ways of ensuring adequate service provision are discussed. Restrictions to mitigate the spread of Covid-19 are likely to continue for many months, and child and adolescent mental health services need to find new ways to provide a sustainable service to young people in Ireland. There is a growing evidence base for the use of telepsychiatry in the assessment and management of ADHD. Factors that should be considered when developing a telepsychiatry service for children and adolescents with ADHD are highlighted.
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29
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Cortese S. Regional analysis of UK primary care prescribing and adult service referrals for young people with attention-deficit hyperactivity disorder: from little to very little. BJPsych Open 2020; 6:e43. [PMID: 32349851 PMCID: PMC7331081 DOI: 10.1192/bjo.2020.28] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Drawing on data from the Clinical Practice Research Datalink, Price et al reported UK regional variations in primary care prescribing and referral rates to adult mental health services for young people with attention-deficit hyperactivity disorder (ADHD) in transition from child and adolescent mental health services. Overall, considering that around 65% of young adults with childhood ADHD present with impairing ADHD symptoms and up to 90% of individuals with ADHD may benefit from ADHD medications, the study by Price et al shows that the rate of appropriate treatment for youngsters in the transition period varies from low to very low across the UK. As such, there is a continuous need for education and training for patients, their families, mental health professionals and commissioners, to eradicate the misconception that, in the majority of the cases, ADHD remits during adolescence and to support the devolvement of appropriate services for the evidence-based management of adult ADHD across the UK.
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Affiliation(s)
- Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, UK; Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, UK; Solent NHS Trust, UK; New York University Child Study Center, USA; and Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, UK
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30
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Nøvik TS, Haugan ALJ, Lydersen S, Thomsen PH, Young S, Sund AM. Cognitive-behavioural group therapy for adolescents with ADHD: study protocol for a randomised controlled trial. BMJ Open 2020; 10:e032839. [PMID: 32213517 PMCID: PMC7170565 DOI: 10.1136/bmjopen-2019-032839] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Persistence of attention deficit hyperactivity disorder (ADHD) into adolescence is a significant burden to patients. Clinical guidelines recommend non-pharmacological therapies, but the evidence to support this recommendation is sparse. This study aims to evaluate the effect of a 12-week group cognitive-behavioural therapy (CBT) programme for adolescents with ADHD aged 14-18 years, who still have impairing symptoms after treatment with medication. We will study the effect of the treatment on ADHD symptoms and examine moderators and mediators of the effect of the treatment on ADHD. METHODS AND ANALYSIS We conduct a randomised controlled trial of CBT group therapy in adolescents with ADHD recruited from child psychiatric outpatient units in Mid-Norway. 99 adolescents who met inclusion criteria and consented to participation have been randomised to a 12-week group intervention or to a control group receiving treatment as usual. Assessments are made at admission to the clinic, preintervention, postintervention and at a 9-month follow-up, obtaining adolescent, parent and teacher reports. Clinicians blinded to group allocation rate all participants as to their functioning preintervention and at the two postintervention assessment points. The primary outcome is change in symptom scores on the ADHD Rating Scale-IV. ETHICS AND DISSEMINATION The Regional Committee for Medical and Health Research Ethics in South East Norway approved the study protocol (2015/2115). We will disseminate the findings in peer-reviewed publications and conference presentations, to user organisations and at courses attended by families and professionals. Two PhD students will publish and defend dissertations relating to the study. Planned publications include primary and secondary outcomes and patient satisfaction with the treatment. Furthermore, we plan to publish a manual of CBT group therapy in adolescent ADHD to benefit treatment of patients in Norway and elsewhere. TRIAL REGISTRATION NUMBER NCT02937142.
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Affiliation(s)
- Torunn Stene Nøvik
- Department of Child and Adolescent Psychiatry, St Olav University Hospital, Trondheim, Norway
- Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian University of Science and Technology, Trondheim, Norway
| | - Anne-Lise Juul Haugan
- Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian University of Science and Technology, Trondheim, Norway
| | - Stian Lydersen
- Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian University of Science and Technology, Trondheim, Norway
| | - Per Hove Thomsen
- Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark
| | - Susan Young
- Psychology Services Limited, London, UK
- Department of Psychology, University of Reykjavik, Reykjavik, Iceland
| | - Anne Mari Sund
- Department of Child and Adolescent Psychiatry, St Olav University Hospital, Trondheim, Norway
- Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian University of Science and Technology, Trondheim, Norway
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31
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Wernersson R, Johansson J, Andersson M, Jarbin H. Evaluation of a new model for assessment and treatment of uncomplicated ADHD - effect, patient satisfaction and costs. Nord J Psychiatry 2020; 74:96-104. [PMID: 31596156 DOI: 10.1080/08039488.2019.1674377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Aim: Attention-deficit/hyperactivity disorder (ADHD) is the most common diagnosis within child- and adolescent psychiatry. Waiting lists and delayed care are major issues. The aim was to evaluate if standardized care (SC) for assessment and treatment of uncomplicated ADHD would reduce resource utilization and increase satisfaction with preserved improvement within the first year of treatment.Method: Patients 6-12 years with positive screen for uncomplicated ADHD at the brief child and family phone interview (BCFPI), a routine clinical procedure, were triaged to SC. The control group consisted of patients diagnosed with ADHD in 2014 and treated as usual. BCFPI factors at baseline and follow-up after one year and resource utilization were compared.Results: Patients improved in ADHD symptoms (Cohen's d = 0.78, p < 0.001), child function (Cohen's d = 0.80, p < 0.001) and in family situation (Cohen's d = 0.61, p < 0.001) without group differences. Parents of SC patients participated more often in psychoeducational groups (75.5 vs. 49.5%, p < 0.001). SC had shorter time to ADHD diagnosis (8.4 vs. 15.6 weeks, p = 0.01) and to medication (24.6 vs. 32.1 weeks, p = 0.003). SC families were more satisfied with the waiting time (p = 0.01), otherwise there were no differences in satisfaction between the groups. Families of SC patients had fewer visits (4.7 vs. 10.8, p < 0.001) but used the same number of phone calls (6.3 vs. 6.2, p = 0.71). Costs were 55% lower.Conclusions: A SC for ADHD can markedly reduce costs with preserved quality. As resources are limited, child psychiatry would benefit from standardization.
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Affiliation(s)
- Rebecca Wernersson
- Department of Child and Adolescent Psychiatry, Region Halland, Halmstad, Sweden
| | - Jan Johansson
- Department of Child and Adolescent Psychiatry, Region Halland, Halmstad, Sweden
| | - Markus Andersson
- Department of Child and Adolescent Psychiatry, Region Halland, Halmstad, Sweden.,Faculty of Medicine, Department of Clinical Sciences Lund, Child and Adolescent Psychiatry, Lund University, Lund, Sweden
| | - Håkan Jarbin
- Department of Child and Adolescent Psychiatry, Region Halland, Halmstad, Sweden.,Faculty of Medicine, Department of Clinical Sciences Lund, Child and Adolescent Psychiatry, Lund University, Lund, Sweden
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Coghill D. Debate: Are Stimulant Medications for Attention-Deficit/Hyperactivity Disorder Effective in the Long Term? (For). J Am Acad Child Adolesc Psychiatry 2019; 58:938-939. [PMID: 31515164 DOI: 10.1016/j.jaac.2019.07.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/31/2019] [Indexed: 10/26/2022]
Abstract
Long-term effectiveness studies for ADHD medications are complicated to design well, and no single study design will capture the entire picture. Although randomized controlled trials are the highest level of evidence, most authorities agree that, when you have treatments as efficacious as the ADHD medications (methylphenidate and amphetamine derivatives and prodrugs, atomoxetine, guanfacine, and clonidine), it is neither practical nor ethical to conduct long-term placebo-controlled RCTs. As a consequence, almost all of the RCT evidence for ADHD medications relates to short-term studies. Although these provide strong evidence for short-term efficacy,1 they do not speak to long-term effectiveness. The European Medicines Agency (EMA) recognized the need for additional evidence of long-term effects before granting licenses for medications that will usually be required to be taken for several years. They therefore introduced a requirement for companies to demonstrate longer-term efficacy. This has generally been done through the use of randomized withdrawal designs that are designed to demonstrate continued efficacy over a period of 6 to 12 months. Several of these have been completed and published, all of which, as expected, demonstrate continued efficacy.2 The EMA also insisted that all new ADHD medications demonstrate continued effectiveness, and that adverse effects and safety be assessed up to 2 years. Again the studies completed so far support continued effectiveness, and, although highlighting the presence of common, expected adverse effects, have not identified any new safety signals or unexpected problems in targeted areas such as growth and cognition.3.
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Affiliation(s)
- David Coghill
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia; Royal Children's Hospital, Melbourne, Australia
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33
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Bonati M, Cartabia M, Zanetti M. Waiting times for diagnosis of attention-deficit hyperactivity disorder in children and adolescents referred to Italian ADHD centers must be reduced. BMC Health Serv Res 2019; 19:673. [PMID: 31533711 PMCID: PMC6751639 DOI: 10.1186/s12913-019-4524-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 09/10/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND To investigate timely access to and the time needed to complete the diagnostic path of children and adolescents with suspected attention deficit hyperactivity disorder (ADHD) in the 18 Italian Lombardy Region ADHD reference centers. METHODS Data of children and adolescents enrolled in the Regional ADHD disease-oriented Registry for suspected ADHD who requested their first visit in 2013-2017 were analyzed. RESULTS The sample comprised 2262 children and adolescents aged 5-17 years who accessed the ADHD centers for diagnostic classification and management. The median waiting time was of 177 days (range 66-375) from the request for the initial appointment to the completion of the diagnostic path, with a three - fold difference between centers. In addition to the center, the strongest significant predictors of long waiting times were age comorbidities, the severity of the disorder, and having already completed some diagnostic procedures provided by the common standard path. CONCLUSIONS To guarantee an equal standard of care in ADHD centers for all children and adolescents there is a pressing need to reduce the times to complete the diagnostic path. It is the task of both policymakers and each center to optimize the quality of the service and of the care delivered.
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Affiliation(s)
- Maurizio Bonati
- Laboratory for Mother Child Health, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Giuseppe La Masa 19, 20156, Milan, Italy.
| | - Massimo Cartabia
- Laboratory for Mother Child Health, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Giuseppe La Masa 19, 20156, Milan, Italy
| | - Michele Zanetti
- Laboratory for Mother Child Health, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Giuseppe La Masa 19, 20156, Milan, Italy
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34
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Wong ICK, Banaschewski T, Buitelaar J, Cortese S, Döpfner M, Simonoff E, Coghill D. Emerging challenges in pharmacotherapy research on attention-deficit hyperactivity disorder-outcome measures beyond symptom control and clinical trials. Lancet Psychiatry 2019; 6:528-537. [PMID: 31122482 DOI: 10.1016/s2215-0366(19)30096-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 02/07/2019] [Accepted: 02/08/2019] [Indexed: 12/24/2022]
Abstract
Although pharmacological therapies are recommended as a key component in the treatment of attention-deficit hyperactivity disorder, their use continues to prompt intense debate. Despite considerable research efforts, several gaps in the knowledge base and several questions over the quality of evidence exist. Particular issues surrounding pharmacological treatments include uncertainties about long-term effectiveness and safety, safety profiles in adults, and the comparative effectiveness of different medications. In this Review, we focus on four key methodological issues for future research: (1) the use of appropriate trial designs; the need for (2) outcome measures targeting effectiveness beyond symptom control and (3) safety outcome measures; and (4) the application of clinical and administrative research databases to assess real-world outcomes. Potential solutions include increased use of randomised placebo-controlled withdrawal trials and large pharmacoepidemiological studies that use electronic health-care records on the long-term effectiveness and safety of medications. Pragmatic head-to-head randomised trials would also provide direct evidence on comparative effectiveness and safety profiles.
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Affiliation(s)
- Ian C K Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong Special Administrative Region, China; Research Department of Practice and Policy, University College London, School of Pharmacy, London, UK
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Jan Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, and Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, Netherlands
| | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology and Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK
| | - Manfred Döpfner
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty of the University of Cologne, Cologne, Germany
| | - Emily Simonoff
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and National Institute for Health Research Maudsley Biomedical Research Centre for Mental Health, London, UK
| | - David Coghill
- Departments of Paediatrics and Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, and Murdoch Children's Research Institute, Melbourne, VIC, Australia.
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Taylor E. ADHD Medication in the Longer Term. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2019; 47:542-546. [PMID: 31012801 DOI: 10.1024/1422-4917/a000664] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This review starts from the finding that there is strong persistence of ADHD problems into adult life, despite the availability of effective treatment with stimulants and other drugs. Short-term trials in adults reveal that those drugs can still be efficacious in adults. Pharmacoepidemiology studies, on the other hand, clearly show that most young people discontinue medication during adolescence. Neuropharmacology research suggests a waning of stimulant effects after a few years. Longitudinal studies are scarce but provide some evidence that prognosis is often determined by factors other than the core symptoms of inattentiveness and impulsive overactivity. The implications for clinical practice are discussed. Continuing care, especially during the follow-up after initial therapy, needs further development.
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Affiliation(s)
- Eric Taylor
- Institute of Psychiatry, Psychology and NeuroScience, King's College London, UK
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Treatment strategies for ADHD: an evidence-based guide to select optimal treatment. Mol Psychiatry 2019; 24:390-408. [PMID: 29955166 DOI: 10.1038/s41380-018-0116-3] [Citation(s) in RCA: 140] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 04/20/2018] [Accepted: 05/14/2018] [Indexed: 12/12/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a common and impairing disorder affecting children, adolescents, and adults. Several treatment strategies are available that can successfully ameliorate symptoms, ranging from pharmacological to dietary interventions. Due to the increasing range of available options, an informed selection or prioritization of treatments is becoming harder for clinicians. This review aims to provide an evidence-based appraisal of the literature on ADHD treatment, supplemented by expert opinion on plausibility. We outline proposed mechanisms of action of established pharmacologic and non-pharmacologic treatments, and we review targets of novel treatments. The most relevant evidence supporting efficacy and safety of each treatment strategy is discussed. We review the individualized features of the patient that should guide the selection of treatments in a shared decision-making continuum. We provide guidance for optimizing initiation of treatment and follow-up of patients in clinical settings.
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Hsu JW, Tsai SJ, Chen MH, Huang KL. Treatment-resistant attention-deficit hyperactivity disorder: Clinical significance, concept, and management. TAIWANESE JOURNAL OF PSYCHIATRY 2019. [DOI: 10.4103/tpsy.tpsy_14_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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38
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Du Y, Zheng Y, Ke X, Su L, Coghill D, Chen Y, Zhang Y, Yuan Z, Cheng Y, Chen W. Validity and reliability of the Dundee difficult times of the day scale in Chinese children and adolescents with attention-deficit/hyperactivity disorder. J Comp Eff Res 2018; 8:33-44. [PMID: 30468394 DOI: 10.2217/cer-2018-0091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
METHODS A cross-sectional study enrolled 200 children and adolescents with attention-deficit/hyperactivity disorder visiting four Chinese tertiary care psychiatric clinics to assess the validity and reliability of the Dundee difficult times of the day scale (D-DTODS), using the Weiss functional impairment rating scale for parents form (WFIRS-P) and the Swanson, Nolan and Pelham, version IV 26-item teacher and parent rating scale (SNAP-IV-26). RESULTS The calculated Cronbach's-α for the D-DTODS total score was 0.793. The calculated Spearman's correlation coefficients for D-DTODS versus WFRIS-P and Swanson, Nolan and Pelham, version IV 26-item teacher and parent rating scale (SNAP-IV-26) were 0.425 (p < 0.01) and 0.452 (p < 0.001), respectively. CONCLUSION The D-DTODS was worth future test-retest confirmation regarding reliability and validity for assessing functional impairment associated with attention-deficit/hyperactivity disorder across different time periods of the day in Chinese children and adolescents.
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Affiliation(s)
- Yasong Du
- Department of Pediatric Psychiatry, Shanghai Mental Health Center, Shanghai, China
| | - Yi Zheng
- Department of Pediatric Psychiatry, Beijing Anding Hospital, Beijing, China
| | - Xiaoyan Ke
- Research Centre for Children Psychology, Nanjing Brain Hospital, Nanjing, China
| | - Linyan Su
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Changsha, China
| | - David Coghill
- Department of Pediatrics & Psychiatry, University of Melbourne, Melbourne, Australia
| | - Yun Chen
- Eli Lilly China, Shanghai, China
| | | | | | | | - Wendong Chen
- Changsha Normin Health Technology Ltd, Changsha, China.,Normin Health Consulting Ltd, Toronto, Canada
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Courtabessis E, Pupier F, Surig L, Picot MC, Nogué E, Macioce V, Stein E, Purper-Ouakil D. Clinical factors associated with decision to recommend methylphenidate treatment for children with ADHD in France. Eur Child Adolesc Psychiatry 2018; 27:367-376. [PMID: 28983797 DOI: 10.1007/s00787-017-1061-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 09/25/2017] [Indexed: 11/29/2022]
Abstract
European guidelines advise on best practices for the diagnosis and non-pharmacological and pharmacological treatment of attention-deficit hyperactivity disorder (ADHD). This study aimed to (1) assess whether clinician's decisions to initiate methylphenidate treatment in children diagnosed with ADHD are in accordance with European guidelines and (2) identify clinical factors associated with the decision to recommend methylphenidate prescription. 5 to 13-year-old patients with an ADHD diagnosis were consecutively evaluated in an outpatient child and adolescent psychiatry clinic in France. Patients underwent a multidisciplinary evaluation including a diagnostic interview, symptom severity assessments with parent questionnaires, and IQ testing. We compared children with (n = 105) and without (n = 55) recommended methylphenidate treatment using Student's t test or Wilcoxon Mann-Whitney test and Chi-square or Fisher's test. Multivariate logistic regression was implemented to determine the respective influence of each variable on treatment recommendation. Recommendation to initiate methylphenidate treatment was associated with (1) ADHD combined presentation, (2) co-occurring Oppositional Defiant Disorder/Conduct Disorder (ODD/CD), Developmental Coordination Disorder (DCD) and Learning Disorder (LD), (3) clinical severity and impairment indicated on parent questionnaires, and (4) reduced perceptual reasoning. Using a multivariate regression model, ADHD combined presentation [combined versus predominantly hyperactive/impulsive and unspecified OR 4.52 (1.23-16.55), p = 0.023], age [OR 1.46 (1.14-1.88), p = 0.003], ODD/CD [OR 5.53 (2.19-14.01), p < 0.001], DCD [OR 4.22 (1.70-10.48), p = 0.002], PRI [OR 0.97 (0.94-0.99), p = 0.01] were significantly associated with recommendation of methylphenidate treatment. Our results indicate that clinicians' treatment decision-making complies with European guidelines and is furthermore associated with the type and severity of ADHD symptoms but also with co-occurring disorders.
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Affiliation(s)
- Elodie Courtabessis
- Médecine Psychologique de l'Enfant et de l'Adolescent, CHRU Montpellier-Hopital Saint Eloi, Montpellier Cedex 5, France.
| | - Florence Pupier
- Médecine Psychologique de l'Enfant et de l'Adolescent, CHRU Montpellier-Hopital Saint Eloi, Montpellier Cedex 5, France
| | - Laurie Surig
- Médecine Psychologique de l'Enfant et de l'Adolescent, CHRU Montpellier-Hopital Saint Eloi, Montpellier Cedex 5, France
| | - Marie-Christine Picot
- Unité de Recherche Clinique et Epidémiologie, Département Information Médicale, CHU Montpellier, 34295, Montpellier Cedex 5, France.,INSERM, Centre d'Investigation Clinique 1411, Montpellier, France
| | - Erika Nogué
- Unité de Recherche Clinique et Epidémiologie, Département Information Médicale, CHU Montpellier, 34295, Montpellier Cedex 5, France
| | - Valérie Macioce
- Unité de Recherche Clinique et Epidémiologie, Département Information Médicale, CHU Montpellier, 34295, Montpellier Cedex 5, France
| | - Elizabeth Stein
- Médecine Psychologique de l'Enfant et de l'Adolescent, CHRU Montpellier-Hopital Saint Eloi, Montpellier Cedex 5, France
| | - Diane Purper-Ouakil
- Médecine Psychologique de l'Enfant et de l'Adolescent, CHRU Montpellier-Hopital Saint Eloi, Montpellier Cedex 5, France
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ADHD in children and young people: prevalence, care pathways, and service provision. Lancet Psychiatry 2018; 5:175-186. [PMID: 29033005 DOI: 10.1016/s2215-0366(17)30167-0] [Citation(s) in RCA: 544] [Impact Index Per Article: 90.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 03/30/2017] [Accepted: 03/30/2017] [Indexed: 12/17/2022]
Abstract
Attention-deficit hyperactivity disorder (ADHD) is a common childhood behavioural disorder. Systematic reviews indicate that the community prevalence globally is between 2% and 7%, with an average of around 5%. At least a further 5% of children have substantial difficulties with overactivity, inattention, and impulsivity that are just under the threshold to meet full diagnostic criteria for ADHD. Estimates of the administrative prevalence (clinically diagnosed or recorded) vary worldwide, and have been increasing over time. However, ADHD is still relatively under-recognised and underdiagnosed in most countries, particularly in girls and older children. ADHD often persists into adulthood and is a risk factor for other mental health disorders and negative outcomes, including educational underachievement, difficulties with employment and relationships, and criminality. The timely recognition and treatment of children with ADHD-type difficulties provides an opportunity to improve long-term outcomes. This Review includes a systematic review of the community and administrative prevalence of ADHD in children and adolescents, an overview of barriers to accessing care, a description of associated costs, and a discussion of evidence-based pathways for the delivery of clinical care, including a focus on key issues for two specific age groups-younger children (aged ≤6 years) and adolescents requiring transition of care from child to adult services.
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Clavenna A, Bonati M. Pediatric pharmacoepidemiology - safety and effectiveness of medicines for ADHD. Expert Opin Drug Saf 2017; 16:1335-1345. [DOI: 10.1080/14740338.2017.1389894] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Antonio Clavenna
- Laboratory for Mother and Child Health, Department of Public Health, IRCCS – Istituto di Ricerche Farmacologiche “Mario Negri”, Milan, Italy
| | - Maurizio Bonati
- Laboratory for Mother and Child Health, Department of Public Health, IRCCS – Istituto di Ricerche Farmacologiche “Mario Negri”, Milan, Italy
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Abstract
There is considerable variation in practice, both between and with different countries in the management of attention deficit hyperactivity disorder (ADHD). Whilst there is no one optimal model of service organisation there are general principles of care that can be introduced to reduce this variability. There are frequent debates and discussions about which professional group is best placed to manage ADHD at different points in the life cycle. Who delivers care is however less important than ensuring that training schemes provide adequate exposure, training and experience to both the core and non-core skills required to provide a comprehensive package of care. Most evidence-based guidelines recommend a multi-modal, multi-professional and multi-agency approach. Many also promote the use of both stepped care and shared care approaches for the management of ADHD. As most of those with ADHD continue to have ADHD-related problems into adulthood, it is important to consider how best to transition care into adulthood and think about who should deliver care to adults with ADHD. Young people with ADHD should generally be transferred to adult mental health services if they continue to have significant symptoms of ADHD or other coexisting conditions that require treatment. Unfortunately services for adults with ADHD remain relatively scarce across much of the world and some adult psychiatrists remain unsure of the diagnosis and uncertain about the appropriate use of ADHD medications in adults, but there is a strong case for increased services for adults. ADHD is on the one hand easy to treat; it is much more difficult to treat well. Although optimised care for ADHD requires routine measurement of outcomes, this often does not happen in routine clinical practice. Focusing on optimising symptoms and minimising adverse effects can significantly improve both short- and long-term outcomes.
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Attention-deficit/hyperactivity disorder (ADHD): from randomised controlled trials to evidence-based clinical services. Epidemiol Psychiatr Sci 2017; 26:445-447. [PMID: 28065196 PMCID: PMC6998897 DOI: 10.1017/s2045796016001177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Willig TN, Blanc JP, Assathiany R. [The private pediatrician in the clinical care pathway for children affected by specific learning disorders in France]. Arch Pediatr 2017; 24:1088-1095. [PMID: 28970040 DOI: 10.1016/j.arcped.2017.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 07/11/2017] [Accepted: 08/30/2017] [Indexed: 11/29/2022]
Abstract
The clinical care pathway for children presenting specific learning disorders, including language, motor coordination, and attention disorders is based on different levels of assessment by the professionals involved. In France, a first step of organization was established in 2002 by founding of a network of structures devoted to clinical assessment of complex cases, research, and teaching for the professionals involved. Although this organization proved to contribute an essential service, the demand largely exceeded the availability of access. A three-level organization was therefore suggested in 2013 including a first-level devoted to clinical analysis of simple cases, together with the professionals involved in rehabilitation (i.e., speech therapists, occupational therapists, psychologists), a second-level in charge of analyzing complex situations, involving comorbidities and failure of first-level care, together with the already structured third level of assessment devoted to genetic disorders, severe situations, and association with neurological conditions. To plan the practical application of these different levels, we assessed the situation of ambulatory pediatricians working in private practice, because this network appeared to be the most available in France to play these roles. A survey was therefore conducted among the main representative association of pediatricians (Association française de pédiatrie ambulatoire), including 1565 members of the 2700 in activity in France, on their level of knowledge and clinical expertise, and the drawbacks encountered in their practice in this field. Of the 481 respondents (36%), 25% were not yet in 2016 self-confident in assuming a first-level role, while 56% were ready to participate in a first-level response and 18% in a second-level response. In the 5 upcoming years, the vast majority of pediatricians intended to progress in their involvement, which should provide all regions in France with a network of professionals able to respond to the specific needs of children (48% in the first-level and 43.5% in the second-level of expertise). Specific obstacles have already been encountered by professionals who wish to play a full role in this domain: insufficient funding for medical evaluations and lack of access to specialized evaluations. This survey emphasizes the need for obtaining access to both practical and theoretical professional development programs (77.5%), funding of clinical assessment time (76%), all of which need to be answered by the French health authorities. To date, very few nationwide programs of clinical care pathways in these fields have been developed, but examples are available in France on Alzheimer disease and elderly populations, providing a model for children affected by specific development and learning difficulties. Setting up a clinical care pathway by the French Ministry of Health (Haute Autorité de santé) assumes that the needs expressed by ambulatory pediatricians will be taken into account, including the design and implementation of Medical Education programs according to the level of expertise, together with the adequate funding of diagnosis, follow-up, and care pathway coordination time.
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Affiliation(s)
- T-N Willig
- Clinique Ambroise-Paré, 387, route de Saint-Simon, 31082 Toulouse cedex 01, France; Réseau Ptitmip, troubles des apprentissages, 330, avenue de Grande-Bretagne, 31059 Toulouse, France; Association française de pédiatrie ambulatoire, 54, rue Léon-Desoyer, 78100 Saint-Germain-en-Laye, France.
| | - J P Blanc
- Association française de pédiatrie ambulatoire, 54, rue Léon-Desoyer, 78100 Saint-Germain-en-Laye, France; 17, rue Nicolas-Chaize, 42100 Saint-Étienne, France
| | - R Assathiany
- Association française de pédiatrie ambulatoire, 54, rue Léon-Desoyer, 78100 Saint-Germain-en-Laye, France; 30, avenue Victor-Cresson, 92130 Issy-les-Moulineaux, France
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Sikirica V, Gustafsson PA, Makin C. Treatment Patterns among Children and Adolescents with Attention-Deficit/Hyperactivity Disorder with or without Psychiatric or Neurologic Comorbidities in Sweden: A Retrospective Cohort Study. Neurol Ther 2017; 6:115-130. [PMID: 28455812 PMCID: PMC5447559 DOI: 10.1007/s40120-017-0066-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Attention-deficit/hyperactivity disorder (ADHD) is a common psychiatric disorder in children/adolescents and occurs frequently with psychiatric/neurologic comorbidities. The objective of this study was to assess the impact of psychiatric/neurologic comorbidities on pharmacotherapy patterns among patients with ADHD in Sweden. METHODS A retrospective cohort analysis was conducted using medical records from a regional database in Sweden. Patients aged 6-17 years, with ≥1 prescription for ADHD medication between July 1, 2007 and June 30, 2009, and continuously active in the database for ≥12 months before and after their prescription index date were selected. Patients were categorized as ADHD alone (ADHD-only) or with comorbidities (ADHD-comorbid). Between-group differences were analyzed before and after adjusting for potentially confounding variables. RESULTS Data on 1794 patients (1083 ADHD-only; 711 ADHD-comorbid) were analyzed. Among newly treated patients, 21.7% augmented their index therapy (ADHD-only, 20.5%; ADHD-comorbid, 24.4%; p = 0.23). After adjustment, ADHD-only patients were less likely (p = 0.002) to augment versus ADHD-comorbid patients [odds ratio = 0.44, 95% confidence interval (CI) 0.27, 0.73]. ADHD-comorbid patients received more prescriptions versus ADHD-only patients (mean 13.1 vs 10.0; p < 0.001), and had more outpatient visits (mean 11.9 vs. 8.1; p < 0.001) and hospitalizations (10.7% vs. 6.0%; p < 0.001). After adjustment, ADHD-only patients had fewer outpatient visits (p < 0.001) and referrals (p < 0.001) versus ADHD-comorbid patients (visits: β = -0.21, 95% CI -0.28, -0.13; referrals: β = -0.25, 95% CI -0.33, -0.18). CONCLUSION Patients with ADHD with comorbidities had more hospitalizations, physician visits, and medication prescriptions during 12 months' follow-up than did those with ADHD alone. ADHD therapy augmentation was prevalent among children/adolescents with ADHD, even among those without psychiatric/neurologic comorbidities.
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Affiliation(s)
| | - Per A Gustafsson
- Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.,Department of Child and Adolescent Psychiatry, Linköping University, Linköping, Sweden
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Cortese S, D'Acunto G, Konofal E, Masi G, Vitiello B. New Formulations of Methylphenidate for the Treatment of Attention-Deficit/Hyperactivity Disorder: Pharmacokinetics, Efficacy, and Tolerability. CNS Drugs 2017; 31:149-160. [PMID: 28130762 DOI: 10.1007/s40263-017-0409-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Psychostimulants are the recommended first-line pharmacological treatment for attention-deficit/hyperactivity disorder (ADHD). Methylphenidate is one of the most commonly used psychostimulants worldwide. Given that immediate-release and/or tablet/capsule formulations may decrease adherence to methylphenidate treatment, several drug companies have been developing novel long-acting and/or liquid/chewable formulations that may improve adherence as well as (for long-acting formulations) reduce abuse potential, decrease stigma associated with multiple administrations per day, and decrease the potential for adverse effects related to dosage peak. Here, we review the pharmacokinetics, efficacy, and tolerability of novel formulations of methylphenidate that are in development or have been approved by the US FDA or European Medicines Agency (EMA) in the last 5 years. We searched the websites of the FDA, EMA, ClinicalTrials.gov, and the pertinent drug companies. We also searched PubMed, Ovid databases (MEDLINE, PsycINFO, Embase + Embase classic), and ISI Web of Knowledge (Web of Science [Science Citation Index Expanded], Biological Abstracts, Biosis, Food Science and Technology Abstracts) to retrieve any additional pertinent information. We found data from trials for the following compounds: (1) methylphenidate extended-release oral suspension (MEROS; NWP06, Quillivant™); (2) methylphenidate extended-release chewable capsules (NWP09, QuilliChew ER™); (3) methylphenidate hydrochloride extended-release capsules (Aptensio XR™); (4) methylphenidate extended-release orally disintegrating tablets (XR-ODT; NT-0102, Cotempla™); (5) ORADUR technology (once-daily tamper-resistant formulation) methylphenidate sustained release (SR); and (6) methylphenidate modified-release (HLD-200; Bejorna™). Overall, available evidence based on trials suggests these compounds have good efficacy and tolerability. Future research should further explore the effectiveness and tolerability of these new formulations as well as their potential to improve adherence to treatment in the 'real world' via pragmatic trials.
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Affiliation(s)
- Samuele Cortese
- Academic Unit of Psychology, Department of Psychology, Developmental Brain-Behaviour Laboratory, University of Southampton, Building 44 Highfield Campus, Clinical and Experimental Sciences (CNS and Psychiatry) and Solent NHS Trust, Southampton, SO17 1BJ, UK.
- New York University Child Study Center, One Park Ave, 7th floor, New York, NY, 10016, USA.
| | - Giulia D'Acunto
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Viale del Tirreno 331, 56128, Calambrone, Italy
| | - Eric Konofal
- Pediatric Sleep Center, Hospital Robert Debré, 48 Bd Sérurier, 75019, Paris, France
- NLS-Pharma, Breitenweg 10, 6370, Stans, NW, Switzerland
| | - Gabriele Masi
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Viale del Tirreno 331, 56128, Calambrone, Italy
| | - Benedetto Vitiello
- Division of Child and Adolescent Neuropsychiatry, University of Turin, Piazza Polonia 94, 10126, Turin, Italy
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Coghill D. Services for adults with ADHD: work in progress: Commentary on . . . Specialist adult ADHD clinics in East Anglia. BJPsych Bull 2015; 39:140-3. [PMID: 26191454 PMCID: PMC4478922 DOI: 10.1192/pb.bp.114.048850] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 07/28/2014] [Indexed: 11/23/2022] Open
Abstract
Magon and colleagues highlight a number of relative strengths and weaknesses very reminiscent of those we have seen over the years in the development of similar services for children and adolescents. It is clear that we all have a lot of work to do to improve our approach to the transition from child to adult services. There was clear evidence that adult services can adapt to manage ADHD, but there is also a clear need for increased upskilling of clinicians in the practical management of medication and other treatments. I disagree with Magon and colleagues about the role of primary care and believe that treatment initiation and ongoing monitoring should, for the time being, remain in secondary care and that, because of the volume of work that will come our way, this will need to become a core rather than specialist task. As with other aspects of psychiatric care, there is a clear role for specialist nurses in delivering a significant proportion of the core care.
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