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Lakes KD, Cibrian FL, Schuck S, Nelson M, Hayes GR. Digital health interventions for youth with ADHD: A systematic review. COMPUTERS IN HUMAN BEHAVIOR REPORTS 2022. [DOI: 10.1016/j.chbr.2022.100174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Walkup JT, Parkhurst J, Lavigne J. Editorial: Promoting Quality Psychotherapy: It Is Not the Process but the Outcome That Matters! J Am Acad Child Adolesc Psychiatry 2020; 59:797-799. [PMID: 32439400 DOI: 10.1016/j.jaac.2020.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 05/08/2020] [Indexed: 02/06/2023]
Abstract
The article published in this issue of the Journal by Bear et al.1 is the first to use meta-analytic procedures to try to understand the value of psychotherapy for pediatric anxiety and depression as usually delivered in the community. The authors scoured the literature for psychotherapy clinical trials that used treatment as usual as a control group or observational studies of treatment in mental health settings, then applied meta-analytic approaches to get a better idea of what treatment as usual outcomes were and by extension what to expect from psychotherapy as usually delivered. The study findings suggest that psychotherapy as practiced in the community even in high-quality settings does not provide consistently good outcomes. In this editorial, we will review the results of this study and discuss trends in psychotherapy research and practice that could improve the outcomes for patients and families.
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Affiliation(s)
- John T Walkup
- Ann and Robert H. Lurie Children's Hospital of Chicago, and Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - John Parkhurst
- Ann and Robert H. Lurie Children's Hospital of Chicago, and Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - John Lavigne
- Ann and Robert H. Lurie Children's Hospital of Chicago, and Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Wolraich ML, Chan E, Froehlich T, Lynch RL, Bax A, Redwine ST, Ihyembe D, Hagan JF. ADHD Diagnosis and Treatment Guidelines: A Historical Perspective. Pediatrics 2019; 144:peds.2019-1682. [PMID: 31570649 DOI: 10.1542/peds.2019-1682] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2019] [Indexed: 11/24/2022] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is the most common behavioral condition and the second most common chronic illness in children. The observance of specific behaviors in multiple settings have remained the most successful method for diagnosing the condition, and although there are differences in specific areas of the brain, and a high heritability estimate (∼76%), they are not diagnostically specific. Medications, and particularly stimulant medication, have undergone rigorous studies to document their efficacy dating back to the 1970s. Likewise, behavioral interventions in the form of parent training and classroom programs have demonstrated robust efficacy during the same time period. Both medication and behavioral interventions are symptomatic treatments. The availability of only symptomatic treatments places ADHD in the same category as other chronic conditions such as diabetes and asthma. Successful treatment of most individuals requires ongoing adherence to the therapy. Improved communication between patients and their families, primary and mental health providers, and school personnel is necessary for effective ADHD treatment. Further enhancement of electronic systems to facilitate family, school, and provider communication can improve monitoring of ADHD symptoms and functional performance. The American Academy of Pediatrics ADHD guidelines were initially developed to help primary care clinicians address the needs of their patients with ADHD and were further refined with the second revision in 2019.
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Affiliation(s)
- Mark L Wolraich
- University of Oklahoma Health Sciences Center, The University of Oklahoma, Oklahoma City, Oklahoma;
| | - Eugenia Chan
- Boston Children's Hospital, Boston, Massachusetts
| | - Tanya Froehlich
- Department of Pediatrics, University of Cincinnati and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Ami Bax
- University of Oklahoma Health Sciences Center, The University of Oklahoma, Oklahoma City, Oklahoma
| | - Susan T Redwine
- University of Oklahoma Health Sciences Center, The University of Oklahoma, Oklahoma City, Oklahoma
| | - Demvihin Ihyembe
- University of Oklahoma Health Sciences Center, The University of Oklahoma, Oklahoma City, Oklahoma
| | - Joseph F Hagan
- University of Vermont Children's Hospital, Burlington, Vermont
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Wahabi HA, Esmaeil SA, Bahkali KH, Titi MA, Amer YS, Fayed AA, Jamal A, Zakaria N, Siddiqui AR, Semwal M, Car LT, Posadzki P, Car J. Medical Doctors' Offline Computer-Assisted Digital Education: Systematic Review by the Digital Health Education Collaboration. J Med Internet Res 2019; 21:e12998. [PMID: 30821689 PMCID: PMC6418481 DOI: 10.2196/12998] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 01/06/2019] [Accepted: 01/31/2019] [Indexed: 01/19/2023] Open
Abstract
Background The widening gap between innovations in the medical field and the dissemination of such information to doctors may affect the quality of care. Offline computer-based digital education (OCDE) may be a potential solution to overcoming the geographical, financial, and temporal obstacles faced by doctors. Objective The objectives of this systematic review were to evaluate the effectiveness of OCDE compared with face-to-face learning, no intervention, or other types of digital learning for improving medical doctors’ knowledge, cognitive skills, and patient-related outcomes. Secondary objectives were to assess the cost-effectiveness (CE) of OCDE and any adverse effects. Methods We searched major bibliographic databases from 1990 to August 2017 to identify relevant articles and followed the Cochrane methodology for systematic reviews of intervention. Results Overall, 27 randomized controlled trials (RCTs), 1 cluster RCT (cRCT), and 1 quasi-RCT were included in this review. The total number of participants was 1690 in addition to the cRCT, which included 24 practices. Due to the heterogeneity of the participants, interventions, and outcomes, meta-analysis was not feasible, and the results were presented as narrative summary. Compared with face-to-face learning, the effect of OCDE on knowledge gain is uncertain (ratio of the means [RM] range 0.95-1.17; 8 studies, 495 participants; very low grade of evidence). From the same comparison, the effect of OCDE on cognitive skill gain is uncertain (RM range 0.1-0.9; 8 studies, 375 participants; very low grade of evidence). OCDE may have little or no effect on patients’ outcome compared with face-to-face education (2 studies, 62 participants; low grade of evidence). Compared with no intervention, OCDE may improve knowledge gain (RM range 1.36-0.98; 4 studies, 401 participants; low grade of evidence). From the same comparison, the effect of OCDE on cognitive skill gain is uncertain (RM range 1.1-1.15; 4 trials, 495 participants; very low grade of evidence). One cRCT, involving 24 practices, investigated patients’ outcome in this comparison and showed no difference between the 2 groups with low-grade evidence. Compared with text-based learning, the effect of OCDE on cognitive skills gain is uncertain (RM range 0.91-1.46; 3 trials with 4 interventions; 68 participants; very low-grade evidence). No study in this comparison investigated knowledge gain or patients’ outcomes. One study assessed the CE and showed that OCDE was cost-effective when compared with face-to-face learning if the cost is less than or equal to Can $200. No trial evaluated the adverse effect of OCDE. Conclusions The effect of OCDE compared with other methods of education on medical doctors’ knowledge and cognitive skill gain is uncertain. OCDE may improve doctors’ knowledge compared with no intervention but its effect on doctors’ cognitive skills is uncertain. OCDE may have little or no effect in improving patients’ outcome.
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Affiliation(s)
- Hayfaa Abdelmageed Wahabi
- Research Chair of Evidence-Based Healthcare and Knowledge Translation, Deanship of Research, King Saud University, Riyadh, Saudi Arabia
| | - Samia Ahmed Esmaeil
- Research Chair of Evidence-Based Healthcare and Knowledge Translation, Deanship of Research, King Saud University, Riyadh, Saudi Arabia
| | - Khawater Hassan Bahkali
- Research Chair of Evidence-Based Healthcare and Knowledge Translation, Deanship of Research, King Saud University, Riyadh, Saudi Arabia.,Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Maher Abdelraheim Titi
- Research Chair of Evidence-Based Healthcare and Knowledge Translation, Deanship of Research, King Saud University, Riyadh, Saudi Arabia.,Patient Safety Unit, Quality Management Department, King Khalid University Hospital, King Saud Medical City, Riyadh, Saudi Arabia
| | - Yasser Sami Amer
- Research Chair of Evidence-Based Healthcare and Knowledge Translation, Deanship of Research, King Saud University, Riyadh, Saudi Arabia.,Clinical Practice Guidelines Unit, Quality Management Department, King Khalid University Hospital, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Amel Ahmed Fayed
- College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia.,High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Amr Jamal
- Research Chair of Evidence-Based Healthcare and Knowledge Translation, Deanship of Research, King Saud University, Riyadh, Saudi Arabia.,Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Nasriah Zakaria
- Medical Informatics and e-Learning Unit, Medical Education Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Amna Rehana Siddiqui
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Monika Semwal
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Lorainne Tudor Car
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Paul Posadzki
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Josip Car
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Epstein JN, Kelleher KJ, Baum R, Brinkman WB, Peugh J, Gardner W, Lichtenstein P, Langberg JM. Impact of a Web-Portal Intervention on Community ADHD Care and Outcomes. Pediatrics 2016; 138:peds.2015-4240. [PMID: 27462065 PMCID: PMC4960725 DOI: 10.1542/peds.2015-4240] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/09/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The quality of care for children with attention-deficit/hyperactivity disorder (ADHD) delivered in community-based pediatric settings is often poor. Interventions have been developed to improve community-based ADHD care but have not demonstrated that better care results in improved patient outcomes. The objective of this study was to determine whether an ADHD quality improvement (QI) intervention for community-based pediatric practices improves patient outcomes. METHODS A cluster randomized controlled trial was conducted in which 50 community-based pediatric primary care practices (213 providers) were randomized either to receive a technology-assisted QI intervention or to a control condition. The intervention consisted of 4 training sessions, office flow modification, guided QI, and an ADHD Internet portal to assist with treatment monitoring. ADHD treatment processes and parent- and teacher-rated ADHD symptoms over the first year of treatment were collected for 577 patients. RESULTS Intent-to-treat analyses examining outcomes of all children assessed for ADHD were not significant (b = -1.97, P = .08). However, among the 373 children prescribed ADHD medication, there was a significant intervention effect (b = -2.42, P = .04) indicating greater reductions in parent ratings of ADHD symptoms after treatment among patients treated by intervention physicians compared with patients treated at control practices. There were no group differences on teacher ratings of ADHD symptoms. ADHD treatment care around medication was significantly better at intervention practices compared with control practices. CONCLUSIONS A technology-assisted QI intervention improved some ADHD care quality and resulted in additional reductions in parent-rated ADHD symptoms among patients prescribed ADHD medications.
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Affiliation(s)
- Jeffery N. Epstein
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Kelly J. Kelleher
- Department of Pediatrics, Nationwide Children’s Hospital, Columbus, Ohio
| | - Rebecca Baum
- Department of Pediatrics, Nationwide Children’s Hospital, Columbus, Ohio
| | - William B. Brinkman
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - James Peugh
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - William Gardner
- Department of Epidemiology, University of Ottawa, and Research Institute, Children's Hospital of Eastern Ontario, Ottawa, Ontario
| | | | - Joshua M. Langberg
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia
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Geltman PL, Fried LE, Arsenault LN, Knowles AM, Link DA, Goldstein JN, Perrin JM, Hacker KA. A planned care approach and patient registry to improve adherence to clinical guidelines for the diagnosis and management of attention-deficit/hyperactivity disorder. Acad Pediatr 2015; 15:289-96. [PMID: 25906699 DOI: 10.1016/j.acap.2014.12.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 12/04/2014] [Accepted: 12/08/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) affects almost 2.4 million US children. Because American Academy of Pediatrics guidelines for ADHD recommend use of standardized diagnostic instruments, regular follow-up and the chronic care model, this pilot project sought to implement and assess an electronic registry of patients with ADHD combined with care coordination by a planned care team. METHODS This quality improvement project was structured with 2 intervention and 2 control clinics to facilitate evaluation of the use of a planned care system for management of ADHD. Care teams included a pediatrician, nurse, medical assistant, and care coordinator and tracked patients using an electronic registry with data drawn from the EMR. Clinical work flows were pilot tested to facilitate use of the Vanderbilt scales and their incorporation into the EMR at intervention sites. Outcome measures included 2 recommended clinical follow-ups based on HEDIS measures as well as use of the Vanderbilt rating scales. Initiation phase measure was for follow-up after initiating medication, while the continuation phase measure was for subsequent follow-up during the first year of treatment. Measures were monitored during the project year and then also in the ensuing period of spread of the intervention to other sites. RESULTS Although the modified HEDIS initiation phase measure for patients newly on medication remained static at approximately 50% throughout the project period, the continuation phase measure showed improvement from 35% at baseline to 45% at the end of the project assessment year, a 29% increase. Follow-up for patients stable on medications also remained unchanged during the project period, but during subsequent spreading of the intervention to nonproject sites, follow-up of these patients improved to over 90%. In adjusted analyses, patients with ADHD at intervention sites were over 2 times more likely than patients at control sites to have had a Vanderbilt score documented in their records. CONCLUSIONS The project achieved modest improvements in the diagnostic and treatment process for patients with ADHD. The use of a planned care system and electronic patient registry shows promise for improving the diagnosis and treatment process for patients with ADHD.
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Affiliation(s)
- Paul L Geltman
- Department of Pediatrics, Cambridge Health Alliance (Cambridge, MA) and Harvard Medical School, Boston, Mass.
| | - Lise E Fried
- Institute for Community Health, Cambridge Health Alliance (Cambridge, MA) and Harvard Medical School, Boston, Mass
| | - Lisa N Arsenault
- Institute for Community Health, Cambridge Health Alliance (Cambridge, MA) and Harvard Medical School, Boston, Mass
| | - Alice M Knowles
- Institute for Community Health, Cambridge Health Alliance (Cambridge, MA) and Harvard Medical School, Boston, Mass
| | - David A Link
- Department of Pediatrics, Cambridge Health Alliance (Cambridge, MA) and Harvard Medical School, Boston, Mass
| | - Joel N Goldstein
- Division of Child Psychiatry, Cambridge Health Alliance (Cambridge, MA) and Harvard Medical School, Boston, Mass
| | - James M Perrin
- Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, Boston, Mass
| | - Karen A Hacker
- Allegheny County Health Department and University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pa
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Bauer NS, Carroll AE, Downs SM. Understanding the acceptability of a computer decision support system in pediatric primary care. J Am Med Inform Assoc 2014; 21:146-53. [PMID: 23788628 PMCID: PMC3912729 DOI: 10.1136/amiajnl-2013-001851] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 05/16/2013] [Accepted: 06/02/2013] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Individual users' attitudes and opinions help predict successful adoption of health information technology (HIT) into practice; however, little is known about pediatric users' acceptance of HIT for medical decision-making at the point of care. MATERIALS AND METHODS We wished to examine the attitudes and opinions of pediatric users' toward the Child Health Improvement through Computer Automation (CHICA) system, a computer decision support system linked to an electronic health record in four community pediatric clinics. Surveys were administered in 2011 and 2012 to all users to measure CHICA's acceptability and users' satisfaction with it. Free text comments were analyzed for themes to understand areas of potential technical refinement. RESULTS 70 participants completed the survey in 2011 (100% response rate) and 64 of 66 (97% response rate) in 2012. Initially, satisfaction with CHICA was mixed. In general, users felt the system held promise; however various critiques reflected difficulties understanding integrated technical aspects of how CHICA worked, as well as concern with the format and wording on generated forms for families and users. In the subsequent year, users' ratings reflected improved satisfaction and acceptance. Comments also reflected a deeper understanding of the system's logic, often accompanied by suggestions on potential refinements to make CHICA more useful at the point of care. CONCLUSIONS Pediatric users appreciate the system's automation and enhancements that allow relevant and meaningful clinical data to be accessible at point of care. Understanding users' acceptability and satisfaction is critical for ongoing refinement of HIT to ensure successful adoption into practice.
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Affiliation(s)
- Nerissa S Bauer
- Department of Pediatrics, Section of Children's Health Services Research, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Aaron E Carroll
- Department of Pediatrics, Section of Children's Health Services Research, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Regenstrief Institute for Healthcare, Indianapolis, Indiana, USA
| | - Stephen M Downs
- Department of Pediatrics, Section of Children's Health Services Research, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Regenstrief Institute for Healthcare, Indianapolis, Indiana, USA
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Linn D, Murray A, Smith T, Fuentes D. Clinical considerations for the management of pediatric patients with attention-deficit/hyperactivity disorder. Ment Health Clin 2013. [DOI: 10.9740/mhc.n145467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Attention-deficit/hyperactivity disorder (ADHD) is a chronic health condition presenting with symptoms of hyperactivity, impulsivity, and/or inattention in early childhood, adolescence and adulthood. Many patients will persist with associated symptoms throughout their life and may require long term treatment to maintain adequate control.
Objective: The purpose of this article is to review the current literature in regards to diagnosis, treatment, and management of ADHD in the pediatric and adolescent population.
Methods: A search was conducted using PubMed, Medline, Ovid, and CINHAL with a focus on studies and reviews in the English language from 2008 – 2013, featuring pediatric/adolescent patients across the ages of 4–17 years using the terms: “management”, “attention-deficit”, “hyperactivity”, and “treatment.” Literature referenced prior to the five-year time frame outlined herein provided foundational information on diagnostics and medications.
Discussion: Stimulants, in conjunction with behavioral therapy, are standard first line treatments used in ADHD. While stimulant medications have been shown to be effective in treating symptoms associated with ADHD, there are a variety of concerns that may prevent their use. These concerns are related to adverse consequences, many of which are not supported by concrete evidence. Other pharmacotherapy options such as norepinephrine reuptake inhibitors and selective alpha-2 adrenergic agonists are typically reserved as second line options. The use of novel and emerging complementary therapies will also be explored.
Conclusion: Patients diagnosed with ADHD must be thoroughly evaluated when making decisions regarding treatment. Many studies and reviews support the efficacy of pharmacotherapy in treatment of ADHD; however, there is insufficient evidence regarding long-term safety of the medications. Further research is warranted to evaluate current treatment options and associated risks and benefits to guide the clinician in optimal management of these patients.
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Affiliation(s)
- Dustin Linn
- 1 Assistant Professor of Pharmacy Practice, Manchester University College of Pharmacy, Fort Wayne, IN
| | - Andrea Murray
- 1 Assistant Professor of Pharmacy Practice, Manchester University College of Pharmacy, Fort Wayne, IN
| | - Thomas Smith
- 1 Assistant Professor of Pharmacy Practice, Manchester University College of Pharmacy, Fort Wayne, IN
| | - David Fuentes
- 2 Department Chair of Pharmacy Practice, Associate Professor of Pharmacy Practice, Manchester University College of Pharmacy, Fort Wayne, IN
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Lavigne JV. Commentary for pioneers in pediatric psychology: thirty-seven years of research, training, and clinical practice in pediatric psychology. J Pediatr Psychol 2012; 38:135-40. [PMID: 22847882 DOI: 10.1093/jpepsy/jss082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- John V Lavigne
- Department of Child and Adolescent Psychiatry, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA.
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Millichap JG. Computer-Assisted Management of ADHD. Pediatr Neurol Briefs 2011. [DOI: 10.15844/pedneurbriefs-25-8-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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