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Forthun LF, Sajatovic M, Levin JB, DelBello MP, Appling D, Broadnax MD, Fuentes-Casiano E, Cooley R, Blixen CE, Modi AC. Modification of an Intervention to Improve Adherence in Adolescents and Young Adults With Bipolar Disorder. JAACAP OPEN 2023; 1:80-92. [PMID: 38143721 PMCID: PMC10745282 DOI: 10.1016/j.jaacop.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/26/2023]
Abstract
Objective Managing bipolar disorder (BD) is particularly challenging for adolescents and young adults (AYAs) ages 16 to 21. Few interventions exist that address self-management in AYAs with BD. Thus, this study aimed to modify the customized adherence enhancement behavioral intervention for AYAs through an iterative, patient-centered process. Method The Obesity-Related Behavioral Intervention Trials (ORBIT) model was used for intervention development. In phase 1a, adherence barriers and facilitators were identified to refine intervention content. Phase 1b occurred following curriculum modification to ensure that the modified intervention was relevant and usable by the target population. Data were collected via focus groups and interviews with AYAs with BD, parents, and providers. Transcripts were analyzed using directed content analysis. Results Phase 1a included focus groups/interviews with AYAs (n = 10), parents (n = 4), and providers (n = 9) who described the difficulties and successes in managing BD symptoms, improving adherence, and transitioning care from caregivers. Phase 1b included an advisory board composed of 8 phase 1a participants who provided feedback on modified session activities, module delivery, and curriculum. Phase 1b involved usability testing with new participants (n = 8), revealing the need for modifiable language based on developmental level, more engaging visual images, and confirmation that topics were salient to AYAs with BD. Conclusion Though sample sizes were small and not representative of the population of AYAs with BD, the ORBIT methodology informed the adaptation of the customized adherence enhancement intervention to improve adherence in AYAs with BD. Important next steps are to conduct a pilot randomized clinical trial of customized adherence enhancement for AYAs.
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Affiliation(s)
- Larry F Forthun
- Dr. Forthun is with the University of Florida, Gainesville, Florida. Drs. Sajatovic, Levin, and Blixen, Mss. Broadnax and Fuentes-Casiano, and Mr. Appling are with Case Western Reserve University School of Medicine, Cleveland, Ohio, and University Hospitals of Cleveland Medical Center, Cleveland, Ohio. Dr. DelBello and Ms. Cooley are with the University of Cincinnati College of Medicine, Cincinnati, Ohio. Dr. Modi is with Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Martha Sajatovic
- Dr. Forthun is with the University of Florida, Gainesville, Florida. Drs. Sajatovic, Levin, and Blixen, Mss. Broadnax and Fuentes-Casiano, and Mr. Appling are with Case Western Reserve University School of Medicine, Cleveland, Ohio, and University Hospitals of Cleveland Medical Center, Cleveland, Ohio. Dr. DelBello and Ms. Cooley are with the University of Cincinnati College of Medicine, Cincinnati, Ohio. Dr. Modi is with Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jennifer B Levin
- Dr. Forthun is with the University of Florida, Gainesville, Florida. Drs. Sajatovic, Levin, and Blixen, Mss. Broadnax and Fuentes-Casiano, and Mr. Appling are with Case Western Reserve University School of Medicine, Cleveland, Ohio, and University Hospitals of Cleveland Medical Center, Cleveland, Ohio. Dr. DelBello and Ms. Cooley are with the University of Cincinnati College of Medicine, Cincinnati, Ohio. Dr. Modi is with Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Melissa P DelBello
- Dr. Forthun is with the University of Florida, Gainesville, Florida. Drs. Sajatovic, Levin, and Blixen, Mss. Broadnax and Fuentes-Casiano, and Mr. Appling are with Case Western Reserve University School of Medicine, Cleveland, Ohio, and University Hospitals of Cleveland Medical Center, Cleveland, Ohio. Dr. DelBello and Ms. Cooley are with the University of Cincinnati College of Medicine, Cincinnati, Ohio. Dr. Modi is with Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Deionte Appling
- Dr. Forthun is with the University of Florida, Gainesville, Florida. Drs. Sajatovic, Levin, and Blixen, Mss. Broadnax and Fuentes-Casiano, and Mr. Appling are with Case Western Reserve University School of Medicine, Cleveland, Ohio, and University Hospitals of Cleveland Medical Center, Cleveland, Ohio. Dr. DelBello and Ms. Cooley are with the University of Cincinnati College of Medicine, Cincinnati, Ohio. Dr. Modi is with Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Michaela D Broadnax
- Dr. Forthun is with the University of Florida, Gainesville, Florida. Drs. Sajatovic, Levin, and Blixen, Mss. Broadnax and Fuentes-Casiano, and Mr. Appling are with Case Western Reserve University School of Medicine, Cleveland, Ohio, and University Hospitals of Cleveland Medical Center, Cleveland, Ohio. Dr. DelBello and Ms. Cooley are with the University of Cincinnati College of Medicine, Cincinnati, Ohio. Dr. Modi is with Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Edna Fuentes-Casiano
- Dr. Forthun is with the University of Florida, Gainesville, Florida. Drs. Sajatovic, Levin, and Blixen, Mss. Broadnax and Fuentes-Casiano, and Mr. Appling are with Case Western Reserve University School of Medicine, Cleveland, Ohio, and University Hospitals of Cleveland Medical Center, Cleveland, Ohio. Dr. DelBello and Ms. Cooley are with the University of Cincinnati College of Medicine, Cincinnati, Ohio. Dr. Modi is with Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Raechel Cooley
- Dr. Forthun is with the University of Florida, Gainesville, Florida. Drs. Sajatovic, Levin, and Blixen, Mss. Broadnax and Fuentes-Casiano, and Mr. Appling are with Case Western Reserve University School of Medicine, Cleveland, Ohio, and University Hospitals of Cleveland Medical Center, Cleveland, Ohio. Dr. DelBello and Ms. Cooley are with the University of Cincinnati College of Medicine, Cincinnati, Ohio. Dr. Modi is with Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Carol E Blixen
- Dr. Forthun is with the University of Florida, Gainesville, Florida. Drs. Sajatovic, Levin, and Blixen, Mss. Broadnax and Fuentes-Casiano, and Mr. Appling are with Case Western Reserve University School of Medicine, Cleveland, Ohio, and University Hospitals of Cleveland Medical Center, Cleveland, Ohio. Dr. DelBello and Ms. Cooley are with the University of Cincinnati College of Medicine, Cincinnati, Ohio. Dr. Modi is with Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Avani C Modi
- Dr. Forthun is with the University of Florida, Gainesville, Florida. Drs. Sajatovic, Levin, and Blixen, Mss. Broadnax and Fuentes-Casiano, and Mr. Appling are with Case Western Reserve University School of Medicine, Cleveland, Ohio, and University Hospitals of Cleveland Medical Center, Cleveland, Ohio. Dr. DelBello and Ms. Cooley are with the University of Cincinnati College of Medicine, Cincinnati, Ohio. Dr. Modi is with Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Türk S, Korfmacher AK, Gerger H, van der Oord S, Christiansen H. Interventions for ADHD in childhood and adolescence: A systematic umbrella review and meta-meta-analysis. Clin Psychol Rev 2023; 102:102271. [PMID: 37030086 DOI: 10.1016/j.cpr.2023.102271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 03/03/2023] [Accepted: 03/24/2023] [Indexed: 03/28/2023]
Abstract
There are several meta-analyses of treatment effects for children and adolescents with attention deficit hyperactivity disorder (ADHD). The conclusions of these meta-analyses vary considerably. Our aim was to synthesize the latest evidence of the effectiveness of psychological, pharmacological treatment options and their combination in a systematic overview and meta-meta-analyses. A systematic literature search until July 2022 to identify meta-analyses investigating effects of treatments for children and adolescents with ADHD and ADHD symptom severity as primary outcome (parent and teacher rated) yielded 16 meta-analyses for quantitative analyses. Meta-meta-analyses of pre-post data showed significant effects for pharmacological treatment options for parent (SMD = 0.67, 95% CI 0.60 to 0.74) and teacher ADHD symptom ratings (SMD = 0.68, 95% CI 0.54 to 0.82) as well as for psychological interventions for parent (SMD = 0.42, 95% CI 0.33 to 0.51) and teacher rated symptoms (SMD = 0.25, 95% CI 0.12 to 0.38). We were unable to calculate effect sizes for combined treatments due to the lack of meta-analyses. Our analyses revealed that there is a lack of research on combined treatments and for therapy options for adolescents. Finally, future research efforts should adhere to scientific standards as this allows comparison of effects across meta-analyses.
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Affiliation(s)
- Selina Türk
- Clinical Child and Adolescent Psychology, Department of Psychology, Philipps-University Marburg, Gutenbergstraße 18, 35032 Marburg, Germany.
| | - Ann-Kathrin Korfmacher
- Clinical Child and Adolescent Psychology, Department of Psychology, Philipps-University Marburg, Gutenbergstraße 18, 35032 Marburg, Germany.
| | - Heike Gerger
- Family Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 60, 6229, ER, Maastricht, Netherlands
| | | | - Hanna Christiansen
- Clinical Child and Adolescent Psychology, Department of Psychology, Philipps-University Marburg, Gutenbergstraße 18, 35032 Marburg, Germany
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Quintero J, Rodríguez-Quiroga A, Álvarez-Mon MÁ, Mora F, Rostain AL. Addressing the Treatment and Service Needs of Young Adults with Attention Deficit Hyperactivity Disorder. Child Adolesc Psychiatr Clin N Am 2022; 31:531-551. [PMID: 35697400 DOI: 10.1016/j.chc.2022.03.007] [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: 11/25/2022]
Abstract
The transition from adolescence to adulthood is a complex period in which multiple changes take place (education, work, independent living, and social relations). This stage is especially difficult for adolescents suffering from attention deficit hyperactivity disorder (ADHD), who have to move on from child and adolescent mental health services to adult mental health services. This review analyzes developmental and environmental risk and protective factors as well as critical variables such as executive functioning and self-monitoring that influence the course of ADHD in transitional age youth and guide the priorities for an optimal transition of care. The influence of the COVID-19 pandemic is also discussed. We reflect on the unmet needs for an optimal transition of care and propose practice and policy recommendations to achieve this goal.
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Affiliation(s)
- Javier Quintero
- Psychiatry and Mental Health Department, Hospital Universitario Infanta Leonor, Avenida de la Gran Vía del Este 80, Madrid 20830, Spain; Department of Legal Medicine & Psychiatry, Complutense University, Spain.
| | - Alberto Rodríguez-Quiroga
- Psychiatry and Mental Health Department, Hospital Universitario Infanta Leonor, Avenida de la Gran Vía del Este 80, Madrid 20830, Spain; Department of Legal Medicine & Psychiatry, Complutense University, Spain
| | - Miguel Ángel Álvarez-Mon
- Psychiatry and Mental Health Department, Hospital Universitario Infanta Leonor, Avenida de la Gran Vía del Este 80, Madrid 20830, Spain; Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcala, 28801 Alcala de Henares, Spain; Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
| | - Fernando Mora
- Psychiatry and Mental Health Department, Hospital Universitario Infanta Leonor, Avenida de la Gran Vía del Este 80, Madrid 20830, Spain; Department of Legal Medicine & Psychiatry, Complutense University, Spain
| | - Anthony L Rostain
- Department of Psychiatry, Cooper Medical School of Rowan University, 401 Broadway, Camden, NJ 08103, USA
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Ballmann C, Kölle MA, Bekavac-Günther I, Wolf F, Pargent F, Barzel A, Philipsen A, Gensichen J. Evaluation of the German Version of the Adult Attention-Deficit/Hyperactivity Disorder Self-Report Screening Scale for DSM-5 as a Screening Tool for Adult Attention-Deficit/Hyperactivity Disorder in Primary Care. Front Psychol 2022; 13:858147. [PMID: 35529560 PMCID: PMC9075696 DOI: 10.3389/fpsyg.2022.858147] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 04/01/2022] [Indexed: 11/13/2022] Open
Abstract
Adult attention-deficit/hyperactivity disorder (ADHD) is common, but often undiagnosed. A valid and time-efficient screening tool for primary care is needed. Objective of this study is to evaluate the German version of the Adult ADHD Self-Report Scale for DSM-5 (ASRS-5) and its feasibility, acceptability, and reliability as a screening tool for adult ADHD in primary care. A multi-centered prospective, diagnostic study was performed. We recruited 262 patients in primary care practices and at an ADHD Outpatient Service of a department of psychiatry in Germany. Patients from 18 to 65 years with suspected or diagnosed ADHD were included by medical doctors, as well as non-ADHD patients as "negative controls." Participants filled in the ASRS-5 and a sociodemographic questionnaire. The Integrated Diagnosis of Adult ADHD, revised version (IDA-R) performed by trained interviewers was used for validation. Feasibility, acceptability, and credibility in primary care practices were examined through a semi-structured interview. The German version of the ASRS-5 showed comparable psychometric properties to the English original version (sensitivity 95.6% and specificity 72.3%). For factor structure, a parallel analysis suggested one latent dimension. Performing confirmatory factor analysis, the best fit was achieved for a general factor with one correlated error. Internal consistency results in Raykovs Omega = 0.86 and Cronbach's α = 0.88. The ASRS-5 was assessed positively in terms of feasibility, acceptability, and credibility by interviewed general practitioners. Potential problems were raised for "treatment options," "stigmatization," and "knowledge gaps." In conclusion, the German version of the ASRS-5 offers a promising tool to improve adult ADHD patients' diagnosis and healthcare.
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Affiliation(s)
- Cora Ballmann
- Institute of General Practice and Family Medicine, University Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | | | | | - Florian Wolf
- Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany
| | | | - Anne Barzel
- Institute of General Medicine, Ulm University, Ulm, Germany
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Jochen Gensichen
- Institute of General Practice and Family Medicine, University Hospital of the Ludwig-Maximilians-University, Munich, Germany
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Disruption of Pharmacotherapy During the Transition from Adolescence to Early Adulthood in Patients with Attention-Deficit/Hyperactivity Disorder: A Claims Database Analysis Across the USA. CNS Drugs 2021; 35:575-589. [PMID: 33856656 PMCID: PMC8144091 DOI: 10.1007/s40263-021-00808-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/17/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND OBJECTIVE Attention-deficit/hyperactivity disorder (ADHD) treatment rates in adults are low, possibly owing to discontinuation of pediatric care due to various circumstances (including inadequate health insurance coverage, poor disease insight, and patient/family resistance, as well as those who manage their ADHD independent of pharmacologic intervention) during the transition from adolescence to adulthood. To improve the understanding of treatment patterns during this transition, this study characterized pharmacotherapy use in patients with ADHD aged 16-21 years. METHODS A retrospective claims analysis of the IBM® MarketScan® Commercial Databases, which represent all census regions of the USA, included patients aged 16-21 years with two or more ADHD diagnoses between 1/1/2008 and 12/31/2017 (one or more diagnoses during the year of age 17) who were continuously enrolled from ages 16-21 years and prescribed ADHD medication for ≥ 6 months at age 17 years. Pharmacotherapy use was assessed longitudinally. Comparisons between ages were conducted using Wilcoxon signed-rank tests and McNemar tests. Treatment discontinuation was estimated using Kaplan-Meier analyses. RESULTS The analysis included 10,292 patients. The overall percentage of patients receiving pharmacotherapy significantly decreased (p < 0.001, regardless of treatment type and presence of co-occurring psychiatric disorders) as patients aged, with a median time to treatment discontinuation of 2.94 years. Among patients using pharmacotherapy at the age of 17 years, more than 30% were no longer using pharmacotherapy at age 21 years. As patients aged, the percentage using long-acting amphetamines or methylphenidates decreased, and the percentage receiving no treatment increased. The percentage of patients with disrupted treatment from age 18 to 21 years ranged from 17.9 to 24.1%. After transitioning to disrupted treatment or no treatment, low percentages of patients returned to pharmacotherapy use (disrupted treatment: 15.7-21.5% per year; no treatment, 2.7-3.8% per year). Across all age groups, statistically significantly greater (p < 0.05) percentages of patients with co-occurring psychiatric disorders used lisdexamfetamine, dextroamphetamine-amphetamine mix short acting, and non-stimulants compared with patients without co-occurring psychiatric disorders. Patients with co-occurring psychiatric disorders remained on ADHD pharmacotherapy longer and switched or augmented their pharmacotherapy more frequently than patients without co-occurring psychiatric comorbidities. CONCLUSIONS Patients rarely reinitiated treatment after pharmacotherapy was disrupted or discontinued, emphasizing the need for increased focus on the management of ADHD as patients transition from adolescence to adulthood.
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Cleverley K, Rowland E, Bennett K, Jeffs L, Gore D. Identifying core components and indicators of successful transitions from child to adult mental health services: a scoping review. Eur Child Adolesc Psychiatry 2020; 29:107-121. [PMID: 30294756 PMCID: PMC7024692 DOI: 10.1007/s00787-018-1213-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 08/11/2018] [Indexed: 11/03/2022]
Abstract
The aim of this scoping review was to identify the core components of interventions that facilitate successful transition from child and adolescent mental health services to adult mental health services. In the absence of rigorous evaluations of transition program effectiveness for transitioning youth with mental health care needs, these core components can contribute to informed decisions about promising program and intervention strategies. This review examined data from 87 peer-reviewed and non-academic documents to determine the characteristics that support the transition process and to identify opportunities for system and program improvement. Data were extracted and synthesized using a descriptive analytic framework. A major finding of this review is a significant lack of measurable indicators in the academic and gray literature. This review did identify 26 core components organized within the framework of the six core elements of healthcare transitions. Policy makers, practitioners, and administrators can use the core components to guide decisions about transition program and intervention content. Confirmation of the impact of these core program components on youth outcomes awaits the conduct of rigorous randomized trials. Future research also needs to explicitly focus on the development of indicators to evaluate transition programs and interventions.
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Affiliation(s)
- Kristin Cleverley
- CAMH Chair in Mental Health Nursing Research, Lawrence S. Bloomberg Faculty of Nursing and Department of Psychiatry, University of Toronto, 155 College Street, Suite 130, Toronto, ON, M5T 1P8, Canada.
- Centre for Addiction and Mental Health, Toronto, Canada.
| | - Emily Rowland
- Dalla Lana School of Public Health, Social and Behavioural Health Sciences, University of Toronto, Toronto, ON, Canada
| | - Kathryn Bennett
- Department of Health Research Methods, Evidence and Impact (Formerly Clinical Epidemiology and Biostatistics), McMaster University, Hamilton, Canada
- Offord Centre for Child Studies, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Lianne Jeffs
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
- Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Room 720, Toronto, ON, M5B 1W8, Canada
| | - Dana Gore
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
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Geissler J, Jans T, Banaschewski T, Becker K, Renner T, Brandeis D, Döpfner M, Dose C, Hautmann C, Holtmann M, Jenkner C, Millenet S, Romanos M. Individualised short-term therapy for adolescents impaired by attention-deficit/hyperactivity disorder despite previous routine care treatment (ESCAadol)-Study protocol of a randomised controlled trial within the consortium ESCAlife. Trials 2018; 19:254. [PMID: 29703226 PMCID: PMC5921777 DOI: 10.1186/s13063-018-2635-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 04/10/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the high persistence rate of attention-deficit/hyperactivity disorder (ADHD) throughout the lifespan, there is a considerable gap in knowledge regarding effective treatment strategies for adolescents with ADHD. This group in particular often shows substantial psychosocial impairment, low compliance and insufficient response to psychopharmacological interventions. Effective and feasible treatments should further consider the developmental shift in ADHD symptoms, comorbidity and psychosocial adversity as well as family dysfunction. Thus, individualised interventions for adolescent ADHD should comprise a multimodal treatment strategy. The randomised controlled ESCAadol study addresses the needs of this patient group and compares the outcome of short-term cognitive behavioural therapy with parent-based telephone-assisted self-help. METHODS/DESIGN In step 1, 160 adolescents aged 12 to 17 years with a diagnosis of ADHD will undergo a treatment as usual (TAU) observation phase of 1 month. In step 2, those still severely affected are randomised to the intervention group with an Individualised Modular Treatment Programme (IMTP) or a telephone-assisted self-help programme for parents (TASH) as an active control condition. The IMTP was specifically designed for the needs of adolescent ADHD. It comprises 10 sessions of individual cognitive behavioural therapy with the adolescents and/or the parents, for which participants choose three out of 10 available focus modules (e.g. organisational skills and planning, emotion regulation, problem solving and stress management, dysfunctional family communication). TASH combines a bibliotherapeutic component with 10 counselling sessions for the parents via telephone. Primary outcome is the change in ADHD symptoms in a clinician-rated diagnostic interview. Outcomes are assessed at inclusion into the study, after the TAU phase, after the intervention phase and after a further 12-week follow-up period. The primary statistical analysis will be by intention-to-treat, using linear regression models. Additionally, we will analyse psychometric and biological predictors and moderators of treatment response. DISCUSSION ESCAadol compares two short-term non-pharmacological interventions as cost-efficient and feasible treatment options for adolescent ADHD, addressing the specific needs and obstacles to treatment success in this group. We aim to contribute to personalised medicine for adolescent ADHD intended to be implemented in routine clinical care. TRIAL REGISTRATION German Clinical Trials Register (DRKS), Current Controlled Trial DRKS00008974, http://apps.who.int/trialsearch/Trial2.aspx?TrialID=DRKS00008974 ; http://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00008974 ; Registered on 28 December 2015.
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Affiliation(s)
- Julia Geissler
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Center of Mental Health, Margarete-Höppel-Platz 1, 97080 Würzburg, Germany
| | - Thomas Jans
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Center of Mental Health, Margarete-Höppel-Platz 1, 97080 Würzburg, Germany
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Katja Becker
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty of the Philipps-University Marburg and the University Hospital Marburg, Marburg, Germany
| | - Tobias Renner
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Daniel Brandeis
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zürich, Zurich, Switzerland
- Zurich Center for Integrative Human Physiology, University of Zürich, Zurich, Switzerland
- Neuroscience Center Zurich, University and ETH Zürich, Zurich, Switzerland
| | - Manfred Döpfner
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty of the University of Cologne, Cologne, Germany
- School of Child and Adolescent Cognitive Behaviour Therapy (AKiP), University Hospital of Cologne, Cologne, Germany
| | - Christina Dose
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty of the University of Cologne, Cologne, Germany
| | - Christopher Hautmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty of the University of Cologne, Cologne, Germany
- School of Child and Adolescent Cognitive Behaviour Therapy (AKiP), University Hospital of Cologne, Cologne, Germany
| | - Martin Holtmann
- LWL-University Hospital Hamm, Ruhr-University Bochum, Hamm, Germany
| | - Carolin Jenkner
- Clinical Trails Unit at University Medical Center Freiburg, Freiburg, Germany
| | - Sabina Millenet
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Marcel Romanos
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Center of Mental Health, Margarete-Höppel-Platz 1, 97080 Würzburg, Germany
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Inman DD, Scott LK, Aleshire ME. Transitioning Youth With Attention Deficit Hyperactivity Disorder to Adult Health Care. J Nurse Pract 2017. [DOI: 10.1016/j.nurpra.2017.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Nagy B, Setyawan J, Coghill D, Soroncz-Szabó T, Kaló Z, Doshi JA. A conceptual framework for a long-term economic model for the treatment of attention-deficit/hyperactivity disorder. Expert Rev Pharmacoecon Outcomes Res 2016; 17:283-292. [PMID: 27967261 DOI: 10.1080/14737167.2017.1271325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Models incorporating long-term outcomes (LTOs) are not available to assess the health economic impact of attention-deficit/hyperactivity disorder (ADHD). OBJECTIVE Develop a conceptual modelling framework capable of assessing long-term economic impact of ADHD therapies. METHODS Literature was reviewed; a conceptual structure for the long-term model was outlined with attention to disease characteristics and potential impact of treatment strategies. RESULTS The proposed model has four layers: i) multi-state short-term framework to differentiate between ADHD treatments; ii) multiple states being merged into three core health states associated with LTOs; iii) series of sub-models in which particular LTOs are depicted; iv) outcomes collected to be either used directly for economic analyses or translated into other relevant measures. CONCLUSIONS This conceptual model provides a framework to assess relationships between short- and long-term outcomes of the disease and its treatment, and to estimate the economic impact of ADHD treatments throughout the course of the disease.
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Affiliation(s)
- Balázs Nagy
- a Syreon Research Institute , Budapest , Hungary.,b Department of Health Policy and Health Economics , Eötvös Loránd University (ELTE) , Budapest , Hungary
| | | | - David Coghill
- d Division of Neuroscience , Medical Research Institute, University of Dundee, Ninewells Hospital and Medical School , Dundee , UK.,e Departments of Paediatrics and Psychiatry, Faculty of Medicine, Dentistry and Health Sciences , University of Melbourne, Royal Children's Hospital, Melbourne , Parkville , Victoria , Australia
| | | | - Zoltán Kaló
- a Syreon Research Institute , Budapest , Hungary.,b Department of Health Policy and Health Economics , Eötvös Loránd University (ELTE) , Budapest , Hungary
| | - Jalpa A Doshi
- f Department of Medicine, Perelman School of Medicine , University of Pennsylvania , Philadelphia , PA , USA.,g Leonard Davis Institute of Health Economics , University of Pennsylvania , Philadelphia , PA , USA
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Christiansen H. Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung über die Lebensspanne. VERHALTENSTHERAPIE 2016. [DOI: 10.1159/000446337] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Brown LW, Camfield P, Capers M, Cascino G, Ciccarelli M, de Gusmao CM, Downs SM, Majnemer A, Miller AB, SanInocencio C, Schultz R, Tilton A, Winokur A, Zupanc M. The neurologist's role in supporting transition to adult health care: A consensus statement. Neurology 2016; 87:835-40. [PMID: 27466477 DOI: 10.1212/wnl.0000000000002965] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 05/17/2016] [Indexed: 11/15/2022] Open
Abstract
The child neurologist has a critical role in planning and coordinating the successful transition from the pediatric to adult health care system for youth with neurologic conditions. Leadership in appropriately planning a youth's transition and in care coordination among health care, educational, vocational, and community services providers may assist in preventing gaps in care, delayed entry into the adult care system, and/or health crises for their adolescent patients. Youth whose neurologic conditions result in cognitive or physical disability and their families may need additional support during this transition, given the legal and financial considerations that may be required. Eight common principles that define the child neurologist's role in a successful transition process have been outlined by a multidisciplinary panel convened by the Child Neurology Foundation are introduced and described. The authors of this consensus statement recognize the current paucity of evidence for successful transition models and outline areas for future consideration.
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Affiliation(s)
- Lawrence W Brown
- From The Children's Hospital of Philadelphia (L.W.B.); Dalhousie University (P.C.); independent medical writer (M. Capers); Mayo Clinic (G.C.); Indiana University School of Medicine (M. Ciccarelli, S.M.D.); Brigham and Women's Hospital (C.M.d.G.); McGill University (A.M.); Child Neurology Foundation (A.B.M.); Lennox Gastaut Syndrome Foundation (C.S.); Texas Children's Hospital (R.S.); Louisiana State University Health Sciences (A.T.); patient advocate (A.W.); and Children's Hospital of Orange County (M.Z.).
| | - Peter Camfield
- From The Children's Hospital of Philadelphia (L.W.B.); Dalhousie University (P.C.); independent medical writer (M. Capers); Mayo Clinic (G.C.); Indiana University School of Medicine (M. Ciccarelli, S.M.D.); Brigham and Women's Hospital (C.M.d.G.); McGill University (A.M.); Child Neurology Foundation (A.B.M.); Lennox Gastaut Syndrome Foundation (C.S.); Texas Children's Hospital (R.S.); Louisiana State University Health Sciences (A.T.); patient advocate (A.W.); and Children's Hospital of Orange County (M.Z.)
| | - Melissa Capers
- From The Children's Hospital of Philadelphia (L.W.B.); Dalhousie University (P.C.); independent medical writer (M. Capers); Mayo Clinic (G.C.); Indiana University School of Medicine (M. Ciccarelli, S.M.D.); Brigham and Women's Hospital (C.M.d.G.); McGill University (A.M.); Child Neurology Foundation (A.B.M.); Lennox Gastaut Syndrome Foundation (C.S.); Texas Children's Hospital (R.S.); Louisiana State University Health Sciences (A.T.); patient advocate (A.W.); and Children's Hospital of Orange County (M.Z.)
| | - Greg Cascino
- From The Children's Hospital of Philadelphia (L.W.B.); Dalhousie University (P.C.); independent medical writer (M. Capers); Mayo Clinic (G.C.); Indiana University School of Medicine (M. Ciccarelli, S.M.D.); Brigham and Women's Hospital (C.M.d.G.); McGill University (A.M.); Child Neurology Foundation (A.B.M.); Lennox Gastaut Syndrome Foundation (C.S.); Texas Children's Hospital (R.S.); Louisiana State University Health Sciences (A.T.); patient advocate (A.W.); and Children's Hospital of Orange County (M.Z.)
| | - Mary Ciccarelli
- From The Children's Hospital of Philadelphia (L.W.B.); Dalhousie University (P.C.); independent medical writer (M. Capers); Mayo Clinic (G.C.); Indiana University School of Medicine (M. Ciccarelli, S.M.D.); Brigham and Women's Hospital (C.M.d.G.); McGill University (A.M.); Child Neurology Foundation (A.B.M.); Lennox Gastaut Syndrome Foundation (C.S.); Texas Children's Hospital (R.S.); Louisiana State University Health Sciences (A.T.); patient advocate (A.W.); and Children's Hospital of Orange County (M.Z.)
| | - Claudio M de Gusmao
- From The Children's Hospital of Philadelphia (L.W.B.); Dalhousie University (P.C.); independent medical writer (M. Capers); Mayo Clinic (G.C.); Indiana University School of Medicine (M. Ciccarelli, S.M.D.); Brigham and Women's Hospital (C.M.d.G.); McGill University (A.M.); Child Neurology Foundation (A.B.M.); Lennox Gastaut Syndrome Foundation (C.S.); Texas Children's Hospital (R.S.); Louisiana State University Health Sciences (A.T.); patient advocate (A.W.); and Children's Hospital of Orange County (M.Z.)
| | - Stephen M Downs
- From The Children's Hospital of Philadelphia (L.W.B.); Dalhousie University (P.C.); independent medical writer (M. Capers); Mayo Clinic (G.C.); Indiana University School of Medicine (M. Ciccarelli, S.M.D.); Brigham and Women's Hospital (C.M.d.G.); McGill University (A.M.); Child Neurology Foundation (A.B.M.); Lennox Gastaut Syndrome Foundation (C.S.); Texas Children's Hospital (R.S.); Louisiana State University Health Sciences (A.T.); patient advocate (A.W.); and Children's Hospital of Orange County (M.Z.)
| | - Annette Majnemer
- From The Children's Hospital of Philadelphia (L.W.B.); Dalhousie University (P.C.); independent medical writer (M. Capers); Mayo Clinic (G.C.); Indiana University School of Medicine (M. Ciccarelli, S.M.D.); Brigham and Women's Hospital (C.M.d.G.); McGill University (A.M.); Child Neurology Foundation (A.B.M.); Lennox Gastaut Syndrome Foundation (C.S.); Texas Children's Hospital (R.S.); Louisiana State University Health Sciences (A.T.); patient advocate (A.W.); and Children's Hospital of Orange County (M.Z.)
| | - Amy Brin Miller
- From The Children's Hospital of Philadelphia (L.W.B.); Dalhousie University (P.C.); independent medical writer (M. Capers); Mayo Clinic (G.C.); Indiana University School of Medicine (M. Ciccarelli, S.M.D.); Brigham and Women's Hospital (C.M.d.G.); McGill University (A.M.); Child Neurology Foundation (A.B.M.); Lennox Gastaut Syndrome Foundation (C.S.); Texas Children's Hospital (R.S.); Louisiana State University Health Sciences (A.T.); patient advocate (A.W.); and Children's Hospital of Orange County (M.Z.)
| | - Christina SanInocencio
- From The Children's Hospital of Philadelphia (L.W.B.); Dalhousie University (P.C.); independent medical writer (M. Capers); Mayo Clinic (G.C.); Indiana University School of Medicine (M. Ciccarelli, S.M.D.); Brigham and Women's Hospital (C.M.d.G.); McGill University (A.M.); Child Neurology Foundation (A.B.M.); Lennox Gastaut Syndrome Foundation (C.S.); Texas Children's Hospital (R.S.); Louisiana State University Health Sciences (A.T.); patient advocate (A.W.); and Children's Hospital of Orange County (M.Z.)
| | - Rebecca Schultz
- From The Children's Hospital of Philadelphia (L.W.B.); Dalhousie University (P.C.); independent medical writer (M. Capers); Mayo Clinic (G.C.); Indiana University School of Medicine (M. Ciccarelli, S.M.D.); Brigham and Women's Hospital (C.M.d.G.); McGill University (A.M.); Child Neurology Foundation (A.B.M.); Lennox Gastaut Syndrome Foundation (C.S.); Texas Children's Hospital (R.S.); Louisiana State University Health Sciences (A.T.); patient advocate (A.W.); and Children's Hospital of Orange County (M.Z.)
| | - Anne Tilton
- From The Children's Hospital of Philadelphia (L.W.B.); Dalhousie University (P.C.); independent medical writer (M. Capers); Mayo Clinic (G.C.); Indiana University School of Medicine (M. Ciccarelli, S.M.D.); Brigham and Women's Hospital (C.M.d.G.); McGill University (A.M.); Child Neurology Foundation (A.B.M.); Lennox Gastaut Syndrome Foundation (C.S.); Texas Children's Hospital (R.S.); Louisiana State University Health Sciences (A.T.); patient advocate (A.W.); and Children's Hospital of Orange County (M.Z.)
| | - Annick Winokur
- From The Children's Hospital of Philadelphia (L.W.B.); Dalhousie University (P.C.); independent medical writer (M. Capers); Mayo Clinic (G.C.); Indiana University School of Medicine (M. Ciccarelli, S.M.D.); Brigham and Women's Hospital (C.M.d.G.); McGill University (A.M.); Child Neurology Foundation (A.B.M.); Lennox Gastaut Syndrome Foundation (C.S.); Texas Children's Hospital (R.S.); Louisiana State University Health Sciences (A.T.); patient advocate (A.W.); and Children's Hospital of Orange County (M.Z.)
| | - Mary Zupanc
- From The Children's Hospital of Philadelphia (L.W.B.); Dalhousie University (P.C.); independent medical writer (M. Capers); Mayo Clinic (G.C.); Indiana University School of Medicine (M. Ciccarelli, S.M.D.); Brigham and Women's Hospital (C.M.d.G.); McGill University (A.M.); Child Neurology Foundation (A.B.M.); Lennox Gastaut Syndrome Foundation (C.S.); Texas Children's Hospital (R.S.); Louisiana State University Health Sciences (A.T.); patient advocate (A.W.); and Children's Hospital of Orange County (M.Z.)
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Differences in maintenance of response upon discontinuation across medication treatments in attention-deficit/hyperactivity disorder. Eur Neuropsychopharmacol 2015; 25:1611-21. [PMID: 26169574 DOI: 10.1016/j.euroneuro.2015.06.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 05/28/2015] [Accepted: 06/12/2015] [Indexed: 11/22/2022]
Abstract
The attention-deficit/hyperactivity disorder (ADHD) treatment literature has been focused on onset-of-effect and short-term effect size, with little exploration of ADHD symptoms upon medication discontinuation. The objective of this narrative review and analysis was to better understand the relapse of ADHD symptoms upon discontinuation of medication treatment in children, adolescents, and adults with ADHD who have responded to medication treatment and to explore differences among different medications in maintaining treatment response. Randomized withdrawal studies of dexmethylphenidate hydrochloride (d-MPH), methylphenidate modified-release (MPH-LA), lisdexamphetamine dimesylate (LDX), guanfacine extended-release (GXR), and atomoxetine (ATX) in both children/adolescents and adults with ADHD were reviewed. The percentage of relapse was significantly higher and the time-to-relapse significantly shorter with placebo compared to active treatment in patients who were previously stable on 5 weeks to 1 year of active treatment, suggesting clinically significant benefit with continued long-term pharmacotherapy. However, percentage of relapse at each time point studied after discontinuing stimulants and GXR appears substantially higher than observed when discontinuing ATX, suggesting longer maintenance of response after discontinuing ATX than after stimulants and GXR. Additionally, slope of relapse percentages over time appears to be more rapid with stimulants or GXR than with ATX. These differences in maintenance of response among ATX, GXR, and stimulants may reflect differences in mechanisms of action and persistence of the medication effect. Alternatively, they may be due to methodological differences, including study design and response/relapse definitions. Continued investigation is needed regarding factors that affect risk of symptom relapse upon discontinuation of pharmacotherapy.
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13
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Young CC, Calloway SJ. Transition Planning for the College Bound Adolescent with a Mental Health Disorder. J Pediatr Nurs 2015; 30:e173-82. [PMID: 26173385 DOI: 10.1016/j.pedn.2015.05.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 05/29/2015] [Accepted: 05/31/2015] [Indexed: 11/18/2022]
Abstract
Health promotion, disease prevention and anticipatory guidance are the hallmarks of nursing practice, particularly in pediatrics. While there is a wealth of information on anticipatory guidance for the pediatric patient at different ages and developmental stages, there is a paucity of information on anticipatory guidance for the adolescent and emerging adult in transitioning to manage their own health care. While an established need for anticipatory guidance and a transition plan from pediatric to adult health care is apparent for youth routinely followed for significant medical, intellectual, or developmental conditions, a group particularly vulnerable to destabilization of their health as they transition to self-directed adult health care management is composed of youth with mental health disorders. The risk for destabilization increases as they move away from social supports to the university setting. This article reviews available literature on anticipatory guidance for the college bound adolescent with a mental health disorder and makes recommendations for transition planning including examining the college and community services that would support mental health as well as personal choices regarding lifestyle habits while attending the university. Recommendations are made for nurses to be the leaders in filling this anticipatory guidance gap in preparing youth with mental health disorders for a successful transition to and through college life.
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Affiliation(s)
- Cara C Young
- School of Nursing, The University of Texas, Austin, TX
| | - Susan J Calloway
- School of Nursing, Texas Tech University Health Science Center, Lubbock, TX.
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14
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Ferguson SA, Delbert Law C, Sahin L, Montenegro SV. Effects of perinatal methylphenidate (MPH) treatment on postweaning behaviors of male and female Sprague–Dawley rats. Neurotoxicol Teratol 2015; 47:125-36. [DOI: 10.1016/j.ntt.2014.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 12/03/2014] [Accepted: 12/08/2014] [Indexed: 12/16/2022]
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