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Effect of treatment modality on long-term outcomes in attention-deficit/hyperactivity disorder: a systematic review.

Arnold LE, Hodgkins P, Caci H, Kahle J, Young S - PLoS ONE (2015)

Bottom Line: Among significantly improved outcomes, the largest effect sizes were found for combination treatment.The greatest improvements were associated with academic, self-esteem, or social function outcomes.Older treatment initiation age or longer durations did not markedly affect proportion of improved outcomes reported, but measurement of outcomes long periods after treatment cessation may attenuate results.

View Article: PubMed Central - PubMed

Affiliation: Research Unit on Pediatric Psychopharmacology, The Ohio State University, Columbus, Ohio, United States of America.

ABSTRACT

Background: Evaluation of treatments for attention-deficit/hyperactivity disorder (ADHD) previously focused on symptom control, but attention has shifted to functional outcomes. The effect of different ADHD treatment periods and modalities (pharmacological, non-pharmacological, and combination) on long-term outcomes needs to be more comprehensively understood.

Methods: A systematic search of 12 literature databases using Cochrane's guidelines yielded 403 English-language peer-reviewed, primary studies reporting long-term outcomes (≥2 years). We evaluated relative effects of treatment modalities and durations and effect sizes of outcomes reported as statistically significantly improved with treatment.

Results: The highest proportion of improved outcomes was reported with combination treatment (83% of outcomes). Among significantly improved outcomes, the largest effect sizes were found for combination treatment. The greatest improvements were associated with academic, self-esteem, or social function outcomes. A majority of outcomes improved regardless of age of treatment initiation (60%-75%) or treatment duration (62%-72%). Studies with short treatment duration had shorter follow-up times (mean 3.2 years total study length) than those with longer treatment durations (mean 7.1 years total study length). Studies with follow-up times <3 years reported benefit with treatment for 93% of outcomes, whereas those with follow-up times ≥3 years reported treatment benefit for 57% of outcomes. Post-hoc analysis indicated that this result was related to the measurement of outcomes at longer periods (3.2 versus 0.4 years) after treatment cessation in studies with longer total study length.

Conclusions: While the majority of long-term outcomes of ADHD improve with all treatment modalities, the combination of pharmacological and non-pharmacological treatment was most consistently associated with improved long-term outcomes and large effect sizes. Older treatment initiation age or longer durations did not markedly affect proportion of improved outcomes reported, but measurement of outcomes long periods after treatment cessation may attenuate results.

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Related in: MedlinePlus

Treatment Modalities.(A) Benefit with each treatment modality for each outcome domain. Each bar represents the percentage of outcomes reported to exhibit benefit (either significantly improved from untreated baseline or significantly improved compared with a group of untreated individuals with ADHD) with each treatment modality. (B) Benefit with each treatment modality for different age groups at follow-up. The colored sections within bars represent the percentage of outcomes reported to improve (benefit) or not (no benefit) for each treatment modality for children (mid-range age 6–12 years) and adolescents (mid-range age 13–17 years), and all ages. Adults (mid-range age 18–84 years) are not presented separately because there were only studies of pharmacological treatment in this age group at follow-up. The numbers on the bars indicate the number of outcomes represented in each bar. Some studies reported outcomes with more than one type of treatment.
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pone.0116407.g003: Treatment Modalities.(A) Benefit with each treatment modality for each outcome domain. Each bar represents the percentage of outcomes reported to exhibit benefit (either significantly improved from untreated baseline or significantly improved compared with a group of untreated individuals with ADHD) with each treatment modality. (B) Benefit with each treatment modality for different age groups at follow-up. The colored sections within bars represent the percentage of outcomes reported to improve (benefit) or not (no benefit) for each treatment modality for children (mid-range age 6–12 years) and adolescents (mid-range age 13–17 years), and all ages. Adults (mid-range age 18–84 years) are not presented separately because there were only studies of pharmacological treatment in this age group at follow-up. The numbers on the bars indicate the number of outcomes represented in each bar. Some studies reported outcomes with more than one type of treatment.

Mentions: Separating the results by type of outcome allowed examination of which treatment types were most commonly associated with improvement for each outcome (Fig. 3A). The proportion of outcomes that improved varied among treatment modalities, as did the number of available supporting studies and outcomes. Of the outcomes most amenable to treatment, all treatment modalities were reported to be associated with improvement. For example, pharmacological, non-pharmacological, and combination treatments all contributed to the 100% of studies reporting improved outcomes for driving. Similarly, a high percentage of beneficial results for social function outcomes were reported with all three treatment modalities: pharmacological (67%, 6/9), non-pharmacological (83%, 5/6), and combination treatment (86%, 6/7). All treatment modalities also contributed to improved outcomes in the self-esteem, academic, and antisocial behavior domains.


Effect of treatment modality on long-term outcomes in attention-deficit/hyperactivity disorder: a systematic review.

Arnold LE, Hodgkins P, Caci H, Kahle J, Young S - PLoS ONE (2015)

Treatment Modalities.(A) Benefit with each treatment modality for each outcome domain. Each bar represents the percentage of outcomes reported to exhibit benefit (either significantly improved from untreated baseline or significantly improved compared with a group of untreated individuals with ADHD) with each treatment modality. (B) Benefit with each treatment modality for different age groups at follow-up. The colored sections within bars represent the percentage of outcomes reported to improve (benefit) or not (no benefit) for each treatment modality for children (mid-range age 6–12 years) and adolescents (mid-range age 13–17 years), and all ages. Adults (mid-range age 18–84 years) are not presented separately because there were only studies of pharmacological treatment in this age group at follow-up. The numbers on the bars indicate the number of outcomes represented in each bar. Some studies reported outcomes with more than one type of treatment.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4340791&req=5

pone.0116407.g003: Treatment Modalities.(A) Benefit with each treatment modality for each outcome domain. Each bar represents the percentage of outcomes reported to exhibit benefit (either significantly improved from untreated baseline or significantly improved compared with a group of untreated individuals with ADHD) with each treatment modality. (B) Benefit with each treatment modality for different age groups at follow-up. The colored sections within bars represent the percentage of outcomes reported to improve (benefit) or not (no benefit) for each treatment modality for children (mid-range age 6–12 years) and adolescents (mid-range age 13–17 years), and all ages. Adults (mid-range age 18–84 years) are not presented separately because there were only studies of pharmacological treatment in this age group at follow-up. The numbers on the bars indicate the number of outcomes represented in each bar. Some studies reported outcomes with more than one type of treatment.
Mentions: Separating the results by type of outcome allowed examination of which treatment types were most commonly associated with improvement for each outcome (Fig. 3A). The proportion of outcomes that improved varied among treatment modalities, as did the number of available supporting studies and outcomes. Of the outcomes most amenable to treatment, all treatment modalities were reported to be associated with improvement. For example, pharmacological, non-pharmacological, and combination treatments all contributed to the 100% of studies reporting improved outcomes for driving. Similarly, a high percentage of beneficial results for social function outcomes were reported with all three treatment modalities: pharmacological (67%, 6/9), non-pharmacological (83%, 5/6), and combination treatment (86%, 6/7). All treatment modalities also contributed to improved outcomes in the self-esteem, academic, and antisocial behavior domains.

Bottom Line: Among significantly improved outcomes, the largest effect sizes were found for combination treatment.The greatest improvements were associated with academic, self-esteem, or social function outcomes.Older treatment initiation age or longer durations did not markedly affect proportion of improved outcomes reported, but measurement of outcomes long periods after treatment cessation may attenuate results.

View Article: PubMed Central - PubMed

Affiliation: Research Unit on Pediatric Psychopharmacology, The Ohio State University, Columbus, Ohio, United States of America.

ABSTRACT

Background: Evaluation of treatments for attention-deficit/hyperactivity disorder (ADHD) previously focused on symptom control, but attention has shifted to functional outcomes. The effect of different ADHD treatment periods and modalities (pharmacological, non-pharmacological, and combination) on long-term outcomes needs to be more comprehensively understood.

Methods: A systematic search of 12 literature databases using Cochrane's guidelines yielded 403 English-language peer-reviewed, primary studies reporting long-term outcomes (≥2 years). We evaluated relative effects of treatment modalities and durations and effect sizes of outcomes reported as statistically significantly improved with treatment.

Results: The highest proportion of improved outcomes was reported with combination treatment (83% of outcomes). Among significantly improved outcomes, the largest effect sizes were found for combination treatment. The greatest improvements were associated with academic, self-esteem, or social function outcomes. A majority of outcomes improved regardless of age of treatment initiation (60%-75%) or treatment duration (62%-72%). Studies with short treatment duration had shorter follow-up times (mean 3.2 years total study length) than those with longer treatment durations (mean 7.1 years total study length). Studies with follow-up times <3 years reported benefit with treatment for 93% of outcomes, whereas those with follow-up times ≥3 years reported treatment benefit for 57% of outcomes. Post-hoc analysis indicated that this result was related to the measurement of outcomes at longer periods (3.2 versus 0.4 years) after treatment cessation in studies with longer total study length.

Conclusions: While the majority of long-term outcomes of ADHD improve with all treatment modalities, the combination of pharmacological and non-pharmacological treatment was most consistently associated with improved long-term outcomes and large effect sizes. Older treatment initiation age or longer durations did not markedly affect proportion of improved outcomes reported, but measurement of outcomes long periods after treatment cessation may attenuate results.

Show MeSH
Related in: MedlinePlus