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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 benefit by follow-up age group for each outcome domain.Colors and shades within bars represent the percentage of outcomes reported for each outcome domain. Blue = benefit; orange-yellow = no benefit. Darker shades indicate younger age groups. The numbers on the bars are the number of outcomes represented by the section of the bar.
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pone.0116407.g005: Treatment benefit by follow-up age group for each outcome domain.Colors and shades within bars represent the percentage of outcomes reported for each outcome domain. Blue = benefit; orange-yellow = no benefit. Darker shades indicate younger age groups. The numbers on the bars are the number of outcomes represented by the section of the bar.

Mentions: Age at which follow-up measures are taken may also be a factor in the reported outcomes of treatment. Considering all outcomes together (far right bar, Fig. 5), there was a higher proportion of improved outcomes versus no benefit within each age group at follow-up: children (65%, 22/34 outcomes), adolescents (61%, 19/31 outcomes), and adults (53%, 9/17 outcomes). Benefit was associated with all treatment modalities in children and adolescents. Only pharmacological treatment was assessed in studies in which follow-up measures were taken in adulthood. Only for drug use/addicitive behavior outcomes were there studies of all age groups at follow-up that reported benefit with treatment. Of note, drug use/addictive behavior was proportionally more often reported to improve with treatment when follow-up occurred as adults (86%, 6/7 outcomes) compared with studies of children (33%, 1/3 outcomes) and adolescents (25%, 2/8 outcomes), although this outcome may be less sytematically studied in children and adolescents [3]. A high proportion of academic outcomes were reported to benefit from treatment when follow-up occurred in children (73%, 8/11 outcomes) and adolescents (83%, 5/6 outcomes) but not for the 3 outcomes in which follow-up occurred in adults.


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 benefit by follow-up age group for each outcome domain.Colors and shades within bars represent the percentage of outcomes reported for each outcome domain. Blue = benefit; orange-yellow = no benefit. Darker shades indicate younger age groups. The numbers on the bars are the number of outcomes represented by the section of the bar.
© Copyright Policy
Related In: Results  -  Collection

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

pone.0116407.g005: Treatment benefit by follow-up age group for each outcome domain.Colors and shades within bars represent the percentage of outcomes reported for each outcome domain. Blue = benefit; orange-yellow = no benefit. Darker shades indicate younger age groups. The numbers on the bars are the number of outcomes represented by the section of the bar.
Mentions: Age at which follow-up measures are taken may also be a factor in the reported outcomes of treatment. Considering all outcomes together (far right bar, Fig. 5), there was a higher proportion of improved outcomes versus no benefit within each age group at follow-up: children (65%, 22/34 outcomes), adolescents (61%, 19/31 outcomes), and adults (53%, 9/17 outcomes). Benefit was associated with all treatment modalities in children and adolescents. Only pharmacological treatment was assessed in studies in which follow-up measures were taken in adulthood. Only for drug use/addicitive behavior outcomes were there studies of all age groups at follow-up that reported benefit with treatment. Of note, drug use/addictive behavior was proportionally more often reported to improve with treatment when follow-up occurred as adults (86%, 6/7 outcomes) compared with studies of children (33%, 1/3 outcomes) and adolescents (25%, 2/8 outcomes), although this outcome may be less sytematically studied in children and adolescents [3]. A high proportion of academic outcomes were reported to benefit from treatment when follow-up occurred in children (73%, 8/11 outcomes) and adolescents (83%, 5/6 outcomes) but not for the 3 outcomes in which follow-up occurred in adults.

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