Limits...
Relationship between symptom impairment and treatment outcome in children and adolescents with attention-deficit/hyperactivity disorder: a physician perspective.

Setyawan J, Fridman M, Hodgkins P, Quintero J, Erder MH, Katić BJ, Harpin V - Atten Defic Hyperact Disord (2014)

Bottom Line: They were also more likely to be adherent and engaged with treatment, with an explicit treatment goal to improve inattention/school performance.Neither core symptoms' severity nor treatment types were associated with OTS.Potentially modifiable factors affecting OTS were as follows: treatment adherence, treatment engagement, and a treatment goal to improve inattention/school performance.

View Article: PubMed Central - PubMed

Affiliation: Shire, 725 Chesterbrook Boulevard, Wayne, PA, 19087, USA, jsetyawan@shire.com.

ABSTRACT
We evaluated the association between those symptoms/behaviours of attention-deficit/hyperactivity disorder (ADHD) that were present at diagnosis and outcomes of treatment in children and adolescents in six European countries. Physicians abstracted clinical records from patients (6-17 years) diagnosed with ADHD between 2004 and 2007 and treated for ≥2 years. Physicians scored the severity of impairment for core ADHD symptoms and additional (non-core) ADHD symptoms/behaviours at diagnosis and estimated treatment adherence (defined as an estimated >80 % adherence on weekdays and >50 % adherence on weekends). Treatment modalities included pharmacological treatment, behavioural therapy, or both. Pharmacological treatment was further subclassified by medication class. The outcome, optimal treatment success (OTS), was defined as complete symptom control with high satisfaction with treatment. Multivariate logistic regression modelling examined the relationship between OTS and symptom impairment. Of 730 patients, 200 (27 %) achieved OTS. These patients were more likely to demonstrate lower impairment in non-core ADHD symptoms/behaviours and have fewer pre-existing comorbidities. They were also more likely to be adherent and engaged with treatment, with an explicit treatment goal to improve inattention/school performance. Neither core symptoms' severity nor treatment types were associated with OTS. OTS rates were low, with patients having less impairment of non-core ADHD symptoms/behaviours and fewer comorbidities more likely to achieve OTS. Potentially modifiable factors affecting OTS were as follows: treatment adherence, treatment engagement, and a treatment goal to improve inattention/school performance. These data suggest that there may be opportunities to optimize current treatment use, and develop new treatment strategies to improve core and non-core ADHD symptoms/behaviours.

Show MeSH

Related in: MedlinePlus

Characteristics associated with optimal treatment success. a Germany (p = 0.002) and the Netherlands (p < 0.0001) had a significantly higher OTS rate and Italy (p < 0.001) a significantly lower OTS rate compared to the overall OTS rate. b n = 668 due to missing values. c ‘BT only’ was the only treatment type with a significantly different OTS rate compared to the overall OTS rate (p = 0.006). BT behavioural therapy, LA long acting, MPH methylphenidate, Rx pharmacotherapy, SA short acting. ‘Other Rx’ included medications other than MPH, amphetamine, and atomoxetine; ‘No. of therapies’ denotes number of therapies (as per study definition) recorded on the patient’s chart
© Copyright Policy - OpenAccess
Related In: Results  -  Collection


getmorefigures.php?uid=PMC4340973&req=5

Fig1: Characteristics associated with optimal treatment success. a Germany (p = 0.002) and the Netherlands (p < 0.0001) had a significantly higher OTS rate and Italy (p < 0.001) a significantly lower OTS rate compared to the overall OTS rate. b n = 668 due to missing values. c ‘BT only’ was the only treatment type with a significantly different OTS rate compared to the overall OTS rate (p = 0.006). BT behavioural therapy, LA long acting, MPH methylphenidate, Rx pharmacotherapy, SA short acting. ‘Other Rx’ included medications other than MPH, amphetamine, and atomoxetine; ‘No. of therapies’ denotes number of therapies (as per study definition) recorded on the patient’s chart

Mentions: There were significant differences in OTS rates by country (Fig. 1), with higher than average rates of 53 % (38/72) in the Netherlands (p < 0.0001) and 42 % (57/137) in Germany (p = 0.002) and a lower than average rate of 12 % (16/134) in Italy (p < 0.001). Other notable differences across countries included: (1) The Diagnostic and Statistical Manual of Mental Disorders 4th edition diagnostic approach was most commonly used in the Netherlands (81.1 %) and Spain (79.1 %), while the International Classification of Diseases 10th Revision was most common in Germany (87.4 %); (2) the UK had the highest rate of treatment with pharmacotherapy alone (63.7 %), while treatment with BT alone was most common in Italy (41.0 %). Over 54 % of patients in Italy used SA MPHs, while Spain did not report any use. Atomoxetine was most commonly used in Italy (36.7 %), but it was not available in France. SA amphetamines were not used in France or Spain, were used by less than 2 % of patients in Germany, the UK, and the Netherlands, and were most common in Italy (9.0 %); and (3) adherence to ADHD treatment ranged from 50.8 % in Italy to 80.3 % in France.Fig. 1


Relationship between symptom impairment and treatment outcome in children and adolescents with attention-deficit/hyperactivity disorder: a physician perspective.

Setyawan J, Fridman M, Hodgkins P, Quintero J, Erder MH, Katić BJ, Harpin V - Atten Defic Hyperact Disord (2014)

Characteristics associated with optimal treatment success. a Germany (p = 0.002) and the Netherlands (p < 0.0001) had a significantly higher OTS rate and Italy (p < 0.001) a significantly lower OTS rate compared to the overall OTS rate. b n = 668 due to missing values. c ‘BT only’ was the only treatment type with a significantly different OTS rate compared to the overall OTS rate (p = 0.006). BT behavioural therapy, LA long acting, MPH methylphenidate, Rx pharmacotherapy, SA short acting. ‘Other Rx’ included medications other than MPH, amphetamine, and atomoxetine; ‘No. of therapies’ denotes number of therapies (as per study definition) recorded on the patient’s chart
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4340973&req=5

Fig1: Characteristics associated with optimal treatment success. a Germany (p = 0.002) and the Netherlands (p < 0.0001) had a significantly higher OTS rate and Italy (p < 0.001) a significantly lower OTS rate compared to the overall OTS rate. b n = 668 due to missing values. c ‘BT only’ was the only treatment type with a significantly different OTS rate compared to the overall OTS rate (p = 0.006). BT behavioural therapy, LA long acting, MPH methylphenidate, Rx pharmacotherapy, SA short acting. ‘Other Rx’ included medications other than MPH, amphetamine, and atomoxetine; ‘No. of therapies’ denotes number of therapies (as per study definition) recorded on the patient’s chart
Mentions: There were significant differences in OTS rates by country (Fig. 1), with higher than average rates of 53 % (38/72) in the Netherlands (p < 0.0001) and 42 % (57/137) in Germany (p = 0.002) and a lower than average rate of 12 % (16/134) in Italy (p < 0.001). Other notable differences across countries included: (1) The Diagnostic and Statistical Manual of Mental Disorders 4th edition diagnostic approach was most commonly used in the Netherlands (81.1 %) and Spain (79.1 %), while the International Classification of Diseases 10th Revision was most common in Germany (87.4 %); (2) the UK had the highest rate of treatment with pharmacotherapy alone (63.7 %), while treatment with BT alone was most common in Italy (41.0 %). Over 54 % of patients in Italy used SA MPHs, while Spain did not report any use. Atomoxetine was most commonly used in Italy (36.7 %), but it was not available in France. SA amphetamines were not used in France or Spain, were used by less than 2 % of patients in Germany, the UK, and the Netherlands, and were most common in Italy (9.0 %); and (3) adherence to ADHD treatment ranged from 50.8 % in Italy to 80.3 % in France.Fig. 1

Bottom Line: They were also more likely to be adherent and engaged with treatment, with an explicit treatment goal to improve inattention/school performance.Neither core symptoms' severity nor treatment types were associated with OTS.Potentially modifiable factors affecting OTS were as follows: treatment adherence, treatment engagement, and a treatment goal to improve inattention/school performance.

View Article: PubMed Central - PubMed

Affiliation: Shire, 725 Chesterbrook Boulevard, Wayne, PA, 19087, USA, jsetyawan@shire.com.

ABSTRACT
We evaluated the association between those symptoms/behaviours of attention-deficit/hyperactivity disorder (ADHD) that were present at diagnosis and outcomes of treatment in children and adolescents in six European countries. Physicians abstracted clinical records from patients (6-17 years) diagnosed with ADHD between 2004 and 2007 and treated for ≥2 years. Physicians scored the severity of impairment for core ADHD symptoms and additional (non-core) ADHD symptoms/behaviours at diagnosis and estimated treatment adherence (defined as an estimated >80 % adherence on weekdays and >50 % adherence on weekends). Treatment modalities included pharmacological treatment, behavioural therapy, or both. Pharmacological treatment was further subclassified by medication class. The outcome, optimal treatment success (OTS), was defined as complete symptom control with high satisfaction with treatment. Multivariate logistic regression modelling examined the relationship between OTS and symptom impairment. Of 730 patients, 200 (27 %) achieved OTS. These patients were more likely to demonstrate lower impairment in non-core ADHD symptoms/behaviours and have fewer pre-existing comorbidities. They were also more likely to be adherent and engaged with treatment, with an explicit treatment goal to improve inattention/school performance. Neither core symptoms' severity nor treatment types were associated with OTS. OTS rates were low, with patients having less impairment of non-core ADHD symptoms/behaviours and fewer comorbidities more likely to achieve OTS. Potentially modifiable factors affecting OTS were as follows: treatment adherence, treatment engagement, and a treatment goal to improve inattention/school performance. These data suggest that there may be opportunities to optimize current treatment use, and develop new treatment strategies to improve core and non-core ADHD symptoms/behaviours.

Show MeSH
Related in: MedlinePlus