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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.

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Related in: MedlinePlus

Psychiatric comorbidities present at ADHD diagnosis. *p < 0.05. ADHD attention-deficit/hyperactivity disorder, Behavioural Dis behavioural disturbances, Learning Dis learning disabilities, OCD obsessive compulsive disorder, ODD oppositional defiance disorder, SD standard deviation
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Fig4: Psychiatric comorbidities present at ADHD diagnosis. *p < 0.05. ADHD attention-deficit/hyperactivity disorder, Behavioural Dis behavioural disturbances, Learning Dis learning disabilities, OCD obsessive compulsive disorder, ODD oppositional defiance disorder, SD standard deviation

Mentions: Most of the patients (77 %) had at least one psychiatric or developmental comorbidity. Figure 4 describes the proportion of patients with each of the documented comorbidities by OTS group. The mean number of pre-existing comorbidities was significantly lower in the patients who experienced OTS (2.1 vs 3.0, p < 0.0001). Non-OTS patients were more likely to present with autism spectrum disorder (p = 0.015), aggression (p < 0.0001), OCD (p = 0.029), insomnia/sleep disturbances (p = 0.001), behavioural disorder (p = 0.005), Tourette syndrome/tic disorder (p < 0.001), learning disabilities (p < 0.001), and epilepsy (p = 0.033) compared with patients who achieved OTS.Fig. 4


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)

Psychiatric comorbidities present at ADHD diagnosis. *p < 0.05. ADHD attention-deficit/hyperactivity disorder, Behavioural Dis behavioural disturbances, Learning Dis learning disabilities, OCD obsessive compulsive disorder, ODD oppositional defiance disorder, SD standard deviation
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig4: Psychiatric comorbidities present at ADHD diagnosis. *p < 0.05. ADHD attention-deficit/hyperactivity disorder, Behavioural Dis behavioural disturbances, Learning Dis learning disabilities, OCD obsessive compulsive disorder, ODD oppositional defiance disorder, SD standard deviation
Mentions: Most of the patients (77 %) had at least one psychiatric or developmental comorbidity. Figure 4 describes the proportion of patients with each of the documented comorbidities by OTS group. The mean number of pre-existing comorbidities was significantly lower in the patients who experienced OTS (2.1 vs 3.0, p < 0.0001). Non-OTS patients were more likely to present with autism spectrum disorder (p = 0.015), aggression (p < 0.0001), OCD (p = 0.029), insomnia/sleep disturbances (p = 0.001), behavioural disorder (p = 0.005), Tourette syndrome/tic disorder (p < 0.001), learning disabilities (p < 0.001), and epilepsy (p = 0.033) compared with patients who achieved OTS.Fig. 4

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