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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

Estimated probabilities of optimal treatment success by non-core symptoms impairment average, level of patient engagement, adherence to treatment, and inattention improvement as treatment goal. Estimated probabilities from multiple logistic regression model for patients from Germany (as the reference country) not presenting with autism or Tourette syndrome. High and low patient engagement levels were defined as 5 (25th percentile) and 8 (75th percentile), respectively. Pt patient
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Fig5: Estimated probabilities of optimal treatment success by non-core symptoms impairment average, level of patient engagement, adherence to treatment, and inattention improvement as treatment goal. Estimated probabilities from multiple logistic regression model for patients from Germany (as the reference country) not presenting with autism or Tourette syndrome. High and low patient engagement levels were defined as 5 (25th percentile) and 8 (75th percentile), respectively. Pt patient

Mentions: Figure 5 illustrates the model outcome, OTS, by the aggregated non-core symptom impairment score for eight examples of hypothetical patients based on model predictor combinations. This figure can be used to estimate the probability of OTS by average non-core symptom impairment level, given different combinations of patient engagement levels, adherence to treatment, and the treatment goal to improve attention. Patients in Germany who did not present with autism spectrum disorder or Tourette syndrome/tic disorder at diagnosis were used as representative fixed values for all sample-estimated probability curves, and low and high patient engagement levels were fixed at 5 (25th percentile) and 8 (75th percentile), respectively.Fig. 5


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)

Estimated probabilities of optimal treatment success by non-core symptoms impairment average, level of patient engagement, adherence to treatment, and inattention improvement as treatment goal. Estimated probabilities from multiple logistic regression model for patients from Germany (as the reference country) not presenting with autism or Tourette syndrome. High and low patient engagement levels were defined as 5 (25th percentile) and 8 (75th percentile), respectively. Pt patient
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig5: Estimated probabilities of optimal treatment success by non-core symptoms impairment average, level of patient engagement, adherence to treatment, and inattention improvement as treatment goal. Estimated probabilities from multiple logistic regression model for patients from Germany (as the reference country) not presenting with autism or Tourette syndrome. High and low patient engagement levels were defined as 5 (25th percentile) and 8 (75th percentile), respectively. Pt patient
Mentions: Figure 5 illustrates the model outcome, OTS, by the aggregated non-core symptom impairment score for eight examples of hypothetical patients based on model predictor combinations. This figure can be used to estimate the probability of OTS by average non-core symptom impairment level, given different combinations of patient engagement levels, adherence to treatment, and the treatment goal to improve attention. Patients in Germany who did not present with autism spectrum disorder or Tourette syndrome/tic disorder at diagnosis were used as representative fixed values for all sample-estimated probability curves, and low and high patient engagement levels were fixed at 5 (25th percentile) and 8 (75th percentile), respectively.Fig. 5

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