TY - JOUR
T1 - Considerations and evidence for an ADHD outcome measure
AU - Woods, Donna
AU - Wolraich, Mark
AU - Pierce, Karen
AU - Dimarco, Lindsay
AU - Muller, Nicole
AU - Sachdeva, Ramesh
N1 - Funding Information:
We acknowledge the valuable contributions of the many experts and staff who made this report possible. We particularly recognize the PMCoE ADHD Expert Workgroup for their clinical expertise, national perspective, and leadership. We thank all of the PMCoE ADHD Expert Workgroup members who have so generously given their time and contributed their expertise to this valuable work. We acknowledge and express our gratitude for the extremely valuable comments and perspective offered by Denise Dougherty, PhD, Christopher Forrest, MD, PhD, and Kamila Mistry, PhD, MPH in the presentation of our findings and the editing of this manuscript. We would like to acknowledge the contribution of Raymond Kang in providing statistical analytic support. Supported in part by the US Department of Health and Human Services Agency for Healthcare Research and Quality and Centers for Medicare & Medicaid Services, CHIPRA Pediatric Quality Measures Program Centers of Excellence under grant number U18-HS-20498 . The views expressed herein are those of the authors and do not necessarily represent that of the funding sources.
PY - 2014
Y1 - 2014
N2 - Objective The 2011 American Academy of Pediatrics attention-deficit/ hyperactivity disorder (ADHD) guideline emphasizes monitoring and measuring outcomes of children diagnosed with ADHD; however, recommendations for how to measure improvement are less clear. A long-term goal was to develop an outcome measure that assesses the quality of care for children with ADHD. As a first step in that process, we conducted a literature synthesis on the efficacy and effectiveness of guideline-recommended ADHD treatments on patient outcomes. Methods A literature search was conducted in PubMed according to PRISMA protocol and using MeSH terms. US Preventive Services Task Force (USPSTF) criteria were used to assess the level of evidence. Studies of interest were published after 2002 and assessed prospective ADHD improvement using recommended ADHD treatments. Results The systematic review resulted in 35 studies. According to USPSTF criteria, included studies were level I (n = 24), level II-1 (n = 1), and level II-2 (n = 10) and were rated as good (n = 20) or fair (n = 15). DSM-criteria-based rating scales were used most frequently to measure ADHD treatment outcomes. All included treatments resulted in ADHD improvement. Regardless of outcome measure, tool, or treatment type, symptom reduction and improvement were relatively large, with mean percentage reductions ranging from 20% to 86% on ADHD-Behavior Rating Scales scales, with only 1 study with <25% reduction. Effect sizes ranged from 0.15 to 4.57. Conclusions On the basis of this literature review, a consistent pattern of improvement in pediatric ADHD patients' core symptoms emerged across studies, study designs, and recommended treatment approaches. This evidence supports the notion that an improvement of core symptoms within 1 year could satisfy the requirements of an effective outcome measure, which should be further investigated.
AB - Objective The 2011 American Academy of Pediatrics attention-deficit/ hyperactivity disorder (ADHD) guideline emphasizes monitoring and measuring outcomes of children diagnosed with ADHD; however, recommendations for how to measure improvement are less clear. A long-term goal was to develop an outcome measure that assesses the quality of care for children with ADHD. As a first step in that process, we conducted a literature synthesis on the efficacy and effectiveness of guideline-recommended ADHD treatments on patient outcomes. Methods A literature search was conducted in PubMed according to PRISMA protocol and using MeSH terms. US Preventive Services Task Force (USPSTF) criteria were used to assess the level of evidence. Studies of interest were published after 2002 and assessed prospective ADHD improvement using recommended ADHD treatments. Results The systematic review resulted in 35 studies. According to USPSTF criteria, included studies were level I (n = 24), level II-1 (n = 1), and level II-2 (n = 10) and were rated as good (n = 20) or fair (n = 15). DSM-criteria-based rating scales were used most frequently to measure ADHD treatment outcomes. All included treatments resulted in ADHD improvement. Regardless of outcome measure, tool, or treatment type, symptom reduction and improvement were relatively large, with mean percentage reductions ranging from 20% to 86% on ADHD-Behavior Rating Scales scales, with only 1 study with <25% reduction. Effect sizes ranged from 0.15 to 4.57. Conclusions On the basis of this literature review, a consistent pattern of improvement in pediatric ADHD patients' core symptoms emerged across studies, study designs, and recommended treatment approaches. This evidence supports the notion that an improvement of core symptoms within 1 year could satisfy the requirements of an effective outcome measure, which should be further investigated.
KW - attention-deficit/hyperactivity disorder
KW - mental health
KW - outcome measures
KW - pediatrics
KW - quality of health care
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U2 - 10.1016/j.acap.2014.06.011
DO - 10.1016/j.acap.2014.06.011
M3 - Article
C2 - 25169459
AN - SCOPUS:84906888551
SN - 1876-2859
VL - 14
SP - S54-S60
JO - Academic Pediatrics
JF - Academic Pediatrics
IS - 5 SUPPL.
ER -
