ADHD Child Journal Club

 
1: Aust N Z J Psychiatry. 2005 May;39(5):354-8.  

What is a clinically important level of improvement in symptoms of attention-deficit/hyperactivity disorder?

Hazell P, Lewin T, Sly K.

Objective: To compare the desired and actual reduction in scores on a parent reported behaviour rating scale in a naturalistic sample of children and adolescents who had been treated with psychostimulant medication, referenced to global ratings of treatment benefit. Method: Forty-five parents reporting poor global response to psychostimulant treatment, 44 reporting moderate response, and 49 reporting a high response retrospectively completed Conners rating scales describing their child prior to treatment, the child currently, and how the parent hoped the child would be following treatment. Results: Percentage actual improvement in behaviour rating scales from baseline ranged from around 25% for the poor responders to above 50% for the high responders. Desired improvement was above 50%, with no significant difference between the groups on level of expectation. Conclusions: Percentage cut points used to indicate clinical improvement reported in previous controlled trials of psychostimulant medication are probably too low, and could lead to an overestimate of treatment effect. Expectation of treatment benefit is unlikely to contribute to variation in treatment response.

PMID: 15860022 [PubMed - in process]
2: Community Pract. 2005 Apr;78(4):129-32.  

ADHD: assessment and intervention.

Shah M, Cork C, Chowdhury U.

Bedfordshire & Luton Community NHS Trust.

Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common psychiatric disorders of childhood. Although there is a lot of debate and controversy over the recognition of ADHD, it is generally accepted nowadays as a clinical disorder that may warrant treatment Children with ADHD are pervasively overactive, fidgety and disruptive. They have impaired attention and concentration and are impulsive. These symptoms have serious implications for the child's relationships with parents, siblings and peers. It is important that community practitioners, school nurses, health visitors and other health professionals are able to recognise the condition and be able to make an informed clinical assessment and refer and manage accordingly. The assessment should include a clear history from parents, a school report and an individual interview with the child. An assessment of parental management is essential to avoid the child being wrongly diagnosed with the condition. The successful intervention should be aimed at educating the child and family about the disorder and psychosocial interventions that may help the family and school cope with the child. In some cases introduction of medication may be necessary.

PMID: 15875600 [PubMed - in process]
 
3: Clinical practice. Attention deficit-hyperactivity disorder. 

The New England Journal of Medicine, Volume 352:165-173, January 13, 2005, Number 2
Marsha D. Rappley, MD.
Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, East Lansing, MI 48824, USA. rappley@msu.edu
PMID: 15647579 [PubMed - in process]

"A mother brings in her eight-year-old son for evaluation after he is suspended from riding the school bus for jumping out of his seat, teasing other children, and not following directions. He spends two to three hours a night with homework that he never successfully completes. His mother wants to know whether he has attention deficit–hyperactivity disorder. How should he be evaluated . . . "[Full Text of this Article]

4: Assessment and treatment of attention deficit hyperactivity disorder in children with comorbid psychiatric illness.  
Current Opinion in Pediatrics 2003, 15:476-482
Waxmonsky J.
State University of New York at Buffalo, Department of Psychiatry, USA.
Correspondence: James Waxmonsky, Children's Hospital of Buffalo, Dept. of Child Psychiatry,
888 Delaware Rd. NY 14209, USA
jgw@buffalo.edu

PURPOSE OF REVIEW: Attention deficit hyperactivity disorder (ADHD) frequently occurs with a wide variety of comorbid psychiatric disorders such as conduct disorder, depression, mania, anxiety, and learning disabilities. Because the vast majority of children with ADHD are treated in primary care settings, it is important that primary medical doctors be proficient in the diagnosis and initial treatment of children with ADHD and its commonly occurring comorbid disorders. ADHD research is beginning to focus on the treatment of these comorbidly ill children. This review will summarize the recent findings from the psychiatric literature in an attempt to provide the clinician with some initial diagnostic and treatment guidelines for ADHD and its comorbidities.
RECENT FINDINGS: The NIMH Multimodal Treatment Study of ADHD found that children with other disruptive behavior disorders plus ADHD respond well to stimulant medications, with behavioral interventions reducing academic and social impairment. Children with anxiety and ADHD are very responsive across multiple dimensions to behavioral and pharmacological ADHD treatments. Much less is known about the impact of depression on ADHD, and significant debate exists surrounding the identification and treatment of bipolar disorder in children with ADHD. Children with learning disabilities respond well to stimulants but often require additional educational supports. New findings suggest that treating ADHD may prevent the development of future psychiatric disorders.
SUMMARY: The presence of comorbid illness is associated with significant additional morbidity and complicates the diagnosis, treatment, and prognosis of ADHD. Therefore, it is important to identify and treat any comorbid psychiatric conditions in a child with ADHD.
PMID: 14508296 [PubMed - indexed for MEDLINE]
 

par
Claude Jolicoeur. m.d.