Can Parent Reports Serve as a Proxy for Teacher Ratings in Medication Management of Attention-Deficit Hyperactivity Disorder? Use of an Internet Portal to Improve Community-Based Pediatric ADHD Care: A Cluster Randomized Trial Computer-Assisted Management of Attention-Deficit/Hyperactivity Disorder Atomoxetine treatment in children and adolescents with attention-deficit hyperactivity disorder: what are the long-term health-related quality-of-life outcomes? Stimulant treatment in children with attention-deficit/hyperactivity disorder moderates adolescent academic outcome. Effect of supplementation with long-chain ω-3 polyunsaturated fatty acids on behavior and cognition in children with attention deficit/hyperactivity disorder (ADHD): a randomized placebo-controlled intervention trial. Effectiveness and cost-effectiveness of a brief school-based group programme for parents of children at risk of ADHD: a cluster randomised controlled trial. Improving attention-deficit/hyperactivity disorder treatment outcomes through use of a collaborative consultation treatment service by community-based pediatricians: a cluster randomized trial. Preliminary data suggesting the efficacy of attention training for school-aged children with ADHD The effects of L-theanine (Suntheanine®) on objective sleep quality in boys with attention deficit hyperactivity disorder (ADHD): a randomized, double-blind, placebo-controlled clinical trial. Do pediatricians think they are responsible for identification and management of child mental health problems? Results of the AAP periodic survey. Acute impact of immediate release methylphenidate administered three times a day on sleep in children with attention-deficit/hyperactivity disorder. Impact of comorbid autism spectrum disorders on stimulant response in children with attention deficit hyperactivity disorder: a retrospective and prospective effectiveness study. Variability in ADHD Care in Community-Based Pediatrics The Link Between Health-Related Quality of Life and Clinical Symptoms Among Children with Attention-Deficit Hyperactivity Disorder Treatment of Children With Attention-Deficit/Hyperactivity Disorder (ADHD) and Irritability: Results From the Multimodal Treatment Study of Children With ADHD (MTA) Long-term effectiveness and safety of lisdexamfetamine dimesylate in school-aged children with attention-deficit/hyperactivity disorder. Collaborative Care Outcomes for Pediatric Behavioral Health Problems: A Cluster Randomized Trial Aripiprazole in children with attention-deficit/hyperactivity disorder. Childhood predictors of adolescent substance use in a longitudinal study of children with ADHD. A Waitlist-Controlled Trial of Behavioral Parent Training for Fathers of Children with ADHD Development and preliminary evaluation of an integrated treatment targeting parenting and depressive symptoms in mothers of children with attention-deficit/hyperactivity disorder. Atomoxetine in the Management of Children with ADHD: Effects on Quality of Life and School Functioning
Objective : While American Academy of Pediatrics guidelines recommend obtaining symptom reports from both parents and teachers when treating children with attention-deficit hyperactivity disorder ( ADHD ) , information from parents is easier to obtain and practitioners may prefer to rely solely on parent report when managing medications . There are , however , few empirical data on the relationship between parent and teacher reports during medication management of ADHD . This study examined the relationship between parent and teacher reports of symptoms of ADHD during a clinical trial . Methods : A study to improve medication management of ADHD was conducted in 24 pediatric practice s with 270 children . Children meeting criteria for ADHD were r and omized by practice to treatment-as-usual or specialized care groups , with data combined from the groups to examine parent-teacher agreement . Parent and teacher reports on the ADHD Rating Scale-IV  were obtained at pretreatment , 4 months , and 12 months follow-up . Results : At each assessment , correlations between parent and teacher ratings were statistically significant , but the magnitudes of the correlations were low , accounting for no more than approximately 17 % of the variance between measures . Correlations between change scores on parent and teacher ratings were statistically significant but low for Total and Inattentive scales and not significant for the Hyperactive-Impulsive scale . For agreement on extreme scores , 6 of 9 kappas were statistically significant but all were unacceptably low . Conclusions : Agreement between parent and teacher ratings of symptoms of ADHD is too low for clinicians to rely on parent reports while managing medications . Teacher reports are still needed to ensure optimal management OBJECTIVE : To determine the effectiveness of a quality improvement program to improve pediatricians ' adherence to existing , evidence -based , attention-deficit/hyperactivity disorder ( ADHD ) practice guidelines . METHODS : Forty-nine community-based pediatricians at 8 practice s participated in a cluster-r and omized trial . Practice s were matched according to the numbers of pediatricians and the proportions of patients receiving Medicaid . The medical charts for a r and om sample of patients with ADHD for each of the participating pediatricians were examined at baseline and 6 months . All practice s participated in 4 sessions of training , including didactic lectures and office flow modification workshops . Practice s were then given access to an ADHD Internet portal that allowed parents , teachers , and pediatricians to input information ( eg , rating scales ) about patients , after which information was scored , interpreted , and formatted in a report style that was helpful for assessment and treatment of patients with ADHD . Physicians evaluated their practice behaviors quarterly and addressed underperforming areas . RESULTS : Pediatricians in the intervention group , compared with those in the control group , demonstrated significantly higher rates of many American Academy of Pediatrics – recommended ADHD care practice s , including collection of parent ( Cohen 's d = 0.69 ) and teacher ( d = 0.68 ) rating scales for assessment of children with ADHD , use of Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition , criteria ( d = 0.85 ) , and use of teacher rating scales to monitor treatment responses ( d = 1.01 ) . CONCLUSION : A quality improvement intervention that can be widely disseminated by using Internet-based information technology significantly improved the quality of ADHD care in community-based pediatric setting OBJECTIVES : Medication management of attention-deficit/hyperactivity disorder ( ADHD ) is often suboptimal . We examined whether ( 1 ) brief physician training plus computer-assisted medication management led to greater reduction in ADHD symptoms and ( 2 ) adherence to the recommended titration protocol produced greater symptomatic improvement . METHODS : A r and omized medication trial was conducted that included 24 pediatric practice s. Children who met criteria for ADHD were r and omly assigned by practice to treatment-as-usual or a specialized care group in which physicians received 2 hours of didactic training on medication management of ADHD plus training on a software program to assist in monitoring improvement . Parent and teacher reports were obtained before treatment and 4 , 9 , and 12 months after starting medication . RESULTS : Children in both specialized care and treatment-as-usual groups improved on the ADHD Rating Scales and SNAP-IV , but there were no group differences in improvement rates . Brief physician training alone did not produce improvements . When recommended titration procedures were followed , however , outcomes were better for total and inattentive ADHD symptoms on both the ADHD Rating Scales and SNAP-IV parent and teacher scales . Results were not attributable to discontinuation because of adverse effects or failure to find an effective medication dose . CONCLUSIONS : Brief physician training alone did not lead to reductions in ADHD symptoms , but adherence to a protocol that involved titration until the child 's symptoms were in the average range and had shown a reliable change led to better symptom reduction . Computer-assisted medication management can contribute to better treatment outcomes in primary care medication treatment of ADHD OBJECTIVE Numerous investigations have examined the efficacy of pharmacological treatment for attention-deficit/hyperactivity disorder ( ADHD ) in children . However , relatively few studies have addressed the impact of treatment on long-term subjective , psychosocial outcomes , such as health-related quality of life ( HRQL ) . This study examines the long-term effects of pharmacological treatment with atomoxetine on HRQL in children and adolescents with ADHD . METHODS Participants included 6- to 17-year-old children and adolescents ( n = 912 ) with ADHD enrolled in a 24-month , multicenter , open-label trial of atomoxetine . Outcomes included clinician ratings of ADHD , parent ratings of ADHD , and a widely used measure of HRQL ( The Child Health Question naire ( CHQ ) ) . Treatment response rates were calculated based on a CHQ improvement of at least 1 st and ard error of measurement . RESULTS Significant improvements in HRQL were found following both acute and long-term treatment for psychosocial but not physical health . Of participants who completed treatment ( n = 312 or 34.2 % of those enrolled ) , 81 % responded to acute treatment and 78 % responded to long-term treatment . Improvements noted after acute treatment were maintained during long-term treatment with the majority of participants ( 86 % ) continuing to respond to treatment . CONCLUSIONS Atomoxetine is associated with improvements in HRQL , and the improvements are generally stable over time Treatment with psychostimulant medication has been shown to improve scholastic functioning in children with attention-deficit/hyperactivity disorder ( ADHD ) . However , the extent to which long-term academic gains are apparent in those having received such treatment remains elusive . This study examined prospect ively the relationship of childhood stimulant treatment to academic functioning during adolescence . Children ( n = 169 ) were initially recruited and diagnosed with ADHD when they were 7 - 11 years old . A sub sample of those with childhood ADHD ( n = 90 ) was reevaluated on average 9.13 ( SD = 1.5 ) years later . Prob and s who did and did not receive treatment with stimulant medication were compared to each other and to a never-ADHD comparison group ( n = 80 ) on three subtests from the Wechsler Individual Achievement Test-II ( WIAT-II ) , as well as high school grade point average ( GPA ) and number of retentions in school as derived from school records . Analyses of covariance controlling for severity of childhood ADHD symptoms indicated that prob and s treated with psychostimulant medication achieved better academic outcomes , as measured by WIAT-II subtests and high school GPA , than those not treated with psychostimulants ( p < .05 ) . However , treated prob and s did not fare as well as the never-ADHD comparison group . Psychostimulant treatment for children with ADHD may benefit long-term adolescent academic performance , although the extent of improvement is likely to vary as a function of multiple factors OBJECTIVE To determine whether supplementation with the long-chain omega-3 polyunsaturated fatty acids eicosapentaenoic ( EPA ) and docosahexaenoic acid ( DHA ) affects behavioral symptoms and cognitive impairments in children 6 - 12 years of age diagnosed with attention-deficit/hyperactivity disorder ( ADHD ) . STUDY DESIGN The r and omized , double-blind placebo-controlled 16 weeks trial was conducted with 95 children diagnosed with ADHD according to DSM-IV criteria . Behavior was assessed by parents , teachers and investigators using st and ardized rating scales and question naires . Further outcome variables were working memory , speed of information processing and various measures of attention . For a subgroup of 81 participants , erythrocyte membrane fatty acid composition was analyzed before and after the intervention . RESULTS Supplementation with the omega-3 fatty acid mix increased EPA and DHA concentrations in erythrocyte membranes and improved working memory function , but had no effect on other cognitive measures and parent- and teacher-rated behavior in the study population . Improved working memory correlated significantly with increased EPA , DHA and decreased AA ( arachidonic acid ) BACKGROUND National Institute for Health and Care Excellence guidelines recommend a stepped care approach for the identification and management of children with , or at risk of , attention-deficit/hyperactivity disorder ( ADHD ) . We investigated the effectiveness , cost-effectiveness and acceptability of a group parenting intervention programme ( + /- a teacher session ) for children at risk of ADHD . METHODS In a three-arm cluster r and omised controlled trial , 12 primary schools were r and omly assigned to  control , parent-only and combined ( parent + teacher ) intervention arms . Eligible children had high levels of parent-rated hyperactivity/inattention ( n = 199 ) . At 6 month follow-up , the primary outcome measure was the parent-completed Conners ' Rating Scale - Revised ( ADHD index ) . Secondary outcomes included the Conners ' sub-scales ( hyperactivity , cognitive problems/inattention and oppositional behaviour ) , the teacher-completed Conners ' Rating Scale - Revised , child health-related quality of life , parental burden and parental mental health . The cost-effectiveness analyses reflected a health and personal social services perspective . TRIAL REGISTRATION IS RCT N87634685 . RESULTS Follow-up data were obtained from 76 parents and 169 teachers . There was no effect of the parent-only ( mean difference = -1.1 , 95 % CI -5.1,2.9 ; p = 0.57 ) or combined interventions ( mean difference = -2.1 , 95 % CI -6.4,2.1 ; p = 0.31 ) on the ADHD index . The combined intervention was associated with reduced parent-reported hyperactivity symptoms ( mean difference = -5.3 ; 95 % CI -10.5,-0.01 ; p = 0.05 ) and the parent-only intervention with improved parental mental health ( mean difference = -1.9 ; 95 % CI -3.2,-0.5 ; p = 0.009 ) . The incremental costs of the parent-only and the combined interventions were £ 73 and £ 123 , respectively . Above a willingness-to-pay of £ 31 per one-point improvement in the ADHD index , the parent-only programme had the highest probability of cost-effectiveness . Participants found the interventions acceptable . CONCLUSIONS For children at risk of ADHD , this school-based parenting programme was not associated with improvement in core ADHD symptoms . Secondary analyses suggested a possible reduction in parent-reported hyperactivity and parental mental health problems . Future research should compare targeted interventions against watchful waiting and specialist referral OBJECTIVE To test whether adoption of a collaborative consultative service model results in improved patient outcomes . DESIGN Twelve pediatric practice s were r and omly assigned to receive access to collaborative consultative services or to a control group . SETTING Community-based pediatric offices . PARTICIPANTS Fifty-two pediatricians and their 377 patients with attention-deficit/hyperactivity disorder ( ADHD ) . Intervention A collaborative consultative service promoting the use of titration trials and periodic monitoring during medication maintenance . Main Outcome Measure Physician practice behaviors and child ADHD symptomatology . RESULTS Using self-report of pediatricians , the collaborative consultative service increased the use of evidence -based practice s by pediatricians , but no difference in children 's ADHD symptomatology was observed between the groups . However , many pediatricians did not fully use the collaborative consultative services . Those children who actually received collaborative consultative services showed significant behavioral improvement compared with children not receiving these services . CONCLUSIONS When actually implemented by pediatricians , the collaborative consultative service appears to be an effective method for facilitating evidence -based treatment procedures for ADHD and use of these procedures appear to improve children 's outcomes . Barriers to implementation of collaborative consultative service in pediatric practice need to be further understood A pilot r and omized clinical trial was conducted to examine the initial efficacy of Pay Attention ! , an intervention training sustained , selective , alternating , and divided attention , in children diagnosed with Attention-Deficit/Hyperactivity Disorder ( ADHD ) . After a diagnostic and baseline evaluation , school-aged children with ADHD were r and omized to receive 16 bi-weekly sessions of Pay Attention ! ( n=54 ) or to a waitlist control group ( n=51 ) . Participants completed an outcome evaluation approximately 12 weeks after their baseline evaluation . Results showed significant treatment effects for parent and clinician ratings of ADHD symptoms , child self-report of ability to focus , and parent ratings of executive functioning . Child performance on neuropsychological tests showed significant treatment-related improvement on strategic planning efficiency , but no treatment effects were observed on other neuropsychological outcomes . Treatment effects were also not observed for teacher ratings of ADHD . These data add to a growing body of literature supporting effects of cognitive training on attention and behavior , however , additional research is warranted INTRODUCTION The purpose of this study was to investigate the efficacy and safety of L-theanine as an aid to the improvement of objective ly measured sleep quality in a population of 98 male children formally diagnosed with attention-deficit/hyperactivity disorder ( ADHD ) . METHODS A r and omized , double-blind , placebo-controlled trial was conducted involving boys , ages 8 - 12 years , who had been previously diagnosed with ADHD . An experienced physician confirmed the diagnosis of ADHD in each subject . R and omization was stratified based upon current use of stimulant medication to ensure an equal distribution of stimulant/non-stimulant treated subjects into active and placebo treated groups . Participants consumed two chewable tablets twice daily ( at breakfast and after school ) , with each tablet containing 100 mg of L-theanine ( total 400 mg daily Suntheanine ® , Taiyo Kagaku , Yokkaichi , Japan ) or identical tasting chewable placebo for six weeks . Subjects were evaluated for five consecutive nights using wrist actigraphy at baseline , and again at the end of the six-week treatment period . The Pediatric Sleep Question naire ( PSQ ) was completed by parents at baseline and at the end of the treatment period . RESULTS Actigraph watch data findings indicated that boys who consumed L-theanine obtained significantly higher sleep percentage and sleep efficiency scores , along with a non-significant trend for less activity during sleep ( defined as less time awake after sleep onset ) compared to those in the placebo group . Sleep latency and other sleep parameters were unchanged . The PSQ data did not correlate significantly to the objective data gathered from actigraphy , suggesting that parents were not particularly aware of their children 's sleep quality . L-theanine at relatively high doses was well tolerated with no significant adverse events . CONCLUSIONS This study demonstrates that 400 mg daily of L-theanine is safe and effective in improving some aspects of sleep quality in boys diagnosed with ADHD . Since sleep problems are a common co-morbidity associated with ADHD , and because disturbed sleep may be linked etiologically to this disorder , L-theanine may represent a safe and important adjunctive therapy in childhood ADHD . Larger , long-term studies looking at the wider therapeutic role of this agent in this population are warranted OBJECTIVE Childhood psychosocial problems have profound effects on development , functioning , and long-term mental health . The pediatrician is often the only health professional who regularly comes in contact with young children , and it is recommended that health care supervision should include care of behavioral and emotional issues . However , it is unknown whether pediatricians believe they should be responsible for this aspect of care . Our objective was to report the proportion of physicians who agree that pediatricians should be responsible for identifying , treating/managing , and referring a range of behavioral issues in their practice s , and to examine the personal physician and practice characteristics associated with agreeing that pediatricians should be responsible for treating/managing 7 behavioral issues . METHODS The 59th Periodic Survey of members of the American Academy of Pediatrics was sent to a r and om sample of 1600 members . The data that are presented are based on the responses of 659 members in current practice and no longer in training who completed the attitude questions . RESULTS More than 80 % of respondents agreed that pediatricians should be responsible for identification , especially for attention-deficit/hyperactivity disorder ( ADHD ) , eating disorders , child depression , child substance abuse , and behavior problems . In contrast , only 59 % agreed that pediatricians were responsible for identifying learning problems . Seventy percent thought that pediatricians should treat/manage ADHD ; but for other conditions , most thought that their responsibility should be to refer . Few factors were consistently associated with higher odds of agreement that pediatricians should be responsible for treating/managing these problems , except for not spending their professional time exclusively in general pediatrics . CONCLUSIONS These data suggest that pediatricians think that they should identify patients for mental health issues , but less than one-third agreed that it is their responsibility to treat/manage such problems , except for children with ADHD . Those not working exclusively in general pediatrics were more likely to agree that pediatricians should be responsible for treating and managing children 's mental health problems OBJECTIVE To determine the impact of immediate release Ritalin , given three times a day , on sleep quality and quantity in medication-naïve , newly diagnosed children with attention-deficit/hyperactivity disorder ( ADHD ) . METHODS Children ( aged 6 - 12 ) rigorously diagnosed with ADHD ( n = 21 ) underwent multiple measurement assessment s ( i.e. , actigraphy , sleep diary , and question naires ) during a 1-week baseline and then during a 3-week blinded r and omized medication trial . RESULTS Although the medication was effective in reducing ADHD symptoms , analyses of actigraphy and sleep diary data found statistically and clinical ly significant changes in the children 's total sleep time and sleep onset latency in the medication compared to the no medication conditions . No effects on sleep were found based on the sleep question naire . CONCLUSIONS Physicians and parents are encouraged to closely monitor children 's sleep when treating ADHD with stimulant medication BACKGROUND In the recent past , psychiatrists and paediatricians have avoided prescribing stimulant medication , such as methylpheni date and dexamphetamine to patients with autism spectrum disorders ( ASD ) because of both doubts about efficacy and concern that these medications make stereotypies worse . Recently , a number of small trials have suggested that methypheni date does have a role in the management of hyperactivity in children with autistic spectrum disorders . METHODS Children with ASD and attention deficit hyperactivity disorder ( ADHD ) , and children with ADHD without ASD received st and ard treatment with methypheni date from one specialist centre . A combination of st and ardized and novel outcome tools was used to allow both an exploratory retrospective study of 174 children and then a prospect i ve study of a further 52 children to be carried out . RESULTS After treatment with stimulants , the subjects in both groups showed statistically significant improvements in target symptoms of ' hyperactivity ' , ' impulsivity ' , ' inattention ' , ' oppositionality ' , ' aggression ' and ' intermittent explosive rage ' . The Clinical Global Impression-Improvement and efficacy index measures also improved in each group . In both the retrospective and the prospect i ve studies , there was no statistically significant difference in the degree of improvements between each group . Importantly , neither tics nor repetitive behaviours worsened in either group . Children in the ' ADHD-only ' group who were prescribed stimulants experienced significant ' nausea ' , ' giddiness ' , ' headaches ' and ' sleep difficulties ' , whereas sleep difficulties were the only side effect that emerged in children in the ASD with ADHD group . CONCLUSIONS Both studies presented here support previous findings from smaller studies that show children with autism and ADHD can respond as well to stimulants as children with ADHD alone . Although r and omized controlled trials remain the gold st and ard for efficacy studies , systems like this that allow clinicians to continue rigorous and consistent monitoring for many years have a valuable role to play . Furthermore , such monitoring systems which now exist electronically can easily accumulate large data sets and reveal details about long-term effectiveness and long-term side effects of medication that are unlikely to be discovered in short-term trials BACKGROUND : Although many efforts have been made to improve the quality of care delivered to children with attention-deficit/hyperactivity disorder ( ADHD ) in community-based pediatric setting s , little is known about typical ADHD care in these setting s other than rates garnered through pediatrician self-report . METHODS : Rates of evidence -based ADHD care and sources of variability ( practice -level , pediatrician-level , patient-level ) were determined by chart review s of a r and om sample of 1594 patient charts across 188 pediatricians at 50 different practice s. In addition , the associations of Medicaid-status and practice setting ( ie , urban , suburban , and rural ) with the quality of ADHD care were examined . RESULTS :  Parent- and teacher-rating scales were used during ADHD assessment with approximately half of patients . The use of Diagnostic and Statistical Manual of Mental Disorders criteria was documented in 70.4 % of patients . The vast majority ( 93.4 % ) of patients with ADHD were receiving medication and only 13.0 % were receiving psychosocial treatment .  Parent- and teacher-ratings were rarely collected to monitor treatment response or side effects . Further , fewer than half ( 47.4 % ) of children prescribed medication had contact with their pediatrician within the first month of prescribing . Most variability in pediatrician-delivered ADHD care was accounted for at the patient level ; however , pediatricians and practice s also accounted for significant variability on specific ADHD care behaviors . CONCLUSIONS : There is great need to improve the quality of ADHD care received by children in community-based pediatric setting s. Improvements will likely require systematic interventions at the practice and policy levels to promote change ABSTRACT . Clinical research on attention-deficit hyperactivity disorder ( ADHD ) has begun to integrate measures of health-related quality of life ( HRQL ) as part of the overall assessment of treatment outcomes . This study examines the association between HRQL and measures of clinical symptoms of ADHD . Data were gathered from 297 children and adolescents in an 8-week , r and omized , double-blind , placebo-controlled , clinical trial of atomoxetine treatment for ADHD . HRQL was assessed with the Child Health Question naire 50-item Parent Form . ADHD symptoms were assessed with the ADHD Rating Scale-IV ; Parent Version and Clinical Global Impressions-ADHD-Severity . Associations between HRQL and clinical symptoms were assessed with correlations , analyses of variance with post hoc comparisons , and t tests . The Child Health Question naire 50-item Parent Form scales assessing psychosocial domains of HRQL were significantly negatively correlated with clinical measures . Improvement in clinical symptoms was associated with corresponding improvement in psychosocial aspects of HRQL . The findings suggest that HRQL instruments can add important information to efficacy measures in clinical trials of ADHD treatment Objective Clinical ly impairing irritability affects 25 % to 45 % of children with attention-deficit/hyperactivity disorder ( ADHD ) ; yet , we know little about what interventions are effective in treating children with ADHD and co-occurring irritability . We used data from the Multimodal Treatment Study of Children With ADHD ( MTA ) to address 3 aims : to establish whether irritability in children with ADHD can be distinguished from other symptoms of oppositional defiant disorder ( ODD ) ; to examine whether ADHD treatment is effective in treating irritability ; and to examine how irritability influences ADHD treatment outcomes . Method Secondary analyses of data from the MTA included multivariate analyses , and intent-to-treat r and om-effects regression models were used . Results Irritability was separable from other ODD symptoms . For treating irritability , systematic stimulant treatment was superior to behavioral management but not to routine community care ; a combination of stimulants and behavioral treatment was superior to community care and to behavioral treatment alone , but not to medication alone . Irritability did not moderate the impact of treatment on parent- and teacher-reported ADHD symptoms in any of the 4 treatment groups . Conclusion Treatments targeting ADHD symptoms are helpful for improving irritability in children with ADHD . Moreover , irritability does not appear to influence the response to treatment of ADHD . Clinical trial registration information Multimodal Treatment Study of Children With Attention Deficit and Hyperactivity Disorder ( MTA ) ; http://www . clinical trials.gov ; NCT00000388 INTRODUCTION Lisdexamfetamine dimesylate ( LDX ) , a prodrug stimulant , is indicated for attention-deficit/hyperactivity disorder ( ADHD ) in children 6 - 12 years of age and in adults . In short-term studies , once-daily LDX provided efficacy throughout the day . This study presented here was conducted to assess the long-term safety , tolerability , and effectiveness of LDX in 6- to 12-year-olds with ADHD . METHODS This open-label , multicenter , single-arm study enrolled children with Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition-Text Revision criteria for ADHD . Following 1-week screening and washout periods , subjects were titrated to LDX 30 , 50 , or 70 mg/day over 4 weeks and placed on maintenance treatment for 11 months . The ADHD Rating Scale and Clinical Global Impression-Improvement scale measured effectiveness . RESULTS Of 272 subjects receiving LDX , 147 completed the study . Most adverse events were mild to moderate and occurred during the first 4 weeks . There were no clinical ly meaningful changes in blood pressure or electrocardiographic parameters . From baseline to endpoint , mean ADHD Rating Scale scores improved by 27.2 points ( P<.0001 ) . Improvements occurred during each of the first 4 weeks , and were maintained throughout . Based on Clinical Global Impression-Improvement scale scores , > 80 % of subjects at endpoint and > 95 % of completers at 12 months were rated " improved . " CONCLUSION Long-term 30 , 50 , and 70 mg/day LDX was generally well tolerated and effective in children with ADHD OBJECTIVE : To assess the efficacy of collaborative care for behavior problems , attention-deficit/hyperactivity disorder ( ADHD ) , and anxiety in pediatric primary care ( Doctor Office Collaborative Care ; DOCC ) . METHODS : Children and their caregivers participated from 8 pediatric practice s that were cluster r and omized to DOCC ( n = 160 ) or enhanced usual care ( EUC ; n = 161 ) . In DOCC , a care manager delivered a personalized , evidence -based intervention . EUC patients received psychoeducation and a facilitated specialty care referral . Care processes measures were collected after the 6-month intervention period . Family outcome measures included the V and erbilt ADHD Diagnostic Parent Rating Scale , Parenting Stress Index-Short Form , Individualized Goal Attainment Ratings , and Clinical Global Impression-Improvement Scale . Most measures were collected at baseline , and 6- , 12- , and 18-month assessment s. Provider outcome measures examined perceived treatment change , efficacy , and obstacles , and practice climate . RESULTS : DOCC ( versus EUC ) was associated with higher rates of treatment initiation ( 99.4 % vs 54.2 % ; P < .001 ) and completion ( 76.6 % vs 11.6 % , P < .001 ) , improvement in behavior problems , hyperactivity , and internalizing problems ( P < .05 to .01 ) , and parental stress ( P < .05–.001 ) , remission in behavior and internalizing problems ( P < .01 , .05 ) , goal improvement ( P < .05 to .001 ) , treatment response ( P < .05 ) , and consumer satisfaction ( P < .05 ) . DOCC pediatricians reported greater perceived practice change , efficacy , and skill use to treat ADHD ( P < .05 to .01 ) . CONCLUSIONS : Implementing a collaborative care intervention for behavior problems in community pediatric practice s is feasible and broadly effective , supporting the utility of integrated behavioral health care services OBJECTIVE To examine the effectiveness and cognitive effects of aripiprazole ( APZ ) in children with a primary diagnosis of attention-deficit/hyperactivity disorder ( ADHD ) . METHODS Youths , ages 8 - 12 years , with a diagnosis of ADHD combined-type or ADHD predominately inattentive-type were enrolled into a 6-week , open-label pilot trial . Outcome measures included the ADHD Rating Scale-IV ( ARS-IV ) , Clinical Global Impressions Scale ( CGI ) , and Children 's Global Assessment Scale ( CGAS ) . The Conners ' Continuous Performance Test II , Reading and Math Fluency subscales of the Woodcock-Johnson III Tests of Achievement , and the Stroop Color and Word Test  were administered at baseline and end of study . RESULTS Fourteen ( 9 males and 5 females ) youths were diagnosed with ADHD-combined type , while 9 ( 5 males and 4 females ) were diagnosed with ADHD-inattentive type . At a mean dose of 6.7 mg/day , end of study results showed overall significant improvement from baseline on ADHD and functional outcome measures . No significant differences in baseline performance at end of study were found on the cognitive measures . The most frequently reported adverse events were sedation ( n = 18 ; 78.3 % ) and headache ( n = 11 ; 47.8 % ) . CONCLUSIONS Although this was a brief pilot study with a small sample size , in this cohort , APZ led to clinical benefit in reducing ADHD symptoms and improving overall functioning . Of note , cognitive functioning did not appear to be negatively impacted by APZ treatment Children diagnosed with attention-deficit/hyperactivity disorder ( ADHD ; n = 142 ) were prospect ively monitored into adolescence ( 13 - 18 years old ) to evaluate their risk for elevated substance use relative to same-aged adolescents without ADHD ( n = 100 ) . Prob and s reported higher levels of alcohol , tobacco , and illicit drug use than did controls . Group differences were apparent for alcohol symptom scores but not for alcohol or marijuana disorder diagnoses . Within prob and s , severity of childhood inattention symptoms predicted multiple substance use outcomes : childhood oppositional defiant disorder/conduct disorder ( ODD/CD ) symptoms predicted illicit drug use and CD symptoms . Persistence of ADHD and adolescent CD were each associated with elevated substance use behaviors relative to controls . Further study of the mediating mechanisms that explain risk for early substance use and abuse in children with ADHD is warranted Fathers , in general , have been underrepresented in studies of parent training outcome for children with attention deficit hyperactivity disorder ( ADHD ) , and the present study aim ed to investigate the efficacy of a behavioral parent training program developed expressly for fathers . The present investigation r and omly assigned 55 fathers of children ages 6 to 12 with ADHD to the Coaching Our Acting-out Children :  Heightening Essential Skills ( COACHES ) program or a waitlist control group . Outcomes for the study included objective observations of parent behaviors and parent ratings of child behavior . Results indicated that fathers in the COACHES group reduced their rates of negative talk and increased rates of praise as measured in parent – child observations , and father ratings of the intensity of problem behaviors were reduced , relative to the waitlist condition . Groups did not differ on observations of use of comm and s or father ratings of child behavior problems . Untreated mothers did not significantly improve on observational measures or behavioral ratings . This study provides preliminary evidence for the efficacy of the COACHES parenting program for fathers of children with ADHD . Results are cast in light of the larger literature on behavioral parent training for ADHD as well as how to best work with fathers of children with ADHD in treatment context OBJECTIVE More than 50 % of mothers of children with attention-deficit/hyperactivity disorder ( ADHD ) have a lifetime history of major depressive disorder ( MDD ) . Maternal depressive symptoms are associated with impaired parenting and predict adverse developmental and treatment outcomes for children with ADHD . For these reasons , we developed and examined the preliminary efficacy of an integrated treatment targeting parenting and depressive symptoms for mothers of children with ADHD . This integrated intervention incorporated elements of 2 evidence -based treatments : behavioral parent training ( BPT ) and cognitive behavioral depression treatment . METHOD Ninety-eight mothers with at least mild depressive symptoms were r and omized to receive either st and ard BPT ( n = 51 ) or the integrated parenting intervention for ADHD ( IPI-A ; n = 47 ) . Participants were assessed at baseline , posttreatment , and 3- to 6-month follow-up on measures of ( a ) self-reported maternal depressive symptoms , ( b ) observed positive and negative parenting , and ( c ) observed and mother-reported child disruptive behavior and mother-reported child and family impairment . RESULTS The IPI-A produced effects of small to moderate magnitude relative to BPT  on maternal depressive symptoms , observed negative parenting , observed child deviance , and child impairment at posttreatment and on maternal depressive symptoms , child disruptive behavior , child impairment and family functioning at follow-up . Contrary to expectations , the BPT group demonstrated moderate to large effects relative to IPI-A on observed positive parenting at follow-up . CONCLUSIONS This treatment development study provides encouraging preliminary support for the integrated intervention targeting parenting and depressive symptoms in mothers of children with ADHD . Future studies should examine whether this integrated intervention improves long-term developmental outcomes for children with ADHD . ( PsycINFO Data base Record ( c ) 2013 APA , all rights reserved ) The purpose of this study was to examine in a controlled trial the effects of atomoxetine on the management of attention deficit-hyperactivity disorder ( ADHD ) symptoms and functional impairments at school and at home . Participants were 153 children ( age 8 to 12 years ) diagnosed with attention-deficit hyperactivity disorder who were r and omized to double-blind treatment with either atomoxetine  ( n = 101 ) or placebo  ( n = 52 ) . Findings revealed significant improvements both for parent and teacher ratings of behavior for children receiving atomoxetine therapy . Children also were reported to evidence a trend toward better response to active medication than to placebo for health-related quality of life as rated by parents . No significant effects were revealed for the teacher ratings of academic productivity . Data were interpreted to provide support for the efficacy of atomoxetine on the symptoms associated with ADHD . The effects of atomoxetine on other functional outcomes including academic performance and health-related outcomes are of interest , albeit less compelling for this particular investigation , than for the effects on overt symptom display
All included treatments result ed in ADHD improvement .
On the basis of this literature review , a consistent pattern of improvement in pediatric ADHD patients ' core symptoms emerged across studies , study design s , and recommended treatment approaches .
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 .