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 .
A double-blind, placebo-controlled withdrawal trial of dexmethylphenidate hydrochloride in children with attention deficit hyperactivity disorder.
OBJECTIVES d , l-threo-methylpheni date HCl ( D , L-MPH ) is the most common treatment of attention deficit hyperactivity disorder ( ADHD ) . A previous report showed placebo-controlled efficacy for the purified d-isomer ( dexmethylpheni date hydrochloride , d-MPH , Focalin ) with a 2:1 potency compared to dl , and suggested a 6-hour duration of action . This study complements that report by study ing the effect of placebo-controlled discontinuation and retesting the duration of action . METHODS A 6-week , open-label titration of d-MPH ( 2.5 - 10 mg twice-a-day ) was followed by a double-blind , placebo-controlled , 2-week withdrawal study of responders . RESULTS In the open titration , 82 % of the 89 enrolled patients achieved a Clinical Global Impression-Improvement ( CGI-I ) rating of much or very much improved . Only 5 patients discontinued for adverse events .  Seventy-five patients continued into the placebo-controlled discontinuation . For the r and omly assigned d-MPH ( n=35 ) and placebo ( n=40 ) groups , mean ages , respectively , were 10.1 + /- 2.9 and 9.9 + /- 2.7 years , 86 % and 78 % were male , and 70.6 % and 80.0 % took the ceiling dose of 10 mg twice-daily , respectively . Each group had 80 % combined type ADHD and 20 % inattentive type .  By the end of the 2-week , placebo-masked withdrawal , significantly more placebo patients ( 24 of 39 ) than d-MPH continuers ( 6 of 35 ) relapsed ( 61.5 % versus 17.1 % , p=0.001 ) . Compared to d-MPH continuers , placebo patients deteriorated significantly more in the 2-week period on teacher ratings of the 18 ADHD symptoms rated 0 - 3 ( p=0.028 ) , the 3 p.m. and 6 p.m. parent ADHD symptom ratings ( p=0.0026 and p=0.0381 , respectively ) , and clinic ( 2 - 3 p.m. ) and home ( 6 p.m. ) Math Tests ( p=0.024 and p<0.0001 , respectively ) . The 6 p.m. scores replicated the significant effect at 6 hours reported in the previous study . CONCLUSIONS d-MPH is safe , tolerable , and effective , with a 6-hour duration of effect suggested by the significant difference from placebo at 6 hours on a double-blind discontinuation
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 .