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 .
Transition from methylphenidate or amphetamine to atomoxetine in children and adolescents with attention-deficit/hyperactivity disorder--a preliminary tolerability and efficacy study.
BACKGROUND The primary treatment for attention-deficit/hyperactivity disorder ( ADHD ) has been psychostimulants . Recently developed nonpsychostimulant treatments have allowed certain patients to switch from a psychostimulant to a nonpsychostimulant . However , the outcomes of such switches have not been systematic ally studied . OBJECTIVE The purpose of this pilot study was to assess treatment tolerance and efficacy during a cross-taper transition from methylpheni date or amphetamine to atomoxetine among children and adolescents with ADHD . METHODS This pilot study was conducted in patients ( aged 6 - 17 years ) with incomplete responses ( failure to obtain full reduction/elimination of symptoms ) or intolerance of adverse events ( AEs ) during psychostimulant treatment . Patients continued ongoing psychostimulant treatment during the first week of the study . Transition to atomoxetine began by administering atomoxetine 0.5 mg/kg . d plus full-dose psychostimulant for 1 week , followed in the second week by 1.2 mg/kg . d atomoxetine plus half-dose psychostimulant . Patients remained on 1.2 mg/kg . d atomoxetine monotherapy for the remaining 5 weeks . This stepwise transition was enacted due to the difference in pharmacodynamics between the psychostimulants and atomoxetine . Applying a stepwise cross-titration allowed for better control of ADHD symptoms during the intervening period . Change in ADHD symptoms , as measured by the mean change in the Attention-Deficit/Hyperactivity Disorder Rating Scale-IV-Parent Version : Investigator-administered and -scored ( ADHDRS-IV-Parent : Inv ) , was assessed from baseline to end point . RESULTS Of the 62 subjects enrolled in the study , 39 ( 62.9 % ) were diagnosed as ADHD-combined type . Similar proportions were receiving methylpheni date ( 51.6 % ) and amphetamine ( 48.4 % ) . Slightly more wished to switch due to inadequate response ( 53.2 % ) than intolerability ( 46.8 % ) . Nine subjects discontinued at various times during the course of the study ( patient or parent/caregiver decision [ 4 ] , AE [ 2 ] , protocol violation [ 2 ] , and lack of efficacy [ 1 ] ) . Mean ( SD ) ADHDRS-IV-Parent : Inv total scores ( n = 59 , last-observation-carried-forward ) improved significantly from baseline ( visit 2 ) to an end point ( 32.1 [ 10.5 ] vs 22.6 [ 14.0 ] ; P < 0.001 ) . Of the 58 subjects answering in the atomoxetine  monotherapy phase , 38 ( 65.5 % ) reported a preference for atomoxetine treatment over their previous psychostimulant .  Tolerability results were as follows : 26 ( 44.1 % ) of 59 patients reported > or=1 AE , the most common being somnolence ( 4 [ 6.8 % ] ) , fatigue ( 3 [ 5.1 % ] ) , decreased appetite ( 3 [ 5.1 % ] ) , cough ( 3 [ 5.1 % ] ) , headache ( 3 [ 5.1 % ] ) , and contact dermatitis ( 2 [ 3.4 % ] ) . No clinical ly severe AEs were reported . Both mean ( SD ) diastolic ( 2.4 [ 7.8 ] mm Hg ; P = 0.031 ) and systolic ( 2.4 [ 7.9 ] mm Hg ; P = 0.029 ) blood pressures increased significantly from baseline to end point . Electrocardiography revealed a significant increase in mean ( SD ) heart rate ( 9.2 [ 11.6 ] bpm ; P < 0.001 ) and a corresponding decrease in mean ( SD ) RR interval ( -77.8 [ 98.2 ] ms ; P < 0.001 ) . Statistically significant , but mild , increases in diastolic pressure and heart rate were observed . CONCLUSION These children and adolescent patients were successfully switched from methylpheni date or amphetamine to atomoxetine treatment , with result ing improvement in ADHD symptom severity from baseline in this pilot study
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 .