Pharmacological treatment of attention-deficit/hyperactivity disorder: assessing outcomes

Abstract

A substantial body of evidence has supported the efficacy and safety of pharmacological treatment available for attention deficit/hyperactivity disorder (ADHD). There is increasing agreement that the important treatment outcomes for ADHD extend beyond improvement in core symptoms and that a more generic (or global) concept of remission is the overarching goal of treatment. However, there is no consensus on the best definition of remission or on how best to conceptualize and measure broader treatment outcomes. In this article, we provide an overview of the various methods and approaches to measuring treatment outcomes for ADHD with respect to symptoms, impairment, quality of life, adverse events and safety as well as cognition. We will describe the ways that they may be used within routine clinical practice and think ahead about the kinds of studies that are required to move the field forward.

Keywords:

• ADHD
• adverse events
• cognition
• functional impairment
• quality of life

Financial & competing interests disclosure

S Seth has received compensation for serving as a consultant or speaker, and she or the institution she works for have received research support or royalties from the following companies or organizations: Lilly, Shire Jansen-Cilag, and Oxford University Press. The present work is unrelated to the aforementioned support and relationships, and none of the companies listed had any involvement in the preparation of the manuscript. D Coghill has received compensation for serving as a consultant or speaker, and he or the institution he works for have received research support or royalties from the following companies or organizations: Flynn, Janssen-Cilag, Lilly, Medice, Novartis, Otsuka, Oxford University Press, Pfizer, Schering-Plough, Shire, Vifor Pharma. The present work is unrelated to the aforementioned support and relationships, and none of the companies listed had any involvement in the preparation of the manuscript. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Key issues

• There is compelling evidence that treatment with medications is effective and prevents, at least, in part, the poor long-term outcomes associated with ADHD.

• In measuring outcomes of ADHD treatment, clinical trials have mostly focused on efficacy of medications in reducing ADHD symptoms and on safety and tolerability of the administration of the compounds, with increasing interest also on functional and QOL outcomes. Furthermore, pharmacology regulators have required that these aspects are included in clinical trials.

• Clinicians should seek to measure ADHD treatment response based on a more global concept of remission that includes a range of outcomes from symptoms to impairment and QOL, to persistence and severity of the associated symptoms when comorbid disorders are present.

• It is important that symptomatic reduction is measured with clinician-rated DSM-based rating scales like the ADHD-RS or the SNAP-IV based on all available information at diagnosis and at all stages of treatment.

• Measuring functional outcomes with generic measures of functioning like the CGI and C-GAS adds little time to the assessment, can inform treatment decisions and should be part of routine visits.

• Assessment of adverse events and safety is advisable at baseline and at all stages of treatment and best obtained with structured measures and comparison of physiological parameters with normative data.

• In clinical practice, it would also be advisable to periodically (i.e., yearly) measure quality of life through child report once treatment is stable.

• While cognition does not currently represent a helpful measure of treatment outcome, there is potential for further development in this area.