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Attention-deficit/hyperactivity disorder outcomes for children treated in community-based pediatric settings

Jeffery N Epstein1, Joshua M Langberg, Philip K Lichtenstein

  • 1Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA. jeff.epstein@cchmc.org

Archives of Pediatrics & Adolescent Medicine
|February 4, 2010
PubMed

Insights

Community physicians improved attention-deficit/hyperactivity disorder (ADHD) symptoms in children using evidence-based care. However, functional impairment persisted, suggesting a need for integrated mental health and educational services alongside medication for comprehensive ADHD treatment.

Area of Science:

  • Pediatric Medicine
  • Behavioral Science
  • Healthcare Quality Improvement

Background:

  • Attention-deficit/hyperactivity disorder (ADHD) significantly impacts children's lives.
  • University-based clinical trials often set the benchmark for ADHD treatment outcomes.
  • Community physicians' ability to replicate these outcomes in primary care settings is crucial for widespread effective ADHD management.

Purpose of the Study:

  • To assess if children treated by community physicians in an ADHD quality improvement program showed symptom and impairment improvements comparable to those in clinical trials.
  • To evaluate the effectiveness of a quality improvement intervention designed to enhance physician adherence to evidence-based ADHD guidelines.

Main Methods:

  • A case series design involving 785 children aged 7-11 years diagnosed with ADHD.
  • 158 community physicians from 47 practices participated in the ADHD Collaborative quality improvement intervention.
  • Medical records were reviewed for 1 year to assess parent- and teacher-rated ADHD symptoms and functional impairment.

Main Results:

  • Children experienced substantial improvements in ADHD symptoms, aligning with findings from some clinical trials.
  • No significant improvements were observed in functional impairment among the participating children.
  • The quality improvement intervention focused on enhancing adherence to American Academy of Pediatrics ADHD guidelines.

Conclusions:

  • Evidence-based ADHD care, particularly medication management by physicians in primary care, can lead to significant symptom reduction.
  • Despite symptom improvement, persistent functional impairment highlights the need for a multidisciplinary approach.
  • Collaboration with mental health and educational services is recommended to address functional deficits in children with ADHD.
Abstract

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