Treating ADHD may not improve kids’ school grades

Originally published in MedPage Today

by Kristina Fiore, MedPage Today Staff Writer

Adhering to guidelines when treating children with attention deficit hyperactivity disorder (ADHD) relieved symptoms but had no effect on kids’ performance in school or in their relationships with others, researchers found.

Although parents and teachers noted significant improvements in symptoms among ADHD kids (P<0.001) in a special treatment program, there weren’t similar outcomes for functional impairment, Jeffery N. Epstein, PhD, of the Center for ADHD at Cincinnati Children’s Hospital in Ohio, reported in the February Archives of Pediatrics and Adolescent Medicine.

“This finding highlights the need for physicians to work with or refer patients to educational and mental healthcare specialists who can work with children to develop skills to address targeted areas of deficit,” the researchers wrote.

University-associated trials have shown stimulants are effective against ADHD, but these findings may not be translated into community practices — a potential public health concern, the researchers suggested.

Guidelines for proper treatment exist, but they can be difficult to put into practice because of time, effort, and reimbursement concerns.

So the researchers decided to test the efficacy of a quality improvement intervention called ADHD Collaborative, designed to enhance physician adherence to evidence-based, ADHD treatment guidelines.

They conducted a case series involving 785 children ages 7 to 11, who were treated by 158 physicians at rural, suburban, and urban practices.

The researchers found that, based on teacher and parent ratings, children showed vast improvements in ADHD symptoms (P<0.001).

“Improvement of ADHD symptoms occurred mainly in the first three months of treatment and remained improved and relatively stable thereafter,” the researchers wrote. “These results suggest that community-based physicians can achieve gains in ADHD symptom improvement comparable with carefully controlled, university-based clinical trials.”

However, there were no significant improvements in functional impairment as measured by parents and teachers.

The proportion of functionally impaired children didn’t change after treatment for any outcomes except teachers’ ratings of writing and assignment completion (P=0.03 and P=0.04, respectively).

“Effective treatment likely requires a multimodal strategy that includes a focus on teaching children [organizational and learning] skills,” they wrote, adding that collaboration with other mental health or educational services “appears to be warranted.”

Researchers said the study was limited because it didn’t have a control group. Thus, it couldn’t determine whether a similar pattern of treatment response would have been observed without physician training.

The lack of a control group also made it impossible to account for any potential placebo effects.

Finally, the authors didn’t collect data on medication adherence.

Still, they concluded that “large improvements in symptoms can be achieved in primary care settings when physicians provide evidence-based ADHD care using medication.”

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