title: Atomoxetine in the Management of Children with ADHD: Effects on Quality of Life and School Functioning Multisite controlled study of OROS methylphenidate in the treatment of adolescents with attention-deficit/hyperactivity disorder. Long-term effectiveness and safety of lisdexamfetamine dimesylate in school-aged children with attention-deficit/hyperactivity disorder. Symptomatic improvement in children with ADHD treated with long-term methylphenidate and multimodal psychosocial treatment. Efficacy and safety of dexmethylphenidate extended-release capsules in children with attention-deficit/hyperactivity disorder. Evidence, Interpretation, and Qualification From Multiple Reports of Long-Term Outcomes in the Multimodal Treatment Study of Children With ADHD (MTA) Clinical responses to atomoxetine in attention-deficit/hyperactivity disorder: the Integrated Data Exploratory Analysis (IDEA) study. Atomoxetine treatment in adolescents with attention-deficit/hyperactivity disorder. Summary health statistics for U.S. children: National Health Interview Survey, 2009. A Randomized, Double-Blind, Placebo-Controlled Study of Guanfacine Extended Release in Children and Adolescents With Attention-Deficit/Hyperactivity Disorder A double-blind, placebo-controlled withdrawal trial of dexmethylphenidate hydrochloride in children with attention deficit hyperactivity disorder. Guanfacine extended release in children and adolescents with attention-deficit/hyperactivity disorder: a placebo-controlled trial. Effectiveness, safety, and tolerability of lisdexamfetamine dimesylate in children with attention-deficit/hyperactivity disorder: an open-label, dose-optimization study. Clonidine Extended-Release Tablets as Add-on Therapy to Psychostimulants in Children and Adolescents With ADHD Evidence, Interpretation, and Qualification From Multiple Reports of Long-Term Outcomes in the Multimodal Treatment Study of Children With ADHD (MTA) Effects of open-label atomoxetine on African-American and Caucasian pediatric outpatients with attention-deficit/hyperactivity disorder. Open-label study of dexmethylphenidate hydrochloride in children and adolescents with attention deficit hyperactivity disorder. Transition from methylphenidate or amphetamine to atomoxetine in children and adolescents with attention-deficit/hyperactivity disorder--a preliminary tolerability and efficacy study. Pediatricians’ Attitudes and Practices on ADHD Before and After the Development of ADHD Pediatric Practice Guidelines
abstract: The purpose of this study was to examine in a controlled trial the effects of atomoxetine on the management of attention deficit-hyperactivity disorder ( ADHD ) symptoms and functional impairments at school and at home . Participants were 153 children ( age 8 to 12 years ) diagnosed with attention-deficit hyperactivity disorder who were r and omized to double-blind treatment with either atomoxetine  ( n = 101 ) or placebo  ( n = 52 ) . Findings revealed significant improvements both for parent and teacher ratings of behavior for children receiving atomoxetine therapy . Children also were reported to evidence a trend toward better response to active medication than to placebo for health-related quality of life as rated by parents . No significant effects were revealed for the teacher ratings of academic productivity . Data were interpreted to provide support for the efficacy of atomoxetine on the symptoms associated with ADHD . The effects of atomoxetine on other functional outcomes including academic performance and health-related outcomes are of interest , albeit less compelling for this particular investigation , than for the effects on overt symptom display BACKGROUND Despite the persistence of attention-deficit/hyperactivity disorder ( ADHD ) into adolescence , little is known about the efficacy and tolerability of stimulant medications in this age group . OBJECTIVE To report the results of a multisite controlled study among adolescents with ADHD evaluating the efficacy and tolerability of osmotic-release oral system ( OROS ) methylpheni date . DESIGN Adolescents ( N = 220 ) having a confirmed Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition diagnosis of ADHD underwent dose titration to identify dosages of OROS methylpheni date that improved symptoms to predefined criteria . Subjects successfully completing the dose titration phase ( n = 177 ) ( ie , tolerated and responded to treatment and adhered to the protocol ) were r and omized to receive 2 weeks ' treatment with their individualized dosage of OROS methylpheni date ( 18 , 36 , 54 , or 72 mg once daily ) or placebo .  Treatment effectiveness was measured using investigator , parent , and adolescent assessment s of ADHD . RESULTS A significant reduction from baseline in the investigator-rated ADHD Rating Scale , the primary efficacy measure , was found with OROS methylpheni date treatment compared with placebo . Similar findings were noted with parent- and adolescent-report measures . Based on a Clinical Global Impression improvement subscale score of much or very much improved , 52 % of subjects in the OROS methylpheni date group improved compared with 31 % receiving placebo . Thirty-seven percent of subjects required the maximum dosage of 72 mg/d . The incidence of drug-related adverse events was similar between the 2 study groups . CONCLUSION In adolescents , once-daily OROS methylpheni date significantly reduced ADHD symptoms and was well tolerated using dosages up to 72 mg/d INTRODUCTION Lisdexamfetamine dimesylate ( LDX ) , a prodrug stimulant , is indicated for attention-deficit/hyperactivity disorder ( ADHD ) in children 6 - 12 years of age and in adults . In short-term studies , once-daily LDX provided efficacy throughout the day . This study presented here was conducted to assess the long-term safety , tolerability , and effectiveness of LDX in 6- to 12-year-olds with ADHD . METHODS This open-label , multicenter , single-arm study enrolled children with Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition-Text Revision criteria for ADHD . Following 1-week screening and washout periods , subjects were titrated to LDX 30 , 50 , or 70 mg/day over 4 weeks and placed on maintenance treatment for 11 months . The ADHD Rating Scale and Clinical Global Impression-Improvement scale measured effectiveness . RESULTS Of 272 subjects receiving LDX , 147 completed the study . Most adverse events were mild to moderate and occurred during the first 4 weeks . There were no clinical ly meaningful changes in blood pressure or electrocardiographic parameters . From baseline to endpoint , mean ADHD Rating Scale scores improved by 27.2 points ( P<.0001 ) . Improvements occurred during each of the first 4 weeks , and were maintained throughout . Based on Clinical Global Impression-Improvement scale scores , > 80 % of subjects at endpoint and > 95 % of completers at 12 months were rated " improved . " CONCLUSION Long-term 30 , 50 , and 70 mg/day LDX was generally well tolerated and effective in children with ADHD OBJECTIVE To test the hypotheses that in children with attention-deficit/hyperactivity disorder ( ADHD ) ( 1 ) symptoms of ADHD , oppositional defiant disorder , and overall functioning are significantly improved by methylpheni date combined with intensive multimodal psychosocial treatment compared with methylpheni date alone and with methylpheni date plus attention control and ( 2 ) more children receiving combined treatment can be taken off methylpheni date . METHOD One hundred three children with ADHD ( ages 7 - 9 ) , free of conduct and learning disorders , who responded to short-term methylpheni date were r and omized for 2 years to ( 1 ) methylpheni date alone ; ( 2 ) methylpheni date plus psychosocial treatment that included parent training and counseling , social skills training , psychotherapy , and academic assistance , or ( 3 ) methylpheni date plus attention psychosocial control treatment . Assessment s included parent , teacher , and psychiatrist ratings , and observations in academic and gym classes . RESULTS Combination treatment did not lead to superior functioning and did not facilitate methylpheni date discontinuation . Significant improvement occurred across all treatments and continued over 2 years . CONCLUSIONS In stimulant-responsive children with ADHD , there is no support for adding ambitious long-term psychosocial intervention to improve ADHD and oppositional defiant disorder symptoms . Significant benefits from methylpheni date were stable over 2 years OBJECTIVE The efficacy and safety of dexmethylpheni date extended release ( d-MPH-ER ) was compared to placebo in pediatric patients with attention-deficit/hyperactivity disorder ( ADHD ) . METHOD This multicenter , r and omized , double-blind , placebo-controlled , parallel-group , two-phase study included 97 patients ( ages 6 - 17 years ) with DSM-IV-defined ADHD . The study was carried out between 2001 and 2003 . After a 2-week evaluation phase , patients were r and omized to d-MPH-ER or placebo for 7 weeks . Flexible d-MPH-ER dosing ( 30 mg/day ) was permitted for 5 weeks , then patients remained on their optimal dose during the last 2 study weeks . The primary efficacy measure was change from baseline to final rating in Conners ADHD/DSM-IV Scale-Teacher version ( CADS-T ) total subscale score . Secondary efficacy variables included changes from baseline to final visit in CADS-T Inattentive and Hyperactive-Impulsive subscale scores , CADS-P DSM-IV total subscale score and Inattentive and Hyperactive-Impulsive subscale scores , Clinical Global Impressions-Improvement ( CGI-I ) and CGI-Severity ( CGI-S ) scale scores , and Child Health Question naire Parent Form 50 scores . RESULTS d-MPH-ER improved CADS-T total scores significantly compared with placebo ( p < .001 ) , and 67.3 % of d-MPH-ER patients were rated much improved or very much improved on CGI-I at final visit versus 13.3 % of placebo patients ( p < .001 ) . More patients taking d-MPH-ER ( 49.1 % ) than placebo ( 25.5 % ) spontaneously reported adverse events suspected as drug related . CONCLUSIONS Once-daily d-MPH-ER was more effective than placebo in the treatment of ADHD in children and adolescents Objective : To review the primary and secondary findings from the Multimodal Treatment study of ADHD ( MTA ) published over the past decade as three sets of articles . Method : In a two-part article — Part I : Executive Summary ( without distracting details ) and Part II : Supporting Details ( with additional background and detail required by the complexity of the MTA)—we address confusion and controversy about the findings . Results : We discuss the basic features of the gold st and ard used to produce scientific evidence , the r and omized clinical trial , for which was used to contrast four treatment conditions : medication management alone ( MedMgt ) , behavior therapy alone ( Beh ) , the combination of these two ( Comb ) , and a community comparison of treatment “ as usual ” ( CC ) . For each of the three assessment points we review three areas that we believe are important for appreciation of the findings : definition of evidence from the MTA , interpretation of the serial presentations of findings at each assessment point with a different definition of long-term , and qualification of the interim conclusions about long-term effects of treatments for ADHD . Conclusion : We discuss the possible clinical relevance of the MTA and present some practical suggestions based on current knowledge and uncertainties facing families , clinicians , and investigators regarding the long-term use of stimulant medication and behavioral therapy in the treatment of children with ADHD . ( J. of Att . Dis . 2008 ; 12(1 ) 4 - 14 OBJECTIVE Clinical experience suggests that some ( but not all ) patients with attention-deficit/hyperactivity disorder ( ADHD ) are highly responsive to the nonstimulant atomoxetine . We conducted a retrospective analysis of r and omized controlled trials ( RCTs ) to identify potential baseline ( moderator ) and on-treatment ( mediator ) predictors of responses . METHOD Data from 6 U.S. RCTs among patients aged 6 to 18 years were pooled ( N = 1,069 ; subjects treated with atomoxetine , n = 618 ) . Subjects were categorized as much improved ( > or = 40 % decrease in ADHD Rating Scale-IV-Parent Version : Investigator Administered and Scored total score ) , minimally improved ( 25%- < 40 % decline ) , or nonresponders ( < 25 % decrease ) . Logistic regression , analyses of variance , and repeated- measures analyses were used to explore associations between baseline and on-treatment variables , achieving a much improved response at trial endpoint ( 6 - 9 weeks ) . RESULTS Forty-seven percent of patients showed a much improved clinical response , and 40 % did not respond . Only 13 % of the patients had a minimal response . No baseline characteristics predicted achieving a much improved clinical response ; the only predictor of achieving this response was being at least minimally improved by treatment week 4 ( sensitivity = 81 % , specificity = 72 % , positive predictive value = 75 % , and negative predictive value = 79 % ) . CONCLUSIONS Clinical response to atomoxetine was bimodal , with most subjects being either responders who were much improved or nonresponders . There were no demographic or clinical predictors of response . However , subjects who ultimately achieved a much improved response were likely to be at least minimal responders by week 4 . The recommendation to consider either augmenting or switching treatment in patients who do not achieve at least this level of response to atomoxetine by 4 weeks offers a method for limiting the extended duration of titration to subjects who are most likely to benefit further , while minimizing the duration of exposure in those less likely to achieve an excellent response INTRODUCTION This study compared two atomoxetine titration dosing schedules and two atomoxetine maintenance doses for treating adolescent attention-deficit/hyperactivity disorder ( ADHD ) inattention and hyperactivity/impulsivity .  METHODS Adolescents ( N = 267 ) were r and omized to a slow or fast titration schedule . Patients who responded continued on a 40-week maintenance treatment , r and omized to either 0.8 or 1.4 mg/kg/day . RESULTS During the acute period , significant benefit was demonstrated with both titration schedules on the ADHD Rating Scale total score . Although patients in both groups maintained benefit relative to week 0 , statistically significant loss of benefit was found for patients maintained on 0.8 mg/kg/day but not on 1.4 mg/kg/day . A similar pattern was observed on the Clinical Global Impressions-ADHD-Severity scores and Life Participation Scale for ADHD-Child Version scores . Mean grade s for most subjects improved for patients in both maintenance treatment groups although most improvements were not statistically significant . CONCLUSIONS In adolescents with ADHD , treatment benefit at 8 weeks was better maintained long-term with 1.4 mg/kg/day than with 0.8 mg/kg/day . Improvement in adaptive functioning and age-appropriate developmental function was also demonstrated . Atomoxetine 0.8 and 1.4 mg/kg/day were equally well tolerated . CLINICAL TRIALS REGISTRY Maintenance of benefit with atomoxetine hydrochloride in adolescents with ADHD , NCT00191035 OBJECTIVES This report presents both age-adjusted and unadjusted statistics from the 2009 National Health Interview Survey ( NHIS ) on selected health measures for children under age 18 , classified by sex , age , race , Hispanic origin , family structure , parent education , family income , poverty status , health insurance coverage , place of residence , region , and current health status . The topics covered are asthma , allergies , learning disability , attention deficit hyperactivity disorder ( ADHD ) , prescription medication use , respondent-assessed health status , school days missed due to illness or injury , usual place of health care , time since last contact with a health care professional , selected measures of health care access and utilization , and dental care . New in 2009 - - Data on food and skin allergies , previously combined in " other allergies , " are presented separately in this report . DATA SOURCE NHIS is a multistage probability sample survey conducted annually by interviewers of the U.S. Census Bureau for the Centers for Disease Control and Prevention 's National Center for Health Statistics and is representative of the civilian noninstitutionalized population of the United States . Data are collected for all family members during face-to-face interviews with adults present at the time of interview . Additional information about children is collected for one r and omly selected child per family in face-to-face interviews with an adult proxy respondent familiar with the child 's health . SELECTED HIGHLIGHTS In 2009 , most U.S. children aged 17 and under had excellent or very good health ( 84 % ) . However , 8 % of children had no health insurance coverage , and 5 % of children had no usual place of health care . Fourteen percent of children had ever been diagnosed with asthma . An estimated 8 % of children aged 3 - 17 had a learning disability , and an estimated 9 % of children had ADHD OBJECTIVE . With this study we assessed the efficacy and safety of an extended-release formulation of guanfacine compared with placebo for the treatment of children and adolescents with attention-deficit/hyperactivity disorder . METHODS . In this multicenter , double-blind , placebo-controlled , fixed-dosage escalation study , patients aged 6 to 17 years were r and omly assigned to 1 of 3 treatment groups of guanfacine extended release ( 2 , 3 , or 4 mg/day ) or placebo for 8 weeks . The primary outcome measurement was the Attention-Deficit/Hyperactivity Disorder Rating Scale IV total score . Secondary measurements included Clinical Global Impression of Improvement , Parent 's Global Assessment , Conners ' Parent Rating Scale – Revised : Short Form , and Conners ' Teacher Rating Scale – Revised : Short Form . RESULTS . A total of 345 patients were r and omly assigned to placebo ( n = 86 ) or guanfacine extended release 2 mg ( n = 87 ) , 3 mg ( n = 86 ) , or 4 mg ( n = 86 ) treatment groups . Least-squares mean changes from baseline to the end point in Attention-Deficit/Hyperactivity Disorder Rating Scale IV total scores were significant in all groups of children taking guanfacine extended release : −16.18 in the 2-mg group , −16.43 in the 3-mg group , and −18.87 in the 4-mg group , compared with −8.48 in the placebo group . All groups of children taking guanfacine extended release showed significant improvement on hyperactivity/impulsivity and inattentiveness subscales of the Attention-Deficit/Hyperactivity Disorder Rating Scale IV , Clinical Global Impression of Improvement , Parent 's Global Assessment , Conners ' Parent Rating Scale – Revised : Short Form , and Conners ' Teacher Rating Scale – Revised : Short Form assessment s compared with placebo . The most commonly reported treatment-emergent adverse events were headache , somnolence , fatigue , upper abdominal pain , and sedation . Small to modest changes in blood pressure , pulse rate , and electrocardiogram parameters were observed but were not clinical ly meaningful . CONCLUSIONS . Guanfacine extended release met the primary and secondary efficacy end points . It was well tolerated and effective compared with placebo 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 OBJECTIVE This study compared the efficacy of guanfacine extended release ( GXR ) , a selective alpha(2A)-adrenoceptor agonist , with placebo in children and adolescents with attention-deficit/hyperactivity disorder ( ADHD ) . METHOD This double-blind , 9-week , dose-ranging , parallel- design , multicenter trial r and omized 6- to 17-year-olds with ADHD to once-daily oral GXR in 1- , 2- , 3- , and 4-mg doses or placebo . Primary outcome was change in total ADHD Rating Scale-IV score from baseline to endpoint . Secondary outcomes included changes in scores of hyperactive/impulsive and inattentive subscales ; clinician and parent ratings ; duration of clinical effect ; and safety measures . RESULTS Statistically significant reductions in ADHD Rating Scale-IV scores were observed from baseline to endpoint at all doses of GXR , with effect sizes ranging from 0.43 to 0.62 . In subjects receiving GXR , mean heart rate and systolic and diastolic blood pressure decreased as the dose of GXR increased and then returned toward baseline during the dose-maintenance and dose-tapering phases of the trial . Most frequent treatment-emergent adverse events ( > or = 5 % ) were somnolence , headache , fatigue , sedation , dizziness , irritability , upper abdominal pain , and nausea . Somnolence , sedation , and fatigue adverse events emerged within the first 2 weeks of dosing and generally resolved by study end . CONCLUSIONS : Guanfacine extended-release was effective in reducing symptoms of ADHD . Adverse events were mild to moderate , did not interfere with improvements in attention , and rarely led to discontinuation OBJECTIVE The aim of this study was to assess the effectiveness and safety of lisdexamfetamine dimesylate ( LDX ) in children with attention-deficit/hyperactivity disorder ( ADHD ) . METHOD This was a 7-week , open-label study evaluating 20 , 30 , 40 , 50 , 60 , or 70 mg/day LDX in 318 children aged 6 - 12 years with ADHD . The ADHD Rating Scale IV ( ADHD-RS-IV ) was the primary efficacy assessment . Secondary measures included the Clinical Global Impressions-Improvement ( CGI-I ) , Expression and Emotion Scale for Children ( EESC ) , and Behavior Rating Inventory of Executive Function ( BRIEF ) . Safety assessment s included  treatment-emergent adverse events ( TEAEs ) , vital signs , and electrocardiograms .  RESULTS At end point , mean ( st and ard deviation [ SD ] ) improvement from baseline in ADHD-RS-IV total score was 28.6 ( 10.9 ) ( p < 0.0001 ) . Most subjects ( 89.9 % ) were rated " improved " ( i.e. , CGI-I 1 or 2 ) . Improvements from baseline were observed in the EESC total and subscale scores ( p < or = 0.0002 ) . LDX treatment result ed in significant improvement on the Global Executive Composite , Behavioral Regulation , and Metacognition indices of the BRIEF ( p < 0.0001 ) . TEAEs ( incidences > or = 10 % ) were decreased appetite , decreased weight , irritability , insomnia , headache , upper abdominal pain , and initial insomnia . CONCLUSIONS LDX was effective and generally well tolerated with a safety profile consistent with long-acting stimulant use . There was overall improvement in ADHD symptoms and executive function measures and no worsening of emotional expression measures . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00500071 OBJECTIVE : To assess the efficacy and safety of clonidine hydrochloride extended-release tablets ( CLON-XR ) combined with stimulants ( ie , methylpheni date or amphetamine ) for attention-deficit/hyperactivity disorder ( ADHD ) . PATIENTS AND METHODS : In this phase 3 , double-blind , placebo-controlled trial , children and adolescents with hyperactive- or combined-subtype ADHD who had an inadequate response to their stable stimulant regimen were r and omized to receive CLON-XR or placebo in combination with their baseline stimulant medication . Predefined efficacy measures evaluated change from baseline to week 5 . Safety was assessed by spontaneously reported adverse events , vital signs , electrocardiogram recordings , and clinical laboratory values . Improvement from baseline for all efficacy measures was evaluated using analysis of covariance . RESULTS : Of 198 patients r and omized , 102 received CLON-XR plus stimulant and 96 received placebo plus stimulant . At week 5 , greater improvement from baseline in ADHD Rating Scale IV ( ADHD-RS-IV ) total score ( 95 % confidence interval : −7.83 to −1.13 ; P = .009 ) , ADHD-RS-IV hyperactivity and inattention subscale scores ( P = .014 and P = .017 , respectively ) , Conners ' Parent Rating Scale scores ( P < .062 ) , Clinical Global Impression of Severity ( P = .021 ) , Clinical Global Impression of Improvement ( P = .006 ) , and Parent Global Assessment ( P = .001 ) was observed in the CLON-XR plus stimulant group versus the placebo plus stimulant group . Adverse events and changes in vital signs in the CLON-XR group were generally mild . CONCLUSIONS : The results of this study suggest that CLON-XR in combination with stimulants is useful in reducing ADHD in children and adolescents with partial response to stimulants Objective : To review and provide details about the primary and secondary findings from the Multimodal Treatment study of ADHD ( MTA ) published during the past decade as three sets of articles . Method : In the second of a two part article , we provide additional background and detail required by the complexity of the MTA to address confusion and controversy about the findings outlined in part I ( the Executive Summary ) . Results : We present details about the gold st and ard used to produce scientific evidence , the r and omized clinical trial ( RCT ) , which we applied to evaluate the long-term effects of two well-established unimodal treatments , Medication Management ( MedMGT ) and behavior therapy ( Beh ) , the multimodal combination ( Comb ) , and treatment “ as usual ” in the community ( CC ) . For each of the first three assessment points defined by RCT methods and included in intent-to-treat analyses , we discuss our definition of evidence from the MTA , interpretation of the serial presentations of findings at each assessment point with a different definition of long-term varying from weeks to years , and qualification of the interim conclusions about long-term effects of treatments for ADHD based on many exploratory analyses described in additional published articles . Conclusions : Using a question and answer format , we discuss the possible clinical relevance of the MTA and present some practical suggestions based on current knowledge and uncertainties facing families , clinicians , and investigators regarding the long-term use of stimulant medication and behavioral therapy in the treatment of children with ADHD . ( J. of Att . Dis . 2008 ; 12(1 ) 15 - 43 BACKGROUND Data on the management of attention-deficit/hyperactivity disorder ( ADHD ) in African-American children and adolescents are limited . METHODS This study sought to evaluate the tolerability , safety , and efficacy of atomoxetine hydrochloride in the management of ADHD in African-American children and adolescents by conducting a post hoc subgroup analysis of 2 multicenter , open-label studies . RESULTS Atomoxetine was safe and well tolerated , with > or=3.0 % of African-Americans and Caucasians discontinuing treatment because of adverse events . A significantly higher proportion of Caucasians reported > or=1 treatment-emergent adverse event , including vomiting ( 7.2 % vs 1.2 % ; P=.037 ) and fatigue ( 6.1 % vs 0 % ; P=.012 ) . No serious safety concerns were observed . Changes from baseline in height , weight , and hemodynamic variables were modest and similar in both racial subgroups . African-Americans and Caucasians showed significant improvement from baseline to end point in the mean ADHD Rating Scale-IV-Parent Version : Investigator Administered and Scored ( ADHDRS-IV-P : I ) . Scores decreased by 20.1 in African-Americans and by 19.55 in Caucasians , without significant between-group differences . Patients in both racial groups experienced similar , significant improvements in ADHDRS-IV-P : I inattention and hyperactivity-impulsivity symptoms , Clinical Global Impression-ADHD-Severity , and Conners ' Parent Rating Scale-Revised : Short Form . CONCLUSIONS Atomoxetine exhibited similar tolerability , safety , and efficacy profiles in African-Americans and Caucasians with ADHD BACKGROUND This pilot study examined the efficacy and duration of the effect of dexmethylpheni date ( d-MPH ) given once-daily in subjects with attention deficit hyperactivity disorder ( ADHD ) . METHOD Subjects aged 6 - 18 years ( inclusive ) with ADHD were enrolled in this 8-week , openlabel study . Outcome measures included the Conners'Teacher and Parent Rating Scales , the Attention Deficit Disorder Rating Scale ( ADDRS ) , the Clinical Global Impression ( CGI ) Scale , and teacher and parent visual analog scales to estimate the duration of efficacy .  d-MPH was initiated at a dose of 2.5 mg/day . The dose was flexible , based on response and tolerability , and could be increased in increments of 2.5 mg/day to a maximum daily dose of 30 mg/day . RESULTS Twenty-two subjects ( mean age , 8.7 + /- 0.4 years ) were treated . Significant improvements ( p < 0.0001 ) from baseline occurred in the Conners ' Teacher and Parent Rating Scales after 8 weeks . Of the evaluated subjects , 85.7 % ( 18 of 21 ) showed at least a 30 % improvement from baseline on the Conners ' Teacher Rating Scale , and 86.4 % ( 19 of 22 ) of subjects showed at least a 30 % improvement from baseline on the Conners ' Parent Rating Scale . Most subjects demonstrated an improvement on the ADDRS and the CGI-Improvement ( CGI-I ) scale . Median duration of effect was estimated at 6.2 hours ( teachers ) and at 7.5 hours ( parents ) . On average , patients gained 2.4 pounds over the course of the study . CONCLUSIONS A single daily dose of d-MPH was effective in controlling ADHD in children and was well tolerated . Future studies are needed to confirm these findings and to evaluate chronic dosing with d-MPH 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 Purpose : The study aims to assess the changes in attitudes and practice s about ADHD reported by AAP fellows between 1999 and 2005 during which AAP ADHD guidelines , training , and quality improvement initiatives occurred . Method : The study assesses AAP-initiated surveys  that were conducted between 1999 and 2005 and involving a r and om sample of 1,000 and 1,603 pediatricians , respectively . Results : The findings reveal that significant , although modest , increases occurred in pediatric practitioners ’ self-reported adherence to the guidelines . About 81 % of respondents reported routine use of formal diagnostic criteria ( up from 67 % ) , and 67 % of the respondents routinely use ADHD teacher rating scales ( compared to 49 % in the 1999 survey ) . Findings further reveal that treatment with stimulant medications was used extensively by pediatricians from both surveys ; more pediatricians in the 2005 survey reported use of a second stimulant if the first did not work , and still more reported almost always providing parent training , although the estimated number remained only about a quarter of the total ; and greater familiarity with the initiatives predicted better reported adherence to the guidelines . Conclusion : The reported behaviors of practitioners have moved in the direction of greater adherence with the recommended AAP ADHD guidelines , and there was a positive response to , and a greater use of , the material s developed to enhance practice . The authors infer that practice changes may be due to many factors , including AAP guidelines and associated implementation efforts . Changing physician practice s needs to be sustained through a continuing process that requires multiple , varying , sustained efforts directed at physicians , other providers , and families
target: 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 .
background: 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 .