Quality Assessment of Treatment of Children and Adolescents with Developmental Disorders – A Feasibility Study Using the Example of Attention Deficit Hyperactivity Disorder

AbstractThe question of a possible presence of attention deficit/hyperactivity disorder (ADHD) is raised with increasing frequency in pediatric practice. There are guidelines and expert recommendations for diagnostic approaches. But there are no instruments available to evaluate the structural, process and outcome quality. In this pilot study, a set of quality indicators on the treatment quality of ADHD was analyzed in terms of their feasibility in tertiary referral centers.A set of 39 quality indicators (QI) on ADHD developed in advance in a multistage procedure was assessed at 9 tertiary referral centers, with a focus on process verifiability and feasibility. QI values were calculated as ratios for individual centers as well as across centers, followed by an explorative analysis to assess feasibility under due consideration of possible influencing factors.QI assessment is possible but highly complex and expensive in practice. Calculated QI values showed a high degree of heterogeneity between facilities as well as between institutions, which was mainly due to a lack of standardization in the documentation of required data.Basically, it is possible to assess the quality of ADHD treatment via QIs. The approach described here in assessing QIs may be also applied to other types of developmental disorders.

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Automated extraction of quality indicators for treatment of children with complex developmental disorders: A feasibility study using the example of attention-deficit/hyperactivity disorder

International Journal for Quality in Health Care ◽

10.1093/intqhc/mzy209 ◽

2018 ◽

Vol 31 (7) ◽

pp. 563-567

Author(s):

Peter Borusiak ◽

Karin A Hameister ◽

Dennis Jozwiak ◽

Inga M Saatz ◽

Lutz Mathea ◽

...

Keyword(s):

Attention Deficit Hyperactivity Disorder ◽

Quality Indicators ◽

Attention Deficit ◽

Developmental Disorders ◽

Daily Practice ◽

Lessons Learned ◽

Automated Extraction ◽

Semantic Level ◽

Hyperactivity Disorder ◽

Medical Reports

Abstract Quality issue Quality assessment is challenging in children with developmental disorders. Previously, a set of quality indicators (QIs) was developed and analyzed in terms of feasibility of use with patients with attention-deficit/hyperactivity disorder (ADHD). QI assessment turned out to be possible but highly complex. Thus, we compared different technologies for automated extraction of data for assessment of QIs. Choice of solution Four automated extraction technologies (regular expressions, Apache Solr, Apache Mahout, Apache OpenNLP) were compared with respect to their properties regarding the complexity of implementing the QI, the complexity of implementing a check module, the reliability and quality of results, the complexity of preparation of interdisciplinary medical reports, and the complexity of deployment and installation. Implementation Twenty medical reports from different institutions were reviewed for compliance with three QIs by these technologies and compared with expert opinions. Evaluation Among the four technologies, Apache Solr had the best overall performance. For manual extraction of the three QIs, at least 77 s were necessary per medical report, whereas the prototype evaluated and extracted the QIs automatically in 8 s on average. Unexpectedly, different assessments of the degree of compliance by the experts turned out to be one of the stumbling blocks. An in-depth evaluation compared results on a semantic level. Lessons learned It is possible to extract QIs by post-processing automated technologies. This approach can also be applied to other developmental disorders. However, a more uniform documentation throughout institutions involved will be necessary in order to implement this method in daily practice.

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Individualization of attention-deficit/hyperactivity disorder treatment: pharmacotherapy considerations by age and co-occurring conditions

CNS Spectrums ◽

10.1017/s1092852919001822 ◽

2020 ◽

pp. 1-20 ◽

Cited By ~ 1

Author(s):

Greg W. Mattingly ◽

Joshua Wilson ◽

Leticia Ugarte ◽

Paul Glaser

Keyword(s):

Attention Deficit Hyperactivity Disorder ◽

Attention Deficit ◽

Neurodevelopmental Disorder ◽

Treatment Options ◽

Hyperactivity Disorder ◽

Psychosocial Therapy ◽

Adhd Treatment ◽

Disorder Treatment ◽

Adhd Medications

Abstract Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that manifests in childhood and can persist into adolescence and adulthood. Impairments associated with ADHD can impact quality of life, social interactions, and increase the risk of morbidity and mortality; however, for many patients, effective treatment can lessen these effects. Pharmacotherapy with stimulants or nonstimulants is recommended in conjunction with psychosocial therapy for most patients. Determining the optimal pharmacotherapy can be complex, and the clinician needs to consider many factors such as the patient’s age, comorbidities, and lifestyle. Furthermore, the needs of the patient with ADHD will change over time, with specific challenges to consider at each stage of life. A variety of Food and Drug Administration (FDA)-approved stimulant and nonstimulant formulations are available with different modes of delivery and durations of effect. This armamentarium of ADHD medications can be used to individualize ADHD treatment for each patient’s needs. This article combines current information from the literature and the first-hand experience of the authors to provide guidance on ADHD treatment options for patients of different ages and for some of the more common comorbidities.

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How common is attention deficit hyperactivity disorder in a cohort of children with functional constipation, and does ADHD treatment improves functional constipation?

Archives of Medical Science ◽

10.5114/aoms/111841 ◽

2021 ◽

Author(s):

Hassan Bazmamoun ◽

Alireza Momeni ◽

Leila Jahangard ◽

Farzaneh Asnaashari ◽

Nasrollah Pezeshki

Keyword(s):

Attention Deficit Hyperactivity Disorder ◽

Attention Deficit ◽

Neurodevelopmental Disorders ◽

Functional Constipation ◽

Well Being ◽

Response To Treatment ◽

Hyperactivity Disorder ◽

Adhd Treatment ◽

Randomization Method

IntroductionAttention Deficit Hyperactivity Disorder (ADHD) is one of the most common neurodevelopmental disorders in children. Functional constipation is common in children and has a significant impact on the quality of their life, affecting both physical and emotional well-being. The aim of this study was to evaluate the frequency of ADHD in functional constipation patients and its treatment effect on constipation.Material and methodsIn this clinical trial study, 80 children with simultaneous ADHD and functional constipation were allocated to two equal groups by block randomization method. One group was treated only with ADHD drugs and the second group was treated for ADHD and functional constipation. Subsequently, the treatment outcome was evaluated in both groups.ResultsThe frequency of ADHD in functional constipation patients was 13.87%. The frequency of functional constipation recovery in the first and second group was respectively 2 (5%) and 39 (97.5%) (p <0.001). ADHD treatment has no significant effect on the recovery of constipation. There was no statistically significant relationship between the response to treatment with age, sex and duration of having ADHD and constipation.ConclusionsIn patients with simultaneous ADHD and functional constipation, ADHD treatment alone did not influence on the recovery of functional constipation and vice versa.

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Insomnia Disorder in Adult Attention-Deficit/Hyperactivity Disorder Patients: Clinical, Comorbidity, and Treatment Correlates

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.663889 ◽

2021 ◽

Vol 12 ◽

Author(s):

Christian Fadeuilhe ◽

Constanza Daigre ◽

Vanesa Richarte ◽

Lara Grau-López ◽

Raul F. Palma-Álvarez ◽

...

Keyword(s):

Quality Of Life ◽

Attention Deficit Hyperactivity Disorder ◽

Attention Deficit ◽

Adult Adhd ◽

Rating Scales ◽

Clinical Severity ◽

Hyperactivity Disorder ◽

Insomnia Disorder ◽

Adhd Treatment

Introduction: Several investigations have been performed on insomnia symptoms in adult attention-deficit/hyperactivity disorder (ADHD). However, the relationship between insomnia disorder and adult ADHD has been neglected in research. The main objective of the current study is to analyze the differences between adult ADHD patients with and without insomnia disorder, in terms of ADHD clinical severity, medical and psychiatric comorbidity, psychopharmacological treatment, and quality of life.Material and Methods: Two hundred and fifty-two adult patients with ADHD (mean age 37.60 ± 13.22 years; ADHD presentations—combined: 56.7%, inattentive: 39.7%, hyperactive/impulsive: 3.6%) were evaluated with an exhaustive clinical and psychological evaluation protocol including semistructured interviews (for comorbidities and ADHD assessment) and symptom rating scales for ADHD. The diagnosis of ADHD and insomnia disorder was made according to DSM-5 criteria. Furthermore, the Pittsburgh Sleep Quality Index, Insomnia Severity Index, and Epworth Sleepiness Scale were administered.Results: Insomnia disorder was found in 44.4% of adult ADHD patients and was more common in combined presentation (64.3%) and in patients with more ADHD severity. Comorbidities (both medical and psychiatric), especially mood disorders (42%), anxiety disorder (26.8%), personality disorder (39.3%), and any substance use disorder (11.6%), were associated with a higher insomnia disorder prevalence. ADHD stimulant treatment was related to lower insomnia disorder compared to patients without medication, as well as ADHD stable treatment. Additionally, worse health-related quality of life was associated with insomnia disorder.Conclusion: Insomnia disorder is highly prevalent in adult ADHD and is related to higher ADHD severity and more psychiatric and medical comorbidities. Some stimulants and stable pharmacological ADHD treatment are associated with better outcomes of insomnia disorder.

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