Dieter Breuer

Effectiveness of an adaptive multimodal treatment in children with Attention-Deficit Hyperactivity Disorder -- global outcome.

AbstractBackgroundThe meaning of different components within a multimodal treatment of ADHD remains to be further clarified.ObjectiveTo evaluate the effectiveness of behaviour therapy and drug treatment within an adaptive and individually tailored multimodal treatment for children with ADHD.MethodAfter an initial psychoeducation n = 75 school-children aged 6–10 years with a diagnosis of ADHD/HKD were assigned to either behaviour therapy (including continued psychoeducation) or medical management with methylphenidate plus psychoeducation. Depending on the effectiveness, the treatment was either terminated (if totally effective) with long–term aftercare and continuation of medication if needed, or (if partially effective) the other treatment component was added (combined treatment), or (if ineffective) the treatment components were replaced. Thus a treatment rationale was applied which resulted in an adaptive and individually tailored therapy – similar to a strategy that may be useful in clinical practice.ResultsOf the children who started with behaviour therapy after initial psychoeducation 26% received a combined treatment in later treatment stages. In most of the cases (82%) with initial medical management, behaviour therapy was added. ADHD symptoms, individually defined behaviour problems and comorbid symptoms were significantly reduced during the course of treatment. On core measures large pre–post effect sizes were found. On teacher ratings combined treatment was more effective than behaviour therapy.ConclusionsBoth, behaviour therapy and combined treatment are effective interventions within an adaptive and individually tailored multimodal treatment strategy.

Comparative efficacy of once-a-day extended-release methylphenidate, two-times-daily immediate-release methylphenidate, and placebo in a laboratory school setting.

AbstractBackgroundGiven the dosing limitations of methylphenidate short–acting preparations in treating ADHD, galenics with longer release of the substance were developed mainly to avoid drug intake during school hours.ObjectivesThis investigation was conducted to assess the efficacy and the duration of action of a new extended-release formulation of methylphenidate (Medikinet® retard) as a once–daily treatment for children with attention–deficit hyperactivity disorder (ADHD).MethodThis was a randomized, double–blind, crossover multicentre study with three treatment conditions: once–daily extended–release methylphenidate, twice–daily immediate–release methylphenidate and placebo given to 79 children (8–14 years old) with ADHD. Daily assessments in an analogue classroom setting included blind ratings of attention and deportment and a performance measure (math test) obtained 5 times over an 8–hour period. Secondary measures included an ADHD rating scale, based on DSMIV/ ICD–10 separately rated for the morning and the afternoon.ResultsBoth active treatment conditions displayed significant time course effects and were superior to placebo in improving all efficacy measures. Once a day extended–release methylphenidate was not different from the same dose of twice daily immediate–release methylphenidate.ConclusionsThese data provide support for the benefit of this novel, once-daily methylphenidate preparation in the treatment of ADHD. The longer duration of action of Medikinet Retard has the potential to simplify psychostimulant treatment, thus reducing dose diversion and eliminating the need for in–school administration.

Die Erfassung von Merkmalen von Aufmerksamkeitsdefizit-/Hyperaktivitätsstörungen (ADHS) anhand von Lehrerurteilen

Fragestellung: In der vorliegenden Arbeit soll der Fremdbeurteilungsbogen-Hyperkinetische Storungen (FBB-HKS) aus dem Diagnostik-System fur Psychische Storungen im Kindes- und Jugendalter (DISYPS-KJ) in Lehrerform validiert werden. Untersucht werden die faktorielle, konvergente, divergente und differenzielle Validitat, sowie die Reliabilitat des Verfahrens mittels Prufung der internen Konsistenzen und der Wiederholungszuverlassigkeiten. Methodik: Der Fragebogen besteht aus 20 vierfach gestuften Symptom-Items, welche die 18 Symptom-Kriterien nach ICD-10 und DSM-IV abbilden. Zur Verfugung stehen die erhobenen Daten aus einer Schule fur Kinder mit Verhaltensauffalligkeiten/Lernstorungen (Studie 1: n = 50), einer Inanspruchnahmestichprobe einer kinder- und jugendpsychiatrischen Ambulanz (Studie 2: n = 78) und einer multizentrischen Studie zur Wirksamkeitsuberprufung eines lang wirksamen Methylphenidatpraparates (Studie 3: n = 79). Ergebnisse: Die explorativen und konfirmatorischen Faktorenanalysen bestatigen ...OBJECTIVES This study analyzes the German version of the teacher rated Symptom Checklist for Attention Deficit Hyperactivity Disorders (FBB-HKS) which is part of the Diagnostic System of Mental Disorders in Children and Adolescents (DISYPS-KJ). Factorial validity as well as convergent, divergent und differential validity and reliability (internal consistency and retest reliability) of the scale are analyzed. METHODS The questionnaire consists of 20 four point symptom items, assessing the 18 symptom-criteria according to ICD-10 und DSM-IV. Data were collected in a sample of pupils from a school for children with behavioral, emotional and learning problems (study 1: n = 50), as well as in a referred sample from a child and adolescent psychiatric outpatient clinic (study 2: n = 78), and a sample from a multi-center study on the effects of long-acting methylphenidate (study 3: n = 79). RESULTS The exploratory and the confirmatory factor analyses confirm both a three factor structure with hyperactivity, impulsivity and inattention as separate factors and a two factor structure (with hyperactivity-impulsivity and inattention). Internal consistencies and retest reliabilities are in a good to very good range. Convergent, divergent and differential validity can be confirmed. Thus, the rating scale is suitable for the assessment of ADHD symptoms at school.

Efficacy and Safety of Omega-3/6 Fatty Acids, Methylphenidate, and a Combined Treatment in Children With ADHD.

Objective: To compare efficacy of Omega-3/6 fatty acids (Equazen eye q™) with methylphenidate (MPH) and combined MPH + Omega-3/6 in children with ADHD. Method: Participants (N = 90) were randomized to Omega-3/6, long-acting MPH, or combination for 12 months. ADHD symptoms were assessed using the ADHD Rating Scale and Clinical Global Impressions–Severity (CGI-S) scale. Results: ADHD symptoms decreased in all treatment arms. Although significant differences favoring Omega + MPH over Omega-3/6 alone were found for ADHD Total and Hyperactivity-Impulsivity subscales, results on the Inattention subscale were similar. CGI-S scores decreased slowly and consistently with Omega-3/6, compared with a rapid decrease and subsequent slight increase in the MPH-containing arms. Adverse events were numerically less frequent with Omega-3/6 or MPH + Omega-3/6 than MPH alone. Conclusion: The tested combination of Omega-3/6 fatty acids had similar effects to MPH, whereas the MPH + Omega combination appeared to have some tolerability benefits over MPH.

Aufmerksamkeitsdefizit-/ Hyperaktivitätsstörungen bei Drei- bis Sechsjährigen in der ärztlichen Praxis - eine bundesweite Befragung

Zusammenfassung: Fragestellung: Ziel der Arbeit ist die Ermittlung der Pravalenzen von Symptomen und Diagnosen einer Aufmerksamkeitsdefizit- /Hyperaktivitatsstorung (ADHS) bei Kindern im Vorschulalter, die Erfassung der Funktionseinschrankungen und komorbider Symptome im Eltern- und Erzieherurteil. Methodik: Bundesweit nahmen 708 Kinder aus 103 padiatrischen oder kinder- und jugendpsychiatrischen Praxen teil. Verwendet wurden Fremdbeurteilungsbogen fur Hyperkinetische Storungen im Vorschulalter (FBB-ADHS-V) im Eltern- und Erzieherurteil, sowie arztliche Beurteilungen von n = 521 Kindern aus U8/U9 Vorsorgeuntersuchungen (U8/U9), oder vom Arzt als ADHS-auffallig eingeschatzte Kinder n = 187 (AUF) unter Ausschluss einer U8/U9-Vorsorgeuntersuchung. Ergebnisse: In U8/U9 erfullen im Elternurteil 11,3% der Kinder die Diagnosekriterien fur eine der drei ADHS-Diagnosen nach DSM-IV (ICD-10: 3,8%), im Erzieherurteil sind es nur 6,6% (ICD-10: 1,5). Bei Beurteilerubereinstimmung erfullen 4,2 % aller Kinder aus U8/U9 d...

An observational study of once-daily modified-release methylphenidate in ADHD: the effect of previous treatment on ADHD symptoms, other externalising symptoms and quality-of-life outcomes

Methylphenidate (MPH) is the most commonly prescribed stimulant for children with ADHD. Data on the effects of different MPH formulations in real-life settings are scarce, and the role of previous therapy on treatment outcome when switching medications has not been well studied. OBSEER was an observational study designed to evaluate the effectiveness and safety of Equasym XL® in routine care. This study assessed whether the improvements reported with Equasym XL® are influenced by the degree of symptom control achieved with the previous medication. Patients enrolled in OBSEER were stratified by prior treatment (none, MPH-immediate release [IR] once daily [o.d.] [MPH-IR o.d.], MPH-IR repeated [MPH-IR >o.d.] and MPH-MR [modified release] excluding Equasym XL®), and changes in ADHD and other externalising symptoms (CGI-S, FBB-ADHD and DAYAS) and quality of life (QoL, KINDL) were evaluated during treatment with Equasym XL®. A total of 782 patients were analysed. Significant group-by-time interactions were found for all symptom variables analysed, indicating that effects varied by previous medication. For CGI-S and FBB-ADHD total scores, the greatest reductions in ADHD symptoms were observed in the treatment-naïve subgroup, followed (in order) by MPH-IR o.d., MPH-IR >o.d. and MPH-MR. A similar profile was seen for DAYAS ratings for all periods of the day except the evening, when there were no significant differences between subgroups. Similarly, the treatment-naïve and MPH-IR o.d. subgroups showed the greatest improvements in KINDL ratings. Although effects were greatest for treatment-naïve patients, improvements were also observed in the prior treatment subgroups for symptoms and QoL. This suggests that a change to Equasym XL® may be beneficial in patients with suboptimal effects on prior medication.

Entwicklung eines Fragebogens zur Erfassung von Aufmerksamkeitsdefizit-/Hyperaktivitätsstörungen (ADHS) bei Vorschulkindern im Eltern- und im Erziehungsurteil

Zusammenfassung. Fragestellung: Zur Erfassung von Aufmerksamkeitsdefizit-/Hyperaktivitatsstorungen (ADHS) im Kindergarten- und Vorschulalter wurde die Validitat und Reliabilitat einer altersangepassten Version des Fremdbeurteilungsbogens fur Hyperkinetische Storungen (FBB-HKS), der Fremdbeurteilungsbogen fur Aufmerksamkeitsdefizit-/Hyperaktivitatsstorungen im Vorschulalter (FBB-ADHS-V) gepruft. Methodik: Bundesweit nahmen 708 Patienten (2,9 bis 7,3 Jahre) aus 103 Arztpraxen teil, die im Rahmen von kinderarztlichen Vorsorgeuntersuchungen vorgestellt (U8/U9, n = 521) oder vom Arzt als expansiv auffallig eingeschatzt wurden (AUF, n = 187). Eltern- und Erzieherbogen wurden erganzt durch nachgeordnete, eher deskriptive arztliche Beurteilungen. Ergebnisse: Durch konfirmatorische Faktorenanalysen konnte sowohl im Eltern- als auch im Erzieherurteil eine zweifaktorielle Losung analog zu den DSM-IV-Subkategorien fur ADHS (hyperaktiv/impulsiv; unaufmerksam) ermittelt werden. Die internen Konsistenzen aller Skalen li...

Evaluation of a computer-based neuropsychological training in children with attention-deficit hyperactivity disorder (ADHD).

BACKGROUND We report the effects of a computer-based neuropsychological training in children with Attention-Deficit Hyperactivity Disorder (ADHD). We hypothesized that a specific training focusing on attentional dysfunction would result in an improvement of inattention, observable in test performance, behavior and performance during experimental school lessons and in parent and teacher ratings of the related core symptom. METHOD We chose a within-subject-control-design with a 4 week baseline period and subsequent 12 to 15 weekly training-sessions. 30 children (6 to 13 years old) with a diagnosis of ADHD (ICD 10: F 90.0) and no other comorbidities participated in the study. RESULTS The training revealed significant improvement in training parameters of the neuropsychological training and in the symptoms of inattention and deportment as rated during experimental school lessons. However, generalization of training effects as measured by parent and teacher ratings was not detected. CONCLUSIONS We conclude that neuropsychological training could be helpful as one adjunct module in the complex treatment of ADHD but to prove clinical value, similar training programs must focus more strongly on individually existing neuropsychological deficits. Training programs should be more intensive and should eventually be combined with home based training access.

Die Erfassung von Aufmerksamkeits- und Verhaltensproblemen im Unterricht mit dem Fragebogen zur Verhaltensbeurteilung im Unterricht (FVU)

Zusammenfassung. Sowohl fur diagnostische Zwecke als auch fur die Beurteilung von Interventionen in der psychotherapeutischen und der padagogischen Praxis sowie in der Forschung sind Verfahren sehr wichtig, die im Lehrerurteil Storungen des Arbeitsverhaltens von Schulern im Unterricht zeitokonomisch und reliabel erfassen. Diese fehlen aber im deutschen Sprachraum. Daher wurde der Fragebogen zur Verhaltensbeurteilung im Unterricht (FVU) auf der Basis der englischsprachigen SKAMP-Skala entwickelt, die im Rahmen von Studien zu Aufmerksamkeitsdefizit-/Hyperaktivitatsstorungen (ADHS) eingesetzt wurde. In der vorliegenden Studie wurde der FVU in drei klinischen Stichproben im Umfang von n1 = 50, n2 = 28 und n3 = 79 Kindern und Jugendlichen hinsichtlich der Validitat und Reliabilitat untersucht. Anhand einer konfirmatorischen Faktorenanalyse erweisen sich die beiden Subskalen Aufmerksamkeitsprobleme und mangelnde Regelbefolgung nach Elimination eines Items als faktoriell valide. Die Interrater-Reliabilitat ist e...

Long-Term Course After Adaptive Multimodal Treatment for Children With ADHD An 8-Year Follow-Up

Objective: This study reassessed adolescents and young adults (15-22 years old) who received individually tailored multimodal treatment for ADHD (behavior therapy and/or stimulant medication) during childhood 6 to 12 years after treatment (M = 8.8 years, SD = 1.6). Method: All participants (N = 75) provided information about their social functioning. Most parents (83%) completed behavior rating scales. Results: Participants demonstrated significant improvement in behavior during the follow-up period with effect sizes on ADHD symptoms of d = 1.2 and 68% of the former patients in the normal range at follow-up. Participants reported elevated rates of grade retention (51%), school dropout (13%), special education service use (17%), school change (47%), and conviction (16%), but few were unemployed (4%). Conclusion: This study provides evidence that the effects of individually tailored multimodal treatment for ADHD in childhood are maintained into adolescence and young adulthood. No hints could be found that continued medication results in a more favorable long-term outcome.