Maria Lorenzo

Influence of gender on attention-deficit/hyperactivity disorder in Europe--ADORE.

BackgroundAttention-deficit/hyperactivity disorder (ADHD) in girls in Europe is poorly understood; it is not known whether they exhibit similar symptom patterns or co-existing problems and receive the same type of treatment as boys.ObjectiveTo examine gender differences for referral patterns, social demographic factors, ADHD core symptomatology, co-existing health problems, psychosocial functioning and treatment.MethodsBaseline data from the ADHD Observational Research in Europe (ADORE) study, a 24-month, naturalistic, longitudinal observational study in 10 European countries of children (aged 6–18 years) with hyperactive/inattentive/impulsive symptoms but no previous diagnosis of ADHD, were analysed by gender.ResultsData from 1,478 children were analysed: 231 girls (15.7 %) and 1,222 boys (84.3 %) (gender data missing for 25 patients). Gender ratios (girl:boy) varied by country, ranging from 1:3 to 1:16. Comparisons showed few gender effects in core ADHD symptomatology and clinical correlates of ADHD. Compared with boys, girls had significantly more parent-rated emotional symptoms and prosocial behaviour and were more likely to be the victim of bullying and less likely to be the bully. Girls and boys had similar levels of co-existing psychiatric and physical health problems, and received the same type of treatment.ConclusionsFewer girls than boys are referred for ADHD treatment, but they have a similar pattern of impairment and receive similar treatment.

Factors related to Health-Related Quality of Life (HRQoL) among children with ADHD in Europe at entry into treatment

ObjectiveTo describe the associations between a range of baseline factors (demographic, family and clinical) and parent-reported health-related quality of life (HRQoL) of children with ADHD taking part in the ADORE study.MethodsHRQoL was rated using the Parent Report Form of the Child Health and Illness Profile-Child Edition (CHIP-CE). Forward-stepwise linear regression models were used to investigate associations with 26 independent variables. Separate models were fitted for each of the five CHIP-CE domains (Satisfaction, Comfort, Resilience, Risk Avoidance and Achievement) and two subdomains of Achievement (Academic Performance and Peer Relations).ResultsCHIP-CE domain mean scores were lower than community norms, especially for Risk Avoidance and Achievement, indicating a low level of HRQoL. Clinical factors significantly associated with a poorer HRQoL included ADHD symptoms (inattention, hyperactivity-impulsivity), conduct problems, peer relationship problems, having asthma, multiple other somatic symptoms and co-ordination problems. Family factors, such as having a parent with a health or mental health problem possibly caused by the childs illness, child not living with both parents and maternal smoking during pregnancy were also associated with a worse HRQoL in some CHIP-CE domains/subdomains.ConclusionsNumerous factors independently impact on the HRQoL of children with ADHD.

Co-existing psychiatric problems in ADHD in the ADORE cohort

ObjectiveTo study the impact of co-existing psychiatric problems with ADHD on behavioural features, psychosocial functioning and quality of life in subjects of the ADORE cohort (N=1,478).MethodsThe following six groups of associated psychiatric problems with ADHD were compared: oppositional-defiant disorder or conduct disorder only (ODD/CD); anxiety or depressive disorder only (ANX/DEP); tic/Tourette’s disorder only (TIC/ Tourettes); developmental co-ordination disorder only (DCD); two or more associated conditions; and none. Dependent variables included the ADHD Rating Scale-IV, the Strengths and Difficulties Questionnaire, the Clinical Global Impression-Severity scale, the Childrens Global Assessment Scale and the Child Health Illness Profile-Child Edition.ResultsHaving multiple co-existing psychiatric problems increased the severity of ADHD in all domains, be it behavioural features, psychosocial impairment or deterioration of quality of life. A similar though less consistent pattern applied to subjects with co-existing ODD/CD.ConclusionsThe ADORE study provides impressive evidence for the far-reaching consequences of co-existing psychiatric problems in children with ADHD that warrant intensive consideration in clinical assessment and treatment.

Psychopathological screening of children with ADHD: strengths and difficulties questionnaire in a pan-European study

ObjectiveTo examine the psychometric properties of the Strengths and Difficulties Questionnaire (SDQ) parent version and to determine the effects of age, gender, country and investigator type (paediatrician, child psychiatrist, other physician) on the SDQ scores in the prospective, non-interventional ADORE study.MethodsThe SDQ was completed for 1,459 children with ADHD (aged 6–18 years) in 10 European countries.ResultsFactor analysis provided an exact replication of the original 5-factor SDQ subscale structure. All subscales were sufficiently homogeneous. The mean total difficulties and SDQ subscale scores of the ADORE sample clearly differed from UK normative data. Younger children were more impaired on different SDQ scales than older children, and girls were more emotionally affected than boys. Differences between countries were found for each SDQ scale, but the investigator type had no significant effect. Correlation coefficients between SDQ scales and other scales used in ADORE ranged from low (r<0.30) to high (r>0.50).ConclusionsThe present study confirmed the validity and reliability of the parent-reported SDQ scale structure and showed that the scale scores are dependent on age and gender. In contrast to investigator type, different cultures had a significant effect on SDQ scores. Correlations with other scales used in the ADORE study underline both separate domains and meaningful associations.

Validity of the health-related quality of life assessment in the ADORE study: Parent Report Form of the CHIP-Child Edition.

ObjectivesTo examine the cross-sectional reliability and validity of the Parent Report Form of the Child Health and Illness Profile-Child Edition (CHIP-CE), a generic measure of health-related quality of life (HRQoL), in children with ADHD in the pan-European ADHD Observational Research in Europe (ADORE) study.MethodsParents of children with ADHD (aged 6–18 years) in 10 European countries completed the CHIP-CE at the baseline visit (n=1,477; data missing for one patient). Analyses included determination of internal consistency reliability, ceiling and floor effects, factor analysis, and Pearsons correlations between CHIP-CE and other scales used to measure ADHD severity, problems and family strain.ResultsInternal consistency reliability was good-to-excellent (Chronbachs α>0.70) for all CHIP-CE domains and subdomains, and almost no ceiling and floor effects were observed. Factor analysis of the subdomains yielded a 12-factor solution. The domainlevel factor analysis identified six factors, the four domains of Satisfaction, Comfort, Resilience and Risk Avoidance. The two subdomains of Achievement domain, Peer Relations and Academic Performance, were separate factors in this sample. There were moderate-to-high correlations between the CHIP-CE scales and measures of ADHD and family factors. The HRQoL of children in ADORE was dramatically lower than that of community youth,with mean CHIP-CE scores almost 2 standard deviations below community norms.ConclusionsThe validity and reliability of CHIP-CE to measure HRQoL in children with ADHD across Europe was confirmed.

Study design, baseline patient characteristics and intervention in a cross-cultural framework: results from the ADORE study

ObjectiveTo describe the methodology and to present the baseline findings of the Attention-deficit/hyperactivity Disorder Observational Research in Europe (ADORE) study, the primary objective of which is to describe the relationship between treatment regimen prescribed and quality of life of children with ADHD in actual practice.MethodsIn this 2-year prospective observational study, data on diagnosis, prescribed treatment and outcomes of ADHD were collected at seven time points by paediatricians and child psychiatrists on 1,573 children recruited in 10 European countries. The data presented here from the 1,478 patients included in the analyses describe the baseline condition, initial treatment regimen prescribed and quality of life of families with children with ADHD.ResultsPatients had a mean age of 9.0 years (SD 2.5) and 84% were male. Physicians diagnoses were made using DSM-IV (43 %), ICD-10 (32%) and both DSM-IV and ICD-10 (12 %). Mean age of awareness of a problem was 5.1 years, suggesting an average delay of approximately 4 years between awareness and diagnosis of ADHD. Baseline ADHD rating scale scores (physicianrated) indicated moderate to severe ADHD. Parent-rated SDQ scores were in agreement and suggested significant levels of co-existing problems. CGI-S, CGAS and CHIPCE scores also indicated significant impairment. Patients were offered the following treatments after the initial assessment: pharmacotherapy (25 %), psychotherapy (19 %), combination of pharmacotherapy and psychotherapy (25 %), other therapy (10 %) and no treatment (21 %).ConclusionThe ADORE study shows that ADHD is similarly recognised across 10 European countries and that the children are significantly impaired across a wide range of domains. In this respect, they resemble children described in previous ADHD samples.

ADORE – Attention–Deficit Hyperactivity Disorder Observational Research in Europe

AbstractBackgroundSince there is little information about the naturalistic way of treatment in daily European practice, the Attention–Deficit Hyperactivity Disorder Observational Research in Europe (ADORE) project was designed as a prospective, non–interventional study of approximately 1,500 patients observed by approximately 300 investigators in various European regions.ObjectiveThe primary objective is the description of the relationship between treatment regimen prescribed and quality of life in ADHD patients over a two–year period.MethodThe naturalistic care provided and the outcomes (psychopathology, quality of life) are recorded at 7 data collection points.ResultsThe present preliminary report provides data on the first 315 patients who were included in the study by the beginning of January 2004. The data provide an impression of the sample characteristics, the clinical diversity, and the effects of ADHD on school careers and social activities. Furthermore, treatment information dealing with the time both before and at baseline is given.ConclusionEven with this limited sample the negative effects on psychosocial development and quality of life in ADHD children are apparent.

The Family Strain Index (FSI). Reliability, validity, and factor structure of a brief questionnaire for families of children with ADHD

BackgroundAttention-deficit/hyperactivity disorder (ADHD) in children affects every member of the family. Practical tools are needed to assess the effects of ADHD on families to better understand and address the level of stress, strain and burden that families experience.ObjectiveTo provide the preliminary reliability, validity and factor structure of the Family Strain Index (FSI), a 6-item parent-report questionnaire.MethodsThe FSI was completed by 1,477 parents of children with ADHD (aged 6–18 years) at the baseline visit of the ADORE study in 10 European countries (data missing for one patient).ResultsThe FSI taps into an overall experience of worry and interruptions of activities in families of children with ADHD, as a single factor was identified with excellent internal consistency (α=0.87). Despite its brevity, almost no ceiling (worst score) or floor (best score) effects were observed for families of these highly symptomatic children. This score distribution and the 5-point response options suggest that the FSI will be responsive to changes in the experience of family strain associated with childrens ADHD treatment.ConclusionThe ease of completion and coherence of the underlying construct indicates that the FSI may be a practical clinical tool for monitoring changes in family strain associated with childrens ADHD treatment.

Which factors impact on clinician-rated impairment in children with ADHD?

ObjectivesTo describe the associations between a range of demographic, family and clinical factors and clinician-rated measures of global impairment in children with ADHD symptoms obtained at the baseline assessment in the ADHD Observational Research in Europe (ADORE) study.MethodsGlobal impairment was measured by clinicians using the Clinical Global Impression-Severity (CGIS) scale and the Childrens Global Assessment Scale (CGAS).Associations with independent variables were investigated using forward-stepwise regression models.ResultsFor the CGI-S and CGAS analyses, complete data sets were available for 1,265 and 985 children, respectively. The baseline mean CGI-S score in this population was 4.4 (SD 0.9) and the mean CGAS score was 55.0 (SD 10.6). Factors significantly associated with increased impairment on both outcome measures were: increased severity of ADHD symptoms, increased peer relationship problems and presence of oppositional defiant disorder and/or conduct disorder.Also, the presence of anxiety and/or depression and the presence of somatic symptoms were associated with increased impairment on CGI-S,while family health problems and premature birth were associated with increased impairment on CGAS.ConclusionsThe severity of clinician-rated impairment in the ADORE sample is increased by the presence of disruptive behaviour problems and emotional problems, somatic symptoms, peer relationship difficulties, family health problems and premature birth.

Short-Term Effectiveness of Medication and Psychosocial Intervention in a Cohort of Newly Diagnosed Patients With Inattention, Impulsivity, and Hyperactivity Problems

Objective: The article discusses the ADHD Observational Research in Europe (ADORE) study that examined the impact of early treatment choices on outcome within the first few months, in previously untreated children with impairing inattention, impulsivity, and hyperactivity. Methods: Data are collected from a longitudinal, observational study conducted in 10 European countries that involve 1,478 children (aged 6 to 18 years) with symptoms of hyperactivity, impulsivity, or inattentiveness. Linear model with a propensity score adjustment compares the decrease in ADHD-RS scores between baseline and last recorded visit across treatment groups (2 to 5 months). Results: At baseline, 49.9% of participants are prescribed pharmacotherapy and 44.3% a psychosocial intervention. Analysis of the effect of treatment on the evolution of ADHD-RS scores shows a positive effect of medications and either an insignificant or negative effect of psychosocial intervention. Conclusions: Early use of medication effectively reduces ADHD symptoms in routine clinical practice in Europe. The effect of psychosocial intervention has to be interpreted cautiously because the number, length, and level of standard of the sessions are not taken into account in the analyses.