The management of patients with ADHD would benefit from clear definitions for long-term treatment response and remission, a systematic review reports.
A literature search was conducted to investigate the long-term therapeutic goals of pharmacological treatment for ADHD reported in the literature (January 1998 – February 2010) using commonly prescribed ADHD treatments as keywords combined with the following outcomes: remission, relapse, remit, response, normal, normalisation, recovery and effectiveness.
Of the publications identified (n=102), 88.2% contained predefined criteria for treatment response; however, only 4.9%, 12.7% and 3.9% of publications reported predefined criteria for normalisation, remission and relapse, respectively. Although similar rating scales were applied to assess each outcome between studies, there was a lack of consistency with how rating scale scores were utilised and interpreted to measure outcomes. For example, although the majority of studies defined treatment response as a ≥25% reduction in ADHD-RS-IV* score and/or a CGI† score of 1 or 2, others utilised different score boundaries.
Based on the findings in this review, the authors proposed the following definitions for the long-term therapeutic goals of ADHD: syndromal remission – ‘no longer meeting diagnostic criteria for ADHD’; symptomatic remission – ‘having symptom scores within the normal range with some remaining functional impairment’; and functional remission (i.e. recovery) – ‘having both symptom scores and functioning within the normal ranges’.
These therapeutic goals should be incorporated into treatment algorithms for ADHD so that they can be easily adopted by clinicians, the authors suggest. Future studies are needed to validate and standardise criteria for each type of remission.
*ADHD Rating Scale – Fourth Edition
†Clinical Global Impressions
Rostain A, Jensen PS, Connor DF, et al. Toward quality care in ADHD: defining the goals of treatment. J Atten Disord. 2015; 19: 99-117.