A ‘global’ approach that takes into account not only improvement in ADHD core symptoms, but also improvements in functioning and quality of life, will offer a more comprehensive definition of remission, suggests a recent review from the UK.
This review discusses the best way to evaluate response to treatment in ADHD clinical trials and practice, given the recent shift towards a global concept of remission as the overarching goal of treatment. Such global remission of ADHD should be reflected across a combination of criteria including ADHD symptom improvement (as assessed by multiple observers), functional impairment and quality of life. In addition, tolerability of pharmacological interventions, comorbidities and cognitive profiles of individual patients must be considered as potential influences on remission. The need for a standardised definition of global remission is highlighted.
The authors make a number of recommendations regarding the implementation of remission outcomes in clinical trials and practice. For example, the importance of DSM*-based rating scales (e.g. ADHD-RS† or SNAP-IV‡) to measure the presence and severity of ADHD core symptoms is emphasised, along with the use of clinician ratings that are based on multi-source information (i.e. parents, teachers and patients). For the assessment of functional improvement, scales like the CGI§ and WFIRS-P¥ (the latter of which requires further support from psychometric studies) could be incorporated into routine patient assessment procedures. Assessment of adverse events and safety outcomes using structured measures and comparisons with normative data, is advised to occur at baseline and throughout treatment. Furthermore, future research may help to elucidate the role of neurocognitive profiles in allocating patients to the treatment that is most tailored to their needs (e.g. combining pharmacological treatment with working memory training).
In summary, the authors highlight the need for more objective measures of remission in ADHD, citing wearable technologies as potentially exciting tools with which to record objective symptom changes following ADHD treatment. The alignment of outcomes from clinical trials with observations from clinical practice is seen as a priority going forward, potentially through the development of psychometrically-validated measures of treatment response.
Read more about outcome measures in ADHD here
*Diagnostic and Statistical Manual of Mental Disorders
†ADHD-IV Rating Scale
‡Swanson, Nolan, and Pelham, Version IV
§Clinical Global Impression
¥Weiss Functional Impairment Rating Scale
Adamo N, Seth S, Coghill D. Pharmacological treatment of attention-deficit/hyperactivity disorder: assessing outcomes. Expert Rev Clin Pharmacol 2015; 8: 383-397.