Better adherence to titration levels needed for physicians treating children with ADHD

Lavigne JV. Pediatrics. 2011;doi:10.1542/peds.2010-2684.

Improved adherence to titration levels for attention-deficit/hyperactivity disorder medications was linked to improved treatment outcomes, according to study results.

However, although physician training on medication administration also was linked to improved outcomes, a computer program designed to assist physicians in appropriate dosing was not independently associated with improvements.

Researchers from 24 pediatric practices in Chicago conducted a randomized medication trial to determine whether brief physician training with computer-assisted medication management yielded better reduction in ADHD symptoms. The other aim of the study was to evaluate whether adherence to recommended titration protocols was linked to improvement in symptoms.

There were two treatment groups. Children in the first group received standard care, whereas children in the second group were treated by physicians who had received 2 hours of training on management of stimulant medications and atomoxetine, plus training on a software program designed to assist monitoring titration and improvement, according to the results.

Parents and teachers of the children in the cohort provided reports before treatment and at 4, 9 and 12 months after treatment initiation.

Improvements were observed in both the standard treatment and specialized care groups, as measured by the ADHD Rating Scales and SNAP-IV parent and teacher scales. The improvements began at the 4-month mark and continued through the final two assessment periods.

However, no significant difference in the rate of change over time was observed between the two treatment groups.

Adherence to recommended titration procedures was linked to better outcomes for total and inattentive ADHD symptoms on both measurement scales.

Neither ineffective dosing nor discontinuation due to adverse events affected the results.

“Brief physician training alone did not lead to reductions in ADHD symptoms, but adherence to a protocol that involved titration until the child’s symptoms were in the average range and had shown a reliable change led to better symptom reduction,” the researchers wrote. “Computer-assisted medication management can contribute to better treatment outcomes in primary care medication treatment of ADHD.”

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