Avoid common mistakes on your manuscript.
Dear Editor,
In their July issue paper, Hodgkins et al. concluded that “European patients may benefit from better standardization of ADHD management across countries and additional treatment options” [2].
According to science and human rights, all management should be appropriate, evidence-based, and up-to-date, and all patients should be guaranteed the best available treatment. Thus, “better standardization” and “additional treatment options” refer to a limited retrospective study that was also potentially dated.
The broad, discretionary criteria in sampling both physicians and patients consistently affected results, leading to imbalance within and between countries. For example, despite the study's selection of “physicians with ADHD expertise,” 15 % of patients in the Netherlands and 24 % in UK received a diagnosis of ADHD without either of the two main diagnostic criteria (ICD-10 or DSM-IV).
Starting therapy, duration, and intensity/dosage were not reported. The authors' comments concerning therapy switch, satisfaction, outcome, and treatment management are thus not supported by adequate analyses. Authors reported, for example, that symptom control was strongest in patients receiving long-acting methylphenidate (36 %) and weakest in patients receiving behavioral therapy (BT) (only 16 %), but duration and intensity should be considered in BT.
Another important bias of the study is the long follow-up period (2–5 years), knowing that ADHD symptoms are affected by the duration and type of treatment [3].
Since only 34.5 % of included patients were treated with a combination of pharmacotherapy and BT, according to NICE guideline recommendations [4], only 30.8 % of patients would be expected to show “complete symptom control.”
Lastly, the profile of ADHD management resulting from this study is completely different from the Italian reality [1, 5].
One of the acknowledged needs of ADHD patients is effective evidence-based interventions, and this can be achieved through (useful) data collection, assessment of prevalence, case identification, and outcome measurements. This work does not seem to contribute to this aim.
References
Didoni A, Sequi M, Panei P, Bonati M, Lombardy ADHD Registry Group (2011) One-year prospective follow-up of pharmacological treatment in children with attention-deficit/hyperactivity disorder. Eur J Clin Pharmacol 67(10):1061–1067
Hodgkins P, Setyawan J, Mitra D, Davis K, Quintero J, Fridman M, Shaw M, Harpin V (2013) Management of ADHD in children across Europe: patient demographics, physician characteristics and treatment patterns. Eur J Pediatr 172(7):895–906
Jensen PS, Arnold LE, Swanson JM, Vitiello B, Abikoff HB, Greenhill LL, Hechtman L, Hinshaw SP, Pelham WE, Wells KC, Conners CK, Elliott GR, Epstein JN, Hoza B, March JS, Molina BS, Newcorn JH, Severe JB, Wigal T, Gibbons RD, Hur K (2007) 3-year follow-up of the NIMH MTA study. J Am Acad Child Adolesc Psychiatry 46(8):989–1002
National Institute for Health and Clinical Excellence (2009) Attention deficit hyperactivity disorder: diagnosis and management of ADHD in children, young people and adults: national clinical practice guideline number 72. National Institute for Health and Clinical Excellence, London
Panei P, Arcieri R, Vella S, Bonati M, Martini N, Zuddas A (2004) Italian attention-deficit/hyperactivity disorder registry. Pediatrics 114(2):514
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Reale, L., Clavenna, A., Panei, P. et al. More and better should be done to guarantee evidence-based management of ADHD in children across Europe. Eur J Pediatr 173, 549 (2014). https://doi.org/10.1007/s00431-013-2184-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00431-013-2184-3