Impact of Mental Health Comorbidities on the Community-Based Pediatric Treatment and Outcomes of Children with Attention Deficit Hyperactivity Disorder.
Nour Al Ghriwati, Joshua M Langberg, William Gardner and 6 others
PMID 27902542WHAT IT FOUND
Children with ADHD and anxiety or depression improved less on medication than those with ADHD alone.
Remission was lower in both comorbidity groups. Most referred children never received therapy, leaving many without the combined care guidelines recommend.
Key findings
01Children with internalizing comorbidities showed a weaker treatment response for inattention and hyperactivity compared to those with no comorbidities.
02Remission rates at one year were substantially lower for children with internalizing or externalizing comorbidities than for those with ADHD alone.
03Although children with comorbidities were referred to therapy more often, very few actually received it during the study year.
STILL TO COME
How it was doneWhat they found
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What it does not show
Comorbidity status was determined by parent ratings on screening scales rather than diagnostic interviews, so some children may not have met full clinical criteria for anxiety or depression. Parent ratings were used for all outcomes, but children are often better reporters of their own internalizing symptoms. The study did not collect teacher ratings, which are recommended for assessing ADHD symptoms in school settings. Data came from practices in a single geographic region that volunteered for a quality improvement study, which may not represent all community pediatricians. Patient-level socioeconomic data and insurance type were not available to adjust for, though practice-level Medicaid rates did not differ between groups.
Declared interests
The authors declared no conflicts of interest. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
The easy way to misread this
Do not conclude that medication is ineffective for children with ADHD and comorbid anxiety or depression. The study shows these children respond less robustly than those with ADHD alone, but they still showed improvement. The finding suggests a need for combined care, not a reason to withhold medication.