What is a clinically important level of improvement in symptoms of attention-deficit/hyperactivity disorder?
OBJECTIVE
To compare the desired and actual reduction in scores on a parent reported behaviour rating scale in a naturalistic sample of children and adolescents who had been treated with psychostimulant medication, referenced to global ratings of treatment benefit.


METHODS
Forty-five parents reporting poor global response to psychostimulant treatment, 44 reporting moderate response, and 49 reporting a high response retrospectively completed Conners rating scales describing their child prior to treatment, the child currently, and how the parent hoped the child would be following treatment.


RESULTS
Percentage actual improvement in behaviour rating scales from baseline ranged from around 25% for the poor responders to above 50% for the high responders. Desired improvement was above 50%, with no significant difference between the groups on level of expectation.


CONCLUSIONS
Percentage cut points used to indicate clinical improvement reported in previous controlled trials of psychostimulant medication are probably too low, and could lead to an overestimate of treatment effect. Expectation of treatment benefit is unlikely to contribute to variation in treatment response.
Hazell
Philip
P
Child and Youth Mental Health Service, Locked Bag 1014, Wallsend, NSW 2287, Australia. Philip.Hazell@newcastle.edu.au
Lewin
Terry
T
Sly
Ketrina
K
D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D000697:Central Nervous System Stimulants / Q000627:therapeutic use*; D002648:Child; D006801:Humans; D008774:Methylphenidate / Q000627:therapeutic use*; D015588:Observer Variation; D010290:Parents; D012189:Retrospective Studies; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
D000697:Central Nervous System Stimulants; D008774:Methylphenidate