Adaptive strategies for treating childhood mania.
The conduct of trials in children is beset with special difficulties associated with the dearth of treatment data, the considerable heterogeneity of pediatric patient populations connected with (for example) developmental stage, and the strong desire of parents to see that children are provided with the best possible care at all times. To address these issues, we propose the adaptive treatment strategy (ATS) study in which medication changes are adaptively determined according to the evolving treatment response of the individual child. To formalize this methodological approach, we parameterize an ATS as a "threshold" decision rule that monitors whether the patient's response trajectory crosses some threshold of failure. In this formulation, the threshold represents a priori judgments about when to give up on response to medication, and the goal is to find the right response thresholds for continuation, augmentation, or switching. Our exposition is developed in the specific clinical context of childhood mania to maximize accessibility of the ideas but applies more generally to other chronic mental and physical health disorders that are difficult to treat.
Dawson
Ree
R
Frontier Science Technology and Research Foundation, Boston, Massachusetts 02215, USA. Dawson@fstrf.dfci.harvard.edu
Lavori
Philip W
PW
Luby
Joan L
JL
Ryan
Neal D
ND
Geller
Barbara
B
D000293:Adolescent; D000465:Algorithms; D001714:Bipolar Disorder / Q000175:diagnosis / Q000628:therapy*; D002648:Child; D002657:Child Development; D002662:Child Health Services; D002908:Chronic Disease; D002985:Clinical Protocols; D003663:Decision Trees; D006801:Humans; D010347:Patient Care Planning / Q000592:standards*; D012720:Severity of Illness Index