title: Toward quality care in ADHD: defining the goals of treatment.
abstract: OBJECTIVE
  Therapeutic goals for chronic mental disorders like major depressive disorder (MDD) and schizophrenia have evolved in parallel with the growing medical knowledge about the course and treatment of these disorders. Although the knowledge base regarding the clinical course of ADHD, a chronic psychiatric disorder, has evolved beyond symptomatic improvement and short-term treatment response, long-term goals, such as functional remission, have not yet been clearly defined.
  
  
  METHODS
  A PubMed literature search was conducted to investigate the therapeutic goals of pharmacologic treatment referenced in the published literature from January 1998 through February 2010 using the following commonly used ADHD treatments as keywords: amphetamine, methylphenidate, atomoxetine, lisdexamfetamine, guanfacine, and clonidine. This search was then combined with an additional search that included the following outcome keywords: remission, relapse, remit, response, normal, normalization, recovery, and effectiveness.
  
  
  RESULTS
  Our search identified 102 publications. The majority (88.2% [90/102]) of these contained predefined criteria for treatment response. Predefined criteria for normalization and remission and/or relapse were presented in 4.9% (5/102), 12.7% (13/102), and 3.9% (4/102) of publications, respectively. There was a lack of consistency between the instruments used to measure outcomes as well as the criteria used to define treatment response, normalization, and remission as well as relapse.
  
  
  CONCLUSIONS
  The therapeutic goals in treating ADHD should address optimal treatment outcomes that go beyond modest reductions of ADHD symptoms to include syndromatic, symptomatic, and functional remission. Future work should focus on reliable and valid tools to measure these outcomes in the clinical trial setting.
authors: University of Pennsylvania Health System, Philadelphia, USA rostain@mail.med.upenn.edu.
authors: Anthony
authors: A
authors: Rostain
authors: The REACH Institute, New York, NY, USA Mayo Clinic, Rochester, MN, USA.
authors: Peter S
authors: PS
authors: Jensen
authors: University of Connecticut School of Medicine, Farmington, USA.
authors: Daniel F
authors: DF
authors: Connor
authors: The JB Ashtin Group Inc., Plymouth, MI, USA.
authors: Laura M
authors: LM
authors: Miesle
authors: SUNY Upstate Medical University, Syracuse, NY, USA.
authors: Stephen V
authors: SV
authors: Faraone
mesh_terms: D000069445:Atomoxetine Hydrochloride; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy* / Q000523:psychology; D000697:Central Nervous System Stimulants / Q000008:administration & dosage / Q000627:therapeutic use*; D003913:Dextroamphetamine / Q000008:administration & dosage / Q000627:therapeutic use; D006040:Goals; D016316:Guanfacine / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D000069478:Lisdexamfetamine Dimesylate; D008774:Methylphenidate / Q000008:administration & dosage / Q000627:therapeutic use; D011437:Propylamines / Q000008:administration & dosage / Q000627:therapeutic use; D011787:Quality of Health Care; D016896:Treatment Outcome
chemical_list: D000697:Central Nervous System Stimulants; D011437:Propylamines; D008774:Methylphenidate; D016316:Guanfacine; D000069445:Atomoxetine Hydrochloride; D000069478:Lisdexamfetamine Dimesylate; D003913:Dextroamphetamine
keywords: ADHD; outcome measures; therapeutic goals; treatment terminology