title: Considerations and evidence for an ADHD outcome measure.
abstract: OBJECTIVE
  The 2011 American Academy of Pediatrics attention-deficit/hyperactivity disorder (ADHD) guideline emphasizes monitoring and measuring outcomes of children diagnosed with ADHD; however, recommendations for how to measure improvement are less clear. A long-term goal was to develop an outcome measure that assesses the quality of care for children with ADHD. As a first step in that process, we conducted a literature synthesis on the efficacy and effectiveness of guideline-recommended ADHD treatments on patient outcomes.
  
  
  METHODS
  A literature search was conducted in PubMed according to PRISMA protocol and using MeSH terms. US Preventive Services Task Force (USPSTF) criteria were used to assess the level of evidence. Studies of interest were published after 2002 and assessed prospective ADHD improvement using recommended ADHD treatments.
  
  
  RESULTS
  The systematic review resulted in 35 studies. According to USPSTF criteria, included studies were level I (n = 24), level II-1 (n = 1), and level II-2 (n = 10) and were rated as good (n = 20) or fair (n = 15). DSM-criteria-based rating scales were used most frequently to measure ADHD treatment outcomes. All included treatments resulted in ADHD improvement. Regardless of outcome measure, tool, or treatment type, symptom reduction and improvement were relatively large, with mean percentage reductions ranging from 20% to 86% on ADHD-Behavior Rating Scales scales, with only 1 study with <25% reduction. Effect sizes ranged from 0.15 to 4.57.
  
  
  CONCLUSIONS
  On the basis of this literature review, a consistent pattern of improvement in pediatric ADHD patients' core symptoms emerged across studies, study designs, and recommended treatment approaches. This evidence supports the notion that an improvement of core symptoms within 1 year could satisfy the requirements of an effective outcome measure, which should be further investigated.
authors.affiliation: Center for Healthcare Studies, Northwestern University, Feinberg School of Medicine, Chicago, Ill. Electronic address: woods@northwestern.edu.
authors.forename: Donna
authors.initials: D
authors.lastname: Woods
authors.affiliation: University of Oklahoma Health Sciences Center, Oklahoma City, Okla.
authors.forename: Mark
authors.initials: M
authors.lastname: Wolraich
authors.affiliation: Northwestern University Feinberg School of Medicine, Chicago, Ill.
authors.forename: Karen
authors.initials: K
authors.lastname: Pierce
authors.affiliation: Center for Healthcare Studies, Northwestern University, Feinberg School of Medicine, Chicago, Ill.
authors.forename: Lindsay
authors.initials: L
authors.lastname: DiMarco
authors.affiliation: Center for Healthcare Studies, Northwestern University, Feinberg School of Medicine, Chicago, Ill.
authors.forename: Nicole
authors.initials: N
authors.lastname: Muller
authors.affiliation: American Academy of Pediatrics, Elk Grove Village, Ill; Medical College of Wisconsin, Milwaukee, Wis.
authors.forename: Ramesh
authors.initials: R
authors.lastname: Sachdeva
mesh_terms: D001289:Attention Deficit Disorder with Hyperactivity / Q000628:therapy*; D002648:Child; D006801:Humans; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic; D058996:Quality Improvement; D014481:United States
keywords: attention-deficit/hyperactivity disorder; mental health; outcome measures; pediatrics; quality of health care