Abstract
ObjectivesTo explore the influence of age on treatment responses to atomoxetine and to assess the relationship between core symptoms of attention deficit/hyperactivity disorder (ADHD) and health-related quality of life (HR-QoL) outcomes.Data SourcesData from five similar clinical trials of atomoxetine in the treatment of children and adolescents with ADHD were included in this meta-analysis.Study SelectionAtomoxetine studies that used the ADHD Rating Scale (ADHD-RS) and the Child Health and Illness Profile Child Edition (CHIP-CE) as outcome measures were selected.InterventionsTreatment with atomoxetine.Main Outcome MeasuresTreatment group differences (atomoxetine vs placebo) in terms of total score, domains, and subdomains of the CHIP-CE were compared across age groups, and correlations between ADHD-RS scores and CHIP-CE scores were calculated by age.ResultsData of 794 subjects (611 children, 183 adolescents) were pooled. At baseline, adolescents showed significantly (p < 0.05) greater impairment compared with children in the Family Involvement, Satisfaction with Self, and Academic Performance subdomains of the CHIP-CE. Treatment effect of atomoxetine was significant in both age groups for the Risk Avoidance domain and its subdomains. There was a significant age-treatment interaction with greater efficacy seen in adolescents in both the Risk Avoidance domain and the Threats to Achievement subdomain. Correlations between ADHD-RS and CHIP-CE scores were generally low at baseline and moderate in change from baseline and were overall similar in adolescents and children.ConclusionsAtomoxetine was effective in improving some aspects of HR-QoL in both age groups. Correlations between core symptoms of ADHD and HR-QoL were low to moderate.
Highlights
Attention deficit/hyperactivity disorder (ADHD) is one of the most frequently diagnosed psychiatric disorders in childhood, characterized by 3 core symptoms: inattentiveness, hyperactivity, and impulsivity
Correlations between ADHD Rating Scale (ADHD-RS) and Child Health and Illness Profile Child Edition (CHIP-CE) scores were generally low at baseline and moderate in change from baseline and were overall similar in adolescents and children
Atomoxetine was effective in improving some aspects of health-related quality of life (HR-QoL) in both age groups
Summary
Attention deficit/hyperactivity disorder (ADHD) is one of the most frequently diagnosed psychiatric disorders in childhood, characterized by 3 core symptoms: inattentiveness, hyperactivity, and impulsivity. ADHD was consistently associated with complex short-term and long-term impairments and negative outcomes regarding educational achievement, social and emotional impairment, behavioral disturbances, problems with interpersonal relations, and psychiatric comorbidity [2,3,4,5]. The impact of ADHD goes beyond the direct effects of core symptoms on the individual’s everyday functions and represents a serious burden on the patient’s and the family’s life, seriously impairing the emotional, social, and physical well-being of patients and their health-related quality of life (HR-QoL) [6]. HR-QoL has received increasing attention in children and adolescents with ADHD, both from clinicians and investigators [7,8,9,10]. HR-QoL is a multidimensional concept that reflects the subjective physical, social, and psychological aspects of health, and goes beyond symptoms of the disorder and objective functional outcomes [11]
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