Rethinking ADHD intervention trials: feasibility testing of two treatments and a methodology

Philippa Fibert,Clare Relton,Tessa Peasgood

doi:10.1007/s00431-019-03374-z

Abstract

Attention deficit hyperactivity disorder (ADHD) is a lifelong condition associated with considerable costs. The long-term effectiveness and acceptability of treatments to improve outcomes remains in doubt. Long-term trials are needed comparing interventions with standard care and each other. The Sheffield Treatments for ADHD Research (STAR) project used the Trials within Cohorts (TwiCs) approach. A cohort of children with ADHD was recruited and outcomes collected from carers and teachers. A random selection was offered treatment by homoeopaths (hom) or nutritional therapists (NT). Their outcomes (Conners Global ADHD Index) were compared with those not offered interventions. The feasibility of the methods and interventions was assessed. The TwiCs approach was feasible with modifications. 144 participants were recruited to the cohort, 83 offered treatment, 72 accepted, and 50 attended 1+ appointments. Results according to carers assessments at 6 months were as follows: t = 1.08, p = .28 (− 1.48, 4.81) SMD .425 (hom); t = 1.71, p = .09 (− .347, 5.89), SMD = .388 (NT). Teachers’ responses were too few and unstable. No serious treatment adverse events occurred.Conclusion: the STAR project demonstrated the feasibility of the TwiCs approach for testing interventions for children with ADHD.What is Known:• Attention deficit hyperactivity disorder (ADHD) is a lifelong condition associated with considerable costs to ADHD stakeholders. Children are at risk of negative outcomes and in need of pre-emptive strategies• The long-term effectiveness and acceptability of recommended treatments to improve outcomes remains in doubtWhat is New:• A small-scale test of the design demonstrated that the Trials within Cohorts (TwiCs) approach is feasible and can make a useful contribution regarding testing the effectiveness of interventions for children with ADHD to improve long-term negative outcomes• Treatment by homoeopaths and nutritional therapists may offer novel opportunities to improve outcomes.

Highlights

Attention deficit hyperactivity disorder (ADHD) is a lifelong condition associated with considerable costs to a significant proportion of those with ADHD, their carers, and society
Collection is important because blinded teacher outcomes provide objective assessments of behaviour in group settings, the majority of early year costs of ADHD are in education [17] and decision makers prioritise blinded results
Children with ADHD are at risk of negative outcomes and in need of pre-emptive strategies implemented as early as possible

Summary

Introduction

Attention deficit hyperactivity disorder (ADHD) is a lifelong condition associated with considerable costs to a significant proportion of those with ADHD, their carers, and society It is a leading cause of child referrals to mental health services, and a major risk factor for early criminality, poor educational outcomes, school drop-out, and expulsion. Short-term effects (12 weeks) are reported for pharmaceutical medications, and behavioural interventions during participation, the long-term effectiveness and acceptability of mainstream recommended treatments to improve outcomes remains in doubt [5, 29,30,31]. The effects found during participation in behavioural interventions are contested due to lack of blinded outcomes, and lack of improvement in core ADHD symptoms [35]. Other interventions are tried by carers [3, 10,11,12], but their effectiveness has not yet been rigorously assessed

Methods

Discussion

Conclusion