Comparing Treatment Outcomes in Children and Adolescents With ADHD to Other Disorders Within an Australian and Dutch Outpatient Cohort

Abstract

Objective: Previous studies at child and youth mental health services (CYMHS) suggest that children with ADHD have poorer outcomes compared to those with other diagnoses. This study investigates this in more detail. Methods: Children with ADHD were compared to those with ASD and those with emotional disorders, on routinely collected outcomes at CYMHS in Australia ( N = 2,513) and the Netherlands ( N = 844). Results: Where the emotional disorders group reached a similar level of emotional symptoms at the end-of-treatment as the ADHD and ASD groups, the latter two groups still had higher scores on ADHD and ASD symptoms (attention and peer problems). The poorer outcomes were mainly explained by higher severity at baseline. In Australia, an ADHD and/or ASD diagnosis also independently contributed to worse outcomes. Conclusion: Those with neurodevelopmental disorders within both countries had poorer outcomes than those with emotional disorders. Services should aim to optimize treatment to ensure best possible outcomes.

Examining the pharmacological and psychological treatment of child and adolescent ADHD in Australia: Protocol for a retrospective cohort study using linked national registry data

“…This good response to treatment of comorbid emotional conditions is in line with the findings of Gould and colleagues, 17 who found the presence of comorbid ADHD did not affect treatment outcomes of CBT for anxiety disorders. The poorer response to treatment for attention symptoms found by our group 15 is in line with previous studies. [18][19][20] A notable discrepancy is that these findings of suboptimal improvements in attention symptoms in clinical settings are in contrast to the good outcomes reported in medication treatment trials.…”

“…Children under the care of these services may experience a treatment ceiling; having already received evidence-based treatment from a primary care provider, there may be fewer gains to be made in the public system. This was confirmed by Payne et al , 15 who showed that the severity of symptoms in children attending CYMHS in Queensland, Australia, played a role in explaining poorer routine outcome measure improvement. Few studies have explored the treatment provided to children with ADHD.…”

“…Recent research by our group has examined the differences in outcomes of children treated at Brisbane Child and Youth Mental Health Service community clinics. It was found that, compared with those with emotional disorders, children with neurodevelopmental disorders (ADHD and/or autism) had poorer outcomes in relation to behavioural, attention and social problems on the Health of the Nation Outcome Scales for Children and Adolescents, 15 the Strengths and Difficulties Questionnaire (SDQ), 15 and the Children’s Global Assessment Scale. 16 Despite having poorer response in behavioural, attention and social difficulties, in Payne et al ’s study, 15 children with ADHD and/or autism improved on comorbid emotional symptoms to the same extent as those with emotional disorders.…”

“…A diagnosis of only ADHD with no comorbidities is uncommon in CYMHS, with 86.2% of CYMHS children with ADHD also having at least one additional diagnosis. 15 CDS focus on the assessment and diagnosis of children with neurodevelopmental disorders, as opposed to other mental disorders, and children are mostly seen by developmental paediatricians. Given the severity and acuity required to be seen in the public health system in Australia, young people who have lesser symptom severity or who are not accepted into a public clinic will therefore be seen by private practitioners in the community, with the fees of medical practitioners and some allied health practitioners partially subsidised by a government Medicare rebate.…”

“…Public CYMHS accept children who have severe and complex mental health problems for treatment, meaning they do not only see children with ADHD. A diagnosis of only ADHD with no comorbidities is uncommon in CYMHS, with 86.2% of CYMHS children with ADHD also having at least one additional diagnosis 15. CDS focus on the assessment and diagnosis of children with neurodevelopmental disorders, as opposed to other mental disorders, and children are mostly seen by developmental paediatricians.…”