With onset often occurring before 6 years of age, attention-deficit/hyperactivity disorder (ADHD) involves attention problems, impulsivity, overactivity, and sometimes disruptive behavior. Impairment usually persists into adulthood, with an estimated worldwide prevalence in adults of 2.5%. Existing gaps in evidence concerning ADHD hinder decision-making about treatment. This article describes and prioritizes future research needs for ADHD in three areas: treatment effectiveness for at-risk preschoolers; long-term treatment effectiveness; and variability in prevalence, diagnosis, and treatment.
Using a recent systematic review concerning ADHD completed by a different evidence-based practice center as a foundation, we worked with a diverse group of 12 stakeholders, who represented researchers, funders, healthcare providers, patients, and families, to identify and prioritize research needs. From an initial list of 29 evidence gaps, we enumerated 8 high-priority research needs: a) accurate, brief standardized diagnosis and assessment; b) comparative effectiveness and safety of pharmacologic treatments for children under 6 years of age; c) comparative effectiveness of different combinations of psychosocial and pharmacologic treatments for children under 6 years of age; d) case identification and measurement of prevalence and outcomes; e) comparative effectiveness of psychosocial treatment alone versus pharmacologic and combination treatments for children under 6 years of age; f) comparative long-term treatment effectiveness for people 6 years of age and older; g) relative efficacy of specific psychosocial program components for children under 6 years of age; and h) identification of person-level effect modifiers for people 6 years of age and older. In this article, we describe these future research needs in detail and discuss study designs that could be used to address them. (Journal of Psychiatric Practice 2014;20:104–117)
GAYNES, WINES, JONAS, ELLIS, and CAREY: University of North Carolina at Chapel Hill and the Cecil G. Sheps Center for Health Services Research, RTI-UNC Evidence-based Practice Center, Chapel Hill, NC; CHRISTIAN: University of North Carolina at Chapel Hill and the Carolina Institute for Developmental Disabilities, Chapel Hill, NC; SAAVEDRA, VISWANATHAN, and WOODELL: Research Triangle Institute International, RTI-UNC Evidence-based Practice Center, Research Triangle Park, NC
The authors declare no conflicts of interest. Funding for this project was provided by the Agency for Healthcare Research and Quality (AHRQ) through the American Recovery and Reinvestment Act (ARRA) (Contract No. 290 2007 10056 I). The views expressed in this manuscript do not represent and should not be construed to represent a determination or policy of AHRQ or the U.S. Department of Health and Human Services.
Please send correspondence to: Bradley N. Gaynes, MD, MPH, Department of Psychiatry, CB #7160, University of North Carolina School of Medicine, 100 Manning Drive, Chapel Hill, NC 27599. firstname.lastname@example.org