Frazier Thomas W, Weiss Margaret, Hodgkins Paul, Manos Michael J, Landgraf Jeanne M, Gibbins Christopher
Center for Pediatric Behavioral Health and Center for Autism Children's Hospital, Cleveland Clinic, Cleveland, Ohio 44195, USA.
J Child Adolesc Psychopharmacol. 2010 Oct;20(5):355-64. doi: 10.1089/cap.2009.0092.
The aim of this study was to evaluate the time course and predictors of improvement in health-related quality of life (HRQL) and medication satisfaction in children diagnosed with attention-deficit/hyperactivity disorder (ADHD) and treated with the methylphenidate transdermal system (MTS).
Temporal relationships between ADHD symptoms, medication satisfaction, and HRQL measures were examined via latent growth curve, structural path, and growth mixture models.
Higher levels of medication satisfaction at the end of titration predicted greater increases in family HRQL (p=0.004) and, to a lesser extent, child HRQL (p=0.068) throughout the study. At 4 of 6 (p<0.05) and 5 of 6 (p<0.10) contemporaneous time points, ADHD symptoms predicted child HRQL. At 2 of 6 (p<0.05) and 3 of 6 (p<0.10) contemporaneous time points, ADHD symptoms predicted family HRQL. ADHD did not predict child or family HRQL improvements at subsequent time points. A uniform pattern of change for child HRQL was noted, with most HRQL change following the pattern of symptom change during titration. Three distinct patterns of change were noted for family HRQL.
In most cases, medication satisfaction, ADHD symptoms, and HRQL improved simultaneously, suggesting that HRQL was not a delayed response to improvement in symptoms. Children showed a uniform pattern of improvement in HRQL that followed symptom change; three distinct patterns of change were found for improvement in family HRQL.
本研究旨在评估诊断为注意力缺陷多动障碍（ADHD）并使用哌甲酯透皮系统（MTS）治疗的儿童，其健康相关生活质量（HRQL）改善的时间进程及预测因素，以及药物满意度情况。
通过潜在增长曲线、结构路径和增长混合模型，研究ADHD症状、药物满意度和HRQL测量指标之间的时间关系。
在滴定结束时较高的药物满意度预示着在整个研究过程中家庭HRQL有更大的提升（p = 0.004），在较小程度上也预示着儿童HRQL的提升（p = 0.068）。在6个同期时间点中的4个（p < 0.05）以及6个中的5个（p < 0.10）时间点，ADHD症状可预测儿童HRQL。在6个同期时间点中的2个（p < 0.05）以及6个中的3个（p < 0.10）时间点，ADHD症状可预测家庭HRQL。ADHD在后续时间点并不能预测儿童或家庭HRQL的改善情况。观察到儿童HRQL有统一的变化模式，大多数HRQL变化遵循滴定期间症状变化的模式。家庭HRQL则观察到三种不同的变化模式。
在大多数情况下，药物满意度、ADHD症状和HRQL同时改善，这表明HRQL并非对症状改善的延迟反应。儿童在HRQL方面呈现出与症状变化一致的统一改善模式；家庭HRQL的改善发现了三种不同的变化模式。
