Boyer Bianca E, Doove Lisa L, Geurts Hilde M, Prins Pier J M, Van Mechelen Iven, Van der Oord Saskia
Department of Developmental Psychology, University of Amsterdam, Amsterdam, The Netherlands.
Dutch Autism & ADHD research center (d'Arc), Department of Brain and Cognition, University of Amsterdam, Amsterdam, The Netherlands.
PLoS One. 2016 Mar 15;11(3):e0150698. doi: 10.1371/journal.pone.0150698. eCollection 2016.
This study explored qualitative treatment-subgroup interactions within data of a RCT with two cognitive behavioral treatments (CBT) for adolescents with ADHD: a planning-focused (PML) and a solution-focused CBT (SFT). Qualitative interactions imply that which treatment is best differs across subgroups of patients, and are therefore most relevant for personalized medicine.
Adolescents with ADHD (N = 159) received either PML or SFT. Pre-, post- and three-month follow-up data were gathered on parent-rated ADHD symptoms and planning problems. Pretreatment characteristics were explored as potential qualitative moderators of pretest to follow-up treatment effects, using an innovative analyses technique (QUINT; Dusseldorp & Van Mechelen, 2014). In addition, qualitative treatment-subgroup interactions for the therapeutic changes from pre- to posttest and from post- to follow-up test were investigated.
For the entire time span from pretest to follow-up only a quantitative interaction was found, while from posttest to follow-up qualitative interactions were found: Adolescents with less depressive symptoms but more anxiety symptoms showed more improvement when receiving PML than SFT, while for other adolescents the effects of PML and SFT were comparable.
Whereas subgroups in both treatments followed different trajectories, no subgroup was found for which SFT outperformed PML in terms of the global change in symptoms from pretest to three months after treatment. This implies that, based on this exploratory study, there is no need for personalized treatment allocation with regard to the CBTs under study for adolescents with ADHD. However, for a subgroup with comorbid anxiety symptoms but low depression PML clearly appears the treatment of preference.
Nederlands Trial Register NTR2142.
本研究在一项随机对照试验（RCT）的数据中探索了针对患有注意力缺陷多动障碍（ADHD）青少年的两种认知行为疗法（CBT）的定性治疗亚组交互作用：一种是以计划为重点的（PML）和一种以解决问题为重点的CBT（SFT）。定性交互作用意味着哪种治疗方法对不同亚组的患者效果最佳，因此与个性化医疗最为相关。
159名患有ADHD的青少年接受了PML或SFT治疗。收集了家长评定的ADHD症状和计划问题的治疗前、治疗后及三个月随访数据。使用一种创新分析技术（QUINT；Dusseldorp和Van Mechelen，2014）探索治疗前特征作为治疗前至随访治疗效果的潜在定性调节因素。此外，还研究了从治疗前到治疗后以及从治疗后到随访测试的治疗性变化的定性治疗亚组交互作用。
从治疗前到随访的整个时间段内仅发现了定量交互作用，而从治疗后到随访发现了定性交互作用：抑郁症状较轻但焦虑症状较多的青少年在接受PML治疗时比接受SFT治疗时改善更大，而对于其他青少年，PML和SFT的效果相当。
尽管两种治疗方法中的亚组遵循不同的轨迹，但在从治疗前到治疗后三个月的症状总体变化方面，未发现SFT优于PML的亚组。这意味着，基于这项探索性研究，对于所研究的患有ADHD青少年的CBT，无需进行个性化治疗分配。然而，对于伴有焦虑症状但抑郁程度较低的亚组，PML显然是首选治疗方法。
荷兰试验注册NTR2142。
