Enns Jennifer E, Randall Jason R, Smith Mark, Chateau Dan, Taylor Carole, Brownell Marni, Bolton James M, Burland Elaine, Katz Alan, Katz Laurence Y, Nickel Nathan C
1 Department of Community Health Sciences, Manitoba Centre for Health Policy, University of Manitoba, Manitoba, Canada.
2 Department of Psychiatry, University of Manitoba, Manitoba, Canada.
Can J Psychiatry. 2017 Jun;62(6):403-412. doi: 10.1177/0706743717692301. Epub 2017 Feb 1.
To evaluate whether a multimodal intervention for children with attention-deficit hyperactivity disorder (ADHD) resulted in better long-term health and education outcomes and reduced inequity across the socioeconomic gradient.
We analyzed administrative data held in the Manitoba Population Research Data Repository describing recipients of a combined pharmacological/behavioural intervention for ADHD. The study cohort included children aged 5 to 17 years who visited the Manitoba Adolescent Treatment Centre's ADHD intervention service at least 3 times (2007-2012). Controls were matched on age, sex, year of ADHD diagnosis, and income quintile. We compared rates of hospital and emergency department visits, medication use and adherence, contact with child welfare services, and whether children were in their age-appropriate grade. We used concentration curves to estimate differences in outcomes between children from high- and low-income families.
Children who received the intervention ( n = 485) had higher rates of medication use (rate ratio [RR], 1.21; 95% CI, 1.08 to 1.36) and adherence (RR, 1.42; 95% CI, 1.03 to 1.96) and were more likely to be in their age-appropriate grade (RR, 1.33; 95% CI, 1.09 to 1.63) compared with controls ( n = 1884). The intervention was also associated with reduced inequity in these outcomes across income deciles. There was no difference in the rates of hospital or emergency department visits or contacts with child welfare services.
A multimodal ADHD intervention was associated with increased medication use and adherence and higher academic achievement. It was also related to lower inequity across the socioeconomic gradient. These results suggest that multimodal approaches may provide more equitable health and education outcomes for children with ADHD.
评估针对注意力缺陷多动障碍（ADHD）儿童的多模式干预是否能带来更好的长期健康和教育成果，并减少社会经济梯度上的不平等。
我们分析了曼尼托巴人口研究数据存储库中的行政数据，这些数据描述了接受ADHD药物/行为联合干预的人群。研究队列包括5至17岁的儿童，他们在2007年至2012年期间至少3次就诊于曼尼托巴青少年治疗中心的ADHD干预服务。对照组在年龄、性别、ADHD诊断年份和收入五分位数上进行匹配。我们比较了住院和急诊就诊率、药物使用和依从性、与儿童福利服务机构的接触情况，以及儿童是否处于与其年龄相符的年级。我们使用集中曲线来估计高收入和低收入家庭儿童在结局方面的差异。
与对照组（n = 1884）相比，接受干预的儿童（n = 485）药物使用（率比[RR]，1.21；95%可信区间[CI]，1.08至1.36）和依从性（RR，1.42；95%CI，1.03至1.96）更高，并且更有可能处于与其年龄相符的年级（RR，1.33；95%CI，1.09至1.63）。该干预还与这些结局在收入十分位数间的不平等减少有关。住院或急诊就诊率或与儿童福利服务机构的接触情况没有差异。
多模式ADHD干预与药物使用和依从性增加以及学业成绩提高有关。它还与社会经济梯度上较低的不平等有关。这些结果表明，多模式方法可能为ADHD儿童提供更公平的健康和教育成果。
