Lilja Maria M, Lichtenstein Paul, Serlachius Eva, Bhagia Jyoti, Malmberg Kerstin, Malm Christer, Lenhard Fabian, Halldner Linda
Department of Clinical Sciences, Child and Adolescent Psychiatry, Umea University, Umea, Sweden.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Eur Child Adolesc Psychiatry. 2025 Jan 29. doi: 10.1007/s00787-025-02650-8.
Predictors for the pharmacological effect of ADHD medication in children and adolescents are lacking. This study examined clinically relevant factors in a large (N = 638) prospective cohort reflecting real-world evidence. Children and adolescents aged 6-17 diagnosed with ADHD were evaluated at baseline and three months following ADHD medication initiation. The outcome was measured as a reduction in total SNAP-IV (Swanson Nolan and Pelham teacher and parent rating scale) score at three months compared to baseline. Outcome groups were defined as Responders (≥ 40% reduction), Intermediate Responders (≥ 20 to < 40% reduction), and Non-responders (< 20% reduction). Included independent variables were the Autism Spectrum Questionnaire (ASSQ), the Spence Children's Anxiety Scale (SCAS), the Pediatric Side Effect Checklist (P-SEC), anthropometrics measures, geographical region, relative age, Children´s Global Assessment Scale (CGAS), Intelligence quotient (IQ), pharmacological treatment initiation month, ADHD symptom severity, ADHD presentation, and psychotic-like experiences. Multinomial logistic regression suggested that ADHD symptom severity, region, relative age, and stating ADHD medication at three-month follow-up were associated with the response outcome group. However, when validating the data with Bootstrap Forest, none of the variables were significant. Thus, in our large naturalistic cohort, we could not identify any clinically relevant factors that reliably predict pharmacological treatment outcomes.Trial registration: NCT02136147.
目前尚缺乏儿童和青少年注意力缺陷多动障碍（ADHD）药物治疗效果的预测指标。本研究在一个大型（N = 638）前瞻性队列中考察了反映真实世界证据的临床相关因素。对6至17岁诊断为ADHD的儿童和青少年在基线期及开始ADHD药物治疗三个月后进行评估。结果指标为与基线相比，三个月时SNAP-IV（斯旺森·诺兰和佩勒姆教师及家长评定量表）总分的降低情况。结果分组定义为有反应者（降低≥40%）、中度反应者（降低≥20%至＜40%）和无反应者（降低＜20%）。纳入的自变量包括自闭症谱系问卷（ASSQ）、斯彭斯儿童焦虑量表（SCAS）、儿科副作用清单（P-SEC）、人体测量指标、地理区域、相对年龄、儿童总体评定量表（CGAS）、智商（IQ）、药物治疗开始月份、ADHD症状严重程度、ADHD表现类型以及类精神病体验。多项逻辑回归分析表明，ADHD症状严重程度、地区、相对年龄以及在三个月随访时开始使用ADHD药物与反应结果分组有关。然而，在用Bootstrap森林法验证数据时，没有一个变量具有显著性。因此，在我们这个大型自然队列研究中，我们未能识别出任何能可靠预测药物治疗结果的临床相关因素。试验注册号：NCT02136147。
