Investigation of the Relationship Between Treatment Duration and Compliance with Neuropsychological Test Scores and Prognostic Factors in Patients with Attention Deficit Hyperactivity Disorder: A Naturalistic Follow-up Study

Project no. 31939 · Status: Kapanmış (Yayın bekleniyor) · 2024

Summary

<p class="ql-align-justify"><strong style="color: black;">Objective:&nbsp;</strong><span style="color: rgb(0, 0, 0);">This&nbsp;study&nbsp;aimed&nbsp;to&nbsp;examine&nbsp;the&nbsp;relationship&nbsp;between&nbsp;treatment&nbsp;duration,&nbsp;treatment&nbsp;adherence,&nbsp;neuropsychological&nbsp;test&nbsp;performance,&nbsp;clinical&nbsp;improvement&nbsp;levels,&nbsp;digital&nbsp;media&nbsp;use&nbsp;habits,&nbsp;family&nbsp;mental&nbsp;health&nbsp;characteristics,&nbsp;and&nbsp;various&nbsp;prognostic&nbsp;factors&nbsp;in&nbsp;children&nbsp;and&nbsp;adolescents&nbsp;diagnosed&nbsp;with&nbsp;attention-deficit/hyperactivity&nbsp;disorder&nbsp;(ADHD).&nbsp;The&nbsp;study&nbsp;sought&nbsp;to&nbsp;systematically&nbsp;address&nbsp;the&nbsp;multidimensional&nbsp;nature&nbsp;of&nbsp;ADHD,&nbsp;which&nbsp;encompasses&nbsp;cognitive,&nbsp;behavioral,&nbsp;and&nbsp;environmental&nbsp;components&nbsp;beyond&nbsp;core&nbsp;symptoms</span></p><p class="ql-align-justify"><strong style="color: black;">Materials&nbsp;and&nbsp;methods:&nbsp;</strong><span style="color: rgb(0, 0, 0);">This&nbsp;naturalistic&nbsp;follow-up&nbsp;study&nbsp;included&nbsp;80&nbsp;children&nbsp;and&nbsp;adolescents&nbsp;diagnosed&nbsp;with&nbsp;ADHD&nbsp;between&nbsp;2017&nbsp;and&nbsp;2018.&nbsp;Clinical&nbsp;assessments&nbsp;consisted&nbsp;of&nbsp;the&nbsp;Turgay&nbsp;DSM-IV&nbsp;Scale&nbsp;(pre-&nbsp;and&nbsp;post-treatment)&nbsp;and&nbsp;the&nbsp;Clinical&nbsp;Global&nbsp;Impression&nbsp;(CGI)&nbsp;scales.&nbsp;Neuropsychological&nbsp;performance&nbsp;was&nbsp;evaluated&nbsp;using&nbsp;the&nbsp;CNS&nbsp;Vital&nbsp;Signs&nbsp;(CNSVS)&nbsp;battery,&nbsp;covering&nbsp;the&nbsp;Neurocognition&nbsp;Index,&nbsp;composite&nbsp;memory,&nbsp;cognitive&nbsp;flexibility,&nbsp;psychomotor&nbsp;speed,&nbsp;reaction&nbsp;time,&nbsp;and&nbsp;complex&nbsp;attention.&nbsp;Digital&nbsp;media&nbsp;exposure,&nbsp;gaming&nbsp;duration,&nbsp;age&nbsp;at&nbsp;first&nbsp;internet&nbsp;use,&nbsp;family&nbsp;mental&nbsp;health&nbsp;history,&nbsp;socioeconomic&nbsp;status,&nbsp;and&nbsp;behavioral&nbsp;outcomes&nbsp;(disciplinary&nbsp;actions,&nbsp;grade&nbsp;repetition,&nbsp;emergency&nbsp;department&nbsp;admissions)&nbsp;were&nbsp;systematically&nbsp;recorded.&nbsp;The&nbsp;effects&nbsp;of&nbsp;treatment&nbsp;duration,&nbsp;medication&nbsp;type,&nbsp;medication&nbsp;holidays,&nbsp;and&nbsp;other&nbsp;prognostic&nbsp;factors&nbsp;on&nbsp;clinical&nbsp;improvement&nbsp;were&nbsp;analyzed&nbsp;using&nbsp;multivariable&nbsp;regression&nbsp;models</span></p><p class="ql-align-justify"><strong style="color: black;">Results:&nbsp;</strong><span style="color: rgb(0, 0, 0);">After&nbsp;treatment,&nbsp;all&nbsp;core&nbsp;ADHD&nbsp;symptoms&nbsp;showed&nbsp;significant&nbsp;reductions&nbsp;(p&lt;0.001).&nbsp;According&nbsp;to&nbsp;CGI-I&nbsp;scores,&nbsp;72.5%&nbsp;of&nbsp;participants&nbsp;demonstrated&nbsp;clinically&nbsp;significant&nbsp;improvement,&nbsp;while&nbsp;27.5%&nbsp;showed&nbsp;inadequate&nbsp;response.&nbsp;Additionally,&nbsp;all&nbsp;Turgay&nbsp;subscale&nbsp;scores&nbsp;significantly&nbsp;decreased&nbsp;from&nbsp;baseline&nbsp;to&nbsp;post-treatment&nbsp;(p&lt;0.001).&nbsp;The&nbsp;inadequate-response&nbsp;group&nbsp;had&nbsp;higher&nbsp;atomoxetine&nbsp;use,&nbsp;more&nbsp;frequent&nbsp;medication&nbsp;holidays,&nbsp;and&nbsp;longer&nbsp;treatment&nbsp;duration&nbsp;(all&nbsp;p&lt;0.05).&nbsp;Earlier&nbsp;internet&nbsp;exposure&nbsp;and&nbsp;longer&nbsp;daily&nbsp;screen&nbsp;time&nbsp;were&nbsp;associated&nbsp;with&nbsp;poor&nbsp;treatment&nbsp;response&nbsp;(p&lt;0.05).&nbsp;Greater&nbsp;symptom&nbsp;severity&nbsp;was&nbsp;associated&nbsp;with&nbsp;lower&nbsp;Neurocognition&nbsp;Index&nbsp;scores&nbsp;(r&nbsp;=&nbsp;–0.295,&nbsp;p&nbsp;=&nbsp;0.008),&nbsp;composite&nbsp;memory&nbsp;(r&nbsp;=&nbsp;–0.251,&nbsp;p&nbsp;=&nbsp;0.025),&nbsp;and&nbsp;cognitive&nbsp;flexibility&nbsp;(r&nbsp;=&nbsp;–0.227,&nbsp;p&nbsp;=&nbsp;0.008),&nbsp;whereas&nbsp;complex&nbsp;attention&nbsp;showed&nbsp;a&nbsp;positive&nbsp;association&nbsp;(r&nbsp;=&nbsp;0.329,&nbsp;p&nbsp;=&nbsp;0.003).&nbsp;Final&nbsp;hyperactivity&nbsp;scores&nbsp;increased&nbsp;complex&nbsp;attention&nbsp;(r&nbsp;=&nbsp;0.338,&nbsp;p&nbsp;=&nbsp;0.002)&nbsp;but&nbsp;decreased&nbsp;cognitive&nbsp;flexibility&nbsp;(r&nbsp;=&nbsp;–0.248,&nbsp;p&nbsp;=&nbsp;0.026).&nbsp;Conduct&nbsp;problems&nbsp;were&nbsp;associated&nbsp;with&nbsp;reduced&nbsp;cognitive&nbsp;flexibility&nbsp;(r&nbsp;=&nbsp;–0.228,&nbsp;p&nbsp;=&nbsp;0.033).&nbsp;Regression&nbsp;models&nbsp;indicated&nbsp;that&nbsp;male&nbsp;sex&nbsp;(OR&nbsp;=&nbsp;13.833,&nbsp;p&nbsp;=&nbsp;0.004)&nbsp;and&nbsp;younger&nbsp;age&nbsp;(OR&nbsp;=&nbsp;0.962,&nbsp;p&nbsp;=&nbsp;0.040)&nbsp;significantly&nbsp;increased&nbsp;the&nbsp;risk&nbsp;of&nbsp;digital&nbsp;gaming,&nbsp;whereas&nbsp;older&nbsp;age&nbsp;(OR&nbsp;=&nbsp;2.192,&nbsp;p&nbsp;=&nbsp;0.042)&nbsp;</span><span style="color: black;">and&nbsp;higher&nbsp;psychomotor&nbsp;speed&nbsp;(OR&nbsp;=&nbsp;1.06,&nbsp;p&nbsp;=&nbsp;0.036)&nbsp;independently&nbsp;predicted&nbsp;substance-use&nbsp;risk.</span><span style="color: red;">&nbsp;</span><span style="color: rgb(0, 0, 0);">Age&nbsp;was&nbsp;the&nbsp;strongest&nbsp;predictor&nbsp;of&nbsp;body&nbsp;mass&nbsp;index&nbsp;(BMI)&nbsp;(β&nbsp;=&nbsp;0.46,&nbsp;p&nbsp;&lt;&nbsp;0.001),&nbsp;and&nbsp;</span><span style="color: black;">lower&nbsp;reaction&nbsp;time&nbsp;(β&nbsp;=&nbsp;0.395,&nbsp;p&nbsp;=&nbsp;0.018)&nbsp;was&nbsp;</span><span style="color: rgb(0, 0, 0);">also&nbsp;positively&nbsp;associated&nbsp;with&nbsp;higher&nbsp;BMI.&nbsp;Behavioral&nbsp;indicators&nbsp;such&nbsp;as&nbsp;social&nbsp;media&nbsp;use,&nbsp;disciplinary&nbsp;action,&nbsp;grade&nbsp;repetition,&nbsp;and&nbsp;emergency&nbsp;visits&nbsp;were&nbsp;not&nbsp;significantly&nbsp;related&nbsp;to&nbsp;neuropsychological&nbsp;performance&nbsp;(p&gt;0.05).&nbsp;CGI-I&nbsp;improvement&nbsp;was&nbsp;significantly&nbsp;predicted&nbsp;by&nbsp;sex&nbsp;(β&nbsp;=&nbsp;0.261,&nbsp;p&nbsp;=&nbsp;0.021)&nbsp;and&nbsp;reaction&nbsp;time&nbsp;(β&nbsp;=&nbsp;–0.438,&nbsp;p&nbsp;=&nbsp;0.012)</span></p><p class="ql-align-justify"><strong style="color: black;">Conclusion:&nbsp;</strong><span style="color: rgb(0, 0, 0);">This&nbsp;naturalistic&nbsp;follow-up&nbsp;study&nbsp;evaluated&nbsp;the&nbsp;clinical&nbsp;and&nbsp;neuropsychological&nbsp;follow-up&nbsp;of&nbsp;80&nbsp;children&nbsp;with&nbsp;ADHD,&nbsp;examining&nbsp;the&nbsp;interaction&nbsp;between&nbsp;treatment&nbsp;duration,&nbsp;treatment&nbsp;adherence,&nbsp;and&nbsp;various&nbsp;prognostic&nbsp;factors.&nbsp;A&nbsp;significant&nbsp;reduction&nbsp;was&nbsp;observed&nbsp;in&nbsp;all&nbsp;core&nbsp;ADHD&nbsp;symptoms&nbsp;after&nbsp;treatment,&nbsp;with&nbsp;72.5%&nbsp;of&nbsp;cases&nbsp;demonstrating&nbsp;clinically&nbsp;adequate&nbsp;improvement,&nbsp;while&nbsp;27.5%&nbsp;showed&nbsp;an&nbsp;inadequate&nbsp;response.&nbsp;Inadequate&nbsp;response&nbsp;was&nbsp;associated&nbsp;with&nbsp;atomoxetine&nbsp;use,&nbsp;drug&nbsp;holidays,&nbsp;early&nbsp;digital&nbsp;exposure,&nbsp;and&nbsp;extended&nbsp;screen&nbsp;time.&nbsp;Regression&nbsp;analyses&nbsp;showed&nbsp;that&nbsp;male&nbsp;gender&nbsp;and&nbsp;younger&nbsp;age&nbsp;increased&nbsp;the&nbsp;risk&nbsp;of&nbsp;digital&nbsp;gaming,&nbsp;while&nbsp;older&nbsp;age&nbsp;and&nbsp;higher&nbsp;psychomotor&nbsp;speed&nbsp;increased&nbsp;the&nbsp;risk&nbsp;of&nbsp;substance&nbsp;use.&nbsp;Age&nbsp;was&nbsp;the&nbsp;strongest&nbsp;predictor&nbsp;of&nbsp;BMI.&nbsp;Social&nbsp;media&nbsp;use&nbsp;and&nbsp;behavioral&nbsp;indicators&nbsp;were&nbsp;not&nbsp;associated&nbsp;with&nbsp;neuropsychological&nbsp;performance.&nbsp;The&nbsp;findings&nbsp;suggest&nbsp;that&nbsp;treatment&nbsp;response&nbsp;in&nbsp;ADHD&nbsp;should&nbsp;be&nbsp;evaluated&nbsp;not&nbsp;only&nbsp;based&nbsp;on&nbsp;symptoms&nbsp;but&nbsp;also&nbsp;on&nbsp;cognitive&nbsp;functions&nbsp;and&nbsp;digital&nbsp;behavioral&nbsp;patterns.&nbsp;The&nbsp;most&nbsp;important&nbsp;result&nbsp;obtained&nbsp;from&nbsp;regression&nbsp;analyses&nbsp;indicates&nbsp;that&nbsp;focusing&nbsp;on&nbsp;male&nbsp;gender&nbsp;and&nbsp;reaction&nbsp;time&nbsp;would&nbsp;be&nbsp;beneficial&nbsp;for&nbsp;clinical&nbsp;improvement&nbsp;in&nbsp;ADHD.</span></p>

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