Comorbidity prevalence and treatment outcome in children and adolescents with ADHD

Laura Reale; Beatrice Bartoli; Massimo Cartabia; Michele Zanetti; Maria Antonella Costantino; Maria Paola Canevini; Cristiano Termine; Maurizio Bonati; Stefano Conte; Valeria Renzetti; Laura Salvoni; Massimo Molteni; Antonio Salandi; Sara Trabattoni; Paola Effedri; Elena Filippini; Elisabetta Pedercini; Edda Zanetti; Nadia Fteita; Daniele Arisi; Roberta Mapelli; Simona Frassica; Simonetta Oriani; Christian Trevisan; Susanna Acquistapace; Ottaviano Martinelli; Davide Villani; Emanuela Binaghi; Andrea Deriu; Ernesta Ricotta; Arianna Borchia; Paola Morosini; Maddalena Breviglieri; Giuseppe Capovilla; Roberto Segala; Claudio Bissoli; Isabella Cropanese; Emiddio Fornaro; Silvia Merati; Alberto Ottolini; Monica Saccani; Roberto Vaccari; Vera Valenti; Alessandra Valentino; Umberto Balottin; Matteo Chiappedi; Elena Vlacos; Corrado Meraviglia; Maria Grazia Palmieri; Gianpaolo Ruffoni; Francesco Rinaldi; Federica Soardi; Chiara Luoni; Francesca Pavone; Giorgio Rossi; On Behalf Of Lombardy Adhd Group

doi:10.1007/s00787-017-1005-z

Comorbidity prevalence and treatment outcome in children and adolescents with ADHD

Laura Reale, Beatrice Bartoli, Massimo Cartabia, Michele Zanetti, Maria Antonella Costantino, Maria Paola Canevini, Cristiano Termine, Maurizio Bonati, Stefano Conte, Valeria Renzetti, Laura Salvoni, Massimo Molteni, Antonio Salandi, Sara Trabattoni, Paola Effedri, Elena Filippini, Elisabetta Pedercini, Edda Zanetti, Nadia Fteita, Daniele ArisiRoberta Mapelli, Simona Frassica, Simonetta Oriani, Christian Trevisan, Susanna Acquistapace, Ottaviano Martinelli, Davide Villani, Emanuela Binaghi, Andrea Deriu, Ernesta Ricotta, Arianna Borchia, Paola Morosini, Maddalena Breviglieri, Giuseppe Capovilla, Roberto Segala, Claudio Bissoli, Isabella Cropanese, Emiddio Fornaro, Silvia Merati, Alberto Ottolini, Monica Saccani, Roberto Vaccari, Vera Valenti, Alessandra Valentino, Umberto Balottin, Matteo Chiappedi, Elena Vlacos, Corrado Meraviglia, Maria Grazia Palmieri, Gianpaolo Ruffoni, Francesco Rinaldi, Federica Soardi, Chiara Luoni, Francesca Pavone, Giorgio Rossi, On Behalf Of Lombardy Adhd Group

Research output: Contribution to journal › Article › peer-review

Abstract

Although ADHD comorbidity has been widely studied, some issues remain unsolved. This multicenter observational study aims to examine comorbid psychiatric disorders in a clinical sample of newly diagnosed, treatment naïve children and adolescents with and without ADHD and, to compare treatment efficacy based on the type of comorbidity. We performed an analysis of the medical records of patients identified from the Regional ADHD Registry database, enrolled in 18 ADHD centers in the 2011–2016 period. 1919 of 2861 subjects evaluated (67%) met the diagnostic criteria for ADHD: 650 (34%) had only ADHD, while 1269 (66%) had at least one comorbid psychiatric disorder (learning disorders, 56%; sleep disorders, 23%; oppositional defiant disorder, 20%; anxiety disorders, 12%). Patients with ADHD of combined type and with severe impairment (CGI-S ≥5) were more likely to present comorbidity. 382 of 724 (53%) followed up patients improved after 1 year of treatment. ADHD with comorbidity showed greater improvement when treated with combined interventions or methylphenidate alone. Specifically, combined treatment showed significant superiority for ADHD with learning disorders (ES 0.66) and ODD (ES 0.98), lower for ADHD with sleep or anxiety disorders. Training intervention alone showed only medium efficacy (ES 0.50) for ADHD and learning disorders. This study was the first describing comorbidity patterns of ADHD in Italy, confirming, in a multicenter clinical setting, that ADHD is more often a complex disorder. Findings highlight important diagnostic, therapeutic, and service organization aspects that should be broadly extended to ensure an appropriate and homogenous ADHD management.

Original language	Italian
Pages (from-to)	1443-1457
Number of pages	15
Journal	European Child and Adolescent Psychiatry
Volume	26
Issue number	12
DOIs	https://doi.org/10.1007/s00787-017-1005-z
Publication status	Published - 2017

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10.1007/s00787-017-1005-z

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Reale, L., Bartoli, B., Cartabia, M., Zanetti, M., Costantino, M. A., Canevini, M. P., Termine, C., Bonati, M., Conte, S., Renzetti, V., Salvoni, L., Molteni, M., Salandi, A., Trabattoni, S., Effedri, P., Filippini, E., Pedercini, E., Zanetti, E., Fteita, N., ... Group, O. B. O. L. A. (2017). Comorbidity prevalence and treatment outcome in children and adolescents with ADHD. European Child and Adolescent Psychiatry, 26(12), 1443-1457. https://doi.org/10.1007/s00787-017-1005-z

Comorbidity prevalence and treatment outcome in children and adolescents with ADHD. / Reale, Laura; Bartoli, Beatrice; Cartabia, Massimo; Zanetti, Michele; Costantino, Maria Antonella; Canevini, Maria Paola; Termine, Cristiano; Bonati, Maurizio; Conte, Stefano; Renzetti, Valeria; Salvoni, Laura; Molteni, Massimo; Salandi, Antonio; Trabattoni, Sara; Effedri, Paola; Filippini, Elena; Pedercini, Elisabetta; Zanetti, Edda; Fteita, Nadia; Arisi, Daniele; Mapelli, Roberta; Frassica, Simona; Oriani, Simonetta; Trevisan, Christian; Acquistapace, Susanna; Martinelli, Ottaviano; Villani, Davide; Binaghi, Emanuela; Deriu, Andrea; Ricotta, Ernesta; Borchia, Arianna; Morosini, Paola; Breviglieri, Maddalena; Capovilla, Giuseppe; Segala, Roberto; Bissoli, Claudio; Cropanese, Isabella; Fornaro, Emiddio; Merati, Silvia; Ottolini, Alberto; Saccani, Monica; Vaccari, Roberto; Valenti, Vera; Valentino, Alessandra; Balottin, Umberto; Chiappedi, Matteo; Vlacos, Elena; Meraviglia, Corrado; Palmieri, Maria Grazia; Ruffoni, Gianpaolo; Rinaldi, Francesco; Soardi, Federica; Luoni, Chiara; Pavone, Francesca; Rossi, Giorgio; Group, On Behalf Of Lombardy Adhd.

In: European Child and Adolescent Psychiatry, Vol. 26, No. 12, 2017, p. 1443-1457.

Research output: Contribution to journal › Article › peer-review

Reale, L, Bartoli, B, Cartabia, M, Zanetti, M, Costantino, MA, Canevini, MP, Termine, C, Bonati, M, Conte, S, Renzetti, V, Salvoni, L, Molteni, M, Salandi, A, Trabattoni, S, Effedri, P, Filippini, E, Pedercini, E, Zanetti, E, Fteita, N, Arisi, D, Mapelli, R, Frassica, S, Oriani, S, Trevisan, C, Acquistapace, S, Martinelli, O, Villani, D, Binaghi, E, Deriu, A, Ricotta, E, Borchia, A, Morosini, P, Breviglieri, M, Capovilla, G, Segala, R, Bissoli, C, Cropanese, I, Fornaro, E, Merati, S, Ottolini, A, Saccani, M, Vaccari, R, Valenti, V, Valentino, A, Balottin, U, Chiappedi, M, Vlacos, E, Meraviglia, C, Palmieri, MG, Ruffoni, G, Rinaldi, F, Soardi, F, Luoni, C, Pavone, F, Rossi, G & Group, OBOLA 2017, 'Comorbidity prevalence and treatment outcome in children and adolescents with ADHD', European Child and Adolescent Psychiatry, vol. 26, no. 12, pp. 1443-1457. https://doi.org/10.1007/s00787-017-1005-z

Reale, Laura ; Bartoli, Beatrice ; Cartabia, Massimo ; Zanetti, Michele ; Costantino, Maria Antonella ; Canevini, Maria Paola ; Termine, Cristiano ; Bonati, Maurizio ; Conte, Stefano ; Renzetti, Valeria ; Salvoni, Laura ; Molteni, Massimo ; Salandi, Antonio ; Trabattoni, Sara ; Effedri, Paola ; Filippini, Elena ; Pedercini, Elisabetta ; Zanetti, Edda ; Fteita, Nadia ; Arisi, Daniele ; Mapelli, Roberta ; Frassica, Simona ; Oriani, Simonetta ; Trevisan, Christian ; Acquistapace, Susanna ; Martinelli, Ottaviano ; Villani, Davide ; Binaghi, Emanuela ; Deriu, Andrea ; Ricotta, Ernesta ; Borchia, Arianna ; Morosini, Paola ; Breviglieri, Maddalena ; Capovilla, Giuseppe ; Segala, Roberto ; Bissoli, Claudio ; Cropanese, Isabella ; Fornaro, Emiddio ; Merati, Silvia ; Ottolini, Alberto ; Saccani, Monica ; Vaccari, Roberto ; Valenti, Vera ; Valentino, Alessandra ; Balottin, Umberto ; Chiappedi, Matteo ; Vlacos, Elena ; Meraviglia, Corrado ; Palmieri, Maria Grazia ; Ruffoni, Gianpaolo ; Rinaldi, Francesco ; Soardi, Federica ; Luoni, Chiara ; Pavone, Francesca ; Rossi, Giorgio ; Group, On Behalf Of Lombardy Adhd. / Comorbidity prevalence and treatment outcome in children and adolescents with ADHD. In: European Child and Adolescent Psychiatry. 2017 ; Vol. 26, No. 12. pp. 1443-1457.

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abstract = "Although ADHD comorbidity has been widely studied, some issues remain unsolved. This multicenter observational study aims to examine comorbid psychiatric disorders in a clinical sample of newly diagnosed, treatment na{\"i}ve children and adolescents with and without ADHD and, to compare treatment efficacy based on the type of comorbidity. We performed an analysis of the medical records of patients identified from the Regional ADHD Registry database, enrolled in 18 ADHD centers in the 2011–2016 period. 1919 of 2861 subjects evaluated (67%) met the diagnostic criteria for ADHD: 650 (34%) had only ADHD, while 1269 (66%) had at least one comorbid psychiatric disorder (learning disorders, 56%; sleep disorders, 23%; oppositional defiant disorder, 20%; anxiety disorders, 12%). Patients with ADHD of combined type and with severe impairment (CGI-S ≥5) were more likely to present comorbidity. 382 of 724 (53%) followed up patients improved after 1 year of treatment. ADHD with comorbidity showed greater improvement when treated with combined interventions or methylphenidate alone. Specifically, combined treatment showed significant superiority for ADHD with learning disorders (ES 0.66) and ODD (ES 0.98), lower for ADHD with sleep or anxiety disorders. Training intervention alone showed only medium efficacy (ES 0.50) for ADHD and learning disorders. This study was the first describing comorbidity patterns of ADHD in Italy, confirming, in a multicenter clinical setting, that ADHD is more often a complex disorder. Findings highlight important diagnostic, therapeutic, and service organization aspects that should be broadly extended to ensure an appropriate and homogenous ADHD management.",

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AU - Reale, Laura

AU - Bartoli, Beatrice

AU - Cartabia, Massimo

AU - Zanetti, Michele

AU - Costantino, Maria Antonella

AU - Canevini, Maria Paola

AU - Termine, Cristiano

AU - Bonati, Maurizio

AU - Conte, Stefano

AU - Renzetti, Valeria

AU - Salvoni, Laura

AU - Molteni, Massimo

AU - Salandi, Antonio

AU - Trabattoni, Sara

AU - Effedri, Paola

AU - Filippini, Elena

AU - Pedercini, Elisabetta

AU - Zanetti, Edda

AU - Fteita, Nadia

AU - Arisi, Daniele

AU - Mapelli, Roberta

AU - Frassica, Simona

AU - Oriani, Simonetta

AU - Trevisan, Christian

AU - Acquistapace, Susanna

AU - Martinelli, Ottaviano

AU - Villani, Davide

AU - Binaghi, Emanuela

AU - Deriu, Andrea

AU - Ricotta, Ernesta

AU - Borchia, Arianna

AU - Morosini, Paola

AU - Breviglieri, Maddalena

AU - Capovilla, Giuseppe

AU - Segala, Roberto

AU - Bissoli, Claudio

AU - Cropanese, Isabella

AU - Fornaro, Emiddio

AU - Merati, Silvia

AU - Ottolini, Alberto

AU - Saccani, Monica

AU - Vaccari, Roberto

AU - Valenti, Vera

AU - Valentino, Alessandra

AU - Balottin, Umberto

AU - Chiappedi, Matteo

AU - Vlacos, Elena

AU - Meraviglia, Corrado

AU - Palmieri, Maria Grazia

AU - Ruffoni, Gianpaolo

AU - Rinaldi, Francesco

AU - Soardi, Federica

AU - Luoni, Chiara

AU - Pavone, Francesca

AU - Rossi, Giorgio

AU - Group, On Behalf Of Lombardy Adhd

PY - 2017

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N2 - Although ADHD comorbidity has been widely studied, some issues remain unsolved. This multicenter observational study aims to examine comorbid psychiatric disorders in a clinical sample of newly diagnosed, treatment naïve children and adolescents with and without ADHD and, to compare treatment efficacy based on the type of comorbidity. We performed an analysis of the medical records of patients identified from the Regional ADHD Registry database, enrolled in 18 ADHD centers in the 2011–2016 period. 1919 of 2861 subjects evaluated (67%) met the diagnostic criteria for ADHD: 650 (34%) had only ADHD, while 1269 (66%) had at least one comorbid psychiatric disorder (learning disorders, 56%; sleep disorders, 23%; oppositional defiant disorder, 20%; anxiety disorders, 12%). Patients with ADHD of combined type and with severe impairment (CGI-S ≥5) were more likely to present comorbidity. 382 of 724 (53%) followed up patients improved after 1 year of treatment. ADHD with comorbidity showed greater improvement when treated with combined interventions or methylphenidate alone. Specifically, combined treatment showed significant superiority for ADHD with learning disorders (ES 0.66) and ODD (ES 0.98), lower for ADHD with sleep or anxiety disorders. Training intervention alone showed only medium efficacy (ES 0.50) for ADHD and learning disorders. This study was the first describing comorbidity patterns of ADHD in Italy, confirming, in a multicenter clinical setting, that ADHD is more often a complex disorder. Findings highlight important diagnostic, therapeutic, and service organization aspects that should be broadly extended to ensure an appropriate and homogenous ADHD management.

AB - Although ADHD comorbidity has been widely studied, some issues remain unsolved. This multicenter observational study aims to examine comorbid psychiatric disorders in a clinical sample of newly diagnosed, treatment naïve children and adolescents with and without ADHD and, to compare treatment efficacy based on the type of comorbidity. We performed an analysis of the medical records of patients identified from the Regional ADHD Registry database, enrolled in 18 ADHD centers in the 2011–2016 period. 1919 of 2861 subjects evaluated (67%) met the diagnostic criteria for ADHD: 650 (34%) had only ADHD, while 1269 (66%) had at least one comorbid psychiatric disorder (learning disorders, 56%; sleep disorders, 23%; oppositional defiant disorder, 20%; anxiety disorders, 12%). Patients with ADHD of combined type and with severe impairment (CGI-S ≥5) were more likely to present comorbidity. 382 of 724 (53%) followed up patients improved after 1 year of treatment. ADHD with comorbidity showed greater improvement when treated with combined interventions or methylphenidate alone. Specifically, combined treatment showed significant superiority for ADHD with learning disorders (ES 0.66) and ODD (ES 0.98), lower for ADHD with sleep or anxiety disorders. Training intervention alone showed only medium efficacy (ES 0.50) for ADHD and learning disorders. This study was the first describing comorbidity patterns of ADHD in Italy, confirming, in a multicenter clinical setting, that ADHD is more often a complex disorder. Findings highlight important diagnostic, therapeutic, and service organization aspects that should be broadly extended to ensure an appropriate and homogenous ADHD management.

KW - Adolescents

KW - Attention deficit hyperactivity disorder

KW - Children

KW - Comorbidity

KW - Treatment outcome

U2 - 10.1007/s00787-017-1005-z

DO - 10.1007/s00787-017-1005-z

M3 - Articolo

VL - 26

SP - 1443

EP - 1457

JO - European Child and Adolescent Psychiatry

JF - European Child and Adolescent Psychiatry

SN - 1018-8827

IS - 12

ER -