Biomedical subjects

Melissa A Doffing

Publications and source records attributed to Melissa A Doffing.

5 recordsLinked to original sources

PubMed2005

Intervening to improve communication between parents, teachers, and primary care providers of children with ADHD or at high risk for ADHD.

This study examines interventions designed to improve communication between individuals who take care of children with ADHD. A teacher rating of 6,171 elementary school children identifies 1,573 children with ADHD or with high risk for ADHD. Parent interviews and information from teachers are collected on 243 children who are randomized into treatment and control conditions and followed for 39 months. The interventions consisted of group workshops and single one-on-one tutorials with parents, teachers, and providers about the evaluation and treatment of ADHD that stressed the need for communication between the three parties. There are few significant effects on communication that are short lived. Results suggest that the interventions are insufficient to cause significant increase in communication. Future attempts to improve parent-teacher-provider coordination should be continuing rather than single-session interventions.

Attention Deficit Disorder with Hyperactivity↗

PubMed2004

Assessing the impact of parent and teacher agreement on diagnosing attention-deficit hyperactivity disorder.

This study examines the impact of interrater reliability on the diagnosis of attention-deficit hyperactivity disorder (ADHD). A screening of 6171 elementary school children identified 1573 children with a high risk for ADHD according to teacher rating. Follow-up parent interviews and information from teachers were collected on 243 children. Before screening, health care professionals had diagnosed ADHD in 40% of the identified children. There was low agreement between the parent and teacher reports of ADHD symptoms according to DSM-IV-based questionnaires: Inattentive (r =.34, kappa = 0.27), Hyperactive/Impulsive (r =.27, kappa = 0.22), and Performance Impairment (r =.31, kappa = 0.07). When the two-setting requirement was strictly enforced, poor interrater agreement decreased diagnostic rates for all three types of ADHD in this clinical sample: Inattentive (15%-5%), Hyperactive/Impulsive (11%-3%), and Combined (23%-7%). Parent and teacher agreement was low concerning ADHD symptoms and performance. The recommendation of multiple informants significantly decreased the prevalence. Allowing for observer disagreement by using more lenient core symptom scores could reduce the effect.

Attention Deficit Disorder with Hyperactivity↗

PubMed2004

Pharmacokinetic considerations in the treatment of attention-deficit hyperactivity disorder with methylphenidate.

Methylphenidate is commonly used for the treatment of attention-deficit hyperactivity disorder (ADHD). Its efficacy in improving the core symptoms of ADHD, as well as some of the aggressive and oppositional behaviours, is well documented, based on a large volume of research. Methylphenidate has a wide margin of safety and relatively mild adverse effects, most commonly appetite suppression and insomnia. Methylphenidate is a rapidly absorbed medication that, in its d-isomer form, readily penetrates the CNS, particularly the striatum. It appears to function by blocking the reuptake of dopamine. Both the plasma concentrations and behavioural effects of methylphenidate demonstrate a time to maximum of between 1 and 3 hours, with the maximum behavioural effects occurring when the plasma concentrations are increasing. Because of the rapid onset of action, the effects of methylphenidate can be dramatic but usually last only about 4 hours with the immediate-release formulation. The behavioural responses of individuals are also highly variable, so that it is necessary to start treatment at a low dosage and increase up to a maximally effective dosage (usually starting at 10-15 mg/day with increases of 10-15mg at weekly intervals to a maximum dosage of 60 mg/day, irrespective of formulation). Because of the variability in behavioural responses, assessment of plasma concentrations is not clinically useful nor does weight help in deciding an appropriate dosage. The difficulties in administering methylphenidate multiple times a day, particularly during the school day, have been alleviated in the past few years by the development of extended-release preparations with varying behavioural effects lasting 8-12 hours. The 8-hour preparations (Metadate) CD and Ritalin) LA) utilise a microbead technology, while the 12-hour preparation (Concerta) utilises an osmotic pump system. All extended-release formulations effectively control the symptoms of ADHD. While pharmacokinetic differences appear to exist between some of these new formulations, there are currently no clinical data available to demonstrate clinical efficacy differences between them.

Attention Deficit Disorder with Hyperactivity↗

PubMed2003

Teachers' screening for attention deficit/hyperactivity disorder: comparing multinational samples on teacher ratings of ADHD.

This study evaluates a measurement model for Attention Deficit/Hyperactivity Disorder (ADHD). The DSM-IV divides 18 symptoms into two groups, inattentive and hyperactive/impulsive. Elementary school teachers rated 21,161 children in 4 locations: Spain, Germany, urban US, and suburban US. Confirmatory factor analysis suggested that the 2-factor model (inattention, hyperactivity/impulsivity) shows the best fit. A third factor, impulsivity, was too slight to stand-alone. Children with academic performance problems were distinguished by inattention, but children with behavior problems typically had elevations in inattention, hyperactivity, and impulsivity. Between-site differences were statistically significant, but so small that we conclude that same measurement model fits all 4 samples in 2 continents.

Attention Deficit Disorder with Hyperactivity↗

PubMed2003

Psychometric properties of the Vanderbilt ADHD diagnostic parent rating scale in a referred population.

OBJECTIVE: s To determine the psychometric properties of the Vanderbilt Attention Deficit/Hyperactivity Disorder Parent Rating Scale (VADPRS), which utilizes information based on the Diagnostic and Statistical Manual of Mental Disorders, 4th Ed. (DSM-IV). The VADPRS was created to collect uniform patient data and minimize the time burden of lengthy interviews. METHODS: Participant data (N = 243) was used from the first 2 years of a longitudinal study on communication among physicians, teachers, and parents in diagnosing, treating, and managing children with attention deficit/hyperactivity disorder (ADHD). The reliability, factor structure, and concurrent validity of the VADPRS were evaluated and compared with ratings of children in clinical and nonclinical samples on the Vanderbilt ADHD Teacher Rating Scale and the Computerized Diagnostic Interview Schedule for Children-IV, Parent version. RESULTS: The internal consistency and factor structure of the VADPRS are acceptable and consistent with DSM-IV and other accepted measures of ADHD. CONCLUSION: The VADPRS is a reliable, cost-effective assessment for ADHD in clinical and research settings.

Attention Deficit Disorder with Hyperactivity↗