Adaptive Changes Related to Medication Treatment of ADHD: Listening to Parents of Children in Clinical Trials of a Novel Nonstimulant Medication

The DSM-IV diagnostic criteria for attention-deficit/hyperactivity disorder (ADHD) have proved usefulin providing a common language for diagnosing, treating, and researching the disorder. Despite theutility of current ADHD diagnostic criteria, sophisticated theoretical conceptualizations of the etiology ofADHD have described a much more complex disorder that includes a range of neuropsychological impairments(such as working memory deficits and other executive dysfunction) and underlying structuraland functional neuropathology (e.g., caudate nucleus volume, frontal lobe activity). Inattention, hyperactivity,and impulsivity, the hallmark triumvirate symptoms of ADHD, may be better viewed as someof the many meaningful symptoms with roots in executive-functioning impairment. Outcomes of brain-imagingstudies, public skepticism about diagnosis and treatment, and a demand for meaningful clinicaloutcomes of treatment point to a considerable need to broaden treatment-outcome criteria beyond theDSM-IV domains. The wide-ranging decrements in adaptive function and quality of life reported by parentsof children diagnosed with ADHD further support core executive dysfunction. Emerging findingsconcerning medication-related improvements in adaptive functioning (e.g., social, emotional, academic),as well as the rapid search for the neuropathology that may underlie these improvements, are fueling interestin the assessment of adaptive function in clinical trials. In a series of ongoing clinical trials of anovel nonstimulant medication for ADHD, many parents reported significant improvements in the livesof their children beyond the DSM-IV criteria. These parental reports, despite their inherent sources oferror, underscore the importance of including broader and more meaningful clinical outcome assessmentin clinical trials. Research protocols that omit parental interviews that assess adaptive and executivefunction may well overlook several meaningful and consequential medication-related improvements.