Journal of Psychosocial Nursing and Mental Health Services
Vol. 46 No. 8 August 2008
Approaching ADHD as a Chronic Condition: Implications for
Long-Term Adherence
Jeanne Van Cleave, MD; and Laurel K. Leslie, MD, MPH
ABSTRACT
Attention-deficit/hyperactivity disorder (ADHD) is one of the most
common chronic conditions of childhood. Although evidence-based treatments for
ADHD, including stimulant medication and behavior modification, have long been
established, and guidelines for care of ADHD in primary care settings have been
developed, adherence to long-term therapy is poor among youth with ADHD. This
article proposes use of the Chronic Care Model for Child Health, the purpose of
which is to develop informed, activated patients who will interact with a
prepared, proactive health care team. Six “pillars” make up the
model: decision support, delivery system design, clinical information systems,
family and self-management support, community resources and policies, and
health care organizations. Each of these is discussed, and an individual
example is described. Adopting the Chronic Care Model for Child Health has the
potential to improve the quality of care for ADHD.
ABOUT THE AUTHORS
Dr. Van Cleave is Assistant in Pediatrics, Center for Child and
Adolescent Health Policy, Massachusetts General Hospital for Children, and
Instructor, Harvard Medical School, and Dr. Leslie is Associate Director,
Center on Child and Family Outcomes, Institute for Clinical Research and Health
Policy Studies, and Associate Professor of Medicine and Pediatrics, Tufts
University School of Medicine, Boston, Massachusetts.
The authors disclose that they have no significant financial interests
in any product or class of products discussed directly or indirectly in this
activity, including research support.
Information contained in this article is reprinted from
Psychiatric Annals, Vol. 38, No. 1, pp. 35-42.
Address correspondence to Laurel K. Leslie, MD, MPH, Associate Professor
of Medicine and Pediatrics, Tufts University School of Medicine, 750 Washington
Street, #345, Boston, MA 02111; e-mail: lleslie@tufts-nemc.org.
Long-Term Safety of Stimulant Medications Used to Treat
Children with ADHD
Marc Lerner, MD; and Tim Wigal, PhD
ABSTRACT
Attention-deficit/hyperactivity disorder (ADHD) is a common mental
health condition that affects children, adolescents, and adults. Because it is
a chronic condition and typically requires effective treatment for several
years or more, information on the benefits and risks of long-term
pharmacotherapy for ADHD is vital to clinicians. This article reviews the
emerging literature on the safety of long-term stimulant medications in
ADHD—the most commonly prescribed medications for this condition. Common
side effects, including cardiovascular effects, growth effects, and tics, are
discussed, as well as treatment of children younger than age 6 and evidence of
carcinogenic and reproductive effects.
ABOUT THE AUTHORS
Dr. Lerner is Clinical Professor of Pediatrics, University of
California, Irvine, Medical Center, Department of Pediatrics, Orange, and Dr.
Wigal is Associate Clinical Professor of Pediatrics, University of California,
Irvine, Child Development Center, Irvine, California.
Dr. Lerner has disclosed the following relevant financial relationships:
Eli Lilly and Company, McNeil Pediatrics, and Shire: Consultant; Eli Lilly,
McNeil Pediatrics, Novartis, Shire, and National Institute of Mental Health:
Research Support; and McNeil Pediatrics, Novartis, and Shire: Member of
Speakers’ Bureaus. Dr. Wigal has disclosed the following relevant
financial relationships: Celltech Pharmaceuticals Inc./UCB, Cephalon Inc, Eli
Lilly and Company, Janssen Division of Ortho-McNeil-Janssen Pharmaceuticals,
Inc., McNeil Pharmaceutical, Novartis Pharmaceuticals Corporation, and Shire
Development: Research Support; Johnson & Johnson: Consultant; and Eli
Lilly, McNeil, and Shire: Member of Speakers’ Bureaus.
Information contained in this article is reprinted from
Psychiatric Annals, Vol. 38, No. 1, pp. 45-53.
Address correspondence to Marc Lerner, MD, Clinical Professor of
Pediatrics, University of California, Irvine, Medical Center, Department of
Pediatrics, 101 The City Drive ZC 4482, Orange, CA 92868; e-mail:
malerner@uci.edu.
Psychosocial Interventions Used to Treat Children with
ADHD: Safety and Efficacy
Steven W. Evans, PhD; Brandon K. Schultz, EdD; and Joanna M.
Sadler, BS
ABSTRACT
Although stimulant therapy is the most common treatment for
attention-deficit/hyperactivity disorder (ADHD) in children, it is not always
effective in reducing behavioral symptoms. As a result, research on
psychosocial interventions has progressed in recent years. This article
provides a synopsis of psychosocial interventions for childhood ADHD, with an
emphasis on basic behavior management principles, evidence-based interventions,
and safety issues. Developmental issues that distinguish psychosocial
interventions for children and adolescents are highlighted, and practical
recommendations for collaborating with mental health professionals are
provided.
ABOUT THE AUTHORS
Dr. Evans is Alvin V. Baird Jr. Centennial Chair of Psychology, and Dr.
Schultz is Director of Clinical Services, Alvin V. Baird Attention and Learning
Disabilities Center, and Ms. Sadler is a graduate student, James Madison
University, Harrisonburg, Virginia.
The authors disclose that they have no significant financial interests
in any product or class of products discussed directly or indirectly in this
activity, including research support.
Information contained in this article is reprinted from
Psychiatric Annals, Vol. 38, No. 1, pp. 58-65.
Address correspondence to Steven W. Evans, PhD, Alvin V. Baird Jr.
Centennial Chair of Psychology, Alvin V. Baird Attention and Learning
Disabilities Center, MSC 9013, James Madison University, Harrisonburg, VA
22807; e-mail: evanssw@jmu.edu.
