Individual differences v. the average patient: mapping the heterogeneity in ADHD using normative models

BackgroundThe present paper presents a fundamentally novel approach to model individual differences of persons with the same biologically heterogeneous mental disorder. Unlike prevalent case-control analyses, that assume a clear distinction between patient and control groups and thereby introducing the concept of an ‘average patient’, we describe each patient's biology individually, gaining insights into the different facets that characterize persistent attention-deficit/hyperactivity disorder (ADHD).MethodsUsing a normative modeling approach, we mapped inter-individual differences in reference to normative structural brain changes across the lifespan to examine the degree to which case-control analyses disguise differences between individuals.ResultsAt the level of the individual, deviations from the normative model were frequent in persistent ADHD. However, the overlap of more than 2% between participants with ADHD was only observed in few brain loci. On average, participants with ADHD showed significantly reduced gray matter in the cerebellum and hippocampus compared to healthy individuals. While the case-control differences were in line with the literature on ADHD, individuals with ADHD only marginally reflected these group differences.ConclusionsCase-control comparisons, disguise inter-individual differences in brain biology in individuals with persistent ADHD. The present results show that the ‘average ADHD patient’ has limited informative value, providing the first evidence for the necessity to explore different biological facets of ADHD at the level of the individual and practical means to achieve this end.

Consumption of medicines for attention deficit hyperactivity disorder treatment per patient in children and adolescents in Slovenia from 2003 to 2012

BackgroundAccording to the attention deficit hyperactivity disorder (ADHD) treatment guidelines, atomoxetine (ATX) is a second line treatment after stimulants and therefore a serious monitoring of ATX prescribing is necessary to avoid inappropriate prescribing.ObjectivesIn most countries in Central Europe, except Germany, there is no data on drug consumption for ADHD medicines (expressed in defined daily dose (DDD)/ADHD patient/year).AimThe main purposes of this study were: calculate and present the pattern and evolution of national consumption in Slovenia expressed in the percentage of DDD/patient/year consumption for the period 2003–2012.MethodsThe national consumption and population data for this period were obtained from Slovenian databases. A DDD/ADHD patient/year was calculated. Only immediate-release methylphenidate (IR-MPH), methylphenidate-osmotic release oral delivery system (OROS-MPH) and ATX have been available and included in this study.ResultsLess than 50% of patients with ADHD are treated with medications in Slovenia. A total consumption rose rapidly from 41.3 in 2003 to 148.5 DDD/ADHD patient/year in 2012. The total consumption for ATX and MPH is almost equal (140.9 for ATX and 150.3 for MPH in 2012). This result is lower as it has been seen in Germany (208 DDD/ADHD patient/year in 2008 for MPH).ConclusionsIn the last decade in Slovenia, the total consumption is increasing rapidly, which indicates a positive trend. This pattern (low total consumption) has not been seen in Germany. After the new drugs have been available on the Slovenian market, the total consumption rose rapidly.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Health Care Services for Adults With ADHD: Patient Satisfaction and the Role of Psycho-Education

Objective: To evaluate health care experiences of adults with ADHD and to identify predictors for patient satisfaction. Method: Multisite, questionnaire-based survey in a cohort of adult patients diagnosed and treated for ADHD in the Bergen area of Western Norway between 2005 and 2011. Results: Among the 171 included patients, only 61 (35.7%) reported being satisfied to a large or very large extent with the received health care. The strongest predictor for overall satisfaction, independent of duration, medication, and reported outcome of treatment, was whether they were satisfied with the information they had received from clinicians regarding ADHD and treatment options. Patients who reported that they had been offered other treatments in addition to pharmacotherapy were generally more satisfied. Conclusion: Our results emphasize the importance of consistent information routines as part of ADHD management. More teaching and training about ADHD for clinicians working in adult psychiatric health services may be needed.