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1. Comorbidity prevalence and treatment outcome in children and adolescents with ADHD

Author

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, Bonati, Maurizio, Canevini, Maria Paola, Cartabia, Massimo, Costantino, Maria Antonella, Cropanese, Isabella, Fornaro, Emiddio, Merati, Silvia, Ottolini, Alberto, Reale, Laura, Saccani, Monica, Vaccari, Roberto, Valenti, Vera, Valentino, Alessandra, Zanetti, Michele, Balottin, Umberto, Chiappedi, Matteo, Vlacos, Elena, Meraviglia, Corrado, Palmieri, Maria Grazia, Ruffoni, Gianpaolo, Rinaldi, Francesco, Soardi, Federica, Luoni, Chiara, Pavone, Francesca, Rossi, Giorgio, Termine, Cristiano, and on behalf of Lombardy ADHD Group

Published
2017
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2. Age level vs grade level for the diagnosis of ADHD and neurodevelopmental disorders

Author

Bonati, Maurizio, Cartabia, Massimo, Zanetti, Michele, Reale, Laura, Didoni, Anna, Costantino, Maria Antonella, Conte, Stefano, Renzetti, Valeria, Salvoni, Laura, Molteni, Massimo, Trabattoni, Sara, Effedri, Paola, Fazzi, Elisa, 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, Vasile, Gabriella, Borchia, Arianna, Morosini, Paola, Breviglieri, Maddalena, Capovilla, Giuseppe, Segala, Roberto, Battaini, Chiara, Bissoli, Claudio, Canevini, Maria Paola, Cropanese, Isabella, Fornaro, Emiddio, Leonardi, Giorgio, Merati, Silvia, Saccani, Monica, Vaccari, Roberto, Valenti, Vera, Balottin, Umberto, Chiappedi, Matteo, Vlacos, Elena, Meraviglia, Corrado, Palmieri, Maria Grazia, Ruffoni, Gianpaolo, Rinaldi, Francesco, Soardi, Federica, Luoni, Chiara, and Rossi, Giorgio

Subjects
School, Male, Parents, medicine.medical_specialty, Pediatrics, Adolescent, Epidemiology, Comorbidity, behavioral disciplines and activities, 03 medical and health sciences, 0302 clinical medicine, Neurodevelopmental disorder, Age factors, Attention-deficit hyperactivity disorder, Children, Italy, Attention Deficit Disorder with Hyperactivity, Child, Female, Humans, Incidence, Neurodevelopmental Disorders, Prevalence, Registries, Schools, Age Factors, Pediatrics, Perinatology and Child Health, Developmental and Educational Psychology, Psychiatry and Mental Health, mental disorders, medicine, Child and adolescent psychiatry, Attention deficit hyperactivity disorder, 0501 psychology and cognitive sciences, Cumulative incidence, 030212 general & internal medicine, business.industry, Incidence (epidemiology), 05 social sciences, General Medicine, Relative age effect, Perinatology and Child Health, medicine.disease, business, 050104 developmental & child psychology
Abstract

A number of worldwide studies have demonstrated that children born later in the school year are more likely to receive an ADHD diagnosis than their same school-year peers. There is, however, variation in findings between countries. We aimed to confirm whether relative age is associated with ADHD diagnosis, with or without comorbidities, and to investigate whether relative age is associated with ADHD type and severity, and if this age relationship is in common with other neurodevelopmental disorder. We used the Lombardy Region’s ADHD registry. Data on children aged 6 years and older from September 1, 2011 to December 31, 2017 were considered. We calculated incidence ratios to assess the inter-relations between relative age within the school year, using age at diagnosis of ADHD or of other psychiatric disorder, year of diagnosis, and total number of children born in Lombardy during the corresponding timeframe. Data on ADHD type, severity of diagnosed disorder clinical global impressions–severity scale, and repetition of a school-grade were also considered. 4081 children, 2856 of whom with ADHD, were identified. We confirmed that the cumulative incidence of ADHD diagnosis was greatest for younger children, in particular for boys, for whom the prevalence is greater. The relative age effect was not accounted for by ADHD comorbid disorders, ADHD of combined type or severity. The relative age effect was also observed for children with other neurodevelopmental disorders (without ADHD), with a similar profile as ADHD children: the incidence ratio was 1.78 (95% CI 1.07–2.97; p

Published
2018

3. Italian regional health service costs for diagnosis and 1-year treatment of ADHD in children and adolescents

Author

Casadei, Gianluigi, Cartabia, Massimo, Reale, Laura, Costantino, Maria Antonella, Bonati, Maurizio, Conte, Stefano, Renzetti, Valeria, Salvoni, Laura, Molteni, Massimo, 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, Canevini, Maria Paola, Costantino, Antonella, Cropanese, Isabella, Didoni, Anna, 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, Zanetti, Michele, Casadei, G, Cartabia, M, Reale, L, Costantino, M, Bonati, M, Conte, S, Renzetti, V, Salvoni, L, Molteni, M, 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, Canevini, M, Costantino, A, Cropanese, I, Didoni, A, Fornaro, E, Merati, S, Ottolini, A, Saccani, M, Vaccari, R, Valenti, V, Valentino, A, Balottin, U, Chiappedi, M, Vlacos, E, Meraviglia, C, Palmieri, M, Ruffoni, G, Rinaldi, F, Soardi, F, Luoni, C, Pavone, F, Rossi, G, and Zanetti, M

Subjects
medicine.medical_specialty, Psychological intervention, Ambulatory/outpatient care, Child and adolescent health, Health care cost, Health administration, lcsh:RC321-571, 03 medical and health sciences, Health services, 0302 clinical medicine, medicine, 030212 general & internal medicine, Treatment costs, Psychiatry, Psychiatric Mental Health, lcsh:Neurosciences. Biological psychiatry. Neuropsychiatry, Health policy, business.industry, Research, Health Policy, Environmental and Occupational Health, Public Health, Environmental and Occupational Health, Mental health, Cost driver, Psychiatry and Mental Health, Public Health, Pshychiatric Mental Health, Health care costs, business, 030217 neurology & neurosurgery, Time to diagnosis
Abstract

The main aim of this study was to estimate the costs associated with diagnostic assessment and 1-year therapy in children and adolescents enrolled in 18 ADHD reference centres. Data concerning 1887 children and adolescents from the mandatory ADHD registry database during the 2012–2014 period were analysed. The overall diagnostic and treatment costs per patient amounts to €574 and €830, respectively. The ADHD centre, the school as sender, and the time to diagnosis constitute cost drivers. Non-pharmacological therapy resulted as being more expensive for patients concomitantly treated with drugs (€929) compared to those treated with psychological interventions alone (€590; p = 0.006). This study gives the first and reliable estimate of the costs associated with both diagnosis and treatment of ADHD in Italy. Although costs associated with mental disorders are difficult to estimate, continuing efforts are need to define costs and resources to guarantee appropriate care, also for ADHD. Electronic supplementary material The online version of this article (doi:10.1186/s13033-017-0140-8) contains supplementary material, which is available to authorized users.

Published
2017

4. Italian regional health service costs for diagnosis and 1-year treatment of ADHD in children and adolescents

Author

Casadei, G, Cartabia, M, Reale, L, Costantino, M, Bonati, M, Conte, S, Renzetti, V, Salvoni, L, Molteni, M, 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, Canevini, M, Costantino, A, Cropanese, I, Didoni, A, Fornaro, E, Merati, S, Ottolini, A, Saccani, M, Vaccari, R, Valenti, V, Valentino, A, Balottin, U, Chiappedi, M, Vlacos, E, Meraviglia, C, Palmieri, M, Ruffoni, G, Rinaldi, F, Soardi, F, Luoni, C, Pavone, F, Rossi, G, Zanetti, M, Casadei, Gianluigi, Cartabia, Massimo, Reale, Laura, Costantino, Maria Antonella, Bonati, Maurizio, Conte, Stefano, Renzetti, Valeria, Salvoni, Laura, Molteni, Massimo, 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, Canevini, Maria Paola, Costantino, Antonella, Cropanese, Isabella, Didoni, Anna, 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, Zanetti, Michele, Casadei, G, Cartabia, M, Reale, L, Costantino, M, Bonati, M, Conte, S, Renzetti, V, Salvoni, L, Molteni, M, 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, Canevini, M, Costantino, A, Cropanese, I, Didoni, A, Fornaro, E, Merati, S, Ottolini, A, Saccani, M, Vaccari, R, Valenti, V, Valentino, A, Balottin, U, Chiappedi, M, Vlacos, E, Meraviglia, C, Palmieri, M, Ruffoni, G, Rinaldi, F, Soardi, F, Luoni, C, Pavone, F, Rossi, G, Zanetti, M, Casadei, Gianluigi, Cartabia, Massimo, Reale, Laura, Costantino, Maria Antonella, Bonati, Maurizio, Conte, Stefano, Renzetti, Valeria, Salvoni, Laura, Molteni, Massimo, 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, Canevini, Maria Paola, Costantino, Antonella, Cropanese, Isabella, Didoni, Anna, 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, and Zanetti, Michele

Abstract

The main aim of this study was to estimate the costs associated with diagnostic assessment and 1-year therapy in children and adolescents enrolled in 18 ADHD reference centres. Data concerning 1887 children and adolescents from the mandatory ADHD registry database during the 2012-2014 period were analysed. The overall diagnostic and treatment costs per patient amounts to €574 and €830, respectively. The ADHD centre, the school as sender, and the time to diagnosis constitute cost drivers. Non-pharmacological therapy resulted as being more expensive for patients concomitantly treated with drugs (€929) compared to those treated with psychological interventions alone (€590; p=0.006). This study gives the first and reliable estimate of the costs associated with both diagnosis and treatment of ADHD in Italy. Although costs associated with mental disorders are difficult to estimate, continuing efforts are need to define costs and resources to guarantee appropriate care, also for ADHD.

Published
2017

5. Comorbidity prevalence and treatment outcome in children and adolescents with ADHD

Author

Reale, L, Bartoli, B, Cartabia, M, Zanetti, M, Costantino, M, Canevini, M, 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, M, Ruffoni, G, Rinaldi, F, Soardi, F, Luoni, C, Pavone, F, Rossi, G, 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, Reale, L, Bartoli, B, Cartabia, M, Zanetti, M, Costantino, M, Canevini, M, 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, M, Ruffoni, G, Rinaldi, F, Soardi, F, Luoni, C, Pavone, F, Rossi, G, 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, and Rossi, Giorgio

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.

Published
2017

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