ARTICLES
A Feasibility Study of the Children's Medication Algorithm Project (CMAP) Algorithm for the Treatment of ADHD

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ABSTRACT

Objective

To determine whether an algorithm for the treatment of attention-deficit/hyperactivity disorder (ADHD) can be implemented in a community mental health center.

Method

Fifty child and adolescent patients at Texas community mental health centers who met criteria for ADHD were treated according to an algorithm-based disease management program for ADHD. Psychiatrists were trained in the use of the algorithm, and each subject underwent a baseline assessment consisting of a structured interview and standardized rating scales. Subjects were monitored for 4 months. At the end of treatment, the psychiatrists completed the Clinical Global Impression Scale (CGI) and the baseline rating scales were repeated. The primary variables of interest were psychiatrist and family adherence to the algorithm. To examine impact on treatment outcome, the CGI of the algorithm subjects was compared with CGIs based on chart reviews of 118 historical controls.

Results

Psychiatrists implemented the major aspects of the algorithm, but the detailed tactics of the algorithm (use of fixed titration of stimulants) were less well adhered to.

Conclusions

An algorithm for the treatment of ADHD can be implemented in a community mental health center.

Section snippets

Subjects

Subjects were 50 children aged 6 to 17 years who were being treated at one of four community mental health centers in Texas. Eligible children had a clinical diagnosis of ADHD made according to the usual practice of the center psychiatrist. Typically, the psychiatrist saw the patient after an intake interview by a master's-level clinician and had access to the written note describing the chief complaint and social history. Most psychiatrists conducted an unstructured, open-ended clinical

Baseline Measures

Table 1 compares the algorithm patients with the historical controls. The groups were not different with regard to ethnicity or comorbid ODD/conduct disorder. In contrast to many research studies, this sample had a high representation of minorities, consistent with their proportion in the community in which the centers were located. The algorithm group showed more severe symptoms at baseline relative to the TAU group (t69.5 = 4.18, p < .0001) and was older (t122 = −3.66, p = .0004). Age and

DISCUSSION

To our knowledge, this was the first attempt to implement and evaluate an evidence-based algorithm for the treatment of ADHD into a community mental health center environment. At a broad level, the algorithm was well accepted and implemented by the psychiatrists. Stimulant medications were used as the drugs of first choice, and the psychiatrists attempted to use a fixed titration strategy to expose patients to the full range of stimulant dosages. This was done in nearly half the cases. All the

REFERENCES (19)

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The research was made possible by grants from the Meadows Foundation, the Hogg Foundation for Mental Health, and the Houston Endowment.

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