Cross Cultural and Cross Treatment Outcomes of Functional Impairment in ADHD

In a review of functional outcomes using the Weiss Functional Impairment Rating Scale (WFIRS) from both pharmacological and psychological ADHD studies, functional impairment showed greatest improvement of several months in open label follow up. The most robust improvement overall for stimulant studies was found in the School (learning/behavior) domain, where response in Life Skills, Self-Concept, and in some studies Risky Activities, were sluggish. While Risky Activities was designed to capture rare but salient events, the domain has shown sensitivity to change with intervention despite low baseline scores indicating that the absolute value of mean domain scores is not necessarily a marker of clinical impact. Regarding psychosocial interventions, improvement across different domains was as diverse as were the nature of the interventions. Overall, the extent to which functional impairment can be measured and ultimately treated is evident across multiple populations, interventions, and countries. Measurement of functional outcome will allow for development of targeted interventions to the patient’s unique challenges. A paradigm of functional improvement based on the Minimal Important Difference Score, and functional remission based on the ROC that differentiates clinical from population norms may be a useful way to conceptual functional outcome studies in the future.