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

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.

Key Words:  attention-deficit/hyperactivity disorder , treatment algorithms , Children's Medication Algorithm Project , evidence-based medicine , psychopharmacology