COUNSELING POINTS. Caring for Individuals with ADHD Throughout the Lifespan A three-part educational series. Educational Outcomes Report

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1 COUNSELING POINTS Caring for Individuals with ADHD Throughout the Lifespan A three-part educational series Educational Outcomes Report July 2009

2 Summary This is a report of the findings of an educational outcomes measurement study conducted for a series of three 1-hour continuing education activities entitled Counseling Points: Caring for Patients with ADHD Throughout the Lifespan. This print and web-based activity was presented to members of the American Psychiatric Nurses Association (APNA) and the National Association of Pediatric Nurse Practitioners (NAPNAP). The activity was funded by an educational grant provided by McNeil Pediatrics, Division of Ortho-McNeil Janssen Pharmaceuticals, Inc., administered by Ortho-McNeil Janssen Scientific Affairs, LLC. NAPNAP provided the accreditation for this program. This study was designed to measure whether providers who participated in the activity learned key concepts about the current approaches to diagnosing and treating ADHD across the lifespan. During the planning process key clinical messages were developed into Clinical Statements. Participants were asked to rate their level of agreement/disagreement about each statement on a 6-point scale before and after participation in the activity. Not all participants completed both surveys, making the results a reflection of the group s response not the individuals. For this activity, 12 Clinical Statements were developed, and the results are grouped by membership: APNA or NAPNAP. Study Objectives The objective of the study was to determine if differences existed between pre-test and post-test surveys pertaining to three issues of Counseling Points with a focus on ADHD. The three issues and their statements were: Issue #1: An Introduction to ADHD 1. ADHD is a highly inheritable psychiatric disorder. 2. Long-term nutritional intake of free sugars or artificial additives causes ADHD. 3. Tests such as an electroencephalogram (EEG), magnetic resonance imaging (MRI) scans, single photo emission computed tomography (SPECT) scan, or positron emission tomography (PET) scan are not usually needed to diagnose ADHD. 4. Psychiatric co-morbidities are common in patients with ADHD. Issue #2: Pharmacologic Treatment Strategies for Children, Adolescents, and

3 Adults with ADHD 1. No treatment has been found to cure attention deficit hyperactivity disorder (ADHD), but there are a number of pharmacologic interventions that have been demonstrated to manage symptoms effectively. 2. The primary goal of pharmacologic treatment for children and adolescents with ADHD is to reduce disruptive behaviors, better relationships with others, and otherwise improve social functioning. 3. Stimulants are the first-line treatments for ADHD in children, adolescents, and adults. 4. There is adequate research and agreed-upon guidelines to support evidence-based practice of ADHD in adults. Issue #3: Enhancing Patient Communication for the Psychiatric Nurse and the Family and Pediatric Nurse Practitioner 1. Nonpharmacologic treatments are important components of the management of attention-deficit hyperactivity disorder (ADHD). 2. The combination of nonpharmacologic and pharmacologic treatments for management of ADHD symptoms is more accepted by individuals with ADHD and their families and more efficacious than use of either modality alone. 3. It is widely acknowledged that the assessment for ADHD requires a multimodal/collaborative approach. 4. Research suggests that insight-based therapies such as cognitive behavioral therapy, individual psychotherapy, and coaching work as well for children and adolescents with ADHD as for adults with ADHD. Data Collection Methodology Pre-test and post-test surveys were conducted. The pretest surveys were sent out a few weeks prior to the distribution of the issue. Surveys were sent to the memberships of both the APNA and NAPNAP. The same surveys were sent to both audiences. The posttest results were included as part of the CE evaluation forms that were returned. The samples varied for each group. Analysis of data included means, standard deviations and median scores for each of the statements contained in each Issue. The non-parametric Mann-Whitney U test was used to determine if differences existed between pre-test and post-test statements for each of the three issues. Statistically significant levels are reported for p values less than or equal to Highly significant levels are p values less than.001. Survey Results Descriptive statistics together with the Mann-Whitney U test results are presented in Tables 1-4. Tables 1-3 represent the results from the Psychiatric Nurse (APNA).

4 Tables 3-5 represent the results of the Pediatric and Family Nurse Practitioners (NAPNAP). The statements appearing in the Tables have been abbreviated. Table 1. Difference Between Pre and Posttest Statements for Issue #1 (APNA members): Statement sample Mean S.D. Median Z score p value 1. ADHD is highly inheritable Pre-test Results Post-test Results Intake of free sugars or artificial additives causes ADHD Pre-Test Results Post-test Results EEG, MRI, SPECT, PET not needed for ADHD diagnosis Pre-Test Results Post-test Results Psychiatric co-morbidities are common in patients with ADHD Pre-Test Results Post-test Results **P value of <.05 is statistically significant ****P value of<.001 is Highly significant

5 Table 2. Difference Between Pre and Posttest Statements for Issue #2 (APNA members): Statement sample Mean SD Median Z-score p-value 1. There are a number of pharmacologic interventions for ADHD Pre-test Results Post-test Results The primary goal of pharmacologic treatment for children and adolescents with ADHD is to reduce disruptive behaviors, etc Pre-test Results Post-test Results Stimulants are the first-line treatments for ADHD in children, adolescents, and adults. Pre-Test Results Post-Test Results There is adequate research and agreed-upon guidelines to support evidence-based practice of ADHD in adults. Pre-test Results Post-test Results **P value of <.05 is statistically significant ****P value of<.001 is Highly significant

6 Table 3. Difference Between Pre and Posttest Statements for Issue #3 (APNA members): Statement sample Mean SD Median Z-score p-value 1. Nonpharmacologic treatments are important in the management of ADHD. Pre-test Results Post-test Results The combination of nonpharmacologic and pharmacologic treatments for ADHD symptoms is more accepted by individuals with ADHD and their families and more efficacious than use of either modality alone. Pre-test Results Post-test Results The assessment for ADHD requires a multimodal/collaborative approach. Pre-Test Results Post-Test Results Research suggests insight-based therapies such as behavioral therapy and coaching work well for children and adolescents with ADHD as for adults with ADHD. Pre-test Results Post-test Results **P value of <.05 is statistically significant ****P value of<.001 is Highly significant

7 Table 4. Difference Between Pre and Posttest Statements for Issue #1 (NAPNAP members): Statement sample Mean S.D. Median Z score p value 1. ADHD is highly inheritable Pre-test Results Post-test Results Intake of free sugars or artificial additives causes ADHD Pre-Test Results Post-test Results EEG, MRI, SPECT, PET not needed for ADHD diagnosis Pre-Test Results Post-test Results Psychiatric co-morbidities are common in patients with ADHD Pre-Test Results Post-test Results **P value of <.05 is statistically significant ****P value of<.001 is Highly significant

8 Table 5. Difference Between Pre and Posttest Statements for Issue #2 (NAPNAP members): Statement sample Mean SD Median Z-score p-value 1. There are a number of pharmacologic interventions for ADHD Pre-test Results Post-test Results The primary goal of pharmacologic treatment for children and adolescents with ADHD is to reduce disruptive behaviors, etc Pre-test Results Post-test Results Stimulants are the first-line treatments for ADHD in children, adolescents, and adults. Pre-test Results Post-test Results There is adequate research and agreed-upon guidelines to support evidence-based practice of ADHD in adults. Pre-test Results Post-test Results **P value of <.05 is statistically significant ****P value of<.001 is Highly significant

9 Table 6. Difference Between Pre and Posttest Statements for Issue #3 (NAPNAP members) Statement sample Mean SD Median Z-score p-value 1. Nonpharmacologic treatments are important in the management of ADHD. Pre-test Results Post-test Results The combination of nonpharmacologic and pharmacologic treatments for ADHD symptoms is more accepted by individuals with ADHD and their families and more efficacious than use of either modality alone. Pre-test Results <.001 Post-test Results The assessment for ADHD requires a multimodal/collaborative approach. Pre-Test Results Post-Test Results Research suggests insight-based therapies such as behavioral therapy and coaching work well for children and adolescents with ADHD as for adults with ADHD. Pre-test Results Post-test Results **P value of <.05 is statistically significant ****P value of<.001 is Highly significant

10 Difference Between Pre and Posttest Statements for Issue #1 (APNA members) 6 5 *** *** *** *** * item 1 item 2 item 3 item 4 sum 1-4 pre test post test *p<0.05= significant, ***p<0.001= highly signicant

11 Difference Between Pre and Posttest Statements for Issue #2 (APNA members) *** *** *** *** ns 3 2 pre test post test 1 0 item 1 item 2 item 3 item 4 sum 1-4 ns = not significant, ***p<0.001

12 Difference Between Pre and Posttest Statements for Issue #3 (APNA members) 6 5 * ** ** ** ns pre test post test 1 0 item 1 item 2 item 3 item 4 sum 1-4 ns = non-significant, *p<0.05, **p<0.01

13 Difference Between Pre and Posttest Statements for Issue #1 (NAPNAP members) 6 *** ns *** 5 *** * item 1 item 2 item 3 item 4 sum 1-4 pre test post test ns = not significant, *p<0.05, ***p<0.001

14 Difference Between Pre and Posttest Statements for Issue #2 (NAPNAP members) 6 ns *** *** *** 5 ns pre test post test 1 0 item 1 item 2 item 3 item 4 sum 1-4 ns = non-significant, ***p<0.001

15 Difference Between Pre and Posttest Statements for Issue #3 (NAPNAP) 6 * *** ns ns 5 * pre test post test 1 0 item 1 item 2 item 3 item 4 sum 1-4 ns = non-significant, *p<0.05, ***p<0.001 Conclusions

16 The results indicate a substantial difference between pre and post testing. The majority of the statements, 19 out of 24 or 79%, contained within the three issues were significant (9) or highly significant (10). The five statements that demonstrated no statistical difference revealed marginal difference in the pre- and post-test scores suggesting the respondents might have already had sufficient information regarding the statement made. Overall, this educational series was a very effective program that will have an impact on the care and treatment of patients with ADHD.