The long-term outcome for emotional and behavioural problems.

Long-term outcome of psychological problems in childhood is important in a variety of ways including understanding disease entities, managing treatment and implementing research. It is of particular importance to courts in cases involving children. Judges have the unenviable task of determining best action for the future of children. Research is now available showing linkages between childhood and adult disorder but also revealing increasing complexity of factors determining outcome. A model of child to adult continuity can be constructed showing linkages between genetic influence, intrauterine environment, perinatal risks, early upbringing and lifetime risk and resilience influences. Known continuities of behaviours are traced from child to adult life. The presentation is intended to give a glimpse of some of the data available to assist in decision-making. Childhood determination of disorders such as schizophrenia may enable treatment to prevent further damage. Exciting developments particularly in genetics and functional imaging, will radically improve data over the next few years, possibly challenging currently held beliefs. At present expert witness contribution is under challenge but knowledge of the continuities can save court time, help prevent future heartache for vulnerable children, and later cost to the taxpayer.

A multi-centre, randomised, open-label study of atomoxetine compared with standard current therapy in UK children and adolescents with attention-deficit/hyperactivity disorder (ADHD).

OBJECTIVE: To assess the broader efficacy (i.e., improvements in quality of life/functional outcomes) of atomoxetine compared with standard current therapy (SCT) in UK paediatric patients with ADHD and to explore clinician/parent/child perceptions of ADHD. RESEARCH DESIGN AND METHODS: A total of 201 patients with ADHD were randomised into this multi-centre, open-label study to receive atomoxetine (n = 104) or SCT (n = 97) for 10 weeks. Broader efficacy was assessed using the parent-rated Child Health and Illness Profile-Child Edition (CHIP-CE) total (global) t-score. Secondary outcome measures included the five CHIP-CE domains; parent-rated Family Burden of Illness Module (FBIM); investigator-rated ADHD-Rating Scale; investigator-rated Clinical Global Impression (CGI)-Severity/Improvement scales; and child-rated Harter Self-Perception Profile (HSPP). RESULTS: Quality of life of children/adolescents with ADHD was extremely compromised at baseline (CHIP-CE total t-scores: atomoxetine, 23.2 +/- 12.2; SCT, 23.9 +/- 11.0), and improved during the 10-week study for both groups; the CHIP-CE score was statistically significantly higher for patients treated with atomoxetine (38.4 +/- 1.3) compared with SCT (30.8 +/- 1.3) at week 10 (p < 0.001). ADHD-RS, CGI-Severity, and CGI-Improvement scores were significantly different between the groups in favour of atomoxetine (p < 0.001). There was a statistically significant difference between the groups in the HSPP Social Acceptance domain in favour of atomoxetine, but not in the five other HSPP domains or FBIM total score. Atomoxetine was well-tolerated. CONCLUSIONS: Results from this open-label trial show that atomoxetine is superior to SCT in addressing broader efficacy and functional outcomes in UK children/adolescents with ADHD. This study contributes to the understanding of broader efficacy in children with ADHD, and is timely in light of recent NICE guidance.