A Paradigm for Targeting Functional Impairment as an Outcome in Attention-Deficit/Hyperactivity Disorder

Abstract

Although functional impairment is required for a diagnosis in the DSM 5, the time frame and definition of functional impairment is ambiguous. We present a conceptual review clarifying the difference between functional impairment as a stable trait representing strength or disability in various domains, and functional impairment as secondary to emotional or behavior problems, which is a state sensitive to change with treatment intervention. Functional impairment as a measure of treatment outcome includes both change from baseline and status at the endpoint of treatment. When using a validated measure of function, functional improvement can be defined as the percentage of patients who achieve the Minimal Important Clinical Difference (MCID) and functional remission as the percentage of patients who normalize at treatment endpoint. True treatment remission should be defined as both symptomatic and functional remission.

Real-World Efficacy and Safety of Extended-Release Methylphenidate (PRC-063) in the Treatment of ADHD in Pediatric and Adult Subjects: Results of a Phase IV Multicenter Comparison With Lisdexamfetamine Dimesylate

“…Fifty questions assess the severity of impact of the subject’s ADHD behavior on clinically relevant domains of functioning. The WFIRS-P has been psychometrically validated in an ADHD population ( Gajria et al, 2015 ; Weiss, 2022 ; Weiss et al, 2018 ). Functional improvement is commonly defined as the percentage of patients who achieve the minimal clinically important difference (MCID) while functional remission is defined as the percentage of patients who normalize at treatment endpoint.…”

Receiver operating characteristic curve analysis of the Weiss Functional Impairment Rating Scale‐Parent Report for screening children with ADHD: Looking beyond symptoms in ADHD diagnosis

“…The Weiss Functional Impairment Rating Scale-Parent Report (WFIRS-P; Weiss et al, 2018) specifically measures the parent's perception of how the child's emotional and behavioural problems with ADHD impact their capacity to function in different domains. The WFIRS has been well validated in an ADHD population, although it has also been used in population studies and in other disorders (Weiss, 2022). The WFIRS is sensitive to change over a short period of time, which means that it is useful in looking at functional outcomes with treatment (Weiss et al, 2018).…”

“…The WFIRS is sensitive to change over a short period of time, which means that it is useful in looking at functional outcomes with treatment (Weiss et al, 2018). This is distinct from measures of disability, which tend to be static (Weiss, 2022).…”