Conclusions: The findings of this review suggest that paraprofessional training in mental health may yield effective outcomes despite the occurrence of wide variation in training packages. However, training courses should pay more attention to improving the specificity of diagnosis.
Weiss, A. P., Guidi, J. & Fava, M. (2009). Journal of Clinical Psychiatry, 70(4), 446-44.
There is a well-known gap between the clinical outcomes achieved within randomized controlled trials (RCTs) and those seen in real-world clinical practice. This phenomenon, sometimes called the "efficacy effectiveness" gap, has been cited as a potential barrier to achieving optimal benefit from available treatments. One major cause of this gap is the failure to consistently implement those treatments identified as efficacious in RCTs. To encourage adoption of more consistent, evidence based treatment practices, a number of disorder-specific guidelines and treatment algorithms have been developed. Even in a guideline-driven practice, however, clinical treatment is often associated with wide variations among practitioners. Therefore, while we strongly agree with the importance of translating the content of RCTs to clinical practice, we also believe that clinicians should adopt some of the processes that have been shown to be effective in clinical trials, including routine outcomes mean.
Solanto, M. V., Marks, D.J., Wasserstein, J., Mitchell, K., Abikoff, H., Alvir, J. & Kofman, K. American Journal of Psychiatry
It is now recognized that ADHD, once thought to be exclusively a childhood disorder, frequently persists into adulthood, afflicting approximately 4% of the U.S. adult population (1) and generating significant impairment in academic, occupational, social, and emotional functioning (2, 3). This impairment may result in completion of fewer years of education and elevated rates of unemployment, antisocial behavior, interpersonal conflict, marital separation, and divorce. Adults with ADHD are also at significantly greater risk for substance use disorders (4) as well as other comorbid disorders, such as anxiety and depressive disorders (1). Adult studies of stimulant (5) and nonstimulant (6) medication, paralleling results with children, have found these agents to be effective in reducing the core symptoms of ADHD. However, there are limitations associated with drug treatment. First, little is known about the impact of pharmacotherapy on the functional impairment typically associated with ADHD (7), particularly in time management and organization.
Given the likely underdevelopment of meta-cognitive skills in these areas in youths with ADHD (8), drug treatment alone may not be sufficient to remediate these deficits, and explicit skills training in adulthood may be necessary. Second, 20%-50% of adults do not respond to drug treatment or have adverse responses (9), which highlights the need for additional interventions. Furthermore, since response to medication treatment is typically defined as having at least a 30% reduction in symptoms (9), many patients considered to have responded do not achieve full remission, leaving room for improvement through other modalities. Thus, there is clearly a need for psychosocial interventions to help adults with ADHD develop essential self-management skills. A recent review (10) revealed that there has been limited research on psychosocial treatments for adults with ADHD. A case series (11) and several open studies of group (12, 13) and individual (14) cognitive-behavioral treatments yielded promising results. However, controlled studies have been limited to trials of group- administered (15) and individually administered (16) cognitive-behavioral interventions, each compared to a waiting list