Introduction
Quality of life in children with ADHD
Measuring paediatric quality of life
Parent proxy-report in paediatric QoL research
Parent–child concordance on QoL measures
Aim of the review
Method
Inclusion and exclusion criteria
Population
Study design
Outcome measures
Language
Literature search strategy and study selection
Electronic database searches
Hand searching of selected journals
Reference list searches
Study appraisal process
Criterion 1 | Title/abstract—reduced to one criterion |
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Criterion 4 | Setting—broken down to further criteria of (a) ‘location’ and (b) ‘relevant dates’ |
Criterion 8 | Measurement—altered to indicate use of valid/reliable outcome measures appropriate to the population and for use with parent/child dyads |
Criterion 9 | Bias—altered to indicate active control for bias rather than the authors’ description |
Criterion 12 | Statistical methods: parts (b), (d) and (e) removed |
Criterion 13 | Participants—part (c) ‘consider use of a flow diagram’ removed |
Criterion 16 | Main results—reduced to one criterion |
Criterion 19 | Limitations—broken down to further criteria of (a) ‘sources of potential bias or imprecision’ and (b) ‘direction and magnitude of potential bias’ |
Results
Author (year), country | QoL Measure | Sample characteristics (all ADHD samples include matched QoL dyads) | Design | Main findings relevant to current review (p values shown where reported) | Database | Co-morbidities | Domains |
---|---|---|---|---|---|---|---|
Thaulow and Jozefiak (2012), Norway | ILC | Age range 8–15.5 62 ADHD groups, 23 girls (37.1%), 39 boys (62.9%) 49 anxiety/depression groups, 20 girls (40.8%), 29 boys (59.2%) 65 healthy control groups, 25 girls (38.5%), 40 boys (61.5%) | Case–control (comparison of QoL in children with ADHD and children with anxiety/depression) | In the ADHD group, children’s self-reported QoL was significantly higher than the parent-reported QoL (p < .01). The same analysis did not find a significant difference for the anxiety/depression group. Children in ADHD group rated QoL as being higher than anxiety/depression group (p < .05), lower than healthy controls (p < .05) | N/A | Not excluded | No only totals for QoL measure. |
Sciberras et al. (2011), Australia | Peds-QL | Age range 8–18 47 ADHD children 45 boys, 2 girls Aged 8–12: (36) Aged 13 or over: (11) | Cross-sectional (children’s experiences of ADHD) | Children rated their QoL higher than their parents rated them for total QoL scores and on all domains except physical functioning. Total: mean diff. = −11.6, 95% CI’s −18.64 to −4.70, p < .001. Psychosocial: mean diff. = −14.64, 95% CI’s −22.04 to −7.24, p < .01. Emotional: mean diff −14.15, 95% CI’s −23.56 to −4.74, p < .001. Largest mean differences were in social: mean diff.: −16.49, 95% CI’s −26.41 to −6.57, p < .001; and School: mean diff −15.11, 95% CI’s −23.01 to −7.21, p < .001 domains | PsycINFO | Not excluded | Yes |
Marques et al. (2013), Brazil | Peds-QL | Age range 8–12 45 ADHD 43 control (age and gender not specified) | Cross-sectional (with comparison group) (parent–child comparison of QoL) | Both children and parents rated QoL as lower in ADHD group than control group on all domains. Good concordance between parents and children on all domains except school functioning, which children self-reported higher than parents (mean difference: 14.55, CI 95%: 7.77, 21.33, SD: 3.36). | MEDLINE | Specified no co-morbidities in ADHD group except ODD | Yes |
Limbers et al. (2011a), USA | Peds-QL | Age range 5–18 179 children (57 girls, 124 boys) 181 parents (177 matched dyads) | Cross-sectional (paediatric clinic vs mental health clinic) | Children rated QoL higher than parents for total QoL score (mean diff. = 8.57, p < .001, d = 0.5). Children rated QoL higher across all domains except physical health. Greatest discrepancies were on school functioning (mean diff. = 12.06, p < .001, d = 0.61), and psychosocial health (mean diff. = 10.18, p < .001, d = 0.57) | EMBASE | Not excluded | Yes |
Limbers et al. (2011b), USA | Peds-QL | Age range 5–18 ADHD group 1: 17 general paediatric clinic (10 boys, 7 girl) and parents. ADHD group 2: [see Limbers et al. (2011a)]. Healthy controls from previous sample (957 boys, 496 girls) | Case–control (validation of Peds-QL in a sample of children with ADHD and co-morbid psychiatric disorders) | Group 1: no statistically significant differences between parent- and child-rated mean QoL scoresa, but sample size was small (N = 17) Group 2: [see Limbers et al. (2011a)] | PsycINFO | Not excluded | Yes |
Flapper and Schoemaker (2008), The Netherlands | DUX-25 and TACQOL | Age range 7–10 years 8 months ADHD + DCD (developmental coordination disorder) 23, control 23 | Double-blind placebo-controlled clinical trial (effects of methylphenidate on QoL) | DUX-25: no significant differences between parent and child reports for total scores but over some domains (physical p < .001, home p < .004) (children self-rated higher) TACQOL: bodily functioning (p < .02) and positive moods (p < .02) (parents rated higher) (baseline scores analysed) | PsycINFO | Excluded except for developmental coordination disorder (DCD) | Yes |
Varni and Burwinkle (2006), USA | Peds-QL | Age range 5–16 72 ADHD dyads 60 boys (83.3%), 12 girls (16.7%) 66 cancer, 57 cerebral palsy, 3256 healthy controls | Case–control (population based Peds-QL validation study) | Good reliability for total scale score (Cronbach’s α .92 child self-report, .92 parent proxy-report) and across domains Effect sizes (parent, child): total, .71, .70, physical .67, .67, psychosocial, .69, .69, emotional .67, .66, social .75, .75, school, .59, .59 | MEDLINE | Excluded | Yes |
Klassen et al. (2006), Canada | CHQ | Age range 10–17 58 dyads Male 48 (82.8%), female 10 (17.2%) | Cross-sectional (parent and child comparison on QoL) | Children self-reported significantly higher QoL than parents on 4 domains: behaviour (mean diff. = 22.9, 95% CI’s 17.6–28.3, SD 19.8, p < .001), self-esteem (mean diff. = 14.7, 95% CI’s 8.2–21.1, SD 23.7, p < .001), mental health (mean diff. = 6.8, 95% CI’s 1.6–12.0, SD 19.2, p < .01), family cohesion (mean diff. = 10.6, 95% CI’s 3.7–17.5, SD 25.7, p < .01), and worse on one: physical function (mean diff. = −4.3, 95% CI’s −7.8 to −0.8, SD 13.2, p < .01) Discrepancies were related to co-morbid ODD, worse ADHD symptoms and psychosocial stressors | PsycINFO | Excluded | Yes |
Schei et al. (2013), Norway | ILC | Age range 13–18 194 dyads Male 55.2% | Case–control (impact of emotional and conduct problems on QoL in ADHD) | For the ADHD only group, adolescents reported higher total QoL scores than parents (p < .01). There were no significant differences between total QoL scores for parents and adolescents for the ADHD with additional emotional problems group or the ADHD with additional conduct problems group. No subdomain scores were reported, only totals | N/A | Excluded for direct comparison with ADHD + co-morbid conditions | No only totals |
Jafari et al. (2011), Iran | Peds-QL | Age range 8–17 72 dyads, 140 controls 8–12 year (75%), 13–18 years (25%) | Cross-sectional (parent and child comparison on QoL) | Children rated their total QoL as higher than parents (mean diff. = 5.33, 95% CI’s −10.6 to −0.06, p < .05)a. They also rated higher mean QoL scores for the school domain (mean diff. = 8.9, 95% CI’s −16.62 to −1.2, p < .05)a
Parents and children in ADHD group rated QoL significantly poorer than control group across all domains | PsycINFO | Information not provided | Yes |
Pongwilairat et al. (2005), Thailand | Peds-QL | 46 ADHD 94 healthy control children (information not provided) | Cross-sectional (QoL of children with ADHD) | Means show children rate their total QoL higher than parents (mean diff. = 146, 95% CI’s 20.1–272.2, p < .05)a. Children also rated QoL higher on physical domain (mean diff. = 84.24, CI’s 22.2–146.3, p < .01)a; however, differences on other subdomains were not significant. Children and parents rated QoL poorer than healthy controls, except children self-report no significant difference in physical health domain, while parents do | EMBASE | Information not provided | Yes |
Bastiaansen et al. (2004), The Netherlands | Peds-QL | Age range 6–18 310 dyads 107 ADHD 57 anxiety 28 developmental disorders 29 mood disorders 22 other disorders 67 no diagnosis | Cross-sectional (QoL in children with psychiatric disorders) | For ADHD group, children self-reported higher mean QoL scores than parents across all domains Total: mean diff. = 6.6, 95% CI’s 3.1–10.1, p < .001a
Psychosocial: mean diff. = 8, 95% CI’s 3.9–12.1, p < .001a
Physical: mean diff. = 4, 95% CI’s 0.02–8.0, p < .05a
Emotional: mean diff. = 6.4, 95% CI’s 1.25–11.5, p < .05a
Social: mean diff. = 11.2, 95% CI’s 7.1–15.3, p < .001a
School: mean diff. = 6.6, 95% CI’s 2.01–11.9, p < .05a
| PsycINFO | Excluded for direct comparisons with other conditions | Yes |
Gürkan et al. (2010) | Peds-QL | Age range 8–14 45 dyads (75.6%) 34 boys (24.4%) 11 girls | Open-label trial (psychiatric symptoms and methylphenidate) | Children rated their QoL better than their parents for total QoL score at baseline (mean diff. = 5.4, 95% CI’s 0.2–10.6, p < .05)a. No significant differences observed for psychosocial or physical domains | EMBASE | Excluded | Yes |
Characteristics of included studies
Sample characteristics
Quality of life measures
Statistical analyses
Quality ratings of included studies
Items (Y/N) | Thaulow and Jozefiak (2012) | Sciberras et al. (2011) | Marques et al. (2013) | Limbers et al. (2011a) | Limbers et al. (2011b) | Flapper and Schoemaker (2008) | Varni and Burwinkle (2006) | Klassen et al. (2006) | Schei et al. (2013) | Jafari et al. (2011) | Pongwilairat et al. (2005) | Bastiaansen et al. (2004) | Gürkan et al. (2010) |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1. Title and abstract | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y |
2. Rationale | N | Y | Y | Y | Y | Y | Y | Y | Y | Y | N | Y | Y |
3. Objectives | N | Y | Y | Y | Y | Y | Y | Y | N | Y | N | Y | Y |
4. Study design | Y | Y | Y | Y | Y | Y | Y | N | Y | Y | N | Y | Y |
3. (a) Location | Y | Y | Y | Y | Y | Y | Y | Y | Y | N | Y | Y | Y |
(b) Relevant dates | Y | Y | N | Y | N | N | Y | Y | Y | N | N | Y | N |
6. (a) Participants | N | Y | Y | Y | Y | Y | Y | Y | Y | N | N | Y | Y |
(b) Control group | Y | N/A | N | Y | N | N | Y | N/A | Y | Y | N | N/A | N/A |
7. Variables | Y | N | Y | Y | Y | Y | Y | Y | Y | N | Y | Y | Y |
8. Measurement | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y |
9. Bias | Y | Y | N | Y | Y | Y | Y | N | Y | N | N | N | Y |
10. Study size (rationale) | N | N | N | N | N | Y | N | N | N | N | N | N | N |
11. Quantitative variables | Y | Y | Y | Y | Y | Y | Y | Y | Y | N | Y | Y | Y |
12. (a) Statistical methods | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y |
(c) Missing data | Y | N | N | N | N | N | Y | N | Y | N | Y | N | N |
13. (a) Participants | Y | Y | Y | N | Y | Y | Y | Y | Y | N | Y | Y | Y |
(b) Non-participation | Y | N | N | N | N | Y | N | Y | Y | N | N | N | Y |
14. (a) Sample characteristics | Y | Y | N | Y | Y | Y | Y | Y | Y | N | Y | Y | Y |
(b) Missing data | N | N | N | Y | N | N | Y | N | Y | N | Y | Y | N |
15. Outcome data | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y |
16. Main results | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y |
17. Other analyses | Y | Y | Y | Y | N/A | Y | Y | Y | N/A | N/A | N/A | Y | Y |
18. Key results | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y |
19. Limitations (a) sources | N | Y | Y | Y | Y | N | Y | Y | Y | N | Y | Y | N |
(b) Magnitude | N | N | N | N | N | N | Y | Y | N | N | N | N | N |
20. Interpretation | Y | Y | N | Y | Y | Y | Y | Y | Y | Y | N | Y | Y |
21. Generalisability | Y | Y | N | Y | Y | N | Y | Y | Y | Y | N | Y | N |
22. Funding | Y | Y | Y | Y | Y | N | Y | N | Y | N | N | Y | Y |