From the Editor-in-Chief's Desk

I n the last issue we published an illuminating investigation of alpha adrenergic agonists from Sallee et al. that also offered suggestions about broadening the targets of treatment and indicators of response in pediatric attention-deficit/hyperactivity disorder (ADHD). The authors' wide-ranging discussion of efficacy and the study drugs' effects on comorbid symptomatology (particularly cognitive dysfunction) was a model of how a literature review can illuminate pathways to future study.

In this issue, I am pleased that we can offer another paper that suggests both new ways to think about ADHD and new avenues of inquiry. Katic et al. perform a post-hoc analysis of a 7-week open label trial of lisdexamfetamine dimesylate with the aim of bolstering the literature on this formulation. The authors choose to study possible improvements in emotional control related to impaired executive function (EF).

Their results are intriguing. Katic et al. report that there appears to be a link between emotional lability and core ADHD symptoms, as both improved with treatment. “Moderate correlations were evident between global and emotion control domains of EF behaviors and ADHD symptoms,” they write, “suggesting value in measuring additional outcomes beyond assessment of core ADHD symptoms.” Further study could confirm these observations and lead to a more nuanced understanding of the disorder. “The use of a single outcome measure may not be sufficient to capture all relevant ADHD symptom domains.”

In the course of their investigation the authors also demonstrated the connection of EF emotional control with more classical concepts of mood and emotion by comparing diverse rating scale results in their analysis.

But even as we capture glimpses of an accelerated future in treatment development and efficacy, we need to reflect on how it is delivered in the real world, which, as we all know, is distant from clinical drug trials. Myers et al.'s trial of telemental health techniques in underserved communities may be just a first step, but it is a necessary and welcome one. In addition to reporting their encouraging results on treatment compliance and infrastructure, the authors also provide a concise review of the existing literature. Long-distance care is necessary “to correct disparities in children's access,” they write. “An evidence base is now needed.”

Myers et al. make a valuable contribution to that base. Their article lays the groundwork for the continued, rigorous study of distance interventions, as well as validating the concept of medication management in remote sites and the applicability of manualization of treatment protocols to telemental health. Perhaps the most encouraging thing about the project that Myers et al. are nurturing is that they bring science and the concept of an evidence base to a non-ideal situation. For too long we have lamented the thinness of our numbers but failed to propose an adequate solution. This work is how we test one promising possibility.