It is controversial whether current treatments for AD/HD are truly beneficial or simply reduce children with AD/HD to compliant“zombies” for the convenience of adult caretakers. Demonstration of the effectiveness of therapy for remediation of the functional limitations present in AD/HD would support the hypothesis that treatment reduces disability characteristic of AD/HD. In this study, effects of multimodal therapy for AD/HD were examined. At baseline, the WeeFIM and Conner's Parent Rating Scale-48 (CPRS) were given to 27 children who met DSM-IV creteria for AD/HD (mean Hyperactivity Index t=84.8). The WeeFIM provides a concise, comprehensive, “discipline-free” measure of functional independence sensitive to the self-care, communication, and social cognition limitations seen in AD/HD. Individual prescriptions for a combination of special education (13), behavioral or social skills counseling (15), and medication (25) were determined. After an average of 4.7 months follow-up WeeFIM and CPRS were re-administered. The 27 children from whom only follow-up WeeFIM's were obtained did not differ in IQ (71-128, M=91), gender (89% male), Medicaid status (64%), or age (3.2-9.2, M=6.5y) from the 19 children from whom follow-up Conners and WeeFIM scores were obtained. As expected, there was significant improvement in AD/HD behavior with decreases in the CPRS score in the Learning Problem (t-test, p=0.015), Impulsive-Hyperactive (p=0.025), and Hyperactivity Index (p=0.019). There was no reduction on the Conduct Problem scale (p=0.43). Age normalized WeeFIM scores showed significant improvement of self-care (sign-test, p=0.026), communication (p=0.022), social cognition(p=0.0003), and total WeeFIM scores (p=0.015). Despite an improvement of about 1/3 in functional scores, the pattern of limitations in self care, communication, and social cognition characteristic of AD/HD remained (ANOVA, p<0.001). These results support the utility of current therapy for AD/HD in improving functional skills, not just reducing unwanted behaviors. The WeeFIM is sensitive to changes in functional deficits in AD/HD and may be useful in further conrolled studies of the contributions of specific therapies to the attainment of functional independence in AD/HD.
