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Abstract
This study sought to examine parent perceptions of medication use for 151 preschool children (M age = 5.05 years, 78% male, 82% Hispanic/Latino) with or at-risk for ADHD who were medication naive. Parents completed questionnaires regarding family background and perceptions of medication treatment. Parents and teachers completed ratings of child diagnostic symptomatology, behavioral functioning, and functional impairment. Results indicate that only 45% of parents were open to the possibility of medication. No associations were found between child demographics, severity of ADHD symptoms, or level of functional impairment and parental openness to medication. On the other hand, children of parents who were open to medication tended to have higher levels of oppositionality and aggression (as reported by parents but not teachers) compared with children of parents who were not open to medication. These findings are discussed in the context of early intervention given their implications for a variety of treatment providers.
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Gould ON, Doucette C. Self-Management of Adherence to Prescribed Stimulants in College Students With ADD/ADHD. J Atten Disord 2018; 22:349-355. [PMID: 27016530 DOI: 10.1177/1087054716638509] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We examined how college students manage ADHD medication and how beliefs regarding the medication and attitudes of friends and families influence adherence on weekdays and weekends during an academic semester. METHOD Undergraduate students ( n = 53) responded to an online survey to report their adherence, their beliefs about the effects of the medication, and their perception of important others' views of adherence. RESULTS Students chose to take more medication on weekdays than weekends. On weekdays, beliefs that the medications enhance academic performance and social skills influenced adherence, and on weekends, beliefs regarding negative side effects were important. The perception that medication leads to a loss of authentic self reduced adherence at both times. Generally, students believed that important others wanted them to take medication. CONCLUSION Students were actively weighing the costs and benefits of taking their ADHD medication and consciously adjusting adherence levels from day to day.
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Affiliation(s)
- Odette N Gould
- 1 Mount Allison University, Sackville, New Brunswick, Canada
| | - Clara Doucette
- 1 Mount Allison University, Sackville, New Brunswick, Canada
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Coghill D. Current issues in child and adolescent psychopharmacology. Part 1: Attention-deficit hyperactivity and affective disorders. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/apt.9.2.86] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Drug treatments play an important role in the treatment of child and adolescent psychiatric disorders. However, there is often a long delay before research findings are translated into clinical practice; furthermore, changes in clinical practice outstrip the available evidence. This paper focuses on current issues and research findings on the pharmacological treatment of attention-deficit hyperactivity disorder (ADHD) and affective disorders. Clinical findings from a US study of the treatment of ADHD with extended-release stimulants and non-stimulants, and the development and use of clinical guidelines are discussed. Clinical trials of selective serotonin reuptake inhibitors for early-onset depression, approaches to managing treatment-resistant depression and guidance on the drug treatment of early-onset mania are considered.
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Abstract
Risk management is a requirement of clinical governance and a new paradigm for child and adolescent mental health services. Issues are different from those of adult services and a wide range need to be considered, which include not only the risk of harm to self, to others and from others but also from the system (by omission or commission) and to the staff. Systematic policy development, using information from audits, complaints, incidents and inquiries, will be helpful and interagency agreements necessary to promote coordination. The complex regulatory framework is discussed.
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Abstract
OBJECTIVE To estimate the prevalence of adult ADHD diagnosis and treatment in U.S. Medicaid beneficiaries. METHOD Using outpatient, inpatient, and pharmacy billing records for patients eligible for Medicaid fee-for-service benefits within 29 states from 1999 to 2010, we estimated the annual prevalence of ADHD diagnosis and treatment. RESULTS The prevalence of ADHD diagnosis increased from 2.20 per 1,000 patients in 1999 to 10.57 in 2010. Likewise, prevalence of ADHD treatment increased from 1.95 per 1,000 patients in 1999 to 13.16 in 2010. Between 40% and 65%, patients had ADHD drug prescription fills 6 months after ADHD diagnosis, whereas 45% to 55% of the beneficiaries with an ADHD drug prescription fill had ADHD diagnoses within 6 months before the prescription. CONCLUSION In publicly insured adults, the prevalence of ADHD diagnosis and treatment increased dramatically over the years. Approximately half of the diagnosed patients are not treated, whereas half of the treated adults are not diagnosed.
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Affiliation(s)
- Yanmin Zhu
- 1 University of Florida, Gainesville, USA
| | - Wei Liu
- 2 Food and Drug Administration, Silver Spring, MD, USA
| | - Yan Li
- 1 University of Florida, Gainesville, USA
| | - Xi Wang
- 1 University of Florida, Gainesville, USA
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The Use of Stimulant Medication to Treat Attention-Deficit/Hyperactivity Disorder in Elite Athletes: A Performance and Health Perspective. Sports Med 2017; 48:507-512. [DOI: 10.1007/s40279-017-0829-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Jaber L, Rigler S, Shuper A, Diamond G. Changing Epidemiology of Methylphenidate Prescriptions in the Community: A Multifactorial Model. J Atten Disord 2017; 21:1143-1150. [PMID: 24776713 DOI: 10.1177/1087054714528044] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To examine dispensing patterns of methylphenidate (MPH) to determine how socioeconomic status (SES), ethnocultural affiliation, and gender affect the medical treatment of ADHD. METHOD We reviewed MPH prescription records for year 2011 of children aged 6 to 18, from regional pharmacies serving homogeneous neighborhoods. RESULTS MPH prescriptions showed an increase in prevalence from 4.2% to 7.5% in the years 2007 to 2011, respectively. Jewish children were four times more likely to be prescribed MPH than Arab children, with significant discrepancies along SES and gender lines ( p < .001). Higher SES and male gender were associated with greater use of MPH. General pediatric prescription rates of MPH in all communities increased by 85%, compared with year 2007 statistics ( p < .001). CONCLUSION Prescription patterns for MPH in children reflect diagnostic patterns of ADHD that appear to be heavily influenced by additive factors of SES, cultural attitudes, and gender. Dispensing data provide valuable information for targeting underserved groups and defining potential areas of abuse.
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Affiliation(s)
- Lutfi Jaber
- 1 The Bridge to Peace Community Pediatric Center, Taibe, Israel
- 2 Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- 3 Clalit Health Services, Tel Aviv, Israel
- 4 Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Shmuel Rigler
- 3 Clalit Health Services, Tel Aviv, Israel
- 5 Hefer Authority, Israel
| | - Avinoam Shuper
- 2 Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- 3 Clalit Health Services, Tel Aviv, Israel
- 4 Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Gary Diamond
- 2 Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- 3 Clalit Health Services, Tel Aviv, Israel
- 4 Sackler Faculty of Medicine, Tel Aviv University, Israel
- 6 Rose F. Kennedy Center, CERC, Albert Einstein College of Medicine, Bronx, NY, USA
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58
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Silberstein RB, Levy F, Pipingas A, Farrow M. First-Dose Methylphenidate-Induced Changes in Brain Functional Connectivity Are Correlated With 3-Month Attention-Deficit/Hyperactivity Disorder Symptom Response. Biol Psychiatry 2017; 82:679-686. [PMID: 28465019 DOI: 10.1016/j.biopsych.2017.03.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 03/14/2017] [Accepted: 03/14/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) symptoms are most commonly treated with stimulant medication such as methylphenidate (MPH); however, approximately 25% of patients show little or no symptomatic response. We examined the extent to which initial changes in brain functional connectivity (FC) associated with the first MPH dose in boys newly diagnosed with ADHD predict MPH-associated changes in ADHD inattentiveness and hyperactivity symptoms at 3 months. METHODS Brain FC was estimated using steady-state visual evoked potential partial coherence before and 90 minutes after the administration of the first MPH dose to 40 stimulant drug-naïve boys newly diagnosed with ADHD while they performed the AX version of the continuous performance task. The change in parent-rated inattention and hyperactivity scores over the first 3 months of MPH medication was correlated with the initial 90-minute MPH-mediated FC changes. RESULTS Hyperactivity improvements at 3 months were associated with first-dose MPH-mediated FC reductions restricted to frontal-prefrontal sites following the appearance of the "A" and at frontal and right temporal sites during the appearance of the "X." Corresponding 3-month inattention score improvement was associated with initial MPH-mediated FC reductions restricted to occipitoparietal sites following the appearance of the "A." CONCLUSIONS These findings are discussed in the context of MPH effects on the default mode network and the possible role of the default mode network in MPH-mediated improvements in inattention and hyperactivity symptom scores.
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Affiliation(s)
- Richard B Silberstein
- Centre for Human Psychopharmacology, Swinburne University, Hawthorn, Victoria, Australia; Neuro-Insight Pty Ltd, Melbourne, Victoria, Australia.
| | - Florence Levy
- Child and Family East, Prince of Wales Hospital and School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Andrew Pipingas
- Centre for Human Psychopharmacology, Swinburne University, Hawthorn, Victoria, Australia
| | - Maree Farrow
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Australia
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Vierhile AE, Palumbo D, Belden H. Diagnosis and treatment of attention deficit hyperactivity disorder. Nurse Pract 2017; 42:48-54. [PMID: 28926497 DOI: 10.1097/01.npr.0000521995.38311.e7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Attention-deficit hyperactivity disorder (ADHD) is a neurobehavioral disorder characterized by signs and symptoms of inattention, hyperactivity, and impulsivity that typically begin in childhood. ADHD can persist into adulthood, causing impairments in occupational performance and peer and family relationships. This article reviews the epidemiology, diagnosis, and treatment of ADHD.
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Affiliation(s)
- Amy E Vierhile
- Amy E. Vierhile is a senior NP at the University of Rochester Medical Center and assistant professor at the University of Rochester, School of Nursing, Rochester, N.Y. Donna Palumbo is a medical director, ADHD franchise at Pfizer, Inc., New York, N.Y. Heidi Belden is a medical director at Tris Pharma, Inc., Monmouth Junction, N.J
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Caballero J, Darsey EH, Walters F, Belden HW. Methylphenidate extended-release oral suspension for the treatment of attention-deficit/hyperactivity disorder: a practical guide for pharmacists. INTEGRATED PHARMACY RESEARCH AND PRACTICE 2017; 6:163-171. [PMID: 29354563 PMCID: PMC5774317 DOI: 10.2147/iprp.s142576] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition that affects children, adolescents, and adults worldwide. The purpose of this review was to inform pharmacists of the numerous options to treat ADHD, with a focus on one of the more recently approved formulations, methylphenidate extended-release oral suspension (MEROS). Symptoms of ADHD can negatively impact an individual’s health and quality of life and impair function in multiple settings. Psychostimulants such as methylphenidate- and amphetamine-based agents are first-line pharmacologic treatments for ADHD. However, there are multiple formulations, including immediate release (administered two to three times/day), solid extended release (ER), or transdermal patch. MEROS is a once daily, long-acting liquid preparation that has demonstrated favorable safety and efficacy in patients with ADHD. MEROS may improve treatment adherence in patients who cannot tolerate or have difficulties administering pill or transdermal patch formulations.
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Affiliation(s)
- Joshua Caballero
- Department of Clinical and Administrative Sciences, College of Pharmacy, Larkin Health Sciences Institute, Miami, FL
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Verbeeck W, Bekkering GE, Van den Noortgate W, Kramers C. Bupropion for attention deficit hyperactivity disorder (ADHD) in adults. Cochrane Database Syst Rev 2017; 10:CD009504. [PMID: 28965364 PMCID: PMC6485546 DOI: 10.1002/14651858.cd009504.pub2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is a prevalent neurobiological condition, characterised by behavioral and cognitive symptoms such as inattention, impulsivity and/or excessive activity. The syndrome is commonly accompanied by psychiatric comorbidities and is associated with educational and occupational underachievement.Although psychostimulant medications are the mainstay of treatment for ADHD, not all adults respond optimally to, or can tolerate, these medicines. Thus, alternative non-stimulant treatment approaches for ADHD have been explored. One of these alternatives is bupropion, an aminoketone antidepressant and non-competitive antagonism of nicotinic acetylcholine receptors. Bupropion is registered for the treatment of depression and smoking cessation, but is also used off-label to treat ADHD. OBJECTIVES To assess the effects and safety of bupropion for the treatment of adults with ADHD. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and seven other databases in February 2017. We also searched three trials registers and three online theses portals. In addition, we checked references of included studies and contacted study authors to identify potentially relevant studies that were missed by our search. SELECTION CRITERIA We included all randomised controlled trials (RCTs) that evaluated the effects (including adverse effects) of bupropion compared to placebo in adults with ADHD. DATA COLLECTION AND ANALYSIS Two review authors (WV, GB) independently screened records and extracted data using a data extraction sheet that we tested in a pilot study. We extracted all relevant data on study characteristics and results. We assessed risks of bias using the Cochrane 'Risk of bias' tool, and assessed the overall quality of evidence using the GRADE approach. We used a fixed-effect model to pool the results across studies. MAIN RESULTS We included six studies with a total of 438 participants. Five studies were conducted in the USA, and one in Iran. All studies evaluated a long-acting version of bupropion, with the dosage ranging from 150 mg up to 450 mg daily. Study intervention length varied from six to 10 weeks. Four studies explicitly excluded participants with psychiatric comorbidity and one study included only participants with opioid dependency. Four studies were funded by industry, but the impact of this on study results is unknown. Two studies were publicly funded and in one of these studies, the lead author was a consultant for several pharmaceutical companies and also received investigator-driven funding from two companies, however none of these companies manufacture bupropion. We judged none of the studies to be free of bias because for most risk of bias domains the study reports failed to provide sufficient details. Using the GRADE approach, we rated the overall quality of evidence as low. We downgraded the quality of the evidence because of serious risk of bias and serious imprecision due to small sample sizes.We found low-quality evidence that bupropion decreased the severity of ADHD symptoms (standardised mean difference -0.50, 95% confidence interval (CI) -0.86 to -0.15, 3 studies, 129 participants), and increased the proportion of participants achieving clinical improvement (risk ratio (RR) 1.50, 95% CI 1.13 to 1.99, 4 studies, 315 participants), and reporting an improvement on the Clinical Global Impression - Improvement scale (RR 1.78, 95% CI 1.27 to 2.50, 5 studies, 337 participants). There was low-quality evidence that the proportion of participants who withdrew due to any adverse effect was similar in the bupropion and placebo groups (RR 1.20, 95% CI 0.35 to 4.10, 3 studies, 253 participants). The results were very similar when using a random-effects model and when we analysed only studies that excluded participants with a psychiatric comorbidity. AUTHORS' CONCLUSIONS The findings of this review, which compared bupropion to placebo for adult ADHD, indicate a possible benefit of bupropion. We found low-quality evidence that bupropion decreased the severity of ADHD symptoms and moderately increased the proportion of participants achieving a significant clinical improvement in ADHD symptoms. Furthermore, we found low-quality evidence that the tolerability of bupropion is similar to that of placebo. In the pharmacological treatment of adults with ADHD, extended- or sustained-release bupropion may be an alternative to stimulants. The low-quality evidence indicates uncertainty with respect to the pooled effect estimates. Further research is very likely to change these estimates. More research is needed to reach more definite conclusions as well as clarifying the optimal target population for this medicine. Treatment response remains to be reported in a DSM5-diagnosed population. There is also a lack of knowledge on long-term outcomes.
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Affiliation(s)
- Wim Verbeeck
- Centrum ADHD/ASS, GGZ Vincent van Gogh Instituut Venray, Noordsingel 39, Venray, Netherlands, 5801 GJ
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Myers K, Nelson EL, Rabinowitz T, Hilty D, Baker D, Barnwell SS, Boyce G, Bufka LF, Cain S, Chui L, Comer JS, Cradock C, Goldstein F, Johnston B, Krupinski E, Lo K, Luxton DD, McSwain SD, McWilliams J, North S, Ostrowski J, Pignatiello A, Roth D, Shore J, Turvey C, Varrell JR, Wright S, Bernard J. American Telemedicine Association Practice Guidelines for Telemental Health with Children and Adolescents. Telemed J E Health 2017; 23:779-804. [DOI: 10.1089/tmj.2017.0177] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Kathleen Myers
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
- Department of Psychiatry and Behavioral Medicine, Seattle Children's Hospital, Seattle, Washington
| | - Eve-Lynn Nelson
- KU Center for Telemedicine & Telehealth, University of Kansas Medical Center, Kansas City, Kansas
- Department of Pediatrics, School of Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Terry Rabinowitz
- Department of Psychiatry, Larner College of Medicine, University of Vermont, Burlington, Vermont
- Department of Family Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont
| | - Donald Hilty
- Psychiatry & Addiction Medicine, Kaweah Delta Medical Center, UC Irvine Affiliate, Visalia, California
- Department of Psychiatry, Keck School of Medicine at University of Southern California, Los Angeles, California
- Research and Health Services, Aligned Telehealth, Calabasas, California
| | - Deborah Baker
- Office of Legal and Regulatory Affairs, Practice Directorate, American Psychological Association, Washington, District of Columbia
| | - Sara Smucker Barnwell
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
- Seattle Psychology PLLC, Seattle, Washington
| | | | - Lynn F. Bufka
- Practice Research and Policy, Practice Directorate, American Psychological Association, Washington, District of Columbia
| | - Sharon Cain
- Child and Adolescent Psychiatry Division, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Lisa Chui
- Department of Psychiatry and Behavioral Medicine, Seattle Children's Hospital, Seattle, Washington
| | - Jonathan S. Comer
- Center for Children and Families, Florida International University, Miami, Florida
- Mental Health Interventions and Technology (MINT) Program, Florida International University, Miami, Florida
| | | | | | | | - Elizabeth Krupinski
- Department of Radiology & Imaging Sciences, Emory University, Atlanta, Georgia
| | - Katherine Lo
- Department of Psychiatry and Behavioral Medicine, Seattle Children's Hospital, Seattle, Washington
| | - David D. Luxton
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
- Office of Forensic Mental Health Services, State of Washington, Olympia, Washington
| | - S. David McSwain
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
- Department of Telehealth Optimization, Medical University of South Carolina, Charleston, South Carolina
| | | | - Steve North
- Center for Rural Health Innovation, Spruce Pine, North Carolina
- Mission Virtual Care, Spruce Pine, North Carolina
| | - Jay Ostrowski
- Behavioral Health Innovation, Charlotte, North Carolina
| | - Antonio Pignatiello
- TeleLink Mental Health Program, The Hospital for Sick Children, Toronto, Ontario, Canada
- Medical Psychiatry Alliance, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - David Roth
- Mind and Body Works, Inc., Honolulu, Hawaii
| | - Jay Shore
- Department of Psychiatry, Center for American Indian and Alaska Native Health, University of Colorado, Denver, Colorado
- Telepsychiatry Committee, American Psychiatric Association, Arlington, Virginia
| | - Carolyn Turvey
- Department of Psychiatry, Carver School of Medicine, University of Iowa, Iowa City, Iowa
| | | | - Shawna Wright
- KU Center for Telemedicine & Telehealth, University of Kansas Medical Center, Kansas City, Kansas
- Wright Psychological Services, Chanute, Kansas
| | - Jordana Bernard
- American Telemedicine Association, Washington, District of Columbia
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63
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Efron D, Danchin MH, Cranswick NE, Gulenc A, Hearps S, Hiscock H. Medication prescribed by Australian paediatricians: Psychotropics predominate. J Paediatr Child Health 2017; 53:957-962. [PMID: 28664628 DOI: 10.1111/jpc.13615] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 03/30/2017] [Accepted: 04/12/2017] [Indexed: 12/01/2022]
Abstract
AIM The aims of this study were to examine: (i) medications prescribed by Australian general and community paediatricians, (ii) predictors of prescribing (child age, gender) and (iii) changes in medication prescription between 2008 and 2013. METHODS Two patient-level practice national audits were conducted by the Australian Paediatric Research Network in 2008 and 2013. General and community paediatricians in outpatient clinics and private practices recorded demographic data, diagnoses and medications prescribed for all patients seen over a 2-week period. RESULTS In 2008, 199 paediatricians submitted data on 8345 consultations, and in 2013, 180 paediatricians submitted data on 7102 consultations. The most frequently prescribed drug class was psychotropics, prescribed for 46.8% of patients with developmental-behavioural/mental health (DB/MH) diagnoses in 2008 and 49.8% in 2013 (P = 0.015). Within this class, in 2013, the stimulants were prescribed in 35.3% of DB/MH consultations, antidepressants in 7.8% and antipsychotics in 5.6%. The next most frequently prescribed drug classes were laxatives (4.6% of all consultations in 2013), asthma preventers (4.1%), melatonin (3.7%), asthma relievers (2.6%) and proton-pump inhibitors (2.2%), topical corticosteroids (1.8%) and antihistamines (1.4%). Medication prescription was predicted by patient age (P < 0.001, both audits) and male gender (P < 0.01, both audits) but not by measured prescriber variables. The rates of prescribing of psychotropics, melatonin, laxatives and enuresis medications increased between 2008 and 2013. CONCLUSIONS Australian paediatricians prescribe mostly psychotropic medications, and the amount prescribed appears to be increasing. Paediatricians need good training and professional development in mental health diagnosis and management and the rational prescribing of psychotropic medications.
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Affiliation(s)
- Daryl Efron
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Margie H Danchin
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Noel E Cranswick
- Australian Paediatric Pharmacology Research Unit, Murdoch Childrens Research Institute and Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Alisha Gulenc
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Centre for Community and Child Health, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Stephen Hearps
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Harriet Hiscock
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Centre for Community and Child Health, Royal Children's Hospital, Melbourne, Victoria, Australia
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Soleimani R, Kousha M, Zarrabi H, Tavafzadeh-haghi SM, Jalali MM. The Impact of Methylphenidate on Motor Performance in Children with both Attention Deficit Hyperactivity Disorder and Developmental Coordination Disorder: A Randomized Double-Blind Crossover Clinical Trial. IRANIAN JOURNAL OF MEDICAL SCIENCES 2017; 42:354-361. [PMID: 28761201 PMCID: PMC5523042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 06/22/2016] [Accepted: 07/17/2016] [Indexed: 10/31/2022]
Abstract
BACKGROUND Children with attention deficit hyperactivity disorder/developmental coordination disorder (ADHD/DCD) suffer from problems associated with gross and fine motor skills. There is no effective pharmacological therapy for such patients. We aimed to assess the impact of methylphenidate (MPH) on motor performance of children with ADHD/DCD. METHODS In this double-blind placebo-controlled, 17 children (12 boys) with ADHD/DCD with a mean age of 7 years 6 months were recruited in Shafa Hospital, Rasht, Iran. The response was defined as ≥25% reduction in the total score of ADHD rating scale-IV from the baseline. Sixteen boys entered phase 2 of the study in which the impact of MPH on motor function was determined through a crossover randomized clinical trial. Eligible individuals were scheduled for baseline and two assessment visits after a one-week period of intervention. We used the short form of Bruininks-Oseretsky test (BOT-2) to identify the disability of motor function. Children were randomly assigned to receive MPH or inert ingredients (placebo). In the second period, medication (MPH/placebo) was crossed over. The effects of MPH were analyzed using χ2 test for related samples to compare the performance during baseline, placebo, and MPH trials. The results were analyzed using the SPSS software version 16.0. RESULTS The mean minimal effective dose of MPH per day was 17.3 mg (0.85 mg/kg). Children with higher ADHD rating scale had a significantly lower standard score in BOT-2 (P=0.03). Following MPH intake, 26.6% of the children showed clinically significant improvement in motor function. However, the improvement was not statistically different between the MPH and placebo. CONCLUSION Although MPH improved ADHD symptoms, problems with motor performance still remained. Further work is required to determine the probable effects of MPH in a higher dosage or in different subtypes of ADHD. TRIAL REGISTRATION NUMBER IRCT201107071483N2.
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Affiliation(s)
- Robabeh Soleimani
- Department of Psychiatry, Cognitive and Addiction Research Center, Shafa Hospital, Guilan University of Medical Sciences, Guilan, Iran
| | - Maryam Kousha
- Department of Child Psychiatry, Shafa Hospital, Guilan University of Medical Sciences, Guilan, Iran
| | - Homa Zarrabi
- Department of Psychiatry, Shafa Hospital, Guilan University of Medical Sciences, Guilan, Iran
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65
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Schreiber S, Bader M, Rubovitch V, Pick CG. Interaction between methylphenidate, methadone and different antidepressant drugs on antinociception in mice, and possible clinical implications. World J Biol Psychiatry 2017; 18:300-307. [PMID: 26529542 DOI: 10.3109/15622975.2015.1086492] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Methylphenidate (MPH), a psychostimulant used for treatment of attention deficit hyperactivity disorder (ADHD), is widely used by patients on antidepressants and methadone maintenance treatment (MMT). Preclinical studies showed MPH to exert analgesic effects when given alone or with morphine. METHODS Using the hotplate assay on mice, we studied the interaction of acute doses of MPH with sub-threshold doses of methadone and different antidepressant medications and the interaction of increasing doses of MPH with chronic methadone. RESULTS Adding a sub-threshold dose of venlafaxine, desipramine or clomipramine to MPH produced significant augmentation of MPH antinociception with each medication (P < 0.05). No such interactions were found between escitalopram and acute methadone. However, addition of increasing doses of MPH to chronic methadone given for 2 weeks using ALZET osmotic mini pumps induced augmentation of the antinociceptive effect of chronic methadone exclusively at high dose of MPH (7.5 mg/kg). CONCLUSIONS These findings may implicate the need of an excessive attention to the administration of MPH to MMT patients. The no interaction found between MPH and escitalopram may hint to the possibly safe co-administration of MPH and selective serotonin reuptake inhibitors (SSRIs) to depressed ADHD patients. Further studies are needed in order to validate these possible clinical implications.
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Affiliation(s)
- Shaul Schreiber
- a Department of Psychiatry , Tel Aviv Sourasky Medical Center & Tel Aviv University Sackler Faculty of Medicine , Tel Aviv , Israel
| | - Miaad Bader
- b Department of Anatomy, and Anthropology , Sackler Faculty of Medicine
| | - Vardit Rubovitch
- b Department of Anatomy, and Anthropology , Sackler Faculty of Medicine
| | - Chaim G Pick
- b Department of Anatomy, and Anthropology , Sackler Faculty of Medicine.,c Sagol School of Neuroscience, Tel Aviv University , Tel Aviv , Israel
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Bonnefois G, Robaey P, Barrière O, Li J, Nekka F. An Evaluation Approach for the Performance of Dosing Regimens in Attention-Deficit/Hyperactivity Disorder Treatment. J Child Adolesc Psychopharmacol 2017; 27:320-331. [PMID: 28165318 PMCID: PMC5460958 DOI: 10.1089/cap.2016.0108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Stimulant medications, with methylphenidate as the main agent, are the most prescribed for the treatment of attention-deficit/hyperactivity disorder. Nevertheless, real challenges still remain for clinicians concerned with adaptation of the therapeutic regimens, in terms of doses and timing, to children's daily activities. The aim of this study was to optimize short-acting methylphenidate regimens according to specific children's needs by evaluating the performance of a particular regimen through a web-based application. METHODS In this article, accounting for day-to-day children's activities and using up-to-date pharmacokinetic knowledge of methylphenidate, we propose a computational approach for the identification of the most suitable dosing regimens of immediate-release formulations of methylphenidate based on constraints on drug concentration and time frame of activities, defined through therapeutic boxes. To assess the performance of these regimens, time- and concentration-based therapeutic indicators, as well as a roller coaster effect, are proposed. RESULTS A web-based interface that can serve as an educational tool for clinicians and patients has been developed based on the proposed approach for the evaluation of dosing regimens. Comparison of those optimal regimens identified by our method with the well-accepted regimens defined in the NIMH Collaborative Multisite Multimodal Treatment study of Children with attention-deficit/hyperactivity disorder indicates that there is still room for improvement in the current practice especially for the last dose administration to avoid side effects such as sleep disturbance. CONCLUSION The developed approach and its associated web-based interface provide an efficient way to evaluate and adapt the methylphenidate regimens to children's daily activities. In addition, this approach could be used as proof of concept to further implement combination of short- and long-acting methylphenidate.
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Affiliation(s)
| | - Philippe Robaey
- Children's Hospital of Eastern Ontario (CHEO), Ottawa, Canada.,Department of Psychiatry, University of Ottawa, Ottawa, Canada.,Département de Psychiatrie, Université de Montréal, Montréal, Canada
| | | | - Jun Li
- Faculté de Pharmacie, Université de Montréal, Montréal, Canada.,Centre de Recherches Mathématiques, Université de Montréal, Montréal, Canada
| | - Fahima Nekka
- Faculté de Pharmacie, Université de Montréal, Montréal, Canada.,Centre de Recherches Mathématiques, Université de Montréal, Montréal, Canada
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Robison LS, Ananth M, Hadjiargyrou M, Komatsu DE, Thanos PK. Chronic oral methylphenidate treatment reversibly increases striatal dopamine transporter and dopamine type 1 receptor binding in rats. J Neural Transm (Vienna) 2017; 124:655-667. [PMID: 28116523 PMCID: PMC5400672 DOI: 10.1007/s00702-017-1680-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 01/11/2017] [Indexed: 11/29/2022]
Abstract
Previously, we created an 8-h limited-access dual bottle drinking paradigm to deliver methylphenidate (MP) to rats at two dosages that result in a pharmacokinetic profile similar to patients treated for attention deficit hyperactivity disorder. Chronic treatment resulted in altered behavior, with some effects persisting beyond treatment. In the current study, adolescent male Sprague-Dawley rats were split into three groups at four weeks of age: control (water), low-dose MP (LD), and high-dose MP (HD). Briefly, 4 mg/kg (low dose; LD) or 30 mg/kg (high dose; HD) MP was consumed during the first hour, and 10 mg/kg (LD) or 60 mg/kg (HD) MP during hours two through eight. Following three months of treatment, half of the rats in each group (n = 8-9/group) were euthanized, and remaining rats went through a 1-month abstinence period, then euthanized. In vitro receptor autoradiography was performed to quantify binding levels of dopamine transporter (DAT), dopamine type 1 (D1R)-like receptors, and dopamine type 2 (D2R)-like receptors using [3H] WIN35,428, [3H] SCH23390, and [3H] Spiperone, respectively. Immediately following treatment, HD MP-treated rats had increased DAT and D1R-like binding in several subregions of the basal ganglia, particularly more caudal portions of the caudate putamen, which correlated with some previously reported behavioral changes. There were no differences between treatment groups in any measure following abstinence. These findings suggest that chronic treatment with a clinically relevant high dose of MP results in reversible changes in dopamine neurochemistry, which may underlie some effects on behavior.
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Affiliation(s)
- Lisa S Robison
- Department of Psychology, Stony Brook University, 100 Nicolls Road, Stony Brook, NY, 11794, USA
| | - Mala Ananth
- Department of Neurobiology, Stony Brook University, 100 Nicolls Road, Stony Brook, NY, 11794, USA
| | - Michael Hadjiargyrou
- Department of Life Sciences, New York Institute of Technology, Northern Boulevard, P.O. Box 8000, Old Westbury, NY, 11568, USA
| | - David E Komatsu
- Department of Orthopedics, Stony Brook University, 100 Nicolls Road, Stony Brook, NY, 11794, USA
| | - Panayotis K Thanos
- Behavioral Neuropharmacology and Neuroimaging Laboratory On Addictions, Research Institute On Addictions, University at Buffalo, 1021 Main St, Buffalo, NY, 14203, USA.
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He JA, Antshel KM. Cognitive Behavioral Therapy for Attention-Deficit/Hyperactivity Disorder in College Students: A Review of the Literature. COGNITIVE AND BEHAVIORAL PRACTICE 2017. [DOI: 10.1016/j.cbpra.2016.03.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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69
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Gupte-Singh K, Singh RR, Lawson KA. Economic Burden of Attention-Deficit/Hyperactivity Disorder among Pediatric Patients in the United States. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2017; 20:602-609. [PMID: 28408002 DOI: 10.1016/j.jval.2017.01.007] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 01/04/2017] [Accepted: 01/13/2017] [Indexed: 05/06/2023]
Abstract
OBJECTIVES To determine the adjusted incremental total costs (direct and indirect) for patients (aged 3-17 years) with attention-deficit/hyperactivity disorder (ADHD) and the differences in the adjusted incremental direct expenditures with respect to age groups (preschoolers, 0-5 years; children, 6-11 years; and adolescents, 12-17 years). METHODS The 2011 Medical Expenditure Panel Survey was used as the data source. The ADHD cohort consisted of patients aged 0 to 17 years with a diagnosis of ADHD, whereas the non-ADHD cohort consisted of subjects in the same age range without a diagnosis of ADHD. The annual incremental total cost of ADHD is composed of the incremental direct expenditures and indirect costs. A two-part model with a logistic regression (first part) and a generalized linear model (second part) was used to estimate the incremental costs of ADHD while controlling for patient characteristics and access-to-care variables. RESULTS The 2011 Medical Expenditure Panel Survey database included 9108 individuals aged 0 to 17 years, with 458 (5.0%) having an ADHD diagnosis. The ADHD cohort was 4.90 times more likely (95% confidence interval [CI] 2.97-8.08; P < 0.001) than the non-ADHD cohort to have an expenditure of at least $1, and among those with positive expenditures, the ADHD cohort had 58.4% higher expenditures than the non-ADHD cohort (P < 0.001). The estimated adjusted annual total incremental cost of ADHD was $949.24 (95% CI $593.30-$1305.18; P < 0.001). The adjusted annual incremental total direct expenditure for ADHD was higher among preschoolers ($989.34; 95% CI $402.70-$1575.98; P = 0.001) than among adolescents ($894.94; 95% CI $428.16-$1361.71; P < 0.001) or children ($682.71; 95% CI $347.94-$1017.48; P < 0.001). CONCLUSIONS Early diagnosis and use of evidence-based treatments may address the substantial burden of ADHD.
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Affiliation(s)
- Komal Gupte-Singh
- Health Outcomes and Pharmacy Practice Division, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA.
| | - Rakesh R Singh
- Health Outcomes and Pharmacy Practice Division, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
| | - Kenneth A Lawson
- Health Outcomes and Pharmacy Practice Division, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
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dosReis S, Park A, Ng X, Frosch E, Reeves G, Cunningham C, Janssen EM, Bridges JF. Caregiver Treatment Preferences for Children with a New Versus Existing Attention-Deficit/Hyperactivity Disorder Diagnosis. J Child Adolesc Psychopharmacol 2017; 27:234-242. [PMID: 27991834 PMCID: PMC5397221 DOI: 10.1089/cap.2016.0157] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Parental experiences with managing their child's attention-deficit/hyperactivity disorder (ADHD) can influence priorities for treatment. This study aimed to identify the ADHD management options caregivers most prefer and to determine if preferences differ by time since initial ADHD diagnosis. METHODS Primary caregivers (n = 184) of a child aged 4-14 years old in care for ADHD were recruited from January 2013 through March 2015 from community-based pediatric and mental health clinics and family support organizations across the state of Maryland. Participants completed a survey that included child/family demographics, child clinical treatment, and a Best-Worst Scaling (BWS) experiment to elicit ADHD management preferences. The BWS comprised 18 ADHD management profiles showing seven treatment attributes, where the best and worst attribute levels were selected from each profile. A conditional logit model using effect-coded variables was used to estimate preference weights stratified by time since ADHD diagnosis. RESULTS Participants were primarily the mother (84%) and had a college or postgraduate education (76%) with 75% of the children on stimulant medications. One-on-one caregiver behavior training, medication use seven days a week, therapy in a clinic, and an individualized education program were most preferred for managing ADHD. Aside from caregiver training and monthly out-of-pocket costs, caregivers of children diagnosed with ADHD for less than two years prioritized medication use lower than other care management attributes and caregivers of children diagnosed with ADHD for two or more years preferred school accommodations, medication, and provider specialty. CONCLUSIONS Preferences for ADHD treatment differ based on the duration of the child's ADHD. Acknowledging that preferences change over the course of care could facilitate patient/family-centered care planning across a range of resources and a multidisciplinary team of professionals.
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Affiliation(s)
- Susan dosReis
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, Maryland
| | - Alex Park
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, Maryland
| | - Xinyi Ng
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, Maryland
| | - Emily Frosch
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Gloria Reeves
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland
| | - Charles Cunningham
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario Canada
| | - Ellen M. Janssen
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - John F.P. Bridges
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
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Kim HW, Kim E, Kim JH, Park J, Bahn GH, Lee YJ, Jhung K, Shin D. The Revised Korean Practice Parameter for the Treatment of Attention-Deficit Hyperactivity Disorder (III) - Pharmacological Treatment -. Soa Chongsonyon Chongsin Uihak 2017. [DOI: 10.5765/jkacap.2017.28.2.70] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Hyo-Won Kim
- Department of Psychiatry, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Eunjoo Kim
- Department of Psychiatry, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Korea
| | - Ji-Hoon Kim
- Department of Psychiatry, Pusan National University School of Medicine, Busan, Korea
| | - Jangho Park
- Department of Psychiatry, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea
| | - Geon Ho Bahn
- Department of Psychiatry, Kyung Hee University School of Medicine, Seoul, Korea
| | - Yeon Jung Lee
- Department of Psychiatry, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Kyungun Jhung
- Department of Psychiatry, International St. Mary’s Hospital, Catholic Kwandong University, Incheon, Korea
| | - Dongwon Shin
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Korea
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Altszuler AR, Morrow AS, Merrill BM, Bressler S, Macphee FL, Gnagy EM, Greiner AR, Coxe S, Raiker JS, Coles E, Pelham WE. The Effects of Stimulant Medication and Training on Sports Competence Among Children With ADHD. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2017; 48:S155-S167. [PMID: 28103159 PMCID: PMC6141352 DOI: 10.1080/15374416.2016.1270829] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The current study examined the relative efficacy of behavioral sports training, medication, and their combination in improving sports competence among youth with attention deficit/hyperactivity disorder (ADHD). Participants were 73 youth (74% male; 81% Hispanic) between the ages of 5 and 12 diagnosed with Diagnostic and Statistical Manual of Mental Disorders (4th ed.) ADHD enrolled in a Summer Treatment Program (STP). The study consisted of a 2 (medication: methylphenidate, placebo) × 2 (sports training: instruction and practice, recreational play) between-groups design and was conducted over a 3-week period during the STP. Sports training was conducted with a novel sport, badminton, to limit previous sport knowledge and to differentiate it from concurrent sports training that occurred within the STP. Objective and subjective measures of sports skills, knowledge, and behavior were collected. Results indicated that, relative to recreational play, brief sports training improved observed and counselor-rated measures of sports competence including sports skills, knowledge, game awareness, effort, frustration, and enjoyment. During sports training, medication incrementally improved children's observed rule following behavior and counselor-rated sportsmanship relative to placebo. In the absence of sports training, medication improved behavior, effort, and sport knowledge. Training in sports skills and rules produced the largest magnitude effects on sports-related outcomes. Therefore, skills training, rather than medication alone, should be used in conjunction with behavioral intervention to teach sports to youth with ADHD. It is recommended that medication be used only as an adjunct to highly structured sports skills training for youth who display high rates of negative behavior during sports activities.
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Affiliation(s)
- Amy R Altszuler
- a Center for Children and Families and Department of Psychology , Florida International University
| | - Anne S Morrow
- a Center for Children and Families and Department of Psychology , Florida International University
| | - Brittany M Merrill
- a Center for Children and Families and Department of Psychology , Florida International University
| | - Shannon Bressler
- b Department of Child and Adolescent Psychiatry and Behavioral Sciences , Children's Hospital of Philadelphia
| | - Fiona L Macphee
- a Center for Children and Families and Department of Psychology , Florida International University
| | - Elizabeth M Gnagy
- c Center for Children and Families , Florida International University
| | - Andrew R Greiner
- c Center for Children and Families , Florida International University
| | - Stefany Coxe
- a Center for Children and Families and Department of Psychology , Florida International University
| | - Joseph S Raiker
- a Center for Children and Families and Department of Psychology , Florida International University
| | - Erika Coles
- a Center for Children and Families and Department of Psychology , Florida International University
| | - William E Pelham
- a Center for Children and Families and Department of Psychology , Florida International University
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Pelham WE, Smith BH, Evans SW, Bukstein O, Gnagy EM, Greiner AR, Sibley MH. The Effectiveness of Short- and Long-Acting Stimulant Medications for Adolescents With ADHD in a Naturalistic Secondary School Setting. J Atten Disord 2017; 21:40-45. [PMID: 23460704 DOI: 10.1177/1087054712474688] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Stimulant medication is an efficacious and first-line approach to treating ADHD in adolescence. However, less is known about the effectiveness of this approach as a treatment in real-world settings. The complicated nature of the secondary school environment and documented adolescent nonadherence with stimulant medication may undermine the exportability of this approach. METHOD This study investigates stimulant medication effectiveness and adherence in a sample of adolescents with ADHD who were observed in their natural secondary school environment. RESULTS Results indicated that the effect of stimulant medication on adolescent functioning is smaller in naturalistic settings than in previous analogue studies. Long-acting pemoline produced greater adherence than the short-acting methylphenidate (MPH), but parents and adolescents preferred the short-acting MPH. CONCLUSIONS Overall, adolescents reported very low satisfaction with stimulant medication. Findings are discussed.
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Affiliation(s)
| | | | | | - Oscar Bukstein
- 4 University of Texas Health Sciences Center-Houston, TX, USA
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Maia CRM, Cortese S, Caye A, Deakin TK, Polanczyk GV, Polanczyk CA, Rohde LAP. Long-Term Efficacy of Methylphenidate Immediate-Release for the Treatment of Childhood ADHD. J Atten Disord 2017; 21:3-13. [PMID: 25501355 DOI: 10.1177/1087054714559643] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate the long-term effects of methylphenidate imediate-release (MPH-IR), and to confirm the efficacy established in previous meta-analyses of short-term studies. METHOD Published and unpublished studies in which participants were treated with MPH-IR for 12 weeks or more were searched. Pooled effect sizes from these studies were computed with the DerSimonian and Laird random-effect model. Meta-regression analysis was conducted to estimate covariates associated with treatment effects. RESULTS Seven studies were included. Pooled parents ratings for inattention and hyperactivity/impulsivity resulted in standardized mean difference (SMD) = 0.96 (95% confidence interval [CI] = [0.60, 1.32]) and SMD = 1.12 (95% CI = [0.85, 1.39]), respectively; pooled teachers ratings showed SMD = 0.98 (95% CI = [0.09, 1.86]) for inattention and SMD = 1.25 (95% CI = [0.7, 1.81]) for hyperactivity/impulsivity. No evidence of association of any covariates with treatment effect was detected in the meta-regression. CONCLUSION MPH-IR is efficacious for childhood ADHD for periods longer than 12 weeks.
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Affiliation(s)
| | - Samuele Cortese
- 2 Cambridge University Hospitals NHS Foundation Trust, Nottingham, UK
| | - Arthur Caye
- 1 Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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López FA, Childress A, Adeyi B, Dirks B, Babcock T, Scheckner B, Lasser RA, Shepski J, Arnold V. ADHD Symptom Rebound and Emotional Lability With Lisdexamfetamine Dimesylate in Children Aged 6 to 12 Years. J Atten Disord 2017; 21:52-61. [PMID: 23407278 DOI: 10.1177/1087054712474685] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To describe symptom rebound in children with ADHD treated with lisdexamfetamine dimesylate (LDX) or placebo. METHOD During a 4-week, randomized, double-blind, placebo-controlled trial of LDX, parents/caregivers completed the Conners' Parent Rating Scale-Revised: Short Form symptom rating scale throughout the day. Response, rebound, and emotional lability (EL) were assessed post hoc based on predefined criteria. RESULTS Most participants given LDX ( n = 207) were responders throughout the day (50.7%-55.6%) versus placebo ( n = 72; 11.1%-22.2%). A total of seven (3.4%) LDX participants showed rebound in the afternoon and/or evening versus seven (9.7%) with placebo. In both groups, most incidences of rebound occurred in the evening. EL (mean) was higher in LDX rebounders and nonresponders (range = 4.2-9.0) versus LDX responders (range = 1.3-1.6) and versus placebo rebounders (range = 0.7-1.9). CONCLUSION ADHD symptom rebound occurred in few participants (3.3%) given LDX (accompanied by clinically significant EL). Overall, more participants given LDX versus placebo responded throughout the day.
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Affiliation(s)
- Frank A López
- 1 Children's Developmental Center, Winter Park, FL, USA
| | - Ann Childress
- 2 Center for Psychiatry and Behavioral Medicine, Las Vegas, NV, USA
| | - Ben Adeyi
- 3 Shire Development LLC, Wayne, PA, USA
| | | | | | | | - Robert A Lasser
- 4 Pharmanet/i3, an inVentiv Health clinical, Princeton, NJ, USA
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Landgren M, Nasic S, Johnson M, Lövoll T, Holmgren D, Fernell E. Blood pressure and anthropometry in children treated with stimulants: a longitudinal cohort study with an individual approach. Neuropsychiatr Dis Treat 2017; 13:499-506. [PMID: 28243103 PMCID: PMC5317316 DOI: 10.2147/ndt.s123526] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Knowledge about the long-term effects on blood pressure (BP) and body mass index (BMI) when treating young patients for attention-deficit/hyperactivity disorder (AD/HD) with stimulants is limited. Most of the studies have reported mean and not individual values for anthropometrics and BP in treatment with stimulants. This seems to be the first study of changes based on the analyses of individual data measured over time. PATIENTS AND METHODS Seventy young patients (aged 8-18 years) diagnosed with AD/HD and responding well to treatment with stimulants were followed for a mean period of 3 years and 3 months. BP, heart rate, height, weight, and BMI were transformed to standard deviations or z-scores from before treatment to the last registered visit. RESULTS The mean dose of methylphenidate was 0.95 mg/kg. The mean increase of systolic and diastolic BP was 0.4 z-score and 0.1 z-score, respectively. The systolic BP was associated with BMI; a higher BMI at baseline increased the risk for an increase in systolic BP. Ten percent of the total group had a weight at follow-up of <-1.5 standard deviation (SD) and 12% had a height of <-1.5 SD. Mean height at follow-up was -0.2 SD, but 40% had a reduced height of at least 0.5 SD during the treatment period. BMI on a group level was reduced from +0.8 SD to +0.3 SD. Of the 19 patients with a BMI >+1.5 SD at baseline, 50% had a significantly reduced BMI. CONCLUSION Consequences of stimulant treatment must be evaluated individually. Besides significant effects on core AD/HD symptoms, some patients have lower BMI and BP and some increase/maintain their BMI and/or increase their systolic BP. The risk of reduced height trajectory needs further research.
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Affiliation(s)
- Magnus Landgren
- Department of Pediatrics, Unit of Developmental Disorders, Skaraborg's Hospital, Mariestad; Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg
| | | | - Mats Johnson
- Department of Pediatrics, Unit of Developmental Disorders, Skaraborg's Hospital, Mariestad; Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg
| | - Trygve Lövoll
- Department of Pediatrics, Unit of Developmental Disorders, Skaraborg's Hospital, Mariestad
| | - Daniel Holmgren
- Department of Pediatrics, Skaraborg's Hospital, Skövde; University of Gothenburg, Gothenburg, Sweden
| | - Elisabeth Fernell
- Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg
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Wang SM, Han C, Lee SJ, Jun TY, Patkar AA, Masand PS, Pae CU. Modafinil for the treatment of attention-deficit/hyperactivity disorder: A meta-analysis. J Psychiatr Res 2017; 84:292-300. [PMID: 27810669 DOI: 10.1016/j.jpsychires.2016.09.034] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 09/17/2016] [Accepted: 09/20/2016] [Indexed: 11/26/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is one of the most common and a debilitating neuro-behavior disorder in the pediatric population. Although numerous effective psychostimulants are available, more than 30% of patients still do not show adequate treatment response rendering diverse pharmacological options. We aimed at assessing the efficacy and safety of modafinil in the treatment of children and adolescents with ADHD by conducting a meta-analysis. An extensive search of databases and clinical trial registries resulted in five published short-term randomized, double-blind, placebo-controlled trials. Primary efficacy measures were mean change in ADHD Rating Scale-IV Home (ADHD-RS-IV Home) and School Version (ADHD-RS-IV School) from baseline to study end point. The results showed that modafinil more significantly improved ADHD-RS-IV Home (SMD, -0.77 [95%CI, -1.11 to -0.44]) and School (SMD, -0.71 [95%CI, -0.96 to -0.47]) than placebo. Dropout rate due to adverse event did not significantly differ between two groups. In terms of commonly observed side effects, modafinil showed significantly higher incidence of decreased appetite (RR = 5.02, 95% CIs, 2.55 to 9.89, P < 0.00001) and insomnia (RR = 6.16, 95% CIs, 3.40 to 11.17, P < 0.00001). Modafinil did not cause a clinically significant increase of heart rate, systolic blood pressure, and diastolic blood pressure. Although we found that modafinil may be another treatment option in children and adolescents with ADHD, the results should be interpreted and translated into clinical practice with caution, as the meta-analysis was based on a limited number of clinical trials.
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Affiliation(s)
- Sheng-Min Wang
- Department of Psychiatry, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea
| | - Changsu Han
- Department of Psychiatry, Korea University, College of Medicine, Seoul, Republic of Korea
| | - Soo-Jung Lee
- Department of Psychiatry, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea
| | - Tae-Youn Jun
- Department of Psychiatry, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea
| | - Ashwin A Patkar
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | | | - Chi-Un Pae
- Department of Psychiatry, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.
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Lee S, Choi JW, Kim KM, Kim JW, Kim S, Kang T, Kim JI, Lee YS, Kim B, Han DH, Cheong JH, Lee SI, Hyun GJ, Kim BN. The Guideline of Diagnosis and Treatment of Attention-Deficit Hyperactivity Disorder: Developed by ADHD Translational Research Center. Soa Chongsonyon Chongsin Uihak 2016. [DOI: 10.5765/jkacap.2016.27.4.236] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Sumin Lee
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
| | - Jae-Won Choi
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
| | - Kyoung-Min Kim
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
| | - Jun Won Kim
- Department of Psychiatry, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Sooyeon Kim
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
| | | | - Johanna Inhyang Kim
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
| | - Young Sik Lee
- Department of Psychiatry, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Bongseog Kim
- Department of Psychiatry, Sanggye Paik Hospital, School of Medicine, Inje University, Seoul, Korea
| | - Doug Hyun Han
- Department of Psychiatry, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Jae Hoon Cheong
- Uimyung Research Institute for Neuroscience, Sahmyook University, Seoul, Korea
| | - Soyoung Irene Lee
- Department of Psychiatry, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Korea
| | - Gi Jung Hyun
- Department of Psychiatry, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Bung-Nyun Kim
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
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79
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DuPont RL, Bucher RH, Wilford BB, Coleman JJ. School-Based Administration of ADHD Drugs Decline, Along With Diversion, Theft, and Misuse. J Sch Nurs 2016; 23:349-52. [DOI: 10.1177/10598405070230060801] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Since 2000 researchers have reported a decline in the administration of attention-deficit/hyperactivity disorder (ADHD) medications given by school nurses, although no decline has been noted in the incidence of ADHD in school-age populations. Government data for the same period show reduced levels of methylphenidate abuse as measured by its involvement in hospital emergency department (ED) admissions. Offsetting this, however, is an increase in the involvement of amphetamine-dextroamphetamine in hospital ED admissions for the same period. Because ADHD medications are often administered in the school setting, a survey of school nurses was undertaken to identify factors related to the administration as well as to the diversion, theft, and misuse of ADHD medications. Of 311 school nurses responding, 295 (95%) reported a significant or moderate decline between 2002 and 2004 in the need for school-based administration of ADHD medications. Respondents also reported reductions in diversion, theft, and misuse of ADHD drugs.
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Affiliation(s)
- Robert L. DuPont
- Robert L. DuPont, MD, is President of the Institute for Behavior and Health, Inc., Rockville, MD
| | - Richard H. Bucher
- Richard H. Bucher, PhD, serves on the Board of Directors of the Institute for Behavior and Health, Inc., Rockville, MD
| | - Bonnie B. Wilford
- Bonnie B. Wilford, MS, is Director of the Center for Health Services & Outcomes Research, JBS International, Inc., Silver Spring, MD
| | - John J. Coleman
- John J. Coleman, PhD, is President of the Prescription Drug Research Center LLC, George Mason University Enterprise Center, Fair-fax, VA
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80
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Dougherty DM, Olvera RL, Acheson A, Hill-Kapturczak N, Ryan SR, Mathias CW. Acute effects of methylphenidate on impulsivity and attentional behavior among adolescents comorbid for ADHD and conduct disorder. J Adolesc 2016; 53:222-230. [PMID: 27816696 DOI: 10.1016/j.adolescence.2016.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 10/26/2016] [Accepted: 10/27/2016] [Indexed: 01/24/2023]
Abstract
Adolescents with Attention Deficit Hyperactivity Disorder (ADHD) and Conduct Disorder (CD) experience deficits in neuropsychological measures of attention, inhibition, and reward processes. Methylphenidate treatment for ADHD and CD has acute effects on these processes. Some of these same aspects of performance are separately described in the Behavioral Model of Impulsivity, which uses a modified approach to measurement. This study characterized the acute effects of methylphenidate attention, initiation, inhibition, and reward processes described in this model of impulsivity. Thirty-one adolescents from the United States of America with comorbid ADHD and CD completed measures of impulsivity (response initiation, response inhibition, and consequence) and attention following placebo, 20 mg, and 40 mg of a long-acting dose of methylphenidate. Methylphenidate effects on attentional performance was more robust than on any of the measures of impulsivity. Adolescent performance from this behavioral perspective is interpreted in the context of divergence from previous neuropsychological tests of acute methylphenidate effects.
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Affiliation(s)
- Donald M Dougherty
- Department of Psychiatry, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Rene L Olvera
- Department of Psychiatry, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Ashley Acheson
- Psychiatry and Behavioral Sciences, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Nathalie Hill-Kapturczak
- Department of Psychiatry, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Stacy R Ryan
- Department of Psychiatry, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Charles W Mathias
- Department of Psychiatry, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
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81
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Mullin BC, Pyle L, Haraden D, Riederer J, Brim N, Kaplan D, Novins D. A Preliminary Multimethod Comparison of Sleep Among Adolescents With and Without Generalized Anxiety Disorder. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2016; 46:198-210. [PMID: 27736237 DOI: 10.1080/15374416.2016.1220312] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Previous studies suggest that youth with anxiety disorders experience their sleep as more disrupted and unsatisfying than their healthy peers. However, it is unclear whether these subjective complaints align with objective measures of sleep quantity and quality. The purpose of this preliminary study was to assess subjective and objective sleep parameters, and their relationships with anxiety symptomatology, among adolescents (62.8% female, 81.4% Caucasian), ages 12 to 18 (M = 15.29 years), with generalized anxiety disorder (n = 26) and controls without any psychopathology (n = 17). We measured sleep over 7 nights using sleep diaries and actigraphy and collected self- and parent-report questionnaires pertaining to sleep, anxiety, and depression. Repeated-measures mixed models were used to examine relationships between nightly sleep duration and morning anxiety. We found a number of differences in sleep between our anxious and healthy participants. Via sleep diary, our anxious participants had longer sleep onset latencies and lower satisfaction with sleep relative to controls, whereas via actigraphy we found longer sleep onset latencies but greater overall sleep duration among anxious versus control participants. Actigraphic measures of sleep disturbance were associated with parent-report of anxiety and depression. Our mixed-model analyses revealed that decreases in nightly sleep duration were associated with increased morning anxiety, but only among our participants with generalized anxiety disorder. Findings suggest that sleep disturbance among anxious adolescents can be detected using both subjective and objective measures and that, for these individuals, fluctuations in sleep duration may have real consequences for daytime anxiety.
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Affiliation(s)
| | - Laura Pyle
- a School of Medicine, University of Colorado
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82
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Abstract
Although side effects and family concerns are common and long-term medication adherence is low, stimulant medications are a front-line treatment for attention-deficit/hyperactivity disorder (ADHD). Psychosocial treatments include classroom, family, and child-focused interventions that teach caregivers and teachers how to implement contingencies to shape behavior and provide children with skills to compensate for ADHD deficits. Such programs have a growing evidence-base and can be implemented alone or in conjunction with pharmacological treatments. The most efficacious psychosocial treatments for children with ADHD include Behavioral Parent Training, Behavioral Classroom Management, and Behavioral Peer Interventions, which all focus on contingency management by adults. Training interventions are increasingly used to teach organizational and interpersonal skills to children and adolescents. These treatments are found to improve functional outcomes associated with ADHD, including on-task behavior, compliance, academic performance, social relationships, and family functioning. Clinicians play an important role in educating families about psychosocial treatments for ADHD, increasing family motivation and engagement, and including these interventions in multimodal treatment plans for youth with ADHD across development. [Pediatr Ann. 2016;45(10):e367-e372.].
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83
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Weyandt LL, Oster DR, Marraccini ME, Gudmundsdottir BG, Munro BA, Rathkey ES, McCallum A. Prescription stimulant medication misuse: Where are we and where do we go from here? Exp Clin Psychopharmacol 2016; 24:400-414. [PMID: 27690507 PMCID: PMC5113141 DOI: 10.1037/pha0000093] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Prescription stimulants, including methylphenidate (e.g., Ritalin) and amphetamine compounds (e.g., dextroamphetamine; Adderall), have been approved by the U.S. Food and Drug Administration for the treatment of attention-deficit/hyperactivity disorder (ADHD) and are classified by the United States Drug Enforcement Administration as Schedule II medications because of their high potential for abuse and dependence (Drug Enforcement Administration, U.S. Department of Justice, 2015). Despite the potential health and judicial consequences, misuse of prescription stimulants, typically defined as taking stimulants without a valid prescription, or use of stimulants other than as prescribed, has become a serious problem in the United States and abroad, especially on college campuses. The purpose of the present article is to review historical information concerning prescription stimulants and to summarize the literature with respect to misuse among adults, particularly college students, including risk factors, mediators and moderators, and motivations for prescription stimulant misuse. In addition, evidence is presented concerning the question of whether prescription stimulants truly enhance cognitive functioning in individuals with and without ADHD, and the ethical and professional implications of these findings are explored. Lastly, recommendations for addressing prescription stimulant misuse and suggestions for future research are advanced. (PsycINFO Database Record
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84
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Evans C, Blackburn D, Butt P, Dattani D. Use and Abuse of Methylphenidate in Attention-Deficit/Hyperactivity Disorder. Can Pharm J (Ott) 2016. [DOI: 10.1177/171516350413700606] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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85
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Bhang SY, Hwang JW, Kwak YS, Joung YS, Lee S, Kim B, Sohn SH, Chung US, Yang J, Hong M, Bahn GH, Choi HY, Oh IH, Lee YJ. Differences in Utilization Patterns among Medications in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder: a 36-Month Retrospective Study Using the Korean Health Insurance Review and Assessment Claims Database. J Korean Med Sci 2016; 31:1284-91. [PMID: 27478341 PMCID: PMC4951560 DOI: 10.3346/jkms.2016.31.8.1284] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 04/30/2016] [Indexed: 11/26/2022] Open
Abstract
We evaluated the differences in utilization patterns including persistence and adherence among medications in children and adolescents with attention deficit hyperactivity disorder (ADHD). The current study was performed using data from the Korean Health Insurance Review and Assessment claims database from January 1, 2009 to December 31, 2013. Our study sample consisted of 10,343 children and adolescents with ADHD who were not given their newly prescribed medication in 360 days before the initial claim in 2010. Data were followed up from the initiation of treatment with ADHD medications in 2010 to December 31, 2013. Discontinuation rates for 4 ADHD medications in our sample ranged from 97.7% for immediate-release methylphenidate to 99.4% for atomoxetine using refill gap more than 30 days and from 56.7% for immediate-release methylphenidate to 62.3% for extended-release methylphenidate using refill gap more than 60 days. In the number of discontinued, we found significant differences among medications using refill gap more than 30 days. Among 4 ADHD medications, extended-release methylphenidate and atomoxetine had more days than immediate-release methylphenidate and osmotic-controlled oral delivery system methylphenidate. In logistic regression analyses, extended-release methylphenidate, osmotic-controlled oral delivery system methylphenidate, and atomoxetine showed less discontinuation compared to immediate-release methylphenidate group when a refill gap more than 30 days was used. In logistic regression analysis of adherence, we could not find any differences among 4 medication types. We suggest that the utilization patterns should be assessed regularly in order to improve future outcomes in children and adolescents with ADHD.
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Affiliation(s)
- Soo-Young Bhang
- Department of Psychiatry, Eulji University School of Medicine, Eulji General Hospital, Seoul, Korea
| | - Jun-Won Hwang
- Department of Psychiatry, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Young-Sook Kwak
- Department of Psychiatry, Jeju National University College of Medicine, Jeju, Korea
| | - Yoo Sook Joung
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soyoung Lee
- Department of Psychiatry, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Korea
| | - Bongseog Kim
- Department of Psychiatry, Inje University School of Medicine, Sanggyepaik Hospital, Seoul, Korea
| | | | - Un Sun Chung
- Department of Psychiatry, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jaewon Yang
- Department of Psychiatry, KAIST Clinic, Daejeon, Korea
| | - Minha Hong
- Department of Psychiatry, Myungji General Hospital, Goyang, Korea
| | - Geon Ho Bahn
- Department of Psychiatry, Kyung Hee University School of Medicine, Seoul, Korea
| | - Hyung Yun Choi
- Korean Centers for Disease Control and Prevention, Cheongju, Korea
| | - In-Hwan Oh
- Department of Preventive Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Yeon Jung Lee
- Department of Psychiatry, Soonchunhyang University College of Medicine, Seoul Hospital, Seoul, Korea
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86
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Battel L, Kieling RR, Kieling C, Anés M, Aurich NK, da Costa JC, Rohde LA, Franco AR. Intrinsic Brain Connectivity Following Long-Term Treatment with Methylphenidate in Children with Attention-Deficit/Hyperactivity Disorder. J Child Adolesc Psychopharmacol 2016; 26:555-61. [PMID: 27027427 DOI: 10.1089/cap.2015.0221] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Although widely used for the treatment of attention-deficit/hyperactivity disorder (ADHD) across the life span, the effects of methylphenidate (MPH) on the brain are not completely understood. Functional neuroimaging techniques may help increase knowledge about the mechanisms of MPH action. OBJECTIVE To evaluate changes in functional connectivity patterns of the default mode network (DMN) in children with ADHD following long-term treatment with MPH. METHODS Twenty-three right-handed treatment-naïve boys with ADHD underwent a protocol of intrinsic functional connectivity before and after 6 months of treatment with MPH. Functional connectivity was analyzed using a region of interest (ROI) approach and independent component analysis (ICA). RESULTS ROI analyses showed no significant changes in connectivity between regions of the DMN following treatment, with a relatively small increase in the anterior-posterior connectivity of the network. ICA revealed a significant increase in connectivity between the left putamen and the DMN (p < 0.001, corrected). There was a correlation between the reduction of symptoms and the increased connectivity between the putamen and the DMN after treatment (rho = -0.65, p = 0.017). CONCLUSION Dysfunctions in cortical-subcortical circuits have often been associated with the pathophysiology of ADHD. Our findings suggest that effective treatment with MPH in children with ADHD may affect brain functioning by increasing connectivity between the DMN and subcortical nuclei.
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Affiliation(s)
- Lucas Battel
- 1 Department of Psychiatry, Hospital de Clínicas de Porto Alegre , Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Renata R Kieling
- 1 Department of Psychiatry, Hospital de Clínicas de Porto Alegre , Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Christian Kieling
- 1 Department of Psychiatry, Hospital de Clínicas de Porto Alegre , Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Maurício Anés
- 1 Department of Psychiatry, Hospital de Clínicas de Porto Alegre , Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil .,2 Brain Institute (InsCer) , PUCRS, Porto Alegre, Brazil
| | - Nathassia Kadletz Aurich
- 3 National Institute of Developmental Psychiatry for Children and Adolescents , Porto Alegre, Brazil
| | | | - Luis Augusto Rohde
- 1 Department of Psychiatry, Hospital de Clínicas de Porto Alegre , Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil .,3 National Institute of Developmental Psychiatry for Children and Adolescents , Porto Alegre, Brazil
| | - Alexandre Rosa Franco
- 2 Brain Institute (InsCer) , PUCRS, Porto Alegre, Brazil .,4 School of Engineering , PUCRS, Porto Alegre, Brazil
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87
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Serrallach B, Groß C, Bernhofs V, Engelmann D, Benner J, Gündert N, Blatow M, Wengenroth M, Seitz A, Brunner M, Seither S, Parncutt R, Schneider P, Seither-Preisler A. Neural Biomarkers for Dyslexia, ADHD, and ADD in the Auditory Cortex of Children. Front Neurosci 2016; 10:324. [PMID: 27471442 PMCID: PMC4945653 DOI: 10.3389/fnins.2016.00324] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 06/27/2016] [Indexed: 11/13/2022] Open
Abstract
Dyslexia, attention deficit hyperactivity disorder (ADHD), and attention deficit disorder (ADD) show distinct clinical profiles that may include auditory and language-related impairments. Currently, an objective brain-based diagnosis of these developmental disorders is still unavailable. We investigated the neuro-auditory systems of dyslexic, ADHD, ADD, and age-matched control children (N = 147) using neuroimaging, magnetencephalography and psychoacoustics. All disorder subgroups exhibited an oversized left planum temporale and an abnormal interhemispheric asynchrony (10–40 ms) of the primary auditory evoked P1-response. Considering right auditory cortex morphology, bilateral P1 source waveform shapes, and auditory performance, the three disorder subgroups could be reliably differentiated with outstanding accuracies of 89–98%. We therefore for the first time provide differential biomarkers for a brain-based diagnosis of dyslexia, ADHD, and ADD. The method allowed not only allowed for clear discrimination between two subtypes of attentional disorders (ADHD and ADD), a topic controversially discussed for decades in the scientific community, but also revealed the potential for objectively identifying comorbid cases. Noteworthy, in children playing a musical instrument, after three and a half years of training the observed interhemispheric asynchronies were reduced by about 2/3, thus suggesting a strong beneficial influence of music experience on brain development. These findings might have far-reaching implications for both research and practice and enable a profound understanding of the brain-related etiology, diagnosis, and musically based therapy of common auditory-related developmental disorders and learning disabilities.
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Affiliation(s)
- Bettina Serrallach
- Department of Neurology, Section of Biomagnetism, University Hospital HeidelbergHeidelberg, Germany; Division of Neuroradiology, University Hospital HeidelbergHeidelberg, Germany; Division of Radiology and Nuclear Medicine, Kantonsspital St. GallenSt. Gallen, Switzerland
| | - Christine Groß
- Department of Neurology, Section of Biomagnetism, University Hospital Heidelberg Heidelberg, Germany
| | | | - Dorte Engelmann
- Department of Neurology, Section of Biomagnetism, University Hospital Heidelberg Heidelberg, Germany
| | - Jan Benner
- Department of Neurology, Section of Biomagnetism, University Hospital HeidelbergHeidelberg, Germany; Division of Neuroradiology, Department of Radiology, University of Basel HospitalBasel, Switzerland
| | - Nadine Gündert
- Department of Neurology, Section of Biomagnetism, University Hospital Heidelberg Heidelberg, Germany
| | - Maria Blatow
- Division of Neuroradiology, Department of Radiology, University of Basel Hospital Basel, Switzerland
| | - Martina Wengenroth
- Department of Neuroradiology, University Hospital Lübeck Lübeck, Germany
| | - Angelika Seitz
- Department of Pediatric Neurology, University Hospital Heidelberg Heidelberg, Germany
| | - Monika Brunner
- Phoniatrics and Pedaudiology, University Hospital Heidelberg Heidelberg, Germany
| | - Stefan Seither
- Institute of Psychology, University of GrazGraz, Austria; BioTechMed GrazGraz, Austria
| | - Richard Parncutt
- Centre for Systematic Musicology, University of Graz Graz, Austria
| | - Peter Schneider
- Department of Neurology, Section of Biomagnetism, University Hospital HeidelbergHeidelberg, Germany; Division of Neuroradiology, University Hospital HeidelbergHeidelberg, Germany
| | - Annemarie Seither-Preisler
- Department of Neurology, Section of Biomagnetism, University Hospital HeidelbergHeidelberg, Germany; Division of Neuroradiology, University Hospital HeidelbergHeidelberg, Germany; Institute of Psychology, University of GrazGraz, Austria; BioTechMed GrazGraz, Austria; Centre for Systematic Musicology, University of GrazGraz, Austria
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88
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Eklund H, Cadman T, Findon J, Hayward H, Howley D, Beecham J, Xenitidis K, Murphy D, Asherson P, Glaser K. Clinical service use as people with Attention Deficit Hyperactivity Disorder transition into adolescence and adulthood: a prospective longitudinal study. BMC Health Serv Res 2016; 16:248. [PMID: 27400778 PMCID: PMC4940923 DOI: 10.1186/s12913-016-1509-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 07/05/2016] [Indexed: 12/27/2022] Open
Abstract
Background While Attention Deficit Hyperactivity Disorder (ADHD) often persists into adulthood, little is known about the needs and service use among adolescents and young adults with ADHD. The present study followed-up a cohort diagnosed with ADHD as children and assessed their: 1) needs, 2) correlates of contact with clinical services, and 3) experiences of transition from child to adult health services. Methods Ninety one young people aged 14–24 were recruited from the UK subset of the International Multi-Centre ADHD Genetics (IMAGE) Project. Affected young people and parents conducted face-to-face interviews and self-completion questionnaires including a modified version of the Client Services Receipt Inventory, The Barkley’s ADHD rating scale, The Clinical Interview Schedule-Revised, and the Zarit Burden Interview. Changes in key need characteristics (e.g. ADHD symptoms and impairments) over a 3-year period were examined using fixed effect models. Generalised Estimating Equations (GEE) were used to explore how key characteristics (such as ADHD symptoms) were associated with contact with clinical services across the three years. Results At baseline 62 % met diagnostic criteria for ADHD and presented with a range of ADHD related impairments, psychiatric comorbidities, and significant caregiver burden. While ADHD symptoms and related impairments lessened significantly over the three years, psychiatric comorbidities and caregiver burden remained stable. The strongest correlate of contact with clinical services was age (OR 0.65 95 % CI 0.49–0.84) with the odds of reported contact with clinical services decreasing by 35 % for each year increase in age at baseline and by 25 % for each year increase in age over time. Only 9 % of the sample had experienced a transfer to adult services, with the majority reporting unmet needs in healthcare transition. Conclusions Despite continuing needs, few were in contact with adult health services or had received sufficient help with transition between child and adult health services. The main determinant of health service use for adolescents and young adults with ADHD is age – not needs. Service models should address the needs of ADHD individuals who are no longer children. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1509-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hanna Eklund
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.
| | - Tim Cadman
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - James Findon
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Hannah Hayward
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Deirdre Howley
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Jennifer Beecham
- Personal Social Services Research Unit, Cowdray House, London School of Economics and Political Sciences, Houghton Street, London, WC2A 2AE, UK
| | - Kiriakos Xenitidis
- Behavioural Genetics Unit, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK
| | - Declan Murphy
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Philip Asherson
- MRC Social Genetic and Developmental Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Karen Glaser
- Institute of Gerontology, Department of Social Sciences, Health and Medicine, King's College London, Strand, London, WC2R 2LS, UK
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89
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Wilens T, Zulauf C, Martelon M, Morrison NR, Yule A, Anselmo R, Yule A, Anselmo R. Nonmedical Stimulant Use in College Students: Association With Attention-Deficit/Hyperactivity Disorder and Other Disorders. J Clin Psychiatry 2016; 77:940-7. [PMID: 27464314 PMCID: PMC6438382 DOI: 10.4088/jcp.14m09559] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 10/12/2015] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The nonmedical use of stimulants (misuse) in the college setting remains of utmost public health and clinical concern. The objective of this study was to evaluate comprehensively the characteristics of college students who misused stimulants, attending to rates of attention-deficit/hyperactivity disorder (ADHD), other psychopathology, and substance use disorders. METHODS The data presented are from a cross-sectional study of college students who misused prescription stimulant medications (not including cocaine or methamphetamine) and controls (college students without stimulant misuse). Between May 2010 and May 2013, college students were assessed blindly for psychopathology and substance use disorder by way of Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Patient Edition (SCID-I/P) and completion of self-report questionnaires. RESULTS The analysis included 198 controls (mean ± SD age = 20.7 ± 2.6 years) and 100 stimulant misusers (20.7 ± 1.7 years). Misusers, when compared to controls, were more likely to endorse alcohol, drug, alcohol + drug, and any substance use disorder (all P values < .01). When a subset of stimulant misusers (n = 58) was examined, 67% had a full or subthreshold prescription stimulant use disorder. Misusers also had higher rates of conduct disorder (10% vs 3%; P = .02) and ADHD (including subthreshold cases; 27% vs 16%; P = .02) in addition to lower Global Assessment of Functioning score (P < .01). Higher rates of misuse of immediate-release—relative to extended-release—stimulants were reported. CONCLUSIONS Our data suggest that, compared to controls, college students who misuse stimulant medications are more likely to have ADHD, conduct disorder, stimulant and other substance use disorder, and overall dysfunction.
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Affiliation(s)
- Timothy Wilens
- Child Psychiatry Service, Massachusetts General Hospital, 55 Fruit St, YAW 6A, Boston, MA 02114. .,Pediatric Psychopharmacology Program, Division of Child Psychiatry, Massachusetts General Hospital, Boston.,Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston
| | - Courtney Zulauf
- Pediatric Psychopharmacology Program, Division of Child Psychiatry, Massachusetts General Hospital, Boston, MA 02114
| | - MaryKate Martelon
- Pediatric Psychopharmacology Program, Division of Child Psychiatry, Massachusetts General Hospital, Boston, MA 02114
| | - Nicholas R. Morrison
- Pediatric Psychopharmacology Program, Division of Child Psychiatry, Massachusetts General Hospital, Boston, MA 02114
| | - Amy Yule
- Pediatric Psychopharmacology Program, Division of Child Psychiatry, Massachusetts General Hospital, Boston, MA 02114,Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston, MA 02114
| | - Rayce Anselmo
- Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston, MA 02114
| | - Amy Yule
- Pediatric Psychopharmacology Program, Division of Child Psychiatry, Massachusetts General Hospital, Boston.,Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston
| | - Rayce Anselmo
- Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston
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90
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Zhang X, Newport G, Callicott R, Liu S, Thompson J, Berridge M, Apana S, Slikker W, Wang C, Paule M. MicroPET/CT assessment of FDG uptake in brain after long-term methylphenidate treatment in nonhuman primates. Neurotoxicol Teratol 2016; 56:68-74. [DOI: 10.1016/j.ntt.2016.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 06/10/2016] [Accepted: 06/11/2016] [Indexed: 01/14/2023]
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91
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Pelham WE, Fabiano GA, Waxmonsky JG, Greiner AR, Gnagy EM, Pelham WE, Coxe S, Verley J, Bhatia I, Hart K, Karch K, Konijnendijk E, Tresco K, Nahum-Shani I, Murphy SA. Treatment Sequencing for Childhood ADHD: A Multiple-Randomization Study of Adaptive Medication and Behavioral Interventions. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2016; 45:396-415. [PMID: 26882332 PMCID: PMC4930381 DOI: 10.1080/15374416.2015.1105138] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Behavioral and pharmacological treatments for children with attention deficit/hyperactivity disorder (ADHD) were evaluated to address whether endpoint outcomes are better depending on which treatment is initiated first and, in case of insufficient response to initial treatment, whether increasing dose of initial treatment or adding the other treatment modality is superior. Children with ADHD (ages 5-12, N = 146, 76% male) were treated for 1 school year. Children were randomized to initiate treatment with low doses of either (a) behavioral parent training (8 group sessions) and brief teacher consultation to establish a Daily Report Card or (b) extended-release methylphenidate (equivalent to .15 mg/kg/dose bid). After 8 weeks or at later monthly intervals as necessary, insufficient responders were rerandomized to secondary interventions that either increased the dose/intensity of the initial treatment or added the other treatment modality, with adaptive adjustments monthly as needed to these secondary treatments. The group beginning with behavioral treatment displayed significantly lower rates of observed classroom rule violations (the primary outcome) at study endpoint and tended to have fewer out-of-class disciplinary events. Further, adding medication secondary to initial behavior modification resulted in better outcomes on the primary outcomes and parent/teacher ratings of oppositional behavior than adding behavior modification to initial medication. Normalization rates on teacher and parent ratings were generally high. Parents who began treatment with behavioral parent training had substantially better attendance than those assigned to receive training following medication. Beginning treatment with behavioral intervention produced better outcomes overall than beginning treatment with medication.
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Affiliation(s)
- William E Pelham
- a Center for Children and Families, Department of Psychology , Florida International University
| | - Gregory A Fabiano
- b Department of Counseling, School, and Educational Psychology , State University of New York at Buffalo
| | - James G Waxmonsky
- c Department of Psychiatry, Pennsylvania State Hershey Medical Center , Pennsylvania State University
| | - Andrew R Greiner
- f Center for Children and Families , Florida International University
| | - Elizabeth M Gnagy
- f Center for Children and Families , Florida International University
| | - William E Pelham
- d REACH Institute, Department of Psychology , Arizona State University
| | - Stefany Coxe
- a Center for Children and Families, Department of Psychology , Florida International University
| | | | - Ira Bhatia
- g State University of New York at Buffalo
| | - Katie Hart
- a Center for Children and Families, Department of Psychology , Florida International University
| | | | | | - Katy Tresco
- h Department of Psychology , Philadelphia College of Osteopathic Medicine
| | | | - Susan A Murphy
- i Institute for Social Research, Departments of Statistics and Psychiatry , University of Michigan
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92
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dosReis S, Ng X, Frosch E, Reeves G, Cunningham C, Bridges JFP. Using Best-Worst Scaling to Measure Caregiver Preferences for Managing their Child's ADHD: A Pilot Study. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2016; 8:423-31. [PMID: 25392024 DOI: 10.1007/s40271-014-0098-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Management of attention-deficit/hyperactivity disorder (ADHD) is a trade-off between caregivers' concerns about the benefits versus the risks of evidence-based treatment. Few studies have used choice-based methods to assess what treatment attributes matter most to caregivers. OBJECTIVE The aim was to develop and to pilot an instrument to elicit caregivers' preferences for evidence-based management of their child's ADHD. METHODS Mixed methods were used to develop a Best-Worst Scaling (BWS) instrument, and quantitative methods were used to pilot the instrument. Primary caregivers of children with ADHD from two community organizations were recruited for the development (n = 21) and pilot (n = 37) phase. The instrument was a BWS case 2, where 18 management profiles are presented one at a time, with respondents indicating the one best and one worst feature of each profile. Profiles were developed using a main effects orthogonal array. The mean of best-minus-worse scores was estimated, and attribute importance was based on the sum of maximum minus minimum scores for each attribute. Feasibility of eliciting stated preferences was evaluated with t tests and 95 % confidence intervals. RESULTS Seven attributes (medication, therapy, school, caregiver training, provider specialty, provider communication, and out-of-pocket costs) with three levels each were identified. All mean scores were significant except for pediatrician management of the child's ADHD (p = 0.089). Caregiver training had the highest relative importance, followed by medication and provider communication. CONCLUSIONS The BWS instrument was a relatively simple measure, caregivers completed it independently, and it distinguished the relative importance of different attributes in managing a child's ADHD.
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Affiliation(s)
- Susan dosReis
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, 12th Floor, Baltimore, MD, 21201, USA.
| | - Xinyi Ng
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, 12th Floor, Baltimore, MD, 21201, USA
| | - Emily Frosch
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gloria Reeves
- University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - John F P Bridges
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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93
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Abstract
Aim To compare mental health (MH) outcomes of and service use by children born under 1500 g in Ireland with a matched control group. METHOD Using a retrospective cohort design, semi-structured and standardised MH assessments were conducted with parents, teachers and youth. RESULTS A total of 64 of 127 surviving children from a very low birth weight (VLBW) cohort from a National Maternity Hospital participated at a mean age of 11.6 years (s.d. 1.0), along with 51 matched controls. More VLBW children received clinical or borderline scores when rated by parents [χ 2 (1, n=114)=7.3, p=0.007] or youths [χ 2 (1, n=114)=4.83, p=0.028], but not by teachers [χ 2 (1, n=114)=1.243, p=0.463]. There was no increase in the use of MH services. A main effect of birth weight remained on the parent Strengths and Difficulties Questionnaire [F (1, 88)=5.07, p<0.05) after controlling for intelligence quotient (IQ) and socio-economic status (SES), but only on hyperactivity in males. SES, rather than IQ or birth weight, predicted identification of problems by teachers [F (1, 82)=6.99, p=0.01). Interpretations Teachers miss MH difficulties and are influenced more by SES than by IQ or birth weight. This has implications for MH service access. Initial perinatal investment needs to be matched with ongoing surveillance and psychoeducation to ensure that disorders are recognised early and offered appropriate interventions.
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94
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Correction to "The Effectiveness and Tolerability of Central Nervous System Stimulants in School-Age Children with Attention-Deficit/Hyperactivity Disorder and Disruptive Mood Dysregulation Disorder across Home and School". J Child Adolesc Psychopharmacol 2016:cap.2015.0053.cxn. [PMID: 26938370 DOI: 10.1089/cap.2015.0053.cxn] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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95
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Baweja R, Belin PJ, Humphrey HH, Babocsai L, Pariseau ME, Waschbusch DA, Hoffman MT, Akinnusi OO, Haak JL, Pelham WE, Waxmonsky JG. The Effectiveness and Tolerability of Central Nervous System Stimulants in School-Age Children with Attention-Deficit/Hyperactivity Disorder and Disruptive Mood Dysregulation Disorder Across Home and School. J Child Adolesc Psychopharmacol 2016; 26:154-63. [PMID: 26771437 PMCID: PMC4800382 DOI: 10.1089/cap.2015.0053] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This study examines the effectiveness and tolerability of stimulants in children with attention-deficit/hyperactivity disorder (ADHD) and disruptive mood dysregulation disorder (DMDD). METHODS To be eligible, participants had to meet Diagnostic and Statistical Manual of Mental Disorders, 4th ed., Text Revision (DSM-IV) criteria for the combined subtype of ADHD and National Institute of Mental Health (NIMH) severe mood dysregulation criteria. The Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-V) DMDD criteria were retrospectively assessed after the study was completed. An open-label medication trial lasting up to 6 weeks was completed to optimize the central nervous system (CNS) stimulant dose. Measures of affective symptoms, ADHD symptoms and other disruptive behaviors, impairment, and structured side effect ratings were collected before and after the medication trial. RESULTS Optimization of stimulant medication was associated with a significant decline in depressive symptoms on the Childhood Depression Rating Score-Revised Scale (p<0.05, Cohen's d=0.61) and Mood Severity Index score (p<0.05, Cohen's d=0.55), but not in manic-like symptoms on the Young Mania Rating Scale. There was a significant reduction in ADHD (p<0.05, Cohen's d=0.95), oppositional defiant disorder (ODD) (p<0.05, Cohen's d=0.5), and conduct disorder (CD) symptoms (p<0.05, Cohen's d=0.65) as rated by parents. There was also a significant reduction in teacher-rated ADHD (p<0.05, Cohen's d=0.33) but not in ODD symptoms. Medications were well tolerated and there was no increase in side effect ratings seen with dose optimization. Significant improvement in functioning was reported by clinicians and parents (all p's<0.05), but youth still manifested appreciable impairment at end-point. CONCLUSIONS CNS simulants were well tolerated by children with ADHD comorbid with a diagnosis of DMDD. CNS stimulants were associated with clinically significant reductions in externalizing symptoms, along with smaller improvements in mood. However, most participants still exhibited significant impairment, suggesting that additional treatments may be needed to optimize functioning.
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Affiliation(s)
- Raman Baweja
- Department of Psychiatry, Penn State University College of Medicine, Hershey, Pennsylvania
| | - Peter J. Belin
- Center for Children and Families, Florida International University, Miami, Florida
| | - Hugh H. Humphrey
- Department of Psychiatry, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
| | - Lysett Babocsai
- Center for Children and Families, Florida International University, Miami, Florida
| | - Meaghan E. Pariseau
- Department of School and Counseling Psychology, SUNY Buffalo, Buffalo, New York
| | - Daniel A. Waschbusch
- Department of Psychiatry, Penn State University College of Medicine, Hershey, Pennsylvania
| | - Martin T. Hoffman
- Department of Pediatrics, SUNY Buffalo School of Medicine, Buffalo, New York
| | | | - Jenifer L. Haak
- Department of Psychiatry, SUNY Buffalo School of Medicine, Buffalo, New York
| | - William E. Pelham
- Center for Children and Families, Florida International University, Miami, Florida
| | - James G. Waxmonsky
- Department of Psychiatry, Penn State University College of Medicine, Hershey, Pennsylvania
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96
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Takamatsu Y, Hagino Y, Sato A, Takahashi T, Nagasawa SY, Kubo Y, Mizuguchi M, Uhl GR, Sora I, Ikeda K. Improvement of learning and increase in dopamine level in the frontal cortex by methylphenidate in mice lacking dopamine transporter. Curr Mol Med 2016; 15:245-52. [PMID: 25817856 PMCID: PMC5384353 DOI: 10.2174/1566524015666150330144018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Revised: 02/19/2015] [Accepted: 03/24/2015] [Indexed: 12/30/2022]
Abstract
The symptoms of attention-deficit/hyperactivity disorder (ADHD) are characterized by inattention and hyperactivity-impulsivity. It is a common childhood neurodevelopmental disorder that often persists into adulthood. Improvements in ADHD symptoms using psychostimulants have been recognized as a paradoxical calming effect. The psychostimulant methylphenidate (MPH) is currently used as the first-line medication for the management of ADHD. Recent studies have drawn attention to altered dopamine-mediated neurotransmission in ADHD, particularly reuptake by the dopamine transporter (DAT). This hypothesis is supported by the observation that DAT knockout mice exhibit marked hyperactivity that is responsive to acute MPH treatment. However, other behaviors relevant to ADHD have not been fully clarified. In the present study, we observed learning impairment in shuttle-box avoidance behavior together with hyperactivity in a novel environment in DAT knockout mice. Methylphenidate normalized these behaviors and enhanced escape activity in the tail suspension test. Interestingly, the effective dose of MPH increased extracellular dopamine in the prefrontal cortex but not striatum, suggesting an important role for changes in prefrontal dopamine in ADHD. Research that uses rodent models such as DAT knockout mice may be useful for elucidating the pathophysiology of ADHD.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - K Ikeda
- Addictive Substance Project, Tokyo Metropolitan Institute of Medical Science, 2-1-6 Kamikitazawa, Setagaya-ku, Tokyo 156-8506, Japan.
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Carrellas N, Wilens TE, Anselmo R. Treatment of Comorbid Substance Use Disorders and ADHD in Youth. ACTA ACUST UNITED AC 2016. [DOI: 10.1007/s40501-016-0072-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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98
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Scott DA, Gignac M, Kronfli RN, Ocana A, Lorberg GW. Expert Opinion and Recommendations for the Management of Attention-Deficit/Hyperactivity Disorder in Correctional Facilities. JOURNAL OF CORRECTIONAL HEALTH CARE 2015; 22:46-61. [PMID: 26672119 DOI: 10.1177/1078345815618392] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There has been considerably less research on the management of adult attention-deficit/hyperactivity disorder (ADHD) among the inmates of correctional facilities than in the general community. While the successful identification and management of ADHD in the adult correctional setting offer potential benefits to the individuals themselves, to institutional staff, and to wider society, their implementation represents significant challenges. These include high prevalence rates, the low level of ADHD recognition, the high incidence of comorbid psychiatric disorders, and the high risk of abuse and diversion of prescribed medications. Here, the authors provide an overview of current recommendations for the identification and management of adults with ADHD in correctional settings and discuss possible strategies for their further development.
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Affiliation(s)
- Duncan A Scott
- Providence Care, Mental Health Services, Kingston, Ontario, Canada
| | - Martin Gignac
- Department of Psychiatry, Institut Philippe-Pinel de Montreal, Montreal, Quebec, Canada
| | - Risk N Kronfli
- Dalhousie University, Halifax, Canada Offender Health Services, East Coast Forensic Hospital, Dartmouth, Canada Capital District Health, Canada
| | - Anthony Ocana
- North Shore ADHD Clinic, West Vancouver, British Columbia, Canada
| | - Gunter W Lorberg
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada Central North Correctional Centre, Penetanguishene, Ontario, Canada
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99
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Wilens TE, Robertson B, Sikirica V, Harper L, Young JL, Bloomfield R, Lyne A, Rynkowski G, Cutler AJ. A Randomized, Placebo-Controlled Trial of Guanfacine Extended Release in Adolescents With Attention-Deficit/Hyperactivity Disorder. J Am Acad Child Adolesc Psychiatry 2015; 54:916-25.e2. [PMID: 26506582 DOI: 10.1016/j.jaac.2015.08.016] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 07/24/2015] [Accepted: 09/09/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Despite the continuity of attention-deficit/hyperactivity disorder (ADHD) into adolescence, little is known regarding use of nonstimulants to treat ADHD in adolescents. This phase 3 trial evaluated the safety and efficacy of guanfacine extended release (GXR) in adolescents with ADHD. METHOD This 13-week, multicenter, randomized, double-blind, placebo-controlled trial evaluated once-daily GXR (1-7 mg per day) in adolescents with ADHD aged 13 to 17 years. The primary endpoint was the change from baseline in the ADHD Rating Scale-IV (ADHD-RS-IV) total score; key secondary endpoints included scores from the Clinical Global Impressions-Severity of Illness (CGI-S), and Learning and School domain and Family domain scores from the Weiss Functional Impairment Rating Scale-Parent Report (WFIRS-P) at week 13. RESULTS A total of 314 participants were randomized (GXR, n = 157; placebo, n = 157). The majority of participants received optimal doses of 3, 4, 5, or 6 mg (30 [22.9%], 26 [19.8%], 27 [20.6%], or 24 [18.3%] participants, respectively), with 46.5% of participants receiving an optimal dose above the currently approved maximum dose limit of 4 mg. Participants receiving GXR showed improvement in ADHD-RS-IV total score compared with placebo (least-squares mean score change, -24.55 [GXR] versus -18.53 [placebo]; effect size, 0.52; p <.001). More participants on GXR also showed significant improvement in CGI-S scores compared with placebo (50.6% versus 36.1%; p = .010). There was no statistically significant difference between treatments at week 13 in the 2 WFIRS-P domains. Most treatment-emergent adverse events were mild to moderate, with sedation-related events reported most commonly. CONCLUSION GXR was associated with statistically significant improvements in ADHD symptoms in adolescents. GXR was well tolerated, with no new safety signals reported. CLINICAL TRIAL REGISTRATION INFORMATION Dose-Optimization in Adolescents Aged 13-17 Diagnosed With Attention-Deficit/Hyperactivity Disorder (ADHD) Using Extended-Release Guanfacine HCl; http://ClinicalTrials.gov/; NCT01081132.
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Affiliation(s)
| | | | - Vanja Sikirica
- Former employees of Shire, Wayne, PA; GlaxoSmithKline, King of Prussia, PA
| | | | - Joel L Young
- Rochester Center for Behavioral Medicine, Rochester Hills, MI
| | - Ralph Bloomfield
- Former employees of Shire, Wayne, PA; AstraZeneca, Cambridge, UK
| | - Andrew Lyne
- Former employees of Shire, Wayne, PA; Independent statistician, Maidenhead, UK
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100
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Bink M, van Nieuwenhuizen C, Popma A, Bongers IL, van Boxtel GJM. Behavioral effects of neurofeedback in adolescents with ADHD: a randomized controlled trial. Eur Child Adolesc Psychiatry 2015; 24:1035-48. [PMID: 25477074 DOI: 10.1007/s00787-014-0655-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 11/22/2014] [Indexed: 11/28/2022]
Abstract
Neurofeedback has been proposed as a potentially effective intervention for reducing Attention Deficit Hyperactivity Disorder (ADHD) symptoms. However, it remains unclear whether neurofeedback is of additional value to treatment as usual (TAU) for adolescents with clinical ADHD symptoms. Using a multicenter parallel-randomized controlled trial design, adolescents with ADHD symptoms were randomized to receive either a combination of TAU and neurofeedback (NFB + TAU, n = 45) or TAU-only (n = 26). Randomization was computer generated and stratified for age group (ages 12 through 16, 16 through 20, 20 through 24). Neurofeedback treatment consisted of approximately 37 sessions of theta/sensorimotor rhythm (SMR)-training on the vertex (Cz). Primary behavioral outcome measures included the ADHD-rating scale, Youth Self Report, and Child Behavior Checklist all assessed pre- and post-intervention. Behavioral problems decreased equally for both groups with medium to large effect sizes, range of partial η2 = 0.08-0.31, p < 0.05. Hence, the combination of NFB + TAU was not more effective than TAU-only on the behavioral outcome measures. In addition, reported adverse effects were similar for both groups. On behavioral outcome measures, the combination of neurofeedback and TAU was as effective as TAU-only for adolescents with ADHD symptoms. Considering the absence of additional behavioral effects in the current study, in combination with the limited knowledge of specific treatment effects, it is questionable whether theta/SMR neurofeedback for adolescents with ADHD and comorbid disorders in clinical practice should be used. Further research is warranted to investigate possible working mechanisms and (long-term) specific treatment effects of neurofeedback.
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Affiliation(s)
- Marleen Bink
- Scientific Center for Care and Welfare (Tranzo), Tilburg University, Tilburg, The Netherlands,
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